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PROOF OF INSURANCE (2021 - 2021) CLOSED• iti ", CE 1022720 ,e. A MATTER OF poAN ROM n� Insurance Services, Inc. 22231 Mulholland Hwy. #209-A TER COM,� AFFot�0VTTE POLICIES BELOW.� alabaeaa CA 91302 COMPANIES AFFORDING COVERAGE tA181 222-9080 cc&~ LEnm A National Interstate Ins. Co . Cc&~ 9 � .Insurance goMaIa of The West an Lingen Body Shop, Inc. ccb~ a: Van Lingen Towing I.ErTo C 7SS Lomita Blvd. aauvAwr orrance CA 90503 LF77M D (310) 370-4533 COWA E LERSI Co �: �,.--*A.e,,.,»,. THIS IS TO CERM THAT THE POLI= OF INSURANCE LISTED BELOW HAVE BEEN LSSuM To THE INSURED NAMED ABOVE FOR THE POL= PERIOD TED NOTWITWANOM ANY REOULREMENI TERIN OR CONDITM OF ANY CONTRACT OR oTHER DOCUMENT WITH RESPECT To WHICH THIS . CATS MAY BE SUED OR MAY PERTAIN, THE VOURANCE APPORDE0 BY THE POLICES DESCRIBED HEREIN IS SUBJECT TO ALL THE TEAMS. EXCLUMONS, AND CONDITIONS OF SUCH Powra umrm SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS CO LTH TN[OITNABVIIU11N7E /OLII.YMDY�91 POLICYE�TIn OATI M DWM POLICY EvIMTIOY DATE 0AN00" LEA LJMk, L,m GENERAL AOOiEflATE s3,000,000, uwvam "3 L 03,0001000 aAmmALs]� TPC-4400004-03 1/01/20 1/01/21 �aarlL AwTIULnr •1 000 000 EACH OCCUFV* M • 1 0001,000 owe LL OowTnAcroas RSDT, FWnwAW DenN* 5 100 000 L®.E>FENW 1 5 r 000 AWAM UW '1, 000 000 eoo�r wun ALLOWNEDAUMB so�La�AU`= IMAUTIN TPC-4400004-03 1/01/20 1/01/21GWVMUABUTY s RiiJPERTY aLIAOE • UWLW EAMCCCUMME 11 000 000 ' UMBRELLA TPC-4400004-03 1/01/20 1/01/21 AGOFE ATE 0,0001000 erATUIDRr Urns WVE-5021332-09 4/01/20 4/01/21 wcHAc=ea •1 000 000 AMD 06EAsE-P0mLaar 41 000, 000 EMPL OVIIM' UAIIIIun MEM E-EACH B NU3YEE al 000', 000 OTMA On -Hook $ 200,000 Garage Keepers TPC-4400004-03 1/01/20 1/01/21 $ 500,000 he City of E1 Segundo, its officers, officials, employees, agent and volunteers are additional insureds SNOUID ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE ity Of El Segundo EOWTION DATE THEREOF. THE ISSUIM COMPANY WLL ENDEAVOR To l i c Works Dept. MAIL —.IQ DAPS WRITTEN NOTICE TO THE CERTTFt NMI TO THE 50 Main St. LEFT• BUT FAILURE TO MAL SUCH NOTICE OBUOATTON OR 1 Segundo CA 90245 CIrt ANY IOND uPON THT? cIOMPAW. ACI A A POLICY NUMBER: TPC 4400004 03 COMMERCIAL GENERAL LIABILITY CG 20 26 04 13 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): The City of EL Segundo, its officers, officials, employees, agents & volunteers Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect 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 omis- sions of those acting on your behalf: 1. In the performance of your ongoing opera- tions; or 2. In connection with your premises owned by or rented to you. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional in- sured is required by a contract or agree- ment, the insurance afforded to such addi- tional insured will not be broader than that which you are required by the contract or agreement to provide for such additional in- sured. B. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of In- surance shown in the Declarations; whichever is less. This endorsement shall not increase the applic- able Limits of Insurance shown in the Declara- tions. CG 20 26 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 Wolters Kluwer Financial Services i Uniform Forms TM NATIONAL INTERSTATE NATIONAL RA COMPANY 3250 INTERSTATE DR. RICHFIELD, OH 44286-9000 1 • 890 DITIONAL INSURED 225 NORTH LA BREA, LLC C/O: TULLIUS LAW GROUP 515 S. FLOWER ST „ 36TH LOS ANGELES CA 90071 POLICY INTEREST SCHEDULE Policy Number: TPC 4400004 03 Named Insured: VAN LINDEN BODY SHOP, INC. DBA VAN LINGEN TOWING Agent: PCF INSURANCE SERVICES OF THE 4110091 POLICY INTEREST SCHEDULE ADDITIONAL INSURED CALIFORNIA DEPARTMENT OF MOTOR VEHICLES FLOOR P.O. BOX 932370 MS G875 SACRAMENTO CA 94232-3700 MOTOR CARRIER PERMIT BRANCH ADDITIONAL INSURED CALIFORNIA HIGHWAY PATROL BUSINESS SERVICES SECTION P.O. BOX 942898 SACRAMENTO CA 94298 CONTRACT SERVICES UNIT ADDITIONALr CALIFORNIA 601 N. 7TH STREET. CONTRACT SERVICES UNIT CA 95811 ADDITIONAL CITY OF GARDENA POLICE 00 W. 162ND GARDEN. CA 90247 ADDITIONAL PATROLCALIFORNIA HIGHWAY 19700 HAMILTONAVE. TORRANCE CA 90SO2 ADDITIONAL INWIRCITY OF EL �l� PUBLICDE � I MAIN ST. EL r ADDITIONAL INSURED DEPT„ CITY OF MANHATTAN BEACH RISK MANAGER 1400 HIGHLAND AVE. MANHATTAN BEACH CA 90266 ADDITIONAL INSURED CITY OF PALOS VERDES ESTATES 340 PALOS VERDES DR. WEST PALOS VERDES CA 90274 ADDITIONAL CITY OF OR FLEET SERVICES DIVISION 20500 MADRONA TORRANCE CA 90503 ADDITIONAL INSURED COUNTY OF LOS ANGELES SHERIFF DEPT. 4700 RAMONA BLVD. MONTEREY PARK CA 91754 Issued ate:11/20/2020 POINTSCH-0101 AGT Page 1 Of 4 VANUNG-01 ,,. CERTIFICATE OF LIABILITY INSURANCE 3r31r,2021. .................... . TWO CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER- TM CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING NSURER(Sh AUTHOR[= REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER IMPORTANT: H the cw011cad holdw Is an ADDITIONAL INSURED, Ow pollcy(Ise) must hove ADDITIONAL INSURED pmvislorn or be owkwasid. If SUBROGATION 18 WAIVED, subject to the teems rind Conditions of the poilcy, n policies may require an ondorsemanl A on thin cwtific.tt dose not confer r1 to the cartl0cate holder In lieu of such endorsers a . _ PRODUCEII ,T PCF Insurance, Services of the West LLC $200 Canoga Ave F""0!4 T,gr (e7 e) 703-8057 r NNE ;'818 703-0935 Suite 323 IfAb Woodland Hi t, CA913Q1 #" RaNgC aE NLk RERA:Natignpllnt"iatpjp"ran_pgCompany 8 0 iNwnw INeuREa e• Van Lingen Body Shop Inc. '... ......... 2755 Lomita Blvd. e Torrance, CA 90505 llJa. INtulrE3IEL INSURER. IF 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 ANDCONDITIONSOF SUCH P POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. � INSR RTE of ewIIRANCE ... ..._.. IDOL:' 4YkinT roLNcr NursETr ' } Eff POLWY EXP UYIIa COMMERCIAL OMRAL LMLnY 04,'.pIFIrdF Y4awE„_r„_„ CiNM9-mkm El OCCUR MED EXP IA.Mf"*.@ RI^L_ j PPEA ULOC AUTOYOWLE LIAMUTY COM@II' N,EO' S&Ig4°;C.E LbrYq'T SOY I7a,LW„dIT, '.. +w A ....._ '.. ANY AUTO OWNED SCHEDULED AUTOS ONLY '...,,._.„_. AUTOS �UT08 ONLY ,p....., Uesoa LW OCCUR 9 .. ExCEnn UAS CLAIMS -MADE DIED RETENTION S A wolecERseoeroNSAnoN raw nrHl AND EMPLOYERS' PROPRETOMPARTNERIEXECUME NIA ,.. XPWId00004-00 dH/28Z1ANY 11r1R21 CHACF O„ DENTN EElL E0A� w o EXCLUDED? = �i000000 _ POLICV Lliff 1,000,000 p DMFWnON Of OPERATIONS I LOCAnO1O I VOOMES (ACORD 161. AddPftoW AmmeAE SahWvK rsr be reuer S Y nMrM) 'Tow Truck Operation SMOULD ANY OF THE ABOVE DERCREED POLICIES BE CmCEu" BEFORE City of 6 Segundo THE EXPIRATION DATE THEfE#. NOTICE 11A1 BE DELNEMM IN PubOc Works Dept ACCORDANCE VM THE POLICY PROMS ML 350 Main St E1 Segundo, CA 9024S AUTIIORDED FM ATrINE ACORD 25 (201OM3) 01951!wM5 ACORD CORPORATION. AS 00ft The ACORD name and logo am raglalwed mwtla of ACORD 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 ............... of the California workers' compensation premium otherwise due on such remuneration. Schedule Person or Organization Job Description Any person or organization against whom you have agreed to waive your right of recovery in a written contract or agreement provided such contract was executed prior to the date of loss. 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 0410112021 Policy No. TPW 4400004 00 Endorsement No. Insured Premium $ VAN LINGEN BODY SHOP, INC. Insurance Company Countersigned by NATIONAL INTERSTATE INSURANCE COMPANY WC 04 03 06 (Ed. 4 84) Hart Forma & Serwees Reorder No. 14.2420