| DATE (MM/DD/YYYY)
ACORD® CERTIFICATE OF LIABILITY INSURANCE 04/29/2025
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 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).
PRODUCER CONTACT
NAME:
CS&S/AGENCY ONE AZ LLC PHONE FAX
(A/C, No, Ext): (A/C, No):
PO BOX 958489 EMAIL
ADDRESS:
Lake Mary, FL 32746-8989 INSURER(S) AFFORDING COVERAGE NAIC # 1-877-724-2669 Valley Forge Insurance Company 20508
INSURER A:
INSURED INSURER B:
INSURER C:
LEWIS STANLEY INC.
INSURER D:
2633 MANHATTAN BEACH BLVD
INSURER E:
REDONDO BEACH, CA 90278-1604
INSURER F:
REVISION NUMBER:
CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
EXCLUSOE AND CONDITIONS OF SUCH POUCES LIM SHOW MANY INE BEN EUGED BE PAD CLAN DESCRIBED TEEN INSURE TO A HE TERMIS
TYPE OF INSURANCE POLICY NUMBER
X COMMERCIAL GENERAL LIABILITY 7038411860 06/09/25 06/09/26 EACH OCCURRENCE $ 2,000,000 CLAIMS-MADE X OCCUR DAMAGE TO RENTED $ 1,000,000
PREMISES (Ea occurence)
MED EXP (Any one person) $ 10,000
PERSONAL & ADV INJURY $ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 4,000,000 PRO-
POLICY JECT I LOC PRODUCTS - COMP/OP AGG 4,000,000
OTHER:
AUTOMOBILE LIABILITY
ANY AUTO BODILY INJURY (Per person)
OWNED AUTOS SCHEDULED
ONLY AUTOS
HIRED AUTOS NON-OWNED PROPERTY DAMAGE
ONLY AUTOS ONLY (Per accident) s
UMBRELLA LIAB OCCUR EACH OCCURRENCE
EXCESS LIAB CLAIMS-MADE AGGREGATE
DED RETENTIONS
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y/N STATUTE ER
EL. EACH ACCIDENT
N/A
(Mandatory in NH) E.L. DISEASE - EA EMPLOYEE
DESCRIPTION OF OPERATIONS below EL DISEASE - POLICY LIMIT $ OTHER отн-
E.L. EACH ACCIDENT
E.L. DISEASE • EA EMPLOYEE $
DESCRIPTION OF OPERATIONS/ LOCATIONS VEHICLES (Acord 101, Adlional Remarks Schedule, may be altached if more space is required DISEASE - POLCY LIMIT Certificate Holder is named as Vendor
Location #1 2633 Manhattan Beach Blvd, REDONDO BEACH, CA, 90278
CERTIFICATE HOLDER CANCELLATION
CITY OF REDONDO BEACH SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.
415 DIAMOND ST
REDONDO BEACH, CA 90277 AUTHORIZED REPRESENTATIVE
Rya Connaughey
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