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PROOF OF INSURANCE (2025 - 2026) CLOSEDCERTIFICATE OF LIABILITY INSURANCE DATE A E(MM/202) 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 Mark Minh Nguyen y ftnO statep,pC,,Mfo.... ..... FAX ff Mark Minh Nguyen E M 8 Exa 714-418 9050 A �) PHOIWI 6552 Bolsa Ave Ste H s mark neleY1 v e-statefarm.com Huntington Beach .............. ,.. INSURED PFI OFFICE FURNITURE INC 7540 GARDEN GROVE BLVD CA 92647 WESTMINSTER CA 926832332 CO'VFRAr,F'R CERTIFICATE NUMBER: INSURERS AFFORDING COVERAGE E INSURER A I State Farm General Insurance Com an . pa . �.._ 25151 INSURERS:State Farm Mutual Automobile Insurance Company .,..„51 25178 8 INSURE R c State Farm Fire and Cas„ ualty Company 25143 RER D : INSURER E INSURER F 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. e YNTR , TYPE OF m.,. Abt7' Stl , .. INSURANCE INSO WVD POLICY NUMBER 7 POLICY"EFF Y=tsL1Cti"LiiP ! MMIDDfYYYY) (MMIDDrrrM LIMITS COMMERCIAL GENERAL LIABILITY t EACH OCCURRENCE $ 2,000000 _ CLAIMS -MADE X f OCCUR DAMAGE Rif ­ p QED na $ 500OOO ------ (Any one person) $ 50 000 MED EXP (A� A Y Y 92-E9-N340-9 03/21/2025 " 03/21/2026 PERSONAL & ADV INJURY $ 2,000,000 GENLAGGREGATE LIMIT APPLIES PER: -- GENERAL AGGREGATE $ 4,000,000 "- „, PRO " POLICY * LOC ( _ COMP/OP AGG $ 4 OOO OOO PRODUCTS.......,,.. „e EJECT OTHER: I _ y ea... ............. t $ AUTOMOBILE LIABILITY j 649 1804-F10-751 COMBINED SINGLE LIMIT $ 1,000,000 12/10/2024 06 10 2025 m ANY AUTO , � BODILY IN (Per person) $ 1, " OWNED AUTOSULEo 701 1042-C24-75B B Y - Y BODILY INJURY 03/24/2025 09/24/2025 Y INJURY Per accident HIRED AUTOS ONLY NON -OWNED 691 325O-B07-756 02/07/2025 08/07/2025 "'Pk�(�'FG"5�'i'Y"@5'ALTNGxF"--.- AUTOS ONLY AUTOS ONLY „Ptl�'.F°N1r4""eY7!!!tl- ..... $ ,M w.... .. ....... ---„,. UMBRELLA LIAB I Xt X OCCUR EACH OCCURRENCE $ 5 000 000 A EXCESS LIAR CLAIMS MADE N/A 92-GX-A925-5 04/30/2024 04/30/2025 AGGREGATE $ 5,000,000 I-,..--- ,„ ....,- DERETENTION $ 10,000 D . X ...... ........n-....., _ $ -. WORKERS PER i $ YINANY PRO PRIETOR/PARTNERIEXECUTIVE STATh)TF ER.. I E EACH ACCIDENT l $ 1 000OOO C OFFDICERIMEM EREXCLUD D? N NIA' Y 92-TB-GO81-4 03/21/2025'03/21/2026 EL DISEASE - EA EMPLOYEE $ 1,000,000 (Mandatory in NH) If yes, describe under E.L DISEASE- POLICY LIMIT 1,000,000 DESCRIPTION OF OPERATIONS below $ 1 I i i DESCRIPTION OF OPERATIONS ! LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION City of El Segundo 350 Main St El Segundo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 1AUTHORIZED REPRESENTATIVE CA 90245- This form was system -generated on 04/1012025 © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 1001486 2005 155279 205 01-19-2023 (MMIDD TE CERTIFICATE OF LIABILITY INSURANCE DA05/16/202❑ ACORO IIII J'- 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 Mark Minh Nguyen NAMEm . �., _,......... tate e Mark Minh Nguyen PHONE 714-418-9050 FAX No) ... 