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PROOF OF INSURANCE (2024 - 2024)CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 06/15/2024 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 _... Hiscox Inc. d/b/a/ Hiscox Insurance Agency in CA (tN(888) 202-3007.... ...... F!VArX 5 Concourse ParkwayE-MAIL Suite 2150 -oxco.r..- _,_. Atlanta GA, 30328 INSURER(S) AFFORDING COVERAGE NAIL # INSURERA Hiscox Insurance Company Inc I 10200 ........ ............................................................... ,,. _,_.,..... .... . INSURED INSURER B City Advisors, LLC 15 Rastro Street INSURER C Ladera Ranch, CA 92694 i,NSURERD COVERAGES CERTIFICATE NUMBER: REVISION NUMRFR! 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. _................ .......... AOOfI�S4k1I ......_.. .......POLICY NUMBER.... ...., MMOO_POLicIYXYFII �MM UD EXP-.... LIMITS........ ..... _,_... ........... LTR TYPE OF INSURANCE X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 %� ...IJAMAGE'T 7 RENTED' ------ - CLAIMS -MADE OCCUR PREMISE$ tEe 9gcurrnre) $ 100 000 ..... .- .. A ......... ......... P 101.190.755.2 12/08/2023 12/08/2024 PERSONAL &ADVINJURY $ 2,000,00 0 �.----- . GEN__.m:._ I 'LAGGREGATELIMITAPPLIESPER: GENERAL AGGREGATE $ 2,000,000 X PRO, C POLICY JRO , LOC �- PRODUCTS COMP/OP AGG ..... 11 --- ------ 1.g S/T Gen. A g9 _ ---------------- OTIrIER:: , $ AUTOMOBILE LIABILITY COMBINEDSINGLI='.L.IMV"fl' $ ANY AUTO BOpDILYIN JURY(Perperson) $- ALL OWNED - ' SCHEDULED AUTOS AUTOS BODILY INJURY (Per a ccident) $ NON -OWNED m�PRCyP(wRTYDA�,aAUE HIRED AUTOS JJJ ., AUTOS Per 'rqm'&N).. $ a �..... .. ......... ......... UMBRELLA LIAB EACH OCCURRENCE ......_ EXCESS LIAR COCCUR .j .. m LAIMS MADE AGGREGATE .._ .....--- ..-_ . $ ............................ .... DED F RETENTION $ $ WORKERS COMPENSATION Q SSTpT1�7E f � ER I AND LIABILITY YIN V ANYPROPRIETOR/PARTNER/EXECUTIVE E $ OFFICER/MEMBEREXCLUDED� .NIA .......... (Mandatory MBE E.L. D SEASECIDENT LOYEE $ If yes, describe under ..---- ._..---. .._....- .............. .... DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ i DESCRIPTION OF OPERATIONS I LOCATIONS I 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 f ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 06/15/2024 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 PHONEµ ggg 202-3007 FAX 5 Concourse Parkway [ �o CCU __(._. ) ...... t!uGa.ppd,,,, 9 Y AIL Suite 2150 S& contact r@t hi,sCoX corn ..�--......-, Atlanta GA, 30328 INSURER(S)AFFORDINGCOVERAGE NAIC# iNciioan n . Hiscox Insurance Comoanv Inc 10200 INSURED City Advisors, LLC 15 Rastro Street Ladera Ranch, CA 92694 INSURER C : INSURER D INSURER E a cnVFRor.FS cFRTIFICOTF NUMRFR- 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. INSRY -- F ... .....1............ tit _...I EXP ......... ( ADOLShPBR -POLICY ......... ......�m .....,,.._ ......--- TYPE OF INSURANCE POLIC.... Nw R YNUMBERMM/DDYIYYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ I t A9,' uE rb ALiv I Ltr..., --- CLAIMS -MADE ....J OCCUR PREMISES,(Ea occurrence) $ ,.."E _ _ ......... -_ MED EXP (Any one person) $ ----- PERSONAL,& ADV INJURY $ GEN L AGGREGATE LIMIT APPLIES PER: ENERALAGGREGATE $ I POLICY � ��'O'" � LOC 1I;CT ......... . PRODUCTS COMP/OPAGG $ P OTHER: $ '.. AUTOMOBILE LIABILITY �._._._. COMBINED SINGLE V]MIT F-t acri nd $ .,...,......-..,.._.� ,. ANY AUTO rs °0) BODILY INJURY Per pe. I $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) l $ AUTOS AUTOS NON -OWNED PROPERTY DAMAGE $ HIRED AUTOS AUT II c dent) _.... .....I. ....... L$ UMBRELLA LIAB RENCE µ ....., EXCESS LIAB JOCCUR LAIMS-MADE, 1 AGGREGATE $$�,,,, .�_. _ ....... DEL) I RETENTION $ $ WORKERS COMPENSATION k( STATUTE, ERH AND EMPLOYERS' LIABILITY YIN �I ANYPROPRIETOR/PARTNER/EXECUTIVE '" 1 L EACH ACCIDENT E T $ OFFICER/MEMBER EXCLUDED NIA � (Mandatory in NH) $ .... ................._ ._. If yes, ._DISEASE..LI j ''.... OF OPERATIONS below E L DISEASE POLICY LIIMITE�. A Professional Liability P101.190.754.2 12/08/2023 12/08/2024 Each Claim: $1,000,000 Aggregate: $ 1.000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I 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 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD At 6a rw.a cw r &e a i n g Policy Number TCNMKNLVH4 Policy Period From 03/19/2024 12:01AM To 09/19/2024 12:01AM Underwritten By 21st Century Casualty Company 3 Beaver Valley Road Wilmington, DE 19603 Named Insureds) Carlo Tomaino 15 RASTRO LADERA RANCH, CA 92694 Toggle° A Farmers' Company Premiums / Fees Full Term Policy Premium $1,291.00 Fees $1.76 Total $1,292.76 Monthly Charge $215.17 See information on additional fees below Household Driver and Resident Information Are there persons 15 years of age or older not listed below who reside in your household (even if temporarily away from home), or who are guests staying in your home in excess of 90 days, or who regularly operate your vehicle(s) listed below more than 30 days per year? If so, please contact us or update your policy in the self-service portal to add these drivers to your policy. Name Years Licensed Driver Status Name Years Licensed Driver Status Carlo Tomaino 27 Covered Stephanie Tomaino 22 Covered Driver History Operator Claim Citation Date Discounts Information is effective 02/03/202412:28 AM TOG-AUT-CA03 9-22 TA gettoggle.com Page 1 Auto I nS ra nce De III aa uii o t s Page a Toggle" A Farmers Company Coverage Information Coverage only applies to vehicles showing premium or'Included' Premiums by Vehicle Coverage Limits #1 #2 Protect Your Assets Bodily Injury $100,000 each person $145 $100 Liability $300,000 each accident Property Damage $50,000 each accident $71 $92 Liability Protect Your Vehicle $1,000 Ded $1,000 Ded Comprehensive Actual Cash Value Less Deductible $41 $109 ......... .............. _... _ �mm...._�_. _ $1,000 Ded $1,000 Ded Collision al Cash Value Less Deductible Actual $198 $367 g ion Uninsured Motorist Property Damage with Collis w.... V � ��� ��� �������� Actual Cash Value $6 $6 Uninsured Motorist Property Damage $3,500 each accident - Roadside Assistance $75 each disablement Included Included Rental Reimbursement .... - ipment Additional Equipment Limit is $1 000 unless another limit is s ecified P Included Included Protect You & Your Loved Ones Medical Payments No Coverage - - Uninsured Motorist $100,000 each person $78 $78 Bodily Injury $300,000 each accident Total Premium Per Vehicle $539 $752 Policy and Endorsements This section lists the policy form number and any applicable endorsements that make up your insurance contract: TOG-AUT-CA62 1-22 TA; TOG-AUT-CA60 1-22 TA; TOG-AUT-CA50 1-22 TA; TOG-AUT-CA54 1-22 TA Fee Information The "Fees" stated in the "Premium/Fees" section on the front apply on a per -policy, not an account basis. Your policy may include a fraud assessment fee of $0.88 per vehicle per six months and may be subject to a $5.00 late fee if your premium payment is not received on time. The following fee(s) may also apply: $50 cancellation fee, $4 installment plan fee, $10 returned payment fee. Fees may be deemed a part of the premium under applicable state law. el,X ;, AuthorRed � tFiCll 4ryy ajbTe .P7S.6tA'we TOG-AUT-CA03 9-22 TA gettoggle.com Page 3 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. (_) 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 # (`X) 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 provisions or the � ;: ��,�,,,�, ��r,����r automatically become void. v August 2, 2024 Signature of Applicant Date Print Name Stephanie Tomaino for City Advisors, LLC Agreement for: =01 Dated: am ( I Reviewed by: T