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PROOF OF INSURANCE (2019 - 2019) CLOSED 4'i I DATE iMM.rDO.TYYY) AC "�''�'' CERTIFICATE OF LIABILITY INSURANCE 106�1' ..�....................................... 1Drzzr2Dla 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 poticy(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 holder in lieu of such en lorsement(s). PRODUCER coNrACT VERONICA FLORE'S PHONE .,..... 8821 W 19TH ST VE STATE FARM IN� fin,r Y�VERdONICA.FLORES.FMZ4@STAT E'FA RM,COM 24-217.41i118 State-Farm 04, SAN PEDRO,CA 90731 INSURERS)AFFORDING COVERAGE NA1C A INSURER A: Slate Farm Mutual 8 •.•.• State Farm Lire and Ca ualty Company Company25143 INSURED INSURER B _ Y p y OELGADO.GERMAN LM,su,"R,C _.,.®.�wwwwwwwwwww_ww_. .....R DSA D&G ELITE AUTO DETAILING INSURER D 1111 W F ST INSURER E; WILMINGTON,CA 90744 INSVRERF; _..... (, COVERAGES' CERTIFICATE NUMBER: REVISION NUMSER. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR TIIF 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 1R"EDUCED BY PAID CLAIMS. IiTN COMM .. AD'DL 'INVJIcr'_".. POLICY NIIPMBEti..m...._..........•... tlPpM04 CY 4 F �.a{:Y D,XP7 TYPE OF INSURANCE LtM'IFS „, 5aa ,c k�y,� ERCIAL GENEPAL LIABILITY EAACHOODi'RR'EN'CE s 1.000,000 TIAMAa. TQHhN4zU 300,000 Er ,-- CLAIMS-MADE OCCUR .P..: I-c rrMn�,�,trprrwncgj, _ MED EXP,' Iy one mrr,01) s 10,000 92.EF-K461-6 11120/2018 11/20/2019 • Ck_"�i L•^,,V A4r,,AAROV XNArMwr 6 GENrL AnGREGATE LIMITAPPLIES PER, g 2,.0 06,660 MOBILE L� _ 7ENNLETkfl7rfE;'�Ty*I MPlOP AGC s 00 ��ca � � L e r nI'�,LEL L.^4or S 500 0. I LOC _ C'L'!•IEP'k o ILITY 525 9336-A02 75A 07102/2018 01/0212019 ANY AUTO 525 9338-AO2-75 07102/2018 01/0212019 ,BODILY INJURY(per person) s 25,000 X OWNED SCHEDULED BODILY INJURY(Per accident) s 50,000 AUTOS ONLY AUTOS - - •,.......m .w HIREO AUTOS NON-OWNED t C+'NA•S S 25,000 _ Auros UNLv AUTOS ONLY 583 5767-F21-75 06!2112018 1 11120 6 ":aie t. rra,y m Pa.e e,r,a• E i U.N.ORELIA LIAR EACH OCCURRENCE EXCESS LIAR n s _...•.•.•.•.•.•.. I DED R,E'TENT,CX'45 p f •---.•WORKERS COMPENSATION I nNR YIN NIA 92-GD-Q196-7 0811712018 0811712/)19 IT�L3D's DEEL�PLta s 1-1) AND EMPLOYERS'LIABILITY 'MdM rRC^APIF i�.IIRx"PAXd I'NE'iUE%kCUTIVE ❑ G _ ACCIDENT '�O,DDD X t rF9'•CFA1IAEM6ER DXC'.UDED'r i'Monda ory i I E A YEE $ II'}}wad,gtrsttrrlrla iwrrdar EL t71SEfiS,E•ItOb,bL''h'LVAA I7 'S L'dh S,,,.RoP,I'CIN OI'-OP PATioO 4S y oiuw.x _. DESCRIPTION OF OPERATIONS f LOCATIONS I VEHICLES(ACORp 101,Addeional Remarks Schedule,may to attached If more space Is required) .....• .................. CERTIFICATE CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ROVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXP'IR'ATVON ATE THEREOF, NOTICE WILL BE DELIVERED IN CITY OF EL SEGUNDO ACCORDANCE'4VI' THE,POLICY PROVISIONS. 350 MAIN ST 71zat73 P'REr�EaWTATVVE EL SEGUNDO,CA 90245 01988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD 1007498 132649,12 03-76-2016 cmp�rx � rPolicy No. gz �rx«6� 6 oso«-ra�� ""� � Page 1mx THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ |TCAREFULLY, CK8P4786.1ADDITIONAL INSURED -- OWNERS, LESSEES, OR CONTRACTORS (Scheduled) This endorsement modifies insurance provided under the following: 8US|NEGSOVVNERSCOVERAGE FORM SCHEDULE Po|icyNummber- 92 EFK46I 6 Named Insured: DELGADO, GERMAN llII W F ST WILMINGTON CA 90744 5006 0Q__ Name And Address Of Additional Insured Person Or Organization- CITY OF EL SEGDNDO ITS OFFICER OFFICIALS EMPLOYEES AGENTS a VOLUNTEERS 050 M&Z0 ST EL SEGU0DU CA 90245 3813 1. SECTION U -- WHO IS AN INSURED of b. If coverage provided to the additional in- SECTION U -- LIABILITY is amended to in' eunod is required by a contract or ogvoe' o|ude onanadditional insured, any person or mant, the insurance provided to the organization xno,,n in the oxneuu/ebut only additional insured will not be broader than with / liability "bodily i that which you are required bythe contract 11 property damage", or "personal and ~~^~'^'~- or agreement to provide for such uddiUon' ing /rgury" oauaad in by:' � o| insured; and m' Ongoing c. If the contract or agreement between you (i) Your acts oromissions; or and the additional insured is governed by (2) The oda or omissions of those acting California Civil Code Section 2782 or nnyour behalf; 2782.05, the insurance provided to the additional insured is the lesser of that inthe performance of yourongoing opera- which: tions for that additional insured; or (1) Is allowed for the satisfaction of a de- b. Produote—Connp|atedOpmrations fenne orindemnity obligation by Cali- "Your work" a|i'"Yourvvork" performed for that additional fornia Civil Code Section 2782 or insured and included in the "products- 2782.06for your sole liability; or '' completed operations hazard (2) You are required by contract or However, Paragraph i. above insubject tothe agreement to provide for such oddi' foUowing: tiona| inaured. a. The insurance afforded to the additional We have no duty to defend orindemnify the insured only applies to the extent permit- additional insured under this endorsement un' ted by law; til u claim or"suit" is tendered to us. Copyright,State Farm Mutual Automobile Insurance Company,2013 Includes copyrighted material ofInsurance Services Office, /nc.with its permission oowr�NueD CMP-4786.1 Page 2 of 2 2. Any insurance provided to the additional in- (3) The nature and location of any injury sured shall only apply with respect to a claim or damage arising out of the "occur- made or a "suit" brought for damages for rence" or offense; which you are provided coverage. b. Tender the defense and indemnity of any 3. With respect to the insurance afforded to the claim or "suit" to us and to all other insur- additional insured, the following is added to ers who may have insurance potentially SECTION II—LIMITS OF INSURANCE: available to the additional insured; and If coverage provided to the additional insured c. Agree to make available any other insur- is required by contract or agreement, the most ance the additional insured has for de- we will pay on behalf of the additional insured fense or damages for which we would will be the lesser of the amount of insurance: provide coverage under SECTION II — a. Required by the contract or agreement; or LIABILITY. b. Available under the applicable Limits Of 5. With respect to the insurance afforded the ad- Insurance shown in the Declarations. ditional insured, the following replaces SEC- TION II —LIABILITY of Paragraph 7. Other This endorsement shall not increase the ap- Insurance of SECTION I AND SECTION II — plicable Limits Of Insurance shown in the COMMON POLICY CONDITIONS: Declarations. a. This insurance is primary to and will not 4. With respect to the insurance afforded to the seek contribution from any other insurance additional insured, the following is added to available to the additional insured, provided Paragraph 3. Duties In The Event Of Occur- that the additional insured is a named in- rence, Offense, Claim Or Suit of SECTION sured under such other insurance. II—GENERAL CONDITIONS: b. Regardless of any agreement between The additional insured must: you and the additional insured, this insur- ance is excess over any other insurance a. See to it that we are notified as soon as whether primary, excess, contingent or on practicable of an "occurrence" or an of- any other basis for which the additional in- fense which may result in a claim. To the sured has been added as an additional in- extent possible, notice should include: sured on other policies. (1) How, when and where the `occur- There will be no refund of premium in the event rence" or offense took place; this endorsement is cancelled. (2) The names and addresses of any in- jured persons and witnesses; and All other policy provisions apply. CMP-4786.1 1007033 148011 08-21-2014 ©,Copyright,State Farm Mutual Automobile Insurance Company,2013 Includes copyrighted material of Insurance Services Office, Inc,,with its permission, WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed,4-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT-CALIFORNIA We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 5 % of the California workers' compensation premium otherwise due on such remuneration. Schedule R r, gn or Qrga,niga.(ipn Job De��r�tion CITY OF 'EL SEGUNDO WASHES SHUTTLES AND DETAIL 350 MAIN T VEI-T.ICL.E,S EL SEGC.II'JDO CA 90245 -3813 This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 09/30/18 Policy No. 92-GD-4195-7 Endorsement No. WC 04 03 06 Insured DELGADO, GERMAN Insurance Company State Farm Fire and Casualty Company DBA D & G ELITE AUTO DETAILING 1111 W F ST WILMINGTON CA 90744-5006 Countersigned By .......................... WC 04 03 06 (Ed.4-84) 1007722 124282.1 09-28-2015