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PROOF OF INSURANCE (2019) CLOSED DAVIKLU-01 SROTI ACORO" CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 127/2018 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 have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on 9_ .......... 'n lieu of such endorsement(s). this certificate does not confer rights to the certlflcate holder I........ „ �................ PRODUCER LICe'nse#OG19762 C TACT N' E: Momentous Insurance Brokerage Inc PHONEFAX 5990 Sepulveda Blvd.,#550 INCNo,Exl,):(8'18)933-2700 (Arc,Ne):(818)933-2701 Van Nuys,CA 91411 ngLAIL SS; INSURER(S)AFFORDING COVERAGE NAIL At INSURER A:Sentinel Insurance Company 11000 INSURED INSURER B;Twin City Fire Insurance Company 29459 David Klug INSURER C: 24631 Mandeville Dr. INSURER D: Laguna Hills,CA 92653 INSURER E INSURER F . OV RAGES C RT[FIC# .E,(eN,UMO.E'j ... ...,. .. 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 N7R TYPE OF INSURANCE ADDLSUBW POLICY EFF i POLICY EXP _...........................................OLICY,NUMBER.......................... ..�LI)tltllf!/t)�I?GYY.YXd..'_ l�(dA�'�'Y� LIMITS A COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 CLAIMS-MADE OCCUR 72SBMBB6531 07/26/2018 07/26/2019 DAMAGE TO RENTED 1,000,000 PREMISE$(Fa accurrenc„e) $ MED EXP,(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 2,000,000 GEN1 AGGREGATE LIMIT APPLIES PER GENERAL,AGGREGATE $ 4,000,000 POLICY JERO Loc PRODUO.TS-COMPIOR AGG $ 4,000,000 .OTHER _........................................................m..,.,.,.,.,.,.,......,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,. ,.,.,.,.,.,.,.,.,.,.,.,.�.,.,.,.,.,.,............. _ ....................... A AUTOMOBILE LIABILITY COMENNED SINGLE LIMIT 2,000,000 t'Saa agc'iden)) $ ANY AUTO 72SBMBB6531 07/26/2018 07/26/2019 BODILY INJURY(Por p ao°snnl $ OWNED SCHEDULED AUTOS ONLY AUTOSBODILYBODILY INJURY(Per accident,) $ X AUTOS ONLY X AUOTOS ONLD PROPERTY DAMAGE $ per accident ..___._......_...., $ A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 EXCESS LIAB CLAIMS-MADE 72SBMBB6531 07/26/2018 07/26/2019 AGGREGATE $ 1,000,000 DED RETENTION$ $ ,...... FFICER/MEM...�............................................�..........._....,.,.............. l3 WORKERS COMPENSATION X PER '� ORTH- AND EMPLOYERS'LIABILITY 72WECAB7SEE 07/26/2018 07/26/2019 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE ) E L EACH ACCIDENT $ oo BER EXCLUDED? N/A 1,000,000 (AAandatory In NH) E L DISEASE-EA EMPLOYEE, $ If yes,describe under 1,000,000 DESGRIPTION,OF„CLPERATIONS below E L DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) Evidence of Insurance CERTIFICATE HOLDER_ CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Ci of EI Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City 9 ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main St. EI Segundo,CA 90245 AUTHORIZED REPRESENTATIVE ................................................................................................... .............................................. W ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved, The ACORD name and logo are registered marks of ACORD BUSINESS LIABILITY COVERAGE FORM F. OPTIONAL ADDITIONAL INSURED 3. Additional Insured -Grantor Of Franchise COVERAGES WHO IS AN INSURED under Section C. is If listed or shown as applicable in the Declarations, amended to include as an additional insured one or more of the following Optional Additional the person(s) or organization(s) shown in the Insured Coverages also apply. When any of these Declarations as an Additional Insured - Optional Additional Insured Coverages apply, Grantor Of Franchise, but only with respect to Paragraph 6. (Additional Insureds When Required their liability as grantor of franchise to you. by Written Contract, Written Agreement or Permit) 4. Additional Insured - Lessor Of Leased of Section C., Who Is A sured, does not a I Equipment tp the person organization own rn the a. WHO IS AN INSURED under Section C. is Declarations. These coverages are subject to the amended to include as an additional terms and conditions applicable to Business insured the person(s) or organization(s) Liability Coverage in this policy, except as shown in the Declarations as an Additional provided below: Insured — Lessor of Leased Equipment, 1. Additional Insured - Designated Person Or but only with respect to liability for"bodily Organization injury", "property damage" or "personal WHO IS AN INSURED under Section C. is and advertising injury" caused, in whole or amended to include as an additional insured in part, by your maintenance, operation or the person(s) or organization(s) shown in the use of equipment leased to you by such Declarations, but only with respect to liability person(s)or organization(s). for "bodily injury", "property damage" or b. With respect to the insurance afforded to "personal and advertising injury" caused, in these additional insureds, this insurance whole or in part, by your acts or omissions or does not apply to any 'occurrence" which the acts or omissions of those acting on your takes place after you cease to lease that behalf: equipment. a. In the performance of your ongoing 5. Additional Insured - Owners Or Other operations; or Interests From Whom Land Has Been b. In connection with your premises owned Leased by or rented to you. a. WHO IS AN INSURED under Section C. is 2. Additional Insured - Managers Or Lessors amended to include as an additional Of Premises