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PROOF OF INSURANCE (2025 - 2026),�"1 J i' 1 DATE (MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 09125/2025 IiN.IIIIIII-- 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 CONT�wc Justine Bellevue NAME. FAX Kulchin Ross Insurance Services, LLC (818) 996-0900 A, No (818) 279-6999 PHONE „E, . ... 18757 Burbank Blvd. EMAIL justine@kulchinross.com ADDRESS: Suite 320 INSURER(S) AFFORDING COVERAGE _� NAIC # Tarzana CA 91356 INSURERA: Scottsdale Ins Company INSURED INSURER B : LLoyds of London Geekopolis, LLC, DBA: GameTruck LA South Bay INSURER C 2748 Pacific Coast Hwy INSURER D W� Unit 1010 INSURER E : Torrance CA 90505 INSURER F: COVERAGES CERTIFICATE NUMBER: to-zo i vi iwaster KtvIDIUN NUmt5rM: 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 CONTRACTOR 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. w _................ INg POLtCYEFF POLICY EXP LTR. TYPE OF INSURANCE INSD yyV POLICY NUMBER MM2DNYYYY MMIDOIYYYY LIMITS •••• COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A 100,000 $ CLAIMS -MADE OCCUR PMREDfWXP,'.p alcan�rv'yswcuN _ (Any one oerson) S 5,000 A Y CPS8263887 08/01/2025 08/01/2026 PERSONAL&novwJURv $ 1,000,000 ........� GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000 000 X POLICY El JEC ❑ LOC JECT PRODUCTS - COMP/OP ADD $ 2,000,000 .ti 09HER OOMBINEO SINC'LE 1.1 Mqt' S AUTOMOBILE LIABILITY ,LN;",�W-, btu d�rwce'N 'ANYAUTO BODILY INJURY (Per person} $ OWNED SCHEDULED INJURY (Pe BODILY INJ $ AUTOS ONLY AUTOS ' HIRED NON -OWNED HIRED ATY DAMAGE. rrdOP $ AUTOS ONLY AUTOS ONLY dt1 UMBRELLA LIAB OCCUR OCCURRENCE EACH :::: $ EXCESS LIAR CLAIMS -MADE AGGREGATE $ DEO RETENTION $ WORKERS COMPENSATION PER OTH STATUTE ER AND EMPLOYERS' LIABILITY Y/N ANY PROPRIETORIPARTNER/EXECUTIVE ��NIA��(Mandatory E L EACH ACCIDENT r__ OFFICERIMEMBER EXCLUDED? in NH) E.L. DISEASE -EA EMPLOYEEIf yes, describe under EL. DISEASE - POLICY LIMIT DESCRIPTION OF OPERATIONS below ......... v ......... SEXUALABUSE $2,000,000 Sexual Abuse &Molestation B B0621PGEEK000125 05/28/2025 05/28/2026 SEXUALABUSE $2,000,000 (Primary Layer) ............ .. DESCRIPTION .....-... - RIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) .. ..... ..._.......— Excess Layer Details: Policy Number: B0621 PGEEK000225 Policy Term: 5/28/2025 - 5/28/2026 Coverage Type: Sexual Abuse & Molestation Policy Limit: $1,000,000 The City of El Segundo, its officers, officials, employees, agents, and volunteers are included as Additional Insured on General Liability Policy, if required by a 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. 350 Main St '.. AUTHORIZED REPRESENTATIVE ElSegundo, CA 90245 @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 00054007 LOC #: ADDITIONAL REMARKS SCHEDULE Page of AGENCY NAMED INSURED Kulchin Ross Insurance Services, LLC Geekopolis, LLC, DBA: GameTruck LA South Bay POLICY NUMBER - CARRIER I NAIC CODE EFFECTIVE DATE: fnnlTInKIA1 RFMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance written contract. n 2nna ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 'A' SCOTTSDALE INSURANCE COMPANY® ENDORSEMENT NO. ATTACHED TO AND FORMING A PART OF ENDORSEMENT EFFECTIVE DATE NAMED INSURED AGENT NO. (12:01 A.M. STANDARD TIME) POLICY NUMBER CPS8263887 08/01/2025 GEEKOPOLIS, LLC, DBA: GAME TRUCK SOUTHBAY 040BM THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY,. BLANKET ADDITIONAL INSURED ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART With respect to this endorsement, SECTION II —WHO IS AN INSURED is amended to include as an additional in- sured any person or organization whom you are required to add as an additional insured on this policy under a written contract, written agreement or written permit which must be: a. Currently in effect or becoming effective during the term of the policy; and b. Executed prior to the "bodily injury," "property damage," or "personal and advertising injury." The insurance provided to these additional insureds is lim- ited as follows: 1. That person or organization is an additional insured only with respect to liability for "bodily injury," "property damage" or "personal and advertising injury" caused, in whole or in part, by: a. Your acts or omissions; or b. The acts or omissions of those acting on your behalf. A person's or organization's status as an addi- tional insured under this endorsement ends when your operations for that additional insured are completed. 2. With respect to the insurance afforded to these additional insureds, the following exclusions are added to item 2. Exclusions of SECTION (— COVERAGES: This insurance does not apply to "bodily injury," "property damage" or "personal and advertising injury" occurring after: a. All work, including materials, parts or equip- ment furnished in connection with such work, on the project (other than service, mainte- nance or repairs) to be performed by or on behalf of the additional insured(s) at the loca- tion of the covered operations has been com- pleted; or b. That portion of "your work" out of which the in- jury or damage arises has been put to its in- tended use by any person or organization other than another contractor or subcontrac- tor engaged in performing operations for a principal as a part of the same project. 3. The limits of insurance applicable to the additional insured are those specified in the written contract, written agreement or written permit or in the Decla- rations for this policy, whichever is less. These lim- its of insurance are inclusive of, and not in addition to, the Limits of Insurance shown in the Declara- tions for this policy. 4. Coverage is not provided for "bodily injury," "property damage," or "personal and advertising injury" arising out of the sole negligence of the additional insured. 5. The insurance provided to the additional insured does not apply to "bodily injury," "property damage," or "personal and advertising injury" arising out of an architect's, engineer's or surveyor's rendering of or failure to render any professional services including: Includes copyrighted material of ISO Properties, Inc., with its permission. Copyright, ISO Properties, Inc., 2004 GLS-150s (7-06) Page 1 of 2 a. The preparing, approving or failing to prepare or approve maps, shop drawings, opinions, re- ports, surveys, field orders, change orders or drawings and specifications; and b. Supervisory, inspection, architectural or engi- neering activities. 6. Any coverage provided hereunder will be excess over any other valid and collectible insurance avail- able to the additional insured whether primary, ex- cess, contingent or on any other basis unless a written contract specifically requires that this insur- ance be primary. When this insurance is excess, we will have no du- ty under SECTION I —COVERAGES to defend the additional insured against any "suit" if any other in- surer has a duty to defend the additional insured against that "suit." If no other insurer defends, we will undertake to do so, but we will be entitled to the additional insured's rights against all those other insurers. AUTHORIZED REPRESENTATIVE DATE Includes copyrighted material of ISO Properties, Inc., with its permission. Copyright, ISO Properties, Inc., 2004 GLS-150s (7-06) Page 2 of 2 C<- CERTIFICATE OF LIABILITY INSURANCE DATE DlYYYY> 27120z5 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 suCT ch endorsernent�l._ PRDDucER NAME: Pr ores roe Commerci I Lines C m e ri A .ry rvi In. PIAIDIAMOND VLY INS PHONE FAX 3009 DOUGLAS BLVD 300, ROSEVILLE, CA 95661 C No. ores :1-500-04 4 N IIµMiA1I: ,wrra'wrr�+� � srt ocress Ivc ccrlltstir. ^otLlifcatotrttiatl .� ¢ rytTFossi ve, com INSURERS) AFFORDING COVERAGE NAIC # INSURER A: United Financial Casuall Com an 11770 INSURED INSURER B : GEEKOPOLIS LLC DBA: GAME TRUCK LOS ANGELES 274B PACIFIC COAST HIGHWAY, #1010 INSURER C; TORRANCE, CA 90505 INSURER D : INSURER E _._....... INSURER F .......................... ......�... .. ..., nr nTrrnw r wll IwwOG�• 100� on 9nnoo MlG9Qrlf1RO�OGT�P.9111 RF1/ISIl1N NIIMRFR- 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 AILI_ THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR AODL SUBR POLICY EFF POLICY EXP TYPE OF INSURANCE INSD WVO POLICY NUMBER LIMITS LTR (MM1DDlYYW) (MMfODlYYYY) COMMERCIAL GENERAL LIABILITY 4 EACH OCCURRENCE CLAIMS -MADE ❑ OCCUR'•a?,- rAirrn..�` ........ IVIED EXP [An one parsont PERSONAL S ADV INJ URY GENERAL AGGREGATE •iN"L A°N ' F,t:GFlti1"'C LI&I I"APPLIES PER: P'RO- PROOUC'T"S - CO1IP/OP AGG PoucC , F1,M1E% a LOC _ OTHER: AUTOMOBILE LIABILITY EOYRc,tr.tvM) Nc'LF :.fl I',IIT INFn $1.0 DODO IBC,AC)11„•Y INJURY Pgr,.rssan ! _., . ANY AUTO A OWNED x4. I }Uk.lF:,L1 AUTOS ONLY AL��t,� NUTOS ONLYI",>N C"}M'1'NE'I"& .I•IO CJN'LY Y N 01096918 0410612025 10106t2t)25 13ODIf Y INJURY (Per aroldenll �,S 9.[Tciw gl'.m'"a1.1A5eE $ UMBRELLA LIAB CCUR EACH OCCURRENCE $ •.•� EXCESS LIAB RLAIMS-MADE AGGREGATE $�... TN/A H" $ LIED I '..... RETEtdT1 ON $ WORKERS COMPENSATION YIN AND EMPLOYERS' LIABILITY ❑ ANYPROPMETORIPARTNER/EXECUTIVE OFRCEPJMEIVIBEREXCLUDED� (Mandatory in NH) E.L. EACH ACCIDENT F..,L QISEASE - EA FMPLOYE 3 If yes, descnbe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT '.. See ACORD 101 for additional coverage details. $ A Y N 01095918 04/06/2025 1OfO612025 DESCRIPTION OF OPERATIONS/ LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) L__ CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of El Segundo Department of THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Recreation, Parks and Library ACCORDANCE WITH THE POLICY PROVISIONS. 401 Sheldon Street El Segundo, CA 90245 -° AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: LOG #: ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY NAMEDINSURED PIA/DIAMDND VLY INS GEEKOPOLIS LLC DBA: GAME TRUCK LOS ANGELES •••••- 2748 PACIFIC COAST HIGHWAY, #1010 POLICY NUMBER TORRANCE, CA 90505 01095919 CARRIER NAIL CODE ......... Uniled Financial Casualty Company 11770 EFFECTIVE DATE: 04i06/2025 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of l-iabiiit Insurance Additional Coverages Insurance coverages) .............. Limits „ ...............I ............ ........ ., ..... ......... w. ,„„ .. ,. ...•„..., .................................................... UninsuredlUnderinsured Motorist $1,000,OOD Combined Single Limit Description of Locationeicles/Special Items Scheduled autos only _.._.............. ......, .... ........ .,... _,... 2009 CHEVROLETSILVERADO C2500 iGCHC44K69E126988 .... Collision $1,000 Dad Comprehensive $1,000 Dad Medical Payments $5,000 each person 2009 CHEVROLET SILVERADO C2500 1 GCHC446X9F180887 Collision $1,000 Dad Comprehensive $1,000 Dad Medical Payments $51000 each person .,,.. ,,.,....,. , ,.,,..�.. , - ,..... 2012 CHEVROLE.., -.....RADO C2500 1GC2CVC84CZ14. 32'........ ....... T SILVE 33 3 Collision $1,000 Ded Comprehensive $1,000 Ded Medical Payments $5,000 each person .• ..,." ' . , ,..°...•...,- _,..,-- .. .,.. ,,. _,... 2018 FORD T-350 TRANSIT W WF ik ZMXJKA97884 ............... . ... . Collision $1,000 Ded Comprehensive $1,000 Ded Medical Payments $5,000 each person ...,_., ......., .._........,.. 2009GRAVELYTrailer1G9CT32219A22000.............................._.,.... 05 Collision $1,000 Ded Comprehensive $1,000 Ded 2009 GRAVELY Trailer 1 G9CT32218A220005 Collision $1,000 Ded Comprehensive $1,000 Ded 2009 GRAVELY Trailer 1 G9CT24218A220005 Collision $1,000 Ded Comprehensive $1,000 Ded 2014 Bravo Trailer 542BE2425EB006068 Collision $1,000 Ded Comprehensive $1,000 Ded 2014 RAM 2500 3C6TR5HT9EG173444 Collision $1,000 Ded Comprehensive $1,000 Ded 14 Brava Trailer 542BE2422EBO06268 Collision $1,000 Ded Comprehensive $1,000 Ded 2018 RAM 2500 3C6UR5CJ5JG208 386 Collision $1,000 Ded Comprehensive $1,000 Ded Additional Information Certificate holder is listed as an Additional Insured. ACORD 101 (2008101) 02008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD DATE (MIWDD/YYYY) � �EY CERTIFICATE OF LIABILITY INSURANCE 07/02/2025 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CETIFICATE DOES NOT BELOW• AFFIRMATIVELY NEGATIVELY THIS CERT F CATEOF INSURANCE DOES NOTCO ST CONSTITUTE ALTERND OR COVERAGE SN SUING SURER(S),THE AU HOR ZIED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the po rse es) must to endorsed. ff SUftROcate dos WANED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such erldorsement(s), oNE�CT AP Iniego Insurance GrowI1 ,LLC,_ •••_, PRODUCER FttMa...�,.FFAi kP INTEGO INSURANCE GROUP, LLC175 (grO N+x, 88Eactt 8-289tk 93900 - c"14 Wit' E MAILS, CFJrIS Woodcliff Dr. 361e 103 YN$IJRER $AFFORDING Co?FEI AO»E NAlc4 _m;—nrt NY 14450 YNSIIITERA: EnI>7loyelsPrefprred YnsuranoeColll 11D 10046 INSURED Geekopolis LLC DBA GameTruck Los Angeles 2748 Pacific Coast Hwy Torrance CA 90505 INSURER REVISION COVERAGES CERTIFICATE NUMBER,, AMED ABOVE FOR ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERNOD THIS IS TO CER1°NN=1" THAT' Yt-IE POLICIES CIE INSURANCE LISTEO 13EG.OIIW HAVE BEEN OR OTHER DOCUMENT' WITH RESPECT TO WHICH THIS INDICAT'EM NOTWITHSTANDING ANY REOUIREMENTv TERM OR. CONDITION OF ANY CONTRACT BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE SEEN REDUCED BY PAID CLAIMS. EXCLUSIONS - ...-�•---- �t)L'IIB' .... POLICY EF`F tyOLYCY E3iP LIMBS IN TYPE OF INSURANCE PgLrC YNUMBER MM10 MAMLID OCCURRENCE LIABILITY GENERAL L ,$ I"o�"L� '.. COMMERCIALGENEFLAL.LIABILITY PtIiuMISE^a". ,mctcuroronr.rr .. .._. CLMMS'•fi/AOE 0,, OCCUR MED EXP I+ nW w tlllaazaar. ..._. 5. M.� PERSONAL & ADV INJURY GENERAL AGGREGATE PRODUCTS ^ COMP/OP AGG GEN�......�_.,........ 'L AGGREGATE LIMIT APPLIES PER: PI " LO�C PC" ^^^ L LIWa1I AUTOMO ILE LWBILITY rr En4BGYddnrv�l.. .m._. ..—...�_. I BODILY INJURY (Par person) $ ANY AUTO '.. ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS P'ROI*ER dAP,tAGE $ ,_ NON -OWNED .Per :bocFdlanl. HIRED AUTOS AUTOS $ F�kwCH OCCURRENCE $ UMBRELLALIAB OCCUR AGGREGATE $ ...� '... EXCESS LIAB GLAYtatS��t4iADE J...... ...... - -- �$ DEC1 R ENTION.S r�.+ WGSTAYwT41« 7Cc 11- VMORRER�S COMPENSATION J"�" IwI AND EMPLOYERS` LIABILITY ANY PROPRIErORIPARTNERIEXECUTIVE Y� EIG591858701 E. ACIDEIIT $ ti 01h0 0I0 07/01/2025 07/01/2026 L. EACH•-.�-- -- A OFFICEfMEMBER EXCLUDED? N/A A E.,L. DISEASE - EA FMPI.OYE $ 1 1010000 ,,,,� ,,• IMIncclatol In NH) d ytm, describe under E..L. D$$E:AsE w POLICY Lwrr S 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, It more space Is required) CERTIFICATE HOLDER CANCELLATION City of El Segundo Department of Recreation, Parks and Library SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE' WITH THE POLICY PROVISIONS. 401 Sheldon Street AUTHORIZED REPRESENTATIVE EI Segundo CA 90245 © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ACORD 25 (2010105) CIF:aY~ AI#