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PROOF OF INSURANCE (2024 - 2024) CLOSEDATE CERTIFICATE OF LIABILITY INSURANCE D[10/03/2023DD1YYYY) 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 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 LIC #OD862'05 1-94,9-•305-577 tCON Ac Michelle Henricks Unique Risk Management PHONE .. FAX ..... __ Is 949-305-5577 ..... _(AJ6. Nola W9W49-305-5077 23052 Alicia Pk°iy E"MARL ADDRESS: michelleuni erisk.com Suite H #378 WWWWWWWWW ............. ... Mission Viejo, CA 92692 INSURER('S')AFFORDING COVERAGE NAIC# Michelle Henricks INSURERA: NORTHFIELD INS CO 27987 .. ........ ................ ....... ............. ._......m_...._......................... .. ............................ INSURED - INSURER B; STATE COMPENSATION INS FUND 35076 M. Pino & Associates Inc. ._ .................................................... ._ DBA: Myccw.us; DBA: MPA, Inc. INSURERC: NORTH AMERICAN INS CO 68349 ----------------------------------------------- 27475 Ynez Road #234 INSURERD: HISCOX INS CO INC 10200 Temecula, CA 92591 „INSUREREIT. ...._......_------- _______, INSURER F @ Rf1VFROrFR CFRTIFICOTF NIIMRFR• 69835402 RFV1 InN MIINIRFR- 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 OF INSURANCE...... SR0,611"POLICY NUMBER MMIDDY EFF POLICYEXP MMIDDIYYYY LIMITS GENERAL LIABILITY WS501817 01/10/2 01/10/24 EACHOCCURRENCE $1,000,000 rIRA OAiui�OrY'0 8€�rTEO" $100 000 COMMERCIAL GENERAL LIABILITY PRFMI�ES (�a. pcourrencp] ,.. , CLAIMS -MADE OCCUR MED EXP (And ane person) $ 5 , 000 PERSONAL & ADV INJURY $ 0 _ GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: '.. PRODUCTS - COMP/OP AGG $ 2 , 000 , 000 POLICY 171 LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accidenf) ..................... _$...._ ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per a accident) ..........w..._ $ AUTOS AUTOS -PROPERTY NON -OWNED L_ DAMAGEW $ HIRED AUTOS AUTOS Per accident $ . UMBRELLA LIAB .00CUR -' EACH OCCURRENCE $ AGGREGATE- ---------._----.-.-..---.---.......---.-..-.... $ EXCESS LIAR CLAIMS -MADE _ ---.RETENTION DE D RETENTION $-­­­­­­-­ $ B WORKERS COMPENSATION 9203645-23 01/26/2. 01/26/24 X WCS7ATU- OTH- AND EMPLOYERS' LIABILITY Y/N -• TI'?,B.Y..UMIT5:....-. F?. ANY PROPRIETOR/ EXCLUDE OFFICER/MEMBER EXCLUDED? � N / A E.L. EACH ACCIDENT -_.---._.w-.._---------------------------................------...-.�.__...._. $ 1,000,000 (Mandatory in NH) E.L. DISEASE - EA EMPLOYE $ 1, 000, 000 If yes, describe under DESCRIPTION. OF OPERATIONS below ....... --- E.L. DISEASE - POLICY LIMIT -----------...-........ .--- ......__.-_ $ 1 , 000 , 000 y "Bar lability - - - YB R- Each aim , D Errors & Omissions MPL1969980.23 09/08/2 09/08/24 Each Claim 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) The certificate holder is named as additional insured when required by written contract, ULK I II-IUA It HULUtK UArMAU CLLA I IUM SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of El Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street AUTHORIZED REPRESENTATIVE El Segundo, CA 90245� USA © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD shenricks 69835402