insured the person(s) or organization(s) shown in the Declarations as an Additional a. WHO IS AN INSURED under Section C. is Insured —Owners Or Other Interests From amended to include as an additional insured Whom Land Has Been Leased, but only the person(s)or organization(s) shown in the with respect to liability arising out of the Declarations as an Additional Insured - ownership, maintenance or use of that part Designated Person Or Organization; but only of the land leased to you and shown in the with respect to liability arising out of the Declarations. ownership, maintenance or use of that part of the premises leased to you and shown in the b. With respect to the insurance afforded to Declarations. these additional insureds, the following additional exclusions apply: b. With!respect to the insurance afforded to these additional insureds, the following This insurance does not apply to: additional exclusions apply: (1) Any 'occurrence" that takes place This insurance does not apply to: after you cease to lease that land; or (1) Any 'occurrence" which takes place (2) Structural alterations, new after you cease to be a tenant in that construction or demolition operations premises; or performed by or on behalf of such (2) Structural alterations, new person or organization. construction or demolition operations 6. Additional Insured - State Or Political performed by or on behalf of such Subdivision—Permits person or organization. a. WHO IS AN INSURED under Section C. is amended to include as an additional insured the state or political subdivision shown in the Declarations as an Additional Page 18 of 24 Form SS 00 08 04 05 BUSINESS LIABILITY COVERAGE FORM Insured — State Or Political Subdivision - (e) Any failure to make such Permits, but only with respect to inspections, adjustments, tests or operations performed by you or on your servicing as the vendor has agreed behalf for which the state or political to make or normally undertakes to subdivision has issued a permit. make in the usual course of b. With respect to the insurance afforded to business, in connection with the these additional insureds, the following distribution or sale of the products; additional exclusions apply: (f) Demonstration, installation, This insurance does not apply to: servicing or repair operations, (1) Bodily injury", property damage" or except such operations performed at the vendor's premises in "personal and advertising injury" connection with the sale of the arising out of operations performed for product; the state or municipality; or (2) "Bodily injury" or "property damage" (g) Products which, after distribution or sale by you, have been labeled included in the "product-completed or relabeled or used as a operations hazard. container, part or ingredient of any 7. Additional Insured—Vendors other thing or substance by or for a. WHO IS AN INSURED under Section C. is the vendor; or amended to include as an additional (h) "Bodily injury" or "property insured the person(s) or organization(s) damage" arising out of the sole (referred to below as vendor) shown in the negligence of the vendor for its Declarations as an Additional Insured - own acts or omissions or those of Vendor, but only with respect to "bodily its employees or anyone else injury" or "property damage" arising out of acting on its behalf. However, this "your products" which are distributed or exclusion does not apply to: sold in the regular course of the vendor's (i) The exceptions contained in business and only if this Coverage Part Subparagraphs d provides coverage for "bodily injury" or ( )or(fl; or "property damage" included within the (ii) Such inspections, "products-completed operations hazard". adjustments, tests or servicing b. The insurance afforded to the vendor is as the vendor has agreed to make or normally undertakes subject to the following additional exclusions: to make in the usual course of (1) This insurance does not apply to: business, in connection with (a) "Bodily injury" or "property the distribution or sale of the damage" for which the vendor is products. obligated to pay damages by (2) This insurance does not apply to any reason of the assumption of insured person or organization from liability in a contract or agreement. whom you have acquired such This exclusion does not apply to products,' or any ingredient, part or liability for damages that the container', entering into, vendor would have in the absence accompanying or containing such of the contract or agreement; products. (b) Any express warranty 8. Additional Insured—Controlling Interest unauthorized by you; WHO IS AN INSURED under Section C. is (c) Any physical or chemical change amended to include as an additional insured in the product made intentionally the person(s) or organizations) shown in the by the vendor; Declarations as an Additional Insured — (d) Repackaging, unless unpacked Controlling Interest, but only with respect to o solely for the purpose of inspection, their liability arising out of: demonstration, testing, or the a. Their financial control of you; or substitution of parts under b. Premises they own, maintain or control instructions from the manufacturer, while you lease or occupy these premises. and then repackaged in the original container; Form SS 00 08 04 05 Page 19 of 24 BUSINESS LIABILITY COVERAGE FORM This insurance does not apply to structural The limits of insurance that apply to additional alterations, new construction and demolition insureds are described