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PROOF OF INSURANCE (2022 - 2023) CLOSEDS&SLA-1 F-- ,4c'oirc�CERTIFICATE OF LIABILITY INSURANCE 0110612022 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 pollcy(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 cerldicate does not conferrights to the certificate holder in lieu of such endorsement s PRODUCER 877-242-9600 Mecl Central Insurance ,agency Central Insutanco Agency„ Inc. PHONE 877.242-9600 FAX 87'7.24 �c hoI -8'995 93 East Main Street (Arc No, Ein Smit%ttown, NY 11787 F NAIoerRifioatDs@ciainsure's.com �DOIss, Stephen Ormsby a INSURER(S) AFFORDING COVERAGE NAIC INSURERA:PeleuS Insurance Company 34118 . CorePomt Insurance Company WIS ED INSURER B! G Force, Inc DBA JRM 9.abor John McKIHOP INSURER . 26893 Bouquet. Canyon Rd. #413 Saugus, CA�9135'0 I>asurecRo INSURER E' . INSURER P COVERAGES CERTIFICATE N'UMBEW REVISC N NfIIMCSER:, THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATLU NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CER'IIFICATL MAY Rf 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 pT4Sf# TYPE OF INSURANCE AD�1% SId9R' Piw��IOY' NUMBER POLICY ErF� POLICY ETi P LIMITS WV0 A X COMMERCIAL GENERAL LIABILITY ; $ 1,000,000 .. X 08/3012022 t 250,000 X Assault Battery kTH1) �X�P� AA 119 0, pm ,„�ql : 1 5,000 X Professional LOD PO F4 )Na. A,r„pA9k'J BUR' , S 1,000,000 3,000.000 8 r P t,t'rdLUY,".c �+rIGPCtir+,tf;_ T, 31000,000 X L9TiU AUTOMOBILE LIABILITY .Ji4ia I , WPT1, T IN 19 4'rwo c'v"o" $. 'WR FFfT', TY UlwVAt',d. A X A t.Id:B X ,.,,::;E,a EA( OCCURRENCE ; 4 5P000,000 UMV0000262 0813012021 0813012022 rnrr.vsLIA6 ,:. �� cc.Rr.Grrrr EXCESS 5,000,000' X a ;.� e 10„000 lulu wORKII HS „APrIWSATION X PEfF R ' E RR , AIN0 PLOYERS'I EAWLWY YfN CPW1000381 01(0512022 01/0512023 EACH 1,000,000 _ - ".... I ACHA ACCD NT NIA 1,0000000 Qnv 7ryrlti'lil ldlil L '.N(5`T3�'SL k sNdVR IS S 1„000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) The City of EI Segundo its officers, officials„ employees aents, and volunteers are IncludeJ as an additional insured under tile' general liability With respect to the liability created by the negligent acts, errors and omissions of the named Insured flcrein as required by Written contract, SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN The City of El Segundo 1 ACCORDANCE WITH THE POLICY PROVISIONS. 3501 Main St. El Segundo, CA 90425 AUTHORIZED REPRESENTATIVE . � ORD 25 i .D2 (2016103) ©1988-2015 ACORD CORPORATION. All rights reserved. AC The ACORD name and logo are registered marks of ACORD CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 06/02/2022 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 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 endorsements . PRODUCER CONTACT DARIN TSUKASHIMA NAME: StateFarm DARIN TSUKASHIMA PHONE 661 260 1400 1FAX 661-260-2787 ..C. 10-ExtL ........ .......... C N oj OW STATE FARM INSURANCE E-MAIL , OARIN@DARINTSUKASHIMA,COM 26650 THE OLD ROAD SUITE 205 VALENCIA CA 91381 INSURED S & S LABOR FORCE, INC 26893 BOUQUET CANYON RD # 413 SAUGUS CA 91350-3500 INSURER S� AFFORDING COVERAGE NAIC # INSURER A: State Farm Mutual Automobile Insurance Company 25178 INSURER B INSURER C : COVERAGES CERTIFICATE NUMBER: REVISION NUMRER- 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. M_ _... INSR ADDL U6R POL-0CY EFF POLICY EJCP LTR TYPE OF INSURANCE V4VD POLICY NUMBER, lMMIDQMYYI (MMIDPIYYYY)LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ _... A� 1T�i... ... ............................ ........... CLAIMS -MADE OCCUR PREMISES Ea occurrence $ MED EXP Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY El PRO- JECT LOG PRODUCTS - COMP/OP AGG $ $ OTHE.R� AUTOMOBILE LIABILITY Y 6780555-A06-75 01/06/2022 01/06/2023 cOM6INEDSINGLE. LIMIT EA aatt:aderel $ 1,000,000 X BODILY INJURY (Per person) $ ANY AUTO 678 0556-A06-75 01/06/2022 01 /06/2023 BODILY INJURY (Per accident) PROPERTY vAMA0E Per ac�'VdetKC� $ _$"""" -.�........�."""" _..... ...... ,,,,,,,_,,, ...... A OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY 673 5870-E05-75 01/06/2022 01/06/2023 UMBRELLA LIAB OCCUR ®.... EACH OCCURRENCE _,_,__................ $ m-------------------------------_ EXCESS LIAB CLAIMS -MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N PER OTH- --- STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE EL. EACH ACCIDENT $ OFFICERWEMSER. EXCLUDED? ❑ N / A IMandatory in NH) EL.. DISEASE - EA EMPLOYEE $ aas describs underSC RIPTION OF OPERATIONS be wnw E L DISEASE- POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Certificate holder listed as additional insured. City of El Segundo 3501 Main St El Segundo, Ca 90425 ACORD 25 (2016/03) CANCELLATION 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 Completed by an authorized State Farm representative. If signature is required, please contact a State Farm agent. ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 1001486 132849,13 04-22-2020