PROOF OF INSURANCE (2023) CLOSEDCERTIFICATE OF LIABILITY INSURANCE
DATE (MMIDDIYYYY)
03/22/2023
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 Avenue E-MAIL F contact@hiscox.com ox.com 07 t c N .
"".
32nd Floor ADDRESS;
M D Ss °� i .ox..... ............_........_ .... .
New York, New York 10022 "" ....... INSURER(S) AFFORDING COVERAGE NAIC #
Hiscox Insurance COmDanv Inc 10200
INSURED
TM Consulting
20300 Charring Lane
Yorba Linda, CA 92887
INSURER C :
INSURER D 7
INSURER E :..
INSURER F :
t'^f"i%1=PAr1_rQ f`FRTIFIf_ATF NIIMRFR• RFVIRInN Nt1MRFR'
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.
�.................. ._................ _ ........................._
POLICY
INSR TYPE OF INSURANCE ADOL S B POLICY NUMBER MMODDdYY F MM DD EXP LIMITS
LTR.
X COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$ 1 000 000
CLAIMS -MADE EXI OCCUR
AMAG
ccurrence
PREMISES Ea occurrence)
$ 100,000
MED EXP (Any one person)
$ 5,000
..".............._
A
P100.792.921.2
12/14/2022
12/14/2023
PERSONAL & ADV INJURY
$ 1,000,000
L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$ 2,000,000
..........................
X POLICY PRO* ACT ElLOC
_........m.
PRODUCTS - COMP/OP AGG
$ 2,000,000
OTHER°
$
AUTOMOBILE LIABILITY
C�CDMBINEDSiNGLE.LIMIT
I;a aocident).................................
$
_.
ANY AUTO
BODILY INJURY (Per person)
$
ALL OWNED SCHEDULED
BODILY INJURY (Per accident)
$
AUTOS AUTOS
NON -OWNED
DAdwdduGE.......
_.
$
HIREDAUTOS _,,,,,,,,, AUTOS
PPROPERTY
n
UMBRELLA LIAB OCCUR
EACH OCCURRENCE
$
EXCESS LIAB CLAIMS -MADE
_ .....
AGGREGATE
$
DEO I RETENTION $
WORKERS COMPENSATION
PER TH-
STATUTE ER
AND EMPLOYERS' LIABILITY Y / N
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,_�
ANYPROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED? ❑
N / A
E L EACH ACCIDENT
"'""""""""""" "mTy-''�
$ .------.
,(Mandatory in NH)
E.L. DISEASE EA EMPLOYEE''
$
If yes, describe under
'..DESCRIPTION OF OPERATIONS below
E.L. DISEASE -POLICY LIMIT
$
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required)
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
r
Il;�"'
U 19tIB-ZU75 AGUKU GUKf°UKA I IUN. All rights reservea.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD