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PROOF OF INSURANCE (2024 - 2024) CLOSED14 CERTIFICATE OF LIABILITY INSURANCE °�W27 02 ' 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 endorsemenl(s). PRODUCER NA fLIP PrDgrarn Suppo-A Veracity Insurance Solutions. LLC. Ptictte (644 5 2 FAX .iAGflr'�.167.,E,P,F ,._ ,,,.m..,_,.,.... 260 South 25M Wes(, Suite 303 kxc ir!"'Wiprogram corn ... _ ..,. ,,..,. ..., .......... Pleasant Grove UT 04062 UtSUfiErEIS ArraRDUTO CC4VE1LAQ6 NAIC t Great Amefiran ANance lasusance (,'c, 26832 INSURED 9B-mStl.ARE'LR Cti �, The sand of times, DBAOniMon INSURER c: 770 West Imperial Avenue unit 51 INSUHtR la, El Segundo CA 90245 KSURER E; INSURER.Fr COVERAGES CERTIFICATE NUMBER: REVISION NUMBER; THIS IS TO CERTIFY THAT T)IE'.. POLICIES OF INSURANCE. LISTED Bitow HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PER= 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. �.,. %URA' `POM1IC.Y£0. .P LTR TYPE OF 04URANCE `.. r�r Ah ND POLICY NUFRIER� DDNYYY YY4... LINiTS OENERALLULDILM EACH OCCURRENCE S 1.000.D1.ID 114 CUUMERCIAt. OtNVRAL LAD MIT A r--,, w ,.. I � �P£ O.�rvk;S Ea xr�_ers¢e$.._ % .„ , ,...... _ 300.000 ... . w.tAVArS MADEE oCcufa 91E0 . $ , .. 5,000 , . PLF046122-F222756 �027R023 7 24 A 1 PSRsa SADV INJURY., S &.IO,fAtkO .,,GENERAL AGGREGATE........_ s ,,._. ,., .._..... .... ... ... ....._.. ,. _ _..,, ia''L�' L1,�AGDHtQ'ATE LIMIT APPLIES PER: Ifla'�bP,v0JCT'S - C 0N# MBC1PAGG �S 2,000. X P _ PrARC e 'PRO' -- LtJG _I' ANIMAL EIAILEE _• IT 1 A11TONR. ANYAUTO �. SOOILYINJURY (Pa pmonl S ALL OWNED SCHEDULED kkiOOW.Y IAd,MJRY 61Tme dlnnfly S AUTOS AUTOS _fl9V7AL.yMJrkE,i7 f*G44Y'pEtikDw Cd114.+.."tl HIRED AUTOS - AUTOS , . I. S UNaRELLA UA5 OCCUR ..� .. E.ACN OUT:99F1'REtaCE. 4 A EXCESS LIAR . C L„ Lh15 m.AL7R,' DEC VErgnatll'p, 4 � iVKMXM C0#&VXSATMNER AND ' AND PLOYEP-7IUAsxny YIN 1 , . •. . . ANY PROPRIETOR'PARTNERVEXECUTIVE i•—L .P�' EL EACH ACCSDENT 5 OFFICEIMRWER EXCLUDED? NrA 11I,w.Ndwt. .fl 'Pm NNI •-- Vt S EL DISEASE-. FAY, I.'4Pf,O"A .. - ...., .. dcetlK'�$#4'o" . °LERI6'4CL2La: 'a"^• , S .IUAII S E L UdDE:A*'E .� Pt3l ILY pW .t:S2 _. DESCRIPTION OF OPERATIORS I LOCATMUS I VERK:.ES (ADxJI ACORD 19t, Addiuw Rr ks Sch dWq. d rACTe spaco iS mWimdl Certificate holder had been added as additional insured regarding the above mentioned pofiCy per attached Additional Insured - Designated Person or Organization (CG 20 26 Ed. 04 13) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of 8 Seglulda Recreation, Parks, & Library ACCORDANCE WITH THE POLICY PROVISIONS, 300 Main Streel Ell Scgundo, CA 90245 AUrAORIM REPRESENTATIVE /•" @HOAR-9n1A Af`nRn f_nRPnPATICIN Ail rinhm rr*SminNpd ACORD 25 12014101) The ACORD name and logo are registered marks of ACORD INS025 poi4ai- PLF046122-F222758 CG 20 26 (Ed. 04 13) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies Insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Schedule Name of Additional Insured Person(s) or Organizatlon(s): City of Ell Segundo Recreation, Parks, & Library Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. SECTION 11- WHO IS AN INSURED is amended to include as an Additional Insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury," "properly damage" or "Personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: 1. in the performance of your ongoing operations; or 2, in connection with your premises owned by or rented to you. However.- 1. the insurance afforded to such additional insured only applies to the extent permitted by law; and 2. if coverage provided to the Additional Insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these Additional Insureds, the following is added to SECTION Ill — LIMITS OF INSURANCE: If coverage provided to the Additional Insured is required by a contract or agreement, the most we will pay on behalf of the Additional Insured is the amount of insurance: 1. required by the contract or agreement; or 2. available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. Copyright, ISO Properties, Inc., 2012 CG 20 26 (Ed. 04/13) PRO Page 1 of 