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PROOF OF INSURANCE (2018 - 2019) CLOSED 02/07/2018 WED 13: 33 FAX U004/005 ,4�. CERTIFICATE OF LIABILITY INSURANCE OATe(MM/DDlYYWI 10210712,018 TISTIFI ATE3SNOSUEDI AS ATIMETTER F INFO MATI AIIAEN LYA ND CONFERS NO RIGHTS UPON THE CERTIFICATE OLDER_ THIS CERTIFICATE XTEND 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: iI"tho certificate holder Is an ADDITIONAL INSURED,the policy(loo) must have. ADDITIONAL INSURED provtslons or be andomad, If SUBROGATION 15 WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does net confer rIgIettl to the certificate holder in lieu of such ondoraamam(e), PftoDllcEt2 _ _agUTACT �,4vrlt lneuranat Aoericv,Inc. sI I 12: _RS30i 89'1.13'02 I I�' � __.s._..)891.6966 Avrlt Insurance Agency, ct Inc. 1, 2735 Esplanade kimbeelv0avritineufance.com _w_....w Chico CA 98973 I tFl.nwaawr,iwr�cDuaftAns' m+Alu rr tMME&AL.;entinel Insurance Company,Limited ^ INSURED 9HEr a,„Techrlal y—insuranra Company. 01 Joe Moralli(SBA:1413 Consulting INSURER C: Sentinel Insurance Coman ,Limned 476 East Sacramento Ave. Chico CA 95925 INSURER E,:. -^•• - INSURER F, .. ., ..„.w COVERAGECERTIFICATE NUMBER; � REVISION NUMBER :-, P THIS IS TO IFY THAT THE ANYIES OF INSURANCE LISTED REQUi REQUIREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH TO... PERI OD ISSUED HAVE BEEN TO "CHC INSURED NAMED ABOVE ICOR THE POLICY RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECTALL THE TERMS, EXCLUSIONb AND CONDITIONS OF SUCH PO9UCIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, 1N R TYPE OF INSURANCE WA p USi �.........»�..CkggYVWM NMOD=POLICY P PO ICY exp i LIMITS X C�O-MIMERCIAL OENERAL LIABILITY E A SII CLAIMS-MADEFX OCCUR IARAACiE C'I^NTE'O r %1,,000,000. PFZEhtI;1['S.(LB.�.,�IrRZDs`•* _ X 57SBAR19196 0310512018 03105/1019 _mED Lxp flAm,one poreww) $101000. PERSONAL I:<ADV„4C+�J^UO,Y .,f 1,000,000, " " ..5... CEN"L.AC�GII' TE LIMIT APPLIES PER: fl Iwthj"AL AgCRFCIAT� S 2,000,000 �.,�... ^T9-COMPdOF'Ais _ l,,,g—NMA"t'1 PR PRODU $ .� JET LOC AUTOMO ILE LIAINLITY IV.' COPuIDPNk§,D SINOLGx�I.tlM1AAT'strwlwu'iY -- ANY ._,,,.....»ANY AUTO BODILY INJURY(Per pereoo) $ .. OWNED gGHEDULED BODILY INJURY(ParA011dartll $ AUTOS ONLY AUTO$ PROPERTY DAMAGE ..... HIRED N -OVVNED AUTOS ONLY ,AUTOS ONLY 1 UMERELLA LIAB OCCUR I .._' '. EA1C!~I OCUI~<flT!EIJCE: EXOEISSLIAR Cl.A,9II,i^L°GAG,�C ;AGORECATE Crofr7 I T-N'TflC9N ' WORHE'RS COMPENSATION M" 'C_T� S'LIABILITY X A _ T ,0 AND EMPLQYP,R E,L Cildr A�^E—gEEMPLOYEET ANYpRbPRIEFOIUPArxTNII�aE;CI<DUTIVE N ..®m�.Ffa..,CcsraEN' I r= 00,000, B Irr ICe1 uofuaBER EOLUiJEO N I A T WC396152etA 09101/2017 0910112018 (Mandatory 1n�IHi L L. r �IQ,000. dI ipp stoyy In NH)or Each Claim Limit'IItlT sd0D,000' .. C Professional Liability X 67SBAR1919S 0310612019 0310612019 Aggregate Limit $1,000,000. ........................ DESCRIPTION OF OPERATIONS!LOCATIONS f VEHICLES (ACORD 101,Additional Remarks Schedule,may bo attached If more space Is required) City of EI Segundo,its officials,and employees are named and added as Additional Insured. Those usual to the Insured's Operations, Certificate Holder is an Additional Insured per the Business Liability Coverage Form SS005, CERTIFICA'It HOLDER_ __ CANCEI.LATIC)hi ANYBE City of EI Segundo THE SHOuLD EXPIRA©ONH DATEVTHEREOF,DESCRIBENOTICEI ES WILL DBECELLED DELIVERED BEFOREDELIVERED 350 Main St.Room B ACCORDANCE WITH THE POLICY PROVISIONS. EI Segundo,CA 90245 ,« AUTHORIZED REPnE6CNTATIV X11988-2015 ACORD CORPORATION. All riGhts reserved. ACORD 25(2015103 The ACORD name and logo are regiatered marks of ACORD 02/07/2018 WED 13- 34 FAX POLICY NUMBER: 57 SBA RI�1596 CHANGE NUMSEkt 001 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement moclIf195 insurance provided under the following: BUSINESS LIABILITY COVERAGE FORM SCHEDULE Name Of Additional insured Person(s)or Organization(s): CXTY OF RL SRGT3Nl)0 Location And Description Of Completed Operations: ISO MAIN ST. ROOM 6 2L SEGUNDO, CA - 90245 Information required to complete this Schedule, if not shown above,will be shown in the Declarations. Section C, — Who Is An Insured is amended to Include as an additional insured the person(a) or organization(s) shown In the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whois or in part. by "your work" at the location designated and described In the schedule of this endorsement performed for that additional insured and Included In the "products- complated operations hazard". Form SS 4171 06 11 Page 1 of 1 Process Date: 01/26/18 Policy Expiration Date: 03/09/19 Q 2011,The Hartford (includes copyrighted material of Insurance Services Office, Inc,,with Its permission) y ISI VN"tlp�l�aa�l�W✓PII'uVi n „IIWC VGG�IWa IWaXWv GGI � "&N�„n„"M' �„!'�W iW lli'°�Wu'"Mm MM rW�n V III 1 4 V p II I I IIeI�Iell�elllillel�ll�l1i11'11�Illelullelllelul�lluelltlnlll ft ky No.CAAS100473127 e�U JOSEPH O MORALLI Policy base Y 1995 476 E SACRAMENTO AVE Nicy eflectrve date 03.02-2017 CHICO CA 95926.3932 I',��IIIII�I�Ii�'��IrV^V,N�;u tiv,Ni;'id"9(^I�dl„"liN"'r Ildll��l,°'Na::"IIIIVII�N"'p�l'�;ui�"Id�P'P�b'��QIQ°:Ids^';i'lll^ plpl"nupu,Iuu Nlrc,'rIP"'V. rlu IIS rM^'I,,,h'"' udIIVjl'gI'! "I'i'V.IIAi+"r^4,IIk, Y'II,'ua, "Id"o„N' .Iwll;;Ilu V'NuIVI ;IIp' IVr,Qlln lol'"vl;a Ihl lu �a"111"'vP'VI VuM I'uW!"II�I;ryY,dml,N�r'V ftih„ nu „a llhv, ,,,,m N'""'IU K lu .NY Ill N 1141 m iil III Ili a r`GY II GIIIII"Ill III" 1,IC 1114 I 'lil'II.III I I I I I ^dll G li I(1111 G1'I6 Ilul nee�e�t�ttnet��e�ee�e�eee�� DO 11OT IU'w'OLD I S'T,ikUi"' f ....SUBMIT Ir;1RII'GIINAL T()IG:.a1141rI 11x41 01"'n'!11II;IV';IIdW�,I" 'I'I',;;'Va"VI I,I, a III"'Ir'ia I I�'a,,,,,, h "pll llu„I II^gyp I 4"4000 r ':Il.ltl; aallewwa':,la,..Yt�a II',m arla o"m mll a,,', 'N ,J'O'B'',„6II',4'4 11a' Utt1(,14RAL,IL„1 IICvMU.JEUGIF17 3X 1. C'oN 'C 2016 PX,Pd:'dl "78Na'k "14 aY;.'a'IIi VIWI�.d".'mNgaryd "N 'N'�, "'m.,u''VlV lYP"IWA" Ua"Al�: .'^PoY RU,KAV,111 w.ICd IINA,^+.nv°'°✓gANNI AAS 1 004 3 2 7 0 ,„gip'„;,-2 R.n,'' 03-02-2018 C!5iAA T urs IQ.s II"a Ira c IE X It,.h Ips n g1su t:40vvw,la an,'al'!N ,7''' P0 Box 22221 Oak I and CA 52 3-2221 155319 04/10/2018 TUB 11:43 FAX E0006/006 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC Ort 03 06 (Ed.D4-64) WAIVER Of OUR RIGHT To RECOVER FROM OTHERS ENDORSEMENT-CALIFORNIA We have the right To recover our payments from anyone liable For an injury covered by this policy.We will Not enforce our right against the person Or organization named In the Schedule.(This agreement applies only To the extent that you perform work under a written contract that requires you To obtain this agreement from us.) You must maintain payroll records accurately segregating the ramuneration Of your employees While engaged In the work deaodbed In the Schedule. The additional premium For this endorsement shall tae 5%Of the California workers'compensation premium otherwise due on such remuneration. Schedule Person or Organisation Job Description CIty of EI Segundo Specific waiver per written contract El Segundo,CA 90245 .Oel-1 This erximment do p o the pg6W to v dch It to attached and Is efkdlue on the dale Issued unlese olhe*M etalted. UM Informadon below Is mqulrod only when this ooftrwoont Is Issued asubeetimt to preparation of tM pollcy.) Endorsement EReciMe II IM17 Policy No. TYMM5244 F-radoreament No. 3 Insured Mansel,Joe On InONVUSl) Premwm a 600 Insurwlce Company Taftoloyy Insurance Company Ina Cour lgnsd by WC 04 03 06 (E&04.84)