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PROOF OF INSURANCE (2026 - 2027)
AC"R"' DATE(MM/DD/YYYY CERTIFICATE OF LIABILITY INSURANCE 0 3/19/2026 - ----------------- - - --------- - . ..... . . ..... . THIS CETIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOTAFFIRMATIVELY OR NEGATIVELY AMEND,REXTEND 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. -11111 ... .. .................. .... .. .... . — ---------- -1--1 ......... . . ...... IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, sub jectto 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 NAME: GARETH - N I I C - K ERS.-O.N Gareth Nickerson(993039V) PHONE FAX 27194 Baseline St Ste C (A/C, NO, EXT): 909-385-3200 (A/C, No): 909-839-4372 ... .. .. .. .. ................ ....... . . . . . ..... . ....... - ------ . .............. ----- E-MAI L Highland CA 92346-3197 ADDRESS: gnickerson@farmersagent.com . . ..... . ........ ......... . . . ............. ... .. ....... . . . . ............ . . ..... NG COVERAGE NAIC# I NSU RER(S) AFFORDI I .... . .. .. .................. .... ..... ... --- . . . . . .. . ........ . ........................ .. . . . .............. INSURED ]l INSURER NORTHFIELD INSURANCE 27987 THIS IS TO CERTIFY IAT TI iE POLICIES OF INSURANCE I..IS1ED BELOW HAVE BEEN ISSUED TO THE INSURED NAME ABOVE FOR TI IE POLICY PERIOD MIDICAR:1) NOTWITHSTANDING ANY REQUIRE.:MEN :MEN F, TERM OR CONDITION OF ANY CONTRACTOR OTI IER DOCUMEN r WITH RESPECTTO WI fiCH THIS CERTIFICATE MAYBE ISSUED OR MAY PER 'Al N, 1 HE INSURANCE AFFORDED BY THE POLIOES DESCRIBE D I IEREIN IS SIJBj ECTTO ALL THE 7 ERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE W . E-.N REDUCED BY PAID CLAIMS, - - - - ------------ — . ....... ...... ....... -' -- TYPECIFINSURANCE ADDTL SUBR POLICY NUMBER POLICY EFF POLICY EXP . . ........ .. ......... . . . INSR ] V%fVD MBER (MM/DD/YYYY) (MM/DD/ LIMITS LTR I—[ N S- D- I YYYY) COMMERCIAL GENERAL LIABILITY CLAIMS MADE x OCCUR �X UMBRELLA LIAB fX OCCUR EX CESS LIA B CLAIMS MADE 0100212520-1 (EXCESS RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/ Y/N EXECUTIVE OFFICER/MEMBER — N/A A09505451 EXCLUDED? (Mandatory in NH) f y Ifyes, describe under DESCRIPTION OF OPERATIONS below EACH OCCURRENCE I$ 1,000,UUO - ... ........... . . . . DAMAGE O REN FED PREMISEST(Ea Occuvrence) 100,000 MED EXP (Any one person) $ 5,000 10/27/2025 10/27/2026 - ------------ - PERSOINAL&ADV INJURY Is . ............... . . . . .. . 1,000,000 ... GENERAILAGGREGATE ... . . ................ 2,000,000 PRODUCTS COMP/OPAGG 2,000,000 . .......... . COMBINED SINGLE LIMIT (Ea accident) 2,000,000 r- --------- - M)DII.YINJUR ----------- - - - ---- 09/04/2025 09/04/2026 BO DI I-Y INJIJ RY (Per acciden 0 1$ PROPERTY DAMAGE (Per accident) $ - — EACH OCCURRENCE - - ----------------- 1$ - 5,000,000 ..... ..... . 10/27/2025 10/27/2026 AGGREGATE - -- ---- 1$ 5,000,000 - ------------ - I 1$ --- PER OTHER $ STATUTE . ......................... . .... . . . ............ .... ... E L EACH ACCIDENT I$ 1,000,000 02/15/2026 02/15/2027 E-ILD-1-SEASEE"A' E M'I"LOYE-E j ........... .. 1, .. 000 '00 0 , -------- ...... ........ ........ E L DISEASE-POILICYLI000 MIT 1$ 1.000, DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule, maybe attached if more space is required) CERTIFICATE HOLDER IS ADDITIONAL INSURED CERTIFICATE HOLDER CANCELLATION ......... ------ - ... I . ... . . . .. ............... . ................ --------- --- --- — - -------- CITY OF EL SEGUNDO SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL NCE WITH THE POLICY PROVISIONS, .. . . . ..... 350 MAIN STREET BE'o5i — - - ----- . ....... EL SEGUNDO CA 90245 AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) @1988-2015 ACORD CORPORATION. All Rights Reserved 31-1769 11-15 The ACORD name and logo are registered marks ofACORD POLICY NUMBER: WHOO8318 COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR. ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE .................................... ........ Name Of Additional Insured Person(s) Or Organization(s) Location(s) Of Covered Operations City of E1 Segundo, 350 Main Street, El Segundo, CA 90245 ... ................ ............... .. Information required to complete this Schedule, if not shown above, will be shown in the Declarations.. 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, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. 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 insurance 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 additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. Ali work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. CG 20 10 04 13 Copyright, Insurance Services Office, Inc., 2012 Page 1 of 2 C. With respect to the insurance afforded to these additional insureds, the following is added to Section III - Limits Of Insurance: 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. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 10 04 13 Copyright, Insurance Services Office, Inc., 2012 Page 2 of 2 T t�Y,i DATE(MMIDDIYI'YY) ACOORI CERTIFICATE OF LIABILITY INSURANCE 1311912026 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 NAME: John Josepl1 Premier One Insurance Services, LLC PHONE .No e t (949) 727-2025 A,C NoI 100 Pacifica Ste Suite 480 &NA9L AIL55v John.Joseph@Insureone.com ADDRE_. INSURER(S) AFFORDING COVERAGE NAIC # Irvine CA 92618 INSURERA: BeaZley Insurance Co 37540 ww. INSURED INSURER B . !Water, Inc. INSURERC,, 12 Goodyear #130 INSURER D INSURER E: Irvine CA 92618 INSURER F t COVERAGES CERTIFICATE NUMBER: CL2631946342 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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, 'IN R LTR _......,...._ TYPE OF INSURANCE INSD WVD ......._ __ POLICY NUMBER MM OIYYY DY (MMIDDIYYYY) .. LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S _ffA A CLAIMS -MADE 1:1 OCCUR PREMISES l,Ea occurrence $ .......... MED EXP (Any one person) $ PERSONAL&ADV INJURY $ GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ P'C' POLICY ❑ .7 LOC PRODUCTS - COMP/OP AGG $ $ OTHER:. COMBINED SINGLE LtM"T $ AUTOMOBILE LIABILITY LEa accident ......... I ANYAUTO BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY INJURY (Per accident) $ ....� AUTOS ONLY AUTOS HIRED NON -OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY I Her acoadenk) •••• $ UMBRELLA LIAB OCCUR ........ EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE J AGGREGATE S ,,,,,,,,,,_, DED ''—'__'.... RETENTIONS $ WORKERS COMPENSATION . . . ............ .............. ........... . . . PER OrH- STATUTE ER AND EMPLOYERS' LIABILITY YIN _ ANY PROPRIETOR/PARTNER/EXECUTIVE NIA E L EACH ACCIDENT S •••• ''. E L.. DISEASE EA EMPLOYEE S _ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E L.. DISEASE POLICY LIMIT $ LMIT PER OCC $2,000,000 A Professional Liability V1307D231401 10/04/2025 10/04/2026 DEDUCTIBLE $15,000 RETRO DATE 08-04-2011 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of El Segundo 350 Main Street AUTHORIZED REPRESENTATIVE El Segundo CA 90245 �� ? ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD