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PROOF OF INSURANCE (2021 - 2021) CLOSEDA�X 'aI DATE (MM/Y) I�....'"' CERTIFICATE OF LIABILITY INSURANCE III 04/14/20202020 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 state 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 Nicole Gonzalez NAME: Kessler Alalr Insurance Services, Inc PHONE (909) 931-1500 FAX (909) 932-2133 MICA111111. Ezt1. .........................� d'AdC„ License # OA 91387 ADDRESS: ngonzalez@kessleralair tom .... __.................. ....�....... 12487 N, Mainstreet, Ste, 240 INSURER(S) AFFORDING COVERAGE NAIC # Rancho Cucamonga CA 91739 INSURER A : Mercury Casualty Company _ 11908 �. _._._ ._._.._........ INSURED INSURER 13: Metropolitan Direct Property and Casualty Ins Co 25321 J & L Building Maintenance Services INSURER C 6635 Florence Ave, Ste 337 INSURER D ; ................................... .... INSURER E Bell Gardens CA 90201 INSURER F : COVERAGES CERTIFICATE NUMBER: 20/21 GL/Auto 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 CONTRACTOR 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 f1�STi �m "'ktt9IXSUEbt ._._..._.. POLICY EFF POLICY EXP ................... .��..................... LIMITS LTR TYPE OF INSURANCE IVSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) X �COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 5 1,000,000 CLAIMS -MADE ® OCCUR PREMISES (Ea occurrences $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of EI Segundo is named as an additional insured per the attacheds forms. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of EI Segundo ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main St. AUTHORIZED REPRESENTATIVE EI Segundo CA 90245 I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD MED EXP (Any one ._ person) ........... S 5,000 ............................................ A Y CCP0042411 03/29/2020 03/29/2021 PERSONAL & ADV INJURY S 1,0001000 ......................................e, GIITL A(BGRIF:GATT:: I ))till rAl'1'LII:S I'ER GENERAL AGGREGATE _........•. S 2,000,000 nP0 POLICY „1,; T LOG PRODUCTS - COMP(OPAGG S 2,000,000 rJ'rHER � 5 .__.......__.........LI ._. AUTOMOBILE LIABILITY E' aBINIiD SINGLE LIMIT 0 u ' �BODIHLY......J S 1,000,000 F,IVY .\l. rG,. v INJURY (Per 5 B (7\1'INED SCHEDULED Y CA054443P2020 .person) 01/22/2020 01/22/2021 BODILY INJURY (Par accident) S ros 0141-Y AUTOS NON -OWNED PROPERTY DAMAGE .���........ S „" AUTO, (?I'JI Y AUTOS ONLY AUTO, (Per accident) Uninsured motorist cSL $ 1,000,000 ........,_..m ............ a...... ................................... UMBRELLA LIAB OCCUR ...._...�_......................... EACH OCCURRENCE _ " ..... EXCESS LIAB _DE ILAIMS-MADE wAGGREGATE S DED ry RETENTION S - WORKERS COMPENSATION PERI OTH- AND EMPLOYERS' LIABILITY Y / N ,STAiI,I7F I ER ANY PROPRIETOR/PARTNER/EXECUTIVE E L EACH ACCIDENT S OFFICER/MEMBER EXCLUDED? NIA MndatorNH) (Mandatory E� L DISEASE - EA EMPLOYEE ..m.......� S If yes, describe under DESCRIPTION OF OPERATIONS below EL DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of EI Segundo is named as an additional insured per the attacheds forms. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of EI Segundo ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main St. AUTHORIZED REPRESENTATIVE EI Segundo CA 90245 I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD MCBOP Liability Plus 0512 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. MERCURY LU''S LIABILITY E:N!D�ORSEM,ENT This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM GENERAL DESCRIPTION OF COVERAGE — This endorsement broadens coverage. The following list is a gen- eral coverage description only. Limitations and exclusions may apply to these coverages. Read all the PROVISIONS of the endorsement to determine rights, duties and what is and is not covered. A. Increased Supplementary Payments E. • Cost for bail bonds increased to F. $1,000 G 0 Loss of earnings increased to $500 H. per day I. B. Damage to Premises Rented To You Exten- sion Perils of fire, explosion, lightning, J. smoke, water K. Limit increased to $300,000 C. Blanket Waiver of Subrogation D. Blanket Additional Insured — By Contract With Primary and Noncontributory Clause Incidental Medical Malpractice Extension of Coverage — Bodily Injury Injury to Co -Employees Aircraft Chartered with Crew Knowledge and Notice of Occurrence or Of- fense Reasonable Force — Bodily Injury or Property Damage Unintentional Omission PROVISIONS A. Increased Supplementary Payments Part A.1.f. Coverage Extension — Supplementary Payment (Section II — Liability) is amended as follows: 1. In Part A.1.f.(1).(b). the amount we will pay for the cost of bail bonds is increased to $1,000. 2. In Part A.1.f.(1).