ACORD® DATE (MM/DD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE
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 INSURERS), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(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 endorsements).
Next First Insurance Agency, Inc. PHONE FAX
PO Box 60787 (AC, No. Ext): (855) 222-5919 A/C, No):
E-MAIL
Palo Alto, CA 94306 ADDRESS: [email protected]
INSURER(S) AFFORDING COVERAGE NAIC #
INSURER A : State National Insurance Company, Inc. 12831 INSURED INSURER B:
Lillian Laree Washington
Sew Into It INSURER C:
4306 W 145th St
Lawndale, CA 90260 INSURER D:
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: 0974639
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.
TYPE OF INSURANCE (MM/DD/YYYY) (MM/DD/YYYY)
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE
$1.000.000.00
DAMAGE TO RENTED
CLAIMS-MADE OCCUR $100.000.00
PREMISES (Ea occurrence)
MED EXP (Any one person) S15.000.00
A NXTQXEWXYU-00-GL 10/25/2022 PERSONAL & ADV INJURY
$1.000.000.00
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2.000.000.00 PRO
X POLICY JECT LOC
PRODUCTS- COMPOP AGG $2.00.00.00
OTHER:
AUTOMOBILE LIABILITY COMBINED SINGLE LIMI
Ea acciden
ANY AUTO BODILY INJURY (Per person)
OWNED SCHEDULED BODILY INJURY (Per accident S
AUTOS ONLY AUTOS
HIRED NON-OWNED PROPERTY DAMAGE
AUTOS ONLY AUTOS ONLY (Per accident
UMBRELLA LIAB OCCUR EACH OCCURRENCE
EXCESS LIAB CLAIMS-MADE
AGGREGATE
DED RETENTIONS
/WORKERS COMPENSATION PER OTH-
AND EMPLOYERS' LIABILITY STATUTE I ER
YIN
NYPROPRIETOR/PARTNER/EXECUTIV E.L. EACH ACCIDENT
-FICER/MEMBEREXCLUDED N/ A
E.L. DISEASE - EA EMPLOYEE S
DESCRIPTION OF OPERATIONS below E.L. DISEASE • POLICY LIMIT S DESCRIPTION OF OPERATIONS/ LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Operations Al each ofter eleges al on i retired by mile genent been the criticade header and the nured, and are suic io prig term and conditions.
CERTIFICATE HOLDER CANCELLATION
City of Redondo Beach
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 22 Artesia Biv NOTICE WILL BE DELIVERED IN
dondo Beach, CA 9021
AUTHORIZED REPRESENTATIVE
-
© 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: NXTQXEWXYU-00-GL COMMERCIAL GENERAL LIABILITY CG 20 10 04 13
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS - SCHEDULED PERSON OR
ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person(s)
Or Organization(s) Location(s) Of Covered Operations
City of Redondo Beach, its officers, elected and appointed CA officials, employees and volunteers
1922 Artesia Blvd
Redondo Beach, CA 90278
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
A. Section II - Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following additional organization(s) shown in the Schedule, but only exclusions apply:
with respect to liability for "bodily injury", , "property This insurance does not apply to "bodily injury" or damage" or "personal and advertising injury" "property damage" occurring after:
caused, in whole or in part, by:
1. All work, including materials, parts or
1. Your acts or omissions; or
equipment furnished in connection with such
2. The acts or omissions of those acting on your work, on the project (other than service, behalf;
in the performance of your ongoing operations for
the additional insured(s) at the locations) Compiet of the covered operations has been designated above.
However:
1. The insurance afforded to such additional
insured only applies to the extent permitted by
law; and ngaged in performing operations for
2. If coverage provided to the additional insured is rincipal as a part of the same projec by a contract or agreement, the
insurance afforded to such additional insured
will not be broader than that which you are
required by the contract or agreement to
provide for such additional insured
CG 20 10 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 2