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PROOF OF INSURANCE (2024) CLOSED
CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDIYYYY) 01 /30/2023 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 endorsement(s). PRODUCER CONTACT Hiscox Inc. d/b/a/ Hiscox Insurance Agency in CA PHONE " ..... FAX 520 Madison AvenueA,E ADDREssp (588) 202 3007 tub„rm� �..... _ 32nd Floor Intact@hiscox.com 'contact@hiscox.com New York, New York 10022 INSURER Hiscox Insurance Company Inc _._-_ NAIc n SURER A: 5..... _Ins .... [ 10200 INSURED David Rodriguez 563 La Mirada Ave San Marino. CA 91108 B: F: rnvGDAnl=Q rFRTII=IrATF MIIMRFR• RFVIiIf1N NLIMRFR' 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, .............. - ..,.....,. _______.—MMIDDYIYYYY ... ..._ _. AO L U(9 ' .....POLICY .INS TYPE OF INSURANCE NUMBER MM/DD/YYYY LIMITS(------..... COMMERCIALGENERALLIABILITY EACH OCCURRENCE $ 1,000„000 CLAIMS -MADE X OCCUR b EAU vJr� PREMISES (Ea acrurrencPJ. $ 100 000 d MED EXP (Any one person) Y $ 5,000 A .. ....._._ Y P 101.475.250,1 01 /30/2023 01 /30/2024 � PERSONAL a ADy INJURY � .0 $ 1,000,000 .._. �. N EGATE&LIMIITA APPLIES PER: GENERALAGGREGATE 000 $ 1"/T X POLICY nT I.00 �� PRODUCTS - COMP/OP . $ S Gen AC�g ...... . OTHER: V AUTOMOBILE LIABILITY CO&MINESINGLE LIMIT $ ,f,Cpc.dgrip ANY AUTO BODILY INJURY (Per person} ..---- ---�AUTOS�... $ .... .,.............-- ALL OWNED �., SCHEDULED cidenl) $ .... AUTOS ._.. NON OWNED �. sC9Pb'nbwTIMK.1Ad�tlA$ Ca ...�-- .. ..., HIREDAUTOS AUTOS 1 (Par ac odiA) UMBRELLA LIAB ry OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION PER [ 11H `}TATUTF t ERNIA j I AND EMPLOYERS' LIABILITY YIN "'" _ ANYPROPRIETOR/PARTNER/EXECUTIVE E„L EACH ACCIDENT $ " OFFICER/MEMBEREXCLUDED?"„ (Mandatory in NH) E EA E PLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below EL. DISEASE- POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of El Segundo is listed as additional insured. Subject to policy terms and conditions, CERTIFICATE HOLDER CANCELLATION City of El Segundo 350 Main St SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE El Segundo, CA 90245 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD