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PROOF OF INSURANCE (2019 - 2020) CLOSED�.-. '' I DATE (MMIDDIYYYY) �7...a%RL...�+' CERTIFICATE OF LIABILITY INSURANCE 06/25/2019 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 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 rights to the certificate holder in lieu of such V endorsement(s). CbriPRODUCER coN a m Pe4 P ... NAM Insurance Solutions PHONE (949) 3487400 � FAx IA(C, (1a, EIV (fat»,, Not: (949 ) 348-2373 License #0746539 E MA L. Ib(ahimP@ins-solullons.com ADDRESS,: 33302 Valle Rd, Suite 200 q INSURERIS) AFFORDING COVERAGE NAIC # San Juan Capistrano CA 92675 INSURERA: Hiscox Insurance Company Inc. 10200 INSURED INSURER B: Emergency Management Consulting Solutions Inc. q INSURER C: 21520 Yorba Linda Blvd. Ste. G560 q INSURER D: gp INSURER E : Yorba Linda CA 92887 INSURER F: COVERAGESREVISION NUMBER. CERTIFICATE NUMBER: 18-19 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NA11 MED 11 ABOVE FO11 R TH11 E 11 PO11 L 11 IC 11 Y PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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 ILLTR TYPE OF INSURANCE INSO WVID POLICY NUMBER (MM/LDDYIYVYYI (MM/LDD�YI I LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DA AGL 10 REN I EU CLAIMS -MADE rx-1 OCCUR I PREM SES (Ea occurrence) $ MED EXP (Any one person) $ A UDC -1487197 -CGL -18 08/28/2018 08/28/2019 PERSONAL B ADV INJURY $ GEN'LAGGREGATE LIMITAPPLIES PER: POLICY "PRO F-1LOCJECT OTHER' AUTOMOBILE LIABILITY ANYAUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY UMBRELLALIAB OCCUR EXCESS LIAB HCLAIMS-MADE DED I A RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNERIEXECUTIVE OFFICER/MEMBER EXCLUDED? NIA (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Errors and Omissions A UDC -1487197 -EO -18 08/28/2018 08/28/2019 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: Disaster Preparedness Consulting Services @ Witherbee Auditorium at The Los Angeles Zoo Certificate Holder is included as additional insured. GENERAL AGGREGATE 3,000,000 100,000 5,000 3,000,000 3,000,000 PRODUCTS -COMP/OPAGG $ 3,000,000 IEACH OCCURRENCE $ II AGGREGATE $ �Y PER I tl OTH- I STATUTE VER EL EACH ACCIDENT $ E L DISEASE- EA EMPLOYEE $ E DISEASE -POLICY LIMIT $ Limit: $1,000,000 Ded: $500 Aggregate: $1,000,000 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of EI Segundo Attn: Carol Lynn Urner ACCORDANCE WITH THE POLICY PROVISIONS. Senior Management Analyst AUTHORIZED REPRESENTATIVE 5333 Zoo Drive Los Angeles CA 90027ir ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD COMSINED SINGLE LIMIT $ ('Ea am ontV BODILY INJURY (Per person) $ BODILY INJURY (Per acadent) $ NPROPERTY DAMAGE $ (peer accident), IEACH OCCURRENCE $ II AGGREGATE $ �Y PER I tl OTH- I STATUTE VER EL EACH ACCIDENT $ E L DISEASE- EA EMPLOYEE $ E DISEASE -POLICY LIMIT $ Limit: $1,000,000 Ded: $500 Aggregate: $1,000,000 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of EI Segundo Attn: Carol Lynn Urner ACCORDANCE WITH THE POLICY PROVISIONS. Senior Management Analyst AUTHORIZED REPRESENTATIVE 5333 Zoo Drive Los Angeles CA 90027ir ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD Hiscox Insurance Company Inc. Policy Number: UDC -1487197 -CGL -18 Named Insured: Emergency Management Consulting Solutions Inc. Endorsement Number: 9 Endorsement Effective: August 28, 2018 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ' IN � • i +� � Iw � • + I 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. Proprietary Information 0 "` Not for Publication t - Interinsurance Exchange of the Automobile Club Automobile Insurance Policy Coverages and Limits Policy Change Declarations Insurance is in effect only for the vehicles, coverages, and limits of liability shown on this declarations page and as set forth in the insurance policy and endorsements. These declarations, together with the contract and the endorsements in effect, complete your policy. NAMED INSURED (It ern 1,) LL, JAMES I "LOVERD YORBA LINDA CA 92886-1948 SUBJECT OF POLICY CHANGE CANCEL VEHICLE AUTO -CORRECTION ANNUAL MILEAGE CHG VEHICLES VEH O, NYEAR MAKE O� MODEL IDENTIFICATION I AUTO POLICY NUMBER: CAA 087664017 POLICY PERIOD (PACVFIC STANDARD TIME) POLICY EFFECTIVE DATE: 01-25-19 12:01 A.M. POLICY EXPIRATION DATE: 01-25-20 12:01 A.M. POLICY CHANGE EFFECTIVE DATE: 04-02-19 12:01 A.M. THIS IS NOT A BILL This policy change will decrease your premium by $398.00. VEHICLE GARAGE ANNUAL VERIFIED COVERAGES AND LIMITS Coverage Is not in effect unless a premium or the word "included" is shown. COVERAGES LIMITS OF LIABILITY Liability Bodily Injury $500,000 each person/ $1,000,000 each occurrence Property Damage $1,000,000 each occurrence Medical ANNUAL PREMIUMS Vehicle 7 Vehicle 8 Vehicle 9 _ Vehicle 10 Vehicle i No Coverage No Coverage No Coverage No Coverage Physical Damagre en value unlet,$ olkoorMse ked, less deductible) on Vehicle 8 Vehicle Comprehensive ACV (Less Deductible) $500 Collision ACV (Less Deductible) $500 Car Rental Expense Per ay) No Mot gist overage No Coverage No Coverage No CoverageNo Coverage:: �3i^ No Coverage g . No Coverage No Coverage ( Bodily Injury - $500,000 each person/ $1,000,000 each accident Uninsured & Underinsured Vehicles Uninsured Deductible Waiver Include Uninsured Collision No Coves Total Premium PREMIUM DISCOUNTS Please refer to the enclosed document entitled "Premium Discounts Applied to Your Automobile Policy." * If at any time you choose to pay less' than the full balance outstanding, finance charges of up to 1.5'% per month of the balance outstanding will apply as explained in your billing statements, which are part of these declarations. Adjusted Total Annual Premium* (includes all applicable discounts) Less Policyholder Savings Dividend (Previously applied to your premium balance) Adjusted Net Annual Premium* nd (Balance after previous divide EE22007010A7 PROCESS DATE 04-03-19 PLEASE ATTACH TO YOUR POLICY (SEE REVERSE) AAMI0 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: U 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. iJ 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 # (JL/) 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 1 must immediately comply with those provisions or the agreement will automatically become void. Signature of Appli '_ � Date r i// -5—l" G 61 Agreement for. Dated: v8 • I -� -I cv ,_. Reviewed by:``