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PROOF OF INSURANCE (2016) CLOSED (2)THIS CERTIFICATE IS ISSUE CERTIFICATE DOES NOT Al BELOW. THIS CERTIFICATE REPRESENTATIVE OR PRODi the terms and conditions of thi certificate holder In lieu of suet PRODUCER FRANK LEON II State -,Faun 725 W PACIFIC WILMINGTON C iNSURlD..,.... GERMAAi�13�1, mm. C CERTIFICATE OF LIABILITY INSURANCE DA -9 — /-1 2015Y) ATE AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS iIRMATiVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES �F INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURr=k(S)„ AUTHORIZED CER, AND THE CERTIFICATE HOLDER. Molder Is an ADDITIONAL INSURED, the policyli'esp must be endorsed. If SUBROGATION IS VNAIVED, subject to r policy, certain policies may require an endorsement, A statement on this certificate does not confer rights to the d endormen s)__ A TNANCYGUZMAN JSURANCE AGENCY PH N .. (OV COAST HWY a 1 510 618 -8700. YSTATEFARM COMW µJAW $ NANCY S GU ��� .._....A. ._ ZMAN T4IJBo c+ERAOE iA 90744 INSIIRE SIAFFgrii�l r Nei 18 78.....�. _ State Farm General Insurance CO ....2616 1 Lm_...., ..,.. m _ INSOR,ERA. rnpany 4 23.... 161 DBA D & G ELITE AUTO DETAIL 1111 W F ST WILMINGTON CA 90744 INSURCRW IrrSIIRER E FI' R CTHISFIS T REVISION A TGO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN F INDICATED_ NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION O THE POLICY PERIOD RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT T TO ALL THE TERMS, D CONDITIONS REDUCED BY PAID CLAIMS PE OF INSURANCE H ADO IiBtF.,. L POLICY N W y COMMERCIAL 4L LIABOF S NUMBER ymrt µ CLAIMS - A 5 -75 f 01lilif2�16 �iMA "SIdIRENTED b 5 1.000000 -MADE DCLI � b MED ExP k nM rnw pw roL " " 5,000 ..., � � PERSONAL.,.,& ADV JNJURY g g G EN . GENERAL AGGREGATE S S 2,000 000 „ JECT 6 � D PRODUCTS - COMPlOPAGG 5 5 2,OOD,O(i0 OTHER: + + � DEDUCTIBLE _ � � . � � u o AUTOMOBILE LIABIUTY N N,/Eyy a LI . . THE CITY OF EL SEGU'N'DO, ITS OFFICERS, OFFICIALS,! EMPLOYEES,AGENTS AND VOLUNTEERS, 350 MAIN ST` "`ry EL SEGUNDO, CA 90245 i I 1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 4 ) The ACOi2D name and lags are iS88 20i' CORD CO'NPORATION. All rights reserved. %CORD 25 2014/01 marks of AC RD 1001486 1 2848, 02-04-2014 Policy No. 92 C6D367 7 CMP- 4786.1 Page 1 of 2 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CMP - 4786.1 ADDITIONAL INSURED — OWNERS, LESSEES, OR CONTRACTORS (Scheduled) This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE Policy Number: 92 C6D367 7 Named Insured: DELGADO, GERMAN DBA D & G ELITE AUTO DETAILING 1111 W F ST WILMINGTON CA 90744 -5006 Name And Address Of Additional Insured Person Or Organization; THE CITY OF EL SEGUNDO ITS OFFICERS OFFICIALS EMPLYEES AGENTS & VOLUNTEERS C 339 SHELDON ST EL SEGUNDO CA 90245 4099 1. SECTION Il — WHO IS AN INSURED of b. If coverage provided to the additional in- SECTION ll -- LIABILITY is amended to in- sured is required by a contract or agree - clude, as an additional insured, any person or ment, the insurance provided to the organization shown in the .Schedule, but only additional insured will not be broader than with respect to liability for "bodily injury', that which you are required by the contract property „damage " ", or " "personal and advertis- or agreement to provide for such addition- i injury" caused, in whole or in part, by: al al insured; and a. Ongoing Operations c. If the contract or agreement between you (1) Your acts or omissions; or and the additional insured is governed by (2) The acts or omissions of those acting California Civil Code Section 2782 or on your behalf; 2782.05, the insurance provided to the additional insured is the lesser of that in the performance of our ongoing opera- P Y 9 g P which: lions for that additional insured; or (1) Is allowed for the satisfaction of a de- b. Products – Completed Operations fense or indemnity obligation by Cali- "Your work" performed for that additional fornia Civil Code Section 2782 or insured and included in the "products- 2782.05 for your sole liability; or compieted operations hazard". (2) You are required by contract or However, Paragraph 1. above is subject to the agreement to provide for such addi- following: tional insured. a. The insurance afforded to the additional We have no duty to defend or indemnify the insured only applies to the extent permit- additional insured under this endorsement un- ted by law; til a claim or "suit' is tendered to us. 0. copyright, State Farm Mutual Automobile Insurance Company. 2013 Includes copyrighted material of Insurance Services Office. Inc., with its permission. CfaN'rft UED 2. Any insurance provided to the additional in- sured shall only apply with respect to a claim made or a "suit "' brought for damages for which you are provided coverage. 3. With respect to the insurance afforded to the additional insured, the following is added to SECTION If — LIMITS OF INSURANCE: If coverage provided to the additional insured is required by contract or agreement, the most we will ppay on behalf of the additional insured will be the lesser of the amount of insurance: a. Required by the contract or agreement; or b. Available under the applicable Limits Of Insurance shown in the Declarations. This endorsement shall not increase the ap- plicable Limits Of Insurance shown in the Declarations. 4. With respect to the insurance afforded to the additional insured, the following is added to Paragraph 3. Duties In The Event Of Occur- rence, Offense, Claim Or Suit of SECTION II — GENERAL CONDITIONS: The additional insured must: a. See to it that we are notified as soon as practicable of an "occurrence" or an of- fense which may result in a claim. To the extent possible, notice should include: (1) Mow, when and where the "occur- rence" or offense took place; (2) The names and addresses of any in- jured persons and witnesses; and CMP- 4786.1 CMP- 4786.1 Page 2 of 2 (3) The nature and location of any injury or damage arising out of the "occur- rence" or offense; b. Tender the defense and indemnity of any claim or "suit" to us and to all other insur- ers who may have insurance potentially available to the additional insured; and c. Agree to make available any other insur- ance the additional insured has for de- fense or damages for which we would provide coverage under SECTION II — LIABILITY. 5. With respect to the insurance afforded the ad- ditional insured, the following replaces SEC- TION II — LIABILITY of Paragraph 7. Other Insurance of SECTION I AND SECTION 11— COMMON POLICY CONDITIONS: a. This insurance is primary to and will not seek contribution from any other insurance available to the additional insured, provided that the additional insured is a named in- sured under such other insurance. b. Regardless of any agreement between you and the additional insured, this insur- ance is excess over any other insurance whether primary, excess, contingent or on any other basis for which the additional in- sured has been added as an additional in- sured on other policies. There will be no refund of premium in the event this endorsement is cancelled. All other policy provisions apply. ®, Copyright, State Farm Mutual Automobile Insurance Company, 2013 Includes copyrighted material of Insurance Services office, Inc., with its permission. 1007033 148011 08 -21 -2014 DATE (MMJDDJYYYY) VEHICLE OR EQUIPMENT CERTIFICATE OF INSURANCE 0910112016 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. This form Is used to report coverages provided to a single specific vehicle or equipment Do not use this form to report liability coverage provided to multiple vehicles under a Single policy, Use ACORD 25 for that purpose. PRODUCER _ NANCY 8700 N I� 0 . Sta3ft?F7117t FRANK LEON INSURANCE AGENCY X 310 - 518 8700 mµ 725 W PACIFIC COAST HWY EMAIL " N NANCY.S.GUZMAN: 31051 &8788 . T4LSY ST" FA# !M COM WILMINGTON CA 90744 _ .w..._...a.- .,_ — -�_ INSURED INSURER A: State Farm Mutual Automobile Insurance Company 25178 DELGADO GERMAN i USURER r , DBA D & G ELITE AUTO DETAILING INSURER C; INSURERR. D WILMINGTON CA 90744 INSURER E, DESCRIPTION OF VEHICLE OR EQUIPMENT YEAR MIAKEIMANUFACTURER MODEL SODYTYPE VEHICLE IDENTIFICATION NUMBER 2002 CHEVROLET EXPRESS VAN iGCGG25R721143697 _ DESCRIPTION _.e. SERIAL NUMBER COVERAGES CERTIFICATE NUMIBER. REVISION NUMBER* THIS IS TO CERTIFY THAT THE POLICY(IES) OF INSURANCE LISTED BELOW HASIHAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERfOD(S) 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 POLICY(IES) DESCRIBED HEREIN ISIARE SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICY(IES), INSRAWL LTR lNSAD TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION DATE (Mret/R OMYr DATE (MWDtXYYYYr LIMITS VEHICLE LIABILITY COMBINED SINGLE LIMIT S 4918947- A15 -75 07/07/2015 01107/2016 I30DILYINJURY(ParperSOnt 1-1 00,000 µ BbDELY INJURY (Par seratlenq $ 300,000 PROPERTY DAMAGE 5 100,000 GENERAL LIABILITY I EACH OCCURENCE $ OCCURRENCE A GENERALAGGREGATE Is CLAIMS MADE: 5 INSR toss LTR PAYEE TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION..... DATE (IrfIJA'ODIYYYY) DATE (MWDDfYYM LIMITS I DEDUCTIBLE VEH COLLISION LOSS [) ACV ❑ AGREED AMT $ LIMIT ❑ I3 STATED AMT S DED VEH COMP VEH OTC e -- ❑ ACV ❑ AGREED AMT $ LINT ....._ .. ..............,., .....,a._µ.. ❑ ❑ STATED AMT 'S DIED PROPERTY Q ACV 0 AGREEOAMT $ BASIC BROAD LIMIT ❑ RC ©STATED AMT SPECIAL D $ DIED REMARKS (INCLUDING SPECIAL CONDITIONS ! OTHER COVERAGES) (Attach ACORD 10f, Additional Ramarks Schedule, It more spare Is required} ADDITIONAL INTEREST CANCELLATION Select one of the following: THE SHOULD ANY OF ABOVE DESCRIBED POLICIES BE CANCELLED line a0ddt0plal iAI0(*sl'tlG,S0 hied 1aeEcrw h0$ bo" added W Iho plaky(tos)11sted herr oV by policy minhar(s) . d BEFORE THE F-XPIRA71ON DATE THEREOF, NOTICE WILL BE a�sa0a0.lts -s paaern sr.pLwrad &lod Co arJtr tlao IIdDYnons4 tvsora�sl dteaecGrohaad Ir01r� ro the t been m, ba l po$ty(k*s) ID DELIVERED IN ACCORDANCE WITH THE PROVISIONS. uh VEHICLE 7 EQUIPMENT INTEREST: LEASED FlNANCEO EST ...IT� DESCRIPTION OF 171E ADDITIONAL INTEREST NAME AND ADDRESS O ADDITIONAL INTEREST ADDITIONAL INSURED LOSS PAYEE OF EL CITY GUNDD LENDER'S LOSS PAYEE........�� 350 MAIN ST LOAN r LEASE NUMBER EL SEGUNDO, CA 90245 r; ArsTi 0 DATE (MMIDDIYYYY) ACC>R CERTIFICATE OF LIABILITY INSURANCE 0912912015 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 - rAC' NAME.; Michael Eastman Insurance Agency LLC PHONE Its 9 t➢f1 pN,� (866) 936 -9992 iPP A X rr pd1 :. BSt_) 936 -9779 _.. 1200 S. Pacific Coast Hwy Suite A ADDARESS: Info eastmanagency.corn INSURER(S) AFFORDING COVERAGE NAIC # Redondo Beach CA 90277 INSURERA: STATE COMPENSATION INSURANCE FUNDm....._ .,.,»..... 35076 INSURED .....,� ..... ....... .. �.._ �...... ��....._.... ....... ®_.,.��.- ...�..- ..,,,.,. INSURERB: ...._.,.......,_._.,_.,......,,._....... .- .._......._.,m.__..._.._....v ...�_..,�._....__.� German Delgado, DBA D & G Auto Detailing INSURER C : INSURERO: �.._...._._....._._.....,..._.. �..m_._.._..._.._.,.......�.�_. ...... 1111 West F Street INSURER E: Wilmington CA 90744 iNsuRER r: COVERAGES CERTIFICATE NUMBER: 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 ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. _ _ -Y EPF POL "ICY EXP 1 TR TYPE OF INSURANCE ,ucn unln ..... POLICY NUMBER MMIDONI'Y'Y MMdiD V= LIMITS ..- COMMERCIAL GENERAL LIABILITY EACH OCCURRENCLn: $ OCCUR mm CLAIMS -MADE PRCMIr;FSFeacu ;gray $ _ __.....�.._....._...�....�� MED EXP (Any one person) $ ....._,,,_ .PERSONAL &AOVINJURY 5 _..._... LIES PER: GENI'L. AGGREGATE LIMIT APPLIES GENERAL AGGREGATE $ E �POLtC CE LOG PRODUCTS - COMP /OP AGG S OTHER, 5 ,,.... AUTOMOBILE LIABILITY ANY AUTO BODILY INJURY (Per person) S ALL OWNED SCHEDULED BODILY INJURY (Pet accident) S NON-OWNED EO OPa� HIREOAU7pS AUTOS F dh7AAMA - - UMBRELLA LIAR OCCUR EACH OCCURRENCE S EXCESS LIAR CLAIMS -MADE .. AGGREGATE _ 5 OED... RETENTIONSm�mmmW 8 WORkK1ERS COMPENSATION PER STATUTE FRH AND EMPLOYERS LIABILITY YIN .�_ -�- - � _... AtaYry tltOPRir ,TORVPAirTtaLRiGtCCCU1ftlt?L A O.�FI K,ER.lt;9F.CTOR Cxd"LUOED7 W Y NIA � x 9139801 -2015 08112/2015 ' 08/12/2016 £L EACH ACCIDENT 5 1,000,000 �_W iMandstory In NH) E L DISEASE - EA EMPLOYEE S 1,000,000 Ues da5'c be RIPTION OF OP'FRATtONS be$ow . _w....,.�...-.,... - E L DISEASE - POLICY LIMIT S 1,000,000 DESCRIPTION OF OPERATIONS LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may He attached If more space Is required) Waiver of subrogation applies. Certificate holder named as additional insured. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of E! Segundo, It's Agents, Officers, Employees ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street AUTHORIZED REPRESENTATIVE El Segundo CA 902 5 __; 1 Q 1988 -2014 ACORD CORPORATION. All rights reserved, ACORD 25 (2014107) The ACORD name and logo are registered marks of ACORD ENDORSEMENT AGREEMENT BROKER CO Y ADDITIONAL INSURED EMPLOYER 9139801 -15 NEW SC HOME OFFICE SAN FRANCISCO PAGE 1 OF 1 ALL EFFECTIVE DATES ARE AT 1201 AM PACIFIC EFFECTIVE SEPTEMBER 22, 2015 AT 12.01 A.M. STANDARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME DELGADO, GERMAN 111 WEST F STREET WILMINGTON, CA 90744 ANYTHING IN THIS POLICY TO THE CONTRARY NOTWITHSTANDING, IT IS AGREED THAT CITY OF EL SEGUNDO IS HEREBY NAMED AS AN ADDITIONAL INSURED EMPLOYER ON THIS POLICY BUT ONLY AS RESPECTS EMPLOYEES WHOSE NAMES APPEAR ON THE PAYROLL RECORDS OF DELGADO, GERMAN (HEREIN CALLED THE PRIMARY INSURED) WHILE THOSE EMPLOYEES ARE ENGAGED IN WORK UNDER THE SIMULTANEOUS DIRECTION AND CONTROL OF THE PRIMARY INSURED AND THE ADDITIONAL INSURED EMPLOYER. IT IS FURTHER AGREED THAT THE PAYMENT OF THE FULL PREMIUM DUE AND PAYABLE UNDER THIS POLICY SHALL REMAIN THE SOLE RESPONSIBILITY OF THE PRIMARY INSURED. NOTHING IN THIS ENDORSEMENT CONTAINED SHALL BE HELD TO VARY, ALTER, WAIVE OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS POLICY OTHER THAN AS STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR LIMITATIONS OF THIS ENDORSEMENT. COUNTERSIGNED AND ISSUED AT SAN FRANCISCO: SEPTEMBER 24, ///2015 0015 AUTHORIZED REPRESENT 'IVE PRESIDENT AND CEO SCIF FORM 10217 (REV.7 -20141 OLD DP 217 BROKER COPY 9139801-15 NEW SC PLEASE KEEP THIS ENDORSEMENT WITH YOUR POLICY Dear Policyholder: These endorsements amend and are part of your policy. Please keep them with your documents for future reference. If you have any questions concerning these endorsements, Please contact your local State Fund office.