Loading...
PROOF OF INSURANCE (2019 - 2020) CLOSED CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) a 01/31/2019 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 SUBROGATIONIS 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 USAA INSURANCE AGENCY INC/PHS NAME: 65812846 PHONE (888)242-1430 FAX (888)443-6112 (A/C,No,Ext): (a/c,No): The Hartford Business Service Center 3600 Wiseman Blvd E-MAIL San Antonio,TX 78265 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: The Sentinel Insurance Company 11000 REDDOOR CREATIVE,LLC. I INSURER B: 208 E FRANKLIN AVE EL SEGUNDO ,CA 90245-3823 INSURER C INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVI'SIO'N 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 ADDL SUBR POLICY NUMBER POLICY EFF I POLICY EXP - LIMITS T-R, INSR WVD IMM,(D,,,�1__._. !,C,�,PDft_YYY} COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000 CLAIMS-MADE zOCCUR I DAMAGE TO RENTED $1,000,000 PR I4 ..a oacurrencel X General Liability MED EXP(Any one person) $10,000 A 65 SBA TA6820 05/02/2018 05/02/2019 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY7 PRO- LOC PRODUCTS-COMP/OP AGG $2,000,000 JECT OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT „IFa�„Ocridentl ANY AUTO BODILY INJURY(Per person) ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Par accident) HIREDNON-OWNED PROPERTY DAMAGE AUTOS AUTOS (Per accident) UMBRELLA LIAB �--I{OCCUR EACH OCCURRENCE ( EXCESS LIAB CLAIMS- MADE AGGREGATE DED RETENTION$ t WORKERS COMPENSATION _ (SPER 01 TATUTE I �ERH AND EMPLOYERS'LIABILITY ANY YIN ) PROPRIETOR/PARTNER/EXECUTIVE E L EACH ACCIDENT OFFICER/MEMBER EXCLUDED? E N/A IE.L,DISEASE-EA EMPLOYEE (Mandatory in NH) ---- -- - ---If yes,describe under E L DISEASE-POLICY LIMIT DESCRIPTION OF OPERATIONS below I A 65 SBA TA6820 05/02/2018 05/02/2019 Limit DATA BREACH-DEFENSE& $50,000 LIAB COVG - DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACO;D 107,Additional Remarks Schedule,_may be attached If more space is required) ..................... Those usual to the Insured's Operations, CERTIFICATE HOLDER CANCELLATION -- City of EI Segundo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 350 MAIN ST BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED EL SEGUNDO CA 90245-3813 IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE V/ ' 440_ � ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD it THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLICY CHANGE This endorsement changes the policy effective on the Inception Date of the policy unless another date is indicated below: Policy Number: 65 SBA TA6820 DX Named Insured and Mailing Address; REDDOOR CREATIVE, LLC, ell 208 E FRANKLIN AVE EL SEGUNDO CA 90245 Policy Change Effective Date: 01/31/19 Effective hour is the same as stated in the Declarations Page of the Policy. Policy Change Number: 001 Agent Name: USAA INSURANCE AGENCY INC/PHS Code: 812846 POLICY CHANGES: SENTINEL INSURANCE COMPANY, LIMITED ANY 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 BUSINESS LIABILITY OPTIONAL COVERAGES ARE REVISED ADDITIONAL INSURED(S) ARE ADDED THE FOLLOWING ARE ADDITIONAL INSURED FOR BUSINESS LIABILITY COVERAGE IN THIS POLICY. LOCATION 001 BUILDING 001 PERSON/ORGANIZATION: SEE FORM IH 12 00 PRO RATA FACTOR: 0.249 THIS ENDORSEMENT DOES NOT CHANGE THE POLICY EXCEPT AS SHOWN. Form SS 1211 04 05 T Page 001 (CONTINUED ON NEXT PAGE) Process Date: 01/31/19 Policy Effective Date: OS/02/18 Policy Expiration Date: 05/02/19 POLICY NUMBER: 65 SBA TA6820 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - PERSON-ORGANIZATION CITY OF EL SEGUNDO 350 MAIN ST EL SEGUNDO, CA 90245 Form IH 12 00 11 85 T SEQ. NO. 002 Printed in U.S.A. Page 001 Process Date: 01/31/19 Expiration Date: 05/02/19 20 This Spectrum Policy consists of the Declarations, Coverage Forms, Common Policy Conditions and any 68 other Forms and Endorsements issued to be a part of the Policy. This insurance is provided by the stock TA insurance company of The Hartford Insurance Group shown below. SBA INSURER: SENTINEL INSURANCE COMPANY, LIMITED ONE HARTFORD PLAZA, HARTFORD, CT 06155 COMPANY CODE: A THE Policy Number: 65 SBA TA6820 DX HARTFORD SPECTRUM POLICY DECLARATIONS