Loading...
PROOF OF INSURANCE (2025)" CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDNYYY) 05/14/2024 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' ------- Next Box First Ins i PHONE 8 ..... Next First Insurance Agency, Inc. PHONE (855) 222-5919 _�FAx a'MAI xwN _ PP @nextinsura......... Palo Alto, CA 94306 su ort nce.com RER NG StatelNa SnsuranR. Company, NAIC# _ ... p y 12831 INSURED INSURER B : PLAY Soccer........... ------- ----.. , .. 2812Santa Monica Blvd INSURERS: Santa Monica, CA 90404 INSURER D : _................ -- INSURER E : ............ .. _.-..... ..-...... INSURER F COVERAGES CERTIFICATE NUMRFR- 215671128 RFVI CIAIU Al1IlUIR11=10• 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. ... ... ......... ----. ._ bb uw aR TYPE ADDL�uffix ........ � Pouc... PE OF INSURANCEWVD Y NUMBER _.,r�oLrc�.�..... "EFF ....POLICY EXP........ ........ ...... ,.. ,... ------- I (MMI LIMITS X CO COMMERCIAL GENERAL LIABILITY EACH CLAIMS -MADE X I OCCUR OCCURRENCE A U �� � ��� $1,000,000.00 ........ t$1 Pi,EfutR,5g,tm cac¢asgre acyi,.._,00,000.00 ---- m.. ....... P (Any one person $15,000.00 A X NXTX7RDDPP-00-GL 02/29/2024 02/28/2025 PERSONAL 8 ADV INJURY $1,000,000.00 C E "LAGGR GArC LIMIT APPLIES P ER: ;GENERAL AGGREGATE $2,000,000.00 X PRO- LOC POLICY c _� PRODUCTS TS COMP/OP AGG $2,000.000.00 -�I OTHER: _P $ . 4 AUTOMOBILE LIABILITY COMBINED SWGLE q WMI7 $ ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS accident Per BODILY INJURY ( ) $ HIRED NON -OWNED PROPFR'TY OAM,AGE $ ' AUTOS ONLY AUTOS ONLY UMBRELLA LIAB OCCUR „ n EACH OCCURRENCE $ EXCESS LIAB CLAIMS MADE' .......j .... ---- I AGGREGATE 4 _....... .. ..... $ DIED RETENTION $ ( $ WORKERS COMPENSATION pp PER OTH AND EMPLOYERS' LIABILITY Y / N '....... ', d ,STATUTE ER _ ANYPROPRIETOR/PARTNER/EXECUTIVE ""' OFFICER/MEMBEREXCLUDED? L N/A E L EACH ACCIDENT $ (Mandatory in NH) E.L. DISEASE- EA EMPLOYEE If yes, describe under ................._ _......- .......... ......... ........... DESCRIPTION OF OPERATIONS below �..$ EL. DISEASE POLICY LIMIT $ Each Occurrence: $1,000,000.00 A Professional Liability NXTX7RDDPP-00-GL 02/29/2024 02/28/2025 Aggregate: $2,000,000.00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The Certificate Holder isThe City of LI 5egundo, its officers, officials, employees, agents, and volunteers. This Certificate Holder is an Additional Insured on the General Liability policy per the Additional Insured Automatic Status Endorsement. All Certificate Holder privileges apply only if required by written agreement between the Certificate Holder and she insured, and are subject to policy terms and conditions. CERTIFICATE HOLDER CANCELLATION The City of El Segundo, its officers, officials, employees, LIVE CERTIFICATE agents, and volunteers r 9 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE El S IMof THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Segundo, ndo, CA 90245 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE W K: Click or scan to view ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD CALIFORNIA EVIDENCE OF FINANCIAL RESPONSIBILITY Vame and Address of Insured NAIC 25968 JUAN DIEGO GUIGA 2812 SANTA MONICA BLVD STE 202 SANTA MONICA CA 90404-2432 f KELLIE D GUIGA 0 JUAN DIEGO GUIGA I KENNETH D GUIGA d LUCA ALEXANDER GUIGA I nsurance Company PAGE 4 --- -- -- ----- -- - -b_ai c_k. --- _--- - - -_ - - California Evidence of Financial Responsibility Keep this card. IMPORTANT: The California Financial Responsibility Act (Section 16020) of the Vehicle Code requires every owner or operator of a vehicle subject to the requirements of the Financial Responsibility Act to carry evidence of financial responsibility in the vehicle at all times. Under vehicle code (Section 16028) every driver involved in an accident must provide evidence of financial responsibility at the scene. Failure to comply is an infraction and shall be punishable by fines, impoundment or license suspension. olicy Number Effective Date Expiration Date 0OB70 97 78C 7103 8 t04/22/24 10/22/24 'ehicle Make/Vehicle Identification Number Year Additional copies available at usaa.com ESLA 2022 CONTACT US: 210-531—USAA(8722) his policy provides at least the minimum amounts of liability insurance equired by the CA VEH CODE SECTION 16056 for the specified vehicle and OR 800-53 1—USAA amed insureds and may provide coverage for other persons and other ehicles as provided by the insurance policy. 9800 Fredericksburg Road, San Antonio, Texas 78288 _ _ _ _ _ _ - _ _ _ _ _ _ Identification Cards _ _ - _ _ _ _ - - California Automobile -Insurance Iden - _ _ _ _ . _ _ We've issued two identification cards as evidence of liability insurance for your vehicle(s). These cards are valid only as long as liability insurance remains in force. Keep a copy of the ID card in your vehicle at all times. You may be required to produce your identification card at vehicle registration or inspection, when applying for a driver's license, following an accident, or upon a law enforcement officer's request. 53CA 1 Rev. 06-13 03/22/24 'ALIFORNIA EVIDENCE OF FINANCIAL RESPONSIBILITY lame and Address of Insured JUAN DIEGO GUIGA 2812 SANTA MONICA BLVD STE 202 SANTA MONICA CA 90404-2432 KELLIE D GUIGA JUAN DIEGO GUIGA KENNETH D GUIGA LUCA ALEXANDER GUIGA nsurance Company NAIC 25968 'olicy Number 1 Effective Date Expiration Date 00870 97 78C 7103 8 04/22/24 1,10/22/24 iehicle Make/Vehicle Identification Number Year FESLA 2022 t 0 1 d 55047-0513_02 California Evidence of Financial Responsibility Keep this card. IMPORTANT: The California Financial Responsibility Act (Section 16020) of the Vehicle Code requires every owner or operator of a vehicle subject to the requirements of the Financial Responsibility Act to carry evidence of financial responsibility in the vehicle at all times. Under vehicle code (Section 16028) every driver involved in an accident must provide evidence of financial responsibility at the scene. Failure to comply is an infraction and shall be punishable by fines, impoundment or license suspension. Additional copies available at usaa.com rhis policy provides at least the minimum amounts of liability insurance 'equired by the CA VEH CODE SECTION 16056 for the specified vehicle and lamed insureds and may provide coverage for other persons and other ✓ehicles as provided by the insurance oolicv. CONTACT US: 210-531—USAA(8722) OR 800-531—USAA .� ..,..-., V. -— 10waa ------------------------------------- ;ALIFORNIA EVIDENCE OF FINANCIAL RESPONSIBILITY lame and Address of Insured NAIC 25968 JUAN DIEGO GUIGA 2812 SANTA MONICA BLVD STE 202 SANTA MONICA CA 90404-2432 KELLIE D GUIGA JUAN DIEGO GUIGA KENNETH D GUIGA LUCA ALEXANDER GUIGA nsurance Isompany t 0 1 d PAGE 6 ____-,.___,.___- --b-a c-I------ ------- - -- California Evidence of Financial Responsibility Keep this card. IMPORTANT: The California Financial Responsibility Act (Section 16020) of the Vehicle Code requires every owner or operator of a vehicle subject to the requirements of the Financial Responsibility Act to carry evidence of financial responsibility in the vehicle at all times. Under vehicle code (Section 16028) every driver involved in an accident must provide evidence of financial responsibility at the scene. Failure to comply is an infraction and shall be punishable by fines, impoundment or license suspension. 'olicy Number Effective Date Expiration Date' 00870 97 78C 7103 8 1 04/22/24 110/22/24 Jehicle Make/Vehicle Identification Number Year Additional copies available at usaa.com NCURA 2016 CONTACT US: 210-531—USAA(8722) This policy provides at least the minimum amounts of liability insurance OR 800-53 1 —USAA equired by the CA VEH CODE SECTION 16056 for the specified vehicle and lamed insureds and may provide coverage for other persons and other ehicles as provided — an by the insurance policy. _ _ _ _ _ — —9800 FredericksburgvRoad, — San Antonio, Texas 78288 -————— — —__ —— ®� _ - California AutomobileInsuranceIdentification Cards We've issued two identification cards as evidence of liability insurance for your vehicle(s). These cards are valid only as long as liability insurance remains in force. Keep a copy of the ID card in your vehicle at all times. You may be required to roduce your identification card at vehicle registration or inspection, when applying for a driver's license, following an accident, or upon a law enforcement officer's request. —02 53CA3 Rev. 06-13 03/22/24 _ - - - - - - - - - - - - - - - -- -------------------..__---__- -_-- ___-T---------------back CALIFORNIA EVIDENCE OF FINANCIAL RESPONSIBILITY Name and Address of Insured JUAN DIEGO GUIGA 2812 SANTA MONICA BLVD STE 202 SANTA MONICA CA 90404-2432 KELLIE D GUIGA JUAN DIEGO GUIGA KENNETH D GUIGA LUCA ALEXANDER GUIGA Insurance Company Policy Number NAIC 25968 Effective Date G Expiration Date 00870 97 78C 7103 8 04/22/24 10/22/24 Vehicle Make/Vehicle Identification Number Year ACURA 2016 This policy provides at feast the minimum amounts of liability insurance required by the CA VEH CODE SECTION 16056 for the specified vehicle and named insureds and may provide coverage for other persons and other uphirles as provided by the insurance policy. California Evidence of Financial Responsibility Keep this card. IMPORTANT: The California Financial Responsibility Act (Section 16020) of the Vehicle Code requires every owner or operator of a vehicle subject to the requirements of the Financial Responsibility Act to carry evidence of financial responsibility in the vehicle at all times. Under vehicle code (Section 16028) every driver involved in an accident must f provide evidence of financial responsibility at the scene. Failure to comply is an infraction and shall be punishable by I fines, impoundment or license suspension. d Additional copies available at usaa.com CONTACT US: 210-531—USAA(8722) OR 800-531—USAA 9800 Fredericksburg Road, San Antonio, Texas 78288 --------------------------- CALIFORNIA EVIDENCE OF FINANCIAL RESPONSIBILITY -- — I- - - Name and Addre ss of Insured NAIC 25968 JUAN' DIEGO GUIGA 2812 SANTA MONICA BLVD STE 202 SANTA MONICA CA 90404-2432 KELLIE D GUIGA JUAN DIEGO GUIGA KENNETH D GUIGA LUCA ALEXANDER GUIGA Insurance Uompany POlicy Number 00870 97 78C 7103 8 Effective Date Expiration Date 04/22/24 10/22/24 t 0 1 d ----------------- PAGE 5 b-a c-k-------- California Evidence of Financial Responsibility Keep this card. IMPORTANT: The California Financial Responsibility Act. (Section 16020) of the Vehicle Code requires every owner or operator of a vehicle subject to the requirements of the Financial Responsibility Act to carry evidence of financial responsibility in the vehicle at all times. Under vehicle code (Section 16028) every driver involved in an accident must provide evidence of financial responsibility at the scene. Failure to comply is an infraction and shall be punishable by fines, impoundment or license suspension. Vehicle WKe Vehicle ldentificatlon der Year Additional copies available at usaa.com CHEV 2019 This policy provides at least the minimum amounts of liability insurance CONTACT US: 210-531—USAAi87221 required by the CA VEH CODE SECTION 16056 for the specified vehicle and OR 800-531—USAA named insureds and may provide coverage for other persons and other vehicles as provided by the insurance policy. 9800 Fredericksburg Road, San Antonio, Texas 79288 - _ _ _ _ - - _ _ - California Automobile Insurance Identification Cards We've issued two identification cards as evidence of liability insurance for your vehicle(s). These cards are valid only as long as liability insurance remains in force. Keep a copy of the ID card in your vehicle at all times. You may be required to pproduce your identification card at vehicle registration or inspection, when applying for a driver's license, following, an acciddent, or upon a law enforcement officer's request _53CA2Rev 06-13 __ - -- _,-____-03/22/24---------- ----- - -- --- 55047-0513 02 CALIFORNIA EVIDENCE OF FINANCIAL RESPONSIBILITY Name and Address of Insured NAIC 25968 JUAN DIEGO GUIGA 2812 SANTA MONICA BLVD STE 202 SANTA MONICA CA 90404-2432 KELLIE D GUIGA JUAN DIEGO GUIGA KENNETH D GUIGA LUCA ALEXANDER GUIGA Insurance Company nMPANY Policy Number Effective Date Expiration Date 2/24 10/22/24 00870 97 78C 7103 8 04/2„ ^^_ f 0 1 d California Evidence of Financial Responsibility Keep this card. IMPORTANT: The California Financial Responsibility Act (Section 16020) of the Vehicle Code requires every owner or operator of a vehicle subject to the requirements of the Financial Responsibility Act to cant' evidence of financial responsibility in the vehicle at all times. Under vehicle code (Section 16028) every driver involved in an accident must provide evidence of financial responsibility at the scene. Failure to comply is an infraction and shall be punishable by fines, impoundment or license suspension. 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: (_) 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, C_) 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 Name of Agent Policy Number Expiration Date Phone # NZ I certify that, in the performance of the work set forth in the agreement with the City of El Segundo, I will not employ any person in any manner so as to b came subject to the workers' compensation laws of California, and agree that, if I should become sul jegt to t=orkers' compensation provisions of Labor Code § 3700 1 must immediately comply with those prosior'af/t. agreement will automatically become void. Signature of Applicant Print Name Agreement for: Dated: I Reviewed by: ry Date M 2