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PROOF OF INSURANCE (2020) CLOSEDARISINC-02 D LETOURNEAU A �oRL7► CERTIFICATE OF LIABILITY INSURANCE [ (MMIDDIYY DATE 8/2112019rr) ............................... 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). �._......................... Cp TACT' Denise Let'Ottrneau PRODUCER N E. WyomingFinancial Insurance PHONE FAX 400E 1st St, Ste 105 (A./NCp�, No, E'xq) (307) 233-8301 (A/C, i Casper, WY 82601 AtYDR'sS: dletoUr'neatt@Werc.erafrt WSURERI';'il) /h,ll'FORDYNG COVEo U51i!!1:!', NAIC # NSURER A : Adr nt iiY°M 111irmull 1. u' u r r, 'ru tl "", H: �. i 'm' !' u' � ryl 24886 INSURED Arista Tek, Inc. 710 Garfield Street, #220 Laramie, WY 82070 INSURER B INSURER C : INSURER D: 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 iNSR ADDL SUBR' POLICY EFF POLICY EXP' TYPE OF INSURANCE POLICY NUMBER LIMITS IA X COMMERCIAL GENERAL LIABILITY INSO nMMVD t�dlz�Mxxext._.t/Ia��+ EACH OCCURRENCE $ 1,000,000 CLAIMS MADE X OCCUR GENT AGGRFCA I1- LIMI"I' Ar''PI IF S P& -H' POLICY 'Pt IOC OTHER ................ A AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS AC1OS ONLY NaC�t A X UMBRELLA LIAB X OCCUR EXCESS LIAB CLAIMS -MADE FEIECC1648506 FEIECC1648506 FEIEXS2310103 DED RETENTION $ ..._..._.._.._............. ........ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE f RICER/MEMBER EXCLUDED? N / A andatory in NH) H as, describe under DCSCRIPTION OF OPERATIONS below A Professional Liab FEIECC1648506 A Professional Liab FEIECC1648506 7/13/2019 7/13/2020 1 DAMAGE TO RENTED PREMIS_ES_(Ea_accureence) $ MED FXP (Argy oneperson) $ PERSONAL &ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP/OPAGG $ COMBINED SINGLE LIMIT IE'a acOdeno N 113/ "('..N 19 1'"11IN Nll20 I cil iv,, II' I II II 1:1,:!i Fa on) Pil HOD`p' II"Ll I II cli, (I lei al PROPERTY DAMAGE (Per' acmdant) I $ EACH OCCURRENCE $ 7/13/2019 7/13/2020 AGGREGATE $ PER OTH- STATUT'E ER E L EACH ACCIDENT $ E L DISEASE - EA EMPLOYEE $ E I. DISEASE, • POLICY LIMIT S 7/13/2019 7/13/2020 Claim Expense Limit 7/13/2019 7/13/2020 Claim Expense Aggr 50,000 5,000 1,000,000 2,000„0001 2,000,000 1,000,000 1,0'00„000 2„000,000 1,000,000! 2,000„000 DESCRIPTION OF OPERATkONS i LOCATIONS t VEHICLES (ACORD 101„ Additional Remarks Schedule, may be attached' If more space is requiredp� When required by written contract or agreement additional insured applies under the General Liability per forms ECC -319-0712, Primary & Non contributory additional Insured per Porro E'CC-548-0317. Thirty (30) days no'ti'ce of cancellation applies. Ten (1'0) days for non payment of premium. Forms attached. CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Ci of EI Segundo Fire Department THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City g P ACCORDANCE WITH THE POLICY PROVISIONS. 314 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 AristaTek, Inc.; Albany County Research Corp. Endorsement Number: 15 ikDP6iP1°dPlr,92'�rYr w" Automatic Primary and Non -Contributory Insurance Endorsement Designated Work Or Project(s) This endorsement, effective 7/13/2019 attaches to and forms a part of Policy Number PEI -ECC -16485-06. This endorsement changes the Policy. Please read it carefully. This endorsement modifies insurance provided under the Coverage Part(s) indicated below: COMMERCIAL GENERAL LIABILITY COVERAGE SCHEDULE Name of Person or Organization: Any person(s) or organization(s) whom the Named Insured agrees, in a written contract, to provide Primary and/or Non-contributory status of this insurance. However, this status exists only for the project specified in that contract. In consideration of an additional premium of i Lliti Zd and notwithstanding anything contained in this policy to the contrary, it is hereby agreed that this policy shall be considered primary to any similar insurance held by third parties in respect to work performed by you under any written contractual agreement with such third party. It is further agreed that any other insurance which the person(s) or organization(s) named in the schedule may have is excess and non- contributory to this insurance. ECC -548-0317 AristaTek, Inc.; Albany County Research Corp. Endorsement Number: 6 Automatic Additional Insured — Owners, Lessees or Contractors This endorsement, effective 7/13/2019 attaches to and forms a part of Policy Number FEI-ECC-16485-06. This endorsement changes the Policy. Please read it carefully. In consideration of an additional premium of $Applied, this endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: Any person(s) or organization(s) whom the Nained Insured agrees, in a written contract, to name as an additional insured. However, this status exists only for the project specified in that contract. The person or organization shown in this Schedule is included as an insured, but only with respect to that person's or organization's vicarious liability arising out of your ongoing operations performed for that insured. ECC -319-0712 Worker's CoomDe nsatlmnaod Emmo|oye,r'sUabU|tYPohic.-Y GerkshireHathanwayOirectInsuranceCmnnpeny-/\Stmck Co. Policy Number yd9VVCQO17G9 Renewal ofN9VVC9G0374 NCCI No. [21754] Policy Information Page [1]Named Insured and Mailing Address xnstaTekInc 710 EGurfic|d St Ste 220 Laramie' WY 82070 Federal Employer's ID 82'0325339 Insured is Corporation � Business Description Software Development Locations on Policy See Extension of{n[bnnahon Page �|i �r� [2] Policy Period From September 14, 2019 to September 14, 2020, 12:01 AM, standard time at the insured's mailing | __address. [D] Coverage / A. Workers' Compensation Insurance Part One of this policy applies to the Workers' Compensation Law of the following states: California, Oregon, Utah B. Employer's Liability Insurance Part Two of this policy applies to work in each of the states listed in item [3]A. The limits ofour liability under Part Two are: Dodi|yInjurybyAccident-eachaccident $1,000,000 Bodily Injury byDisease each employee $1,000,000 Bodily Injury byDisease policy limit $1,000,000 C. Other States Insurance Part Three of this policy applies to all states, except any state listed in item [3]A. and the states of North Dakota, Ohio, Washington, and Wyoming. D. This policy includes these endorsements and schedules: See Extension of Information Page Schedule of Forms WC 040004 Premium [4] r�mm um The Prcrniurn Dosis and, therefore, the premium will be dcu,nnincd by our Monuo| of Ku|ca, Classifications, Rotes, and Rating Plans. All required information Js subject to verification and change by WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 00 03 (Ed. 7-98) EXTENSION OF INFORMATION PAGE Schedule of Locations ITEM 1 POLICY NO. N9WC001759 (1-2) 12717 Mitchel Ave #2 C. Scott Bunning, Los Angeles, CA 90066 (09/14/2019 - 09/14/2020) (1-3) 9425 Avanyu Dr Thayne Routh, Cedar Hills, UT 84062 (09/14/2019 - 09/14/2020) (1-4) 8540 SW Ash Meadows #1 Reneee Soriano, Wilsonville, OR 97070 (09/14/2019 - 09/14/2020) Page -2 - Includes copyright material of the National Council on Compensation Insurance, Inc. used with its permission ©1998 by the Workers' Compensation Insurance Rating Bureau of California. All rights reserved.