PROOF OF INSURANCE (2020 - 2020) CLOSED$ � �Nb DATE (MM/DD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE 08/14/2019
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 endorsement(s).
PRODUCER CONTACT John Hunt
NAME.
Supreme Choice Insurance Solutions PHONEESR)„ (909) 587-4223 FAX,!No7g (888) 236-6993
WC, No,10700 Jersey Blvd ADDRESS monty@supreme-choice.com
INSURER(S) AFFORDING COVERAGE NAIC #
Rancho Cucamonga CA 91730-5130 INSURERA r United Specialty Ins Co 12537
INSURED INSURER e : Hiscox Insurance Company 10200
Edward Professional Advisors, LLC INSURER C
10700 Jersey Blvd Ste 160 INSURER D
INSURER E:
Rancho Cucamonga CA 91730-5127 INSURER 1:
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
INSR ADDL SUSR POLICY EFF POLICY EXPLIMITS
TYPE OF INSURANCE
LTR INSD WVD POLICY NUMBER d'MMFDD"YYY 0dMPDD'YYYY'Y
X COMMERCIAL GENERAL LIABILITY
I ACI I OCC Ll NEIVC:1. S 2,000,000
CJ t'ttal'Y'"°' 100,000
i'.Lb411VirliV!dJ:)L I iUG;CIJIi
F�HF,gJISE�°'if.r.'.ard�.,wrrs.l7rn,; 5
IVIED EXP (Any r-ru: 5 5,000
A X X CCP851622 08/14/2019 08/14/2020
PL-RSONAL sADV INJUln 5 2,000,000
(.',EN'LA(;G4�I:GAI L LIMIT PilPPLILS I'Eli
GLNI:RA1 S 2,000,000
PMraO
X i"y1.1' JEC
UCL`.5-((:71 h1'!C:!',(;Df S Included
AUTOMOBILE LIABILITY
COMBINED'Si N("'i° E J"MI7 S 2,000,000
,,ra a vdflnlp
AV`r AU 10
L30UII Y IBV•Il 112Y (I'er l'rtrison} $
OWNI" D 'aCHf C•IUI E:.� X X CCP851622 08/14/2019 08 14 2020
A
L?t71.)IL.Y IIV1I..IItY (I''t�r uatlu.r7t} M
„ r�LIT4')S C}NI Y tUv„I
RLD rlr,r•(,:n;r11I.,
ZX X,
K'rc�,lyER1��'raAdi�:'AGE s
1G)5ONI"r AtJ)jbI> Pl r
o,r't:rn�C::1r;r+cJ.
UMBRELLA LIAB Ou C:UR
E6C';,' QC Cl,:! R N:'. I,XE
EXCESS LAB CLAIIUIS IVIADL
AGGRlr.GATF ,
OLD RLTLNTICtNS
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
+”kIV'M'PR(!�f•#18::C(]RoF,'a.'tN^'f'JE,fC.UI'I E: ISI NIA
'QFF I C FRAAr,,' "f�.Rl"R CXtC`LULrLL}"
iMandatory in NHy
4 YU de$i;r44 orllcr
DESC;RIP1 OPliOF OP raTON'S b0ow
Professional Liability
B
MPL2334113.1 08/14/2019 08/14/2020
i I, f"Ai iAC'J;IIA i`01 $
I.. •,iI:,F' ASf A F rrfi 1� ,0,, EE. 5
hl.. IASEA'SIF f'x(.71 ICY 1 IrAi'iS
Aggregate $1,000,000
Per claim $1,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
10700 Jersey Blvd Ste 160, Rancho Cucamonga CA 91730
City of EI Segundo and its officers, employees, elected officials, volunteers, and members of boards and commissions named as additional insured.
CERTIFICATE HOLDER
City of EI Segundo
350 Main Street
EI Segundo
ACORD 25 (2016/03)
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
CA 90245 AUTHORIZED REPRESENTATIVE
Ninotshka Athena Diaz
@ 1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
WAIVER OF TRANSFER OF RIGHTS OF RECOVERY
AGAINST OTHERS TO US
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
SCHEDULE
Marne of Person or Organization
Any person or organization for whom you are required to waive your right of recovery on this Coverage Part under
va written contract or agreement.
The following is added to Paragraph 8. Transfer Of
Rights Of Recovery Against Others To Us of
Section IV - Conditions:
We waive any right of recovery we may have against
the person or organization shown in the Schedule
above because of payments we make for injury or
damage arising out of your ongoing operations or
"your work" done under a contract with that person
or organization and included in the "products -
completed operations hazard". This waiver applies
only to the person or organization shown in the
Schedule above.
CG 24 04 05 09 C Insurance Services Office, Inc., 2008 Page 1 of 1
DATE (MMIDDNYM
CERTIFICATE OF LIABILITY INSURANCE 06/11/2019
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 poficy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If
SUBROGATION IS WAIVED, subjecttothe 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 tiCONTACr
NAMr�
AP INTEGO INS GROUP LLC PHONEFAX
375 WOODCLIFF DR FL 1 STE 102 I&'C' 1/6'r E Xl1: 060y 890-9965 IAC. Nol- (6111) 7335112
FAIRPORT, NY 14450 ra,MARL
INSURER(S) AFFORDING COVERAGE II NAIC #
ASURER A: TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA
INSURED I,INSURER B:
EDWARD PROFESSIONAL ADVISORS 114SURER C:
10700 JERSEY BLVD I I
RANCHO CUCAMONGA, CA 91730 INSURER 0
INSURER E
INSURCR 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 I
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.
INSTR AD
SUBR
LTR TYPE OF INSURANCE POLICY EFF POLICY EXP
INSD WVD POLICY NUMBER (MMIDDfYYYY) I (MM(DDfYYYY) LIMITS
FA�> dCGURRENCE
COMMERCIAL GENERAL LIABILITY
CLAIMSMADE = OCCUR 6A7%4ACIF qi ED
�PREM—S..
ES fEa ocuurry 'Tr)
MED EXa �Any ar"u pulsvl�
PERSONAL & A0VI0CTW—f
W- 77ATLVM=T�ZLIMIT APPLIES PER.
POLICY
ER: LOC
[:)
OTH
±UTOANY AUMOBILETO LIABILITY
dEaC"v
C , Ly 5.4OMEINED
%
... ..... . . . .....
iUhdr
3JenV
OWNED SCHEDULED
AUTOS ONLY AUTOS PROP;:Rl'e UAIO;GE
HIRED NON-OWNED �Pw =gdO
AUTOS ONLY AUTOS ONLY
UMBRELLA LIAB OCCUR
EXCESS LIAS CLAIMS-MADE EACH OCCURRENCE
AGGREGATE
$
. .......... ...
WORKERS COMPENSATION
ORPRTNERN/A
ANY PROPRIET/LIABILITYIEXECUTIVE YN UB-3N547603-19-42 03109/2019 03/09/2020 X SITEAAND EMPLOYERS'AIRT
UTE ER
. FFICEMMEMSER EXCLUDED? E L. EACH ACCIDENT $1,000,000
A (Mandatory in NH) I -''— .-
4 yes, describe under E L, DISEASE - EA EMPLOYEE �$11,000,000
`OFSCMPTION OF OPERATIONS below
E.L DISEASE-, $1'000.()00
DESCRIPTION OF OPERATIONS I LOCATIONS/ VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required)
CERTIFICATE HOLDER CANCELLATION
EDWARD PROFESSIONAL ADVISORS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
10700 JERSEY BLVD BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
RANCHO CUCAMONGA, CA 91730 ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
99&2015 ACORD, CiRPOAAVON. Bi91 r s' reserved,
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
AM WORKERS COMPENSATION
TRAVELERS J AND
ONE TOMER SQUARE EMPLOYERS LIABILITY POLICY
HARTFORD, CT 06183
ENDORSEMENT WC 99 03 76 ( A) - 001
POLICY NUMBER: (UB -3N547603-19-42)
WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS
ENDORSEMENT - CALIFORNIA
(BLANKET WAIVER)
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.
The additional premium for this endorsement shall be 2 .0 % of the California workers' compensation pre-
mium.
Schedule
Person or Organization
ANY PERSON OR ORGANIZATION FOR
WHICH THE INSURED HAS AGREED
BY WRITTEN CONTRACT EXECUTED
PRIOR TO LOSS TO FURNISH THIS
WAIVER.
Job Description
BUSINESS CONSULTANTS
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. Endorsement No.
Insured Premium
Insurance Company Countersigned by
DATE OF ISSUE: 03-09-19 ST ASSIGN: Page 1 of 1