Loading...
PROOF OF INSURANCE (2025 - 2026)DATE (MM/DD/YYYY) 14cqjzo CERTIFICATE OF LIABILITY INSURANCE 0313112025 THIS CERTN11 FICATE 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 BEr#VEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER„ AND THE CERTIFICATE HOLDEk NMPORTANT: 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 terns 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 Maguire Insurance Agency, Inc FWI 1 Bala Piz Ste 100 Bala Cynwyd, PA 19004-1401 610 617 7900 INSURED Loma Richardson COVERAGES NAME: M INSURER A : Philadeaphla Womnmy Insurance Com"AY 18058 INSURER B INSURER C: INSURER D : INSURER E : INSURER F : CERTIFICATE NUMBER: 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 INSD I SUBR WVD POLICY NUMBER POLICY EFF (MMMD POLICYEXP (MMID'DP/YYY) LIMITS q X COMMERCIAL GENERAL LIABILITY PHPK112.5708.0 02d0312025 0r03 B F.ACHOCCURRENCE $2000,000 u DAMAGE TO RENTED PREMISES i(Ea o urt"-) $100-000 CLAIMS -MADE EX OCCUR MED EXP (Anyone person) $2.500 X PROFESSIONAL LIABILITY PERSONAL SADV_INJURY $2,000000 GENERAL AGGREGATE. $ ,000 0 .00000El GENT AGGREGATE LIMIT APPLIES PER: OACTSECOMP/OP AGG$3000 RMDU X POLICY PROJECTL..LOC OTHER 0—WE UIN RUINED Cti S100 000 D SING( E LWI '.. AUTOMOBILE LIABILITY I,Ea ecciderm) $ BODILY INJURY (Prr person) S ANY AUTO BODILY INJURY (Per accideni) $ OWNED AUTOS SCHEDULED AUTOS ONLY HIRED AUTOS NON -OWNED ONLY AUTOS ONLY PROPERTY DAMAGE a) $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS -MADE AGGREGATE $ DED RETENTION $ S WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y! N ;ER iITE OTHER ANYPROPREE'T'ORIPARTNERIEXECUTtVE NIA .EA EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) EL DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below EL. DISEASE - POLICY LIMIT S DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101. Additional Remarks Schedule, may be attached If more space is required) It is understood and agreed [hat the following entity is added as an additional insured but only with respect(s) to the operations of the named insured except that liability resulting from the additional insured's sole negligence. CERTIFICATE HOLDER City of El Segundo 350 Main Street El Segundo, CA 90245 CANCELLATION 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 ©1988-2015 ACORD CORPORATION. All rights reserved. FCA 1 Re.v. 6 - 13 CALIFORNIA EVIDENCE OF FINANCIAL RESPONSIBILITY Name and Address of Insured MISS LORNA RICHARDSON MISS LORNA RICHARDSON NAIC 25968 Insurance Company USAA CASUALTY INSURANCE COMPANY Policy Number Effective Date 01501 84 28C 7101 1 02/14/25 50781-0513 02 --------------------------®----a_-E--k----- ------_-----_-__----- California Evidence of Financial Responsibility Keep this card. IMPORTANT: The California Financial Responsibility Act (Section 16020) of the Vehicle Code requires every owner or operator of a vehicle subject to the requirements of the Financial Responsibility Act to carry evidence of financial responsibility in the vehicle at all times. Under vehicle code (Section 16028) every driver f involved in an accident must provide evidence of o financial responsibility at the scene. Failure to comply is I an infraction and shall be punishable by fines, d impoundment or license suspension. Expiration Date Additional copies available at usaa.com 08/14/25 Vehicle Make/Vehicle Identification 2021 This policy provides at least the minimum rrum amounts of liability insurance required by the CA VEH CODE SECTION 15055 for the specified vehicle and named insureds and may provide coverage for other persons and other vehicles as provided by the insurance policy. CONTACT US: 210-531-USAA(8722) OR 800-531-USAA 9800 Fredericksburg Road, San Antonio, Texas 78288 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 _T,,�I n. Policy Number Expiration Date i p\ Name of Agent Phone # (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 workers' compensation provisions of Labor Code § 3700 I must immediately comply with those provisions or the agreement will automatically become void. Signature of Applicant Print Name Agreement for: Dated: Reviewed by: Date