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PROOF OF INSURANCE (2023 - 2023) CLOSEDDATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 11/09/2022 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 polio IeS) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of tte 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 Sentry Customer Service Sentry Insurance PHONE '.FAX 1800 North Point Drive N • 800-473-6879 A./C Not 800-514-7191 Stevens Point, WI 54461 EMAIL ADDRESS: businessoroducts direct(@sentrv. cam INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Sentry Insurance Company 24988 INSURED _ INSURER B ;. TCTH - Screenworks Inc INSURER C 1705 W 134th St INSURER D Gardena, CA 90249-2032 INSURER E ; INSURER F COVERAGES CERTIFICATE NUMBER: 2709905 _ 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 ADDL SUBR LTR TYPE OF INSURANCE INSR WVD POLICY EFF POLICY EXP ' POLICY NUMBER MM/DO/YYYY _(MMIDgnL Y. ,mIT____ LIMITS _........ . W....m.__. X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE[fl OCCUR DAMAGE TO RENTED PREMISES Ea occurrenco $ 500 000 MED EXP (Any one person) $ 15,000 A '..... 2549311002 05l01/2022 05(01(2023 PERSONAL & ADV INJURY .. ................................... $ 1,000,000 ............................ GEN'L AGGREGATE LIMIT APPLIES PER:..''.... GENERAL AGGREGATE GATE $ 3,000,000 X POLICY ❑ PRO ❑ LOC PRODUCTS - COMP(OP AGG $ OTHER: $ AUTOMOBILE LIABILITY L 1111SINIO SINGLE LIMIT Eaef`C ENint6_ __....................................... $ .............................. ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE i $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LAB CLAIMS -MADE _... _. ......... AGGREGATE $ DED I RETENTION $',. $ __ ........ COMPENSATIONWORKERS O STATUTE AND EMPLOYERS'TH- LIABILITY YIN N TUTE Eft E..L.. EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE N / A OFFICER/MEMBER EXCLUDED? [:]i E..L, DISEASE - EA EMPLOYEE .d� $ (Mandatory in NH) If yes, describe under IT DESCRIPTION OF OPERATIONS below E L DISEASE POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Refer to attached CERTIFICATE HOLDER CANCELLATION ............ �......... ...... . �........... ............. City of El Segundo, Officers, Employees, Agents & Volunteers SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 350 Main St El Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN El Segundo, CA 90245-3813 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHOR/ZEO REPRESENTATIVE ACORD 25 (2016/03) Page 1 of 2 1988-2015 ACORD CORPORATION. All rights reserved. 2549311 The ACORD name and logo are registered marks of ACORD 11 /09/2022 Sentry Insurance Company 1 00001 0000000000 22313 0 N 5339la27-2ab5-4ld7-8217-bf94b37b785d AGENCY CUSTOM ID: XXXXXX8261 RM LOC #: ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMEDINSURED Scott Robinette TCTN - ScreenwDrks Inc POLICY NUMBER 2549311002 CARRIER NAIC CODE Sentry Insurance Cornparry 24988 EFFECTIVE DATE: 05/01/2022 ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. 2549311 The ACORD name and logo are registered marks of ACORD 11/09/2022 Sentry Insurance Company lnterinsurance Exchange of the Automobile Club Automobile Insurance Policy Coverages and Limits Renewal Declarations We are pleased to offer you a renewal for your automobile insurance policy. To renew your policy, send at least the minimum payment on or before the due date. Insurance is in effect only for the vehicles, coverages, and limits of liability shown on this declarations page and as set forth in the insurance policy and endorsements. These declarations, together with the contract and the endorsements in effect, complete your policy. If any change to your policy or to the information we have on file results in a premium decrease during the policy period, the Interinsurance Exchange reserves the right to apply any refund due to your outstanding balance. NAMED INSURED (Item 1.) AUTO POLICY NUMBER: CAA 084731609 HUGHES, TIMOTHY AND HENDRIX- HUGHES, CHE POLICY PERIOD (PACIFIC STANDARD TIME) RYL POLICY EFFECTIVE DATE: 08-14-22 12:01 A.M. EL SEGUNDO CA 90245-2439 POLICY EXPIRATION DATE: 08-14-23 12:01 A.M. VEHICLES VEH. IDENTIFICATION VEHICLE GARAGE ANNUAL" VERIFIED NO YEAR MAKE MODEL NUMBER USE ZIP CODE MILES MILEAGE SALVAG 2 2008 KIA SORENTO COMMUTE 90245 1,501 - 2,500 VERIFIED NO 4 1966 TRIU TR-4A PLEASURE 90245 501 - 1.500 VERIFIED 8 2014 LINC NAVIGATOR PLEASURE 90245 5,501 - 7,500 VERIFIED NO 9 2017 FORD EDGE SEL PLEASURE 90245 3,501 - 4,500 VERIFIED NO COVERAGES AND LIMITS ANNUAL PREMIUMS Coverage is not In effect unless a premium or the word "included" is shown. COVERAGES LIMITS OF LIABILITY Vehicle 2 Vehicle 4 Vehicle 8 Vehicle 9 Vehicle d tl Liability a o Bodily Injury $250,000 each person/ $500,000 each occurrence ;. $ 130 $ 82 $ 234 $ 206 Property Damage $100,000 each occurrence $ 103 ; $ 62 $ 210 $ 167 Medical Medical Payments $5,000 each person $ 15 $ 14 $19 $ 22 Physical Damage (Actual Cash Value unless otherwise stated, less deductible) Vehicle 2 Vehicle 4 Vehicle-8 Vehicle 9 Vehicle Comprehensive ACV ACV ACV ACV e $ 46 q $ 21 $ 56 $ 52 (Less Deductible) $500 $500 $500 $500 a 11 Collision ACV ACV ACV ACV $ 123 n $ 22 $ 426 $ 368 (Less Deductible) $500 $500 $500 $500 Car Rental Expense ; a Per D ) No Covera e NoCoverage No Covera e No Cover a No Covera e No Coverage! No Covera e No Coverage, Uninsured Motorist Bodily Injury - $30,000 each person/ $60,000 each accident $ 27 ^$ 21 $ 30 $ 43 ) M 1 4 Uninsured & Underinsured Vehicles Uninsured Deductible Waiver Included Included Included M Included Uninsured Collision ^ No Coverage No Coverage No Coverage ^ No Coverage ) Total Premium $ 4" $ 222 $ 975 $ 858 ; PREMIUM DISCOUNTS "No Coverage" indicates coverage not purchased. Please refer to the enclosed document entitled "Premium Discounts Applied to Your Automobile Policy." Total Annual Premium* * If at any time you choose to pay less than the full balance outstanding, finance charges of up to 1.5% per month of the balance outstanding will apply as explained in your billing statements, which are part of these declarations. ** To see the annual mileage for your expiring policy, please refer to the "Notice of Annual Mileage" page contained in your renewal package. (Includes all applicable discounts.) $ 24g Less Policyholder Savings Dividend $ 28 Net Premium* $ 221 �ZA PROCESS DATE 07-06-22 PLEASE ATTACH TO YOUR POLICY (SEE REVERSE) 070722