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PROOF OF INSURANCE (2026)DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 03/14/2025 _... _.......m.............. _ _._..._.� 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 INSURERIS), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATIONIS 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: GORST & COMPASS INSURANCE SERVICES 72250102 PHONE (818) 507-0900 ..•........... FAX.... (818) 507-1133........... 5850 CANOGA AVE STE 650 (AIC, No, Ext) (AIC, No): E-MAIL ADDRESS: WOODLAND HILLS CA91367 ------.•• - . - INSURER(S) AFFORDING COVERAGE NAIC# .......... ......_ ......-.-.. w______. ......... .........�..�. INSURER A : Hartford Underwriters Insurance Company 30104 .... ..__ ...,..,.._ _ .................... _ _. INSURED rINURERSDEREK CRAWFORD DBA SOFTWARE SOLUTIONS URER C TEAM ..............,......_ 3220 S HIGUERA ST STE 208 INSURER D .- ._....,., SAN LUIS OBISPO CA 93401-6999 INSURER E7 ................ .................................................... INSURER F s COVERAGES CiERTIFICAfiE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR TH E 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. -LTYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS IN S 7R t m I�_ .. ....m _.�M.�(I�,�LYYCi:t... _�M••.M/onN yyY ..........._ ...... COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $2,000,000 PR MGE TO RENTED Ct' IMS-t na J OCCUR I $1,000,000 X General Lability MED EXP (Any one person) $10,000 A X 72 SBA BE5UO4 1 04/05/2025 04/05/2026 PERsoRAI 8 ADV INJURY ......mm$2,00Q000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $4,000,000 ••••••. POLICY LOC PRODUCTS R.UCT X E] PRO � ODCTS -COMP/OP AGG _ $4,000,000 ..-,,.,,. JECT .•....,_ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMI I $2,000,000 a:!td ................... ANY AUTO BODILY INJURY (Per person) ALL OWNED SCHEDULED ....• A AUTOS AUTOS 72 SBA BE5UO4 04/05/2025 04/05/2026 BODILY INJURY (Per accident) _..._. HIRED NON -OWNED PROPERTY DAMAGE X AUTOS X AUTOS (Per accident) .. ..._ ...... •. _ .._.._.._.. ..........,. UMBRELLA LIAR OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS- --_--_- .. MADE AGGREGATE 4ELT' RETENTION $X W..�.......� .. WORKERS (.Ui VbR§ATION ...............� PER OTH- .._ AND EMPLOYERS' LIABILITY STATUTE ER. '.. ANY YIN E.L. EACH ACCIDENT-...-...........� PROPRIETOR/PARTNER/EXECUTIVE - - . ••-• OFFICER/MEMBER EXCLUDED? NIA E.L. DISEASE -EA EMPLOYEE (Mandatory in NH) .............................-...�..-..._.n..................... If yes, describe under E.L. DISEASE - POLICY LIMIT DESCRIPTI N F.(1PERATIr1NS, beIQN/ ,_ ,.,„... ,,,,,,,,, ,,,,,,,,,, .................. _...,......�, ...__..... ................. ...�.......�.... DESCRIPTION OF OPERATIONS/LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Those usual to the Insured's Operations. Please see page two for additional remarks. CERRIFICATE HOLDER CAIwNCE! I Aj:10: J City of El Segundo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 350 MAIN ST BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED EL SEGUNDO CA 90245-3813 IN ACCORDANCE WITH THE POLICY PROVISIONS. .�..._ .... .,_ ... w — ... AUTHORIZED RE,oPRESENTATIVE ........................................... ..................... © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: LOC#: ADDITIONAL REMARKS SCHEDULE Page 2 of .._2...._ AGENCY ......�......_.... ..... ._..... ......_. _.._.�_._.W._.._._....._ ..�.... - ........�...,. .....� MEDINSURED GORST & COMPASS INSURANCE SERVICES DEREK CRAWFORD DBA SOFTWARE SOLUTIONS TEAM —POLICY NUMBER ............. ,_........_-...._,..�._ 3220 S HIGUERA ST STE 208 SEE ACORD 25 SAN LUIS OBISPO CA 93401-6999 . CARRIER ,--- .... ITIT NAIC CODE SEE ACORD 25 ..... ........ _ _...._ EFFECTIVE DATE: SEE ACORD 25 _...................................... ........ ........ Ar1r11TInNA1 RGMARICA ACORD 101 (2014/01) © 2014 ACORD CORPORATION. All 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: L_) 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 i 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 w ,rkers compensation provisions of Labor Code § 3700 1 must immediately comply with thos provisions or the ernent will automatically become void„ Signature of Applicant "� Date 1/23/2025 Print Name Dereff. Crawford Agreement for: Dated: Reviewed by: