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PROOF OF INSURANCE (2021 - 2021) CLOSED' DATE (MMIDDlYYYY) AC-GIR'" CERTIFICATE OF LIABILITY INSURANCE 12/0112020 THIS CERTIFICATE 1S ISSUE D 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 cortifleato holder is an ADDITIONAL INSURED, the poliey(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 M1ot confer rb hts tp the eertifica'te holder in lieu of such erldorsement(s). PRODUCER TNACRISTIANAMAYA 424 ._._ fAA� wCRISTIAN AMAYA STATE FARPJIcris@myagentcns com$( )477 5887 (424)217 492 WEST O STREET CA 90731StateFarm Firand u l Cns raneeCDm an 43AN PEDRO Casualty pony„ 25143� GERM Farm Mutual A u P Y INSURED yN,SU,RrRD, tote .... AN DELGADO DBA D & G ELITE AUTO RETAILING l IruREr1 e HARBOR CLEANING & DETAILING INSURER D �,, ... V'lILh111NGTONEST F STREET a eNa�aacRe ..._.... _ _....._. .... ....... .._..,.... CA 90744 r BELOWREVISION NUMBER� HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FORTHE CO VERAGES POLICIES REQUIREMENT TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT HEREIN S WITH E POL POLICY PERIOD CERTIFICATE NUMBER: ., ERTIFY THAT THE INDICA H I RESPECT 70 WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN„ THE INSURANCE AFFORDED BY THE POLICIES DESCRIBEDSUBJECT TO ALL THE TERMS, EXCLUSIONS AND C _ YY P4MwrD CLAIMS CONDITIONS OF SUCH POLICIES LIMIT HAVE BEEN R - _ iYr"E: o O suRAN•-....^—..W�..-- SHPOLICY OWN M to MDCI1. ,......ED 7Y CFE �PCM,V�R:'EX EACH S INSURANCE ADOL o' _ IIWTR '; COMMERCIAL GENERAL LIABILITY r LIMITS 1,000 DOB PF-fyrS r.�.op........� 300,000 X CLAIMS -MADE ®OCCUR 10 000 Iim I. AGGREGATE LIMIT APPLES PER (—� PRO- LOC POLICY l dECT ❑ ;. AUTOMOBILE LIABILITY ( ANY AUTO B O'AWED SCHEDULED J AUTOS ONL° j, ._ AUTOS _ HIRED 11 ' NON-OVMIED AUTOS ONLY a,,,,_,,,,,,,,, AUTOS ONLY UMBRELLA LIAR OCCUR EXCESS LIAB ; y;„,L,h.3M $ WORKERS COMPENSATION AND EMPLOYERS LIABILITY YIN ANvPRq TE,i 1,"r'^P.G.R'4pti ("Y"FfC;', I;i Y INIA A iOrr �w n*u (Ea"'41.W D' (Mandatory in NH) t! va c. damre„Y D under "y�FaN EXP zAur�one{rvareoaa�,@,., � T - 92-EF-K461-6 11120/2020 ' 1 V2012021 RSONAL & ACV INJURY $ 10,300 �— OE 6 i ry AC# REG TE t 2,000,000 . 0 Y 3Ef C ' 2,000,000 ED DUCTIBLE il�eE„ .,..�.PRODUCTS •�• 5 OD - —r Y......�..... rL ti �S,�xi Lmt r s 1,000 000 80b!LY INJURY (Per person) 8 525 9338-A02-75 07102/2020 ! U210212021 BODILY INJURY (Per accident) S _-� Ck7LE"'Gk(bf4atXv�xF S. $ `,.. EACH 4aC,C.l.r"";Rar „;E . _.._ S .......�,.,..__. ACar"I� d 1 1,000 000 92-GHS836-9 07117/2019 ; 07/17;2021 j EL DISEAS1.000ODD a —�74 .V,sar W Pr)I J r W I M I I a I r, 1,000,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD { D 101„ Additional Remarks. Schedule, maybe attached if more space is required) T CITY OF EL SEGUNDO 350 MAIN ST EL SEGUNDO ACORD 25 (2016103) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITW,THE POLICY PROVISIONS. AUTHORIZED CA 90245 ©1988-2015 ACORD CORPORATION,. All rights reserved. The ACORD name and logo are registered marks of ACORD 1001486 132849.12 03•tt)-2015 CMP- 6.1 TL PolicyNo. 92 EYK461 6 0904-FA34 Pop 1 of2 i��az 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 EFK4 61 6 Named Insured: DELGADO, GERMAN 1111 W F ST WILMINGTON CA 90744 5006 Name And Address Of Additional Insured Person Or Organization: CITY OF EL SEGUNDO ITS OFFICER OFFICIALS EMPLOYEES AGENTS 6 VOLUNTEERS 350 MAIN ST EL SEGUNDO CA 90245 3813 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 injur)r "property damage', or "personal and advertls- Ing Injury* caused, In whole or in part, by: a. Ongoing Operations (1) Your ads or omissions; or (2) The ads or omissions of those acting on your behalf, in the performance of your on oing opera- tions for that additional insure; 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 e)dent 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 a reement 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 caw fomia Civil Code Section 27 82 or 2782.05 for your sole liability; or (2) You are required by contract or agreement to provide for such addi- tlnal 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. O. copyd9K state Fsumn