6552 Bolsa Ave Ste H ss t)mark.nguyen p4gv@statefarm.com ------- AFFORDING COVERAGE NAIC # Huntington Beach CA 92647 INSURER A: State Farm General Insurance Company . ,.. . 25151 , INSURED le nce Company m Mutual Insurance 2.. 5178 PFI OFFICE FURNITURE INC INSURER C m e and Ca uallttl State FarFir y Company 25143 7540 GARDEN GROVE BLVD INSURERD: INSURER E WESTMINSTER CA 926832332 .... INSURER F. r+nxrcoAr_CQ rea-trICWA t- fdIIRnMls'IEa RFVI!Rl()N NI1MRFR: 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, YNSR, lYiJri $U�B'PbLIC'�EFF ..TYPE OF INSURANCE,.. 1 POLICY LTR INSD WVD ....� MM/DOIYYYX i M ......-- . ........ ....�., l PGLPCY EiCFs ) LIMITS I M/DDIYYYY ' w COMMERCIAL GENERAL LIABILITY 1 X' EACH OCCURRENCE 2,000,000 CLAIMS -MADE X OCCUR ❑ DAMAGE 7b HENTED 00 000 d� prpPrrgp) $ MREMISES ( person) 50,000 Y one ers n $ 5 ®2 - - A I Y Y 92 E9 N340 9 INJURY $ 000 000 t 03/21/2025 03/21/2026 PERsoNAL& ADV INJU GEN'L AGGREGATE LIMIT APPLIES PER: I GENERAL $ 4,000,000 � PRO- I X LOC POLICY I AGG PRODUCTS COMP/OP$ 4000000 „- JECT . $ J OTHER: AUTOMOBILE LIABILITY 691 3250-B07-75E EI19t) w 02/07/2025 08/07/2025 I,'OMDINGD,$%N L q..IPdGd1 $ 1,000,000 ANY AUTO = i BODILY INJURY (Per person) � $ OWNEDSCHEDULED 701 1042=C24-75E B Y Y 03/24/2025 09/24/2025 (Per BODILY INJURY cciden[)� $ ,-, AUTOS ONLY "'''�`•. NON -OWNED HIRED o 649 1804 F10 75L 12/10/2024 06/10/2025 AUTOS ONLY AUTOS ONLY y�µ.( s7.Gp� effl..... -$® 1 $ X UMBRELLA X OCCUR _OCCURRENCE A EXCESS ABIAB CLAIMS -MADE NIA 92-GX-A925-5 04/30/2025 04/30/2026 AGGREGATE $ 5,000,000 DED x RETENTION $ 10,000 j j $ WORKERS COMPENSATION II II I f PER I OTH- J I X STATUTE... E,R ANY PROPRIETOR/PARAND BILITYNER/EXECUTIVE Y (N J ORIPARLUDED7 I $ OOO 000 03/21/2026; C OFFI CER/MEM N N/A[ Y 92-TB-GO81-4 03/21/2025 E.L.oISEASE�IEAEMPLOYEF' 1,000 090,099. (Mandatory in NH) , ..„. $ ..... ... .......... .... If Dyes, describe under I DESCRIPTION OF OPERATIONS below E, L. DISEASE - POLICYmm LIMIT $ 1 000,000 I I I I DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The City of El Segundo, its elected and appointed officials, employees, and volunteers are included as additional insureds. CERTIFICA' City of El Segundo 350 Main St ElSegundo ACORD 25 (2016/03) CAN 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 CA 90245 This form was system -generated on 05/16/2025 @ 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 1001466 2005 155279 205 01-19-2023