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PROOF OF INSURANCE (2025) CLOSEDDATE (MMIDDIYYYY) " C? CERTIFICATE OF LIABILITY INSURANCE 08/09/2024 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 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 CONTaC Risk Mana ement Solutions of America, Inc. PHONE"""' Jaw A Qglla FAX 9 (WC- No- EYn_ 773.991.7636 IAtC, No) 31 .960.1 J2fi m 309 W. Washington St. - Suite 200 Chicago, IL 60606 INSURED Baila Baila LLC 6690 Treemont Circle Simi Valley, CA 9306 INSURER C : INSURER D INSURER E : com INSURER(S) AFFORDING COVERAGE _. NAIC # ............... . n.�r xx rucrswrice PCDrICl/`ArC KIHUDCD• t2F'61"t.:q.InN NIt1MRFRT 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. ........ ,.. ...--....-._ ,........ ....... .,TYPE OF.,,.,,,,„,---.-.-r _. ...................,.. ......-.. ,,,_ . ..... ,�. .......... .-.-......-.-. ILTR- IN (ADDL SU'R� POLICY NUMBER "PfimeDDfYYYY MMIDDY/YYYY LIMITS j GENERA L LIABILITY EACH OCCURRENCE $ 1,000.00 o.... ]_GENERAL MMERCIAL GENERAL LIABILITY (,ii�AAOL Ib RENT150 $ �. PR�I=MISES;a,rarc,calnenc� 100 000 e. CLAIMS -MADE 7 OCCUR [ (Any p on� $ 5.000 MED EXP An one ers,,., . .. ....-.._. _ _ __ A GL 1205765A 6/22/2024 ; 6/22/2025 PERSONAL &ADV INJURY $ 1,000,000 GENERAL AGGREGATE �X!0'000 � �� � LIMIT GEN'L AGGREGATE IMITAPPLIES PER: I PRODUCTS COMP/OP�AGG $ 1,000,000 RO X POLICY AUTOMOBILE LIABILITY Cott 30ckI:O SING1 t.I� % (C;a accadant) $ 1,000,000 ANY AUTO BODILY INJURY (Per person) $ ALL I SCHEDULED . OWNED AUTOS AUTOS A _HIRED GL 1205765A 6/22/2024 6/22/2025 --- .. BODILY INJURY (Per accident) $ .... _. ,,,,_.., ' NON -OWNED AUTOS ' X i AUTOS Pt�OPL.R'PY DAMA�aF $ UMBRELLA LIAB IOCCUR EACH OCCURRENCE $ LIAB CAIMS EXCESS CLAIMS -MADE AGGREGATE $ s DED RETENTION $ ' $ WORKERS COMPENSATION WC STATU iOTH TOf1Y LIMITS, a ER _ AND EMPLOYERS' LIABILITY YINEL ANY PROPRIETORIPARTNERIEXECUTIVE I . EACH ACCIDENT $ - ... D? OFFICERIMEMBER EXCLUDE (Mandatory in NH) N/A DI I E.L SEASE EA EMPLOYEE $ ......, If yes, describe under DESCRIPTION OF OPERATIONS below I C E-L DISEASE POLICY.....- LIMIT $ A Professional Liability GL 1205765A 6/22/2024 6/22/2025 1,000,000 / 2,000,000 Molestation and Abuse 1,000,000 / 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) Per Endorsement L-723, Additional Insured: The City of El Segundo, its officers, officials, employees, agents, and volunteers The City of El Segundo 350 Main St. El Segundo, CA 90245 ACORD 25 (2010/05) 214 W_1VIC•1iJ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Lol ©1988-2010 ACORD CORPORATIPN !Al! rights reserved. The ACORD name and logo are registered marks of ACORD 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 Policy Number Expiration Date Name of Agent 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 Ycomply with oseProvw rons o ttVe agr ment will automatically become void, 04/22/24 Signature of Applicant Date Print Name Agreement for: Dated - Reviewed by: