PROOF OF INSURANCE (2015) CLOSEDPRODUCER E�Mewood'Partners Insurance Center
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nle,, CA 92612
www.edgewoodins.00m
IMBURRO
JM: Diaz Inc
DBA: JMD
18645 E. Gale Ave., Ste #212
City of Industry CA 91748
CERT NO.: 21520280 Shelly Birdzell 9'10/2014 3:03:07 PM (FDT) raqi. 1 of 4
Page 2 of 2 0 2007 The Travelers Companies, Inc. CG D3 8109 07
Includes the copyrighted material of Insurance Services office, Inc., with Its permission.
CERT Nf,: 21F26280 Shelly Birdzell 9/10/2014 3:0:a07 PM (PDT) Page 3 of 4
'W'iTRKERS COMPENSATION
AND
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110
ANY PERSON OR ORGANIZATION FOR WHIca THE INSURED HAS.
AGREED BY WRITTEN CONTRACT EXECUTED PRIOR TO LOSS TO
FURNISH THIS WAIVER.
CERT NO. c 215262130 , hell... Birdzall. 9/1012014 3�03g07 Pjj (PDT) P^ge I of 4
Shillin , Mona
From:
Garcia, Angelina
Sent:
Thursday, September 25, 2014 9:13 AM
To:
Hegvold, Julie
Cc:
Shilling, Mona
Subject:
RE: Bikeway Project Agreement
Hi Julie,
The insurance is ... - -
Angelina Garcia
From: Hegvold, Julie
Sent: Tuesday, September 16, 2014 4:44 PM
To: Garcia, Angelina
Cc: Shilling, Mona; Katsouleas, Stephanie
Subject: Bikeway Project Agreement
Hi Angie,
Here is a Bikeway Project Agreement with the insurance certs /endorsements for your review. Please let me know if
acceptable, and I'll bring the originals by your office for initialing. Thanks!
Julie Hegvold, Management Analyst
•
ro
CITY' IiALL IS CLOSC:9 OiN i�RIDAY
From: Melissa Syauta Imailto:MSyauta imdiaz.coml
Sent: Monday, September 15, 2014 2:16 PM
To: Hegvold, Julie
Cc: Mike Chavez; Juan Diaz
Subject: FW: El Segundo Bikeway Project Agreement
Julie,
Please see the attachment for the following requested items:
1. Contract Agreement — signed by JMD
2. IRS Form W -9
3. Business License Application
4. Insurance certificates and waiver of subrogation
The originals and a check for $49.77, for the business license application, will be mailed tomorrow to the
address in your signature box.
Best Regards,
13645 East Gale Avenue I Suite 212
City of Industry, CA 91743 -1363
(626) 3201137 Tel 1 (626) 320 -1136 Fax
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