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PROOF OF INSURANCE (2023) CLOSEDACC>RL> CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDfYYYY) 07/13/2023 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 does not confer rl hts to the Certificate holder in lieu of such endorsements . PRODUCER CONTACT Brian Hunt StateFarm Brian Hunt PHONE 562 804-9147 5693 Woodruff Avenue E M Ext brlan.tlunt n 5v2 statefrrn com O ._. _... _ ._....._. llw ww. INSURER(3) AFFORDING COVERAGE NAIC A �.. Lakewood n _. �... CA 90713112 - _. 9 INSURER State Farm General Insurance Company 25151 m�_.. _.._ INSURED INSURER B : Allison, Robby INSURER C : .._._...............-..-........... - 4067 HARDWICK ST STE 495 ...,_.....,._..-_..........._..................�....-......�- INS UR ER D :w_...� _....�....... m._... ....... INSURER E : LAKEWOOD CA 907122350 JINSUF RER. COVERAGES CERTIFICATE NUM'BER: 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. ...... TYPE OFINSURNCE ELTR WPOLICY NUMBMMIDD MMIDDII LIMBS COMMERCIAL GENERAL LIABILITY � EACH OCCURRENCEE-$ 1,000,000 - _... �_ � CLAIMS -MADE � OCCUR � OAO,�kJ`w -f'.� �F��NT D � $ 300 OOU A Y N GEWL AGGREGATE LIMIT APPLIES PER: 92-EL-B253-8 10/15/2022 �a��trlw�i. y one person) s 5,000 _ 10/15/2023 .PERSONAL & ADv INJURY $ 1 000 000 GENERAL AGGREGATE s 2 _ _ ... POLICY JEC X LOC PRODUCTS - COMPJOP AGG s 2,000,000000 TS 11 j'1y4I . w..__ OTHER. $ AUTOMOBILE LIABILITY —C-0-RON65 N LE L 1T I $ ..._.,,..-.,,,,m... ...� .,... ANY AUTO BODILY INJURY (Per s OWNED SCHEDULED AUTOS ONLY AUTOS j .... �� BODILY Y INJURY Peraccldent), $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY UMBRELLA OCCUR I E OCCURRENCE $ -.� EXCESS LJAB j CLAIMS -MADE I AGGREGATES 5 _ DED RETENTION s WORKERS COMPENSATION rYER ¢O"PMd ' E AND EMPLOYERS' LABILITYY Y / N ff ANY PROPRIETORJPARTNERIEXECLrrNE I OFFICER/MEMBER EXCLUDED? NI A �ff ... w '`'" E.L. EACH ACCIDENT $ (Mandatory In NH) SEASE EA EMPLOYEE s If yes, describe under 1 1 DESCRIPTION OF OPERATIONS below t t �................ mm. ._..._,. _. __ .. - ....- w�_. " E.L. DISEASE -POLICY LIMIT � $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached If more space Is required) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of El Segundo its, officials and employess ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main St. AUTHORIZED REPRESENTATIVE ElSegundo CA 90245 c ,... This form was system-gerterated on 07/13/2023 C 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD 1001406 2005 155279 205 01-19-2023 wHRK Policy No.: 92ELB2538 FE-6609 ElSECTION II ADDITIONAL INSURED ENDORSEMENT Policy No.: 92ELB2538 Named Insured: ALLISON, ROBBY DBA ALLISON TRAINING PERSPECTIVES & SERVICES 4067 HARDWICK ST STE 495 LAKEWOOD CA 90712-2350 Additional Insured (include address): CITY OF EL SEGUNDO ITS OFFICERS, OFFICIALS, EMPLOYEES, AGENTS & VOLUNTEERS 300 MAIN ST EL SEGUNDO CA 90245 WHO IS AN INSURED, under SECTION 11 DESIGNATION OF INSURED, is amended to include as an insured the Additional Insured shown above, but only to the extent that liability is imposed on that Additional Insured solely because of your work performed for that Additional Insured shown above. Any insurance provided to the Additional Insured shall only apply with respect to a claim made or a suit brought for damages for which you are provided coverage. The Primary Insurance coverage below applies only when there is an "X" in the box. FE-6609 Printed in U.S.A. Z Primary Insurance. The insurance provided to the Additional Insured shown above shall be primary insurance. Any insurance carried by the Additional Insured shall be noncontributory with respect to coverage provided to you. All other policy provisions apply. FE-6671 Printed in U.S.A. (04/09) FE-6671 Page 1 of 1 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US SCHEDULE Policy Number: 92ELB2538 Named Insured: ALLISON, ROBBY DBA ALLISON TRAINING PERSPECTIVES & SERVICES 4067 HARDWICK ST STE 495 LAKEWOOD CA 90712-2350 Name and Address of Person or Organization: CITY OF EL SEGUNDO ITS OFFICERS, OFFICIALS, EMPLOYEES, AGENTS & VOLUNTEERS 300 MAIN ST EL SEGUNDO CA 90245 The following is added to Paragraph 10.b. of SECTION I AND SECTION II — COMMON CONDITIONS: We waive any right of recovery we may have against the person or organization shown in the Schedule because of payments we make for injury or damage arising out of: a. Your ongoing operations; or b. Your work done under contract with that person or organization and included in the products - completed operations hazard. This waiver applies only to the person or organization shown in the Schedule. All other policy provisions apply. FE-6671 ©, Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. FE-6671 Printed in U.S.A. (04/09) 2004 Ford Explorer 4d 4x2 Xis VIN: 2004 Ford Explorer 4d 4x2 Xis VIN: Premium: $488 Coverages Details Change Bodily injury liability Covers costs associated with injuries to others if you cause a car accident.Learn more $25,000 per person $50,000 per occurrence Property damage Covers costs associated with damages to someone else's property -Learn more $50,000 each occurrence Medical payments Covers medical and funeral expenses resulting from a covered car accident for you or your passenger, no matter who is at fault. $2,000 Uninsured collision Covers damage to your car or the actual cash value of the car (whichever is less) up to $3,500 by an uninsured motorist. Learn more.Learn more Uninsured/underinsured motorist(s) bodily injury Covers repairs or the actual cash value of your damaged vehicle, whichever is less, if an uninsured motorist causes a car accident. $25,000 per person $50,000 per occurrence Uninsured deductible waiver Waives the collision deductible when damages are caused by an uninsured motorist.Learn more Me Vehicle details Garage ZIP code 90712 Annual miles 7,501-10,000 miles Loan/lease company None +Add'