IMNutal' Aukombk kwsnm Cwv", 201 Indudsa nrbnsl of kmnna Swvioss OM=, Imo.. v*h b P*C , CONTINUED CMP47M.1 Page 2 of 2 2. Any insurance provided to the additional in- (3) The nature and location of any injury sured shall only apply with respect to a claim or damage arising out of the "occur - made or a "suit' brought for damages for rence' or offense; which you are provided coverage. b. Tender the defense and indemnity of any 3. With respect to the insurance afforded to the claim or 'suit' to us and to all other insur- additional Insured, the followin is added to ers who may have insurance potentially SECTION 11--- LIMITS OF INSI�!RANCE., available to the additional insured; and If coverage provided to the additional insured c. Agree to make available any other insur- is required by contract or agreement, the most ance the additional insured has for de - we will ppay on behalf of the additional insured fense or damages for which we would SECTION II — will be site lesser of the amount of insurance: rovide coverage under a. Required by the contract or agreement; or IAl3ILITY. b. Available under the applicable Limits Of b• With res ct to the insurance afforded the ad'- ditional """cured" the following replaces SEC- Insurance shown in the Declarations. TION 11 —LIABILITY of Paragraph 7. Other This endorsement shall not increase the ap- Insurance of SECTION I AND SECTION 11 plicable Limits Of Insurance shown in the COMMON POLICY CONDITIONS: Declarations. a. This insurance is primary to and will not 4. With respect to the insurance afforded to the seek contribution from any other insurance additional insured, the following is added to available to the additional insured, provided Paragraph 3. Duties In The Event Of Occur- that the additional insured is a named in- rence, Offense, Claim Or Suit of SECTION sured under such other insurance. II — GENERAL CONDITIONS: b. Regardless of any agreement between you and the additional insured,, this insur- The additional insured must: ance is excess over any other insurance a. See to it that we are notified as soon as whether primary, excess„ contingent or on practicable of an 'occurrence' or an of- any other basis for which the additional In- fense which may result in a claim. To the cured has been added as an additional in - extent possible, notice should include: sured on other policies. (1) How, when and where the "occur- There will be no refund of premium in the event rence' or offense took place; this endorsement is cancelled. (2) The names and addresses of any in- jured persons and witnesses; and All other policy provisions apply. 1007033 148011 05-21-2014 CMP'-476.1 O, Copyrigirf„ slCsfa Fanra Maafws.l AaalornobVio In^aurarloo Caamparry, 2013 includescopynomed rWt9rg1 of Isar wance Services onico, inc., aft its pemrssion. WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC "03 04 (Ed 4.94) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENOORSEMENT - CALIFORNIA We have tha right to recover our parments from anyone tisbte for an injury covered by this policy. We vAll not enforce our right nsl the person or orgamalwn named in the Schedule_ (This agreement applies only to the extent that you perform work under a w Merl contract that requlnaa you to obtain [his agreernant from us.) You must maintain payroll records amrately segregating the remuneration of your employees wtvW engaged in the work described In the Schedule. The addnronv premium for this endarsomeni steal he „ ..„- - 5 % of the Caldomia workers' oompensation premium otherwise due on such remuneralion. Schedule CITY OF EL SEGUNDO 350 MAIN ST EL SEGUNDO CA 90245 CONTRACT- $2,500 i CODE 9507 This endorsement changes the policy to which It is att dvd and is efbctwe on the date issued unless ciowwse ststed UM infarmallon below Is rs"I rwsd only endorsemani Is IssuM sub"querit to praWation of tha polley,) E t E%ctlwe 0 a/ 17 /20 PoWyNo 92 GHS936 9 Endorsement No InSWW DELGADO, GERMAN Ir1 (',p��y State Farm Fire and Caouolty Company DSA D & G ELITE AtTt'O DETAILING HARBOR CLEARING � MAINTENANCE Counanprad By �.. _.........._ . WC w 03 06 (Ed. 4-84) 1007722 12421122 01.26.2019