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PROOF OF INSURANCE (2023) CLOSED THE HARTFORD BUSINESS SERVICE CENTER 3600 WISEMAN BLVD SAN ANTONIO TX 78251August 3, 2022 City of El Segundo 350 MAIN ST EL SEGUNDO CA 90245-3813 Account Information: Contact Us VENDING AND AMUSEMENTS INC. Policy Holder Details : Need Help? Start a live chat online or call us at (866) 467-8730. We’re here weekdays from 8:00 AM to 8:00 PM ET. EnclosedpleasefindaCertificateOfInsurancefortheabovereferencedPolicyholder.Pleasecontactusifyouhaveany questions or concerns. Sincerely, Your Hartford Service Team WLTR005 DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 08/03/2022 THISCERTIFICATEISISSUEDASAMATTEROFINFORMATIONONLYANDCONFERSNORIGHTSUPONTHECERTIFICATEHOLDER. THISCERTIFICATEDOESNOTAFFIRMATIVELYORNEGATIVELYAMEND,EXTENDORALTERTHECOVERAGEAFFORDEDBYTHE POLICIESBELOW.THISCERTIFICATEOFINSURANCEDOESNOTCONSTITUTEACONTRACTBETWEENTHEISSUINGINSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT:IfthecertificateholderisanADDITIONALINSURED,thepolicy(ies)mustbeendorsed.IfSUBROGATIONISWAIVED, subjecttothetermsandconditionsofthepolicy,certainpoliciesmayrequireanendorsement.Astatementonthiscertificatedoesnot confer rights to the certificate holder in lieu of such endorsement(s). CONTACT PRODUCER NAME: ABI FOX AGENCY FAX (866) 467-8730 PHONE 52709712 (A/C, No): (A/C, No, Ext): The Hartford Business Service Center E-MAIL 3600 Wiseman Blvd ADDRESS: San Antonio, TX 78251 INSURER(S) AFFORDING COVERAGENAIC# INSURED INSURER A : Sentinel Insurance Company Ltd.11000 VENDING AND AMUSEMENTS INC. INSURER B : 3235 N SAN FERNANDO RD UNIT 1F INSURER C : LOS ANGELESCA90065-1434 INSURER D: INSURER E : INSURER F : COVERAGESCERTIFICATE NUMBER:REVISION NUMBER: THISISTOCERTIFYTHATTHEPOLICIESOFINSURANCELISTEDBELOWHAVEBEENISSUEDTOTHEINSUREDNAMEDABOVEFORTHEPOLICYPERIOD INDICATED.NOTWITHSTANDINGANYREQUIREMENT,TERMORCONDITIONOFANYCONTRACTOROTHERDOCUMENTWITHRESPECTTOWHICHTHIS CERTIFICATEMAYBEISSUEDORMAYPERTAIN,THEINSURANCEAFFORDEDBYTHEPOLICIESDESCRIBEDHEREINISSUBJECTTOALLTHE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSRADDLSUBRPOLICY EFFPOLICY EXP POLICY NUMBER TYPE OF INSURANCELIMITS LTRINSRWVD(MM/DD/YYYY)(MM/DD/Y YYY) EACH OCCURRENCE COMMERCIAL GENERAL LIABILITY $2,000,000 DAMAGE TO RENTED CLAIMS-MADEOCCUR $1,000,000 X PREMISES (Ea occurrence) General Liability $10,000 MED EXP (Any one person) X PERSONAL & ADV INJURY $2,000,000 AX52 SBA RO319509/01/202209/01/2023 X $4,000,000 GENERAL AGGREGATE GEN'L AGGREGATE LIMIT APPLIES PER: PRO- POLICYLOC $4,000,000 PRODUCTS - COMP/OP AGG X JECT OTHER: COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY (Ea accident) ANY AUTO BODILY INJURY (Per person) ALL OWNEDSCHEDULED BODILY INJURY (Per accident) AUTOSAUTOS HIREDNON-OWNEDPROPERTY DAMAGE AUTOSAUTOS(Per accident) OCCUR EACH OCCURRENCE $3,000,000 X UMBRELLA LIAB X CLAIMS- EXCESS LIAB AGGREGATE $3,000,000 52 SBA RO319509/01/202209/01/2023 A MADE DED X RETENTION$ 10,000 WORKERS COMPENSATIONPEROTH- AND EMPLOYERS' LIABILITYSTATUTE ER ANY Y/N E.L. EACH ACCIDENT PROPRIETOR/PARTNER/EXECUTIVE N/ A E.L. DISEASE -EA EMPLOYEE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L. DISEASE - POLICY LIMIT 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) Those usual to the Insured's Operations. CERTIFICATE HOLDERCANCELLATION SHOULDANYOFTHEABOVEDESCRIBEDPOLICIESBECANCELLED City of El Segundo BEFORETHEEXPIRATIONDATETHEREOF,NOTICEWILLBEDELIVERED 350 MAIN ST IN ACCORDANCE WITH THE POLICY PROVISIONS. EL SEGUNDO CA 90245-3813 AUTHORIZED REPRESENTATIVE © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03)The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: LOC# : ADDITIONAL REMARKS SCHEDULE 22 Pageof AGENCYNAMED INSURED ABI FOX AGENCYVENDING AND AMUSEMENTS INC. POLICY NUMBER 3235 N SAN FERNANDO RD UNIT 1F LOS ANGELES CA 90065-1434 SEE ACORD 25 CARRIERNAIC CODE SEE ACORD 25 EFFECTIVE DATE:SEE ACORD 25 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM ACORD 25CERTIFICATE OF LIABILITY INSURANCE FORM NUMBER:FORM TITLE: Blanket Waiver of Subrogation applies in favor of the Certificate Holder per the Waiver of Our Right to Recover from Others Endorsement WC040306, attached to this policy. Notice of Cancellation will be provided in accordance with Form SS1223, attached to this policy. Coverage is primary and noncontributory per the Business Liability Coverage Form SS0008, attached to this policy. Certificate holder is an additional insured per Additional Insured- Owners, Lessees, or Contractors; Scheduled Person or Organization Form SS4170 and Additional Insured: Owners, Lessees or Contractors; Completed Operations form SS4171, 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. ACORD 101 (2014/01)© 2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD