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PROOF OF INSURANCE (2020 - 2021) CLOSEDACCOR" ® CERTIFICATE OF LIABILITY INSURANCE I DATE CERTIFICATE 06/23/2020 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 I CONTACT Evan Bone NAME: Craft Guard Insurance Services I CA/C. o. Extr 760-814-0020 j I 'FL lip Fql pill oil I I),1011.) �IN , � �111 h 111�1 lip! 16 "lly �11V) 11 1) �� I �� . . .... .... THIS, ENDORSEMI NT CMkNGES'THE POLICY. PLEASE READ IT CAREnTLI.Y. nus eudorrau:eut moddies insuzance; provided'undin the followng: KIM W3 0,114 VIAWV33 941)RI 14 M 31411111 WwOlki MIDS a 20 "St" SCHEDULE Name of'Addifional, Iwmred,: As, required by a liegally enforce able wrifteis agreemileni entered imio primr to commencement of the Named Insored's work. DoisLemated ProilectLocation to which flds endersemeni apphes- AU Project and Locifiens - Commercial Work Omh If no entry appears abrye. the info =tron rel to complete du5 era dorsememmill beshawri Co. the Declasaboo as applicable, to dus endorsz ev )I �Se,cfiam Ell - Who ]Ls Au Imsured ig amemded to mcludeali an addi.ti roml insured the peas f, 5) or orgmizadom(s) shosm, irthe Scbedule,but ovI, respect to hatEity for "bal Cc,��71 pro pemdamage"'or"' Ad hol peri cam. 1MW, Aolmpart: by: 2 im the peffon=ncel of "Yela, 'A'I for the adAirional imsured(s) at thelouhotLlra)i deli teed. &Ove. C11 warage, for any ad,&iumaL in,7ared is govermed by the ternai, coadmons, and exclusions of dds poLzy mid, all enders ements, mcludhl,,g the lnsurmg Ageament The covyarap pro+ded. for my addilmnal'insured is, o0y to the extent of and m the pirapicalzom the addrbonal lasured, is hield liable fu the negli-gacle oritrict of the! Named. Imured. No ccwerAge �is pavided for Habililytiased uP011 the, aIan, ermisworcissions of the, Adxiriorul Irsused Pohqr No SIZIGLIDS I 1A236126 Dale 0611112&'2021) Time!! 12: D1 a.m. ,UX Specialty Insurance Company 3250, Grey Hawk Ct, Ste. Z Carhbad, C A 19201D By: re„44 AuthoAzed. Repiresensarx7l INIX AIE COM CC 01 1a Page I of I us . ....... VIII 1Y 111111 061,111 Mkitill') 33 $30130 AIX' SPECIALTY MSUKkNCE COMPANY COMMER.ML, GENERkL I I.LkBILITY POLICY ADDITIONALMSURIED, ENDORSEMENT ENCL! DING PMIL4dZY C0VEPL4LGEA.ND Wkn'ER OF SUBROGAIION The sectim.of the policy eatitted M. — WHO IS AN INSURED ie amended 11D mclude as an addiliom?d insured amq' piez'sam. 107 or:amLzaticm, for whom you are, perfol m w operatiohea ycKviad iuch persain or orgAur LzPaI jou bagreed m a,legnUy- emforceable, 19, writtem col or a, Free entered mm befcffe youz work clo=1enced,, diat styh. persoim or orgnuzation be, added as an addilimat immmidomymirpoficy. The covertgRaffordedbythis endorsement is on2y(E)wLth respi liab'iii,tjmc:omectim,wiih,tlre!,iiodgim,aI Named Insured's onlgoizig op-araltioas performed forsaid Addiltillizil Ensured dmiiig the to of this pollicy, and (2) olmly if the Additional Iasmred pei aLL obligations requked under this poli '•. l'T'he coverage afforded to in Addffional Insmred is hmuedto, ackim mia&_ far a Covered Loss; iaot covered by cihe.T insurance avaUable to an Additional bscred, and di Hmited by thle priavisions ofthe insuring, AgTetmeut,, Exclusions, Cond'itio'ns, sei Forth in the PGHCY ,and all endMemenis, therettlL No coverage, n afforded unifier the 'roductcv-compiefed operations hazard" foTiwn Addifiesal Insured pirsuam totki endorsemew I corveraze afforded to an Addifiloull Loscred under IMs eud@Tiementeuds ac, of the date of comple6aln, abandommant, or te.munadou I atkof the wthe Namied Imsu�red at any joill pro*mm stnacnue. There ��is na, irmierage hereunder for n), Additional Insured in I'Mmecdon with any claim or mit invoRiI amy- cLaim for darnafe that takers place or is ahleged to'lake place Mowimg 1:031 of the Named Insuzed'i work. I w"° ol al Named Insured will be deemed completed as ofthe date, al] wurk,, inctudbg materials, pam or equipment ffirmahed in connectiom with sucb work,, m 1he project or any simcwte flierem (oth)er thim service, malulemance or repairs' to be performed by or lain behalf offlie addido-maJ ruituedl at the location afthe covered operakoms has beam compleoeld, or °w dw parbom of ')vur work" laut of wInch the injuryor damage ansei has been put 1a; ini ':intemdied uie by any pe.TBOU 11317 1101,T: amizatkin, imchidmg amiathei contractor or mbcontrKtor eugaged 'im pefforraLnZ operations as, part of the tame, profect,1, *hchlave-r is emher. The cower age, p-olitided for the AddifiGnal insured n only to the, extemt rMlAbe iddamin,al aniured it hAJA liable fill the MBZ1LgPMCaQ:7 strict limbJUty-of the Named Imsmred, amid is only to 'the evoent of,and im the proportiom Addificimal lusur-ed is hpJd Liable for the ueIe 0i lialOtlit)',',CGMduc°i,"mlc:ti I the Named Issured. 'No coverage it prcmided fm habdity basedupou the, WE, 1 07 loruissioms of the Additional Insured If e% Temly required b3, a written and Legally iffah-rceable co=act,anlered juto by tbe Named Insured prior to commmcement ofwQT1 P biv the, Named Insuredfar the, Additil Ims'ared, then the inimanceafforded by the policy -to the ikiddidemal Insured shall be pnmij�, i2scizaacel amid amy miurnice or iellf-insur=e. majdal by theabove Addifional Insuriedshall beencesi of ffie, insull. afforded to, the Named I:Msmred and. iliall not comtribuzie to k. If expTesily required by a wn'tten amd Legally enforceable contract enlered jacto by die Nmed Imuried prior to commemcei of wail biv the Named Insured for. be Additional Insured, thim we waiveany Tight ofsubrogation we may have� agai:nrA am ezmv�� thin vi mis .kiddifiemal Insured, the terms of iWs encWirsement became of palm'ems we make for nkf1ury or damage wising oulalf "your work," 'Pei perfamiled under such writteu amd legally emforceable contract with flUt Addifional insured. Except ag. Elielforth above, I&E of the terms., couditionizaid exclusm-is' the pobicyapply,aid. remarizi ineffel PrfficyNo,: SEZIGLO511A215326 AM' 'Sp,ecialty iusurance I' Compamy 3250 G,m H3W1 C( "ate. z Date 106)'.20,2020 Carlsbad, CA 92010 B - 'Time 12:101 a.m. A hoTized RepreieI ud DATE (MMIDD/YYYY) .44CC)R" CERTIFICATE OF LIABILITY INSURANCE 06/24/2020 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 Pamela Harrison NAME: FAX Pacific Pro's Insurance Agency ( (AIC,NNo. Ext): 714-909-0755 ( (AIC, No): 8700 Warner Ave, Ste. 220 ( E-MAIL ADDRESS: Service@pacificprosins.com INSURER(S) AFFORDING COVERAGE NAIC # Fountain Valley CA 92708 (INSURERA: Preferred Professional Insurance Company 339950 INSURED INSURER B Ruiz Concrete&Paving, Inc. ( INSURER C: DBA: Ruiz Engineering ( INSURER D: 1344 Temple Ave ( INSURER E : Long Beach CA 90804-2423 (INSURERF: 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 MAYHAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDLSUBR POLICY LTR TYPE OF INSURANCE IWID WVD POLICY NUMBER (MM DD YYYY) (MMIDD YYYY) LIMITS COMMERCIAL GENERAL LIABILITY ICLAIMS -MADE F1 cclip, '- EIN'L ACGPEGATE LIMIT APPLIB7, PER = POLICF Y JBF''T=El D_11- -,THEP AUTOMOBILE LIABILITY .ANY AUTO O'V41ED H SCHEDULED AHT'_'S OML'r' RI ITr_r,3 HIRED PI "-OVMJED ,ALIT_'S ONL'r' AI IT_'S OPIL'r' UMBRELLA LIAB I ,_,CCIJF EXCESS LIAR CLAIMS -MADE DEC' I I RETENTI ,N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y t N ANT A OFFICERIMEMBERE:<CLUDED" Y N/A (Mandatory in NH) If ves, describe under DESCPIPT1,-,N OFC )PERATIONS L.-I,.w EACH OCCUPRENCE DAMAGE T' RENTED PREMISES (Ea o'_'_urrenr, F MED ESP (Anu one parson) PERSC, AL S ,ADV INJUR`r' '- ENERAL AG,- RE,- ATE $ PPODLICTS-CC'fv1F'tOF'A'.G `( -C'MFINED SIN, --LE LIMIT ,( Ea a'_'_Ident) BODILY INJIHP'L (Per person) BODILYINJIJR'Y (Perarrident) `( PRrsPERT'� DAMA,- E ,( (Per a':rident) EACH OCCUPRENCE AG C R E'= ATE x l FTATIJTE I EP" ¢ X QN0$91802 04/01/2020 04101/2021 E L EACH ACCIDENT 1,000,0001,000,000E L DISEASE -EA EMPL,_, rEE `( EL DISEASE - POLI'_ Y LIMIT ( 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS i VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Proof of Insurance CSLB # 966395 **Subject to policy terms, conditions and exclusions." CERTIFICATE HOLDER CANCELLATION City of EI Segundo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Frivera@elsegundo.org ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street EI Segundo CA 90245 AUTHORIZED REPRESENTATIVE Rhonda Holt (Q 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC ON 04 WS A (Ed. 01 -19) 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 engaged in the work described in the Schedule. Blanket Waiver: The additional premium for this endorsement shall be 2% of the California workers' compensation premium otherwise due on such remuneration. Specific Waiver: The additional premium for this endorsement shall be 5% of the California workers' compensation premium otherwise due on such remuneration. Person or Organization Blanket Waiver of Subrogation Schedule Job Description As respects to all CA jobs performed by the named insured during the policy period where by written contract a waiver of subrogation is required prior to the commencement of work. 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: 04/0'1/2020 Insured Ruiz Concrete & Paving, Inc. dba Ruiz Engineering Print Date: 4/1/2020 Policy No.: ON08918 - 02 Endorsement No.: Insurance Company Preferred Professional Insurance Company 57 Countersigned By C--- Print 9