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PROOF OF INSURANCE (2021 - 2021) CLOSED0 DATE (MM/DD/YYYY) � CERTIFICATE OF LIABILITY INSURANCE IVI 07/24/2020 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). PRODUCERI NAAME� T Don Kiger, CSR Strategic Alliance Insurance I PHONE 800-830-1712 FAX License 0764210 g (APC„ No,, Ext) (A/C l 1714 Louise Lane ADDREss donkiger'67@yahoo.com Niomo, CA 93444 p INSURIE'RiS) AFFORDING COVERAGE NAIC # I INSURER A: State Compensation Insurance Fund INSURED !, INSURER B ; Business Insurace Company Lawles Enterprises inc INSURER C 149 Eucalyptus Drive INSURER D EI Segundo CA 90245 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 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. IN.TADDL SUBR POLICY EFF POLICY EXP IR TYPE OF INSURANCE IN,, D WVD POLICY NUMBER (MM/DD/YYYY) WMIDWYYYY1, LIMITS B X COMMERCIAL GENERAL LIABILITY UDC -4234626 -EO -20 8-10-2020 8-10-2021 EACH OCCURRENCE $ 2,000,000 CLAIMS -MADE x OCCUR u'�w'n' 0E R"�C:a'R.ENL'ED 100,000 HE!r .M; E'$ JCaa,C3Cnalr no $ MED EXP !Any one Istat^zralnl S 5,000 x Professional Liability PERSONAL & ADV INJURY $ 2,000,000 GEN'LAGGREGATELIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY SECT LOC PRODUCTS, Q:`.Q v�P7�f' P AGO S 2,000,000 .YIPS 4:°I' OT I°ur R, $ B AUTOMOBILE LIABILITY UDC -4234626 -EO -2'0 8-10-2020 8-10-2021 P',OMBINI::C SINGLE, LIN1b'T $ 2,000,000 'E4accidenij ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS AlJ)PTOS ONLY AUTO ONLY (POP,F;DA cdoriI"vhAtGi':. $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE $ DED RETENTION $ $ A WORKERS COMPENSATION 9227676-20 3-9-2020 3-9-2021 X PEo'1.1,1'TE ERANYPROPRIET�a OFFICERIMEMBE EXCLUDED? R/EXECUTIVE Vp / "'p E j EAyCH ACCIDENT f::IAV $ 1,000,000 ' 0, 0 AND EMPLOYE ' LIABI Y !! OFFICER/MEMBEREXCLUDED? Lmm'_1 N / A DENT NH)IPI OYES' $ 1 ,000 000 If yes, describe under DESCRIPTION OF OPERATIONS below ! V I 01sli:./rSI:::. I'(N.IICY I IN/11 f 'S 1,000,000 B ADP UDC -4234626 -EO -20 8-10-2020 8-10-2021 Broad Form $ 20,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Certificate holder named as additional insured per the attached endorsement CERTIFICATE HOLDER CANCELLATION City of EI Segundo City Clerk Office SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 350 Main St. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN EI Segundo, CA 90245 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE lzr. ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD POLICYNUMBER UDC -4234626 -EO -20 COMMERCIAL GENERAL LIABILITY CG 24 040509 WAIVER OF TRANSFER OFRIGHTS OFRECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following; COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE City of EI Segundo The following is added to Paragraph 8. Transfer of Rights Of Recovery Against Others To Us of Section IV - Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work- done under a contract with that person or organization and included in the "products - completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. OG240406 Insurance Services Office, Inc., 2008 ENDORSEMENT AGREEMENT WAIVER OF SUBROGATION BLANKET BASIS HOME OFFICE SAN FRANCISCO EFFECTIVE MARCH 9, 2020 AT 12.01 A.M. ALL EFFECTIVE DATES ARE AND EXPIRING MARCH 9, 2021 AT 12.01 A.M. AT 12:01 AM PACIFIC STANDARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME LAWLES ENTERPRISES INC 400 CONTINENTAL BLVD FL 6 EL SEGUNDO, CA 90245 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 9227676-20 RENEWAL NA PAGE 1 OF 1 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: MARCH 10, 2020 AUTHORIZED REPRESENT' !VE PRESIDENT AND CEO SCIF FORM 10217 (REV.4-2018) 2572 OLD DR 217