PROOF OF INSURANCE (2026 - 2026)CERTIFICATE OF'LIABILITY INSURANCE
DATE(MM00F Yv)
I �[ /19/2(025
PRODUCER
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY
Alberto 0 Ocon
AND CONIFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS
CERTIFICATE DOES NOT AMEND, EXTEND,
OR ALTER THE
828 V' ( okiratio St,!Sac F"
COVERAGE AFFORDED BY THE POLICIES BELOW,
Glic,miale, CA 9 l �205
Ph 18 f 8)!5107,9 765 Far S 8), f%7- 9`411)6
INSURERS AFFORDING COVERAGE
NAJC #
k komdalc In5urance G,')mpray
. . . ......... .......
4 Q97
Buhblcmama and Comipmy LA LLc'
TINSURER
INSURrR 8� . . ........ .. ....... . .
12405 Vcnicc Bllvd 0384
Los Ang ,c�m C,k 901(*6
114UIRER D-
INSUFtER E
COVERAGES
. . .... . . ....
THE IPrC, GICSSOC III! SUIRANCE LUSTED BELOW HAVE BEEN MSUED 70 7HE INSURED NAMED ABOVE FOR 7HE POLICY PERK0 INMCXrED
NOTWTHSTANDING,
ANY REQIJII1REMEN7,T ERIM OR CONDITION (DIF ANY CONTRAC" OR 01 HER 0010 UMENT WITH RESPECT TO WHIICH THIS CERTIFICATE MAY
iBE ISSUIED OR MAY
PERTAK THE INSURANCE AFFORDED BY THF POLICIES DESCRIBED FIEREIIN G SUBjEcr TO ALL IHE I EIRMS, EXCLUSIONS AND CONDITIONS OF SUCH
POI, 1CW",, AGGREGATE II 9IA1T"S SHOWN MAY HAVE BEEN REDUCED
OY PA110 CLAIMS
N'04 Ajjut,
TYPE OF INSURANCE POLICY NUMBER
POLICY RFIFECnVE POU,CYVXPfRATt0NI
LIMITS
DATE MtMfi)0VYYI UATE fM*NanY__
GENERAL LIABILITY
A
EAO-f OCCIURENCIr,"
$ I'I
COAAMERCM (.10"INF ' RAL UASUXTV
DANMAGE TO MEN TED
11 t) 01 000
70C� AflPdS PJADF [Z 0(-,r',WR
MED EXfm 1,Ar,y vie parson)
S5,0010
rIMERSONA4, M)v M41 ulirk y
$ 1 000,0100
GENE"RAL AGGRr. GATE
ACX32REGATE I,NIT OYPIPHIS PE'k
F, pa 1,",y El molrc,
PP.ODUC, I
'S �� COK)P A W�CC
VrOl�'I01()(Jlo
$ 1,0010,0100
AAJTOM,OStLf LIABILITY
CO@ARI1144E',) SINGIII WA T
E]
El ANY AUTn
(C'adl
All L OWNED AUTOS
$046DU LED AU I CM
......... . . ........
9r0nKYNJ1jrVv
(peu jpfafsa"�)
. .....
HIRED AJUl 0,S
80l'3VL ' ' Y"dTtJ 'I -j "Y"
El NON-OWNEL) AVI 08
(Per Acadiant)
$
. .. .. .. ......
. ............ . .. . . . . . . . ..................
EGARAGLBTY
l �
AU TO NLY , A ACOIDENT
OE
— .........
. .................
IEJANYEMXOIAILI
OTHER '� I fAN EA A9X,L
AVI 0 ONLY, AGG,
EXCESSIUMORELLA UABILA'TY
I OCCIJ RRE NCIE
$
0C(%Hrq El CLAIMS MADIF
[w Cyijc�"84 E
PULNIIIJON
WORKEFA$ COMPENSA7110,14 AND
Wir VAlu, o 01
Empt OYERS'It 1AMI-13 Y
NaRy0milrs IFIR
ANY FIR(Ni IMIL 'Trf;pdrAR; -1 NERtXCCI'J=
1" IVE 0,FFK,-,',E'1RAAEM1DFf4, EACLUDED?
-- — — - ---------
"ye"s chm=biaurn dw
E, I EA EIMIN OYU'
$
SPECIAL
EL US SE P(N.11CYLAZIT
$
OTHER
$1,0100,,000 CSL
p 1 111^ Ill.0
1 .2/01 /2021""
Addft.oinal. lrisux:edr r.Y f„Y i'l Sragjr1fk, [,,*�parUTWYA
Or Fouct.Na"—icm, tlatks and Librai,,,,y
("i'v z )'nlc SHOULD ANY OF THE ADOVE DESCRISED, POLICIES HE CANCELLED BEFORE THE
3nd FXPIRATION D,AT E THEREOF,, THE INSUIREIR AFFORDING COVERAGE, WILL ENDEAVOR TO
4 MAX ,Q MAYS WRITTEN N07'N E 1*0 THE CER'DFICATE KOL DER NAMED TO rHIE LEFT, SUT
FALUAS tO 010, SO, SHALL 01POSE NO OSI OR k 1AII OF AINY KIND UIPONTHE:
k, J, "woundc;' 14 0 1 IINSURIER, ITS AGENTS OR REPRESENTATIVES,
AUTHORWE'D REPRESENTAT
7:Alberto 0 Ocf,,)n
ACORD 25 (2001100) a ORD, CORPORATION 1998
imi� Mi
If the certificate holder is an ADDITIONAL INSURED, the policy(iies) must be endersed, A statement on this
certificate doles not confer rights to the certificate holder in lieu of such eindorsement(s),
If SUBROGAT11ON1 118 WAIVED,, subject to the terms, and conditions of the policy, cartaiin policies may require an
eindorsernent, A statement on this certificate does not confer rights to the certificate holder in lieu of such
endorseme,nit(s)
The Certificate of Insurance on the reverse side of this form does not constitute a contact tie' en the issuing
insiurer(s), authorized representativeor producer, and the certificate holder, nor does it affirmatively or nie,gatively
amend, extend or alter the coverage afforded by the policies listed thereon,
POLICYNUMBER (,PS811,089211
COMMERCIAL GENERAL LIABILITY
CG 20 26 07 04
PRIff-UM
Section 11 — Who Is An Insured is amended to in-
clude as an additional insured the person(s), or or-
ganization(s) shown �n the Schedule, but only With
respect to liability for "bodfly injury property darn
age"' or "'personal and advertising inj�ury" caused, in
whole or in part, by your acts or omissions or the acts
or omissions of those acting on your behial�f:
A. In, the performance of your oingoing operafion% or
connection with your premises owned by or
rented to you,
CG 20 26 017 04 G) IS Properties, Inc,, 2004 Page 1 of I C3
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U17fralitstriao ITRF77: _ 11111 IIIUIF LRU purlivirlinanct UT MO WWK Wit VOIF If 1
W ith: the City of El Segundo.
,I
Policy No.
L.ji I have and will maintain workem'campensation �nsurance ais requilired by Labor Code §3700 for the performance
of the work for which the agreement with the City of El Seguindo is executed. My workers," compensation insuraince
carrier aind poUcy number are:
Carrier Policy Number Ex 'ration Diate
P11
RameotAgent Phone #
(X-) I certify that, in the performance of the work set forth in the a reement with thie City of Ell Segundol, I wJ I no
employ any person in any manner so as to become subject to the workers' compensation laws of California, ail
agree thiat, if I should become subject to the woirkers' compensation provisions of Labor Code § 37'00 l mul,
immediately corovisions or the agireement will automatically become void.
Signature of Applicantw
aDaite 4/27/26
....... . . . . .
Print: Name Joseab Eerd
93zm=