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PROOF OF INSURANCE (2026 - 2026)CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 511 /2025 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 CONTACT NAME TAPCO- KL (5576) PHONE (A/C No, Ext): FAX (A/C No): EMAIL ADDRESS: PO Box 286 Burlington, NC 27216 INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURER A: Mount Vernon Fire Insurance Company 26522 INSUREB B: LA UNIFORM & TAILORING INC. 15625 HAWTHORNE BL INSURER C: INSURER D: SUITE D INSURER E: LAWNDALE, CA 90260 INSURER F: CnVFRAGFS CERTIFICATE NLJMBFRt 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 LTR TYPE OF INSURANCE ADDL INSR SUI IR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DDfYYYY) LIMITS GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FRI OCCUR X X CP 2698401 4/14/2025 4/14/2026jERENTED EACH OCCURENCE $1,000,000 Via. [ a accu rranc a) $100,000 MED EXP (Any one person) $5,000 'PERSONAL & ADV INJURY GENERAL AGGREGATE '.$1.000,000 "$2,000,000 PRODUCTS-COMP/OP AGG $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER : X POLICYEl PRO LOC $ AUTOMOBILE LIABILITY ANY AUTO A�ffNED RtSY8RULED HIRED AUTOS q�{J�Q�WNED UMBRELLA LIAB OCCUR EXCESS LIAB CLAIMS -MADE OMBtN 'D SINGLE LIMIT Eta accnt) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident $ Paa6 ItDAMAGE l) EACH OCCURRENCE $ $ $ AGGREGATE $ DED RETENTION $ $ 'WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY P,ROPR6ETORJPARTNERIE'M'E'CUTWEY / N OFan aRI -FI( RJMEM�tF{R EXCLUDED? l 1 600&fft VOPERATIONS below N / A TORY LAt�ITS OETi- E.L. EACH ACCIDENT $ E.L. DISEASE -EA EMPLOYEE $ E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (See attached Acord 101 for additional liability limits) Clothing Store. Includes a waiver of subrogation (waiver of transfer of rights of recovery against others to us). City of El Segundo Police Department is an additional insured per CG 20 26 04 13 (.PER 1 tl`t'C;Ait: : HULULtd t,:AI°tUtLLA I IUN City of El Segundo Police Department SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE 348 Main Street EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE El Segundo, CA 90245 POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2010105) Copyright 1988-2010 ACORD CORPORATIOights reserved. N�/AIB�r The ACORD name and logo are registered marks of ACORD ,ff AGENCY CUSTOMER ID,_..5576 LOC #: All X>R1 " ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY INSURED TAPCO- KL (5576) LA UNIFORM & TAILORING INC. 15625 HAWTHORNE BL POLICY NUMBER SUITE D CP 2698401 LAWNDALE, CA 90260 CARRIER NAIC CODE EFFECTIVE DATE: 4/14/2025 Mount Vernon Fire Insurance Company 26522 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE COVERAGE FART LIMITS __...� . Commercial Liability Each Occurrence Limit Personal & Advertising Injury Limit (Any One Person/Organization) Medical Expense (Any One Person) Damages To Premises Rented To You (Any One Premises) Products/Completed Operations Aggregate Limit General Aggregate Limit $1,000,000 $1,000,000 $5,000 $100,000 $2,000,000 $2,000,000 ACORD 101 (2008/01) Copyright 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ATE( CERTIFICATE OF LIABILITY INSURANCE 05/0 M/DD'"'"' — 3%2025 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: Ifthe certificate holderisan ADDITIONAL INSURED, the policy(les) must have ADDITIONAL INSURED provisions orbeendorsed. ...-...mmm be endorsed. If SUBROGATION IS WAIVED, subject to the ttererms 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 _. _............. .......... CONTACTW....._ _......-- ...-......, VIOLETTAVA {29-50-35P ) NAME: PHONE (818)800-422 14523 GILMOREST (A/C,NO EXT) 6 (A/C, No): 310 667-9352 _.. _... .............. VAN NUYS CA91411 E-MAIL ADDRESS:vtavakoli@farmersagent.com -, .......................... ----- m INSURER(S)AFFORDING COVERAGE NAIC # INSURED INSURERA. Truck Insurance Exchange 21709 _INSURER� —XXXXXX ._. LA UNIFORM&TAILORING INC. B: Farmers mmmmmmm mmm 21652m NSURERC: Mid Century lnsuranceCom an mm m21m687 15625 HAWTHORNE BLVD INSURERD: Fire Insurance Exchange 21660 LAWNDALE CA90260-2650 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS ISTO CERTIFYTHAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUEDTOTHE INSURED NAME ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY AY REQUIREMENT,TERM OR CONDITION OFANY 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 SUBJECTTO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDTL SUBR POLICY EFF POLICY EXP LIMITS LTR TYPEOFINSURANCE INSD POLICY NUMBER WVD (MM/DD/YYYY) (MM/DD/YYYY) AL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE $ CLAIMS -MADE OCCUR �I (EaOcc rr PREMISES (Ea Occurrence) W W ...........�.... IVIED EXP (Anyone person) w.,-,.,,___....._-...._.....�, $ PERSONAL ,&.ADV INJURY .. $ _............... - - --.---..-.-...._... GENT AGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE _.._ $ POLICY PROJECT LOC PRODUCTS-COMP/OPAGG $ OTHER: COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY (Ea accident) $ - ANYAUTO BODILY INJURY (Per person) _ 1 $ OWNEDAUTOS SCHEDULED BODILY INJURY (Per accidenO$ ONLY AUTOS HIREDAUTOS NON -OWNED PROPERTY DAMAGE $ ONLY AUTOSONLY (Per accident) -__........... ..... ...................... UMBRELLALIAB OCCUR ... _ Emm EACH OCCURRENCE -- $ EXC_CLAIMS -MAD AGGREGATE .,. .........................E DEDESSLIAB RETENTION.. w.,.,_.................... $ WORKERS COMPENSATION X PER OTHER $ AND EMPLOYERS' LIABILITY STATUTE 11 ANY PROPRIETOR/PARTNER/ Y/N N/A A09519882 02/19/2025 02/19/2026 E.L. EACH ACCIDENT •••—........... $1,000,000 C EXECUiIVEOFRCER/MEMBER E.L. DISEASE -EA EMPLOYEE $1 000,000 EXCLUDED? (Mandatory In NH) Ifyes, describe under DESCRIPTION OF E.L.DISEASE-POLICY LIMIT $1,000,000 OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule, may be attached if more space is required) Certificate holder is listed as Additional Insured on the named Insured'sgeneral liablilitypolicy. Waiver of Subrogation applies in favor of the certificate holder on the workers compensation policy. CERTIFICATE HOLDER _...-- CANCELLATION ............._. � WE ANY OFTH E ABOVE ED BEFORE ii ESCRIBED LINIACCORDANCEES BE LWITHTHE EXPIRATION' EL SEGUNDO POLICE DEPARTMENT DATE THEREOF, NOTICE WILSHOULD L BE DELIVERED POLICY PROVISIONS. 348 MAIN ST., _..........__....................._.�......W....-......-- EL SEGUNDO, CA 90245 AUTHORIZED REPRESENTATIVE VIOLET TAVA ACORD 25 (2016/03) @ 1988-2015 ACORD CORPORATION. All Rights Reserved 3 1 -1 769 11-15 The ACORD nameand logo are registered marks of ACORD WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 0630 (Ed.6-20) WAIVER OF OUR RIGHTTO RECOVER FROM OTHERS ENDORSEMENT- CALIFORNIA We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be % of the California workers compensation premium otherwise due on such remuneration, subjectto a minimum charge of 250, Schedule Person or Organization PROVIDE UNIFORMS ELSEGUNDO POLICE DEPARTMENT 348 MAIN STREET EL SEGUNDO, CA 90245 job Description This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The Information below is required only when this endorsement Is Issued subsequent to preparation of the policy.) Endorsement Effective 04/29/25 Policy No. A0951-98-82 Endorsement No. Insured LA UNIFORM &TAILORING INC. 15625 HAWTHORNE BLVD Insurance Company MID-CENTURY INSURANCE COMPANY STE D LAWNDALE CA902602650 Countersigned By WC 99 06 30 (Ed. 6-20) Includes copyright material of the Workers Compensation Insurance Rating Bureau of California. All rights reserved.