Named Insured and Mailing Address: REDDOOR CREATIVE, LLC. (No., Street, Town, State, Zip Code) 208 E FRANKLIN AVE EL SEGUNDO CA 90245 USAA ##: 116808751 Policy Period: From 05/02/18 To 05/02/19 1 YEAR 12:01 a.m., Standard time at your mailing address shown above. Exception: 12 noon in New Hampshire. Name of Agent/Broker: USAA INSURANCE AGENCY INC/PHS Code: 812846 Previous Policy Number: 65 SBA TA6820 Named Insured is: LIMITED LIAR CORP Audit Period: NON-AUDITABLE Type of Property Coverage: SPECIAL Insurance Provided: In return for the payment of the premium and subject to all of the terms of this policy, we agree with you to provide insurance as stated in this policy. TOTAL ANNUAL PREMIUM IS: $743 Countersigned by 02/16/18 Authorized Representative Date Form SS 00 02 12 06 Page 001 (CONTINUED ON NEXT PAGE) Process Date: 02/16/18 Policy Expiration Date: 05/02/19 SPECTRUM POLICY DECLARATIONS (Continued) POLICY NUMBER: 65 SBA TA6820 BUSINESS LIABILITY LIMITS OF INSURANCE LIABILITY AND MEDICAL EXPENSES $1,000,000 MEDICAL EXPENSES -ANY ONE PERSON $ 10,000 PERSONAL AND ADVERTISING INJURY $1,000, 000 DAMAGES TO PREMISES RENTED TO YOU $1,000,000 ANY ONE PREMISES AGGREGATE LIMITS PRODUCTS-COMPLETED OPERATIONS $2,000,000 GENERAL AGGREGATE $2,000,000 BUSINESS LIABILITY OPTIONAL COVERAGES CYBERFLEX COVERAGE FORM SS 40 26 UNMANNED AIRCRAFT LIABILITY FORM: SS 42 06 Form SS 00 02 12 06 Page 005 (CONTINUED ON NEXT PAGE) Process Date: 02/16/18 Policy Expiration Date: 05/02/19 Insurer: SENTINEL INSURANCE COMPANY, LIMITED ONE HARTFORD PLAZA, HARTFORD, CT 06155 This Declarations Page, with Common Policy Conditions, Data Breach Coverage Form and Endorsements, if any, issued to form a part thereof, shall together constitute this Data Breach Coverage Part, which in turn forms a part of the Policy Number shown below. The Common Policy Conditions and Nuclear Energy Liability Exclusion of the policy to which this Coverage Part is attached also apply to this Coverage Part. But if there is any conflict between the policy and this Coverage Part, then this Coverage Part will govern. "Coverage part" means this Declarations page and all Data Breach forms listed herein and attached hereto. POLICY NUMBER: 65 SBA TA6820 CHANGE NUMBER: 001 DATA BREACH COVERAGE DECLARATIONS PLEASE READ YOUR POLICY. IF YOU HAVE PURCHASED DATA BREACH -DEFENSE AND LIABILITY, NOTE THAT CLAIM EXPENSES ARE PAYABLE WITHIN THE LIMITS OF LIABILITY. Named Insured and Mailing Address: REDDOOR CREATIVE, LLC„ 208 E FRANKLIN AVE EL SEGUNDO CA 90245 Policy Period Effective Date: 01/31/19 Expiration Date: 05/02/19 12:01 A.M., Standard time at the address of the named insured as stated herein. Premium: $103 Minimum Premium: NONE Data Breach -Response Expenses Data Breach - Response Expenses Limit Of Insurance: 10,000 Deductible: 1, 000 Retroactive Date: OS/02/1S If no date is entered,the Retroactive Date is the same as the effective date of this Coverage Part. Business Income And Extra Expense Business Income And Extra Expense Sub-limit: NOT INCLD Waiting Period Deductible: NA Hours Extortion Threats Sub-limit: NOT INCLD Data Breach - Response Expenses deductible shown above also applies to Extortion Threats coverage. Data Breach -Defense and Liability (THIS IS CLAIMS FIRST MADE AND REPORTED IN WRITING INSURANCE) Limit Of Insurance: S0, 000 Data Breach -Defense and Liability Deductible: 0 Retroactive Date: 05/02/15 If no date is entered,the Retroactive Date is the same as the effective date of this Coverage Part. Form Numbers Of Forms and Endorsements that apply: Common Policy Conditions: Form SS 00 05, Exclusion Nuclear Energy Liability: SS 05 47 SS00470316 SS00480316 Countersigned by 01/31/19 (where required by law) Authorized Representative Date Form SS 00 46 03 16 Page 1 of 1 Process Date: 01/31/19 Policy Expiration Date: 05/02/19 Auto Poticy Details 04 A— send to printer close window Policy No: CAA063233427 Current Term 02/16/2019 - 02/16/2020 Manage Your Policy Change Coverages Add/Replace Vehicle Remove Vehicles Change Loan/Lease Companies DRIVERS Name Date of Birth Driver Status Timothy Holmes Regular Driver Details Gender Marital Status Year First Licensed 1993 Accidents & Traffic Convictions Accidents 0 Total Traffic Convictions 0 Re ., gular Driver Details Gender Marital Status Year First Licensed 1997 Accidents & Traffic Convictions Accidents 0 Total Traffic Convictions 0 VEHICLES Vehicle No. Year Make 2 2009 Vehicle Details Identification Number Garage Zip Code Annual Miles 7,501 - 10,000 Special Equipment None Sound Equipment None 3 2018 Vehicle Details Identification Number Garage Zip Code Annual Miles 5,501 - 7,500 Special Equipment None Sound Equipment None Lien holder/Other Interests Name Type COVERAGE LIMITS Vehicle No. Year Make Premium 2 2009 $1,102 Coverage Details Coverages Limits of Liability Premium Liability Bodily Injury $1,000,000 Each Person $336 $1,000,000 Each Occurrence Property Damage $50,000 Each Occurrence $201 Physical Damage Comprehensive Deductible $500 $5.. 4 Collision Deductible $500 $242 Uninsured Motorist Uninsured & Underinsured Motorist(s) $1,000,000 Each Person $269 Bodily Injury $1,000,000 Each Occurrence Uninsured Deductible Waiver No Total Premium $1,102 3 2018 $1,364 Coverage Details Coverages Limits of Liability Premium Liability Bodily Injury $1,000,000 Each Person $332 $1,000,000 Each Occurrence Property Damage $50,000 Each Occurrence $198 Physical Damage Comprehensive Deductible $500 $86 Collision Deductible $500 $523 Uninsured Motorist Uninsured & Underinsured Motorist(s) $1,000,000 Each Person $225 Bodily Injury $1,000,000 Each Occurrence Uninsured Deductible Waiver No Total Premium $1,364 Total Premium $2,466 You received a Policy HolderSavings Dividend last year in the amount of: $140 .......... _._..... g .w.. DISCOUNTS Policy Discounts Multi-Policy. Other Discounts°� Driver Discounts Timothy Holmes Good Driver Good Driver Vehicle Discounts Vehicle 2: 2009 Verified Mileage Vehicle 3: 2018 Verified Mileage ENDORSEMENTS AND CERTIFICATES Number Title 2011 MEMBER'S AUTOMOBILE POLICY ' POLICY NUMBER CHANGE 2052 LOSS PAYABLE - NOTICE TOLIENHOLDER 2367 AMENDATORY ENDORSEMENT The information displayed on this website is for informational purposes only and is not intended to replace your policy(including any endorsements)and declarations that are mailed to you.Insurance is in effect only for the coverages and limits of liability shown on the declarations and as set forth in the insurance policy and endorsements. This information is a helpful summary only and is not a comprehensive definition of all coverages,qualifications,limitations,etc. Please consult the policy and one o,our insurance agents for more information. Also,the information displayed onthis welos/temay not reflect recent policy changes nrpayments and/or transactions vnyour account. Please allow untothree business days for your new/nmnnauontourreflected mthese records. The information displayed on this website Is for informational purposes only and is not intended to replace your policy(including any endorsements)and declarations that are mailed to you.Insurance is In effect only for the coverages and limits of liability shown on the declarations and as set forth in the insurance policy and endorsements. This information is a helpful summary only and is not a comprehensive definition of all coverages,qualifications, limitations,etc. Please consult the policy and one vfour insurance agents for more information. Also,the information displayed onthis website may not reflect recent policy changes orpayments and/or transactions vnyour account. Please allow uptothree business days for your new information u,uereflected/nthese records. The required payment must be postmarked, paid over the phone,paid online or paid in-person at one of our AAA office locations during normal business hours prior to the cancellation date/time or the policy will be cancelled for nonpayment of premium and all coverage will cease as of that time.If payment is not made or/smade for less than the required amount,the amount due must uepaid before the cancellation date/time toensure that the insurance coverage does not lapse. Whenever a premium payment is returned unpaid by your flinancial institution,we may,at our option,notify you in writing that the entire outstanding premium balance is immediately due and payable in cash or by cashier's check or money order at one of our AAA office locations.All returned payments,whether by check,electronic transaction,or other form of payment may be presented again electronically for payment.Each returned payment and each late payment is subject to a fee that may also be debited electronically. Fees are subject to change without notice. rayments-areaccrnteufrnm u.s.financial Institutions only. AmmmrnmumPavMCn.tc Automatic debits from your checking account for insurance policies will begin with the first automatic payment billed after the Authorization Agreement is received and processed. (Please allow 15 days for processing.)Until then,your insurance premium payment is still due on the date shown on your most recent billing statement.If you enroll in automatic payments for more than one insurance policy,the processing bank will determine the order of processing debits(i.e., the order urpayment)for each policy. Automatic payments are subject to all applicable finance charges,installment and other fees. We gave you notice of the amount of all applicable finance charges and/or fees at the time you applied for the insurance policy(s)above and upon renewals of your noncv(o).Installment payment plans and all fees are subject tochvnoew/moutoot/cc. Policyholders who have payments returned unpaid from their financial institution may have automatic payments authorization revoked as to all insurance policies ovthe Exchange.znthe event that this occurs,you will benotified uvmail and areturn payment fee and late fee may ueadded toyour bill(or toasecond attempted debit toyour accuunt).Ifautomatic payments are revoked, mst axmentsremaining for the current insurance policy period will uebilled unyour regular payment plan with statements mailed tvyou. � ifanerror/smade the Exchange can correct/tuvinitiating debits o,credits. You may revoke enrollment In automatic payments,as to any one or more insurance policies,at any time by signing and dating a written request and mailing it to: Awyzn*erinsuranceExchange vrthe Automobile Club, P.O. Box 25006,Santa Ana,CA 92799-5006.While not required,a revocation form is available for your use upon request uvcontacting uvat(ouu)yaw'o141uryour local office. Insurance is provided to qualified Auto Club members by the Interinsurance'Exchange of the Automobile Club("Exchange"). CA Dept n,Insurance uc. #u000zso CTR# 1016202-80 Copyright 2013 Automobile Club of Southern Califorrila.All Rights Reserved. The Automobile Club of Southern California is a member club affiliated with the American Automobile Association (AAA) national federation and serves members in the following California counties: Inyo,Imperial, Kern, Los Angeles, Mono,Orange,Riverside,San Bernardino,San Diego,San Luis Obispo, Santa Barbara,Tulare,and Ventura. Find a different AAA club. CITY OF EL SEGUNDO WORKERS' COMPENSATION DECLARATION WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SUBJECTS AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN LABOR CODE § 3706, INTEREST, AND ATTORNEY'S FEES. I affirm under penalty of perjury under the laws of California one of the following declarations: (_) I have and will maintain a certificate of consent of self-insure for workers'compensation, issued by the Director of Industrial Relations as provided for by Labor Code§3700 for the performance of the work set forth the agreement with the City of EI Segundo. Policy No. U I have and will maintain workers'compensation insurance as required by Labor Code§3700 for the performance of the work for which the agreement with the City of EI Segundo is executed. My workers' compensation insurance carrier and policy number are: Carrier Policy Number Expiration Date Name of Agent Phone# (.?L) I certify that, in the performance of the work set forth in the agreement with the City of EI Segundo, I will not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that, if I should become subject to the workers' compensation provisions of Labor Code § 3700 0 must immediately comply with those provisio I or the agreement will automatically become void. Signature of ApplicantPeM "" Date 02/26/2019 A At5� Agreement for: m 1 Dated: Reviewed by: 1