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PROOF OF INSURANCE (2020 - 2021) CLOSEDFSCON-2 -.1.1 . . .... _Q.e.la� CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY)01/2112020 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NH ....•.....I ............. ...... ....... O 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(les) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain polici'e's may require an endorsement. A statement on certificate holder In lieu of such endorsement(s). PRODUCER 916-364-7'380.___. U 916-364-7380 .. _ ...... 394.7381............._ Sierra Oak Insurance Services 0 PHONENo, A 916' this certificate does not confer iso a ce _ � LIc# OC97528 WC, o, E Dent Brock 4d nes'' ecialist.corvif { 'C, Nd}: - 9700 Business Park Dr. Ste 105es; p Sacramento, CA 95827 IN''sURERsyt�DITral ....._.-_.n.6.: M............ Daniel E. Brockmm--•••-••••- co ... INSURER A: Mercury In's'urance Coin pany 27553 INSURED FS Contractors, Inc. INSURER B: The Ohio Casualty Insurance Cc 24074 14838 Bledsoe St INSURER C: Scottsdale Insurance Company 41297 Sylmar, CA 91342 INSURER D: m Insurance Coof the West 27847 p an y INSURER E: Admiral Insurance Company 24856 INSURER F CIV'ERA ES CERTIFICATENUMBER:•m REVI5I!C9(wl!..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 'OLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. !NSR TYPE OF INSURANCE At7DL SUER POLICY NUMBER POLICY EFF MPLIC fDYEXP' LIMITS LTR I ,wait WVD 1. 1MQR!Y`[1(Y1__.d...•......:_._P Y°:�'_+.'1..... Ci X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ ............. 1,000,0001 = CLAIMS -MADE ] OCCUR AGGRE4L,ATE LIMIT APPLIES PER ................DED ....„............... I, RETENTION s D WORKERS MOYER'' LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE ARIMEMMB tory In R EXCLUDED? If yes, describe under DESCRIPTION OF OPERATIONS below E Pollution X X BCS0038453 ............. X BA040000054387 XLS0112973 X WSA 5032771 04 NIA FEIECC25840-01 01113/2020 01/1312021 DAMAr"E.WOREN'TED POLICY I " I rjk�ll' F] LOC EXluded MED EXP (Anv one person) A AUTOMOBILE LIABILITY 1,000,0001 X ,ANY AUTO 2,000,0001 OWNED SCHEDULED _ AURTEOS0NLY PRS..I.IrT.....,!.Pf.P..ar.... AUTOS AUTO® ONLY $ ALOrlf"W5',5' .... C X UMBRELLA LIAB ...._ OCCUR EXCESS LIAB CLAIMS -MADE ................DED ....„............... I, RETENTION s D WORKERS MOYER'' LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE ARIMEMMB tory In R EXCLUDED? If yes, describe under DESCRIPTION OF OPERATIONS below E Pollution X X BCS0038453 ............. X BA040000054387 XLS0112973 X WSA 5032771 04 NIA FEIECC25840-01 01113/2020 01/1312021 DAMAr"E.WOREN'TED 100,000 EXluded MED EXP (Anv one person) 1,000,0001 PERSONAL. & ADV INJURY _....._.__...•.._...._. 2,000,0001 GENERAL AGGREGATE _ ................. ............... 2,000,000 PRS..I.IrT.....,!.Pf.P..ar.... $ $ ...................... ....._.......................................... ......... :',r IBINBD w',If GCE LIMIT ..... ............................. _...... 1000,000 ” e rrr.rurl'Ib $ , 0812612019 08126/2020 _gngl,LXjNJI,JRv IPerrarsnnl LODILrI qLY�F�er accidenO $ NJ.R, I•+ f PIHIIZY�R+ l"PAMiaGE $ EACH OCCURRENCE $ 8,000,000 01/13/2020 01/13/2021 AGGREGATE $ 8,000,000 _�w_......_..�.__........_........................................ $ ............................. GLlCA1WC 7131!2019 071311202...........•..... O..................................................................... ER X PTJeThITF.....d._..........11.P H._.......... D E I, EACH ACCIDENT $ 1,000,000 E L DISEASE- EA EMPLOYEE $ 1000,000 I �...........__....._...� ......�.....�..._._............ 1,000,0001 2-C-61 - 01/1 EL DISEASE- POLICY LIMIT $ 0111312020 312 0 —2 1 Occurance 5,000,000 Aggregate 10,000,000 _..............''. .............................. E C I P' A NS I LO AT N 1 HICLES C D 1. 7 ddV y Ra the a a Ba attache IT more space Is required) o a':° �- :T 'oncree a Il aro` remenTs roo�eh . i$y ot�'�`° egw d r �s name's additional Insured for all liability arising ou't o the operations b, or on behalf of the named insured if required by contract per atttac= endorsements. Waiver of Subrogation applies to General Liability and Workers Compensation. M420A IIIIIAM14' 'I City of EI Segundo 350 Main Street EI Segundo, CA 90245 I ACORD 25 (2016103) CITYSEG SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 4Q*Ud• xzda"O� ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABILITY CG 20 01 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. 