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PROOF OF INSURANCE (2019 - 2019) CLOSED
0 I DATE(MM/DD/YYYY) AC<.>RL> CERTIFICATE OF LIABILITY INSURANCE 04/26/2018 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 ... (Ari,E ..,(�88)202-3007 (AJC,No:I Hiscox Inc.d/b/a/Hiscox Insurance Agency In CA PHONE ................................. I.............................. 520 Madison Avenue E-MAIL _ contact@hiscox.com 32nd Floor INSURER(S)AFFORDING COVERAGE 1. NAIL# New York,NY 10022 ...INSURER.A: Hiscox Insurance Company............................................. ... ..... .. ..... .... INSURER..B: Inc .. .... 0200 INSURED Govinvest Inc. INSURER C: 3625 Del Amo Blvd INSURER D; Ste 110 Torrance,CA 90503 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 iMfk Abn SUaR;' POLICY'E' . .... ..'.., FF ..POLICY EXP. LTR TYPE OF INSURANCE (IN�VD p POLICY NUMBER (MMIDDIYYYYI IMMIDDIYYYY), LIMITS X I�"/K"�;I°AGG to RENTED I� EACH S rFnxcruy wcel $ 100,0'00 0 .r.,CO.� l..X �, �'I�1fuE' 0 CLAIMS-MADE OCCUR E OC .......................... MED EXP(Any one person) $ 5,000 GEN'L AGGREGATE LIMIT V A APr�'LIES PERSONAL&ADV INJURY $ 3,00 '000 _ Y Y UDC-1542150-CGL-18 02/10/2018 02/10/2019 PER. i GENERAL AGGREGATE $ 0,000 XI F 'r (,.... PRODUCTS-COMP/OP AGG ($ S/T Gen.Agg, POLICY LOC OTHER, AUTOMOBILE LIABILITY „CO�Mrd,,BIC;a,,d�PJ,9SINGLE LIMIT $ ANY AUTO BODILY INJURY(Per person) ii$ ALL OWNED ....... SCHEDULED BODILY INJURY(Per accident) $ AUTOS . AUTOS $ ... NON-OWNED LRarec doral) MAGE ............. HIRED AUTOS .,I AUTOS ,(f?4[_C'GudPaultl UMBRELLALI .... .....,,,, „ H TE RENCE $ __ CLAIMS-MADE A EXCESS LIABAB OCCUR ..E.GG,R®GA............. $ .....................,,, --- - .„DED ....I I...RET ENTION$ $ WORKERS COMPENSATION — STATIPER JT EERH- YIN ❑ ..E L DISEASE ............ ANYPR R RIE TNH/ ARTNE /E ECUTIVE E L EACH ACCIEAE ................... $ N/A .... ............ $ (Mandatory• ) EMPLOYEE. If yes,describe under DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT $ u DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe aHached if more apace is required) V CERTIFICATE HOLDER CANCELLATION The 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 REPRESENTATIVE 25� a�M. Y ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD AC"RO CERTIFICATE OF LIABILITY INSURANCE I DA4/26/2018 Y' 9/26/2018 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 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 this certificate does not confer riahts to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT GEICO GEICO NAME: One GEICO Boulevard (A/CNN Fredericksburg,VA 22412 o Ext): 1-8WW9-94M WC,No): Email R1CO�N' �BCO.COM Address: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:GOVERNMENT EMPLOYEES INSURANCE COMPANY 22063 INSURED INSURER B: GOV INVEST, INC 3625 DEL AMO BLVD STE 110 INSURER C: TORRANCE CA 90503-1668 INSURER D: INSURER E: INSURER F: COVERAGES CEFITIFICATE 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, INSR TYPE OF INSURANCE ADD'L SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSRD WVD (MM/DDIYY) (MM/DDIYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ MED.EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PROJECT LOC PRODUCTS—COMP/OP AGG. $ ...........�OTHER............. $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) A ANY AUTO 910008260L 02 4/17/2018 4/17/2019 BODILY INJURY(Per person) $ OWNED X SCHEDULED BODILY INJURY(Per accIdanl) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) _.M.�UMBRELLA LIAB OCCUR V EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ I DED I I RETENTION$ I $ WOR EMLOYERS'LABILITY EXECUTIVE Y/N N/A . EL PER ER AACCIDENT 7................. ,I �p AN ....................................... D P OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under E DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS below DESCRIPTIONDFOPERATIONS/LOCATIONS/VEHICLES(ACORD 101,AdditionaRemarksSchedule,may beattached 1fmore space isreq uired) THE CITY OF EL SEGUNDO, ITS OFFICIALS AND EMPLOYEES ARE LISTED AS ADDITIONAL INSURED. COVERAGE IS PRIMARY AND NON—CONTRIBUTORY. CERTIFICATE'HOLDER CANCELLATION CITY OF EL SEGUNDO SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 350 MAIN ST THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. EL SEGUNDO, CA 90245-3813 AUTHORIZED REPRESENTATIVE @ 1988'..2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD GOVINVE-01 CDEMARCO, CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY)04/26/2018 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. .........._._.......,, .-.W................_...., _W 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 term's 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 A 'EAC'T (Lillian Vasquez Geico Insurance Agency PHONE 80'0 969-5454 FAX 1 Geico Blvd! INC,No,Ewt).( 1 (AIC,Nol.(670)825-2990 Fredericksburg,VA 22412 A&RIEs,s;grip@guard.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:AmGUARD Insurance Company 42390 INSURED INSURER e Gov Invest,Inc. INSURER C: 3625 Del Amo Blvd.,Suite 110, INSURER D; Torrance,CA 90503 INSURER E., INSURER F: COVERAGES CER_ NIFICATE 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. INSR ..... ADON.'SI Ulll'114!" -.. IMPOLICY EFF I 1 POLICY EXP t _LTR TYPE OF INSURANCE �) S,Iry wr)'�ILP' POLICY NUMBER �11yId:. p yyy LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCUR,RENCF $ CLAIMS-MADE OCCUR DAMAG'ETORENTED PREPAISE'S(Ea occurrence) MMD EXP(Any one PLrsopn S PER'SO'NAL&ADVINJURY S GEN'L AGGR'EG'ATE LIMIT APPLIES PER: GENERAL AGGREGA'T'E $ POLICY %pr' El LOC PRODUCTS•'Cd)hAPIL'3P'AGG 5' OTHER' ............ (ONn SbNGLE LIMIT AUTOMOBILE LIABILITY (Ea acedet; S ANY AUTO BOMLY lINJURY(Per person), „S OWNED SCHEDULED AUTOpS ONLY AU�TP�OOS gy %B'OMLY'INJURY'iIPer�aocgdenQ S �. AUTOS ONLY A6,J?O'S'�N 'M q,Per�i dendC)T'A4V�'AGE'� 5 UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE S DED RETENTION$ $ AND EMPLOY..R ....... _.......... ........... A WORKERS COMPENSATION � �rLITE .�eTa"�"'� E LAB TY C74 04/22/2018 04/22/2019 X 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE YIN E L 'EACH ACCIDENT �'S Wnn atoIME BER EXCLUDED? �' NIA 1,OOt� � NH) EL Dt'SEASE-'EA EMP'L.OYE 'S ,E If yes,describe under 1000,000 DESCRIPTION OF OPERATIONS below _,_,_,__„_,_,,,, „,m E,I'.. rASEASE•POLICY LIMIT �' ..m................. ...... DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Excluded:Jasmine Nachtigall-Fournier Exlcuded:Ted Price -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 ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved The ACORD name and logo are registered marks of ACORD WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed.4-84) 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 remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 1.0_2 _% of the California workers' compensation premium otherwise due on such remuneration. Schedule Person or Organization Job Description Blanket Waiver-Any person or organization for whom the All CA Operations Named Insured has agreed by written contract 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, GOWC976948 Endorsement No. Insured Insurance Company Countersigned By ©1998 by the Workers'Compensation Insurance Rating Bureau of California.All rights reserved.