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PROOF OF INSURANCE (2021) CLOSEDCERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) wwr...✓ I W1512020 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. IfIMPORTANT: cADDITIONAL must UBROGATION ISWAIVED, subject to theteLms and conditionsi)hADDITIONAL be endorsed of the policy,certa 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), PROD0.ICERs Et4 _...................... x•41 i-9 7 �... Ed eWood Partners Insurance Center EPIC Ox Irvine CA 92612MacArthur Blvd. PH Floor PHONE n „ ["(AX ... 949-809 -2375 e icbrokers C sra ,cz,.. INSU'RE'R(S)AFFORDING COVERA .. _......_......,.,,� ,,, ENSUREGE NAIL # INSURERA: : Travelers Property Casualty Con WWw.edgewoodins.com i 25674 m. R c : ra _..._..... ., a. mrucof Are�erca ..,..n.... _....._ �_ INSURED 4 JM Diaz Inc DBA: J . velers Casualty and Su �__„ „ y.,.a.................�................ A%ID INSURER B: ._T...u. �........�m —� ryeCA , o a � 3119 ................... INSURER City18645E. Industry CA 917 $212 INSURER........_...... . �_.............................. ..................... _..— ...............__ .....,,.. — _.._.................... ..�..,.......,,,. ,....,,,,,,.,._ INSURER F: COVERAGES CERTIFICATE NUMBER: 56002365 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, )ONS AND CONDITIONS OF SUCH 'OLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. YN4rZ'"CL 3 __._............._..... �_......_............. r_. ....... ...._11.1.1-__ —................ m�,.......... ,r. LTR M TYPE OFINSURA 11-11 .,... ........._,,.,.�.�_.._�, PC1LICyEFF POLICYExP NCE ✓ ✓ POLtCYNUMBER tMMtDDtYYYYY ,dMM1DDAY5'YYt LIMITS I T D MERCIALGENERALLIABILITY I6802J3309942047 6/27/2020 ,6/27/2021 EACH OCCURRENCE $1.000,0'00 CLAIMS -MADE I ✓, OCCUR $1 "000,000 C)AMAGE TO RENTED 1111...-....,,,,,_..—_.._........................�.......,,,........,...—� ...MED EXP,.,(An,y,,,one Parseny.._......,?' i�,!���..........�..................., GEN'LA 11R MI .............._ GENERALAGOREGAlE 1111.' s2,000,000 �............. GGREGATE LIMIT APPLIES PER: I _ 00 POLICY „ rl PRO- ..._.,a.,..OPAG ..w_2,00, 0......m.. JECT PRODUCTS-COMP(OPAGG 52,000.0 Non aeNIS �k�ECDp Sot! OLE LIMIT ., ..? a[ O�Ot OT'H'E'R' $ A AUTOMOBILE BA4J37394120GRP 6/27/2020 6/27!2021 $ ANY AUTO BODILY INJURY (Per person) $ BODILY INJURY(Per accident) $ SCHEDULED $ AUTOS ONLY ._ � AUTOS HIRED NON -OWNED I AUTOS ONLY AUTOS ONLY $2 ggq,000 _ A UMBRELLA LIAB i ✓ V OCCUR ✓ ,CUP7E6067642047 52.000.000 EXCESS LIAB DED II ....I R'ET'ENTION50mryLR41MS-M,,.,.,., G E L. EACH ACCIDENT'$1,000,000 r _ A V40RKERS'COMPENSATION ✓ UB6K8694022047 E L =EASE • POLICY LIMIT AND EMPLOYERS' LIABILITY Y 1 N AN'PR'OPRd ETOR4 PARTNEPEX'ECU'TIVE 612712020 6/27/2021 $2,000.000 per Claim N OFMCERIMEMSEREXCLUDED? Li N/A 1$110,000 Per Claim Deductible (Mandatory In NH) If Yes, doscnbo gander DESC'RsP71ON OF OPERATIONS below B 'Professional Liability 105263164 Claims Made Form Knowledge Date: 4/8/2005 BODILY INJURY(Per accident) $ PORY®;MAGE. $ .............. 1111. 6/27/2020 6/27/2021 EACH OCCURRENCE $2 ggq,000 _ AGGREGATE ,Prod/Co-C1ps 52.000.000 6127/2020 612712021_.....__— G E L. EACH ACCIDENT'$1,000,000 r _ $00 I E.L. DIS'E'ASE-EAEMPLOY'EE, S 1at).9�t�,.1�1,000. 0.0.,_..... ._ — E L =EASE • POLICY LIMIT S 1,000,000 612712020 6/27/2021 $2,000.000 per Claim N $2,000,000 Aggregate 1$110,000 Per Claim Deductible DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) FIE.: PW 17-35 On -Gail Traffic Engineering Services Certificate holder(s) are named as Additional Insureds as respects General Liability per endorsement CG D3 81 09/15 and as respects Automobile Liability per endorsement CA T4 37 02116, but only where required by written contract with the Named Insured prior to an occurrence and subject to all pO icy terms, conditions and exclusions. rr4 Comp Waiver of Subrogation per C 99 03 76(A) CERTIFICATE HOLDER CANCELLATION CitKCityy f El Segundo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE I9 tEl S S THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street EI Segundo CA 90220 AUTHORIZED REPRESENTATIVE I Todd Halliday ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD 510102365 1 20-21 GL, AU, w/AI, WC, Umb, Prof. I Rox,annr citr+ioig I 6/15/2020 4:26:22 PM (PDT) I Page 1 of 5 Th;,, certificate cancels and supersedes ALL Trr,,wico4.s,y issued certificates. JM Diaz, Inc. 6802J3309942047 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, BLANKET ADDITIONAL INSURED (ARCHITECTS, ENGINEERS AND SURVEYORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 1. The following is added to SECTION II — WHO IS AN INSURED: Any person or organization that you agree in a "written contract requiring insurance" to include as an additional insured on this Coverage Part, but: a. Only with respect to liability for "bodily injury", "property damage" or "personal injury"; and b. If, and only to the extent that, the injury or damage is caused by acts or omissions of you or your subcontractor in the performance of "your work" to which the "written contract requiring insurance" applies, or in connection with premises owned by or rented to you. The person or organization does not qualify as an additional insured: c. With respect to the independent acts or omissions of such person or organization; or d. For "bodily injury", "property damage" or "personal injury" for which such person or organization has assumed liability in a contract or agreement. The insurance provided to such additional insured is limited as follows: e. This insurance does not apply on any basis to any person or organization for which coverage as an additional insured specifically is added by another endorsement to this Coverage Part. f. This insurance does not apply to the rendering of or failure to render any "professional services". g. In the event that the Limits of Insurance of the Coverage Part shown in the Declarations exceed the limits of liability required by the "written contract requiring insurance", the insurance provided to the additional insured shall be limited to the limits of liability required by that "written contract requiring insurance". This endorsement does not increase the limits of insurance described in Section III — Limits Of Insurance. h. This insurance does not apply to "bodily injury" or "property damage" caused by "your work" and included in the "products - completed operations hazard" unless the "written contract requiring insurance" specifically requires you to provide such coverage for that additional insured, and then the insurance provided to the additional insured applies only to such "bodily injury" or "property damage" that occurs before the end of the period of time for which the "written contract requiring insurance" requires you to provide such coverage or the end of the policy period, whichever is earlier. 2. The following is added to Paragraph 4.a. of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: The insurance provided to the additional insured is excess over any valid and collectible other insurance, whether primary, excess, contingent or on any other basis, that is available to the additional insured for a loss we cover. However, if you specifically agree in the "written contract requiring insurance" that this insurance provided to the additional insured under this Coverage Part must apply on a primary basis or a primary and non-contributory basis, this insurance is primary to other insurance available to the additional insured which covers that person or organizations as a named insured for such loss, and we will not share with the other insurance, provided that: (1) The "bodily injury" or "property damage" for which coverage is sought occurs; and (2) The "personal injury" for which coverage is sought arises out of an offense committed; after you have signed that "written contract requiring insurance". But this insurance provided to the additional insured still is excess over valid and collectible other insurance, whether primary, excess, contingent or on any other basis, that is available to the additional insured when that person or organization is an additional insured under any other insurance. CG D3 81 09 15 ® 2015 The Travelers Indemnity Company. All rights reserved. Includes the copyrighted material of Insurance Services Office, Inc., with its permission 56'00"65 1 20-21 GL, An, W/AI, WC, Umb, Prof. I Roxanne C.Omplog 1 6/15/2620 4:2'44:x2 PM (PDT) I Page 2 of 5 T'hiS certificate cancels and supersedes ALL previously issued certifS, ates. Page 1 of 2 COMMERCIAL GENERAL LIABILITY 3. The following is added to Paragraph 8., Transfer Of Rights Of Recovery Against Others To Us, of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: We waive any right of recovery we may have against any person or organization because of payments we make for "bodily injury", "property damage" or "personal injury" arising out of "your work" performed by you, or on your behalf, done under a "written contract requiring insurance" with that person or organization. We waive this right only where you have agreed to do so as part of the "written contract requiring insurance" with such person or organization signed by you before, and in effect when, the "bodily injury' or "property damage" occurs, or the "personal injury' offense is committed. 4. The following definition is added to the DEFINITIONS Section: "Written contract requiring insurance" means that part of any written contract under which you are required to include a person or organization as an additional insured on this Coverage Part, provided that the "bodily injury' and "property damage" occurs and the "personal injury" is caused by an offense committed: a. After you have signed that written contract; b. While that part of the written contract is in effect; and c. Before the end of the policy period. Page 2 of 2 02015 The Travelers Indemnity Company. All rights reserved. Includes the copyrighted material of Insurance Services Office, Inc., with its permission 014149 5V�02365 1 20-21 GL, AU, W/AI, WC, Umb, Prof. I Roxanrm C m+MiC�g 1, 6/15/2020 4:sf;[2 PM (PDT) I Page 3 of 5 Thi$ certificate cancels and supersedes ALL.y issued certificates. CG D3 8109 15 JM Diaz, Inc. 6802,13309942047 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AMENDMENT - OTHER INSURANCE CONDITION - ENGINEERS, ARCHITECTS OR SURVEYORS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PROVISIONS The following replaces the part of the first paragraph of Paragraph 4., Other Insurance, of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS that precedes Paragraph a.: If valid and collectible other insurance is available to the insured for a loss we cover under Coverages A or B of this Coverage Part, our obligations are limited as described in Paragraphs a. and b. below. Insurance shown in the Declarations of this Coverage Part. As used anywhere in this Coverage Part, other insurer means a provider of other insurance. As used in Paragraph c. below, insurer means a provider of insurance. 2. The first Subparagraph (2) of Paragraph 4.b., Excess Insurance, of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS regarding any other primary insurance available to you is deleted. As used anywhere in this Coverage Part, other 3. The following is added to Paragraph 4.b., Excess insurance means insurance, or the funding of Insurance, of SECTION IV — COMMERCIAL losses, that is provided by, through or on behalf GENERAL LIABILITY CONDITIONS: of: (i) Another insurance company; (ii) Us or any of our affiliated insurance companies; (iii) Any risk retention group; (Iv) Any self-insurance method or program, including any failure to buy insurance, or 4. decision to not buy insurance, for any reason, in which case the insured will be deemed to be the provider of other insurance; or (v) Any similar risk transfer or risk management method. Other insurance does not include umbrella insurance, or excess insurance, that was bought specifically to apply in excess of the Limits of This insurance is excess over any of the other insurance, whether primary, excess, contingent or on any other basis, that is available to the insured when the insured is added as an additional insured under any other policy, including any umbrella or excess policy. The following is added to Paragraph 4.b. Excess Insurance, of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: This insurance is excess over any of the other insurance, whether primary, excess, contingent or on any other basis, that is Professional Liability or similar coverage, to the extent the loss is not subject to the professional services exclusion of Coverage A or Coverage B. CG D7 97 01 16 @ 2016 The Travelers Indemnity Company. All rights reserved. Page 1 of 1 includes copyrighted material of Insurance Services Office, Inc. with its permission. 56d'W363 1 20-21 GL, AU, w/AI, WC, Umb, Prof. I RoxiarMO CAnrPing 16/15/2020 4:26:22 PM (PDT) I Page 4 of 4 TB L,A certificate cancels and supersedes ALL P4:CViVw SAY issued certificates. JM Diaz, Inc. BA4J37394120GRP COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM The following is added to Paragraph c. in A.I., Who Is An Insured, of SECTION 11 — COVERED AUTOS LIABILITY COVERAGE in the BUSINESS AUTO COVERAGE FORM and Paragraph e. in A.I., Who Is An Insured, of SECTION It — COVERED AUTOS LIABILITY COVERAGE in the MOTOR CARRIER COVERAGE FORM, whichever Coverage Form is part of your policy: This includes any person or organization who you are required under a written contract or agreement between you and that person or organization, that is signed by you before the "bodily injury' or "'property damage" occurs and that is in effect during the policy period, to name as an additional insured for Covered Autos Liability Coverage, but only for damages to which this insurance applies and only to the extent of that person's or organization's liability for the conduct of another "insured". CA T4 37 02 16 0 2016 The Travelers Indemnity Company, All rights reserved. Includes copyrighted material of Insurance Services office, Inc. with its permission. SLGN,1365 1 20-21 GL, AU, W/Al, WC, Umb, Prof. I RoxAnnc q1mping 1 6/15/2020 PM (PD:) I Page 4 of 5 rt Thio ce ificate cancels and supersedes ALL proviouslI y issued CertitiCateS. Page I of 1 AWIlk WORKERS COMPENSATION TRAVELERSJ AND ONE TOWER MARE EMPLOYERS LIABILITY POLICY HARTFORD, CT 06183 ENDORSEMENT WC 99 03 76 ( A) — 001 POLICY NUMBER: UB6K8694022047 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA (BLANKET WAIVER) We have the right to recover our payments frorn anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization narried in the Schedule. The additional premium for this endorsement shall be MiLIM. Schedule Person or Organization ANY PERSON OR ORGANIZATION FOR WHICH THE INSURED HAS AGREED BY WRITTEN CONTRACT EXECUTED PRIOR TO LOSS TO FURNISH THIS WAIVER % of the California workers' compensation pre - 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 Effecti've6/27/2020 Insured JM Diaz, Inc. DBA: JMD Insurance Company DATE OF ISSUE: 6/15/2020 Policy No, UB6K8694022047 ST ASSIGN: Countersigned by )006 02 56C,oi,365 1 20-2.2 GL, AC, W/Al, WC, U111b, ?Xaf. ; R.' �. n Cx-qk1g t � 6/.5/202C 4�-,22 t1M 4PD!: I F,,ge 5 c' 5 Tlhis ce r tificate cancels and super.sedes ALL previounly ).ssued certifii7ates. Endorsement No. Page I of I