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PROOF OF INSURANCE (2025 - 2025) CLOSEDCERTIFICATE OF LIABILITY INSURANCE 11 /28/2024 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 INSUREDS), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. If SUBROGATION IS WAIVED, subject to the terms INSURED, the pgolicy(ies) must have ADDITIONAL INSURED frrotfi:�sions or be endorsed. e 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: Mass Merchandising_ �..� u,.,..._.... K&K Insurance Group, Inc. * Np EXI ....._ 1 800 328 2317 LAIC Nay, W i WW260 459 5502 1712 Magnavox Way EMAIL Fort Wayne IN 46804 ADDRESS; info@eventinsurance-kk.com INSURERIS) AFFORDING COVERAGE NAIC # INSURED 2001033029 CP# 835 INSURER A: Markel Insurance Company 38970 Sandra Delgado I.NSURER B: DBA: Welcome Spanish LLC INSURER C: ................. .... 217 Aviation Place INSURER D: ---------._. .....___ .._. ................. Manhattan Beach, CA 90266 INSURERmE. A Member of the Sports, Leisure & Entertainment RPG INSURER F: COVERAGES CERTIFICATE NUMBER: 2000650306 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. INSR LA TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF MM/DD/YYYYMM(DDPI POLICY EXP YYY.. LIMITS X COMMERCIAL GENERAL LIABILITY X ""'"""� Mi RPG0000000352400 12/02/24 12/02/25 EACH OCCURRENCE $1,000,000 12:01 AM 12:01 AM DAMAGE TRRENTED $1 CLAIMS -MADE.... OCCUR PF#EnratSES �Ea Occurrenael .._ ,000,000 MED EXP (Any one person) ....._. �..,.e.,............,.$5,000 '.. _......................................_... PERSONAL&ADVINJURY $1,000,000 AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $5,000,000 POLICY 0 PROJECT LOC PRODUCT$1,000,000 S—COMP/OPAGG �. OTHER: PROFESSIONAL LIABILITY $1,000,000 LEGAL LIABTOPARTICIPANTS $1,000,000 COMBINED SINGLE LIMIT(Ea AUTOMOBILE LIABILITY accident..._..._._ ......................._._. ANY AUTO '.. BODILY INJURY (Per person) OWNED SCHEDULED�� BODILY INJURY (Per accident) AUTOS ONLY AUTOS HIRED NON -OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident) _ITITIT_' UMBRELLA OCCUR IJAB...._....._._ EACH OCCURRENCE ............ ..... _ . ........................ EXCESS LIAB CLAIMS -MADE AGGREGATE DIED RETENTION WORKERS COMPENSATION N/A PER STATUTE OTHER AND EMPLOYERS' LIABILITY "..... ANY PROPRIETOR/PARTNER/ Y / N E L. EACH ACCIDENT ... _..,_,�....._ EXECUTIVE OFFICER/MEMBER........ EXCLUDED? (Mandatory in NH) ❑ E.I_. DISEASE— EA EMPLOYEE .. .._,..... If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE— POLICY LIMIT MEDICAL PAYMENTS FOR PARTICIPANTS PRIMARY MEDICAL EXCESS MEDICAL DESCRIPTION OF OPERATIONS I LOCATIONS l VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Instructor of: Language The certificate holder is added as an additional insured, but only for liability caused, in whole or in part, by the acts or omissions of the named insured. CERTIFICATE HOLDER The City of El Segundo, its officers, i volunteers 350 Main Street El Segundo, CA 90245 Owner/Manager/Lessor of Premises CANCELLATION als, employees, agents, and 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 @ 1988-2015 ACORD CORPORATION. All rights reserved. Coverage is only extended to U.S. events and activities. "" NOTICE TO TEXAS INSUREDS: The Insurer for the purchasing group may not be subject to all the insurance laws and regulations of the State of Texas. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: M1 RPG0000000352400 COMMERCIAL GENERAL LIABILITY CG 20 26 04 13 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 Name Of Additional Insured Persons Or Organization(s) The City of El Segundo, its officers, officials, employees, agents, and volunteers 350 Main Street El Segundo, CA 90245 Named Insured: Sandra Delgado DBA: Welcome Spanish LLC C P# 835 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 B. With respect to the insurance afforded to these additional insureds, additional insured the person(s) or organization(s) shown in the the following is added to Section III — Limits Of Insurance: Schedule, but only with respect to liability for "bodily injury", If coverage provided to the additional insured is required by a "property damage" or "personal and advertising injury" caused, in contract or agreement, the most we will pay on behalf of the whole or in part, by your acts or omissions or the acts or omissions additional insured is the amount of insurance: of those acting on your behalf: 1. Required by the contract or agreement; or 1. In the performance of your ongoing operations; or 2. Available under the applicable Limits of Insurance shown in 2. In connection with your premises owned by or rented to you. the Declarations; 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. whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 26 04 13 0 Insurance Services Office, Inc., 2012 Page 2 of 2 INSURANCE WAIVER Pursuant to Section 4 of El Segundo City Council Resolution No. 4813, the undersigned authorized the waiver of commercial auto insurance for the City of El Segundo instructor contract with Sandra Delgado. Date: Darrell George, City Manager Fold here Cut along edge Allstate. Please use the printed Insurance Cards below. Please use the printed Insurance Cards below. Allstate. Please use the printed Insurance Cards below. Please use the printed Insurance Cards below. California Proof of Allstate. If you have an accident or loss: Auto Insurance Card • Get medical attention if needed. Allstate Northbrook Indemnity Company NAIC# 36455 PO Box 660598, Dallas, TX 75266-0598 Notify the police immediately. Beach CA 90266-7018 license plate numbers of all persons involved, including passengers and witnesses. • Call 1-800-ALLSTATE (1-800-255-7828), This policy meets the requirements of the applicable California financial logon to allstate.com or contact your Allstate agent as soon as responsibility law(s). possible. POLICY NUMBER YEAR / MAKE / MODEL Mike Herman 067 307147 2005 Toyota Camry (310) 376-0231 EFFECTIVE DATE 09/05/24 VEHICLE ID NUMBER 719 S Pacific Cs Hwy ThEXPIRATION s card mDust be carriedATE 0in the vehicle at all times as evidence of insurance. Redondo Beach, CA 90277 California Proof of Allstate. If you have an accident or loss: Auto Insurance Card • Get medical attention if needed. Allstate Northbrook Indemnity Company PC) Box 660598, Dallas, TX 75266-0598 NAIC# 36455 • Notify the police immediately. Dario names, addresses, phone numbers (work & home) and Manhattan Beach CA 90266-7018 license plate numbers of all persons involved, including passengers and witnesses. • Call 1-800-ALLSTATE (1-800-255-7828), This policy meets the requirements of the applicable California financial logon to allstate.com or contact your Allstate agent as soon as possible. responsibility law(s). POLICY NUMBER YEAR / MAKE / MODEL Mike Herman 067 307147 2007 Honda Odyssey (310) 376-0231 EFFECTIVE DATE 09/05/24 VEHICLE ID NUMBER 719 S Pacific Cs Hwy EXPIRATION DATE 03/05/25 0Now NWW card must be carried in the vehicle at all times as evidence of insurance. Redondo Beach, CA 90277 a DATE (MMIDD/YYYY) ACC)ROO CERTIFICATE OF LIABILITY INSURANCE 10/28/2024 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 Automatic Data Processing Insurance Agency, Inc. Automatic Data Processing Insurance Agency, Inc. 199.6 C. No. Extl, 1-800-524-7024 g -IAJC Nok --__ 1 Adp Boulevard Roseland Welcome Spanish! LLC 217 Aviation Place NJ 07068 INSURER A • Technology Insurance Company, Inc. INSURERI'll B : INSURER C INSURER D : Manhattan Beach CA 90266 1 INSURER F : rnwrc1Ance C'9=0T1I=1rATF nluMRFP- 3922470 REVISION NUMBER: NAIC_# 42376 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. �...... INSIR ... ......... ....... S AbOt'giuO PtbLiC4 EYk APXgC�pCYE�iI LTR TYPE OF INSURANCE I j MWD POLICY NUMBER MM 0D1YY' Da'YY1"'Y LIMIT COMMERCIAL GENERAL LIABILITY CURRENCE EACH OCCURRENCE $ CLAIMS MADE I OCCUR AMAGF C!"J`�1F'Iwl1"t"ti �P f g§ EA95cvrteraco) _ $ d 11 x MEP EXP (Any one person) .. $ ...__ — .,, ---- ERSONAL & ADV INJU RY _..,............. $ ....._____ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE I $ m ... POLICY❑ JECT LOC s ,PRODUCTS COMP/OP AGG $ ---.......� ER: OTHER: AUTOMOBILE LIABILITY �......... � RUC dev_up) wNGLE. L1W II $ ANY AUTO ' BODILY INJURY (Per person) $ II[ _..- ,. . OWNED SCHEDULED BODILY INJ INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON -OWNED I F'T+t7ER)P"iFOfi,tF $ � ONLY AUTOS ONLY �Pmrr,tisl�a�)p ........ ........... ..AUTOS „ is UMBRELLA LIAB OCCUR EACH OCCURRENCE Is EXCESS LIAR E CLAIMS MADE AGGREGATE„ $ .,...... -- .,.,., ________„ DEC 1 RETENTION $ WORKERS COMPENSATION STPITUTE '.. ERH AND EMPLOYERTLIABILITY YIN q! EL, EACH ACCIDENT $ 1 000 000 A ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? NIA N TWC4481887 09/15/2024 09/15/2025 -- ---- �••• .... '°°°° 1 000 000 (Mandatory m NH E EA EMPLOYEE $ L. DISEASE __ If yes, describe under .........E . 1,000, 000 DESCRIPTION OF OPERATIONS below E.L, DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE The City of El Segundo, its officers, officials, employees, agents, THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN and volunteers ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street AUTHORIZED REPRESENTATIVE ElSegundo CA 90245 Q 1988.20115 ACORD CORPORATION. All rights reserved.. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD