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PROOF OF INSURANCE (2025 - 2025)A ' CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 07/19/2024 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 iA) Pltl Ilt) ... - FAX Next First Insurance Agency, Inc. PHONE (855) 222 5919 su ort@nex _ (Arc No), PO Box 60787 tinsuran ADDRr ce com Palo Alto, CA 94306 ADDraes: PP ......... ... INSURERS) AFFORDING COVERAGE _ NAIC # A: State National Insurance Company Inc I,12831 INSURED INSURER B : Farrah wellness 424 aryland St INSURER C El Segundo, CA 90245 INSURER D : nw�ow�oc� roorararerr uuuaoco- imSn�Fr;n RFVIRIr1M MIIMRFR- 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. .......... .INSRL, ............ ..... . i.ADbLft7il... --------- ...,......_ ,.. ,„........,.... ..,.,_,_,...._._. ........�__ FF POLICY EXP I LIMITS I. MMIDDY., LTR TYPE OF INSURANCE POLICY MM/DD X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE I $ 2,000,000 00 CLAIMS -MADE EX OCCUR tyItmAti1 fi3 CaErw tl PRrM1SES tEa oca uereruca„ ... $100,000.00 MED EXP 1_ $15 000.00 A _-- X NXT4XTRRFC-00-GL 07/19/2024 '07/19/2025 — _ (Any one person) PERSONAL&ADVINJURY _..__ I $2,000,00000 .... ... ,.,_, .....__. ..... ..... GEN'LAGGREGATE LIMIT APPLIES PER: ATE GENERAL AGGREGATE $4 000 -- 00 .," ". X .. � JPGI' LOO PRODUCTS COMP/OP AGG $4 000,000.00 OGCHEF $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMP $ ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY INJURY (P I� (Per accident) $ AUTOS ONLY _........ _. AUTOS HIRED NON -OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident),.... ....._ . ... . UMBRELLA LIAB I OCCUR I ^I EACH OCCURRENCE($ 4 EXCESS LIAR J CLAIMS-MADE E AGGREGATE "" . .. .. .. ... .. . . . . ................. .­­­ ^ .. ............ . . I DED RETENTION $ $ WORKERS COMPENSATION ORTH ''. STATUTE """" " AND EMPLOYERS' LIABILITY Y� ... " ANYPROPRIETOR/PARTNER/EXECUTIVE E L EACH ACCIDENT mm " __ $ — ........ - OFFICER/MEMBEREXCLUDED? (Mandatory in NH) N / p` '—....._ E $ If yes, describe under E.L. ISEASE- POLICY LIMIT DESCRIPTION OF OPERATIONS below Each Occurrence: $2,000,000.00 A Professional Liability NXT4XTRRFC-00-GL 07/19/2024 07/19/2025 ,Aggregate: $4,000,000.00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The Certificate Holder is City of El Segundo. This Certificate Holderis an Additional Insured on the General LIability,policy on a primary and non-contributo basis. This Holder is Additional Insured the General Liability with respect to onggoing operations, This Certificate Holder' is an Additional Inscrrer on the General Certificate an on policy Liability with respect to completed operations General Liability coverage applies for Yoga Instructor operations in California. All Certificate Holder privileges apply only if policy required by written agreement between the Certaf¢cxate Holder and the insured, and are subiect to policy terms and conditions. CERTIFICATE HOLDER CANCELLATION City of El Segundo LIVE CERTIFICATE ff SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE o Icers, official employees, agents and volunteers 350 Main St THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN El Segundo, CA 90245 " ACCORDANCE WITH THE POLICY PROVISIONS. i AUTHORIZED REPRESENTATIVE 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 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLICY CHANGES Policy Change Number 01 POLICY NUMBER POLICY CHANGES COMPANY EFFECTIVE NXT4XTRRFC-00-GL 07/19/2024 State National Insurance Company, Inc. NAMED INSURED AUTHORIZED REPRESENTATIVE Leah Turano Family wellness 424 Maryland St 0 Segundo, CA 90245 Ann Ryan COVERAGE PARTS AFFECTED Commercial General Liability Coverage Part CHANGES SEE ATTACHED SCHEDULE Return Total $0.00 Authorized Representative Signature IL 12 01 11 85 Copyright, Insurance Services Office, Inc., 1983 Page 1 of 2 0 Copyright, ISO Commercial Risk Services, Inc., 1983 SCHEDULE OF POLICY CHANGES II Alt is understood and agreed that: The following, forms are added. NXT-0084 BM GL 0218 - Designated Additional Insured - Primary Insurance CG 20 10 04 13 - Additional Insured - Owners, Lessees or Contractors - Scheduled person or Organization CG 20 37 04 13 - Additional Insured - Owners, Lessees or Contractors - Completed Operations I other terms and conditions remain unchanged. IL 12 01 11 85 Copyright, Insurance Services Office, Inc., 1983 Page 2 of 2 ❑ Copyright, ISO Commercial Risk Services, Inc., 1983 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED ADDITIONAL INSURED - PRIMARY INSURANCE This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Additional Insured Person or Organization: Crt of El Segundo officers, official employees, agents and volunteers 50 Main St El Segundo, CA 90245 I. SECTION II - WHO IS AN INSURED is amended to include the person or organization shown in the SCHEDULE, but only with respect to liability for "bodily injury", "property 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. With respect to the insurance afforded to these additional insureds, the following is added to SECTION III — 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. III. Coverage provided to the additional insured shown in the SCHEDULE is afforded on i) a primary basis, ii) a noncontributory basis, or iii) a primary and noncontributory basis in accordance with the applicable written contract between you and the additional insured. All other terms and conditions of the policy remain unchanged. NXT-0084 BM GL 0218 Includes material copyrighted by Insurance Services Office, Inc. used with its Page 1 of 1 permission POLICY NUMBER: NXT4XTRRFC-00-GL COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR • • PERSON OR • ' ,'„ • This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Or anization s Locations Of Covered Operations City of El Segundo CA officers, official employees, agents and volunteers 350 Main St El Segundo, CA 90245 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section If — Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following additional organization(s) shown in the Schedule, but only exclusions apply: with respect to liability for "bodily injury", "property This insurance does not apply to "bodily injury" or damage" or "personal and advertising injury" 11property damage" occurring after: caused, in whole or in part, by: 1. All work, including materials, parts or 1. Your acts or omissions; or equipment furnished in connection with such 2. The acts or omissions of those acting on your work, on the project (other than service, behalf; maintenance or repairs) to be performed by or in the performance of your ongoing operations for on behalf of the additional insured(s) at the the additional insured(s) at the location(s) location of the covered operations has been designated above. completed; or However: 2. That portion of "your work" out of which the injury or damage arises has been put to its 1. The insurance afforded to such additional intended use by any person or organization insured only applies to the extent permitted by other than another contractor or subcontractor law; and engaged in performing operations for a 2. If coverage provided to the additional insured is principal as a part of the same project. 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. CG 20 10 0413 © Insurance Services Office, Inc., 2012 Page 1 of 2 C. With respect to the insurance afforded to these additional insureds, the following is added to Section III — 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. Page 2 of 2 © Insurance Services Office, Inc., 2012 CG 20 10 0413 POLICY NUMBER: NXT4XTRRFC-00-GL COMMERCIAL GENERAL LIABILITY CG 20 37 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. .............. 91IN k I ohT.,ilket 1101i •RN a • • This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations City of El Segundo officers, official employees, agents and volunteers 350 Main St El Segundo, CA 90245 Yoga Instructor services in CA Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — 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" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the Schedule of this endorsement performed for that additional insured and included in the "products -completed operations hazard". 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 III — 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. CG 20 37 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 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. 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. L_) 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 Policy Number Expiration Date Name of Agent Phone # Xd 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 become subject to the workers' compensation laws of California, and agree that, if I should become subject to the workers' compensation provisions of Labor Code § 3700 1 must immediately comply with those provisi' s or the agreement will automatically become void. Signature of Applicant:'' Date 5.10•2024 Print Name Leah Turano Agreement for: -I O 2,1 Dated: 4 Reviewed by: tcY--KA-" A ' � `