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PROOF OF INSURANCE (2023 - 2023) CLOSEDDATE (MM/DD/YYYY) � CERTIFICATE OF LIABILITY INSURANCE _ 01 /27/2023 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND W 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 Brandon Foster StateStaterarm PHONE 310 322-5840 FAX 310-322-0831 STATE FARM AGENT, BRANDON FOSTER AtL ADdon.foster,vab737@statefarm.com ADD /. nAA QTAAIMAMM O'M CT _. ...�............................................�.............. .. 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. .,... .,,,,,,, INSRTYPE OF INSURANCE AOOLB UER POLICY NUMBER POLOICY EFF POLI D EXP LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 . X DAMAGE To RENTED LL 300 000.... CLAIMS -MADE OCCUR '.. P EMISE. — oppylrrpnce) $ ,..„m, ",,,,,,,. EXP (Any one person) $ 5,000 Y 92-GW-F579-3 03/02/2022 03/02/2023 PERSONAL B ADV INJURY ..... S 2,000,000 ... ����� GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY X JE O- LOC PRODUCTS - COMP/OP AGG $ 2 OOO 000 OTHER: Business Property $ 6,000 AUTOMOBILE LIABILITY COMBINED SpNGLE LIMIT tEa a I ni) $ ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS HIRED NON -OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY AN(a e?I,)) ............... UMBRELLA LIAR OCCUR ,-,... ....,...I EACH OCCURRENCE . , ......... ......... ..... $ ...... EXCESS LIAB.,. CLAIMS -MADE.. '..... '.. ... , ,,,,,,, ,,,,,,,.,, . _„-,....... ... - AGGREGATE $ DED ':, RETENTION $ ''. $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITY Y / N ,,,. ,,,,,,,,,,,,, m$'rAT4lTF_ FR ANY $ CERIPROPRIETOR/PARTNER/EXECUTIVE OFFICEOPRIETEREXCLUDED? N/A. . ) (Mandatory NH) E.L. SEASE�IEA EMP LOYEE $ If yes, describe under . ..-.. ...... DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT S DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) Certificate Holder is Additional insured The City of El Segundo, its officer, officials, employees, agents, and volunteers" are designated person endorsement as regards to this policy. Comprehensive General Liability, including coverage for premises, products and completed operations apply. The City of El Segundo 350 Main Street El Segundo, CA 90245 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. 01988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 1001486 132849.13 04-22-2020 State Farm Mutual Automobile Insurance Company PO Box 2358 Bloomington IL 61702-2358 AT2 A-2487 HESSLER, COLLEEN 630 W WALNUT AVE EL SEGUNDO CA 90245-2062 Policy Number: 335 4693-F31-75F Policy Period: December 31, 2022 to June 30, 2023 Vehicle: 2016 FORD FOCUS ELEC Principal Driver: COLLEEN HESSLER A Your auto insurance rates are impacted by the mileage your vehicle is driven. To ensure we've priced our insurance coverage accurately based on the number of miles you drive, we tried to obtain valid mileage information for this vehicle through a third party provider. We were unable to obtain odometer readings and have applied an average annual mileage using information from a third party provider and some of your vehicle and policy characteristics. Please contact your State Farm agent with questions. Policy Number: 335 4693-F31-75F Prepared November 9, 2022 1004583 AState.Farm, AUTO RENEWAL PREMIUM PAID: $518.83 DO PLOT IP Y. Your premium is billed through the State Farm Payment Plan State Farm Payment Plan Number: 1088909723 Your State Farm Agent BRANDON FOSTER Xii=I to] SY4161:T,It, Address: 214 STANDARD ST STE B EL SEGUNDO, CA 90245-3865 If you have anewordifferentcar, haveaddedanydrivers,orhavemoved, please contact your agent. Thank you for choosing State Farm. When you provide a check as payment, you authorize us either to use information from your check to make a one-time electronic fund transfer from your account or to process the payment as a check transaction. When we use information from your check to make an electronic fund transfer, funds may be withdrawn from your account as soon as the same day we receive your payment, and you will not receive your check back from your financial institution. Save up to 25% off on auto care As a valued State Farm° customer, now it's simple to find great mechanic shops in your neighborhood and enjoy exclusive savings from Openbay of up to 25%. Compare estimates Choose local shops Schedule appointments Page number 1 of 4 143562 202 01-15-2018 TP-0B Scan to Sign tiIp and stain s viirigr'. Learn more at Openbay.com "III:I°IIIICLE IINI1:::0RIII A"'IrIICN Review your policy information carefully. If anything is incorrect, or if there are any changes to your vehicle information, please let us know right away. Vehicle Identification Vehicle Description Number (VIN) Who principally drives this vehicle? How is this vehicle normally used? 2016 FORD FOCUS ELEC COLLEEN HESSLER, a single individual, To Work, School or Pleasure. who will have 23 years of driving experience as of December 31, 2022. The premium on the expiring policy term was based on 9,700 miles per year. The premium on the renewal policy term was based on 9,700 miles per year. The premium for this renewal was determined using an annual mileage this vehicle is expected to be driven that was developed from information we obtained or was provided by you. The national average is more than 12,000 miles driven annually according to the U.S. Department of Transportation. Please contact us if you expect your annual mileage to change over the next year. 1I.AZI IIf,;;IR IIIINIf::'CRIMATIQN Assigned Driver(s) The following driver(s) are assigned to the vehicle(s) on this policy. Name ............. COLLEEN HESSLER Driving Experience as of December 31, 2022 23 vears Driver excluded: ERNEST E CAMP JR EFF 11-13-2013. Premium Adjustment Each year, we review our medical payments and personal injury protection coverages claim experience to determine the vehicle safety discount that is applied to each make and model. In addition, we review the comprehensive, collision, bodily injury and property damage claim experience annually to determine which makes and models have earned decreases or increases from State Farm's standard rates. If any changes result from our reviews, adjustments are reflected in the rates shown on this renewal notice. Marital Status Principal Driver & Assigned Drivers For each automobile, the Principal Driver is the individual who most frequently drives it. Each driver is designated as an Assigned Driver on the household automobile that they most frequently drive. Your premium may be influenced by the information shown for these drivers. COVIEii I!RAG . AINIIID III,,, II IIyI Iirrs See your policy for an explanation of these coverages. A Liabilitv 250,000/500,000 Property Damage 100,000 $255.75 . ................... D 500 Deductible Comprehensive _........._....._............. ........ _ ........ ........ ......... ........ $29.02 G 500 Deductible Collision $200..77 H Emergency Road Service $2.45 (continued on next page) Policy Number: 335 4693-F31-75F Page number 2 of 4 Prepared November 9, 2022 CCVI1:..:.II .A ICIII NINE) III,,,,IIIIII ITS continued Uninsured Motor Vehicle 30,000/60,000 U1 Uninsured Motor Vehicle r AStateFartn" $27.41 Progerty Damage $3,43 Tgtaf Premium 5118;8 The claim experience on your make and model of vehicle The claim experience on your make and model of vehicle has resulted in a reduction to your vehicle rating group for has resulted in a reduction to your liability rating group for comprehensive coverage. bodily injury and/or property damage coverages. The claim experience on your make and model of vehicle If any coverage you carry is changed to give broader has resulted in a reduction to your vehicle rating group for protection with no additional premium charge, we will give collision coverage. you the broader protection without issuing a new policy, starting on the date we adopt the broader protection. IG1IISCOU U TS These adjustments have already been applied to your premium. Multiple Line Driving Safety Record California Good Driver ........... ..........____- _.......... ........... Loyalty T t f;l�la atlhW SUII'1CI1--iAlli ' IfIIIS AND DIIISC UNTS Driving Safety Record Rating Plan Your driving safety record, along with other rating factors, determines what you pay for Liability, Medical Payments, Comprehensive, Collision, and Uninsured Motor Vehicle Coverages. Policyholders with no accidents and convictions pay less than those with accidents and convictions. The Driving Safety Record Rate Level that is assigned to your policy moves up, down, or stays the same every policy renewal, depending upon your driving record. For every 12 months since the renewal following the occurrence of a chargeable accident or the conviction of a minor violation, the initial assigned Driver Record Level for that chargeable accident or conviction shall be lowered by 1 level. For each 12 month period since the conviction of a major violation, the initial assigned Driver Record Level for that conviction shall be lowered by 2 levels. The Rate Level is increased if there are subsequent chargeable accidents or convictions. Definition of Chargeable Accidents Chargeable accidents for new business are those which resulted in bodily injury or death or in payment(s) by an insurer due to damage to any property in the amount of more than $1000. For accidents occurring prior to December 11, 2011, an accident shall be chargeable provided it resulted in death or in payment(s) by an insurer due to damage to any property in the amount of more than $750. For applicants without prior insurance at the time of the accident, an accident shall be chargeable provided it resulted in damage to any property in the amount of more than $1000 (more than $750 if the accident occurred prior to December 11, 2011). Chargeable accidents for renewal business are those which resulted in bodily injury or death or State Farm claim payments totaling more than $1000 (more than $750 for accidents occurring prior to December 11, 2011) under property damage liability coverage and collision coverage combined. (continued on next page) Policy Number: 335 4693-F31-75F Prepared November 9, 2022 Page number 3 of 4 For more information about the rating plan, please contact your State Farm agent. Dlf;ir'IrIOIVYAllt„ lN'lll:::'OIRN%'T']0N IMPORTANT NOTICE For your protection California law requires the following to appear with this policy: Any person who knowingly presents false or fraudulent information to obtain or amend insurance coverage or to make a claim for the payment of a loss is guilty of a crime and may be subject to fines and confinement in state prison. , Superior Driver Rate Level If any information on this renewal notice is incomplete or inaccurate, or if you want to confirm the information we have in our records, please contact your agent. For additional information regarding discounts or coverages, see your State Farm agent or visit statefarm.com®. llirnlp rtanf IN fliice IIIle ardhing Youir IPreul-n'vuuilr State Farm works hard to offer you the best combination of price, service, and protection. The amount you pay for automobile insurance is determined by many factors including: The coverage you have • Where you live • The kind of car you drive • How the car is used • Who drives the car Any premium adjustment is reflected on this Auto Renewal. If you have any questions, please contact your agent. Buylhng a new car? IlReirnernber, to contact your a erd! When you buy an additional car or one that replaces a car already on your policy, you need to report the change to your agent promptly. Even though the dealership you purchased the car from may offer to notify your agent or insurance company, you, as the named insured, are responsible for reporting all changes to your auto policy. By contacting your agent, you can help: * avoid any complications or lack of coverage in the event of an accident or loss, avoid insurance verification problems with a lienholder, the police, or the department of motor vehicles, and ensure that you receive any new discounts you may be entitled to. Your current State Farm policy automatically provides certain coverages for a new or replacement car for up to a specified, limited number of days after you take possession of the car. Please refer to your policy for the number of days that applies in your state. If you have any questions about coverage for a newly acquired car, please contact your State Farm agent. Disclaimer: This message is provided for informational purposes only and does not grant any insurance coverage. The terms and conditions of coverage are set forth in your State Farm Car Policy booklet, the most recently issued Declarations Page, and any applicable endorsements. Policy Number: 335 4693-F31-75F Page number 4 of 4 Prepared November 9, 2022