PROOF OF INSURANCE (2025 - 2025)DATE (MMIDD/YYYY)
A4C<>" CERTIFICATE OF LIABILITY INSURANCE
8/1 /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 CONTA 1 aCT Tahina GoiIazalez
TIB Transportation Insurance Brokers, LLC P14ONE y 818-�2d6 280 LdA ,wit S1g 246-469
425 W. Broadway AAX'E-MAIL 0
Suite 300 E-MAIL tr3orl ler t( acr'isure corn .
-
Glendale CA 91204-1269 INSURERIS) AFFORDING COVERAGE NAIC #
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.
111 111 .... ,,m ..., ._,_, _F ,
TYPE OF INSURANCE .`A'DUdti7S�kd ,..... --- POLdDYNUMBE.R.......-.V4CWOI1DDYd" Y % '�AA.CC°YYYY. SURANCE 1 LIMITS
B X COMMERCIAL GENERAL LIABILITY
Y
KGA014292403
5/22/2024 5/22/2025 ( EACH OCCURRENCE
$ 1,000,000 ,
CLAIMS -MADE X OCCUR
....
1REMI„,S t� a ocrurraanlep
0 000
L.,..........
i,
MED EXP (Any- one gram----
$ 5,000
..
yy
PERSONAL & ADV INJURY
$ 1 000 000
GEN'LAGGREGATE LIMIT APPLIES PER:
I GENERAL AGGREGATE
$ Y g71,'I0000
X POLICY LOC
I PROD
1 000 00rd
,. -.-. JECT I
OTHf
�
$ .....,
f UT MOBIILLE LIABILITY
B A..
Y
�
KAA014292403
DS.tlNGMkLOIIMITGG
5/22/2024 � 5/22/2025 , C OaMB NEan1.I„
$
I €
BODILY INJURY (Per person)
$
ANY AUTO
OWNEDS
I �.."
INJURY (Per accident)
$�
X
I AUTOS I AUTOS
X HIRED AUTOALL
AUTOSSCHEDULEDB„ODILY
' X , I NON -OWNED
I
ROPER@'YOAMAOE
q r, 4i,�,irynn "� . .....,.�.
$
.
1
C UMBRELLA LIAB X OCCUR
Y
KXA014292403
5/22/2024 5/22/2025 EACH OCCURRENCE
$ 4,000,000, „
S LIAB
X EXCESS CLAIMS -MADE
GGREGATE
A.. ,.... .... .........
$ .. ............ ....
,..,. ...........-_..
1 DE6 I RETENtI&' N$
I
i
A
WORKERS COMPENSATION
PERO
WVE507407700 11/3/2023 11/3/2024 X 1
STA
rAOCIDENT FRH
_
AND EMPLOYERS' LIABILITY Y / N
E_ LEACH
1 000 000
ANY PROPRIETOR/PARTNER/EXECUTIVE �
OFFICER/MEMBER EXCLUDED?
N / A'
I L DISEASE EA EMPLOYEF.�
S 1,000,000
(Mandatory in NH)
If yes describe under
,....... j
I EL. DISEASE POLICY LIMIT J
...._.................. ..
S 1,000,000
DESC RIP'TION' OF OPERATIONS below
�
I
I
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
Workers Comp, Officer Exclusion Applies : Alex Khorasani
Excess Liability applies to both Auto & General Liabllily coverage.
Cerlificale )-folder is included as Additional Insured with respects to their interest in the operations of the named insured.
llIIFIC:AIt MULUILK %1M114%10 "nrvwr
City of El Segundo
250 Main Street
El Segundo CA 90245
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
LJ 7tlt$t$-LU'14 Ah.UKU L.UKrUK/iIIUII- M11 nynw Ieae1veU.
ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
IEMPLOYERT
EMPLOYERS PREFERRED INS. CO.
A Stock Company
RENEWAL DECLARATIONS
NCCI Carrier # 31283 WCIRB CARRIER# 0
1. Named Insured and Address
SWOOP INC
5151 W ROSECRANS AVE
HAWTHORNE CA 90250-6619
Customer # Carrier # FEIN #
31283 811291420
Additional Locations:
Workers' Compensation and Employers Liability
Insurance Policy
Policy Number From olicy Period
E IG 2577094 07 ]J12/01/2024 12/01/2025
,01JJgwW�Iaeatthryafa9ress ofthe
;s �
tion
PRIOR POLICY NUMBER EIG257709406
Agent
FAR EAST INS MARKETING INC 7316400
6301 BEACH BLVD, STE 302A
BUENA PARK, CA 90621
TeleDhone: 7144517689
Risk ID # Entity of Insured
CORPORATION
2. The Policy Period is from 12/01 /2024 to 12/01 /2025 12:01 a.m. Standard Time at the Insured's mailing address.
3. A. Workers Compensation Insurance: Part ONE of the policy applies to the Workers Compensation Law of the states
listed here: CA
B. Employers Liability Insurance: Part TWO of the policy applies to work in each state listed in Item 3A.
The limits of our liability under Part TWO are:
Bodily Injury by Accident $ 1,000,000 each accident.
Bodily Injury by Disease $ 1,000,000 policy limit
Bodily Injury by Disease $ 1,000,000 each employee
C. Other States Insurance: Part THREE of the policy applies to the states, if any, listed here:
All states except ND, OH, WA, WY and states listed in item 3.A.
D. This policy includes these endorsements and schedules: See attached schedule.
4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates, and Rating Plans.
All information required below is subject to verification and change by audit.
SEE EXTENSION OF INFORMATION PAGE
Minimum Premium $ 500
Assessments and Taxes $
Expense Constant $ 160
Premium Discount $
Total Estimated AnnualPremium $ 4,091
❑ This is a Three Year Fixed Rate Policy
Premium Adjustment Period: M Annual; ❑ Semiannual; ❑ Quarterly; ❑ Monthly
Countersigned this Day of ,
Issued Date: 10/22/2024 Authorized Representative
Issuing Office EMPLOYERS PREFERRED INS. CO.
P.O. BOX 539003
HENDERSON, NV 89053-9003
Issued Date 10/22/2024 INSURED COPY
WC990630 (5/98 Ed.)
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