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PROOF OF INSURANCE (2020 - 2020) CLOSED
ACC>RO CERTIFICATE OF LIABILITY INSURANCE DATE(MMrDD,YYYY) k "„ 03/06/2020 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 Certif'ic'ate holder in lieu of such ondorsoment(s), PRODUCER CONTACT .. CRISTIAN AMAANAW1° ... ,......_"f8 PHONE (424)477-5887 .......... FA% _erc.t4a.hXt,(i24....).. 2.....1 7.A988 CRISTIAN AMAYA STATE FARM EWAIL cris aeris.lem 882 "EST 9TH STREET tfir .. Far�Can 2514 INSURE � - -m Fire and CasuaHy orn 3 INSURED SAN PEDRO CA 90731 ,...,..�......^iINSURERA NsuRER E : State FarmMutu I Automobile Insu ance Company 25178 D & G ELITE AUTO DETAILING INSURER C : __ _ _...... ,.... GERMAN DELGADO wsURERD: 1111 WEST F STREET INSURER E WILMINGTON CA 907'44 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 15 SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Lin .........-�4tB'd � SUB'k - .. ...._ Pi -LACY Elm .. P0LJC" Y EXP — - ......,. —_ ..,..... r�i'n TYPE SOF INSURANCE POLICY NUMBERtiumprilvap tmmmDdVW'YYM l LIMITS ....I �7 CLAIMS -MADE ®OCCUR .&Vkrl,F,.,TO.,i'Icr41E.I S 1,000,000 COMMERCIALGENERAL LIABILITY 4CFdOCCURRENCE Wa occurrence 4._ 300,000.. . MED ---XP (Any raj! pie+!!eo $ 10,000 A 92 -EF -K461-6 11/20/2019 11/20/2020 PERSONAL& ADV !NJURY S 10,300 T �. REGATE LIMIT PER: t�R(T ❑ 2� 000,000 POLICY 4. ... ....,.,1 J'ECT LOC �tJrAGGREGATEAO,I°� 5..... 000,000 .I' OThIER, 5'.... EDOCT I COIA1 00 AUTOMOBILE ABILITY _ COIJUINED SRY AU - O B OWNED SCHEDULED 525 9338-A02-75 AUTOS ONLY AUT OS 01!02!2020 07/02/2020. 0DII,LYINJJIUI Y (P person).......E.........00000 BODILY INJURY (Per accident) 5 300 0 ,_._. HIRED NPN -OWNED AUTOS ONLY ° AUTOS ONLY, I�.g ASFtrTNT'c�R V... fJfdWflr `;E. 100.000 C&� Eq Or,G'dcn9'P I $ �..._ UMBWRW. E OCrC°U�R.r LLA LNI�AB1'a'NTI�OI�'d 1EWN.CF LP _EXCESS LIAJr �._._ ° �...°......_......- GGR�ATC ... ...,�S. .I...... 5A !EO WORKERS COMPENSATION 0FR1'd- ANDEMPLOYERS'LJA91lITY YrN 1 I . . .I k.. .......... �EL �$ ANY rErec�oFCUrIVEAPd1Pazuo �FY I NIA 92-GAH128-8 r EA011 1.000,000 08177/2019 08/1712020 ACIDEN' '(MandatMInNil) ELLDISEASE- EAEMPLOYEdS 1,000,000 If woo. desc nbo undee _. DESCRIPT'ION OF 0PrRAI' ONS bel'bw E.t.. DISEASE • PO'LICY'UMIT ( S 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS i VEHICLES (ACORD 101, Additional Remarks Schedule, n my be attached It more space is requircdl CERTIFICATE HOLDER CANCELLATION I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. CITY OF EL SEGUNDO AUTHORIZED REPRESENTATIVE 350 MAIN ST I ELSEGUNDO CA 902453813 ©1988-20A ACORDD)CORPb"TI'ON. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD 1001486 132649.12 03.16-2016 CC Policy No. 92—EF—K461-6 0984—FA34 CMP -4786.1 Page 1 of 2 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, CMP -4786.1 ADDITIONAL INSURED — OWNERS, LESSEES, OR CONTRACTORS (Scheduled) This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE Policy Number: 92—EF—K461-6 Named Insured: DELGADO, GERMAN DBA D & G ELITE AUTO DETAILING 1111 W F ST WILMINGTON CA 90744-5006 Name And Address Of Additional Insured Person Or Organization: CITY OF EL SEGUNDO ITS OFFICERS OFFICIALS E EMPLOYEES AGENTS & VOLUNTEERS 350 MAIN ST EL SEGUNDO CA 90245-3895 1. SECTION II — WHO IS AN INSURED of SECTION II — LIABILITY is amended to in- clude, as an additional insured, any person or organization shown in the Schedule, but only with respect to liability for „bodily injury", ""property damage", or "personal and advertis- ing injury" caused, in whole or in part„ by: a. Ongoing Operations (1) Your acts or omissions; or (2) The acts or omissions of those acting on your behalf; in the performance of your ongoing opera- tions for that additional insured; or b. Products – Completed Operations "Your work" performed for that additional insured and included in the "products - completed operations hazard". However, Paragraph 1. above is subject to the following: a. The insurance afforded to the additional insured only applies to the extent permit- ted by law; b. If coverage provided to the additional in- sured is required by a contract or agree- ment, the insurance provided to the additional insured will not be broader than that which you are