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PROOF OF INSURANCE (2023 - 2023) CLOSEDDATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE E02/01/2022 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 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 R1EA JOHN DIEHL State Farm Insurance PHONE " FAX ........... tAI� Ng Etlt) t 'CNeat: 18 626 791 9915 - - 835 E Mariposa St. E-MAIL „ "' ""` P ADOR( ss: JOHN O,JDIEHL COM PRODUCER Altadena, CA 91001 m .. OD75608 NAIC # INSURED INSURER A: State Farm General Insurance Company 25151 NETFILE INSURER B State Farm Fire and Casualty Company 25143 PO BOX 70 INSURERC: AHWAHNEE CA 93601-0070 INSURER D: INSURER E: cnVFRAnFR CERTIFICATF 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. ....... INSR .°., ........ ........ .'DDLS0..R R G TYPE OF INSURANCEPOLICY )YIDD/YY1rX LIMITS MMDDIYYYMML ... GENERAL LIABILITY A EACH OCCURRENCE $ 2,,000,000 X "" "" .,. 300,000 COMMERCIAL GENERAL LIABILITY 92-XV-7702-4 Y Y 03/01/2022 03/01/2023 , PR - ISFS (Fa occurrence) , $ i CLAIMS -MADE X :. OCCUR '..MED EXP (Array one pr„.as+�ny $ 5,000 '.. -.PERSONAL &ADVINJURY $ 2,000,000 GENERAL AGGREGATE S 4,000 000 '.. GEN'L AGGREGATE LIMIT APPLIES PER: '.. '.. '.... '... PRODUCTS -COMP/OP AGG $ 4,000,000 X = POLICY PRO ;. LOC $ '.. AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO......... BODILY INJURY (Per person) S ����,.... °l ALL OWNED AUTOS ' BODILY INJURY (Per accident) $ SCHEDULED AUTOS .....PROPERTY DAMAGE """" -- '....... HIRED AUTOS ',, '....... ',, ,.. (Per accident) °....... NON -OWNED AUTOS A ,..... X UMBRELLA LIAB X occuR 92-EO-Y230-0 RNCE $ 03/01/2022 03/01/2023 EACH,OCCURRENCE 2,,000,000 EXCESS LIAB CLAIMS -MADE AGGREGATE $ 2,000.000 L]w' DEDUCTIBLE '... RETENTION $ $ B WORKERS COMPENSATION WIC ST�A u- OTH-° FR D EMPLOYERS' LIABILITY YIN IMIT L PR PRIETOR/PARTTNER/EXECUTIVE � ANY OFFICER/MEMBER EXCLUDED N IA'1 92-MW-F722-4 E EACH 03/01/2022 03/01/2023 ACCIDENT $ 1,000,000 E L DISEASE EA EMPLOYEE $ 1,000 000 QMandatory Cary dru NH) . , ........ _ . ..., ,......, ltyea, describe under ,..,...,. A... - ,iLwhn E L. DISEASE - POLICY LIMIT :. S I,000,000 B .TECHNOLOGY ERRORS&OMISSIONS FYI, Y 342018 02/11/2022 02/11/2023 '$2000,000- EACH WRONGFUL ACT - $2,000,000 - TOTAL LIMIT OF LIABILITY DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) DATA AND INFORMATION STORAGE CANCELLATION NOTICE: IF ANY POLICIES ARE CANCELED BEFORE THE EXPIRATION DATE, STATE FARM WILL TRY TO MAIL A WRITTEN NOTICE TO THE CERTIFICATE HOLDER 30 DAYS BEFORE CANCELLATION. CERTIFICATE HOLDER The City of El Segundo, Its officials, and employees SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE 350 Main Street POLICY PROVISIONS. El Segundo, CA 90245 AUTHORIZED REPRESENTATIVE MIRNA SERNA 7iLidt& sf�� ©1988- 2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD 1001486 132849.4 02-11-2010 THE HARTFORD BUSINESS SERVICE CENTER THE 3600 WISEMAN BLVD HARTFORD SAN ANTONIO TX 78251 The City of El Segundo, its officials, and employees 350 MAIN ST EL SEGUNDO CA 90245 Account Information: Policy Holder Details �NETFILE January 31, 2022 %Q Contact Us Business Service Center Business Hours: Monday - Friday (7AM - 7PM Central Standard Time) Phone: (888) 242-1430 Fax: (888) 443-6112 Email: a �enc .servoces thehartford.com Website: htt s.//business.thehartf rd,com Enclosed please find a Certificate Of Insurance for the above referenced Policyholder. Please contact us if you have any questions or concerns. Sincerely, Your Hartford Service Team WLTRO05 ---*IN DATE (MMIDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE ... _ ._ .01 /31w/2022 THIS CERTIFICATE IS ISSUED AS AmMATTER 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 be endorsed. If SUBROGATIONIS 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 USAA INSURANCE AGENCY INC/PHS NAME; 65812846 PHONE Q888) 242-'I430 FAX (888) 443 61,12 (A/C, No, Ext): (A/C, No): The Hartford Business Service Center 3600 Wiseman Blvd E-MAIL San Antonio, TX 78251 ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC# INSURERA:............Hartf............................................