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PROOF OF INSURANCE (2019 - 2020) CLOSED
CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDMYYYY) 07119120/9 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 this certificate does not confer rights to the certificate holder In Ileu of such endorsement(s). PRODUCER CONTACT JERRY tdtACIA3 No tD ws, ImaciasAnohasslains.net m� Agency AONB F X 0 1400 E (Cooley Dr. Ste. 202-A P' I He �,a+ f586)440�40' Y D Colton, CA 92324 �"� III c. NeI: (909 763.79a...._.� License #:OE74924 INSURE"IArPO1kDINI3mcoVERAGE NAIC0 ... ...... _JtlsuRERA: UnitedSteltW INSURED INSURER 8: Christpher Heppell "".R"' DBA: Precision Reef Systems INauRBRO: 7712 Goddard Ave. kilINSURER Los Angeles, CA 90045 FF - COVERAGES CERTIFICATE NUMBER: 00000000'-14732 REVISION NUMBER: 6 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEDABOVE FOR THE POLICY 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, LIMITS SHOWN EXCLUSIONSWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ......a.... INS TYPE OF INSURANCE 'map, SIUBR N�iSR ADDIV POLICYNUMBER I NDYEFF ir9ddYYE 1 LIMITS A GENERAL LIABILITY 5t; 0611112019I OCCURRENCE 06111/2020 EACH O oo coo $ 1 0,,,,,, —COMMERCIAL CLAIMS MADE X OCCUR ❑ MAQ TO RENT eat $ 1001000– MED EXP SArry one Peraoni $ 51000-1 , _-._ ............... PERSONAL&ADV INJURY $ 1 OQOsQQI) i 'L AGG'RE�GATIw LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY El VPT LOC PRODUCTS-OOMPIOPAQG $ 1,000,0 ---- w OTHER' $ AUTOMOBILE LIABILITY CO211:1 SINQLELIM'IT r,ia�I all ........................................................ � $ ...... ANY AUTO BODILY INJURY (Per person) $ OWNS m .. �7NLYLi'� 4JlEt1 BODILY INJURY (Per arAdenl) $,........- .. AUTOS HIRED NON -OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY 1Prr sclds y1f UMBRELLA LIAR OCCUR EACH OCCURRENCE ® EXCESS LIAB$ LM$- CLAIMADE AGGREGATE $ RETENTION $ DED WORKERS AND EMPLOYCOMPENSATIONRS'LI(LIT Y� . m^ ?ACCI� AOPRIETORIPARTNERIEXECUTIVE NY R EN _...m..._...._.-. OFFICERIMEMBER EXCLUDED? :NIA TI-dateryr In N14y I:.L DISEASE - FJR EMPLOYEE $ --._ .......................................... (1 yaa' (leSKra7o under DES6R'IPTION OF OPERATIONS below E,L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES IACORD 101, Addlllonal Remarks Schedule, may be aHaohed It more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OP THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE The Center for Early Education THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 563 N Alfred St. ACCORDANCE WITH THE POLICY PROVISIONS. West Hollywood, CA 90048 AUTr1n IR1SSdaNTAT -""� I (JMA) ©1988.2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD Printed 6y JMA on July 16, 2019 at 03:04PM a POLICY NUMBER. CL 1757885C COMM9RCI ALGLNERAL LIABILITY 0020100704 THIO ENDORSEMENT CHANOSS TH9 POUCY. PLEASE READ rr CAREFULLY. ; ADDITIONAL INSURED — N$r LESSEES OR CONTRACTOR --SCHEDULED PERSON OR ORGANIZATION a Thlo andorsernanl niodllies Inmuranoo proVidod udder the following, COMMERCIAL MiNERAL L.IA51UTY COVERAGE PM ,SCMEDULB wauria � Cif Acldl'tlnrtal Iheuretl F;erann(a) ...» » _...�. . Or or,", nt tiorIlals �araQei Gd aver�al raikona UUlrorra_r , q1rod ,Oaten oa Ni of or^doMgmqti...................................................... "oratlons of th" nsrnad In r0c1.............,..................,.................. The CIty of EI Segundo and its employees 350 Main Street El Segundo, CA 90246 wrarearrlrralon r trulrod In aavl this %iodvio, if n9t 0hown rr1?pvo,'Will 40 011own, In i"o I owonatlons,, A. Soctlon II — Who Is An Irimumd In urnnnded to S. With mspeoL to the Irtstrroraao affordatl to thou& InolUde as an additional ltta>.wrtd Cite peraon(s) or adds Tonal Insurecls, the following ad dltlonal excttt- orantzalion(s) shrlwwn tat the Schedule, but only 010110 applys wl?Ia resperzt to k sadly lu"rr'"bacl'tly Injury". IpMpnrt'y Thls ilrlsur°t,nco tdeoo not cppty to *bodily Injury" or drsrrrcdo" or i prwraor,al Caird odvor1lalrr0 Idory"property tlarroga"ocMrrin0,oflar. a,ruzed, In whole or In port, by: �. �'apr nate crr rsnllxaiorus; or-1, A!I wnrk; l,^arludtng rrreiertate, parte or eriul rnant 10114hecl in con noollon with sugh wo , 2. The aKtu or coWulons of those Acting all your on 0119 proaut (otlaor then, ser+wlw, rrralntonanao Iwellratft 0r rapeltta to-bo performed by or on behalf of l In the performance of your onooingrfitlone for the addlllonal Inour'edt(e, at the location of the the raddlrlrnni Irarnirad(a) at the Jo0rZn(ra) cdodlD. aravar'ed OrAradono has oon cor'npletadl or noted obovta. 2. That portion 0 Pyoor work* out of wwNch JhD k4ury or damage arlses has boors put to Iia lra» tmrartrad use by My Person or tr,Q, alWktn oth* or than anollter caontroaor or aubodrAraotor onogod In porforrnin2 oporetWo dor a prim al'pal as a nowt of the same prpdecat, r IGC: 20 4007 04 0 ISA Propertles, Ino,. 200 + Page 1 M 9 vi ENDORSEMENT O MVEIR OF qWUMATION - SLANKE1 IT I8 AGREED, FOR AN ADDITIONAL PRSMIUIa,*e OF $ n Gil , THAT THE TRANSFER OF RIGHTS OF RECOVERY AGAINST pTIAI�;RS T'Ci IJ'8 0 E +TION IV -� CI�R M6 RCIAL QSNEIRAI. UASIUTY CONDITIONS) 18 AMENDED AS, FOLLOWS! Wig WAIVE ANY RIGHT OF RIECOVIlAY WE MAY HAVE AGAINST ANY PERSON OR ORGANIZATION THAT QUA JFIE9 AS AN ADDITIONAL INSURED PURSUANT TO THIS TERMS OF ENDORSSM15NT NUMBER i 0EOAU0E OF PAYMENTS WO MAKE FOR BOOILYINJURY OR PROPERTY DAMAGE ARISING OUT IAFI�I� YI�IJIdWORK PERFORMED DURING THE POMQY PEF�ICI'D UNDER AN INSURED CONTRAS NTH THAT PERSON OR ORGANIZATION, PROVIDED T'HA'I' THE moma INJI.JIRY' OR PROPERTY 0AMA06 OCCURS BUaSSQUIMNT TC THE _ .___-_;EXEII"TId�N-�I�"I'"HE"I,IRSLiIR,1�IaD�ITIR�cC"I; I�I��IR�'Y�?kil"�-"FI1�II�I;°,I�1T'Ii�iAhlLkFA++r'�`f°N�IRI3D°DI�BDI~I� ._.. DURING THE; POLICY PERIOD UNDER AN INSUIREDCONT'IRACY WITH'THAT PERSON OR O RGM, [ZATION, PROVIDED THAT THE 001DILY I'N'4U RY CFS PIROPO RTY DAMAOE+I" 0CU RS SUSBECIIry FNT TO THE EXECUTION OF THE INSURED CONTRAOT. I M tl A�I.+I�'"I'HER TERMS A ?40I 0NI!� ITIO S IAF INIO PI.II YAEIIIAIN UNCHANGI'ED. Poky NumOrd CL 1767885C Christopher Happell DBA: Preolsion Cees 5ynterns 06/11/2019 �.. Dvmnlaralq mora al,a 1holizoo" eR w wu I 01009 WIMTCAF A R 077/24/24/22019019 Y) > CERTIFICATE OF LIABILITY INSURANCE ( DAT/ 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 p 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 endorsement(s). PRODUCER CONTACT Melissa Sanders Y, 9 g 9MAIL V FAX „`j, �7f7ff 28441 HWhnd a Rd Ste 03 Agency Inc H�`� meli O a sa Oder .......................................... ta(,tp�): F 4 s.isak@statefarm.com 310-541-6199 ') RAGE NAIC # Rolling Hills Estates, CA 90274 g INSURER(S) AFFORDING COVE INSURER A : State Farm Mutual Automobile Insurance Company 25178 INSURED INSURER 8: Christopehr Heppell I INSURER C: 7712 Goddard AveINSURER 0: Los Angeles, CA 90045 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. ILTR TYPE INS PML....... EFF ) LIMITS E OF INSURANCE ADD, IPOLICY/YYYYI I POLICY EXP O POLICY NUMBER I MMlDD/YYYYI COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR GE INIII'L AGGREGATE LIMIT APPLIES PER: p POLICY C PRO ❑ LOC )ECT ,AUTVOTHER' OMOBILE LIABILITY ANY AUTO A OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY UMBRELLA LIAB OCCUR EXCESS LIAB ( CLAIMS -MADE DED I I RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N / A (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below EACH OCCURRENCE$ ..$ ... ............................... MED EXP (Any one person) $ ..,..- ............... PERSONAL 8 ADV INJURY $ GENERAL AGGREGATE S PRODUCTS - COMP/OP AGG $ I$ _ 6129574-C14-75 03/14/2019 09/14/2019 ;Ettzlacia�,- COMBINED $ SINGLE LIMIT s BODILY INJURY (Per person) $ 1,000,000 BODILY INJURY (Per accident) $ 1,000,000 iiyR5Rr TTv D5 Mn $ 1,000,000 CCURRENCE $ AGGREGATE $ PER$ L STATUTE .ERH ....L.............1..O E EACH ACCIDENT $ E L. DISEASE - EA EMPLOYEE: $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION I � SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN The City of EI Segundo and its employees ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street EI Segundo, CA 90245 AUTHORIZED REPRE' Y @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 1001486 13284912 03-16-2016 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: (_y I have and will maintain a certificate of consent of self4nsure 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 El Segundo. Policy No. (_j 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 # certify that, in the performance of the work set forth in the agreement with the City of El 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, Oovislon� or the pernelt yw 11 automatically become void. Signature of Applicant °-'"' ( Date Print Name4.;,°w�t Agreement for: t' Dated: Reviewed by: