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PROOF OF INSURANCE (2020) CLOSED" � .0 DATE (MM/DD/YYYY) "''RV CERTIFICATE OF LIABILITY INSURANCE 03/10/2020 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 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 "cONTAC'r Dennis Ferguson NAME. License # OA 91387 11"I'l ��' d�909)931-1'500 FAX (909) 932-2133 Kessler Alair Insurance Services, Inc NoErtl: ( /Arc. Na)rIZEss. rguson@kessleralair.com 12487 N. Mainstreet, Ste. 240 INSURER(S) AFFORDING COVERAGE NAIC # Rancho Cucamonga CA 91739 INSURERA: AXIS Surplus 26620 INSURED INSURER B: West American Insurance Company 44393 Titan Environmental Solutions, Inc. S B INSURERC: Ohio Security Insurance Company 1521 EOrangethorpe —a, to INSURERD: uINSURER E: Fullerton CA 92831 VQ INSURER F COVERAGES CERTIFICATE NUMBER: 19/20 GUProf/WC/Auto 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, kNSR ^AUUL SUUK POLICY EFF POLICY EXP LTR TYPE OFINSURANCE VINSD WVD POLICY NUMBER (MMIDDIYYYY) (MMIDD/YYYY) I LIMITS 24082 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of EI Segundo, it's City Council, officers, officials, employees, agents, and volunteers are named as additional insured when required by written contract per the attached blanket additional insured endorsement. Waiver of subrogation applies to the General Liability and Workers Compensaion per the attached forms. 01_�, CERTIFIC'AT'E HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of EI Segundo ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street AUTHORIZED REPRESENTATIVE E) Segundo CA 90245 .9„ . a. �..� I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 VAMNt�'t 10 HLN"VEU 300,000 CLAIMS -MADE � OCCUR PREMISES IEa occunoncel $ `,ye,' Pollution Liability MED EXP (Any one person) $ 5,000 A X Contractual Liability Y Y SP002760-03-2019 08/27/2019 08/27/2020 PERSONAL & ADV INJURY $ 2,000,000 GENLAGG�RFG,AT'ELIMITAPPLIESPER: GENERAL AGGREGATE $ 2,000,000 �,,.« PRD- POLICY �/'"� JECT" LOC PRODUCTS COMPIOP AGG $ 2,000,000 Pollution Liability $ 2,000,000 OTHER, AUTOMOBILE LIABILITY SINGLE LIWT t�OeMBINdED en $ 1,000,000 z ANY AUTO BODILY INJURY (Per person) $ B OWNED AUTOS ONLY SCHEDULED AUTOS BAW59095563 08/27/2019 08/27/2020 BODILY INJURY (Per accident) $ �- HIRED NON -OWNED PROPERTY DA�MAGt: $ AUTOS ONLY AUTOS ONLY d'Per accldentl Uninsured motorist $ 1,000,000 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS -MADE -...-. I AGGREGATE $ DEDLRETENTION $ $ ....I WORKERS COMPENSATION XI STATUTE I I ERH AND EMPLOYERS'LIABILITY YIN 1,000,000 C ANY PROPRIETOR/PARTNER/EXECUTIVE N / A Y XWS59095563 08/27/2019 08/27/2020 E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED?El 1,000,000 (Mandatory in NH) E.L. DISEASE- EA EMPLOYEE $ If yes, desc6be under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 1,000,000 $ Each Claim $2,000,000 Professional Liability A Retro Date: 10/20/2006 SP002760-03 2019 08/27/2019 06/27/2020 Aggregate $2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of EI Segundo, it's City Council, officers, officials, employees, agents, and volunteers are named as additional insured when required by written contract per the attached blanket additional insured endorsement. Waiver of subrogation applies to the General Liability and Workers Compensaion per the attached forms. 01_�, CERTIFIC'AT'E HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of EI Segundo ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street AUTHORIZED REPRESENTATIVE E) Segundo CA 90245 .9„ . a. �..� I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Endorsement No. 4 Effective Date: 08/27/201,9 @12:01 a.m. Standard Time at the address of the Named Insured Policy Number: SP00260-0-2019 Insured Name: Titan Environmental Solutions« Inc. Issuing Company: AXIS Surplus Insurance Company Additional (Return) Premium: SO If the Endorsement Effective Date is blank, then the effective date of this Endorsement is the Inception Date of the Policy. ADDITIONAL INSURED/PRIMARY COVERAGE INCLUDING COMPLETED OPERATIONS (CGL & CONTRACTORS POLLUTION COVERAGE) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies the Specialty Package Policy. In consideration of the premium charged, it is agreed that: SECTION III — WHO IS AN INSURED is amended to include as an Additional Insured the person or organization shown in the schedule below as respects Coverages A, B and D, but only for liability arising out of Your Work or Covered Operations performed by you or on your behalf for that Additional Insured and not due to any actual or alleged independent liability of said Additional Insured. This endorsement does not apply to Bodily Injury. Property Damage or Loss arising out of the sole negligence or willful conduct of, or for defects in design furnished by the Additional Insured. As respects the coverage afforded the Additional Insured, this insurance is primary and non-contributory where a written contract or written agreement in effect prior to any related Claim requires you to provide such coverage. When this insurance is primary and non-contributory, our obligations are not affected by any other insurance carried directly by such additional insured whether it is primary or excess coverage. However, regardless of the provisions above: We will not extend any insurance coverage to the additional Insured person or organization: (1) That is not provided to you in this Policy; or (2) That is broader coverage than you are required to provide to the additional Insured person or organization in the written contract or written agreement. This endorsement does not increase the Company's Limits of Insurance as specified in the Declarations of the Policy, SCHEDULE OF ADDITIONAL INSUREDS As required by written contract prior to any related Claim SPP 0024 (Ed. 06 12) Page 1 of 1 Endorsement No. to Effective Date: D8/27/2019 @)12:01 a.m. Standard Time at the address of the Named Insured Policy Number: SP002760-03-2019 Insured Name: i wtan environmental Solutions, Inc, Issuing Company: AMsurplus Insurance Lompany Additional (Return) Premwm: u If the Endorsement Effective Date is blrifi'k, then the effective date of this Endorsement is the Inception Date of the Policy. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: SPECIALTY PACKAGE POLICY SCHEDULE Name Of Person Or Organization: As required by written contract in effect prior to any related Claim Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 12. Subrogation of Section VI — Common Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or Your Work done under a contract with that person or organization and included in the Products - Completed Operations Hazard. This waiver applies only to the person or organization shown in the Schedule above. Includes copyrighted material of Insurance Services Office, Inc with its permission CG 24 04 05 09 SPP 2404 09 (04 14) Page 1 of 1 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 06 79 (Ed. 01-131 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA 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.) You must maintain payroll records accurately segregating the remuneration of your employees while en- gaged in the work described in the Schedule. The additional premium for this endorsement is $ 250 Schedule Person or Organization Blanket Additional Insured as Required by Contract Job Description 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 Endorsement No. 0008 Policy Effective 08/27/2019 Premium State Policy No. XWS (20) 59 09 55 63 Insured TITAN ENVIROMENTAL SOLUTIONS, INC Insurance Company Ohio Security Insurance Company 19291 Countersigned by WC 99 06 79 (Ed. 01-13) © 2013 Liberty Mutual Insurance Includes copyrighted material of WCIRB,with its permission.