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PROOF OF INSURANCE (2024 - 2024) CLOSEDAi U 10 CC>R CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 10/2/2023 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 rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME,Christine So Alliant Insurance Services, Inc. -- PHONE (855) 827-9642 FAX (NC,NQI: (703) 563 1510 Barry Peters Eb"AIV — AaDR Ss, yoga-questioris al1iani.coni 4530 Walney Rd Ste 200 — Chantilly, VA 20151-2285 _._ .... INSURER(S)AFFORDINGCOVERAGE NAIC# . ... INSURER A . Lloyd's of London 1126609 INSURED Julia Nicole Levee INSURER B : ----- - INSURER C : NSURER D : El Segundo, CA 90245 JWRERE: INSURER F COVERAGES CERTIFICATE NUMBER: 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. ...,., m., ...... ......... �DDI'�''GSE.,......,, .--.."POLICXNUMBER.,-."""""" --.MMfD Y". INRI.. ,TYPE OF INSURANCE MMF27D.FF INSD LIMITS COMMERCIAL GENERALLIABILITY EACH OCCURRENCE $ $1 00O 000 X YOGAI859240 1 10/14/2023 10/14/2024 yrµ ^pup yryvywyvrv��µ� "PREMMISES 100,0_00 mX CLAIMS -MADE _a OCCUR Eaoccurrenszt $ MED EXP (Any one person) $ 2,500 A............. .................................................................................................................... •mmPERSONAL&ADV INJURY....-( $.............INCLUD E D GEN'L AGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ $2,000,000 X €POLICY P!RO' LOC JFCr ❑ PROD,U......................................nw,_,....,.,.....,.m..... -COMP/OP cTm....AGG S $2,000,000 O r�tlERr $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT IEa accident) $ ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per acddent) $ HIRED ..-'TT NON -OWNED "FiRbli5iff CA__M'j E' ,n"" - ....... $ AUTOS ONLY AUTOS ONLY ,,.LPer acdt9ent UMBRELLA LIAB OCCUR I EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE $ DED I RETENTIpN $ $ WORKERS COMPENSATION STATUTE �..;ga OTH AND EMPLOYERS' LIABILITY YIN......•• ,,,,,,, -'""••• ,,,, .... ••-• ANYPROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? � N/A - (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ If yes, describe under ����...........- DESCRIPTION OF OPERATIONS below E.L. DISEASE- POLICY LIMIT $ OTHER A Professional (E&O) Liability X YOGA1859240-1 10/14/2023 10/14/2024 $1,000,000 A Professional (E&O) Liability X YOGA1859240-1 10/14/2023 10/14/2024 $2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) THIS CERTIFICATE SERVES AS EVIDENCE OF PROFESSIONAL (ERRORS & OMISSIONS) LIABILITY COVERAGE ONLY Aggregate Limit of Libility for all coverages set forth above: $2,000,000 The City of El Segundo, its officers, officials, employees, agents, and volunteers -- 350 Main Street El Segundo, CA 90245 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 " ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD ADDITIONAL INSURED ENDORSEMENT Specified Member: Julia Nicole LeVee Policy Number: YOGA1859240-1 Endorsement Effective Date: 10/14/2023 It is hereby agreed and understood that the person(s) or entity(ies) listed below is/are included as Additional Insured(s) underthe combined Professional/General Liability policy number referenced above, but only with respect to claims or damages arising solely out of professional services rendered by the Specified Member: The City of El Segundo, its officers, officials, employees, agents, and volunteers -- 350 Main Street El Segundo, CA 90245 ALL OTHER TERMS AND CONDITIONS REMAIN UNCHANGED. Date: BY: Authorized Representative Alliant Insurance Services, Inc. CALIFORNIA INSURANCE IDENTIFICATION CARD T'Ms cerfifies thal the Pnsured shown below hol& an automobile fiabifity policy Issued f,:ry Amiica Muhial Tinsuraince Company The coverage provFded by thB poficy meets the rinkfirnurn fiibiifi y lirnits prem ibed by law, NA11C # 19976 THIS P01...,.I.CY l)4EE'.PS THE REQU.I.REMENTS OF CAI F.- FORN FA STAf,[.JTE:S SECTIONS 1(3056 OR 16'500.5. SOUTHERN CALIFORK.F.A O.FF'..J..CE 1. 8'77 97 2 6 4 2 2 IM40111121011 Amica Mutual Insurarice Company CORPORATE OFFJCE„ ONE HUNDRED AMICA WAY, I.-INC01-N, RI 02865 1166 MAILPO BOX 6008, PROVII)ENCE, RI 02940 6008 SERVICING OFFICE SOUTHERN CAI.. FORNIA. OFFICE 3200 Park CenteT Dnive, Sube 650 Costa Mesa., CA 92626 1 877 972 6422 CITY OF EL SEGUNDO WORKERS' COMPENSATION DECLARATION WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SUBJECTS AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN LABOR CODE § 3706, INTEREST, AND ATTORNEY'S FEES. I affirm under penalty of perjury under the laws of California one of the following declarations: (U I have and will maintain a certificate of consent of self -insure for workers' compensation, issued by the Director of Industrial Relations as provided for by Labor Code § 3700 for the performance of the work set forth the agreement with the City of El Segundo. Policy No (_) I have and will maintain workers' compensation insurance as required by Labor Code § 3700 for the performance of the work for which the agreement with the City of El Segundo is executed. My workers' compensation insurance carrier and policy number are: Carrier Policy Number Expiration Date Name of Agent Phone # eI certify that, in the performance of the work set forth in the agreement with the City of El Segundo, I will not loy any person in any manner so as to become subject to the workers' compensation laws of California, and agree that, if I should become subject to the workers' compensation provisions of Labor Code § 3700 1 must Signature ant p_ s or the agreement will automatically become void. immediately comply with those ovis�on Date 9/21 /23 Print Name Julia LeVee Agreement for. ilia LRV& Dated: 10 ance Approval;. 'Neviewed •�CII� MI IIMII IIII�I