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PROOF OF INSURANCE (2020 - 2021) CLOSEDDAiii5/s i AC CERTIFICATE OF LIABILITY INSURANCE 20 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(les) must 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 r� r. : John McComb Trinity Tnty Insurance Services, Inc H F.A MPHONE N�E�,p; 773 00%9 .vii $ _77379059. 23287 Ventura Blvd EfAIL Woodland Hills, California 91364 Agpa PRODUCER .... X03.+ mrStIDA892 INSURERS AFFORDING COVERAGE NAIC p INSURED .. 1 D .1...1 ... 1 INSURERA CO ny Ins CO INSURERS:Mobig. ., s CD..,,.. 92551 Collrb nl Ave n, l nc INSURER C, Progressive r 0 I"2 5 51 V 2 I n Northridge, CA. 91324 ERD; AI Nati onal Union F INSURER G- ire 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. NOTWTHSTANDING 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. iLTR ^ GENERAL LIABILITY OF INSURANCE � �DI POLICY NUMBER ^^ ^^� _ - O MiDDBYYYYy $ 100 000 POLICY' IµF'F POLkCY EMP rkviWirDDMYYYi �Aanno;L �d�� y„j I„ LIMITS.. 3,000,00 (ABILITY I EACH OCCURRENCEP'a 0 e ES__ ✓ COMMERCIAL GENERAL LIABILITY r ufR 101GLOO54665-03 06/10/19 06/10 20 r MED EXP (Any person) $ 3 000 000 A _ X X / ., PERSONAL&ADV INJURY $ I ,GENERAL AGGREGATE i5 4,000,000 GEN'L AGGREGATE LIMIT APPI,.IFS PER i PRODUCTS • COMPIOP AGG 4,000,0 $ 00 ..,, ...I POLICY V r% rr LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT i accident). $... .......................1'....000,000 BODI LY — .ANY AUTO BODILYINJURYJ(Per person) $ ALL OWNED AUTOS B SCHEDULED AUTOS X X 00777924-0 05/31/19 05/31/20 accidenkj,,,,,,,,,,,,,, PROPERTY DAMAGE HIREDAUTOS (Per accident) NON -OWNED AUTOS $ OCCUR E $ 5,000,000 �/ EACH OCCURRENCE UMBRELLA LIAB xfi5 WADS � i I D EXCESS LIAR EBU038414371 06/10/19 ',06/10/20 5,000,000 C AI. X $ DEDUCTIBLE .. I$ RETENTION S $ WC STATU I OTH AND ANY PROPRIETOR/ ARBTIUrY NERIEXECUTIVE � .I RY_LI CI ER . WORKERS COMPENSATION OFFICERIMEMBER EXCLUDED?(Mandatory in N I A $ SEASE - ANT Iffyes,describetunlder E.L DISEASE-POLICYLIOMIT.................................. EE DESCRIPTION OF OPERATIONS below $ I DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 701, Additional Remarks Schedule, it more space is required) The City of EI Segundo, its officers, officials, employees, agents, and volunteers 350 Main St. EI Segundo, CA 90245 are hereby named additional insured CERTIFICATE HOLDER CANCELLATION The City of EI Segundo, Its Officers, officials, employees, SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE agents, and volunteers 350 Main St. EI Segundo, CA 90245 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Eric Ca��rJo ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD 101 OL 0054665.02 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL, INSURED - OWNERS, LESSEES OR CONTRACTORS- SCHEDULED PERSON OR ORGANIZATION This endorsement modifies Insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE e -V Name of Additional Insured Person(s) or Organization(s) (Additional Insured): Location(s) of Covered Operations: AS DESIGNATED IN WRITTEN CONTRACT AS DESIGNATED IN WRITTEN CONTRACT WITH THE NAMED INSURED WITH THE NAMED INSURED The insurance afforded bythis Coverage Part forthe additional insured shown in the Schedule is primary insurance and we will not seek contribution from any other insurance available to that additional insured. 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 for whom you are performing operations 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 additional insured only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" 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(s) at the location(s) designated above. A person's or organization's status as an additional insured under this endorsement ends when your operations for that additional insured are completed. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to: Additional Insured Contractual Liability "Bodily injury" or "property damage' for which the additional insureds) are obligated to pay damages by reason of the assumption of liability in a contract or agreement Finished Operations at Work "Bodily injury' or "property damage" occurring after: 1. All work, Including materials, parts or equipment fumiahed 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 worle out of which the iryury or damage arises has been put to its intended use by any person or organization. Negligence of Additional Insured U156-0310 Includes copyrighted material of ISO Properties, Inc., Page 1 of 2 with Its permission. 