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PROOF OF INSURANCE (2025)�yq�r-� CERTIFICATE OF LIABILITY INSURANCE fDATE /19/20 I 25 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 Brian Hunt PFIONE 1111­.. ..... .7 FAX ,_ ���B�aT G Brian Hunt fl S Ex)q 562-804 914 J I.I Nu) E MAIL 5693 Woodruff Avenue brian.tuuni m5v2 skatef.rm.corra Lakewood ._.._. INSURED Allison, Robby 4067 HARDWICK ST STE 495 CA 907131129 LAKEWOOD CA 907122350 w rec r•celrrera^r�w re wrr r��oeo. 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. INSI ..... .... ......... ADD 1'90,6, ....................... ..... ..... ..h(Sficy-EFF i5�SC CY+'ER LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDDIYYYY MMIDD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY LEACH OCCURRENCE $ 1000000 f DAMAGE r Rr N rib $ 300,000 CLAIMS -MADE OCCUR PREMISES,(F,,,p,pps�prrgnpe) Ex (Any one person) $ 5 000 12/15/2024 12/15/2025 (ME9 A Y Y 92-EL-6253-8 PERSONAL $ ADV INJURY $ 1,000,000 F$ 000 GEN � L AGGREGATE LIMIT PLIES PER: .„ PRO- ( GENERAL AGGREGATE PRODUCTS -COMP/OP AGG 2 OOO _ -.. $ 2,000,000 POLICYJECT LOC e ..._._ .. ...�. ....... ........--- ..,,.. F $ AUTOMOBILE LIABILITY AU COMBINED SINGLE LIMIT .i.�r7.�eFIIj�O.t)..... -.- _.... ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED ' BODILY INJURY (Per accident)$ AUTOS ONLY AUTOS .r.--" HIRED NON -OWNED �' AUTOS ONLY ; �,J,„r: er apgidpn)) ,,,J „� I EACH OCCURRENCE UMBRELLA LIAB OCCUR ...,..... $ EXCESS LIAB CLAIMADE ,.,. 1 AGGREGATE .......__ $ .. ............... DED RETENTION $ $ WORKERS COMPENSATION I..... PER A.TU.T.EI � ND EMPLRS' LIABILITY AOYE YIN ANY PROPRIETOR/PARTNER/EXECUTIVE _.......... ,S .......L..EH.H...�,.$ E.L, EACH ACCIDENT ......... $ OFFICER/MEMBER EXCLUDED? ❑ NIA , ..... (Mandatory in NH) J E EA EMPLOYEE, $ It yes, describe under DESCRIPTION OF OPERATIONS below d 1, E.L. DISEAS E-POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached it more space is required) City Of El Segundo 300 Main Street El Segundo CA 90245 FwT,TTr.T:::[' � �:7i W rar'111 I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City Of El Segundo ACCORDANCE WITH THE POLICY PROVISIONS. 300 main street AUTHORIZED REPRESENTATIVE ElSegundo CA 90245 This form was system -generated on 06119/2025 , Y 9 (OlUt3ti-ZUTD AGUKU GUKI'UKAI IUN. All ngnis reserves. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 9009466 2005 155279 205 01-19-2023 VAFM Policy No.: 92-EL-B253-8 FE-6609 SECTION If ADDITIONAL INSURED ENDORSEMENT K Policy No.: 92-EL-B253-8 Named Insured: Robby Allison 4067 Hardwick St STE 495 Lakewood CA 90712 Additional Insured (include address): City Of El Segundo 300 Main Street El Segundo CA 90245 WHO IS AN INSURED, under SECTION II DESIGNATION OF INSURED, is amended to include as an insured the Additional Insured shown above, but only to the extent that liability is imposed on that Additional Insured solely because of your work performed for that Additional Insured shown above. Any insurance provided to the Additional Insured shall only apply with respect to a claim made or a suit brought for damages for which you are provided coverage. The Primary Insurance coverage below applies only when there is an "X" in the box. ® Primary Insurance. The insurance provided to the Additional Insured shown above shall be primary insurance. Any insurance carried by the Additional Insured shall be noncontributory with respect to coverage provided to you. All other policy provisions apply. FE-6609 Printed in U.S.A. FE-6671 Page 1 of 1 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US SCHEDULE Policy Number: 92-EL-B253-8 Named Insured: Robby Allison 4067 Hardwick St STE 495 Lakewood CA 90712 Name and Address of Person or Organization: City Of El Segundo 300 Main Street El Segundo CA 90245 The following is added to Paragraph 10.b. of SECTION I AND SECTION II — COMMON CONDITIONS: We waive any right of recovery we may have against the person or organization shown in the Schedule because of payments we make for injury or damage arising out of: a. Your ongoing operations; or b. Your work done under contract with that person or organization and included in the products - completed operations hazard. This waiver applies only to the person or organization shown in the Schedule. All other policy provisions apply. FE-6671 ©, Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. FE-6671 (04109) Printed in U.S.A.