��..........._............._..._......�.�_�. ord Accident and Indemnit y..Com Pan..y22357 NETFILE INSURER B :. POBOX 70 «.w....www __........................................................................................... .__.. AHWAHNEE CA 93601-0070 wsURERC: INSURERD : �.,..._.,w _....,.._................. _...................................,.._ INSURER E...........�......�.�_.....m,.�.�,,,_,-. m : w.................. ............... .................. ............................. _ INSURER F.. COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: WW THIS IS TO CERTIFY THAT THEPOLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FORTHEWPOLICY PERIOmmmmm D 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,. _...W..._. _................................................................. _.. ..................WTYPE OF INSURANCE ... ADDL SUBR POLICY E•FF POLICY EXP POLICY NUMBER LIMITS .�w.LTR .....��INSR WVD _...,M. ,ta„L?.(.?'%:.:. I .. I IY,KKK.1..............._................_..................... ....�........ .,.....,. COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE DAMAGE TO RENTED CLAIMS -MADE ❑OCCUR ME EXP (Any one person) ....................��..� _,_..... ........_w..._w............................__..................................... . W PERSONAL & ADV WINJURY .�...... �.�.........................�. GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE POLICY _ JEGT ,mmmmmm,,,� LOG PRODUCTS COMPIOPAGG ..�,......_ ........................................................ .............. OTHER: .._..................................�,�,..�,�.._. ..........._................................................,._... AUTOMOBILE LIABILITY COMBINr`D SINGLE LIMIT $1 000 000 X ANY AUTO BODILY INJURY (Per person) ALL OWNED f A .: UTOSI..fI._ED X X 65 UEC IY4482 04/20/2022 04/20/2023 BODILY INJURY (Per accident) Auras Auras HIRED NON -OWNED PROPERTY DAMAGE X AUTOS AUTOS (Per accident) ._.......................UMBRELL....._ 6....._ .......__............... .�......................�����. _......... ........ .............._._._. . LIAB OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS- AGGREGATE MADE OED RETENTION $ WORKERS COMPENSATION PER aTH- AND EMPLOYERS' LIABILITY '.STATUTE ER ANY YIN mEmLmmmEACH ACCIDENT PROPRIETOR/PARTNER/EXECUTIVE •---•••••••••••••••••••• NIA OFFICER/MEMBER EXCLUDED? E.L. DISEASE -EA EMPLOYEE (Mandatory in NH).,.....m...,.w,�.._..._...............���..� If yes, describe under E L. DISEASE - POLICY LIMIT DESCRIPTION OF OPERATIONS below _... ..,....�m_................................................. /LO�(....._�....... ,_..� ,,,.,_�,,,,.w.W., DESCRIPTION OF OPERATIONS CATIONS/VEHICLES ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Those usual to the Insured's Operations. CERTIFICATE HOLDER ww.................. _ ._._ CANCELLATION The City of El Segundo, Its Officials, SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED and employees BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED 350 MAIN ST IN ACCORDANCE WITH THE POLICY PROVISIONS. EL SEGUNDO CA 90245 AUTHORIZED REPRESENTATIVE �........... ._� 6__ �........___..................................... ­._....­.... ....... © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: LOC#;: ADDITIONAL REMARKS SCHEDULE Page 2 v of m2mmmmm ............................__.................... ..................._......_.�....._.........._.._.... AGENCY NAMED INSURED USAA INSURANCE AGENCY INC/PHS NETFILE POLICY NUMBER.......��� ...................�........�_ ..�_.. PO BOX 70 SEE ACORD 25 AHWAHNEE CA 93601-0070 CARRIER_ ................... NAIC CODE............................ SEE ACORD 25 _..... .. ........... EFFECTIVE DATE: SEE ACORD 25 ADDITIONAL REMARKS ACORD 101 (2014/01) © 2014 ACORD CORPORATION. All rights reserved.. The ACORD name and logo are registered marks of ACORD