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PROOF OF INSURANCE (2021) CLOSEDOP ID: MN DATE (MM/DD IYYYY) `� CERTIIICATE 01= LIABILITY INSURANCE 06/05/2020 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 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). 355 Via Vera Cru PHONACT Michelle760-471-71'16 ell IIA _._...� PRODUCER �7anceSery �W_P_NAIEA PHONE Nr�):760-471-9378 "Alliance Mgt. & Insurance FAX PRRO0,U limn MESS@I-1 ............. m San arcus, CA 92078 ADDRESS; CA AgenVBroker Llc 0737966 Michelle A. Nowell S.T?hNP on #: !N§YRIER(S) AFFORDING COVERAGE INSURED Associate INSURER A Acceptance Casualty Ins Comp 1 034 814 Fobe e IC# Inc INSURER 8: Brea Forbes 92821m . INSURER D : . .... ........ .... ..� INS URER E INSURER .... Fa .., 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 LTR: GE... TYPE OF INSURANCE a,Lli)L suBY " POLICY NUMBER �(M IIDDNYYVI IMM DDIYYYYI EACH LIMITS NERAL LIABILITYIAI$� P OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY X CP00961045 06/01/2020 06/01/2021 PRkW$ $A a, ��u,q%q) $100,000 5,0..... —_...-- CLAIMS -MADE �X ( 00 ED EXP (Any one person) $ OCCUR M .............--- Errors &Omission PERSONAL $ADV INJURY $ 1,000,000 DESCRIPTION OF OPERATIO S P L CATIONS I VEHICLES (Attach ACORD 901, AddlUonal Remarks Schedule, If more space is required) Citxof EI ae tar7do i� otficeys,,v,, lunteers,em�io�e,es4nd re�a � enttantfev ss are na ed as a Itfonal Weare With respect to o e orme �I insured. Investigation, CA -- canderson@elsegundo.org 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 ACCORDANCE WITH THE POLICY PROVISIONS. hristopher Donovan 314 Main Street AUTHORIZED REPRESENTATIVE EI Segundo, CA ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD GENERAL AGGREGATE $ 5,000,000 S PEM : LIMIT APPLIES PRODUCTS - COMP/OP „AGG $ 1,000,00 Pr 0 I $ POLICYE'AGGREGATE O AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY (Per person) $ ........... ALL OWNED AUTOS BODILY INJURY (Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE HIRED AUTOS (PER ACCIDENT) $ NON -OWNED AUTOS $ ............. UMBRELLA LI O CCUR HOCCURRENCE -EACH.................. $ ........................,,.. YYfi EXCESS LIA 8 1 ....................................... CLAIMS -MADE R AGGEEG TE DEDUCTIBLE RETENTION $ $ COMPENSATION ry WCSTATU- I' 107, - AND EMPLOYERS' LITY Y I�N -- 7.DR?.' UMIT3- a...............1,,,,.�,RANY .......... ECUTIVE IDENT $ FFIICER/ME M R/EXCLIUER/D N / A (Mandatory ) E L. D SEASECEA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E L DISEASE POLICY LIMIT $ DESCRIPTION OF OPERATIO S P L CATIONS I VEHICLES (Attach ACORD 901, AddlUonal Remarks Schedule, If more space is required) Citxof EI ae tar7do i� otficeys,,v,, lunteers,em�io�e,es4nd re�a � enttantfev ss are na ed as a Itfonal Weare With respect to o e orme �I insured. Investigation, CA -- canderson@elsegundo.org 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 ACCORDANCE WITH THE POLICY PROVISIONS. hristopher Donovan 314 Main Street AUTHORIZED REPRESENTATIVE EI Segundo, CA ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: CP00961045 COMMERCIAL GENERAL LIABILITY CG 20 26 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following; COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Automatic Status Included Where Required by Written Contract. All Where Required by Written Contract. "It is agreed, as respects the Policy, thirty (30) days notice of cancellation, except as respects non- payment of premium, for which ten (10) days notice will apply, or other regulatory requirements that may apply, will be given as respects the indicated certificate holder." Information required to complete this Schedule, if not shown above„ will be shown in the Declarations. Section II — Who Is An Insured is amended to in- clude as an additional insured the person(s) or organ- ization(s) shown in the Schedule, but only with re- spect to liability 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: A. In the performance of your ongoing operations; or B. In connection with your premises owned by or rented to you. CG 20 26 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 0 Get your digital proof of insurance & membership card on the AAA App X>Download the app. Click AAA.com/app75 ��o wil, N�11 11",woi 111;',�Ilwulbl � ................ ... . ..... I -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - --- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - PROOF OF- - - - - INSURANCE VEHICLES ON POLICY----------.,.--- OLICY- - - - - - - - - - - .0� YEAR MAKE Interinsurance Exchange of the Automobile Club VEH LD # NAIC #: 15598 2012 KIA SOUL SW/!