in Section D. — Limits Of operations performed by or for that person or Insurance. organization. How this insurance applies when other insurance 9. Additional Insured — Owners, Lessees Or is available to an additional insured is described in Contractors — Scheduled Person Or the Other Insurance Condition in Section E. — Organization Liability And Medical Expenses General a. WHO IS AN INSURED under Section C. is Conditions. amended to include as an additional G. LIABILITY AND MEDICAL EXPENSES insured the person(s) or organization(s) DEFINITIONS shown in the Declarations as an Additional Insured —Owner, Lessees Or Contractors, 1. "Advertisement" means the widespread public but only with respect to liability for "bodily dissemination of information or images that injury", "property damage" or "personal has the purpose of inducing the sale of goods, and advertising injury" caused, in whole or products or services through: in part, by your acts or omissions or the a. (1) Radio; acts or omissions of those acting on your (2) Television; behalf: (3) Billboard; (1) In the performance of your ongoing (4) Magazine; operations for the additional insured(s); or (5) Newspaper; (2) In connection with "your work" b. The Internet, but only that part of a web performed for that additional insured site that is about goods, products or and included within the "products- services for the purposes of inducing the completed operations hazard", but sale of goods, products or services; or only if this Coverage Part provides c. Any other publication that is given coverage for "bodily injury" or widespread public distribution. "property damage" included within the However, "advertisement"does not include: products-completed operations hazard". a. The design, printed material, information or images contained in, on or upon the b. With respect to the insurance afforded to packaging or labeling of any goods or these additional insureds, this insurance products; or does not apply to "bodily injury", "property b. An interactive conversation between or damage" or "personal an advertising injury" arising out of the rendering of, or among persons through a computer network. the failure to render, any professional 2• "Advertising idea" means any idea for an architectural, engineering or surveying "advertisement". services, including: 3. "Asbestos hazard" means an exposure or (1) The preparing, approving, or failure to threat of exposure to the actual or alleged prepare or approve, maps, shop properties of asbestos and includes the mere drawings, opinions, reports, surveys, presence of asbestos in any form. field orders, change orders, designs or 4. "Auto" means a land motor vehicle, trailer or drawings and specifications; or semi-trailer designed for travel on public (2) Supervisory, inspection, architectural roads, including any attached machinery or or engineering activities. equipment. But "auto" does not include 10. Additional Insured — Co-Owner Of Insured "mobile equipment". Premises 5. "Bodily injury" means physical: WHO IS AN INSURED under Section C. is a. Injury; amended to include as an additional insured b. Sickness; or the person(s) or Organization(s) shown in the c. Disease Declarations as an Additional Insured — Co- Owner Of Insured Premises, but only with sustained by a person and, if arising out of the respect to their liability as co-owner of the above, mental anguish or death at any time. premises shown in the Declarations. 6. "Coverage territory" means: Page 20 of 24 Form SS 00 08 04 05 NASununary of Insurancefor Ra vid ERFIORS & ONHISSIONS kiisurance Cardeir- Scxm.sdae Indemnity cwrlljpmny Policy Tern-s. 7/26/20118 - 7/2(V2(.M.9 Plolky Number. EK13264358 PolkyPrernium: $1,724,00 Poky Form: C Li i m s Ma d e&R epo fled Petroactlw..,Date- 07126/20.18 EM ein se C osts/Ex pens a Irlsil(k Pollicy Urniits Lifyits of Uabfflty::� Aggregate Exh E&O Lass 2,000,000 F*tent Im/Ded u cb Wc. Ex.-A IMO ILoss, SCK) Territoiry-, Worldmdde N40ble Coverap Cand'dofts&Raccirmendatlem, Mease ren-,erritxr that arwy pK..)tenfiA capm oir facts ind dircumstarices d,-tat you know of that ccm.fld give 6ie to a daurri, arrV luip cpaifn, pmestigaUon, dernand, Chreatened cWim, or cofnp�aifkt that has Ibeen made dudrig Ow... jvky period of Vie currm t pcAicy miust be repofted prior to the expVatfon date of the current poficy, Because Che coo.-vage 6,Oairrts.-Made aqd Reported, cIlairns wifl offly p*. . covered H they are rerx.mled durhiig Owl, ;mficy pxirlod 4-n which fl,w clah ps mxie, (see the poficy's "'Notice' of, 0ainslkelpx)rdN!, provisioro fix any poss6le jr..)ost-pdhcy reponpf)g wdows,) These rej..-*.rt0g requkeirmints rrmau.q be suictAy loflo%wd 41 order to protect cow rage for these potenti,M dladrrr, and cpMrm once the exppries, Your,hAure to do 5o could resiult pn O'oe daun Ibeir%p derfled cowragO MW THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA Policy Number: 72 WEC A67SEE Endorsement Number: Effective Date: 07/26/18 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address: Actus Consulting and Training 24631 MANDEVILLE DR LAGUNA HILLS CA 92653 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 remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 2 % of the California workers'compensation premium otherwise due on such remuneration. SCHEDULE Person or Organization Job Description Any person or organization from whom you are required by written contract or agreement to obtain this waiver of rights from us Countersigne