required by the contract or agreement to provide for such addition- al insured; and c. If the contract or agreement between you and the additional insured is governed by California Civil Code Section 2782 or 2782.05, the insurance provided to the additional insured is the lesser of that which: (1) Is allowed for the satisfaction of a de- fense or indemnity obligation by Cali- fornia Civil Code Section 2782 or 2782.05 for your sole liability; or (2) You are required by contract or agreement to provide for such addi- tional insured. We have no duty to defend or indemnify the additional insured under this endorsement un- til a claim or "suit" is tendered to us. ©, Copyright, State Farm Mutual Automobile Insurance Company, 2013 Includes copyrighted material of insurance Services Office, Inc., with its permission. CONTINUED 2. Any insurance provided to the additional in- sured shall only apply with respect to a claim made or a "suit" brought for damages for which you are provided coverage. 3. With respect to the insurance afforded to the additional insured, the following is added to SECTION II — LIMITS OF INSURANCE: If coverage provided to the additional insured is required by contract or agreement, the most we will pay on behalf of the additional insured will be the lesser of the amount of insurance: a. Required by the contract or agreement; or b. Available under the applicable Limits Of Insurance shown in the Declarations. This endorsement shall not increase the ap- plicable Limits Of Insurance shown in the Declarations. 4. With respect to the insurance afforded to the additional insured, the following is added to Paragraph 3. Duties In The Event Of Occur- rence, Offense, Claim Or Suit of SECTION II — GENERAL CONDITIONS: The additional insured must: a. See to it that we are notified as soon as practicable of an "occurrence" or an Of- fense which may result in a claim. To the extent possible, notice should include: (1) How" when and where the "occur- rence" or offense took place; CMP -4786.1 Page 2 of 2 (3) The nature and location of any injury or damage arising out of the "occur- rence" or offense; b. Tender the defense and indemnity of any claim or "suit" to us and to all other insur- ers who may have insurance potentially available to the additional insured; and c. Agree to make available any other insur- ance the additional insured has for de- fense or damages for which we would provide coverage under SECTION II — LIABILITY. 5. With respect to the insurance afforded the ad- ditional insured, the following replaces SEC- TION II —LIABILITY of Paragraph 7. Other Insurance of SECTION I AND SECTION II — COMMON POLICY CONDITIONS: a. This insurance is primary to and will not seek contribution from any other insurance available to the additional insured, provided that the additional insured is a named in- sured under such other insurance. b. Regardless of any agreement between you and the additional Insured, this insur- ance is excess over any other insurance whether primary, excess, contingent or on any other basis for which the additional in- sured has been added as an additional in- sured on other policies. There will be no refund of premium in the event this endorsement is cancelled. (2) The names and addresses of any in- jured persons and witnesses; and All other policy provisions apply. CMP -4786.1 1007033 148011 08-21-2014 ©, Copyright, State Farm Mutual Automobile Insurance Company, 2013 Includes copyrighted material of Insurance Services Office, Inc., with its permission. WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 4-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA 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. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be otherwise due on such remuneration. CITY OF EL SEGUNDO 350 MAIN ST EL SEGUNDO CA 90245 5 % of the California workers' compensation premium Schedule -W■ 'I, WASHES AND DETAILS VEHICLES 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 08/17/19 Policy No. 92 GAH12 e a Endorsement No. Insured DELGADO, GERMAN Insurance Company State Farm Fire and Casualty Company DBA D & G ELITE AUTO DETAILING Countersigned By WC 04 03 06 (Ed. 4-84) 1007722 124282.2 01-25-2019