PROOF OF INSURANCE (2026)ACC)Rf> DATE(MM/DD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE 04114/2026
THIS CERTIFICATE 151SSU ED 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 pollcy(les) must have ADDITIONAL INSURED provisions or be endorsed. II SUBROGATION IS WAIVED, sublect to the Iel ms and
conditlons of the policy, certain policies may require an endorsement, A statement on this certificate does not confer rights to the certlflcate holder in lieu of such endorsement( s 1.
PRODUCER CONTACT
NAME: Deborah A. Colman
PHONE FAX
Deborah Colman (295838C) (A/C. NO. EXT): 310-832-6155 (A/C, NO): 310-832.6621
29000 S Western Ave Ste 404 E-MAIL
Rancho Palos Verdes CA 90275-OB15 ADDRESS: dcolmanQfarmersagent corn
NAIC a
INSURED
LUGI:Iut= RHU 5 SGULPTU FFI /NC
EUGENE DAUB STUDIO INC
295 W 15TH ST
SAN PEDRO CA 90731
COVERAGES
CERTIFICATE NUMBER:
INSURER(5) AFFORDING COVERAGE
. INSURERA:
Truck Insurance Exchange
21709
1NsURERB
Farmers Insurance Exchange
21652
itisuRERC
Mid Century Insurance Company
21687
INSURERD-
INSURER E:
INSURER F:
REVISION NUMBER:
III15KTOCFIITIF)TIhV' H1 POLC!FS IJF PISURANC E wd EL, 6l r„yaav fz fADIUII,E IN3-iFFD"IAMU,Ai11)4+-3 111E POLICY IIRI`IY I rA+:' III II"IOT1ti ITI IS fANOING ANY
NI Q(JIPEI.ILNT IL T`.I OR _W&f TIgN OF AN, ( ONIPAC T OR U ,8 4-- 9 "1' it i , " RE,PFCI TO :AI C I I TI II , ( I,TII q A'r hid, RE ISSIII n' IR YA,(I 6+7NN TI If. INSURANCE AFFORDCU R) TIIL
P,R.CIFSD[ I- RIPL 1) I It RI IN IS SMIII Ci T(; All IIIF IIPM!, I < I ,yPm 'I',+4 I, i.i'U1I:,OI YJ0 Woo ICICS ,l l,5d+C7:4 h1 MMAY I nWI REi I, R1 DO III 1,N,v RAID CLAIMS
INSR ADDTL SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS
LTR TYPE OF INSURANCE INSD WVD (MM, DD/YYYY) (MM/DD/YYYY) 1
V f COMMERCIAL GENERAL LIABILITY t ACI I CCCURRF NCI 2,000,001
IORENTLU .S
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AUTOMOBILE LIABILITY
IIIR'_U•, LI IUS %01`1 OWNED
U4ty ALI7_IS OM,
�. UMBRELLA LIAR
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1 EXCESS LIAR CI AIF.1'i MAOf
IIH) 4kTINPON5
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
Atl'IPR()I'RIEIUR PARTNER Y,N
"I CUTIVE OFI I( FK MEMIBEIi N/A
(Cl UUt II' (Mandatory in NH)
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605867264 09/30/2025 09/30/2026
DESCRIPTION OF OPERATIONS/LOCATIONS/ VEHICLES (ACORD 101, Additional Rumarks Schedule. may be attached it more space is required)
DAUB DESIGN STUDIOS 293 W 15TH ST. SAN PEDRO, CA 90731
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S
PERSONAL A AI)VIIvlURl
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4000„ ' .
GF.NERAI_ AGGREGATE
4„000,000"
PROUI/CT:T COMP OPAGG !a
2,000.000
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E. L DISLISL POLCrLIMIT �S
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CERTIFICATE HOLDER CANCELLATION
City of El Segundo, Its elected and appointed officials, SHOULD ANY OF THEABOVF OFSCRInFn POLICIES HE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, NOTICE VAI t RE DEL IVERED IN ACCORDANCE WITH THE POLICY PROVISIONS,
employees and volunteers, 350 Main Street, El Segundo, AUTHORIZED REPRESENT
California, 90245 w�
ACORD 25 (2016/03) )1988-2015 ACORD CORPORATION. All Rights Reserved
Al 1169 11 15 The ACORD name and logo are registered marks of ACORD
CITY OF EL SEGUNDO
WORKERS' COMPENSATION DECLARATION
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SUBJECTS AN EMPLOYER TO CRIMINAL PENALTIES
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000),
IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED
FOR IN LABOR CODE § 3706. INTEREST, AND ATTgRNEY`S FEES.
I .ilfhr111 IIrlrlr;r t rvolly of Fletp fry 4vwj._r tl'o tiwa o1 CoIiInrnfa one TIf the rciIfnwiti7 derlimtwin a
r I I h,lvt± . ncl will 111.I1r1t,llll .t cerlitic,lle of coop , rlt of self 1n_,urF for worker; comremallon is,ued by the []ire0cir
if lniltv,irial Relatnlms ;a•; pnrvidi,d fnr by Labor t;,Av- 11,'t'I00 for lhe f e r'i;rrtlanl,r. (if they walk `;art Ivrlll Itir` .1l worlivill
.vlffl the �u[y of E-1 Sequrida
Pulley Nil
I _ 1 I h tv,, ana will nlamlaln vvo#ker ; coilipi1ilsdtlln IW,uQllr.,c it9 (clgkllted by L:lbol Gr;de ;j 370:0 fur the perfa;rrltarlLe
nt 11-le wellk lot vrlrlch the .lgrernlcrll .vilh the r. lry of El Segundo 1'. execuietl My wrrkefs rclrnpen_„atir�rl 11ti ,urinr i
,.urea and 1,olu.y nulrll�e:•r ,tr•r
C�rnrr PoNcy Nuwtai!r Exfur litm Date
Fame of Agerll
Pholic
f x t I corllh, Itial in Ih?° performance of the work set htrth rrt men .argrKrment wah the l Ity cif El SeIlun(lo I welt fl0l
ettlpliy arty I'411F5i111 It) any Itl,lmwi 5() as to beccmicl;ubjecl to the coillpermatloll law—, of hqhfortllol .1110
,riff-e: Mal if I Should becnrne -,subject In the worker,,' cnrllptuisltron p-mv.,ofow, of Labor f:o&* t 3700 1 i-mini
�anrllvld4lIrl � rQF1I II N-Vih 111p V.1!r. lf%s or the ldar�� a r TMf rill .11u fjnlaItr ally be vaid
y I y r tiro
App4c and � �„ ,.� a �.. _..n..._ ._..m [7�1tC
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rani at N Iwo
Agreement for
Dated
Revie ad by