PROOF OF INSURANCE (2026)�[ttla5 !/1s�rvw:a„tl:tVOrg9dl8atg,
844-520-6989
Powered by Veracity Insurance
Solutions, LLC
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INSURUCE GROUP
Great American Alliance Insurance Company
301 E. Fourth Street, 25 S
Cincinnati, OH 45202-4201
COMMERCIAL GENERAL LIABILITY COVERAGE PART — OCCURRENCE FORM
CERTIFICATE PAGE
IT IS AGREED THAT THIS CERTIFICATE IS ISSUED TO THE CERTIFICATE HOLDER LISTED BELOWTO CERTIFY COVERAGE
UNDER THE COMMERCIAL GENERAL LIABILITY INSURANCE MASTER POLICY LISTED BELOW.
INSURANCE COMPANY: GREAT AMERICAN ALLIANCE INSURANCE COMPANY POLICY PERIOD:
NAMED INSURED: HANDCRAFTED SOAPMAKERS GUILD, INC.; BEAUTY HEALTH & 06/10/2025
TRADE ALLIANCE to
CERTIFICATE HOLDER: Honestly Raw Beauty 06/10/2026
ADDRESS: 4225 E. 9th St. Apt A, Long Beach, CA 90804
12:01 AM MDT at the Address of The
POLICY NUMBER: PLF197508-HSCGO39826 Ce We Holder
LIMITS OF INSURANCE
General Aggregate Limit (Other than Products —
Completed Operations)
Products - Completed Operations Aggregate Limit
Personal and Advertising Injury Limit
Each Occurrence Limit
Damage to Premises Rented to You Limit
Medical Expense Limit
Liability Deductible
Professional Coverage Extension
1,000,000
1,000,000
1,000,000
1,000,000
300,000 Any One Premises
5,000 Any One Person
None
Not purchased Each Claim ""'""'
$ Not purchased Aggregate
Professional Coverage Deductible $ Not purchased Each Claim
FORM OF BUSINESS: Sole Proprietor/Individual
...............
PREMIUM: $225.00
BHTA FEE: $40.00
TOTAL POLICY COST: (The cost is 100% earned/non refundable) $265.00
CODE NUMBER: 51970 PREMIUM BASIS: PER EACH CERTIFICATE HOLDER
CLASSIFICATION: Manufacturer & Distributor of Handcrafted Health & Beauty Products
THIS INSURANCE IS SUBJECT TO ALL THE TERMS AND CONDITIONS, INCLUDING APPLICABLE ENDORSEMENTS, OF THE
COMMERCIAL GENERAL LIABILITY INSURANCE MASTER POLICY. A COPY OF THE COMMERCIAL GENERAL LIABILITY
INSURANCE MASTER POLICY ACCOMPANIES THIS CERTIFICATE. ADDITIONAL COPIES WILL BE PROVIDED TO THE
CERTIFICATE HOLDER. PLEASE READ THE POLICY AND ALL ENDORSEMENTS.
NO ADMISSION OF LIABILITY MAY BE MADE EITHER VERBALLY OR IN WRITING
FULL DETAIL OF ANY INCIDENT SHOULD BE SENT IMMEDIATELY BY EMAIL TO�5I7f IBS. Olwl' OR BY LETTER
TO VERACITY INSURANCE SOLUTIONS, LLC 260 SOUTH 2500 WEST SUITE 303, PLEASANT GROVE, UT 84062.
FORMS AND ENDORSEMENTS applicable to all Coverage Parts and made part of this Policy at time of issue are listed on
the attached Forms and Endorsements Schedule IL 88 01 (11/85),
AQ_IA NISTRATED BY.
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Veracity Insurance Solutions, LLC
260 South 2500 West Suite 303
Pleasant Grove Utah 64062
888-568-0548
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ADMINISTRATOR'S SIGNATURE:
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:
(__) 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
carrier and policy number are:
Carrier
Name of Agent
Policy Number Expiration Date
Phone #
U 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 1 should beco subjec the rkers' compensation provisions of Labor Code § 3700 1 must
immediately comply with pr i or �reementwill automatically become void.
7/15/25
Signature of Applicant ,; _ Date . —
Print Name Rachel Couvrey
Agreement for: Honestly Raw Beauty
Dated:
Reviewed by: