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PROOF OF INSURANCE (2021 - 2021) CLOSEDACO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDNYYY) 03/02/2020 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 terns 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 Bettis Insurance ServicesACT John Bettis -NAMr1725 S. Gaffey Street PHONE (310)521.4480 - ''OAX (310)521.0111 Suite C ft S jbettis1@bett1slnsxon1 - - San Pedro CA 90731-4663 DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES (ACORD 101, Additional Remarks Schadate, racy be attghad U mare s ace Is required) City of El Segundo is named as additional insured as per additional insured endorsement CG2033 043 where required by written Contract with the named insured subject to the terms and conditions set forth in the policy. Lfl-I CERTIFICATE HOLDER CANCELLATION Al 001387 1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of FJ Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 150 Illinois Street El Segundo CA 90245- AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD INSURER($] AFFORDING COVERAGE N&J#_ ........... INsuR&RA.At'aln Specialty Insurance 17159 INSURED Mike Erland s E a,lnsurance Company of the West Second City Plumbing JM.RER c .Oregon Mutual Insurance Co (Rated A VII) 14907 525 W. Mariposa St. JatUR D,Scottsdale Insurance Company 41297 FI Segundo CA 90245- - .........., .. JlfSM ER F! COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE r'OLICIES, Of INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIUU 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. -IMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADOL SU OR ITP TYPE OF INSURANCE won POLMXAMMUR --- POLICY EFF POLICY EXP rMMMD yyxx M=rvyyVV LIMITS -- A X COMMERCIAL GENERAL LIABILITY X CIP399564 02/15/2020 02/15/2021 EACH OCCURRENCE g 1,000,000 CLAIMS -MADE I A I OCCUR bAMAGE TO RENTED 50,000 I•---- $ MED EXP (Anw one person) $ 5,000 ............ _ . PERSONAL & ADV INJURY $ 1,000,000 EN'L AGGREGATE LIMIT APPLIES PER: XPOLICY D r @I@ GENERAL AGGREGATE $ 2,000,000 JECT LOC C PRODUCTS - COMPIOP AGG $ — 2,1)00.000 f $ C AUTOMOBILE LIABILITYCOMBINED CMO 920869 SINGLE LIMIT 02/24/2020 02/24/2021 $ 1,000,000 ANY AUTO _........................... OWNED X AUTOS SCHEDULED AUTOS ONLY BODILY INJURY (Per person) $ BODILY INJURY (Per $ _X_I,.H'IRED - NON,OWNED___-. ___..__.�PPROE AUTOS ONLY AUTOS ONLY YLOAMAGE IrRuErt, D X UMBRELLALWB OCCUR XBS0117711 — 02/21/2020 02/21/2021 .EACH OCCURRENCE $ 1000,000 EXCESS LIA9 . CLAIMS -MADE _�.......... .� S .................. 1,000,000 DED R ETENTIONR ...,,....., $ B WORKERS COMPENSATION WPL 5054200 00 03/0212020 03/02/2021X PER OTH- mm R AND EMPLOYERS' LUIBILITY / N ANY PROPRIETOWPARTNERIEXECUTIVEEL A, E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMSEREXCLUDED? NIA (Mandatory In NH) E.L. DISEASE - EA EMPLOYEE 1,000,000 If, as, dela ft under TION OF I:,YPERA°PIrYN.^7'� grxw . _... Ij E.L. DISEASE - POLICY LIMIT S 1,1)l)l),l)Ol) C Auto Physcal Damage ,CMO 920869 02/24/2020 02124/2021 Comp Ded $500 Coll Dec $1000 DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES (ACORD 101, Additional Remarks Schadate, racy be attghad U mare s ace Is required) City of El Segundo is named as additional insured as per additional insured endorsement CG2033 043 where required by written Contract with the named insured subject to the terms and conditions set forth in the policy. Lfl-I CERTIFICATE HOLDER CANCELLATION Al 001387 1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of FJ Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 150 Illinois Street El Segundo CA 90245- AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD COM FE:RCiAL GENERAi. LIASILITY QG 20 33 0413 THIS ENDORSEMENT CHANGES THE POLIOY, PLEASE READ IT CAREFULLY. AbRITIO'NAL INSURCD-OWN ERS, LESSEES �7_[ CONTRACTORS -AUTOMATIC STATUS WHEN REQUIRED i•,N CONSTRUCTION AGREEMENT WITH YOU This endorsement modifies insurance provided WOW following: COMMERCIAL -GENERAL LIABILITY COVERAGE PART A. Section II - Who Is An Insurod Is amended to Include as an additional Insured any parson or or. gantzation for whom you are performing opera. tions when you and such person or organization .havr3"agroad in writing In a contract or agreement that such person or organlzatlon,'be added as „an additional insured on your polloy, Such person or organlization N an addltronal Insured only with re. spaut to pablfity for "bodily Injury", "property dam- ao@e or "personal' and advertising Injury" oaused, In whole or In part, by; 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalP,, in the porlotmance of your ongoing operations for the additional' Insured, However, the insurance afrorded to such additional Insured: 1. •Only applies td the extent pnrmitted by law; •and• '2. Will not be broader than that which you are re. qulred by the contract or agwenient to provide foreuoh additional Insured. A person's or organization's status as an addl- tinnal'infsured under this andora meat ends when your operations for that addlrlonai Insured are completed. ' VIM WNIIIIIIIIIIIIIIII B. With respect to the Insurance afforded to these ad- ditlonal insureds, the foiiowing additional exclu- stone apply: • This insurance does not apply to: 1. "Bodily injury", "property damage" or "personal and advartlsing injury" arising out of the ren- dering of, or•the failure to render, shy profes- slonal architectural, engineering or surveying services, Including: a. 'the preparing, approving, or failing to prepare or approve, maps, shop draw. Ings, opinions, reports, surveys, field or - dors, change orders or drawings and specifications; or' b. Supervisory, inspection, architectural or engineering activities. This exclusion applies even If -the claims against any Insured allege negligence or other wrongdoing in the supervision, hiring, employment, tralding or rnonitoring of others by that Insured, It the "occur- rence"' whtoh caused' th'o""bodily Injury" or "prop- erty damage"„ or the offense which; caused the "parsonal and advertising lnjury". W61ved the ren- dering of or the failure to render any professlonal architectural, engineering crsurveying services, CG'20 33 0413 Capyrig ht, Insurance Services Ofiloe, Inc., 2012 Page 1 oft Page 2 of 3 Copyright, Insurance Service* Me, Ino., 2012 Ce 20 33 0413 2. "S'Udilyffl)Uly'ar"property daMage-00curdhg 0. Wth respect to the insurance afforded to thorn after additionat insureds, the followlpq Is added to $so - 9, All work, including materials, parts or Von III- Limits Of Insurance.* equipment furnished In connection with The most we will pay on behalf of the addItIonlal [n - such work, on the project (oth6r than serv. surod 13 the amount or inemmnw. Ice, malntananoe or mpalrs) to be per - formed by or on behalf of the additional 1. Required by the contract or agreement you Insuted(s) at the location of the covered have entered Into with the addMonal Insured; operations has been completed; or or b. That portion of 'Your Work" cut of which 2. Available under the applicable Ljrnb of Insur- anus shown In the Declarations; the Injury or damage arises has been put to'b intended use by any person or or. wh 19hever to less. gunization other than another contractor ThIc ondomemont shall not Inoreato the applicable or subcontractor engaged In performing Limits of insurance shown In the Declarations. operations for a principal he a part of the sa.mo project. Page 2 of 3 Copyright, Insurance Service* Me, Ino., 2012 Ce 20 33 0413 COMMERCIAL GENERAL LIABILITY CG 20 33 04 13 THIS ENDORSEMENT CHANGES TH12 POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -OWNERS, LESSEES OR CONTRACTORS -AUTOMATIC STATUS WHEN REQUIRED NY CONSTRUCTION AGREEMENT WITH YOU This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section II - Who is An insured Is amended to Include as an additional Insured any person or or. Sanitation for whom you are performing opera- tions when you and such person or organization •have agreed in writing in a contract or agreement that such person or organization- be added as ,an additional Insured on your policy. Such person or organization Is an additlonal Insured only with re. spect to liability for "bodily Injury"', ""p,roperty dam- age or "persona;( and advertising Inj',ur"y"° caused', In whole or In part, by: 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. However, the insurance afforded to such additional Insured: 1. Only applies to the extent permitted by law; and, 2. Will not be broader than thal which you are re- quired by the ooirotract or agreement to provide for such additional insured. A person's or organization's status as an addi- tional insured under this endorsement ends when your operations for that additional Insured are completed. B. With respect to the insurance afforded to these ad- ditional insureds, the following additional exclu- sions apply: . This insurance does not apply to: 1. "Bodily injury", "property damage" or "personal and advertising injury" arising out of the ren- dering of, or the failure to render, any profes- sional arohlivotural, engineering or surveying services, including: a. the preparing, approving, or failing to prepare or approve, maps, shop draw. Ings, opinions, reports, surveys, field or- ders, change orders or drawings and specifications; or, b. Supervisory, inspection, architectural or engineering activities. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing In the supervision, hiring, employment, traliiing or monitoring of others by that Insured, if the "occur- rence" which caused the "bodily injury" or "prop- erty damage", or the offense which caused the "Personal and advertising injury", involved the ren. dering of or the failure to render any professional architectural, engineering or surveying services. CG'203304113 Copyright, InsurenCe ServicesOfilce, Inc., 2012 page 1 oft 2. ""Bodily Injury" or "property damage" ocourring after. a. All work, Including materials, parts or equipment furnished In connection with such work, on tho project (other than sere Ice, maintenance or repalyd) to be per- formed by or on behalf of the additional Insureds) at the location of the covered operations has been completed; or b. That portion of '"your work" out of which the Injury or damage arises has been put tolts Intended use by any person or or. ganization other than another contractor or .subcontractor engaged In performing operations for a principal as a part of the same project. G. tWth respect to the Insurance afforded to these additional insureds, the hallowing is added to $ac- tfon III - Limits Of Insurance: The most we will pay on behafF of the additional in- sured Is the amount or Insurance: 9. Required by the comiract or agreement you have entered 'Into with the additional insured, or 2. Available under the applicable limits of Insur- ance shown in the Declarations; wh lchever is less. This endorsement shall not Increase the applicable Limb of Insurance showy: in the Declarations. Page 2 oft Copyright, Insurance Services Office, Inc., 2012 CS 20 33 0413 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 06 34 (Ed. 8-00) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - BLANKET 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). The additional premium for this endorsement shall be otherwise due. Person or Organization ANY PERSON / ORG WHEN REQUIRED BY WRITTEN CONTRACT 2 % of the total California Workers' Compensation premium Schedule Job Description ATiTi CA OPERATIONS r/A 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 3—?—'?()20 '1Policy No. W OL 5 0 a 4 2 a n nn Endorsement No. Insured Second City Plumbing - Premium $ INCL. Insurance Company INSURANCE COMPANY OF THE WEST Countersigned By WC 99 06 34 (Ed. 8-00) INSURED