PROOF OF INSURANCE (2018 - 2019) CLOSED � OP ID: DR
DATE(MMIDDIYYYY)
CERTIFICATE OF'' LIABILITY INSURANCE I 01/25/2018
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED„the policy(les) must be endorsed. If SUBROGATION IS WAIVED,subject to
the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER CONTACT
ichelle A
36 Alliance Vera Cruz ante Sery iAHrCryNo ElM760-471-7116 ell (AIC Nl);760-471-9378
CAA Llc#0737966 E-MAIL
San Iklarcos,CA 92078 -ADDRESS;mnowell@amiscorp.com
A.NowellPRODUCER
. STr .la_ID ANINA-1
___ _ __ INSURER(S)AFFORDING COVERAGE NAIC#
INSURED B.A. ln'vesti' ations LLLCINSURER A: p ,...,. ty p ....................................................... ....
Barry Aninag Investigations INSURERe:Acce tante Casual Ins Com 10349
Barry
LLC
27758 Santa Margarita Pkwy 594 INSURER C:
Mission Viejo,CA 92691 INSURER D:
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
6CW§RTYPE OF INSURANCE "gUDESU'BR P'OL'IOY i��1'LIC 90 Y
LTR INSIL'Im POLICY NUMBER WMIDDVYYYYI IMWDD1YYYY1 C LIMITS
GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000'
AL
RAL LIABILITY
MAGE
000
A X COiCLAIMIS-MADEE X OCCUR CP00961685 11/11/2017 11/11/2018 DESES(nyoneupeerson).. ...$ 10,0,0.0.0,
X Errors 8,Omission PERSONAL&ADV INJURY $ 1,000,000...$..................................5, :
GEr�'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 1
GENERAL AGGREGATE 000,000
X �POLIICY F I JFR,.T V LOC Q $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $
---- (Ea accident)
ANY AUTO INJURY(Per person) $.......................................................
ALL OWNED AUTOS BODILY BODILY INJURY(Per accident) a..................................
SCHEDULED
HIRED AUTOS AUTOS (PER ACCIDENT)PROPERTY AGE $
NON-OWNED AUTOS $
...UMBRELLA LIAB ...., .. .. .....
�OCCUR EACH
EXCESS LIAR
CCLAIMS-MADE AGGR GA ERRENCE
DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION I WC STATU- IIII PITH-
AND EMPLOYERS'LIABILITY YIN .............1TQRY..LlMIT ....V............1L��E.R. .................................,.,................,.,.,.,.,
ANY PROPRIETOR/PARTNER/EXECUTIVE E L.EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED? N/A
(MYyandatory In NH) E L DISEASE-EA EMPLOYEE $
If desonbe under
DESCRIPTIONOF OPERATIONS below E L,DISEASE-POLICY LIMIT ..$
DESC tP ON OF OPERATIO I LOCATt NS I VEHICLES A h ACORD 101,Additional Remarks Schedule,If more space is required)
Pro o in r Ce. ili t e is to Is vcaI altered.
Cert cate Holder may a a e upon request,
Investigations,CA--
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Barry Aninag Investigations ACCORDANCE WITH THE POLICY PROVISIONS.
LLC
27758 Santa Margarita Pkwy 594 AUTHORIZED REPRESENTATIVE Q
Mission Viejo,CA 92691 /�V�'f�^p�-
u
®1988-2009 ACORD CORPORATION. All rights reserved.
ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD
POLICY NUMBER: CP00961685 COMMERCIAL GENERAL LIABILITY
CG 20 26 07 04
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED DESIGNATED
PERSON OR ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person(s)Or Organization(s)
Automatic Status Included Where Required by Written Contract.
All Where Required by Written Contract.
"it is agreed, as respects the Policy, thirty (30) days notice of cancellation, except as respects non-
payment of premium,for which ten(10)days notice will apply,or other regulatory requirements that may
apply,will be given as respects the Indicated certificate holder."
Information required to comlaiete this Schedule, if not shown above,will be shown in the Declarations,
Section II — Who Is An Insured is amended to in-
clude as an additional insured the person(s)or organ-
ization(s) shown in the Schedule, but only with re-
spect to liability for"bodily injury", "property damage" ,
or"personal and advertising injury" caused, in whole
or in part, by your acts or omissions or the acts or
omissions of those acting on your behalf.
A. In the performance of your ongoing operations;or
B. In connection with your premises owned by or
rented to you.
CG 20 26 07 04 0 ISO Properties, Inc.,2004 Page 1 of 1 O
THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY.
PRIMARY AND NON-CONTRIBUTING INSURANCE ENDORSEMENT
This endorsement modifies Insurance provided under the following;
COMMERCIAL GENERAL LIABILITY COVERAGE PART
To the extent that this insurance is afforded to any additional Insured under this policy, SECTION IW' — COMMERCIAL
GENERAL LIABILITY CONDITIONS,4.Othor Insurance,is deleted in its entirety and replaced with the fo'l'lowing condition,
4. Other Insurance
It all of the other insurance permits contribution by equal shares, we will follow this method unless the Insured Is
required by written contract signed by both parties,to provide Insurance that Is primary and non•conVibutory,and the
"Insured oontracC is executed prior to any loss, Where required by a written contract signed by both parties, this
Insurance Wit be primary and non-cantrIbufingi only when and to the specific extent required by that contract.
However.under the contributory approach each insurer contributes equal amounts until it has paid Its applicaLge limit of
Insurance or none of the loss remains.whichever comes first. II any of the other Insurance does not permit contribution
by equal shares,we will contribute by limits.Under this method,each insurer's share is based on the proportional ratio
of ifs applicable limit of Insurance to the totals applicable Ilmits of Insurance of ati insurers.
ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED.
This endorsement forms a part of the Policy to which attached, effective on the inception date of the Policy unless otherwise
stated herein.
(The following information is required only when this endorsement Is Issued subsequent to preparation of the Policy.)
Endorsement effective Policy No.CP00961685 Endorsement No.
Named Insured
Barry Aninag Investiptions,LLC Countersigned by ..
CIGL 30 0114
CITY OF EL SEGUNDO
WORKERS' COMPENSATION DECLARATION
........ .......
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SUBJECTS AN EMPLOYER TO CRIMINAL PENALTIES
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000),
IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED
FOR IN LABOR CODE § 3706, INTEREST, AND ATTORNEY'S FEES.
I affirm under penalty of perjury under the laws of California one of the following declarations:
(_)I have and will maintain a certificate of consent of self-insure for workers'compensation,issued by the Director
of Industrial Relations as provided for by Labor Code§3700 for the performance of the work set forth the agreement
with the City of El Segundo.
Policy No.
( )I have and will maintain workers'compensation insurance as required by Labor Code§3700 for the performance
of the work for which the agreement with the City of El Segundo is executed. My workers'compensation insurance
carrier and policy number are:
Carrier Policy Number Expiration Date
Name of Agent Phone 9
Ld, certify that, in the performance of the work set forth in the agreement with the City of El Segundo,I will not
I employ any person in any manner so as to become subject to the workers' compensation laws of California, and
agree that, if I should become subject to ie workers' compensation provisions of Labor Code § 3700 1 must
Immediately comply with tnh 0 provision or tie agreement will automatically become void,
Signature of Applicant Date
Agreement for:
Dated:
Reviewed by:
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