1 AUTOMOBILE INSURANCE IDENTIFICATION CARD ® MAPFRE I INSURANCE' PO BOX 8006 PLEASANTON, CA 94588 NAIC 413161 POLICY EFFECTIVE EXPIRATION NUMBER DATE DATE 6401050004755 03/14/2024 09/14/2024 NAMED INSURED KANA MUKAI STEVEN CHENG VEHICLE 2010 TOYOTA PRIUS AGENT 317 MARUMOTO INSURANCE AGENCY LLC 1559 W. WILLOW ST. LONG BEACH CA 90810 562-595-4403 Coverage provided by the above referenced policy meets the minimum liability limits prescribed by financial responsibility law, This curd must be carried in the insuredmotor vehicle for production upon demand. AUTOMOBILE INSURANCE IDENTIFICATION CARD ® MAPFRE I INSURANCE' PO BOX 8006 PLEASANTON, CA 94588 NAIC #13161 POLICY EFFECTIVE EXPIRATION NUMBER DATE DATE 6401050004755 03/14/2024 09/14/2024 NAMED INSURED KANA MUKAI STEVEN CHENG VEHICLE 2007 CHEVROLET AVALANCHEC1500 2 AGENT 317 MARUMOTO INSURANCE AGENCY LLC 1559 W. WILLOW ST. LONG BEACH CA 90810 562-595-4403 Coverage provided by the above referenced policy meets the minimum liability limits prescribed by financial responsibility law. This card must be carried in the insured motor vehicle for production upon demand. AUTOMOBILE INSURANCE IDENTIFICATION CARD ® MAPFRE I INSURANCE - PO BOX 8006 PLEASANTON, CA 94588 NAIC #13161 POLICY EFFECTIVE EXPIRATION NUMBER DATE DATE 6401050004755 03/14/2024 09/14/2024 NAMED INSURED KANA MU" STEVEN CHENG VEHICLE 2020 NISSAN ROGUE SPORTSSVSL J. N i6 AGENT 317 MARUMOTO INSURANCE AGENCY LLC 1559 W. WILLOW ST. LONG BEACH CA 90810 562-595-4403 Coverage provided by the above referenced policy meets the minimum liability limits prescribed by financial responsibility law. This card must be carried in the insured motor vehicle for production upon demand.. AUTOMOBILE INSURANCE IDENTIFICATION CARD ® MAPFRE I INSURANCE' PO BOX 8006 PLEASANTON, CA 94588 NAIC #13161 POLICY EFFECTIVE EXPIRATION NUMBER DATE DATE 6401050004755 03/14/2024 09/14/2024 NAMED INSURED KANA MUKAI STEVEN CHENG VEHICLE 2010 TOYOTA PRIUS AGENT 317 MARUMOTO INSURANCE AGENCY LLC 1559 W. WILLOW ST. LONG BEACH CA 90810 562-595-4403 Coverage provided by the above referenced policy meets the minimum liability limits prescribed by financial responsibility lave. This card must be carried in the insured motor vehicle .for production upon demand. AUTOMOBILE INSURANCE IDENTIFICATION CARD O MAPFRE I INSURANCE' PO BOX 8006 PLEASANTON, CA 94588 NAIC #13161 POLICY EFFECTIVE EXPIRATION NUMBER DATE DATE 6401050004755 03/14/2024 09/14/2024 NAMED INSURED KANA MUKAI STEVEN CHENG VEHICLE 2007 CHEVROLET AVALANCHEC1500 AGENT 317 MARUMOTO INSURANCE AGENCY LLC 1559 W. WILLOW ST. LONG BEACH CA 90810 562-595-4403 Coverage provided by the above referenced policy meets the minimum liability limits prescribed by financial responsibility law. This card must be carried in the insured motor vehicle for production upon demand. AUTOMOBILE INSURANCE IDENTIFICATION CARD ® MAPFRE I INSURANCE' PO BOX 8006 PLEASANTON, CA 94588 NAIC #13161 POLICY EFFECTIVE EXPIRATION NUMBER DATE DATE 6401050004755 03/14/2024 09/14/2024 NAMED INSURED KANA MUKAI STEVEN CHENG VEHICLE 2020 NISSAN ROGUE SPORTSSVSL AGENT 317 MARUMOTO INSURANCE AGENCY LLC 1559 W. WILLOW ST. LONG BEACH CA 90810 562-595-4403 Coverage provided by the above referenced policy meets the minimum liability limits prescribed by financial responsibility law. This card must be carriedin the insured motor vehicle for production upon demand. WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL ANDSUBJECTS AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100, ), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN LABOR CODE § 3706, INTERESTAND ATT NE)rS FEES. _ • M ,. • • _ b W a • Wr #b. • m 7 Is ti • aW 7r- 717111.. 1F• ,. a�'b .—..A — Me. I 1., .1 l , r Mir^. ar � r: : r ,., �•, • « urr, .:.� � ., • sw. • • _ 1 1 - - � _. w ♦�. W77 ,.• _. Jtl AIY aa�. M�, 'y. ,. .� �,: : � � , n _ . „�� W r w ,::rr. �. ^.. «ar. _.nr«. . • ^. , �w�`"� r�r .naw �, .�;t• +� • o-..^�* w �,: r ar t• • -, ► ► �. �^ a�..� w. •• • � � •� w ►� ► �►'' � fir' (.. •..a+.: arr�r of P" Nam Agreement for: 0Kj MAYn RevWymd by