No preview available
PROOF OF INSURANCE (2018 - 2019) CLOSED ��,�r-�y�r DATE(MMIDDIYYYY) � CERTIFICATE OF LIABILITY INSURANCE I 05/02/2018 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(ies) 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 NAM PHONE Hiscox Inc.d/b/a/Hiscox Insurance Agency in CA lttl, (888)202-3007 FAX E-MAIL ESSlCOY'pt' Ct(f '119SCox ,,,,,,,, („IAIC',N�oN.� 520 Madison Avenue ADDRExom 32nd Floor .. .. New York, NY 10022 INSURER(S)AFFORDING COVERAGE NAIC# Hiscox ISCOX Insurance Company Inc 10,200 INSURED INSURERB: Edward Professional Advisors INSURER C 8333 Foothill Blvd Ste 106 Rancho Cucamonga,CA 91730 rEsuRER 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 DOLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY 'AID CLAIMS .ILTR., TYPE OF INSURANCE .... ENSD._WjJ.„ POUCYNUMBER.. IkP%i DWYYYOUCY YYY IMMIDCDWYYYYI .... .... LIMITS... ..... X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE � X �OCCUR PREMISES 4 a ocicutrenc S100,000....... . D AMAG . - )„ . MED EXP(Any one person) $ 5,000 A N UDC-1473517-CGL-18 08/01/2017 08/01/2018 PERSONAL&ADV INJURY uzY ...$,..1,000,0.0.0 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 POLICY j:'Ro7 ..,, X JEC'1° , Lac PRODUCTS-COMP/OP AGO $ S/TGen Agg OTHER $ AUTOMOBILE LIABILITY COMBINED SINOLE LIMIT $ I (Ea ecotdentl ANY AUTO BODILY INJURY(Per person) $ BODILY INJURY(Per accident) ALL OWNED SCHEDULED $ AUTOS AUTOS HIREDAUTOS NON-OWNED PIR�,,,,, ,,, ,, ��„� .,,k'AG�, „ P6:'RTW CJAY'aE' E $ AUTOS ..,SF,;pr..pua,ara,rc°J:zB)............................................................................................................................ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ N DED RETENTION$ VVORKER N PER Iy,EDp NIA 9 STATUTE OTH- ARID EMPLO EnRSR LIABILITY-,E�C,41T�'IV'E Y E N E L EACH ACCIDENT ER, $, (Mandatory pry H) EL DISEASE-EA EMPLOYEE $ Ups,describe under IDCRI'PTION OF OF ORATIONS below E L DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) (01 CERTIFICATE HOLDER CANCE'LLATIO'N City Of EI Segundo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 350 Main Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN EI Segundo CA 90245 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVES Q Y ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Am HISCOXHiscox Insurance Company Inc. Policy Number: UDC-1473496-EO-18 Named Insured: Edward Professional Advisors Endorsement Number: 16 Endorsement Effective: March 01, 2018 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - AUTOMATIC STATUS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section II —Who Is An Insured is amended to include as an additional insured any per- son(s) or organization(s) for whom you are performing operations or leasing a premises - when you and such person(s) or organiza- tion(s) rganiza tion(s) have agreed in writing in a contract or agreement that such person(s) or organiza- tion(s) be added as an additional insured on your policy. Such person or organization is an additional insured only with respect to lia- bility 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: 1. In the performance of your ongoing opera- tions;or 2. In connection with your premises owned by or rented to you. A person's or organization's status as an addi- tional insured under this endorsement ends when your operations or lease agreement for that additional insured are completed. CGL E5421 CW(02/14) Includes copyrighted material of Insurance Services Office,Inc.,with its Page 1 of 1 permission. t' HISCOXHiscox Insurance Company Inc. Policy Number: UDC-1473517-CGL-18 Named Insured: Edward Professional Advisors Endorsement Number: 7 Endorsement Effective° August 01, 2017 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL IINSURED - AUTOMATIC