Loading...
PROOF OF INSURANCE (2026)^" DATE (MWDD CERTIFICATE OF LIABILITY INSURANCE IYVWj 06�23�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: It the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. It 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 CON' Ac FLIP Program Support APE.. .... Veracity Insurance Solutions, LLC, PHONEmc,'No. F0 g044) 52i9 6992 FAa! 260 South 2500 West, Suite 303 t H1Moi fliPr0gTeM,ror,n _ Pleasant Grove UT 84062 INSURERIS) AFFORDING COVERAGE a�NAIC p..... INsuRER A: Great American Alliance Insurance Co. 26832 INSURED INSURER B Steven Cheng, DBA OniMon '.... INSURER a; 12140 Ramona Ave INSURERo- .._. ..... ......... ......... Hawthorne CA 90250 INsuNEF'IE M. IIRER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBEW 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: cY EPT)......I ...... Up11 TYPE OF INSURANCE POLICY NUMBER OMfihU'YaCNYVYk MM41GgY'd yY')'):.. LIMITS m 1,oe7i} 0D0 GENERAL LIABILITY EACF-0 OCCURRENCE CE $ �X ",ryAnnAe"I TtCR.rNTP13 .. 300,000 COMMERCIAL GENERAL LIABILITY 1-� p—�' Fa>k R�YR L'� aG.a ei S .,. CLAIMS MAUL YP., OCCUR $ MI D I XP aA tiy, oo� ��, �,�9r . 5 ... 5,000 A - PLF194992-F287360 0211312025 0211312026 1,000000 PERSONAL &ADV INJURY $ .... ........ ..... GENERAL AGGREGATE .960,I 01.'.. 1 dMIA, ( IPIEMA9ELIMIT APPI,,.NE$PER F'ROIDUCT. ,COMPIOPAGU ti 1,ChOD,000 X a�CTLIC'r p,ifi'1 _......................�. 'r°ry i.aA: _ANIMAL BAILEE S AUTOMOBILE LIABILITY .i ANY 'AU'r() BOrtILY INJURY(C I. —I)... $ ALL OWNED .... SCHEDULED BODILY INJURY (P cird-k).. S _.. .. ,..,..,,... AU rOS AUTOS ....... $ ......... NON -OWNED 1:,R rrERTY DAMIAGEI. HIREDAUTr,): AUTOS ...... .. _ _.00CUR .....�F U EXCESS L1A......... ......... ..... ........ .. _..... , P.Ad 4FS.Mn.dP4SY'S NtlI.? .. $ UMBRELLA LIAR B CLAIMS MADE wr r'REi q h'E $ 1 Dkn Ar1EN11QN5 $ woRxERscoMPENSAnoN 1r raril ilrrvi AND EMPLOYERS'LIABILIY YIN ._. V.1btY LINvyIY.r, , Flu,, _ ANY PROPRIETORIPARTNERIEXECUTNE ❑ N / A E L EACH ACCIDENT $ OFFICEIMEMSER EXCLUDED? (Mandatory @n NH) E L DISEASE - EA EMPLOYEE. 0 g EL DISEASE .. POI.ICI L M i` 9 .,....................................��......�....,�....�............... DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ANach ACORD 101, Additional Remarks Schedule, R m m space Is required) Certificate holder had been added as additional insured regarding the above mentioned policy per attached Additional Insured - Designated Person or Organization (CG 20 26 Ed. 04 13) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City Of El Segundo Recreation, Parks, &Library ACCORDANCE WITH THE POLICY PROVISIONS. 401 Sheldon Street El Segundo, CA 90245 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD INS025 (201401) PLF194992-F287360 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 Person(s) or Organization(s): City of El Segundo Recreation, Parks, & Library Information required to complete this Schedule, if not shown above, will be shown in the Declarations. CG 20 26 (Ed. 04 13) A. SECTION II - WHO IS AN INSURED is amended to include as an Additional Insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury," "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: 1. in the performance of your ongoing operations; or 2. in connection with your premises owned by or rented to you. 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. B. With respect to the insurance afforded to these Additional Insureds, the following is added to SECTION III — LIMITS OF INSURANCE: If coverage provided to the Additional Insured is required by a contract or agreement, the most we will pay on behalf of the Additional Insured is the amount of insurance: 1. required by the contract or agreement; or 2. available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. Copyright, ISO Properties, Inc., 2012 CG 20 26 (Ed. 04/13) PRO Page 1 of 1 I affirm under penalty of perjury under the laws of California one of the following declarations: C_) 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. (_J 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 carrier and policy number are: Carrier Name of Agent Policy Number Expiration Date Phone # CV-/) 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 worke ' ; — ensation provisions of Labor Code § 3700 1 must immediately comply with those provisions or th ent will automatically become void. Signature of Applicant Date - Print Name LIZ Agreement for: Dated: Reviewed by: