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PROOF OF INSURANCE (2023) CLOSEDop DATE (MMIDD/YYYY) -� LIABILITY INSURANCE CERTIFICATE OF LIABILImmmmmm �.. _J 05/18/2022 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 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 m USAA INSURANCE AGENCY INC/PHS - _�. 65812845 PHONE (888) 242-1430 [(A/C, x (888) 443-6112 No,X ): No): The Hartford Business Service Centermm.._. 3600 Wiseman Blvd E-MAIL San Antonio, TX 78251 ADDRESS SURER(S) AFFORDING COVERAGE NAIC# Insurance Company Ltd 11000 INSURED INSURERA: Sentinel p y Steven Belisle DBA S Belisle & Associates INSURER B : 15241 NEWCASTLE LN.............................................. _....................... INSURER C :: HUNTINGTON BEACH CA 92647-2632.................................................... ................._...... INSURER D :. .......... ............... INSURER...m...............��_....�...............�.,.,,�. w............��..�.�._ wINSURER F : a„�___�_W.......................................................�������_� .w...........................�,�,___.....�,�,...... ....._...................................,�... .....__.....,............................... COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW mHAVE BEEN ISSUED TO THE INSURED NAMED ABOVE WF OR 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 POLICY NUMBER_......_�,...................... . . . . . . .......................... INSR ADOL�SUBR POLICY EFF POLICY EXP LIMITS ....LTR............COMMEiCIAL.. GENERALL..IABIL..IfY IN R..... N�„�1/-,,,.¢........,��..................��__._____....,,,,., (MM/DD MM/DDIYYYY... EACH OCCURRENCE..........��. ..��. $2,000,000. DAMAGE TO RENTED I 4;iI.AwNS-MPaDL X OCCUR PREMSESIEaoccurrnce ww. $1,000,000 X General Liability MED EXP (Any one person) $10,000 A _ X X 65SBMAA6894 05/10/2022 05/10/2023 PERSONAL&ADVINJORY $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $4,000,000 p_ ....... POI ICY PRO- X IOc PRODUCTS - COMP(OPAGGJ $4,000,000' JECT OTHER __ ...... _.._ _.... AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea acdden 1 ..,.�._.,.�,.�,. .........................�...�........,,,,� ANY AUTO BODILY INJURY (Per person) ALL OWNED SCHEDULED BODILY INJURY (Per accident} ---------��- AUTOS AUTOS ...... HIRED NON -OWNED PROPERTY [DAMAGE .........................�..........,�... AUTOS AUTOS (Per accident) Y. �CCC AUMBRELLA LIAB CH OCCURRENCE EXCESS LIAB EAGGREGATE ..............�,.... RETENTION $ ..... WORKERS COMPENSATION PER �OTH- AND EMPLOYERS' LIABILITY STATUTE ER ANY YIN E.L. EACH ACCIDENT PROPRIETOR/PARTNER/EXECUTIVE ....... OFFICER/MEMBER EXCLUDED C. NIA E.L. DISEASE -EA EMPLOYE (Mandatory in NH) mw,.._....... .........���.. �.............,..�, If yes, describe under E.L. DISEASE - POLICY LIMIT DESCRIPTION OF OPERATION. ,..belowmITITITITmm _........ DESCRIPT/ON OF OPERATIONS/LOCATIONS/VEHICLES(ACORD101,AdditionalRe �mmmmmmmmmmmmmmmmmmmmmmIT �W-mmmmm mmWmmarks Schedule, may be attached if more space is required) Those usual to the Insured's Operations. Certificate holder is an additional insured per the Business Liability Coverage Form SS0008 attached to this policy. Waiver of Subrogation applies in favor of the Certificate Holder per the Business Liability Coverage Form SS0008, attached to this policy. .. CERTIFICATE HOLDER ..........__........_CANCELLATION,..... .. . ... . City LD of Et Segundo SHOUANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED a municipal corporation and general law BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED city IN ACCORDANCE WITH TH THE POLICY PROVISIONS. .. ......................... ._... ................ 350 MAIN ST AUTHORIZED REPRESENTATIVE EL SEGUNDO CA 90245 (_ ©1988-2015 ACORD CORPORATION„ Al ?Irij hts' reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD