PROOF OF INSURANCE (2026)CERTIFICATE OF LIABILITY INSURANCE
DATE (MMIDDIYYYY)
10/28/2025
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 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
Progressive Business Insurance
Progressive Casualty Insurance Company
300 N Commons Blvd W64
Mayfield Village, OH 44143
INSURED
Novo Gym Repair, Inc.
13658 Hawthorne Blvd, STE 213
Hawthorne, CA 90250
COVERAGES
CERTIFICATE NUMBER:
Business Insurance
8888069598
businessinsura
INSURER A: Spinnaker Insurance
INSURER B
INSURER C
INSURER D :
REVISION NUMBER:
NAIC #
24376
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. ........ ........ ..... ..
, ..... m. „......� .., ,,,... .IMI ,,. -_..
......._ -....... .--. ....IIALIDLy'ii�Bit... -. ;44....,POLICYEFF POLICYE7CP.I�........._._,.
- ... - .....
LIMITS
ILTR
TYPE OF INSURANCE POLIC.....,
1L X YNUMBER 1 MWOO/YYYY MM/DDIYYYY
X
COMMERCIAL GENERAL LIABILITY
OCCURRENCE
ERE,TAI�SES
$ 1 OOO 000
DAMAli fd ENIED
50 000
CLAIMS -MADE X OCCUR
EACH
�Ea 9courre9ce)
$
-
CSG-00335385-00
09/18/2025
09/18/2026 MED EXP (Any one person)
$ 5,000
PERSONAL_&ADVINJURY
$ Included
...., .. _.
..GENL
,,,,,,,,,I'll ......... ,....
AGGREGATE LIMIT APPLIES PER:
.GEN GGREGATE
.GENERAL A............... ..
$ 2,000 OOO
....... ............
f
......
X
PS�'O•
POLICY IJE�C"f LOC
...._
OOO OOO
-..-.. ,.,,.....
,
I
oMIAGG
$..2......
$
OTHER';
COMBINED SgNG'ME
AUTOMOBILE LIABILITY
.,.(fvs arxldnral}
ANY AUTO
INJURY (Per person)
$
_.�
OWNED SCHEDULED
INJURY (Pe r acadent}
BODILY INJU
$
AUTOS ONLY AUTOS
HIRED O D
0ROPEfiTY Cd A4M(P
$ , ..
���.,AUTOSf
AUTOS ONLY ..�
I
th�r yyr`c.u9p@,)
,._
UMBRELLA LIAB OCCUR
EACH OCCURRENCE
$
EXCESS LIAB I CLAIMS -MADE.
AGGREGATE _
....
$ .. .m ...
DED RETENTION $
$
WORKERS COMPENSATION
PER L. F
STATUTE 1R
AND EMPLOYERS' LIABILITY Y/N
YPROPRIETOR/PARTNER/EXECUTIVE
ANOFFICER/MEMBER
LEACH ACCIDENT
$ __ .
EXCLUDED. ❑
(Mandatory in NH)
NIA
E DISEASE_ EA EMPOYEE
$ _
If yes, describe underDISEASE
DESCRIPTION OF OPERATIONS below
E.L.L POLICY LIMIT
$
r
+
i
a
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required)
El Segundo Police Department
348 Main Street
El Segundo, CA 90250
%, MM1.0L-I—^
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
ao'r
U I9titi-ZUI O AGUKU GVKYVKAI IUN. Au rlgnL5 re5erveu.
ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
AND CIVIL FINES UP TO ONE `HUNDRED THOUSAND DOLLARS `($108,,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:
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.
i
(_) 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 Policy Number Expiration Date
Name of Agent Phone #
( i/l 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 1 must
immediately comply agreement will automatically become void„
g Applicant provilaj r the ac��reem
Signature A mlicantlt t ose Date
/D