STATUS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section II —Who Is An Insured is amended to include as an additional insured any per- son(s) or organization(s) for whom you are performing operations or leasing a premises when you and such person(s) or organiza- tion(s) have agreed in writing in a contract or agreement that such person(s) or organiza- tion(s) be added as an additional insured on your policy. Such person or organization is an additional insured only with respect to lia- bility 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: 1. In the performance of your ongoing opera- tions; or 2. In connection with your premises owned by or rented to you. A person's or organization's status as an addi- tional insured under this endorsement ends when your operations or lease agreement for that additional insured are completed. CGL E5421 CW(02/14) Includes copyrighted material of Insurance Services Office, Inc.,with its Page 1 of 1 permission. ACCMV CERTIFICATE OF LIABILITY INSURANCE I DATE(MMIDDIYYYY) 05/05/2018 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 NAME, (A�C,Nvw�xrl: ( ) (Af Hiscox Inc.d/b/a/Hiscox Insurance Agency In CA PHONE HONE' 888 202-3007 FAX Nea, 520 Madison Avenue ADDRESS, corllacli�3'l,hisrox.rorru 32nd Floor INSURERIS)AFFORDING COVERAGE NAIC# New York,NY 10022 INSURER A: Hiscox Insurance Company Inc 10200 INSURED INSURER B: Edward Professional Advisors LLC INSURER C: 8333 Foothill Blvd Ste 106 INSURER D INSURER E: Rancho Cucamonga CA 91730 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 RAID CLAIMS. LTR TYPE OF INSURANCE 14M_M 1� POLICY NUMBER .flMIA0CY EFF POLICY E'Y MM'/DDVYYYYb fMM/DOIYYYYt LIMITS CLAIMS-MADE GENERAL LIABILITY $ O) ( .. C LG EACH OCCURRENCE EL.dMINSCS CNpu�n�il�r� OCCUR PREMISES urwi,u,7;p $ MED EXP(Any one person) PERSONAL $ &ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENE II$ EF+R �COC PRODUCTS-COMPfOP A„GG $PTYLR $ AUTOMOBILE LIABILITY COMBINED S14,OLE.LIMIT $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED ) BODILY INJURY Per accident!$ IAUTOS AUTOS ( HIRED AUTOS AUTOSWNED „(Pui�acrNiJnM UMBRELLA LIAB OCCUR EACH OCCURRENCE $ IAB CLAIMS-MADE AGGREGATE $ „DED E 5,�. RETENTION$WOR $ YIN .... r ..V I ER AN""P�WRPANILTtIRiIP Y,,"TBILnY pUCR!'L' El E.L.EACH KERSyCOMPE NSATION PER IT - OTH ANYF"°Rc)PNtILEL5F7.'�VPA.NTµJI:I"7aI:XECUTIVE $ (Mand"lon In NH. E.L.DISEASEC A EMPLOYEE, If yes,describe under $ DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ Professional Liability Each Claim: $ 1,000,000 A Y UDC-1473496-EO-18 03/01/2018 03/01/2019 Aggregate: $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) CERTIFICATE HOLDER CANCELLATION City of EI Segundo 350 Main Street SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE EI Segundo CA 90245 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE q) V ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD From; USAAUSAA,Cuamme:6amica@niaNnantmrusaazmm ' Subject- UQAA Auto insurance Confirmation Date: May tO01Bat 3:41 PM ` To. pedward@ma.com Auto Knsurance �� uow�meCmmr ooNs �� ��/ pou/ ~� m� Confirmation �6;�A um*a~�°�n�w�r w���ums| ��v�mma| m��� Dear Paul LEdward, Please use this as confirmation of auto insurance; however, this does not take the place of aninsurance identification card. Registered owner : PAUL LEDWARD Policy #: USAAUU361669771U2 Policy effective: December 8, 2018 Policy expiration: June 8, 2019 Vehicle: 2OO7CHEVTAHOE 4D »yIN : 1GNFC130273368288 Bodily injury liability limit: $1,000,000 each person / $1,OOO,UOOeach accident Property damage liability limit: $1,OOO,OO8each accident Comprehensive deductible: $100 Collision deductible: $500 Additional insured: CITY OFELSEGUNDO 350 Main Street E| Segundo, CA9U245 This confirmation of coverage neither affirmatively nor negatively amends, extends or alters the coverage given by the policy issued by United Services Automobile Association. Thank you for choosing us for your auto insurance needs. If you have questions, please call usat21O-531-USAA (8722), our mobile shortcut #872ZorOUD-S31-872Z. Thank you, United Services Automobile Association � ~== � NINA *mw,riouw,`, 11)wx0 Rnam' *u*n,,vo*, (��*� /��»m:� ..... m/' amvfl:�:*m��u'�n. *�xorm«�4 TRAVELERSJ WORKERS COMPENSATION ONE TOWER SQUARE AND HARTFORD, CT e6183 EMPLOYERS LIABILITY POLICY TYPE V INFORMATION PAGE WC 00 00 01 ( A) POLICY NUMBER: (IJUB-7X84481-2-18) KV-18 INSURER: TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA 1 NCCI CO CODE: 13579 INSURED: PRODUCER, EDWARD PROFESSIONAL ADVISORS L AUTOMATIC DATA PROC INS SEE ENDORSEMENT RC 99 06 01 1 ADP BLVD MS 625 8333 FOOTHILL BLVD., STE. 106 ROSELAND NJ 07068 RANCRO CUCAMONGA CA 91730 Insured is A LIMITED LIABILITY COMPANY Other work places and identification numbers are shown in the schedule(s) attached. 2. The policy period is from 04-17-1B to 04-17-19 12.01 A.M. at the insured's mailing address. 9. A. WORKERS COMPENSATION INSURANCE: Part One of the policy applies to the Workers Compensation Law of the state(s) listed here: CA B. EMPLOYERS LIABILITY INSURANCE: Part Two of the policy applies to work in each state listed in item 3.A. The limits of our liability under Part Two are: Bodily Injury by Accident: $ 1000000 Each Accident Bodily Injury by Disease: $ 1000000 Policy I.irrlit Bodily Injury by Disease: $ 1000000 Each Fmptoyee C. OTHER STATES INSURANCE: Part Three of the policy applies to the states,if any, listed here. AL AR AZ CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC NE NH NJ NM NV NY OX OR PA RI SC SD TN TX UT VA VT WI WV D. This policy includes these endorsements and schedules: SEE LISTING OF ENDORSEMENTS - EXTENSION OF INFO PAGE 4. The premium for this policy will be determined by our Manuals of Rules,Classifications, Rates and Rating Plans. All required information is subject to verification and change by audit to be made ANNUALLY. DATE OF ISSUE: 03-20-18 AD OFFICE: 'PAYROLL 70A DIRECT BILL PRODUCER: AUTOMATIC DATA PROC INS XV770 TRAVELERSt WORKERS COMPENSATION ON TOWER SQUARE AND RUVORD, CT 06183 EMPLOYERS LIABILITY POLICY TYPE V INFORMATION PAGE WC 00 00 01 ( A) POLICY NUMBER: (IJUB-7](84081-2-18) CLASSIFICATION SCHEDULE: PREMIUM BASIS ESTIMATED RATES ESTIMATED TOTAL ANNUAL PER$100 OF ANNUAL CLASSIFICATIONS CODE NO REMUNERATION REMUNERATION PREMIUM SEE EXTENSION OF INFORMATION PAGE - SCHEDULE(S) SIC-CODE: 8742 NAICS: 541611 --------STANDARD----------- TOTAL ESTIMATED ANNUAL STANDARD PREMIUM $ 1024 PREMIUM DISCOUNT NONE 0900-04 EXPENSE CONSTANT 160 TERRORISM 27 TOTAL ESTIMATED PREMIUM 1211 TAXES AND SURCHARGES 48 DEPOSIT AMOUNT DUE 1259 Minimum Premium: $500 OTHER MINIMUMS ARE INDICATED ON THE APPLICABLE SCHEDULE(S) DATE OF ISSUE: 03-20-18 AD OFFICE: PAYROLL 70A PRODUCER: AUTOMATIC DATA PROC INS XV770 COUNTERSIGNED-AGENT �� ��� WORKERS COMPENSATION TRAVAND ONE TOWER SQUARE EMPLOYERS LIABILITY POLICY HARTFORD, CT 06183 ENDORSEMENT WC 99 03 76 ( A)- 001 POLICY NUMBER: (IJUB-7K84081-2-18) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA (BLANKET WAIVER) 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. The additional premium for this endorsement shall be 2 .0 % of the California workers' compensation pre- mium. Schedule Person or Organization Job Description ANY PERSON OR ORGANIZATION FOR BUSINESS CONSULTANTS WHICH THE INSURED HAS AGREED BY WRITTEN CONTRACT EXECUTED PRIOR TO LOSS TO FURNISH THIS WAIVER. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective Policy No. Endorsement No. Insured Premium Insurance Company Countersigned by DATE OF ISSUE: 05-02-18 ST ASSIGN: Page 1 of 1