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PROOF OF INSURANCE (2021 - 2022) CLOSEDT e, A Ro CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDNYYY) 07/20/2021 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 Staff -Farm CRISTIAN AMAYA- STATE FARM � w J 882 W 9TH ST SAN PEDRO, CA 90731 NAME: CT VERONICA FLORES PHONEE, 424-477-5887 FAX,No): 424-217-4988 A/C No E-MAILADDRESS: VERONICA.FLORES.FMZ4@STATEFARM.COM INSURERS AFFORDING COVERAGE NAIC # INSURERA: State Farm Mutual Automobile Insurance Company 25178 INSURED GERMAN DELGADO DBA D & G ELITE AUTO DETAILING HARBOR CLEANING & DETAILING 1111 W F ST WILMINGTON CA 90744-5006 INSURER B : State Farm Fire and Casualty Company 25143 INSURER C : INSURER D : INSURER E : IINSURERF: r+nvconrrcc rERTIFIreTE 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 TYPE OF INSURANCE DDLINSR N.. VD POLICY NUMBER MM/DDY YY MWDD EXP LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE � OCCUR DAMAGE TO RENTED PREMISES Ea occurrence) $ 300,000 MED EXP (Any one person) $ 10,000 /{ X X 92-EF-K461-6 11/20/2020 11/20/2021 PERSONAL&ADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 POLICY ❑ PRO LOC JECT OTHER: AUTOMOBILE LIABILITY x X (Ea accctlentSINGLE LIMIT $ 1,000,000 BODILY INJURY (Per person) $ ANY AUTO 525 9336-AO2-75F 07/02/2021 01 /02/2022 BODILY INJURY (Per accident) $ A OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED I I RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YiN OFFICER/MEMBER EXCLUDED? (Mandatory in NH) NIA X 92-GZ-K509-8 05/27i2021 05/27/2022 STATUTE �RH E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYE $ 1,000,000 E.L. DISEASE -POLICY LIMIT $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) I-I(;A I h MULUt:K City of El Segundo 350 Main St. ElSegundo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE _ CA 90245 ©1888-2015 ACORD CORPORA I IUN. All ngnts reservea. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 1001486 132849.12 03-16-2016 92-EF-K461-6 013252 CMP-4786.1 Page 1 of 2 IIINMI 1.11:11►19Ze]GN31ON131►1Ire] iiAI01lei 311.lr1NMI ago] IINN wlillaG»T1il1liiW:0:11all IBAIA CMP-4786.1 ADDITIONAL INSURED — OWNERS, LESSEES, OR CONTRACTORS (Scheduled) This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE q Policy Number: 92-EF-K461-6 m Named Insured: DELGADO,GERMAN DBA D & G ELITE AUTO DETAILING HARBOR CLEANING & MAINTENANCE 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 b. 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; C. 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 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 92'sp-K461'* 013252 2. Any insurance in- eumdehal| only apply with respect to a claim made or a "suit" brought for damages for which you are provided coverage. 8. With respect to the insurance afforded to the additional ineured, the following is added to SECTION U--LIMITS OFINSURANCE: If coverage provided tothe additional insured is required by contract oragreement, the most we will pay on behalf of the additional insured will bethe lesser ofthe amount ofinsurance: a. Required bythe contract nragreement; or b. Available under the applicable Limits [f Insurance shown inthe 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 ineured, the following is added to Paragraph 3. Duties In The Event OfOocur' manue. Offense, Claim OrSuit mfSECTION ||-- 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 o claim. To the extent poeeib|e, notice should include: (1) How, when and where the "occur- rence" oroffense took place, (2)The names and addresses ofany in- jured persons and witnesses; and cwp-4ros1 Page of CHThe nature and location of any injury or damage arising out of the "occur- rence" I Tender the defense and indemnity of any claim or^sub.to us and to all other insur- ers who may have insurance potentially available tuthe additional insured-, and o. Agree tomake available any other insur- ance the additional insured has for de- fense or damages for which we would provide coverage under SECTION U -- 04BU|TY, 5. With respect to the insurance afforded the ad- ditional insured, the following replaces SEC- TION U —LIABILITY of Paragraph 7. Other Insurance ofSECTION | AND SECTION U-- COMMON POLICY CONDITIONS: a. This insurance is primary to and will not seek contribution from any other insurance available tothe additional insured, provided that the additional insured is o named in- sured under such other insurance. III Regardless of any agreement between you and the additional insured, this insur- ance is excess over any other insurance whether primary, xoeea. contingent oron any other basis for which the additional in- sured has been added aoan additional in- sured on other policies. There will be no refund of premium in the event this endorsement incancelled. All other policy provisions apply. omp-4r86.1 Q, Copyright, State Farm Mutual Automobile Insurance Company, znm 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. Person or Organization CITY OF EL SEGUNDO 350 MAIN ST EL SEGUNDO CA 90245 5 % of the California workers' compensation premium Schedule Job Description Washing and detailing 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 0 7 / 2 0 / 21 Policy No. 92 GZK5 0 9 Endorsement No. Insured DELGADO, GERMAN Insurance Company State Farm Fire and Casualty Company DBA D & G ELITE AUTO DETAILING 1111 W F ST WILMINGTON CA Countersigned By WC 04 03 06 (Ed. 4-84) 1007722 124282.2 01-25-2019