PROOF OF INSURANCE (2026 - 2026)AIR" CERTIFICATE OF LIABILITY INSURANCE
DATE(MMIDDIYYYY)
10/22/2025
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: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must 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
NAME: Certificate Department
Unique Risk Management and Insurance Services LLC
(A/CC,NNo, Ext): 949-305-5577 (A/c, No): 949-305-5077
23052 Alicia Pkwy
ADDRESS: seivicecuniquerisk.com
INSURER(S) AFFORDING COVERAGE
NAIC #
Suite H378
INSURER A: ARCH SPECIALTY INSURANCE COMPANY-
21199T
Mission Viejo CA 92692
INSURED
INSURER B : STATE COMPENSATION INS FUND
35076
INSURER C : Hiscox Insurance Company
10200
M. Pino & Associates Inc
INSURER D : At -Bay Specialty Insurance Company
27475 Ynez Rd #234
INSURER E :
INSURER F :
Temecula CA 92591-4612
COVERAGES 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.
LTR
TYPE OF INSURANCE
INSD
WVD
POLICY NUMBER
(MM/DDIYYYY)
(MM/DDIYYYY)
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE � OCCUR
BIPKGO214700
1/30/2025
1/30/2026
EACH OCCURRENCE
$ 1,000,000
PREMISES (Ea occurrence)
$ 100,000
MED EXP (Any one person)
$ 5,000
PERSONAL & ADV INJURY
$ 1,000,000
GEN'L
AGGREGATE LIMIT APPLIES PER:
POLICY ❑PRO- JECT ❑ LOC
OTHER:
GENERAL AGGREGATE
$ 3,000,000
X
PRODUCTS - COMP/OP AGG
$ 3,000,000
$
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED SCHEDULED
AUTOS AUTOS
NON -OWNED
HIRED AUTOS AUTOS
(Ea accident)
$
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
HxuHEHTY DAMAGE$
(Per accident)
UMBRELLA LIAB
EXCESS LIAB
OCCUR
CLAIMS -MADE
EACH OCCURRENCE
$
AGGREGATE
$
DED RETENTION $
$
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y I N
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED? ❑Y
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
NIA
9203645
1/26/2025
1/26/2026
X STATUTE ER
E.L. EACH ACCIDENT
$ 1,000,000
E.L. DISEASE - EA EMPLOYEE
$ 1,000.000
E.L. DISEASE - POLICY LIMIT
$ 1,000,000
C
Errors & Omissions
MPL1969980.25
9/8/2025
9/8/2026
Limit: $1.000.000
D
Cyber Liability
AB-6767597-01
3/28/2025
3/23/2026
Limit: $1,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
The Certificate Holder is named as additional insured when required by contract.
CERTIFICATE HOLDER 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.
City of EI Segundo
350 Main Street
AUTHORIZED REPRESENTATIVE
El Segundo CA 90245
(U 1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
BLANKET ADDITIONAL INSURED ENDORSEMENT
This endorsement modifies insurance provided under the following:
Section II, WHO IS AN INSURED, is amended by adding
Any person, organization, trustee or estate:
a. to whom "you" are obligated by written contract to provide insurance such as
that afforded by this policy, or
b. specifically designated as an additional insured on an authorized Certificate of
Insurance received by "us" prior to any `occurrence";
Coverage afforded under (a) or (b) is limited to liability arising out of "your work" for such additional
insured(s) and is caused by the negligent acts of the named insured.
This endorsement shall be excess of any other insurance available except coverage afforded by this endorsement
will be primary and non-contributory, but only if and to the extent required by written contract.
All other terms and conditions of the Policy remain the same.
Endorsement Number:
Policy Number: BIPKGO214700
Named Insured: M. PINO & ASSOCIATES, INC. DBA MPA, INC., MYCCW.US
This endorsement is effective on the inception date of this Policy unless otherwise stated herein:
Endorsement Effective Date: 1/ 3 0/ 2 0 2 5
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INSURED COPY