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PROOF OF INSURANCE (2026)DATE (MM/DDNYYY) AC"R " CERTIFICATE OF LIABILITY INSURANCE 09/18/2025 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 CONTACT Suzanne Altman CAt.O...Na .F atl. FA?( AAioN .... 1 ..4A€ Nct Suzanne Altman Insurance Agency 818-262 020 5900 Canoga Avenue, Suite 310 9 ADDR� — .... L .....""".".., .), . RAGE... ---. ............... ... NAIC # Woodland Hills CA 91367 INSURER S AFFORDING COVE INSURERA: Lio Insurance Company 17346 INSURED A Yummy Future 9100 S Sepulveda Blvd. Los Angeles, CA F: RFVICInN MIIMRFR• 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 BY PAID CLAIMS. ......... ..,.., .... .,.., ..--- ...,�. . .�............._,_ TYPE OF IN 4 ................. Y EXP ILTR INSURANCE ......... �k�kAObL Subk POLICY NUMBER" ... .......... IPMIDDYV CFF ". POLI"d ... __ V MMIO ryyyy LIMITS XCO_MMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 ,.� CLAIMS -MADE OCCUR bAMAdE Tb7 kLNT#b.... „�)iA18RS (Ea occ"urren�gf,,,, $ 100,000 �MED EXP (Any one person) $ 5 000 . A X LIO 1100030567-00 02/03/2025 02/03/2026I .............. PERSONAL& ADV INJURY $ 1,000-00 ....................... - 3,13 OO 000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE.AGG v JEC Loc POLICY PCRODUCTS COMP/OP, $ 3 000,000 ,. _ ..— ........ . ..,. -...- O'rHE'R.; $ OMMNEO5 INGLE LIMIT I $ A UTOMOBILE LIABILITY � .......... 1 ...................._, ... ....�..... ANY AUTO BCODILYII).. I INJURY (Per person) .AUTOS $ ,.., OWNED ODIL INJURY Peracc idenl) BP'. $AHIRED FISCHEDULED ONLY AUTOS NON-OWNEDRTY DAMtAAC"E $ UTOS ONLYAUUT SONLY N �9nnl .. ....... (..eCary , ..... ... .., $ UMBRELLA LIAR i OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE ...._ ...... ........ _ $., " D...V,....,." T RETENTION$ ............. ..........� WORKERS COMPENSATION PER (I OTH STATUTE 1 J ER AND EMPLOYERS' LIABILITY EMPL S' LIABILITY ° N ,.,,. AND IETO ECUTIVE Y . E, ,L EACH ACCIDENT $ "" µ - OFFICERIMEMBEREXCLUDED? (Mandatory in NH) N/A E.L DISEASE EA EMPLOYEE __.-. ................ .,.....,- $ .... .........................................-... If yes, describe under ''. DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY( IMIT $ A Sexual Abuse & Molestation ' X N/A LIO 1100037212-00 02/03/2025 02/03/2026 Per occ/Agg 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) Certificate holder is listed as additonal insured as allowed under this policy The City of El Segundo, its elected and appointed officials, employees, and volunteers are included as additional insureds. CERTIFICATE HOLDER 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 Street '.. AUTHORIZED REPRESENTATIVE ElSegundo CA 90245 ©1988-2015 XCORD CORPORATION. All rights reserved, ACORD 25 (2016/03) 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: L_) 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 o the work for which the agreement with the City of El Segundo is executed. My workers' compensation insurance carrier and policy number are: Carrier Scottsdale Insurance Company Policy Number Expiration Date 06/27/2025 Name of Agent Suzanne Altman Phone # 800-334-5579 L_) 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 immediately comply with those provisions or the agreement will automatically become void. Signature of Applicant Print Name Agreement for: Dated: Reviewed by: Date