PROOF OF INSURANCE (2026)THE HARTFORD
BUSINESS SERVICE CENTER
THE 3600 WISEMAN BLVD
HARTFORD SAN ANTONIO TX 78251
City of El Segundo
350 MAIN ST
EL SEGUNDO CA 90245-3813
Account Information:
_ ......-...
Policy Holder Details : than John DBA Kweku Abimbola
December 17, 2025
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Enclosed please find a Certificate Of Insurance for the above referenced Policyholder. Please contact us if you have any
questions or concerns.
Sincerely,
Your Hartford Service Team
WLTRO05
.4c�►rr CERTIFICATE OF LIABILITY INSURANCE 12/17/2025
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 SUBROGATIONIS 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).
NUTMEG INS AGENCY INC/PHS
76210797
The Hartford Business Service Center
3600 Wiseman Blvd
San Antonio, TX 78251
Nathan John DBA Kweku Abimbola
3060 W OLYMPIC BLVD APT 717
LOS ANGELES CA 90006-3845
PHONE (888)925-3137
(A/C, No, Ext):
ADDRESS:
INSURER A
INSURER B
INSURER C
INSURER D
INSURER E
INSURER F .:
(AIC, No):
INSURER(S) AFFORDING COVERAGE NAIC#
irtford Underwriters Insurance Company 30104
C_TTHIS IO RS ECERTIFICATE
CERTIFY'THAT THE POLICES OFNSURA CENUMBER:
LEISSD BELOW HAVE BEEN ISSUED TO THE N NUMBER: 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 _.---
.....-.....,.... .............._._ ...........
ADDL �SUBR' .m....., POLICY EFF ITPOLICY EXP
EINSURANCE POLICY NUMBER LIMITS
LTR. COMMERCIAL G -......... 1„(il$R - WUD ................ - ..I..... M.MID n YYY,) ....-AC
TYPE F
GENERAL LIABILITY
EACH OCCURRENCE $1 fz0,ail0
�-�--q $1,00 _.,0
CLAnM'-�MAC3L � X. loc�uR '®aMAG� ro liENrEo 0,000
i�u P� `E5..1 q urr nr ..- . _-
X General LI'abiiity MED EXP (Any one person) $10,000
....... ........_ ......................... ........_.
q X 76 SBU BM6KBA 12/11/2025 12/11/2026 ,PERSONAL&ADVINJURY $1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000
.._.
X POLICY PRO LOC PRODUCTS- COMP/OP AGG $2,000,000
-..... JECT ......-_-- ...._.
OTHER:
E ........ ........... .. .................... ............. _. ..........
LIABILITY
COMBINED SINGLE LIMIT
AUTOMOBILE $1 50Q 005
ANY AUTO BODILY INJURY (Per person)
ALL OWNED ......... SCHEDULED
A AUTOS AUTOS 76SBUBM6KBA 12/11/2025 12/11/2026 BODILY INJURY (Per accident)
_.......... . ......................
__
HIRED NON -OWNED PROPERTY DAMAGE
X X Per accident
AUTOS AUTOS ( ),.......... ........
......... ........ ..........m..... . ........................ ........ ...., ..__..... ..............
UMBRELLA LIAB OCCUR EACH OCCURRENCE
EXCESS LIAB CLAIMS- AGGREGATE
MADE ........... -. ........ ....-....._...�..-..;
OELF RETENTION $
AND EMPLOYERS'_�.................,.............._ ..... ... ......... .... .............._
WORKERS COMPENSATION �TEpTUTE �ER'H
LIABILITY ..................
ANY YIN. E.L.. EACH ACCIDENT
PROPRIETOR/PARTNER/EXECUTIVE N/A m''"...............-, ..............._.
OFFICER/MEMBER EXCLUDED? E.L. DISEASE -EA EMPLOYEE
(Mandatory in NH) .........._...r ---._....,....
If yes, describe under E.L. DISEASE - POLICY LIMIT
DESCRIPTION OF OPERATIONS below
....................... .. ......... . . . . . . . . . ........... ............. ........ . . . ..........
DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
Those usual to the Insured's Operations. City of El Segundo is an additional insured per the Additional Insured - Designated Person Or Organization
Form SL3042 attached to this policy. _
Clt O IFICATE - SHOULD ANY OF THE ABOVE DESCRIBE
HOLDER CANCELLATION ......_.._
C f El Segundo D POLICIES BE CANCELLED
350 MAIN ST BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED
EL SEGUNDO CA 90245-3813 IN ACCORDANCE WITH THE POLICY PROVISIONS.
......... ......
AUTHORIZED REPRESENTATIVE
_ 0 19.... .. ........_._ ..........IT.. .............
2015 ACORD 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.
affirm under penalty of perjury under the laws of California one of the following declarations:
(_) 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,
C�_) 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 The Hartford
Name of Agent
Nancy Pluzdrak
Policy Number Expiration Date 09/01/2026
Phone # 888 277 4767
(x) 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 a re e nt will automatically become void.
Signature of Applicant � �Date 11116/24
Print Name Nathan Kweku John
Agreement for:
Dated:
Reviewed by: