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PROOF OF INSURANCE (2024 - 2025)AC"M"' CERTIFICATE OF LIABILITY INSURANCE DATE (MWDDfYYYY) IL.� 09/09/2024 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS Alberto 0 0 -on CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE do St. Ste F 828 E, Colorado COVERAGE AFFORDED BY THE POLICIES BELOW. Glendale, CA 91205 Ph. (818) 507-9705 Fax: (8 t8) 662-9996 INSURERS AFFORDING COVERAGE _._N.A1C # ............ . ..... INSURED INSURER A: Scottsdale Insurance Corrionay 41297 Bubblennania and Company Inc, INSURER B: ........................... ...... . . ....... 12405 Venice 131vd #384 INSURER C: Los Angeles, CA 90066 INSURER D: .. . . . .............. INSURER E: I. f'r%11r_DA1-_CQ 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS .................... . . __ .......... P666V'6FFECTiV'_E . ...... . P"0__[1_GYEXPIRATION k T POLICY NUMBER DATE (MMIDDNY) LIMITS INSRU TYPE OF INSURANCE (MMIDDfYY DATE .LTR A 0 GENERAL LIABILITY CPS7897648 12/01/2023 l2/0(/2024 EACH OCCURENI�!. $1,000,000 1E COMMERICAL GENERAL LIABILITY DAMAGE TO RENTED 1100,000 [I DCLAIMS MADE 0 OCCUR k ED = P (Any one person) $5,000 PERSONAL & ADINJURY n n u c) n 0 GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGO $2,000,0010 POLICY[] PROJECT[:] LOG Abuse & sexual Molestmon $ 1,000,000 ❑ANY AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Each Occurrence) AUTO F-1 ALL OWNED AUTOS BODILY INJURY $ (Per person) SCHEDULED AUTOS F-1 HIRED AUTOS BODILY INJURY F1 NON -OWNED AUTOS (Per accident) _1 11-1 . ....... . .................... . $ ......... — - ------------- PROPERTY DAMAGE (Per accident) $ ❑ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ EIANY AUTO OTHER THAN EA AGO $ F-1 AUTO ONLY: AGO $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR [—] CLAIMS MADE AGGREGATE . $ . ..... . ... F-1 DEDUCTIBLE . ..... ❑ RETENTION S WORKERS COMPENSATION AND U- OTH- WC STATUS L-J ERmm ❑ EMPLOYERS' LIABILITYTORY ANY PROPRIETOR/PARTNERIEXECLL E L_ EACH ACCIDENT TIVE OFFICERIMEMBER EXCLUDED? E. L, DISEASE - EA EMPLOYEE s ir yes, describe under ....... SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ ❑ OTHER DESCRIPTION OF OPERATIONS I LOCATIONS i VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT t SPECIAL PROVISIONS Additional frisured: The City of El Segundo, its ofrcers, officials, employees, agents, and volun�eers SHOULD Th- �:Hy ji 7;L S=q�Ao _FSHO1 LD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE INSURER AFFORDING COVERAGE WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER. ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATW9 ACORD 25 Alberto 0 Ocon @ ACORD CORPORATION 1988 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contact between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25 f Q4 POLICY NUMBER: CPS7897648 COMMERCIAL GENERAL LIABILITY CG 20 26 07 04 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 Section II — Who Is An Insured is amended to in- clude as an additional insured the person(s) or or- ganization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property dam- age" 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: A. In the performance of your ongoing operations; or B. In connection with your premises owned by or rented to you. CG 20 26 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 0 'E�/ ISloli1ly VE This ID card is evidence of liability ity insurance for your veill�.ale The card is valid onl as Ion i/j% '" " insurance ,remains in force. Keep a copy of the ID ��,a�l rRaPd in your vehicle at all�times.g as liability You may be required to per°rraiice Yow identification card ' applying for a driver's license,following an accident, or uatovehicle registration or inspection, when upon a law enforcement officer's request. FCA 1 Re.v. 6 - 13 50 781- 051 3 02 ----------------------------------------------- ------------- CALIFORNIA EVIDENCE OF FINANCIAL RESPONSIBILITY Name and Address of Insured NAIC 25968 CAREY PICKFORD California Evidence of Financial Responsibility Keep this card IMPORTANT: The California Financial Responslbit;ity Act (Seal on 16020) of the Vehicle (de requires every CAREY PICKFORD GINA PICKFORD CAREY PICKFORD JR SOPHIE PICKFORD CARLA PICKFORD Insurance Company USAA CASUALTY INSURANCE COMPANY. Policy Numbe11 r Effective Date Expiration C 00645 41 OOC 7101 6 I 08/03/24 02/03/25 Vehicle Make/Vehicle Iden " Ii G"on 'R �ber year 2019 TOYOTAa " liatillity insurance j This policy provides at least the minimum amounts of specified vehicle and ��jequlred by 'the CA VEH CODE SECTION 16056 for the P Gff' dmad_,insureds and _maw .nrrnrirlo' nnvorano for other per5on5 and other UVIU01KwO Vi II11cili of 1 z5yU1iz)1Uniyy m o1�,uyg 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;carn, CONTACT US: 210-531-USAA(8722) OR 800-531-USAA 9800 Fredericksburg Road, San Antonio, Texas .7a288% 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 # (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 agreement will automatically become void. Signature of ApplicantDate 9/30/24 Print Name Joseph Ferri ` Agr eement for: 9W Dated- 11I 1 Lb Reviewed by: