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PROOF OF INSURANCE (2021 - 2021) CLOSED� 1 C""'' CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) ' 02/16/2021 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 _NAME ., _m_ .............................. --_ _ � ......... Hiscox Inc. d/b/a/ Hiscox Insurance Agency in CA PHONE 888202 3007 FAX w�), NO_EXtL (... _> vrw� _ ---------- ...___.�...................... 520 Madison Avenue E-MAIL contact 32nd Floor ADORE & e° hiscox.com E. New York, NY 10022 INsuRERWAW:WWWWHiscox Insurance Company IncGE w... 10200 ....�.................. ..._.....................�.�.�.� m..........._..........._._............. INSURED INSURER B : Maryam Eskandari 281 East Colorado Blvd INsu aM_. ................... ................. "-........ _ 155 INSURER D Pasadena, CA 91102 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. - _-....._ .................TYPE OF INSURANCE W POLICY.�.....--------............ ...,,,"...�._,._...�.........�..._...................-.-._ INSR ADDL. SUBR POLICY EFT' POLICY EXP LIMITS LTR NUMBER MMdODIYY"YY' (MMIDDIYYYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE s 1,000,000 _ 100,000 CLAIMS -MADE OCCUR PR pull . � �, ... arren�e ?%�., $ MED EXP (Any oneperson) A N UDC-4344593-CGL-20 12/03/2020 12/03/2021 PERSONAL& ADV INJURY $ 1,000,000 droEWL AGGR'EGA1"E LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY PRO- LOC X... .m.....� JECT PR DUCTS -......._ ....... .......................................... $ S/TGen.A _........ . OTHER:. $ AUTOMOBILE LIABILITY COMBINED SINGLE t"hMIT $ A$ ................... ANY AUTO BODILY INJURY (Per person)m OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS ............ .... ,,r,,,,,,,m HIRED NON -OWNED PROPERTRT Y DAMAGE $ AUTOS ONLY ,,. AUTOS ONLY ,. ... Ai ............ mm�m UMBRELLA LIAB OCCUR EACH OCCURRENCE -_"-"-"""""""". $ "" EXCESS LIAB CLAIMS -MADE AGGREGATE ._.�...... .............. .. $ ..$_. ..... DED R RETENTION $ .... WORKERS COMPENSATION STATUTE ORH AND EMPLOYERS' LIABILITY YIN _ ANYPROPRIETORIPARTNER/EXECUTIVE E.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED?"""""""'""-" ❑ N/A ........�.................. Mandatory in NH ( ) '. EwLwwDISEAS,E-EAE MPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below EL DISEASE- POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of El Segundo Gateway Project, Imperial Hwy Gateway Project CERTIFICATE (HOLDER CANCELLATION City of El Segundo I City Clerk's Office 350 Main St. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE El Segundo CA 90245 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE f i ll�a^ d u ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Evidence of Insurance GEICO, California Evidence of Liability Insurance Here are your Evidence of Liability Insurance Cards. geico.com 1-800-841-3000 Two cards have been provided for each vehicle GEICO GENERAL INSURANCE COMPANY insured. One card must be carried in the proper P.O. Box 509090 • San Diego, CA 2150-9090 insured vehicle. Proof of insurance is required to NAIC Code: 35882 register or renew the registration of your vehicle, A Policy Number Effective Date Expiration Date law enforcement officer can ask you to prove that 4538-52-12-89 10-08-20 04-08-21 you have liability insurance meeting the basic requirements of California law. Year Make Model Vehicle ID No. A violation of these requirements can result in a fine 2018 TOYOTA COROLLA of up to: Insured: $1,000 for the first time Maryam Eskandari $2,000 for additional times PO Box 155 Also, a judge can have your vehicle impounded. Pasadena CA 91102-0155 False proof of insurance may result in a fine up to $750 and 30 days in prison. Due to space I imitations on the ID card, only the pie I.,ovoiage Ipiovided by III[s IpoJ[cV III reN, the III nIln9UIII roquI emeri1;,� of sent1r,m 1(30156 ri 10500 s of lhre (,:aopnrnla Named Insured and the Co-insured are listed. For a vehIely,Cod o,niInIniumIlab� IIw11127<<t.G;prr;scirubedIby'I,e waw full list of drivers covered under this policy, please reference the Drivers section of your Declarations Page, which is included with your insurance packet. MARYAM ESKANDARI If you would like additional ID cards you can go online to geico.com or call us at 1-800-841-3000. PO BOX 155 PASADENA CA 91102-0155 GEIC0 California Evidence of Liability Insurance geico.com 1-800-841-3000 GEICO GENERAL INSURANCE COMPANY P.O. Box 509090 • San Diego, CA`9215IX-9090 NAIC Code: 35882 Policy Number Effective Date Expiration Date 4538-52-12-89 10-08-20 04-08-21 Year Make Model Vehicle ID No. 2018 TOYOTA COROLLA Insured: Maryam Eskandari PO Box 155 Pasadena CA 91102-0155 Ire coverrtge pairov[rdrpd by fI nc pollcy wcrel.; Chin iTrnnalI Wn rrnquh .mrn ernf[.=; or . sr:ficns 160156 & 135500 5 of "her Ca foIIII"I Vehicle. Code, uInirTdrrwrri Iislailrty^ Ief'niM presc['dbrod by flan law "0 DATE (MMIDD/YYYY) C6R "' CERTIFICATE OF LIABILITY INSURANCE 02/16/2021 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 endorsements . PRODUCER CONTACT' N �C',.,.... _ ........ m .................. Hiscox Inc. d/b/a/ Hiscox Insurance Agency in CAS Extl (888) 202 3007C No),. 32nd Floor 520 Madison Avenue E-MAIL Apl.ft ss contact hi ..... co ......... ..,_ --- ---- New York, NY 10022 . INSURERtSj AFFO DENG oo P AG m _wwmNAlc # INSURER A: Hiscox Insurance Company Inc 10200 INSURED Maryam Eskandari 281 East Colorado Blvd 155 Pasadena, CA 91102 INSURER E : rweoAn_e0 /1C0 r1CIf ATC KII IRRDCD• RFVIRInN NI IMRFR- 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 '$U k3 POLICY EFF POLICY XWY. TYPE OF INSURANCE POLICY LIMITS LTR� NUMBER MMIDD MMdD COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ l ........ CLAIMS -MADE II OCCUR .........� 6.......� PREMISE �G?-9,wprr nt' ,. ................... XP (Any one person) $ ..... GEN'L AGGREGATE LIMIT APPLIES PER: -mm ..AG, -.,„_EAT ... RAL GREG E $ .. POLICYPRO' LOC ,µGENE PRODUCTS; P AGG COMP/O„ $ mmmmmmmmm AUTOMOBILE LIABILITY....... MBINE'DtS SINGLE LIMIT $...... .. ANY AUTO BODILY INJURY (Per person) -.. $ .._.. OWNED SCHEDULED ......_.�,,,,,,...,., accident) ........................................ . $ _.... AUTOS ONLY _....,. AUTOS HIRED NON-O ....,.,.. .. _ 110 E' DAMAG ...... $ ONEDD AUTOS ONLY AUTOS�.. Per UMBRELLA LIAB OCCUR .......... EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE ____ ........,r....—...' ........ ....... AGGREGATE ...........�.. _ $ ................... DED RETENTION$ $ WORKERS COMPENSATION PER OTH- STATUTE ER AND EMPLOYERS' LIABILITY YIN W _. CCE $ nTNH/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? NIA w_. ...................Y..E MandaANYPR0oPRl (Mandatory ) E.L. D SEAS --DENT YO1�w E A EMPLO--E..., . ..._......._ If yes, describe under DESCRIPTION OF OPERATIONS below E.L.. DISEASE- POLICY LIMIT $ A Professional Liability N UDC-4344593-EO-20 12/03/2020 12/03/2021 Each Claim: $ 1,000,000 Aggregate: $ 1,000,000 DESCRIPTION OF OPERATIONS/ LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) City of El Segundo Gateway Project. Imperial Hwy Gateway Project I-r_0TICIr%A'r UMI INCO ('_e AIrI-I 1 ATICIN City of El Segundo I City Clerk's Office 350 Main St, SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE El Segundo CA 90245 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE / f U 1985-2015 AGOIRD GORPORATION. All rights reserves. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD /)F r I lAUUI! 4 9VN%h9C LVZ) 9 vr r,vavors—evv�-+,e,.+o , o--• a / a 7, r � ���RN ,artPY' F /i /I ' 51 /% /i/ /oir it/i p %�f% +I /� ii �/ , /% /%,,��i e ` gl affirmU�ert�enalt� of�per�ury':�under fhe lavaf California one of the foUowiny �iecfaratpn (�} I have and will maintain erI ficate- A consent of sekf insure for wrkers coinQ�n�zU�f ;cy� Iratlystna,l Relat6en's as provided fir try tabQ'r Code § 370C1 forth ,e�foarmance of kh vyork with the Ciiy of, I Segundo, y,/ ge011 I havetl Naill rna�htain Workers co�pensation insurance as recuita+�N ari of wPr C f¢r which the green ent With i the �i of El Se / �� Gy / 'd►1C]%}S`Of( 11rnikJBrs�fe /0 ilffefr / ,ME )��;/;, ��icjrtlP (J�1f1 itw�fdhq II Jl/o„„/,Wr,�rr/�//d`1���rk jG iiblr/�rlItlJ'rfN �jf 14 j�� r/ a �