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PROOF OF INSURANCE (2023) CLOSEDA DATE (MMIDI]MYY) CERTIFICATE OF LIABILITY INSURANCE I _ 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 sloes not confer rights to the certificate holder In lieu of such endorsements), Her ACT �,20AMTE. HONE P PRODUCER TCP Insurance 820 �tY ON L ..... W. W ., .726 3701 OSB Beach, '9II40 800 > CA y0254 EMAIL _ 3NSURE Sa AFFORDING COVERAGE NAICN .,., ..e,,...—�_...._.-. ,.,.,....__� ...m._ 301 INSURERA: GreatAmerican Insurance Comps 16691 uww.TCPinsurance.com ..- ._... License aY 6008. ....,. _. . INSURED INSURER B • Great American_ Alliance Insurance CO 26832 Jennifer Chettn / teven Nilsson _ 2020 N. Main , #230 INSURERC: Los Angeles CA 90031 INSURER D : (;UVt:KATal :$ CERTIFICATE NUMBER; 71209406 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 _........._.... ---XUM Adp7M O .. __.... POLL, ._. .. .......... .. .................�,. POLNC'Y FPF 7 T TYPE OF INSURANCE CY NUMBER { MMfDO�rrYYY V 'p06tCY EXP VIAM1DDfyy LIMITS A m✓ COMMERCIALGENERALLIABILITY ✓ �/ SPP0249117 ! 1/1/2022 1/1/2023 EACH OCCURRENCE $2.000000 CLAIMS -MADE �OCCUR � PREMISEE"S JE„gS� Iyt "gce ._y 30T0„J000 MED EXP Any one person) 8 10,000 _ PERSONAL&ADVINJURY $2000,000 GEN"L AGGREGATE LIMIT APPLIES PER, GENERALAGGREGATE $ 4 000,000 ✓ POLICY PRO"El _ ..... SECT LOC PRODUCTS -COMPtOPAGG P s4,000,000 OTHER: I $. ANY AUTO ✓ ✓ 'SPP0249117 1/1/2022 1/1/2023 COMBINED SINGLE T�MII $ A AUTOMOBILELIABELffY PHYSICAL DAMAGE tt eg 1 D00 000 BODILY INJURY (Per person) $ OWNED SCHEDULED $125,000 Per Auto AUTOS HIRED ONLYJMAGE ✓ NO OWNED $250,000 Aggregate RwaPERAUTOS BODILY N 1ACEJURY (Per acc dent) $ ...... ,.,,_,_ AUTOS ONLY AUTOS ONLY Deductible 10Io Df LOSS - I ✓ PHYSICAL Min $1 000 / Max $7 500 I $ ..........�...._ A EACH UMBRELLA LIA:OCCUIR E 5260000D MEXCESS LIAB SADE� AGGREGATE $ ._...............m... ., ... DED RETENTION$ $ m 9... . B WORKERS COMPENSATION �/ �WC0992894.wwww...... 1/1/2022 1/1/2023. 1PER OlH- AND EMPLOYERS'LIABILITY OFC ER/MEM ER XCLUDED7TNERIEXECUTIVE Y NIA E ! EACH ACCIDENT S 1 000.000 ✓ STAT (Mandatory In NH) E.L. DISEASE EA EMPlOYEE $ Ir yyes, derdabe under .., DESCRIPTIONOF OPERATIONS below E.L. DISEASE -POLICY LIMIT $1.DOD 000 A MISC RENTED EQUIP ✓ SPPD249117 1/1/2022 111/2023 $5,000 Limit! $500 Deductible A PROPS/SETM/ARDROBE ✓ SPP0249117 1l112022 1/112023 $25,000 Limit !$5DD Deductible A 'THIRD PARTY PROPERTY DAMAGE '', SPP0249117 1/1/2022 1/1/2023 $1,000,000/ Deductible $1000 A ERRORS & OMISSIONS SPP0249117 1/1/2022 1/112023 $i 000 000 Limit DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) The City of El Segundo., its officers, off dals, employees, agents and certified volunteers are included as Additional. Insureds. This insurance will be deemed "primary" such that any other insurance that maybe carried by City of El Segundo wr,rill be eYtcess thereto. This insurance Will be on an occurrence," not a claims made," basis or equivalent. This Insurance Includes "Completed Operations" coverage. It is agreed' that this Insurance will not be canceled, not renewed or the limits of coverage in any way reduced Without at least (30) days advance Written notice ten clays for non. - payment of premium sent by certified mail, return receipt requested to: City of 0 Segundo City Clerk, 350 Main Street, Room 5, EI Segundo, CA 90245 The CIt O( EIv'G�Uli4i0 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Ctt ' of I retl»tn 'O City Clerk ACCORDANCE WITH THE POLICY PROVISIONS. 35 Main Street, Room 5 l Segundo CA 024 -3813 AUT140SIZEDREPRESENT'ATIVE TC'P - Amanda Felix IV 1988.2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD '7'170, rI r t 11AL-1 t W ._e . ^ 11 _. so-;-.., r„,— 1 — 1111.1o, a ✓rv......- w 11 /9/2022 POLICY NUMER: SPP0249117 COMMERCIAL GENERAL LIABILITY INSURED: Jennifer Cheung/Steven Nilsson BP 86 41 (ED 11 06) 1/1/2022 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -- DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: SAFEPAK® BUSINESS OWNERS POLICY SPECIAL FORM PART TWO - SAFEPAe LIABILITY COVERAGE FORM SCHEDULE Name Of Additional Insured Persons Or the Q of El Se undo it of I Seguno City Clerk 3SI7 Main Street, Room S sl Segundo CA 9024S-S81 The City of El Segundo, its officers, officials, employees, agents and certified volunteers Information required to complete this Schedule, if not shown above, will be shown in the Declarations. PART TWO - SAFEPAK LIABILITY COVERAGE FORM, C. 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 omissions of those acting on your behalf: A. In the performance of your ongoing operations; or B. In connection with your premises owned by or rented to you. BP 86 41 (Ed. 11106) PRO © ISP Properties, Inc., 2004 Page 1 of 1 .N 209406 I CHE IF1 I CJI—t— Cowt-i fl',.#. i Tf"k . — i — T.-- I I'I!d!MP l I -11'-11 .. —111 1 11— I — I