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PROOF OF INSURANCE (2020 - 2021) CLOSEDDATE(MM/)DIYYYY) CERTIFICATE OF LIABILITY INSURANCE 03/12/20 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 pollcy(les) must be endorsed. H 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 I CONTACT HELEN SHERLOCK TRI WORLD INSURANCE AGENCY IN + NAME: IPHONE nHic No.EXO (949)756-0863 I iA/c,No): (949)756.1356 4000 BIRCH STREET, STE 201 B E-MAIL HSHERLOCKOTRIWORLDINS.COM NEWPORT BEACH, CA 92660 I ADDRESS: 800-617-8428 INSURERS) AFFORDING COVERAGE NAICM INSURER A ARCH SPECIALTY INS CO. A+XV 21 199 INSURED MARX BROS. FIRE EXTINGUISHER CO. RSUI INDEMNITY CO. A+ XIV 22314 INSURER B: & COOK FIRE EXTINGUISHER INSURANCE CO OF THE WEST A XIII I 27847 INSURER C: 1 159 S. SOTO STREET INSURER D LOS ANGELES, CA 90023 I INSURER E . I 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 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. INSR TYPE OF INSURANCE ADDL SUER LTR INSR MD POLICY NUMBER POLICY EFF POLICY EXP (MM1DD/YYYY) (MMIDDIYYYV) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 x DAMAGE TO RENTED 50 000 COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence) $ 1 CLAIMS -MADE F OCCUR I MED EXP (Any one person) E 5'000 A X OCP DPC 102191501 03/26/20 03/26/21 I PERSONAL 6 ADV INJURY $ 1,000,000 — Y I 2'000,000 GENERAL AGGREGATE $ _ GEN'L AGGREGATE LIMIT APPLIES PER: I PRODUCTS - COMP/OP AGG $ 2'000,000 PRO- n E POLICY JECT LOC AUTOMOBILE LIABILITY - COMBINED SINGLE LIMIT (Ea acciden0 $ ANYAUTO I BODILY INJURY (Per person) $ _ ALL OWNED SCHEDULED I BODILY INJURY (Per accident) $ _ AUTOS AUTOS NON -OWNED I PROPERTY DAMAGE $ HIRED AUTOS AUTOS (Per accident) E UMBRELLA UAB OCCUR NHA246862 03/26/20 03/26/21 I EACH OCCURRENCE $ 4'000'000 B X EXCESS LIAB I 4,000,000 CLAIMS -MADE AGGREGATE E I I PRODUCTS/OPS 4,000,000 DED RETENTION $ I $ WORKERS COMPENSATION X I WC STATU- I IOER AND EMPLOYERS' LIABILITYY/ N WSD505367800 TORY LIMITS 02/18/20 02/18/21 I 1,000,000 `+ AIN PROPRIETOR/PARTNEWEXECVTNE Y E.L. EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? N / A I 1'000'000 (Mandatory in NH) E L DISEASE - EA EMPLOYEE $ If yes, describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L. DISEASE • POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If mole space Is required) ALL OPERATIONS - SERVICE AGREEMENT CITY OF EL SEGUNDO, ITS EMPLOYEES, REPS, OFFICERS AND AGENTS ARE ADDITIONAL INSURED PER ATTACHED ENDORSEMENTS. WORK COMP WAIVER OF SUBROGATION ENDORSEMENT ATTACHED. THIRTY (30) DAYS NOC APPLIES TO ALL LISTED POLICIES. CERTIFICATE HOLDER CANCELLATION CITY OF EL SEGUNDO PUBLIC WORKS DEPARTMENT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 350 MAIN STREET ACCORDANCE WITH THE POLICY PROVISIONS, EL SEGUNDO, CA 90245-3813 AUTHORIZED REPftESENTAT I ®1988-2010 ACORD CORPORATION. All rights reserved. ACORD25(2010/05) The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABILITY CG 20 37 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART -SCHEDULE Name Of Additional Insured Person(s) Location And Description Of Completed Or Organization (s): Operations Any person or organization where the Named N/A Insured has agreed to add as a an additional insured by written contract or agreement, provided the contract or agreement is executed prior to any occurrence or offense Information required to complete this Schedule, if not shown above, will be shown in the Declarations. 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". All other terms and conditions of this policy remain unchanged. Endorsement Number: 18 This endorsement is effective on the inception date of this policy unless otherwise stated herein. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Policy Number: DPC1021915-01 Named Insured: Marx Brothers Fire Extinguishers Co., Inc. Endorsement Effective Date: March 26, 2019 CG 20 37 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 COMMERCIAL GENERAL LIABILITY CG 20 10 07 04 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 Name Of Additional Insured Person(s) Or Organization(s): Any person or organization where the Named N/A Insured has agreed to add as a an additional insured by written contract or agreement, provided the contract or agreement is executed prior to any occurrence or offense Location(s) Of Covered Operations Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is injury" or "property damage" occurring amended to include as an additional after: insured the person(s) or organization(s) shown in the Schedule, but only with 1. All work, including materials, parts respect to liability for "bodily injury", or equipment furnished in "property damage" or "personal and connection with such work, on the advertising injury" caused, in whole or in project (other than service, part, by: maintenance or repairs) to be performed by or on behalf of the 1. Your acts or omissions; or additional insured(s) at the location of the covered operations has been 2. The acts or omissions of those completed; or acting on your behalf; 2. That portion of "your work" out of in the performance of your ongoing which the injury or damage arises operations for the additional insured(s) at has been put to its intended use by the location(s) designated above. any person or organization other than another contractor or B. With respect to the insurance afforded to subcontractor engaged in these additional insureds, the following performing operations for a additional exclusions apply: principal as a part of the same project. This insurance does not apply to "bodily CG 20 10 07 04 0 ISO Properties, Inc., 2004 Page 1 of 2 All other terms and conditions of this policy remain unchanged. Endorsement Number: 17 This endorsement is effective on the inception date of this policy unless otherwise stated herein. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Policy Number: DPC1021915-01 Named Insured: Marx Brothers Fire Extinguishers Co., Inc. This endorsement is effective on the inception date of this Policy unless otherwise stated herein: Endorsement Effective Date: March 26, 2019 CG 20 10 07 04 0 ISO Properties, Inc., 2004 Page 2 of 2 AC40R" ® CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DD/YYYY) 11/21/2019 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 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 I CONTACT JANIECE WILLIAMS NAME: � rfft BRYCE MCKELL INSURANCE AGENCY INC I (A/C,Nr o. Ext): 909-305-1370 A/0/CC, Noll: 909-596-7055 413 E FOOTHILL BLVD STE 102 I ADDRESS: home@bmckell.com ` SAN DIMAS, CA 91773 INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: State Farm Mutual Automobile Insurance Company 25178 INSURED $ INSURER B MARX BROTHERS FIRE EXTINGUISHER CO INC I INSURER C: 1159 S SOTO ST I INSURER D: LOS ANGELES, CA 90023-2198 I INSURER E: $ INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: Replaces 11/18/19 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP I LIMITS LTR iNsn wvn POLICY NUMBER !MM/DD/YYYY1 /MM/DD/YYYYI COMMERCIAL GENERAL LIABILITY = CLAIMS -MADE 1:1 OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY [:]PRO [:]LOC JECT OTHER: AUTOMOBILE LIABILITY ANY AUTO Y 022 5740-1322-75 A OWNED SCHEDULED AUTOSONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY UMBRELLA LIAB OCCUR EXCESS LIAB HCLAIMS-MADE DED I I RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N / A (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below EMPLOYER'S NON -OWNED AND/ A OR HIRED AUTOS LIABILITY Y 041 1832-1322-75 454 0524-1322-75 6441953-1322-75 561 0896-1322-75 EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES (Ea occurrence) $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ 08/22/2019 02/22/2020 C(Ea OMBINED SINGLE LIMIT accident) $ 0 BODILY INJURY (Per person) $ 1,000,000 08/22/2019 02/22/2020 BODILY INJURY (Per accident) $ 1,000,000 08/22/2019 02/22/2020 PROPERTY DAMAGE (Per accident) $ 1,000,000 08/22/2019 02/22/2020 $ EACH OCCURRENCE $ (AGGREGATE $ PER STATUTE EERH E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ B. I. (per person) $1,000,000 08/22/2019 02/22/2020 B. 1. (per accident) $1,000,000 P.D. (per accident) $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) * Automobile Liability Section: State Farm provides certification for Scheduled Autos only, described as all COMPANY-OWNED vehicles insured by State Farm, under the Producer named above. Liability includes the use of NON -OWNED AND/OR HIRED AUTOS, when used specifically for the operation of the business. * This insurance is primary and non-contributory with respects to claims arising out of the operation of the described vehicle. * Additional Insured to be named on all policies: 'the City, its officials, and employees'. * Cancellation Clause to include 30 days written notice to the Certificate Holder listed below. * Certificate Holder: jallen@elsegundo.org CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CITY OF EL SEGUNDO PUBLIC WORKS DEPT ACCORDANCE WITH THE POLICY PROVISIONS. 350 MAIN STREET EL SEGUNDO, CA 90245 AUTHORIZED REPRESENTATIVE Digitally signed by @ 1988-2015 A ORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 1001486 132849.12 03-16-2016 6028BU ADDITIONAL INSURED (Prior Notice of Termination) This endorsement is a part of the policy. Except for the changes this endorsement makes, all other provisions of the policy remain the same and apply to this endorsement. 1. A person or organization shown on the Declarations Page as an Additional Insured is provided Liability Coverage, but only to the extent that person or organization qualifies as an insured as defined in Liability Coverage. 2. An Additional Insured has the same right of recovery under Liability Coverage as if they had not been shown on the Declarations Page as an Additional Insured. 3. If Liability Coverage is changed or terminated as to the interest of the Additional Insured, unless another number of days notice is shown on the Declarations Page, we will provide the Additional Insured: a. 10 days notice of such change or termination if the policy is nonrenewed or the cancellation is for nonpayment of premium; and b. 20 days notice of such change or termination if the cancellation is for any reason other than nonpayment of premium. Additional Insured: 'the City, its officials, and employees' Page 1 of 1 6028BU «0, Copyright, State Farm Mutual Automobile Insurance Company, 2011 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 06 34 (Ed. 8-00) WAIVER OF OUR RIGHT TO RECOVERY 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 form us). The additional premium for this endorsement shall be 2% of the total California Workers' Compensation premium otherwise due. SCHEDULE Person or Organization Job Description Any person or organization when required All California Operations By written contract. Policy Number: WSC505367800 Insured: Marx Bros. Fire Extinguisher Co., Inc. Coverage Provided by: INSURANCE COMPANY OF THE WEST WC 99 06 34 (Ed. 8-00)