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PROOF OF INSURANCE (2021 - 2021) CLOSEDWESTIND 02...........................DATE (MMIDDIYYYY)....................i-, -I,-,- CERTIFICATE OF LIABILITY INSURANCE 3/2312020 THIS CERTIFICATE IS ISSUED AS A MATTEROFINFORMATION ONLY AND CONFERS_L �............................ 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. ­­ _-___�...._......................�.................................__.....................-..m............................................................................. ........ ............... ...m 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 rir hts to the certificate holder in lieu of such endorsement(s),mmmmmmm m PRODUCER C40�;ACT 2001TegiMiller Insurance Brokers insure@tmib.com 9662 FAX 2001 Wilshire Blvd, Suite 101 E-MAIL I )Alc"Nat" PHONE N�„ E>1t): I31 p � 828 Santa Monica, CA 90403 ADDRESS: @ Ib.com INSURE'R(5,1 AFFORDING COVERAGE NAIC # INSURER A: Mesa Underwriters Specialty Insurance Co 36838 INSURED „INSURER B:Nationwide Mutual Insurance, Company 123787 Western Indoor Environmental Services INSURER c:StarStone National Insurance Company 2609 W. Beverly Blvd. Suite 6 INSURER o: Montebello, CA 90640 INSURER E: . INSURER F; COVERAGES CERTIFICATE NUMBER: REVISION NUMUI "C 11: 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, I S .... ^ 0 5 L SUBR POLICY EFF POLICY EXP TYPE OF INSURANCE POLICY NUMBER lM 1 1­1111111.� .. E ...^ EACH OCCURRENCE LIMITS TYPE S 1,000,0001 D . NJ,,,I),IYYYY,,,,,I,jMMIDDIYYYYI A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR X MP0004016005275 2/6/2020 2/6/2021 Dr�F"AGE T jERE�mE D,1, e) � 50,000'1 The ACORD name and logo are registered marks of ACORD 5,0001 IVIED CXP LAny orrr.,persoflfl S 1,000,000' PERSONAL, & ADV INJURY S 2,000,000 GEN1 AGGRI'"CV,'I"I- I IrAl I F'',PPI..II.".`., 4'I -R: GENERAL AGGREGATE S POLICYR',S7• PRODUCTS - COMPIOP AG'G S 2,000,000 C:7 I Ii k:; R" S _._..... B D SII...........LE LIMI... SINGLE LIMIT 1 „000,000 ISw'wl, AUTOMOBILE LIABILITY E re 5 X ANY AUTO X ACP3038130234 3/212020 3/2/2021 BODILY NJuUR'H';Pea Fe'=a�nl S OWNED SCHEDULED AUTOS ONLY AUTOS ',Li,r ratc:;cicnCt„ I�OOII.'^ II���' U,R;YS HtP, i NON -OWNED PROPERTYDAMAGE NAMAGE S A.0 S� ONLY AUTOS ONLY (Par 8crt0orr0 C UMBRELLA LIAB X OCCUR EACH OCCURRENCE S 1'000'000 X EXCESS LIAB CLAIMS -MADE X 83148R204ALI 2/6/2020 2/6/2021 AGGREGATE s 1'000'000 DED RETENTIONS S WORKERS COMPENSATION`d;fa„,I1 L, ER AND EMPLOYERS' LIABILITY YIN ANY PROPRIE.TOR(PARTNER(EXECUTIVE. ._. OFFICERIMEMBE.R EXCLUDED? NIA (Mandatory in NH)------ E L DISEASE - EA EMPLOYEE $ Ifes, describe under DESCRIPTION OF OPERATIONS below E L DISEASE - POLICY, DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The certificate holder is additional insured if required by written contract. City of EI Segundo is Additional Insured as respects the named insured's operations if required by written contract. Blanket Primary/Non-Contributory Wording & Waiver of Subrogation apply if required by written contract. Digitally signed by Joseph 111111 cn=Joseph 10111, o=City of El Segundo, ou=Finance Department, Joseph L i l l i o ou emai1gh111oQ elsegundo org, c=US Date: 2020.04.17 15:35' 10 -07'00' m., m.,.....,�mm.. CERTIFICATE HOLDER _._.. ........ Y......... CANCELLATION" SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Cit Of EI Segundo Y 9 ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street EI Segundo, CA 90245 ............................... „, �........._.._ AUTHORIZED REPRESENTATIVE .......................................................mm.,,... ACORD 25 (2016/03) ......,...........,.,.,.,.,.........,..... © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: MP0004016005275 MESA UNDERWRITERS SPECIALTY INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Al - PRIMARY NON-CONTRIBUTORY - WAIVER OF SUBROGATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM Blanket Additional Insureds - As Required By Contract A. Subject to the Primary and Non -Contributory provision set forth in this endorsement, SECTION II - WHO IS AN INSURED is amended to include as an additional insured any person or organization whom you have agreed in a written contract, written agreement or written permit 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" or "property damage" or, to the extent applicable under the Coverage Part to which this endorsement applies, "personal and advertising injury" caused, in whole or in part, by: 1. Your ongoing operations, "your product", or premises owned or used by you; With respect to the insurance afforded to these additional insureds, the following additional exclusion applies: This insurance does not apply to "bodily injury", "property damage" or, to the extent applicable under the Coverage Part to which this endorsement applies, "personal and advertising injury" arising out of the rendering of, or the failure to render, any professional architectural, engineering or surveying services by or for you, including: a. The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; and b. Supervisory, inspection, architectural or engineering activities. This exclusion applies even if the claims against any insured allege negligence or other wrong -doing in the supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence" which caused the "bodily injury" or "property damage", or, to the extent applicable under the Coverage Part to which this endorsement applies, the offense which caused the "personal and advertising injury", involved the rendering of, or failure to render, any professional architectural, engineering or surveying services. 2. Your maintenance, operation or use of equipment, other than aircraft, "auto" or watercraft, rented or leased to you by such person or organization. A person or organization's status as an additional insured under this endorsement ends when their contract, or agreement with you for such rented or leased equipment ends. With respect to the insurance afforded to these additional insureds, this insurance does not apply to any "occurrence" which takes place after the rental agreement or equipment lease expires. The provisions of this coverage extension do not apply unless the written contract or written agreement has been executed (executed means signed by the named insured) or written permit issued prior to the "bodily injury" or "property damage" or, to the extent applicable under the Coverage Part to which this endorsement applies, "personal and advertising injury". MUS 01 01 20128 0316 INSURED Page 1 of 2 ENDORSEMENT AGREEMENT ADDITIONAL INSURED EMPLOYER 9126780-20 RENEWAL SC 8-75-66-67 PAGE 1 HOME OFFICE SAN FRANCISCO EFFECTIVE MARCH 23, 2020 AT 12.01 A.M. ALL EFFECTIVE DATES ARE AT 12:01 AM PACIFIC STANDARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME WESTERN INDOOR ENVIRONMENTAL SVC 2609 W BEVERLY BLVD STE 6 MONTEBELLO, CA 90640 ANYTHING IN THIS POLICY TO THE CONTRARY NOTWITHSTANDING, IT IS AGREED THAT CITY OF EL SEGUNDO IS HEREBY NAMED AS AN ADDITIONAL INSURED EMPLOYER ON THIS POLICY BUT ONLY AS RESPECTS EMPLOYEES WHOSE NAMES APPEAR ON THE PAYROLL RECORDS OF WESTERN INDOOR ENVIRONMENTAL SVC (HEREIN CALLED THE PRIMARY INSURED) WHILE THOSE EMPLOYEES ARE ENGAGED IN WORK UNDER THE SIMULTANEOUS DIRECTION AND CONTROL OF THE PRIMARY INSURED AND THE ADDITIONAL INSURED EMPLOYER. IT IS FURTHER AGREED THAT THE PAYMENT OF THE FULL PREMIUM DUE AND PAYABLE UNDER THIS POLICY SHALL REMAIN THE SOLE RESPONSIBILITY OF THE PRIMARY INSURED. NOTHING IN THIS ENDORSEMENT SHALL BE HELD TO VARY, ALTER, WAIVE OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS POLICY OTHER THAN AS ABOVE STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR LIMITATIONS IN THIS ENDORSEMENT. COUNTERSIGNED AND ISSUED AT SAN FRANCISCO: AI ITHnPl7Fn PPPRFCFNIT 1\/F MARCH 25, 2020 DDFCIn CHIT Amn rr-n 0015 Primary and Non -Contributory Provision The following is added to Paragraph 4. Other Insurance, b. Excess Insurance under SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS: This insurance shall be excess with respect to any person or organization included as an additional insured under this policy, any other insurance that person or organization has shall be primary with respect to this insurance, unless: 1) The additional insured is a Named Insured under such other insurance; 2) You have agreed in a written contract, written agreement or written permit to include that additional insured on your General Liability policy on a primary and/or non-contributory basis; and 3) The written contract or written agreement has been executed (executed means signed by the named insured) or written permit issued prior to the "bodily injury" or "property damage" or, to the extent applicable under the Coverage Part to which this endorsement applies, "personal and advertising injury". Waiver Of Transfer Of Rights Of Recovery The following is added to Paragraph 8. Transfer of Rights Of Recovery Against Others To Us under SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS: We will waive any right of recovery we may have against a person or organization because of payments we make for "bodily injury" or "property damage" arising out of your ongoing operations or "your work" done under a written contract or written agreement and included in the "products -completed operations hazard", if: You have agreed to waive any right of recovery against that person or organization in a written contract or written agreement; 2. Such person or organization is an additional insured on your policy; or You have assumed the liability of that person or organization in that same contract, and it is an "insured contract'. The section above only applies to that person or organization identified above, and only if the "bodily injury" or "property damage" occurs subsequent to the execution of the written contract or written agreement. All other terms and conditions of this policy remain unchanged, MUS 01 01 20128 0316 Page 2 of 2 POLICYHOLDER COPY SC P.O. BOX 8192, PLEASANTON, CA 94588 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 03-23-2020 CITY OF EL SEGUNDO 350 MAIN ST EL SEGUNDO CA 90245-3813 SC GROUP: POLICY NUMBER: 9126780-2020 CERTIFICATE ID: 165 CERTIFICATE EXPIRES: 03-07-2021 03-07-2020/03-07-2021 This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 30 days advance written notice to the employer We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the pobcy listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this cwtihcate of insurance may be issued or to which it may pertain, the insurance afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy. dry Authorized Representa01ve President and CEO EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT #0015 ENTITLED ADDITIONAL INSURED EMPLOYER EFFECTIVE 2020-03-23 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. NAME OF ADDITIONAL INSURED: CITY OF EL SEGUNDO ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 03-07-2016 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. ENDORSEMENT #2572 ENTITLED BLANKET WAIVER OF SUBROGATION EFFECTIVE 2020-03-07 IS ATTACHED TO AND FORMS A PART OF THIS POLICY ENDORSEMENT #1651 - ANTONIO ROSARIO PRESIDENT - EXCLUDED. .... ENDORSEMENT #1651 - ALBERT TORRES SEC,TRES - EXCLUDED., EMPLOYER WESTERN INDOOR ENVIRONMENTAL SERVICES 2609 W BEVERLY BLVD STE 6 MONTEBELLO CA 90640 SC JL 4/17/2020 [P13,HO] (REV.7-2014) PRINTED : 03-23-2020 ENDORSEMENT AGREEMENT WAIVER OF SUBROGATION BLANKET BASIS HOME OFFICE SAN FRANCISCO EFFECTIVE MARCH 7, 2020 AT 12.01 A.M. AND EXPIRING MARCH 7, 2021 AT 12.01 A.M. ALL EFFECTIVE DATES ARE AT 12:01 AM PACIFIC STANDARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME WESTERN INDOOR ENVIRONMENTAL SVC 2609 W BEVERLY BLVD STE 6 MONTEBELLO, CA 90640 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 2.00% OF THE TOTAL POLICY PREMIUM. SCHEDULE PERSON OR ORGANIZATION ANY PERSON OR ORGANIZATION FOR WHOM THE NAMED INSURED HAS AGREED BY WRITTEN CONTRACT TO FURNISH THIS WAIVER JOB DESCRIPTION BLANKET WAIVER OF SUBROGATION 9126780-20 RENEWAL SC 8-75-66-67 PAGE 1 OF NOTHING IN THIS ENDORSEMENT SHALL BE HELD TO VARY, ALTER, WAIVE OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS POLICY OTHER THAN AS ABOVE STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR LIMITATIONS IN THIS ENDORSEMENT. COUNTERSIGNED AND ISSUED AT SAN FRANCISCO: Al ITF-4npl7pn PFPPFQFNT. 1%/P FEBRUARY 26, 220020 DpGcinGniT Amn rr-n 1 2572