PROOF OF INSURANCE (2025 - 2025)1 0
ACOR" CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DD/YYYY)
04/03/2024
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:
Hiscox Inc. d/b/a/ Hiscox Insurance Agency in CA
PHONE FAX
A/C No Ext : ($$$) 202-3007 A/C No):
5 Concourse Parkway
E-MAIL
Suite 2150
ADDRESS: contact@hiscox.com
INSURER(S) AFFORDING COVERAGE
NAIC#
Atlanta GA, 30328
INSURERA: Hiscox Insurance Company Inc
10200
INSURED
INSURER B
E-Bike Sense, LLC
1401 mahattan ave
INSURER C :
Hermosa Beach, CA 90254
INSURER D :
INSURER E :
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.
INSR
LTR
TYPE OF INSURANCE
ADDL
I
SUBR
POLICY NUMBER
POLICY EFF
MM/DD/YYYY
POLICY EXP
MMIDD/YYYY
LIMITS
X
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$ 2,000,000
CLAIMS -MADE � OCCUR
DAMAGE TO
PREM SES (Ea occurrence) ence)
$ 100,000
_7TED
MED EXP (Any one person)
$ 5,000
PERSONAL BADVINJURY
$ 2,000,000
A
P101.621.387.2
04/04/2024
04/04/2025
GEN'LAGGREGATELIMITAPPLIESPER:
GENERAL AGGREGATE
$ 2,000,000
JPRO-
X POLICY LOC
PRODUCTS - COMP/OP AGG
$ S/T Gen. Agg.
$
OTHER:
AUTOMOBILE
LIABILITY
COMBINED SINGLE LIMIT
Ea accident
$
BODILY INJURY (Per person)
$
ANY AUTO
ALL OWNED SCHEDULED
AUTOS AUTOS
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
Per accident
$
NON -OWNED
HIRED AUTOS AUTOS
UMBRELLALIAB
OCCUR
EACH OCCURRENCE
$
AGGREGATE
$
EXCESS LIAB
CLAIMS -MADE
DED I I RETENTION $
$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
PER OTH-
STATUTE ER
ANYPROPRIETOR/PARTNER/EXECUTIVE
E.L. EACH ACCIDENT
$
OFFICER/MEMBER EXCLUDED? ❑
N/A
E.L. DISEASE- EA EMPLOYEE
$
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
$
A
Professional Liability
P101.620.707.2
04/04/2024
04/04/2025
Each Claim: $ 1,000,000
Aggregate: $ 1,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
CERTIFICATE HOLDER CANCELLATION
City of El Segundo
350 Main Street
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 I
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