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PROOF OF INSURANCE (2020 - 2020) CLOSEDe, II DATE (MM/DD/YYYY) 1►iC/%f`i'd CERTIFICATE OF LIABILITY INSURANCE 8-1-2019 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 endorsement(s). PRODUCER CONTACT NAME: g Don Kiger, CSR Strategic Alliance Insurance PHONEco EKt): 800-830-1712 IAJc Npa, License 0764210 1714 Louise Lane E-MAIL doin'kiger67@yahoo.com Nipomo, CA 93444 INSURER(S) AFFORDING COVERAGE NAIL# INSURERA: State Compensation Insurance Fund INSURED INSURER B : Business Insurace Company Lawles Enterprises inc 400 Continental Blvd, 6th Floor EI Segundo CA 90245 INSURER C : INSURER D: INSURER E : INSURER F 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 INSRTYPE OF INSURANCE iAODL,SUBRi1 POLICY EFF POLICY EXP LTR INSD WVD POLICY NUMBER (,MM/DD/YYYYL.I'dMM/DDFYYYYM LIMITS B X COMMERCIAL GENERAL LIABILITY BUS 01 4578-0 8-10-2019 8-10-2020 EACH OCCURRENCE $ 2,000,000 DAMAGE TO RENTED I 1 OO,000 CLAIMS -MADE X OCCUR PREMISES ,(Ea occurrence) $ MED EXP (Any one person) $ 5,000 X Professional Liability PERSONAL BADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 PRODUCTS COMP/OP AGG $ 2,000,000 X POLICY JE� LOC - $ OTHER B BUS 01 4578-0 8-10-2019 8-10-2020 CONED SINCt. LIPAIT $ 2,000,000 AUTOMOBILE LIABILITY ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS HIRED NON -OWNED PRO'P'E'R'°I'Y'DAMAGE g x AUTOS ONLY AUTOS ONLY it"or ai'T, Jde"O $ UMBRELLA LAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE $ DED RETENI ION S $ A WORKERS COMPENSATION 9227676-19 3-1-2018 3-1-2020 X PER H STATUTE ER AND Y OtoryuEl'ORIAIR7o,EIR/E'ECUTIVE EL EACH ACCIDENT $ 1,000,000 VTY ANYPRER/MEMBER EXCL, NIA u Y 1 in NH).�.NJ E L DISEASE - EA EMPLOYEE, $ ,000,000 If yes R PTION ribe under DESCRIPTION OPERATIONS below EL DISEASE - POLICY LIMIT $ 1,000,000 B ADP 8-10-2019 8-10-2020 Broad Form $ 20,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Certificate holder is named as an additional insured CERTIFICATE HOLDER CANCELLATION City of EI Segundo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE EXPIRATIONTHE DATE THEREOF, NOTICE WILL BE DELIVERED IN City ClerkTMSOffice ACCORDANCE W WITH POLICY PROVISIONS. 350 Main St, EI Segundo, CA 90245 AUTHORIZED REPRESENTATIVE �++y ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD General Liability Policy: Lawles Enterprises, Inc. COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY PLEASE READ CAREFULLY ADDITIONAL INSURED- OWNERS, LESSES, OR CONTRACROR (FORM B) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART. SCHEDULE Name of Person or Organization: City of El Segundo (If no entry appears above, information required to complete this endorsement will be shown in the Declaration as applicable to this endorsement.) WHO IS AN INSURED: (Section 11) is amended to include as an insured this person or Organization shown in this Schedule, but only with respect to liability rising out of "your work" for the insured byor for you. PRIMARY INSURANCE: Such insurance as is afforded by the General Liability policy is primary insurance and no other insurance of the additional insured will be called upon to contribute to a loss. CG 20 10 11 85 ENDORSEMENT AGREEMENT BROKER COPY 9227676-19 RENEWAL NA HOME OFFICE SAN FRANCISCO PAGE 1 OF 2 ALL EFFECTIVE DATES ARE AT 12:01 AM PACIFIC EFFECTIVE MARCH 14, 2019 AT 12.01 A.M. STANDARD TIME OR THE AND EXPIRING MARCH 9 TIME INDICATED AT , 2020 AT 12.01 A.M. PACIFIC STANDARD TIME LAWLES ENTERPRISES INC 400 CONTINENTAL BLVD FL 6 EL SEGUNDO, CA 90245 ANYTHING IN THIS POLICY TO THE CONTRARY NOTWITHSTANDING, IT IS AGREED THAT THE STATE COMPENSATION INSURANCE FUND WAIVES ANY RIGHT OF SUBROGATION AGAINST, CITY OF EL SEGUNDO WHICH MIGHT ARISE BY REASON OF ANY PAYMENT UNDER THIS POLICY IN CONNECTION WITH WORK PERFORMED BY, LAWLES ENTERPRISES INC IT IS FURTHER AGREED THAT THE INSURED SHALL MAINTAIN PAYROLL RECORDS ACCURATELY SEGREGATING THE REMUNERATION OF EMPLOYEES WHILE ENGAGED IN WORK FOR THE ABOVE EMPLOYER. IT IS FURTHER AGREED THAT PREMIUM ON THE EARNINGS OF SUCH EMPLOYEES SHALL BE INCREASED BY 03%. 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: MARCH 18, 2019 2570 AI9HflIZEb REPRESENT' IVE PRESIDENT AND CEO SCIF FORM 10217 (REV.7-2014) OLD OF 217