/SPORT KNDJT2A65C7474113 2009 JEEP WRANGLER UNLIMITED 1J4GA39159L745955 Named Insured Policy Number: CAA065044011 2016 CHEV SLVRDO 1500 CR NEW 3GCUKSEC3GG285230 MICHAEL AND CAROLYNA MESSINA 2017 HYUN ELANTRA SE KMHD84LFOHU299328 Lu o DRIVERS ON POLICY 0 MESSINA, MICHAEL LL Effective Date: 03/25/2020 Expiration Date: 03/25/2021 1 MESSINA, VINCENT 10 n MESSINA, CHRISTOPHER This policy provides at least the minimum amounts of liability insurance MESSINA, CAROLYNA required by the CA VEH CODE SECTION 16056 for the specified vehicles and named insureds. Coverage subject to policy terms and limits --------------------------------------------------------- I ------------------------------------------------------------- k1l:YOU I 1AVi..:..: AN ACOMEN I" CAi.J1 OWIR 24,17 AAAACC1M:..:..:N ASSIST" 1101 1 1 IN 1 8001-672-5246 After an accident, exchange information with the other party and follow these 5 easy steps: Step 1: Pull vehicle over to a safe place. Get the names, addresses, Step 4: Take photos of the vehicles involved, damages and and phone numbers of all persons involved in the accident, e g., surrounding area of the accident, if it is safe to do so pedestrians, witnesses, other passengers, etc uJ Step 5: Call our AAA Accident Assist Hotline at 800-672-5246 to Step 2: Take photos of or write down the other person's driver's -J report the loss. If necessary, we will arrange to have your vehicle towed. 0 license information and other vehicle's license plate number, LL Our provider's tow trucks always display the AAA emblem. including state of registration. Do not admit responsibility for or discuss the circumstances of the accident Step 3: Take photos of or write down the other person's insurance with anyone other than the police or an authorized Auto Club claims card information. representative Do not disclose your policy limits to anyone 1111 For questions or changes to your policy, call 1-877-422-2100, Monday through Friday from 7 a m to 9 p.m. or Saturday from 8 a m to 5 p.m L_-__.._........_,__.....____.._.--- - ----------------------------------------------------------------------------------------- Place a Proof of Insurance card in each vehicle insured under your policy. In addition, we suggest that each listed driver carry a card. Under California law, Call our AAA Accident A Ssist drivers and owners of a motor vehicle must be able to show proof of financial Hotline at 1-800-672-5246 responsibility at all times. These cards become invalid and should be destroyed on the expiration or termination date of the policy, ------------------------------------------------------------------------------------------------- --------------------- PROOF OF INSURANCE VEHICLES ON POLICY ti Interinsurance Exchange of the Automobile Club YEAR MAKE VEH I D. # NAIC #: 15598 2012 KIA SOUL SW/!/SPORT KNDJT2A65C7474113 2009 JEEP WRANGLER UNLIMITED IJ4GA39159L745955 Named Insured Policy Number: CAA065044011 2016 CHEV SLVRDO 1500 CR NEW 3GCUKSEC3GG285230 MICHAEL AND CAROLYNA MESSINA 2017 HYUN ELANTRA SE KMHD84LFOHU299328 Lu DRIVERS ON POLICY Po UO MESSINA, MICHAEL Effective Date: 03/25/2020 Expiration Date: 03/25/2021 1 MESSINA, VINCENT MESSINA, CHRISTOPHER This policy provides at least the minimum amounts of liability insurance MESSINA, CAROLYNA required by the CA VEH CODE SECTION 16056 for the specified vehicles and named insureds Coverage subject to policy terms and limits -1 --- I ----------------------- - - - - - ..., ----------------------------------------------------------------------------------- IF YOU HAVE AN ACCIDENT CALL OUR 24/7 AAA ACCIDENT ASSIST HOTLINE 1-800-672-5246 After an accident, exchange information with the other party and follow these 5 easy steps: Step 1: Pull vehicle over to a safe place. Get the names, addresses, Step 4: Take photos of the vehicles involved, damages and and phone numbers of all persons involved in the accident, e g , ui surrounding area of the accident, if it is safe to do so Po pedestrians, witnesses, other passengers, etc. Lu Step 5: Call our AAA Accident Assist Hotline at 800-672-5246 to Step 2: Take photos of or write down the other person's driver's -i report the loss If necessary, we will arrange to have your vehicle towed. license information and other vehicle's license plate number, 0 LL Our provider's tow trucks always display the AAA emblem including state of registration. i Do not admit responsibility for or discuss the circumstances of the accident Step 3: Take photos of or write down the other person's insurance with anyone other than the police or an authorized Auto Club claims card information representative. Do not disclose your policy limits to anyone For questions or changes to your policy, call 1-877-422-2100, Monday Lw through Friday from 7 a m to 9 p m or Saturday from 8 a m to 5 p m -------------------------------------- MOM CAA E20150622 -------------------------------------------------------------- 8165(3/19) 061020 10 n CITY OF EL SEGUNDO WORKERS' COMPENSATION DECLARATION I affirm under penalty of perjury under the laws of California one of the following declarations: C_) 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 El Segundo. Policy No. (_) I have and will maintain workers' compensation insurance as required by Labor Code §, ,700 forthe performance of the work for which the agreement with the City of El Segundo is executed. My workers' C"ompensation insurance carrier and policy number are: I carri& Nam; of Agent Policy Number Expiration Date Phone # ()0 1 certify that, in the performance of the work set forth in the,, agreement with the City of El Segundo, I will not ern `pioy any person in any manner so as to become subject to4he 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, ent agreem thWoseprovi Eiolhp- will automatically become void. ,�rne .1 Signature of Applicantg0565�Date3 r, 7 Print Name FV.-\ ^r°.�-- I , Agreement for: r� C Dated: Revieweda'