PROOF OF INSURANCE (2023 - 2024) CLOSEDGet your digital proof of insurance &, membership card on t'hle AAA App
*Downloald thei appi. Click AAA.com/ii
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f W66;i OF INSURANCE VEHICLIES ON POLICY
4'00 Interinsurance deafdangle of the A00MIDbile Ctub YEAR MAKE
NAIC #,, 15159,8
20,18 NF1 05010T
Narned Msured Pdiicy Nuirrsberr CAA13091166,94
_SIEGE T
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DRIVERS ON! POUCY
Effective Date: 018105/2023 Expirattori Date-, 08105024
SIFIi SHIHO
Thk pohicy provides at least the rninerruirn ammods of flabifity iftau mrncc�
required by the CA VEH GODE sEx.'rION 160,56 for the spW.'Ified vehides,
and named Insurads. Coverage sotqect 10 Plobicy tar"Is and Ifirrifts,
W )(1R,JU FIA".1E AN CMAL 4DUV2, 24,7 AX41, CLAf'r,"4's, 4ioy , t"I(Iii
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After an accident, exchange infoi With the other party ard
Ullow these 5 easy steps;;
Stop I; Put I vehjicle over to a wife pi1ace, Got the names, widresses, Stop 4, Take phi of the vehicies nnvclved, dama, gies arA
arul phory numbers of alt tti trivalved in the accdiii e,g,, ua surri area of the accidierq, 9 it ins safe No dio so,
pedestrians, witresses, other passengers, etc,
Step 5Ged our, AAA 04ims Hoffine at 800-672-5,246 to repot the
J'i Stop Z Take phi ' (m w Re down the other [pxrsion's drivW's ross. If (wicessary, we, WIN wrainge to has yourvehIcte tcywvxJ, Ouir
0
I I hcense Hormation andl other vehicle's kcmse p1late number, na., provider's tow trucks at'ys misplay the AAA eftlem,
includilngi state, of, registration,
Do nol t,'Adirnit m4ponsibift fan or discuss the circumi ofthe ac0dent
Step I Take photos of or wrihi id�'r the cither person" s kisurance with aii athor thari Me porico or anaiNwfiied Aii4o i r.Wins
Card informaAksr, repirevoirtafive, Do not dirs,0080 yoor pWlcy Units to anyone
For q1rxr,
5,6D-5 r.w chigews In yi;nor IrOcy, calk t-877 422-2100, Manday through r,lmy tor7 n s-m, W 9 p ran, iRdur Sdafro y m 8 a, M'1, ti) 5 P,11n
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Race a proof of tinsurance card in each vehicte insured under, yo�ur pi In
adidifi,on, we suggest that each Hsted driver carry a card, Under Caflifornia law,
drivers and owners of a motor vehicle must be aibte to shoiw proof of tmaficial
responsibility at ail tirnes. These cards become Invalid and should be destroyed on
the expiration or termination date of the policy.
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PROOF OF INSURANCE VEHICLES ON POUCY
Intiatinsurance Ex&&Ve c4the Autormoi Chub YEAR VAIKE
NAIC #: 155981 2018 INPI 050 3.OT
Namied Insured Ploficy Numbec CAA.1 30916694
X
DRIVERS ON POUCY
0
Effecfive MAw 0=512,023 Expirabor, Date- g fg 5/2,02 GSIEGERT, SIF HO
Thai puflicyproAdes at least the ndRnimum arnouirds of liablRyini
required by the CA VEN CODE SECTiION UM56 for the ape6fied vehides
and nomW insureds. Coverage Wbitcl to potilcyterms and hrrifts,
FREMEN
VIE H 1,0 9
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iF YOU IHAVE AN ACODEN'r CALL OUR 2417 AAA C.LAIMS HOTUNIE 1-800-672-5246
AftUm, wa acicident, 44owrnaficm w4h ttxb cAher pairty and
Virwi thii 5 azzy weps�
Step I � Pult vehicle ovw- to a safe peace, Get the narnes, addresses,
11) invoNed the acciden
t, nt, e,g,,
and phmw nurn i of alt perms
pedestrians, Wtni other passengers, etc.
Step 2: Take photos, of or writte down the other person's didwr's
I license information and other w9hildes ficense plate niumbiii 10L
incividing state (i roii,
Step 3; T'aike photos of at wile djoi the other persan'5 wrvsuirance
'i Card 1111wiTwoon,
Step 4, Take photos of the vehklea inwilved, daunt ayes and
SUIFOUndhig arm of the acciident, J it use safe to do so,
Stop 5: Celt our AAA Claims Hot One at 800-672-5246 to repo the
loss, if necessary, we Wit arrant to have your vehitcle towed, Our
pruAders trw trucks always display the, AAA erriAem ,
Do not a0ml ;eVonsibddy kff or discass the circumstarrcoi of thiei accidenit
w&w anyone Wwe than Me podice or an aWhohired Ai Club claims
mprommitafive oar not discifase yorAr policy Yrnils to anyraie,
i
For quesdorms or ctiangei to Vitu pohRRri caH r-877-422.2 IDO, MoryJay thiii Fr dimay Orum'Rl a.m To 9 p rn. ar. Saturday frarn 8 a rim. W 5, p,rn. i
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WIROAR III•'s aur
L _) I I have and will maintain a certificate of consent of self insure for worker's'cornpensation, issued by the Director
tf lnt4strial Ralatisnis as rseVkaii ftW-y L--,Vv&r-,-4e J11i Nr tXe ,* w*rk set NAX t*e qgree-Moht
with the City of �El'Segiundo.
liam'fir
L_) it have and will maintain workers' compensation insurance as required by Labor Code § 370O for the performance
of the, work for which the agreement with the City of El Segundo is executed. My workers' compensation Inis,uraince
carrier and policy number are:
Carrier Policy Id umib,er Expiration Date
ZEM- N #ent Phone #
�) i certify t�hat, in the performance of the work set forth in the agreement with the City of El Segundo, I will not
employ any persoin in any manner so as to, become subject to the workers' compensation laws of California, and
agireei that, if I should be�come subject to the workers' compensation provisions of Labor Code § 3700, 1 must
immediately comply wilth those Provisions or the agreement will automatically become void.
Signature of Applicant Date 11: /26/2�023
Print Name - Shiho, Slegert
Agireeimentfor- DOVV
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