The URL can be used to link to this page

PROOF OF INSURANCE (2026 - 2026)CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 09/01/2025 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 ricihts to the certificate holder in lieu of such endorsement(s). PRODUCER Next First Insurance Agency, Inc. PO Box 60787 Palo Alto, CA 94306 INSURED Naomi Gol DBA The City of El Segundo 350 Main St El Segundo, CA 90245 (855) 222-5919 rt@t)extnsurance.com INSURERA: State National Insurance INSURER B : INSURER C : INSURER D : INSURER E : Inc. 112831 COVERAGES CERTIFICATE NUMBER: 693778888 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 AOOL uU R _ ................... POLICY EFF itt7t, 6F I.XP LIMITS LTR TYPE OF INSURANCE Wvn POLICYNUMBER JMMIQtTnYzY MM/DDIYYYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000.00 ' CLAIMS -MADE 1XI OCCUR AMO R mITITITIT PREMISES fEa appurrenr..e,� $100,000.00_, MED FRCP (Any one person) $10,000.00 A X NXTA44WFQC-04-GL 09/01/2025 09/01/2026 PERSONAL & ADV INJURY $1,000,000.00ITITITIT GEN'L AGGREGATE LIMIT APPLIES PER: _GENERAL AGGREGATE $3 000 000.00 X POLICY JEC ❑ LOC PRODUCTS COMP/OP AGG $3 OOQ000.00 $ OTHER. AUTOMOBILE LIABILITYCOMBINED SINGLE LIMIT $ Caa, i ANY AUTO BOOILY INJURY (Per person) $ .m............. �... .-.... OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS HIRED NON -OWNED •---- •••••_ ......-•••- PRt7PERT'i' DAItPA'E AUTOS ONLY AUTOS ONLY PPer acldonl) •••••••- -$. UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE .......... ,_. - ......_.... AGGREGATE $ ._..................�. - - ....... DED RETENTION $ $ ION WORKERS WORKER' OTH STATP Rt�T� ITITIT, ERS' LIAB AND EMPLOY ILITY YIN wwwER ANYPROPRiE'rOWPAXR'I'NER EXECt7TIVE ❑ OFFCCEPJMEMBEREXCLUDED? N / A ELEACH EACH ACCIDENT ._..-..- $ - ._..,. ---- (Mandatory in NH) E.L. DISEASE EA EMPLOYEE $ If ems, describ. under DESCRIPTION OF OPERATIONS bola r E,L. DISEASE- POLICY LIMIT $ Each Occurrence: $1,000,000.00 A Professional Liability NXTA44WFQC-04-GL 09/01/2025 09/01/2026 Aggregate: $3,000,000.00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD101, Additional Remarks Schedule, may be attached if more space Is required) The Certificam Holder is The City of El Segundo, its elected and appointed officials, employees, and volunteers. This Certificate Holder is an Additional Insured on the General Liability the Additional Insuredd Automatic Status Endorsement. All Certificate Holder privileges apply only if required by written agreement between the Certificate policy per Holder and tfie Insured„ and are subject to policy terms and conditions. CERTIFICATE MOLDER CAN ELLATION The City of El Segundo, its elected and appointed officials, LIVE CERTIFICATE ern toyees, and volunteers "*■- SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 36U Main St THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN El Segundo, CA 90245 ' ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Clickor scan - n to view ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD 0 DATE (MMIDDNYYY) ► " "� CERTIFICATE OF LIABILITY INSURANCE 02/24/2025 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 CONTACYOVIdiu BOlun PHONE 800 891 . - Pacific First Insurance Services` su partyccntractorstin8009897786 790FAX E-MAIL surance com 79734 Parkway Esplanade N Pp La QUlnta , CA 92253 INSURERA, „INSURERjS)AFFORD..._ERAGE 11673 Redwood Fire and Casualty Insurance Company �,3 INSURED Naomi Gol 1619 S SHENANDOAH ST Los Angeles, CA 90035 F: RFVICInPJ NIIIMRFR• vTHIS 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 BYPAIDCLAIMS. ...... ..... . �. ........_ .._ ..__-,. ..... ..... .. .......m -- ... .... .. ^ IN AiaDL Sit' Pk POLtlCY IEF&� POLICY P LIMITS TYPE OF INSURANCE.,..,,.,... R POLICY NUMBER 'MIdAdDDJ'YV'VY" 4 MMC COMMERCIAL GENERAL LIABILITY '.. EACH OCCURRENCE $ .'.... . —" ......,,.. CLAIMS -MADE [X......1 OCCUR ..GkAtt+IJ"b �t:N REN rFID ... w„F?I F'h9d,,.FS tEa o�hUG[ tN.� P,)... . .... .�. $---- ... ......., .. .............- ----- ......... 08/24/2025 MED EXP (Any one person) .......... .._ $ PERSONAL & ADV INJURY ........ .^ .. $ ... -�GL'N LAGGREGATE LIMIT APPLIES....-._..............m PER: GGREGATE GENERAL A. - _— ........�.. ... $ ........... .... ... .- POLICY [[ PRO, LOC ... „ .b .IEGT ❑ .......�.-,,._ _— .$.._- ....._.._. OTHER, OMI'rGG C:'.C7MBIJNE£. SINGLE 1,000,00 0 AUTOMOOWNEDBILITY BILE Ag accndnrvg). __ $.,, ... ...._ BODILY INJURY (Per person) $ ANY AUTO X SCHEDULED 01APM055881-01 02/25/2025 02/25/2026- BODILY INJURY (Per accident) - --- $ A .,,�..... ,._... -.I NON -OWNED AUTOS, DAMAGE .$ $ �..... HIRED AUTOS .. 11 AUTOS (R4yPERTY .. ....... . .... $ UMBRELLA LIAB OCCUR 1- EACH OCCURRENCE $ EXCESS LIAB 1CLAIMS-MADE AGGREGATE --- W^ . $ .. DED RETE $ ......... $ ONN COMPENSATION X PER OTH STATUTE ER AND EMWORKEPLOYERS' Y/N ..... ....,. ANY PROPRIETORIPARTNERIEXECUTIVE EL. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N I A E.L. DISEASE EA EMPLOYE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) CERTIFICATE HOLD City of El Segundo 350 Main Street El Segundo, CA 90245-3895 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 n 1988-2D14 A ORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD 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: (J 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 forthe performance of the work for which the agreement with the City of El Segundo is execrated. My workers' compensation insurance carrier and policy number are: Carrier Policy Number Expiration Date Name of Agent Phone # GK 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 I should become subject to the workers' compensation provisions of Labor Code § 3700 1 must Signature Applicant provisions or the greement will automatically become void. rmrgmediatelypP comply w with those ^ �� Date Prim Name Agreement for. Dated: Reviewed by: