PROOF OF INSURANCE (2027)'� DATE (MMIDDIYYYY)
A� " CERTIFICATE OF LIABILITY INSURANCE
3/3/2026
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 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 NAME, Xanh Tran
IQ Risk Insurance Services, LLC PHONE (949) 679-3700 FA/C NOI: (949) 6793701
8881 Research Dr E-MAIL. xtran@iqrisk.com
ADDRESS:
INSURERS AFFORDING COVERAGE NAIC #
Irvine CA 92618 INSURERA:Hartford Underwriters Insurance Co111 an 30104
INSURED INSURER B:Hart£Ord CdSllalt insurance Coma an 29424
Pacific Harbor Medical Group INSURER C:
360 N Pacific Coast Hwy Ste 30 INSURERD:
INSURER E :
El Segundo CA 90245-4430 INSURERF;
ncr-l- unueoo.r T.Oa477 9SR'7 RFVI_gIAN NIIMRFRr
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.
VNSR TYPE OF INSURANCE AODL. SUER POLICY NUMBER MMIDDNYYY MMI00JYYYY LIMITS
LTR
X
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$ 2,000,000
LAAd�JJt
MOlncd
$ 1,000,000
A
CLAIMS -MADE I.^... a.... OCCUR
MEDEXP (An one person)
$ 10,000
X
72SBACAOLZ7
3/1/2026
3/1/2027
PERSONAL B ADV INJURY
$ 2,000,000
GEN'L AGGREGATE LIMITAPPLIES PER:
GENERAL AGGREGATE
$ 4,000,000
PRODUCTS - COMPIOP AGG
$ 4,000,000
POLICY1:1 PRO. � LOC
X JEC1"
-
$
O 4 kMER
SINGLE LIMIT
Fa
$ 000
AUTOMOBILE
LIABILITY
72SBACAOLZ7
acc�pp'Inq
2, 000,
�----�
BODILY INJURY (Per person)
$
3/112026
2(7./202.I
ANY AUTO
A
ALL OWNED SCHEDULED
X
BODILY INJURY (Per accident)
$
AUTOS AUTOS
WNED
-
PROPER TY V7
$
HIREDAUTOS AUTOS
Poa acrs"c�na
X
UMBRELLA LIAB X OCCUR
EACH OCCURRENCE
$ 1.,. 000, 000
A
EXCESS LIAB '... CLAIMS -MADE
AGGREGATE
$ 1.,000,000
QED RETENTION $
X
72SEACAOLZ7
3/1/2026
3/1/2027
$
WORKERS COMPENSATION
X FER OTH-
iTATTE T1
AND EMPLOYERS' LIABILITY YIN
E L EACH ACCIDENT
$ 11000,000
ANV PROPRIETOR/PARTNERIEXECUTIVE
""'"""
E,L.DISEASE - EA EMPLOYEE
$ 1,000,000
B
OFFICERIMEMBER EXCLUDED? El�NIA
',(Mandatory in NH)
72WECCAOLZN
3/1/2026
3/1/2027
E.L. DISEASE -POLICY LIMIT
$ 1 000 000
If yes descolue under
DESCRIPTION OF OPERATIONS below
r
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
*10 Days Notice of Cancellation for Non -Payment of Premium.
The City of E1 Segundo, Elected Officials, Agents, Employees and Volunteers (collectively City of E1
Segundo and its Agents) are included as Additional Insureds as respects to General Liability.
!`CDTICICATF Uni I I CANCELLATION
City of El Segundo
350 Main Street
E1 Segundo, CA 90245
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
Xanh Tran/XANH
1
CORPORATION. All ritthts reserved.
ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
INS025 (201401)