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PROOF OF INSURANCE (2018 - 2018) CLOSED 6124 Progressive Solutions Inc. Certificate of Insurance (page 1 of 1) 02/28/2018 12:16:12 PM I DATE(MMIDDIYYYY) A�"> CERTIFICATE OF LIABILITY INSURANCE yl 2/28/2018 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 .CONTAv;:'t''Tech .... ..., ., ., NAME: 000 30 N I LaSalle,25th Floor E-MAIL B , xllF..'......nsurance PHONE 800-668-7020 �I� .Ncwpo (877)'826-9067 ,,...... :o:Tech Insurance Chicago, IL 60602 .................s............................................. INSURER(S)AFFORDING COVERAGE ..INSURER ....... ,e . .. �._.... NCO.. ..... _ A:... Sentinel Insurace.nC.ompal Limited INSURED y INSURER B: Beane„ Insurance Company Inc. 37540,,,,,,. .. Progressive Solutions Inc. INSURER C: 850 Steele INSURER D: Brea,CA 92821 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. NSA, .......................................TM............ A�DD�� �+,„., POLICY NUMBER IMOLIC YEFF YMM'fDDWYYYYY L..�..............................................�.................................... ...................... PE OF INSURANCE LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $2,000,000 . .....,d CLAIMS—MADE ✓�OCCUR HEh„91 „�( cTcy;,marcerror:;ak $ 1,000,000 MED EXP(Any one person) $ 10,000 A 46SBARI9399 4/10/2017 4/10/2018 PERSONAL&ADV INJURY $2,000,000 ............. .............................................................................. ............. GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $4,000,000 POL �.......,,,J JEO ... .. .W,W.. PRODUCTS. -COMP'UP A..a' $4,000,000 ........,.. r,�TV�iIER� LOC PR'm..........-��.............�......�A`�......... $ AUTOMOBILE LIABILITY C OMB°.i ED91TtGLE LIMIT Ea N : ) $ 2,000,000 'ANY AUTO BODILY INJURY(Per person) $ ALL OWNED ........... SCHEDULED 46SBARI9399 4/10/2017accident) ..... A -,✓ AUTOS AUTOS (Per $ _t NON-OWNED 4/10/2016 PfdO�'�&�TY 6' G $ ......,,..I HIRED AUTOS `7 AUTOS (Per acci�t�mnN'1p,_q� .........................�.........�... UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ ...................._.,w.. ............ ....,........................... DED RETENTION S $ WORKERS COMPENSATION ,,,..,.,.,.mPER OT'H- AND EMPLOYERS'LIABILITY Y/N .§TATU1F.,,,,,,q,_Ww1„ER Mandato m NH ENT $ ANY PROP IETO PARTNER/EXECUTIVE ,,. .L.,,EISE'AS&N,,,,,,,,,, w._._.w...__ .. . OFFICER/MEM EXCLUDED � N I A L CH ACCID O EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E,L,DISEASE-POLICY LIMIT $ B Professional Liability(Errors and Omissions) V15UE5170901 7(7/2017 7!7/2018 $1,000,000/$1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) City of EI Segundo,its officers,officials,agents and employees are additional insureds as respects the above liability insurance. Note:General Liability Exclusion:Testing or consulting errors and omissions. Form SS0509 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of EI Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 350 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. EI Segundo,CA 90245-3813 AUTHORIZED REPRESENTATIVE II ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD REGIONAL OFFICE INSTRUCTION SHEET POLICY NUMBER: 46 SBA R19399 DX CHANGE NUMBER: 002 CHANGE EFF DATE: 07/31/17 ROUTING INSTRUCTIONS -SEND TO RECORDS, TRANSFER CORR IF APPLICABLE, TERMINAL ID: R045VL9A OPER INIT: JMO 08/03/17 46 SBA R19399 DX (04/10/18) PAGE 1 POLICY FACE SHEET 99 93 INSURER: RI SENTINEL INSURANCE COMPANY, LIMITED SBA CHANGE NO. : 002 CHANGE EFF DATE: 07/31/17 POLICY NO. 46 SBA R19399 DX RECORDS RETENTION - PERMANENT DECLARATIONS ITEMS 1. NAMED INSURED AND PROGRESSIVE SOLUTIONS INC MAILING ADDRESS: PO BOX 783 BREA, ORANGE CA. 92822 2. POLICY PERIOD: 04/10/17 04/10/18 1 INCEPTION EXPIRATION YEAR AGENT'S CODE: 505301 AGENT'S NAME: BIN INSURANCE HOLDINGS LLC/PHS PREVIOUS POLICY NO. 46 SEA R19399 3. THE NAMED INSURED IS: CORP POLICY STATUS: ACTIVE LOB LEVEL OF SUPPORT: SP-S MARKET SEGMENTATION: 830 SELECT CUSTOMER AGENT SALES AGREEMENT (COMMISSION STATUS DIRECT ACCOUNT BILL NUMBER , 50027561A DEDUCTIBLE ADDITIONAL INSUREDS) CODING ENTRY NOT REQUIRED TRANS TYPE: ENDT CNTL#: 003 POLICY FACE SHEET TERMINAL ID: R045VL9A PAGE 2 08/03/17 46 SBA R19399 DX (04/10/18) TIm. E HARTFORD Select Customer Insurance Center 3600 WISEMAN BLVD. SAN ANTONIO TX 78251 Policyholder, please call us at: (866) 467-8730 Agent, please call us at: (866) 467-8730 SERVICE.TX@THEHARTFORD.COM INSURANCE ENDORSEMENT ATTACHED *** PLEASE REVIEW THE CHANGE*** Enclosed is an endorsement for your business insurance policy. Please review it at your convenience. If you have questions or need to make further changes: Policyholder, please call us at: (866) 467-8730 Agent, please call us at: (866) 467-8730 between 7 A.M. and 7 P.M. CST . The premium billing will be mailed to you separately. You can expect to receive it soon. Thank you for allowing us to service your business needs. BIN INSURANCE HOLDINGS LLC/PHS THE HARTFORD SELECT CUSTOMER INSURANCE CENTER The Hartford Hartford Fire Insurance Company and its Affiliates One Hartford Plaza,Hartford,Connecticut 06155 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLICY CH�ANGP This endorsement changes the policy effective on the Inception Date of the policy unless another date is indicated below: Policy Number: 46 SBA RI9399 DX Named Insured and Mailing Address; PROGRESSIVE SOLUTIONS INC PO BOX 783 BREA CA 92822 Policy Change Effective Date: 07/31/17 Effective hour is the same as stated in the Declarations Page of the Policy. Policy Change Number: 002 Agent Name: BIN INSURANCE HOLDINGS LLC/PHS Code: 505301 POLICY . SENTINEL INSURANCE COMPANY, LIMITED Y CHANGES IN YOUR PREMIUM WILL BE REFLECTED IN YOUR NEXT BILLING STATEMENT.IF YOU ARE ENROLLED IN REPETITIVE EFT DRAWS FROM YOUR BANK ACCOUNT, CHANGES IN PREMIUM WILL CHANGE FUTURE DRAW AMOUNTS. THIS IS NOT A BILL. NO PREMIUM DUE AS OF POLICY CHANGE EFFECTIVE DATE FORM NUMBERS OF ENDORSEMENTS REVISED AT ENDORSEMENT ISSUE: IH12001185 ADDITIONAL INSURED - PERSON-ORG IZATION PRO RATA FACTOR: 0.693 THIS ENDORSEMENT DOES NOT CHANGE THE POLICY EXCEPT AS SHOWN. Form SS 12 11 04 05 T Page ool Process Date: 0 8/0 3/17 Policy Effective Date: 04/10/17 Policy Expiration Date: 04/10/18 POLICY NUMBER: 46 SBA RI9399 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - PERSON-ORGANIZATION OFFICE OF Tilf-,' CITY CLERK :350 MAIN s,r. [,,-L, SEGUNDO, CA 90245 COUNTY OF SNOHOMISH 3000 ROCKEFELLER AVENUE EVERETT, WA 98201 LOC 001 BLDG 001 CITY OF ALHAMBRA 111 SOUTH FIRST STREET ALHAMBRA, CA 91801 CITY OF WEST HOLLYWOOD 8300 SANTA MONICA BLVD. WEST HOLLYWOOD, CA. 90069 CITY OF ONTARIO 303 EAST B STREET ONTARIO, CA 91764 CITY OF PLEASANTON 200 OLD BERNAL AVENUE PLEASANTON, CA 94566 CITY OF SANTA BARBARA 735 ANACAPA STREET, ROOM 3 SANTA BARBARA, CA 93101-2203 CITY OF SAN BUENAVENTURA 501 POLI STREET, RM #107 VENTURA, CA. 93001 Form IH 12 00 11 85 T SEQ. NO. 001 Printed in U.S.A. Page 001 (CONTINUED ON NEXT PAGE) Process Date: 08/03/17 Expiration Date: 04/10/18 POLICY NUMBER: 46 SBA R19399 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED PERSON-ORGANIZATION THE CITY OF COSTA MESAAND ITS ELECTED AND APPOINTED BOARDS OFFICERS AGENTS AND EMPLOYEES 77 FAIR DR COSTA MESA, CA 92626 THE CITY OF ALHAMBRA 111 S 1ST ALHAMBRA, CA 91801 CITY OF MONTEREY PARK 320 W. NEWMARK AVE MONTEREY PARK, CA 91754 Form IH 12 00 11 85 T SEQ. NO. 001 PrintedinU.S.A. Page 002 (CONTINUED ON NEXT PAGE) Process Date: 08/03/17 Expiration Date: 04/10/18 PRODUCER'S FACT SHEET NAMED INSURED: PROGRESSIVE SOLUTIONS INC POL #: 46 SEA R19399 DX PRODUCER I S NAME: PRODUCER'S CODE, 505301 AGENT SALES BIN INSURANCE HOLDINGS LLC/PHS ROL EFF DATE: 04/10/17 ROL EXP DATE: 04/10/18 TRANS EFF DATE: 07/31/17 DIRECT ACCOUNT BILL NUMBER - 50027561A TRANSACTION TYPE: ENDORSEMENT CHANGE NO. : 002 ENDORSEMENT PREMIUM: $0.00 NON-PREMIUM BEARING FORM TITLE SS 12 11 04 05 POLICY CHANGE IH 12 00 11 85 ADDITIONAL INSURED - PERSON-ORGANIZATION PRODUCER'S FACT SHEET PAGE 1 08/03/17 46 SEA R19399 DX (04/10/18) CERTHOLDER COPY SP TE • P.O. BOX 8192, PLEASANTON, CA 94588 INSURANCE FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 02-28-2018 GROUP: POLICY NUMBER: 9033101-2017 CERTIFICATE ID: 30 CERTIFICATE EXPIRES: 12-31-2018 12-31-2017/12-31-2018 THIS CERTIFICATE SUPERSEDES AND CORRECTS CERTIFICATE # 28 DATED 12-31-2017 CITY OF EL SEGUNDO SP DEPT OF BUILDING & SAFETY 350 MAIN ST , EL SEGUNDO CA 90245-3813 This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 30 days advance written notice to the employer. We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy. Authorized Representative President and CEO EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT #0015 ENTITLED ADDITIONAL INSURED EMPLOYER EFFECTIVE 2018-02-28 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. NAME OF ADDITIONAL INSURED: CITY OF EL SEGUNDO ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 12-31-2012 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. ENDORSEMENT #2570 ENTITLED WAIVER OF SUBROGATION EFFECTIVE 2017-12-31 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. THIRD PARTY NAME: CITY OF EL SEGUNDO ENDORSEMENT #1650 - GLENN VODHANEL CEO - EXCLUDED. EMPLOYER PROGRESSIVE SOLUTIONS, INC. SP PO BOX 783 BREA CA 92822 [KMC,VL] (REV.7-2014) PRINTED : 02-28-2018 POLICYHOLDER COPY SP CQMPFN5AT1QN P.O. BOX 8192, PLEASANTON, CA 94588 FUN CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 02-28-2018 GROUP: POLICY NUMBER: 9033101-2017 CERTIFICATE ID: 30 CERTIFICATE EXPIRES: 12-31-2018 12-31-2017/12-31-2018 THIS CERTIFICATE SUPERSEDES AND CORRECTS CERTIFICATE # 28 DATED 12-31-2017 CITY OF EL SEGUNDO SP DEPT OF BUILDING & SAFETY 350 MAIN ST EL SEGUNDO CA 90245-3813 This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 30 days advance written notice to the employer. We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy. Authorized Representative President and CEO EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT #0015 ENTITLED ADDITIONAL INSURED EMPLOYER EFFECTIVE 2018-02-28 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. 'NAME OF ADDITIONAL INSURED: CITY OF EL SEGUNDO ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 12-31-2012 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. ENDORSEMENT #2570 ENTITLED WAIVER OF SUBROGATION EFFECTIVE 2017-12-31 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. THIRD PARTY NAME: CITY OF EL SEGUNDO ENDORSEMENT #1650 - GLENN VODHANEL CEO - EXCLUDED. EMPLOYER PROGRESSIVE SOLUTIONS, INC. SP PO BOX 783 BREA CA 92822 [KMC,VL] IREV.7-20141 PRINTED : 02-28-2018 WAIVER OF SUBROGATION NOTICE Enclosed is your copy of a certificate of insurance on which the certificate holder required a waiver of subrogation: 1. Please be advised that a waiver of subrogation requires that a 3% surcharge will be applied by State Fund ONLY to the premium assessed on the payroll of your employees earned while engaged in work for that certificate holder who requested the waiver. (Note: if you have no employee payroll on that job, then there is no charge.) 2. To apply the 3% surcharge, you must also agree to maintain accurately segregated payroll records for employees engaged in work on job/s for the certificate holder who has the waiver. The payroill records are subject to verification by an auditor. Example: Payroll for job : $5 , 000 . 00 Sample Rate : 13 . 300 Regular Premium equals : $ 665 . 00 Surcharge : 3 . 00% Additional Waiver charge : $ 19 . 95 Total premium equals $ 684 . 95 (665 . 00 + 19 . 95)