PROOF OF INSURANCE (2026)AC , "R" CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY)
1 0312512026
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 hoider In lieu of such endorserne
P - rKIDUCER
Brian Hunt
6693 Woodruff Avenue
Lakewood CA 907131129
INSURED
Allison, Robhy
4067 HARDWICK ST STE 495
LAKEWOOD GA 907122350
COVERAGES CERTIFICATE NUMBER:
Bolan Hunt
----------- - - --- --
PH ONE
16& 562-804-9147 . .... .. - - ------------
x§
E-MAIL brian.hcjnt.m5v2@statefarm.com
... .........I NS U RER(SI AFFORDING C 0 V E RAGE N I
. .......
INSURER A State Farni Generat InSuranCe. 25151
------ - --- -. .. ..... . . ....
:
.INSURERS..---------- -- ----- --- ....' ------ - --------------- - . ................ .
_INS4RE92 C,: ......... ... .. .. . ........ ..... - -------
IN ell URFR D:
. .....
INSURER E:
INSURER F:
--- 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 Al I. THE TERMS,
EXCLUSIONS AND CONDi 11ONS OF SUCH POUCIE& LIMITS SHOWN MAY HAVE
BEEN REDUCED BY PAID CLAIMS. ...... . .....
ADD7 S IN- . ....... . .... ..
TRSWI POLICY NUMBER
LTR TYPE OF INSURANCE INSD WV0
'PoOCVEFF''-J-ROL!CY
LISI
MMtDDNr'-' MIT
X, COMMERCIAL GENERAL LIABILITY
I
EACH OCCURRENCE 1,000,000
i
CLAIM% -MADE OCCUR
_�...300,000
MED EXP lAny one VDewn� $ 5,000 ....
---- ---------
y
A N 92-AO-S834-1
1 10115/2025 10/15/2026 PERSONAL & ADV INJURY 1,000,000
.. .. .. ........... - ------ .---- .4-----
. ... . . ......... .. . . . ............ . .... ... .....
qErl L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATF 2 000 000
I..... ----- - ... ...... .
PRO-
I LOC
PRODUCTS - COMP/OP AGG s-...2.1,0-0.0-,-0.00.-..�.."."��-.-.-
POLICY tJECT
.
OTHER
GUMb�NLU SINULL LIMI
AUTOMOBiLE LIABIUTY
ANY AUTO
.#-09I,LY-1N.JuR.Y (Pe.r,perso-n1----------
OWNED SCHEDULED
AUTOS ONLY AUTOS
HIRED NON -OWNED
AUTOS ONLY ii III AUTOS ONLY
iI 11IM: LIAR OCCUR
i$
EACH OC URRENCE
. ...... . ...... ........... . ... .. . . .. . ............
EXCESS LIAS Aq..-
...A.G.G; R,E.GAT,E-., ...... ......... -- --------- --- ....... ....
.-CLAIMS
DEDL 'RETENTlON $
PFR 0 11 TH,
""'E'1A I'M
AND EMPLOYERS' LIABILITY Y/N
ANY PROPRIE70R)PARTNER/EXECUTIVE
E,��E�AOH ACCIDENT $
OFF11 -ER/MEM5ER EXCLUDED? 1� NIA
E.L, DISEASE - EA EMPLOY -
Mendsit
tory In NH)
If yes, describe under
------- ---- — .... . ......
E.L. DISEASE - POLICY LIMIT
ESCRIPTION OF OPERATIONS below
--------------
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required)
CERTIFICATE HOLDER
CANCELLATION
City of El Segundo
300 Main St
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
CA 90245 This forni was sysiem-qenerated on 0312512026
@ 1988-2015 ACORD COR ORATJONi All rights reserved.
ACORD 25 (2016103) The ACCIRD name and logo are registered marks of ACORD 1001486 2005 155279 205 01-19-2023