Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
PROOF OF INSURANCE (2027)
BoldSign Document ID: 057d7fb8-21cf-4296afc3-blc237373614 CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 01 /27/2026 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 end'orsement(s), PRO.... _ . -.........,..,m,,. . ......... —_.,, ,,.... _ .... .... DUCER mmTCONTACT .... GEICO INSURANCE AGENCY, LLC dEAMAI' seTExay (8se) ss1 9aa Aac„ N': i=1s?7J s�zasoa 1 GEICO BLVD 4TH FLOOR ..... _ l FREDERICKSBURG, VA 22412 ApppS parvEca�.caratmr raweuar cmn (888) 661-3938 INSURER(S) AFFORDING COVERAGE ........ .., NAIC # INSURER A FIDELITY AND GUARANTY INSURANCE COMPANY .,.......... ......_......... _ ........... .... INSURED INSURER B .......... ONE STOP VENDING INC. 4958 W 59TH ST INSURE.R_C — LOS ANGELES, CA 90056 INSURER D INSURER E : ....... ............ ....,,,, ....... ,,, .AA..m........._. ...,.,, ......,...__ ........_ �._...... INSURER F , COVERAGES CERTIFICATE NIUMBER: 265899519341720 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. ➢NSR ADDL SUBR POLICY EFF POLICY EXP LTIR„ _,® TYPE F INSURANCE � ,bN�L3 "4 POLICY NUMBER ,,. " . ,. (MMIDt1Fi'YYYj' ,.., (MM�DC7(;'?Y1F'"LIMITS A - X BIP-C443696A-26 X COMMERCIAL GENERAL LIABILITY 01/15/2026 01/15/2027 EACH OC4 JRRENCE $1 000 000 —MADE A_i C,SR ➢„yp, 5�000 _]CLAIMS ➢"nIED EXP(Aary ane Pen xin $5 000 . P'ERS<?NAL�I(A�tlN,JC,IRY $1 r000,000 AGGREGATE LIMIT APPLIES PER EiENCRA ,t^ImRE�Ap.. $2,000,O�j0 POLICY [ PRO JECT 4.,,_,(LOC FCda7%/ROC'T,9,.�....�� _— -,lC.rNNOPAt 0 $2,000,000 OTHER: -�•� $ W :ED Ta Ndret SINGLE LIMIT $ AUTOMOBILE LIABILITY (brad ar,cudG'ra'aaV a" ANY AUTO BODILY INJURY (Per person) $ OWNED" SCHEDULED�� AUTOS ONLY AUTOS BODILY INJURY (Per aucdda vo $ HIRED NON -OWNED _..._.. AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE $ (Per accident) ......... ....... ..... UMBRELLA LIAB OCCUR _ EACH OCCURRENCE $ EXCESwT A9IohShA�ADE h„L AGGREGATE $ DED RETENTION $ $ WORKERS NSATION NIA P PER FER STAT'Ll'TE AN'DEMPLO ERSELIABILITY Y/N ANY PRO)' RNEl'ONOPARI'NERIIEXECLJTIVE OFFICER(MEMBER EXCLLTOED'� E.L. EACH ACCIDENT $ (Mandatory in NH) EL. DISEASE - EA EMPLOYEE $ 11 es LY SC 4 PTOr) rg OF OPERATIONS below E.L DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) AS RESPECTS TO GENERAL LIABILITY, CERTIFICATE HOLDER IS ADDITIONAL INSURED PER FORM COMMERCIAL GENERAL LIABILITY COVERAGE FORM, CG T1 00, MANAGERS OR LESSORS OF PREMISES FOR THE FOLLOWING LOCATION: 4958 W 59TH ST, LOS ANGELES, CA 90056. AN ENDORSEMENT HAS BEEN ADDED TO THE POLICY (OR POLICIES) THAT PROVIDES 30 DAY EARLIER NOTICE OF CANCELLATION, SUBJECT TO THE TERMS OF THAT ENDORSEMENT. RE: SOFT SERVE KIOSK; CONTRACT: 98187-1 M ....�..._. _ .......,.. - .......... ._.,....... CERTIFICATE HOLDER rANrr-I I AT'ION CITY OF EL SEGUNDO SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE DEVELOPMENT SERVICES DEPARTMENT THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 350 MAIN STREET ACCORDANCE WITH THE POLICY PROVISIONS. EL SEGUNDO, CA 90245 AUTHORIZED REPRESENTATIVE Re zw' M. 130raL' ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD