Loading...
PROOF OF INSURANCE (2026 - 2026)CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 03/18/2026 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 endorsement(s). PRODUCER Verifly Insurance Services, LLC DBA Thimble Insurance Services 174 West 4th Street, Suite 204 New York, NY 10014 https://support.thimble.com/ INSURED Kitchens Corner LLC 15545 Gundry Ave, Paramount, CA, 90723 info@kitchenscomerbbq.com COVERAGES CERTIFICATE NUMBER: INSURE -RA : INSURER B : THIMBLE https://support.thimble.com/ com RING COVERAGE REVISION NUMBER: .......NAIC..#. 22608 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. ...P m,_ _ _ -... SURANCE POLICY NUMBER MMIDDIYYYY i MMIDDr�. INSR11 ADDi."S''�p�R m POLICY EFF POLI�CW EXP LTR , TYPE OF IN. T DdYYY`y LIMITS X I COMMERCIAL GENERAL LIABILITY 09/17/2025 " 09/17/2026 $ 000 000 OC U EN ,.. ,,, _.... .. CLAIMS -MADE X,..� OCCUR 7:32 PM 7:32 PM EACH AMA R CE e mca $ 1..?i1b�OQ_ PzE�9s(i xRt E,.. )�,_$ . , PDT PDT MED EXP (Any one person) 5,000 A Y Y IBL-P36849DDJC -- & ADV INJURY $ 1,000,000 .. G"EN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ 1,000 000 X POLICY P"O' LOC tlEC:T P /OMPVAGG ,,000,000 OTHER: t $.,, $ G 07w1B N O SRNGM AUTOMOBILE LIABILITY (a ac6dPav(L . _ „ 3 ANY AUTO BODILY INJURY (Per person) !,$ OWNED C SCHEDULED � INJURY Per acc ( accident) $ AUTOS ONLY d AUTOS HIRED NON -OWNED -. ,P fwOPERt"Y C.YAMAG'C......... .... ..... $ AUTOS ONLY _.. AUTOS ONLY BODILY Hu.a aicrtbd,rrQ]' ,� ,,, „.- ....... I Is UMBRELLA LIAR OCCUR EACH OCCURRENCE --- �$ .... f EXCESS CLAIMS MADE AGGREGATE ATE $ .. ..ENTION.. I WORKERS COMPENSATION - ER OTH STATAJTE R AND EMPLOYERS' LIABILITY Y/N - $ ANY PROPRIETOR/PARTNER/EXECUTIVE E L EACH ACCIDENT .,,.. OFFICER/MEMBER EXCLUDED? ❑ NIA (Mandatory in NH)E �..„„ L DISEASE EA EMP ���� �_.. .m � ������� E.L, $ ������� �-�------� and If yes, describe under DESCRIPTION OF OPERATIONS below LIMIT DISEASE POLICY $ -- .. ...., ---- ... ............ $ ....., DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space isrequired) con't on form Acord 101 City of El Segundo its elected and appointed officials employees and volunteers 350 Main St. El Segundo, CA90245 CANCELLA 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 @ 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ACORD 25 (2016/03) AoeNcv CUSTOMER ID: info akitchenscornerbbq.com LOC 1 ACC ADDITIONAL REMARKS SCHEDULE AGENCY Verifly Insurance Services, LLC DBA Thimble Insurance Services ........ ....................... . ....... POLICY NUMBER IBL-P36849DDJC NAMED INSURED Kitchens Corner LLC 15545 Gundry Ave, Paramount, CA, 90723 info@kitchenscornerbbq.com CARRIER NAIC CODE National Specialty Insurance Company 22608 EFFECTIVE- DATE: Pane 1 of 1 ACORD 101 (2008/01) © 2008 ACORD CORPORATION. Au ngnts reserves. The ACORD name and logo are registered marks of ACORD THSN IL 20 20 10 20 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED ADDITIONAL INSURED This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM PROFESSIONAL LIABILITY COVERAGE FORM SCHEDULE Name of Designated Person or Organization (including its departments and attached agencies, its directors, officers, officials, employees, representatives and agents): Any person(s) or organization(s) for whom you have agreed in writing in a contract or agreement that such person(s) or organization(s) be added as an additional insured on your policy. E-Mail Address: A. SECTION II — WHO IS AN INSURED is amended to include as an additional insured the person(s) or organization(s) shown in the SCHEDULE above, but only with respect to liability for "bodily inju- ry", "property damage", "personal and advertising injury" or "wrongful acts' caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: 1. In the performance of your ongoing operations; or 2. In connection with your premises owned by or rented to you. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insur- ance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following is added to LIM- ITS OF INSURANCE section of the coverage form If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable limits of insurance shown in the Declarations; whichever is less. C. If this policy is cancelled or nonrenewed for any reason, we will deliver notice of the cancellation or non -renewal to any Designated Person or Organization shown in the SCHEDULE above at the e- mail address shown above. D. This endorsement shall not increase the applicable limits of insurance shown in the Declaration All other terms and conditions remain unchanged. THSN IL 20 20 10 20 © Verifly Insurance Services, Inc. 2020 Page 1 of 1 Includes materials copyrighted by Insurance Services Office, Inc., used with its permission POLICY NUMBER: IBL-P36849DDJC COMMERCIAL GENERAL LIABILITY CG24041219 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER R OF SUBROGATION) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART ELECTRONIC DATA LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART DESIGNATED SITES POLLUTION LIABILITY LIMITED COVERAGE PART DESIGNATED SITES PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART UNDERGROUND STORAGE TANK POLICY DESIGNATED TANKS SCHEDULE Name Of Person(s) Or Organization(s): Any person(s) or organization(s) for whom you have agreed in writing in a contract or agreement that such person(s) or organization(s) be added as an additional insured on your policy. Information required to c,omolete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV — Conditions: We waive any right of recovery against the person(s) or organization(s) shown in the Schedule above because of payments we make under this Coverage Part. Such waiver by us applies only to the extent that the insured has waived its right of recovery against such person(s) or organization(s) prior to loss. This endorsement applies only to the person(s) or organization(s) shown in the Schedule above. CG 24 04 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1 THSN IL 20 20 10 20 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.. DESIGNATED ADDITIONAL INSURED This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM PROFESSIONAL LIABILITY COVERAGE FORM SCHEDULE Name of Designated Person or Organization (including its departments and attached agencies, its directors, officers, officials, employees, representatives and agents): City of El Segundo E-Mail Address: Isandoval@elsegundo.org A. SECTION II — WHO IS AN INSURED is amended to include as an additional insured the person(s) or organization(s) shown in the SCHEDULE above, but only with respect to liability for "bodily inju- ry", "property damage", "personal and advertising injury" or "wrongful acts" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: 1. In the performance of your ongoing operations; or 2. In connection with your premises owned by or rented to you. THSN IL 20 20 10 20 © Verifly Insurance Services, Inc. 2020 Page 1 of 2 Includes materials copyrighted by Insurance Services Office, Inc., used with its permission THSN IL 20 20 10 20 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insur- ance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following is added to LIM- ITS OF INSURANCE section of the coverage form If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable limits of insurance shown in the Declarations; whichever is less. C. If this policy is cancelled or nonrenewed for any reason, we will deliver notice of the cancellation or non -renewal to any Designated Person or Organization shown in the SCHEDULE above at the e- mail address shown above. D. This endorsement shall not increase the applicable limits of insurance shown in the Declaration All other terms and conditions remain unchanged. THSN IL 20 20 10 20 © Verifly Insurance Services, Inc. 2020 Page 2 of 2 Includes materials copyrighted by Insurance Services Office, Inc., used with its permission COMMERCIAL GENERAL LIABILITY CG 20 01 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance Condition and supersedes any provision to the contrary: Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and (2) You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. CG 20 01 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1 POLICY NUMBER: IBL-P36849DDJC COMMERCIAL GENERAL LIABILITY CG 24 04 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART ELECTRONIC DATA LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART DESIGNATED SITES POLLUTION LIABILITY LIMITED COVERAGE PART DESIGNATED SITES PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART UNDERGROUND STORAGE TANK POLICY DESIGNATED TANKS SCHEDULE Name Of Person(s) Or Organization(s): City of El Segundo Isandoval@elsegundo.org I Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV —Conditions: We waive any right of recovery against the person(s) or organization(s) shown in the Schedule above because of payments we make under this Coverage Part. Such waiver by us applies only to the extent that the insured has waived its right of recovery against such person(s) or organization(s) prior to loss. This endorsement applies only to the person(s) or organization(s) shown in the Schedule above. CG 24 04 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1 ara�� wr■ev �.� .. EMPLOYERS ASSURANCE CO. A Stock Company POLICY DECLARATIONS NCCI Carrier # 36870 WCIRB CARRIER# 0091 1. Named Insured and Address KITCHENS CORNER 15545 GUNDRY AVE PARAMOUNT CA 90723 Customer # Carrier # I FEIN # 36870 1.991159477 Additional Locations: Workers' Compensation and Employers Liability Insurance Policy Policy Number FrornPolicy Period ,TO DWC 5962547 00�092025 04"30'120 6 soTk�ne at lnA.r yo awa 991he Ion PRIOR POLICY NUMBER NEW Agent VERIFLY INSURANCE SERVICES INC 0003738 THIMBLE 174 W 4TH STREET SUITE 204 NEW YORK, NY 10014 Telephone: 3158701733 Risk ID # TEntity of Insured LIM LIABILITY CO 2. The Policy Period is from 04/30/2025 to 04/30/2026 12:01 a.m. Standard Time at the Insured's mailing address. 3. A. Workers Compensation Insurance: Part ONE of the policy applies to the Workers Compensation Law of the states listed here: CA B. Employers Liability Insurance: Part TWO of the policy applies to work in each state listed in Item 3A. The limits of our liability under Part TWO are: Bodily Injury by Accident $ 1,000,000 each accident Bodily Injury by Disease $ 1,000,000 policy limit Bodily Injury by Disease $ 1,000,000 each employee C. Other States Insurance: Part THREE of the policy applies to the states, if any, listed here: All states except ND, OH, WA, WY and states listed in item 3.A. D. This policy includes these endorsements and schedules: See attached schedule. 4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates, and Rating Plans. All information required below is subject to verification and change by audit. Minimum Premium $ Assessments and Taxes $ SEE EXTENSION OF INFORMATION PAGE 750 Expense Constant $ 160 Premium Discount $ Total Estimated AnnualPremium $ 788 ❑ This is a Three Year Fixed Rate Policy Premium Adjustment Period: ® Annual; ❑ Semiannual Countersigned this Day of Issued Date: 04/22/2025 Issuing Office EMPLOYERS ASSURANCE CO. P.O. BOX 539003 HENDERSON, NV 89053-9003 Issued Date 04/22/2025 WC990630 (5/98 Ed.) ❑ Quarterly; ❑ Monthly INSURED COPY Page 1 of 4 Authorized Representative