101 GL 0054665.02 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. .t& �,, E Kill k III *6 0 This endorsement modes insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV — Conditions: We waive any rights of recovery we may have against any person or organization because of payments we make for Injury or damage resulting from your ongoing operations or "your work" done under a contract with that person or organization and included in the "products -completed operations hazard" if: a. you agreed to such waiver, b. the waiver is included as part of a written contract or lease; and c. such written contractor lease was executed prior to any loss to which this insurance applies. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. U047-0310 Includes copyrighted material of ISO Properties, Inc., Page 1 of 1 with its permission. 101 GL 0064865-02 "Bodily injury" or "property damage" arising directly or indirectly out of the negligence of the additional insured(s). ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. U166-0310 includes copyrighted material of ISO Properties, Inc., Page 2 of 2 with Its permission. 0DATE (MMIDDVYYY) ACC>RV CERTIFICATE OF LIABILITY INSURANCE 03/09/2020 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 CONTACt NAMC: Doug Jones PHONE + :41'77 FAX Y.„ (480) 951-4266 c/o Artex Risk Solutions, Inc. 80p 951 E 8840 E. Chaparral Rd.; Suite 275 SDL,BSD.Certificates@artexrisk.com com Scottsdale, AZ 85250 iNs URE R(S) AFFORDING COVERAGE NAIC A iNSUR.ER a American Zurich Ins Company Insurance Com an 40142 INSURED INSURER B: Avitus, Inc. dba: Avitus Group Labor Contractor, for co-employees of: Mobile Illumination, Inc. INSURER C 175 N. 27th Street, Suite 800 PO Box 2506 INSURER D Billings. MT 59103 INSURER E INSURER F a COVERAGE'S CERTIFICATE NUMBER:20MT901972376 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. ,INTIp TYPEOFI SURANCE IAb'DL'tU6A POLICVYVYa LIMITS .. WVD POLICY NUMBER (MMID POLICY ExP N INSD' D (MMrDDrYYYYI, ITS COMMERCIAL GENERAL LIABILITY EACH OC_CURREPJCE. CLAIMS-MADE OCCUR 6dih(sCGE Tti RE lTECS ., MED EXP (Any one per ant $ PERSONAL & ADV INJURY c, GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE I POLICY ,fEC'T r"11`T LOC PRODUCTS - COMPIOP AGG OfHEn AUTOMOBILE LIABILITYCOl B"tl^gFt:';mIC7t;li.t, N II',tlT rEra ,w,,,.,dcanA'! ANY AUTO BODILY INJURY (Per Person) $ OWNED SCHEDULED BODILY INJURY (Per accident) S AUTOS ONLY AUTOS .. NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY HIRED AUTOS ONLY Par ar,'e,i P nPh -„ I 'T UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS MADE AGGREGATE DED RETENTION$ $ WORKERS COMPENSATION X� PEA! EI EPEA!Try''H AND A ANYPRO RIETOREXCLUDED?ECUTIVE IIS,/N,� NIA' X WC 96-20-045-02 04/01/2020 04/01/2021 E......".�. 9N Ala _" 000000 OFFIC (Mandatory in NH) LIABILITY E.L. DISEASE�EA F 1r Lu�V FE $ 1,000,000 II yyes,descome under DESCRIPTI&' J OF OPERATIONS below E.L. UISEA'SE - POLICY LIMIT ! $ 1,000,000 Location Coverage Period: 04/01/2020 04/01/2021 Client# HH4-CA DESCRIPTION OF OPERATIONS r LOCATIONS I VEHICLES (ACORD 101. Additional Remarks Schedule, maybe attached if more space is required) Ce1ve+<1 r is pa�virfed don Mobile IllumEnat'ion, Inc. Waiver of subrogation issued in favor of the certificate holder for the following project: () 9255 Corbin Ave. An operations �5avty tlata;�rs d:rT°�rnlTVcayrrOs of, bkA not Sutaa:aal /actors Northridge, CA 91324 to; Endorsements: Waiver of Subrogation CERTIFICATE HOLDER CANCELLATION The City of EI Segundo, its officers, officials, employees, agents, and volunteers 350 Main St EI Segundo, CA 90245 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and loco are registered marks of ACORD 2• of 3 14068 ACORD 25 (2016/03) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. WORKERS' COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 4-84) 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 per- form 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 engaged in the work described in the Schedule. The additional premium for this endorsement shall be otherwise due on such remuneration. Person or Organization IN FAVOR OF: The City of EI Segundo, its officers, officials, employees, agents, and volunteers 350 Main St EI Segundo, CA 90245 $0 of the California workers' compensation premium SCHEDULE Job Description Waiver of subrogation issued in favor of the certificate holder for the following project: All Operations 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: 04/01/2020 Policy No: WC 96-20-045-02 Insured: Avitus, Inc. dba: Avitus Group Labor Contractor, for co -employees of: Mobile Illumination, Inc. Insurance Company: American Zurich Insurance Company WC 04 03 06 Copyright 1983 National Council on Compensation Insurance Endorsement No: Countersigned by Me- 3*of3 1406E