9 0 wr'Li+w a:�,� This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance Condition and supersedes any provision to the contrary: Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and (2) You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. CG 20 01 1218 © Insurance Services Office, Inc., 2018 Page 1 of 1 POLICY NUMBER: BCS0038453 COMMERCIAL GENERAL LIABILITY CG 20 37 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - O S, LESSEES O CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies Insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(e) Or Organisation s)�w Location AndDescriptionOf Completed Operations ANY PERSON OR ORGANIZATION WHEN ALL LOCATIONS REQUIRED BY WRITTEN CONTRACT OR AGREEMENT, EXECUTED PRIOR TO THE OCCURRENCE TO WHICH THIS INSURANCE APPLIES, THAT SUCH PERSON OR ORGANIZATION BE ADDED AS AN ADDITIONAL INSURED ON YOUR POLICY ation required to complete this Schedule, if not shown above, will be shown In the Declarations. Inform _ ..............................� A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage''" caused, in whole or in part, by "your work" at the location designated and described in the Schedule of this endorsement performed for that additional insured and included in the "products - completed operations hazard". However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required 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 37 12 19 G Insurance Services Office, Inc., 2018 Page 1 of 2 B. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable limits of insurance; whichever is less. This endorsement shall not increase the applicable limits of insurance. Page 2 of 2 © Insurance Services Office, Inc., 2018 CG 20 37 12 19 POLICY NUMBER: BCS0039453 COMMERCIAL GENERAL LIABILITY CG 20 10 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES O CONTRACTORS - SCHEDULED SO 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) ANY PERSON A REQUIRED BY WRITTEN CONTRACT OR AGREEMENT, EXECUTED PRIOR OCCURRENCE TO WHICH THIS INSURANCE ORGANIZATIONAPPLIES, THAT SUCH PERSON OR AS x: INSURED ON YOUR POLICY Location(s) Of Covered Operations ALL LOCATIONS Information required to complete this S not shown above, will be shown i mmmtm D �... m the Declarations. Schedule, e, i A. Section II — Who Is An Insured is amended to 2. If coverage provided to the additional insured is include as an additional insured the person(s) or required by a contract or agreement, the organization(s) shown in the Schedule, but only insurance afforded to such additional insured with respect to liability for "bodily injury", "property will not be broader than that which you are damage" or "personal and advertising injury" required by the contract or agreement to provide caused, in whole or in part, by: for such additional insured. 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and CG 2010 12 19 ©Insurance Services Office, Inc., 2018 Page 1 of 3 B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. Page 2 of 3 0 Insurance Services Office, Inc., 2018 CG 20 10 1219 C. With respect to the insurance afforded to these additional insureds, the following is added to Section III— Limits of Insurance. If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable limits of insurance; whichever is less. This endorsement shall not increase the applicable limits of insurance. CG 20 10 12 19 0 Insurance Services Office, Inc., 2018 Page 3 of 3 POLICY NUMBER: BCS0039453 COMMERCIAL GENERAL LIABILITY CG 24 04 1219 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER F RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following° COMMERCIAL GENERAL LIABILITY COVERAGE PART ELECTRONIC DATA LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART DESIGNATED SITES POLLUTION LIABILITY LIMITED COVERAGE PART DESIGNATED SITES PROD UCTSICOMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART UNDERGROUND STORAGE TANK POLICY DESIGNATED TANKS SCHEDULE Name Of Person(s) Or Organization(s): ANY PERSON OR ORGANIZATION FOR WHOM THE INSURED HAS AGREED TO WAIVE RIGHTS OR RECOVERY PROVIDED SUCH AGREEMENT IS MADE IN WRITING AND PRIOR TO THE LOSS _..........._.ww. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV — Conditions: We waive any right of recovery against the person(s) or organization(s) shown in the Schedule above because of payments we make under this Coverage Part. Such waiver by us applies only to the extent that the insured has waived its right of recovery against such person(s) or organization(s) prior to loss. This endorsement applies only to the person(s) or organization(s) shown in the Schedule above. CG 24 04 1219 0 Insurance Services Office, Inc., 2018 Page 1 of 1