(d). the amount we will pay for loss of earnings is increased to $500 per day. B. Damage To Premises Rented To You Extension 1. The last paragraph of Part B.1. Exclusions Applicable To Business Liability Coverage (Section II — Liability) is deleted and replaced by the following: Exclusions c., d., e., f., g., h., i., k., I., m., n., and o. in Section II — Liability do not apply to damage to premises while rented to you, or temporarily occupied by you with permission of the owner, caused by: a. Fire; b. Explosion; c. Lightning; d. Smoke resulting from such fire, explosion, or lightning, or e. Water. A separate Damage To Premises Rented To You Limit of Insurance applies to this coverage as de- scribed in Paragraph D. Liability And Medical Expenses Limits Of Insurance (Section II — Liability). MCBOP Liability Plus 0512 Page 1 of 5 2. This insurance does not apply to damage to premises while rented to you, or temporarily occupied by you with permission of the owner, caused by: a. Rupture, bursting, or operation of pressure relief devices; b. Rupture or bursting due to expansion or swelling of the contents of any building or structure, caused by or resulting from water; c. Explosion of steam boilers, steam pipes, steam engines, or steam turbines. 3. Part D.3. Liability And Medical Expenses Limits of Insurance (Section II - Liability) is deleted and re- placed by the follow: The Damage To Premises Rented To You Limit is the most we will pay under Business Liability Cov- erage for damages because of "property damage" to a premises while rented to you, or temporarily occupied by you with permission of the owner, caused by fire, explosion, lightning, smoke resulting from such fire, explosion, or lightning, or water. The Damage To Premises Rented To You Limit will apply to all damage proximately caused by the same "occurrence", whether such damage results from fire, explosion, lightning, smoke resulting from such fire, explosion, or lightning, or water, or any combination of any of these. The Damage To Premises Rented To You Limit will be the higher of: a. $300,000; or b. The amount shown on the Declarations or other amendatory endorsements for Damage To Pre- mises Rented To You Limit. 4. Under Part F.9.a. of Liability And Medical Expenses Definitions (Section II — Liability), the definition of "Insured contract" is amended to: a. A contract for a lease of premises. However, that portion of the contract for a lease of premises that indemnifies any person or organization for damage caused by: i. Fire; ii. Explosion; iii. Lightning; iv. Smoke resulting from such fire, explosion, or lightning; or v. Water; to premises while rented to you or temporarily occupied by you with permission of the owner is not an "insured contract" 5. This Provision B. does not apply if coverage for Damage To Premises Rented To You under Part A.1. Business Liability (Section II — Liability) is excluded by endorsement or no amount is shown on the Declarations or other amendatory endorsements for Damage To Premises Rented To You Limit. C. Blanket Waiver Of Subrogation We waive any right of recovery we may have against any person or organization because of payments we make for injury or damage arising out of premises owned or occupied by or rented or loaned to you; ongoing operations performed by you or on your behalf, done under a contract with that person or organi- zation; "your work, or "your products". We waive this right where you have agreed to do so as part of a written contract, executed by you prior to loss. D. Blanket Additional Insured —By Contract with Primary and Non -Contributory Clause The following is added to part C.2.Who Is An Insured (Section II — Liability): e. Any person or organization when you and such person or organization have agreed in writing in a contract, agreement or permit, that such person or organization be added as an additional insured on your policy to provide insurance such as is afforded under this Coverage Form but only with respect to the liability of that person or organization arising out of "bodily injury' or "property dam- age" occurring: (1) During ongoing operations performed by you or on your behalf; or (2) On premises or facilities owned by used by you; and MCBOP Liability Plus 0512 Page 2 of 5 Only to the extent to which insurance applies under this Coverage Form. A person's or organization's status as an insured under this endorsement ends when their contract or agreement with you for such premises, facilities or ongoing operations ends. This provision D. does not apply: (1) Unless the written contract or agreement has been executed, or permit has been issued, prior to the "bodily injury" or "property damage"; (2) To the rendering of or failure to render any professional services; or (3) To any person or organization included as an insured by separate endorsement issued by us and made a part of this policy. (4) To "personal and advertising injury" for which the insured has assumed liability in a contract, agreement or permit. If you have agreed in a written contract, written agreement or permit that this insurance is primary and non-contributory with the additional insured's own insurance, this insurance is primary and we will not seek contribution from that other insurance. The primary and non-contributory clause does not apply to other insurance to which the additional insured has been added as an additional in- sured. E. . Incidental Medical Malpractice 1. The definition of "bodily injury" in F.3. Liability And Medical Expenses Definitions (Section II — Liability) is amended to include "Incidental Medical Malpractice Injury". 2. The following definition is added to F. Liability And Medical Expenses Definitions (Section II — Liabili- ty): 23. "Incidental medical malpractice injury' means bodily injury, mental anguish, sickness or disease sustained by a person, including death resulting from any of these at any time, arising out of the rendering of, or failure to render, the following services: a. Medical, surgical, dental, laboratory, x-ray or nursing service or treatment, advice or instruc- tion, or the related furnishing of food or beverages; b. The furnishing or dispensing of drugs or medical, dental, or surgical supplies or appliances; or c. First aid; d. "Good Samaritan services". As used in this Provision E., "good Samaritan services" are those medical services rendered or provided in an emergency and for which no remuneration is demanded or received. 3. Part C.2.a.(1).(d). of Who Is An Insured (Section II — Liability) does not apply to any registered nurse, licensed practical nurse, emergency medical technician or paramedic employed by you, but only while performing the services described in paragraph 2. above and while acting within the scope of their employment by you. Any "employees" rendering "Good Samaritan services" will be deemed to be acting within the scope of their employment by you. 4. The following exclusion is added to B.1.Exclusions Applicable to Business Liability (Section II — Liabil- ity): t. Liability arising out of the willful violation of a penal statute or ordinance relating to the sale of pharmaceuticals by or with the knowledge or consent of the insured. 5. For the purpose of determining the applicable limits of insurance, any act or omission, together with all related acts or omissions in the furnishing of the services described in paragraph 2. above to any one person, will be considered one "occurrence". 6. This Provision E. does not apply if you are in the business or occupation of providing any of the ser- vices described in paragraph 2. above. 7. The insurance provided by this Provision E. shall be excess over any other valid and collectible insur- ance available to the insured, whether primary, excess, contingent or on any other basis, except for insurance purchased specifically by you to be excess of this policy. F. Extension of Coverage — Bodily Injury MCBOP Liability Plus 0512 Page 3 of 5 Part F.3 Liability And Medical Expenses Definitions (Section II — Liability) is deleted and replaced by the fol- lowing: 3. "Bodily Injury" means bodily injury, mental anguish, mental injury, shock, fright, disability, humiliation, sickness or disease sustained by a person, including death resulting from any of these at any time. G. Injury To Co -Employees 1. It is agreed that your "employees" are insureds with respect to "bodily injury' to a co -"employee" in the course of the co -"employee's" employment by you, provided that this coverage for your "employees" does not apply to acts outside the scope of their employment by you or while performing duties unrelated to the conduct of your business. 2. Part C.2.a.(1)(a), (b) and (c) of Who Is An Insured (Section II — Liability) do not apply to "bodily injury" for which insurance is provided by paragraph 1. above. H. Aircraft Chartered With Crew 1. The following is added to the exceptions contained in the Aircraft, Auto Or Watercraft Exclusion in Part B.1.g.Exclusions Applicable To Business Liability Coverage (Section II — Liability): (This exclusion does not apply to:) Aircraft chartered with crew to any insured. 2. This Provision H does not apply if the chartered aircraft is owned by any insured. 3. The insurance provided by this Provision H shall be excess over any other valid and collectible insurance available to the insured, whether primary, excess, contingent or on any other basis, except for insurance purchased specifically by you to be excess of this policy. Knowledge And Notice Of Occurrence Or Offense 1. The following is added to Part E.2. Duties In The Event Of Occurrence, Offense, Claim Or suit (Section II — Liability): Notice of an "occurrence" or of an offense which may result in a claim under this insurance shall be given as soon as practicable after knowledge of the "occurrence" or offense has been reported to any insured listed under Part C.1.Who Is An Insured or an "employee" (such as an insurance, loss control or risk manager or administrator) designated by you to give such notice. Knowledge by other "employee(s)" of an "occurrence" or of an offense does not imply that you also have such knowledge. 2. Notice shall be deemed prompt if given in good faith as soon as practicable to your workers' compensa- tion insurer. This applies only if you subsequently give notice to us as soon as practicable after any in- sured listed under Part C.1. Who Is An Insured or an "employee" (such as an insurance, loss control or risk manager or administrator) designated by you to give such notice discovers that the "occurrence", of- fense or claim may involve this policy. 3. However, this Provision I does not apply as respects the specific number of days within which you are re- quired to notify us in writing of the abrupt commencement of a discharge, release or escape of "pollu- tants" which causes "bodily injury" or "property damage" which may otherwise be covered under this poli- cy. J. Reasonable Force — Bodily Injury or Property Damage Part B.1.a.Expected Or Intended Injury Applicable To Business Liability Coverage (Section II - Liability) is de- leted and replaced by the following: (This insurance does not apply to:) a. Expected Or Intended Injury Or Damage "Bodily injury' or "property damage" expected or intended from the standpoint of the insured. This exclu- sion does not apply to "bodily injury" or "property damage" resulting from the use of reasonable force to protect persons or property. MCBOP Liability Plus 0512 Page 4 of 5 K. Unintentional Omission The following is added to Section III — Common Policy Conditions: M. Representations By accepting this policy, you agree: a. The statements in the Declarations are accurate and complete; b. Those statements are based upon representations you made to us; and c. We have issued this policy in reliance upon your representations. The unintentional omission of, or unintentional error in, any information provided by you shall not preju- dice your rights under this policy. However, it does not affect our right to collect additional premium or to exercise our right of cancellation or nonrenewal in accordance with applicable state insurance laws, codes or regulations. MCBOP Liability Plus 0512 Page 5 of 5 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. LINK BUSINESS AUTO PLUS ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM A. BLANKET ADDITIONAL INSURED The following is added to Paragraph A.1., Who Is An Insured, of SECTION II — COVERED AUTOS LIABILITY COVERAGE: d. Any person or organization that you are required to include as an additional insured on this Coverage Form in a written contract or agreement that is signed and executed by you before the "bodily injury" or "property damage" occurs and that is in effect during the policy period is an "insured" for Covered Autos Liability Coverage, but only for damages to which this insurance applies. B. EMPLOYEE HIRED AUTOS The following is added to Paragraph A.1., Who Is An Insured, of SECTION II — COVERED AUTOS LIABILITY COVERAGE: e. An "employee" of yours while operating a covered "auto" hired or rented under a contract or agreement in an "employee's" name, with your permission, while performing duties related to the conduct of your business. The following replaces Paragraph b. in B.5., Other Insurance, of SECTION IV — BUSINESS AUTO CONDITIONS.- b. ONDITIONS: b. For Hired Auto Physical Damage Coverage, the following are deemed to be covered "autos" you own: (1) Any covered "auto" you lease, hire, rent or borrow; and (2) Any covered "auto" hired or rented by your "employee" under a contract in an "employee's" name, with your permission, while performing duties related to the conduct of your business. C. EMPLOYEES AS INSURED The following is added to Paragraph A.1., Who Is An Insured, of SECTION II — COVERED AUTOS LIABILITY COVERAGE: Any "employee" of yours is an "insured" while using a covered "auto" you don't own, hire or borrow in your business or your personal affairs. D. SUPPLEMENTARY PAYMENTS — INCREASED LIMITS 1. The following replaces Paragraph A.2.a.(2) of SECTION II — COVERED AUTOS LIABILITY COVERAGE: (2) Up to $3,000 for cost of bail bonds (including bonds for related traffic law violations) required because of an "accident" we cover. We do not have to furnish these bonds. 2. The following replaces Paragraph A.2.a.(4) of SECTION II — COVERED AUTOS LIABILITY COVERAGE: (4) All reasonable expenses incurred by the "insured" at our request, including actual loss of earnings up to $500 a day because of time off from work. E. TRAILERS — INCREASED LOAD CAPACITY The following replaces Paragraph C.1., Certain Trailers, Mobile Equipment and Temporary Substitute Autos of SECTION I — COVERED AUTOS: 1. "Trailers" with a load capacity of 3,000 pounds or less designed primarily for travel on public roads. F. HIRED AUTO PHYSICAL DAMAGE However, any "auto" that is leased, hired, rented COVERAGE or borrowed with a driver is not a covered "auto". The following is added to Paragraph AA., Coverage Extensions, of SECTION III — PHYSICAL DAMAGE COVERAGE: MPL-CA-0416 (Ed 04-2016) Includes copyrighted material of Insurance Services Offices, Inc., Page 1 of 3 with permission. c. Hired Auto Physical Damage Coverage Extension If hired, rented, and borrowed "autos" are covered "autos" for Covered Autos Liability Coverage and this policy also provides Physical Damage Coverage for an owned "auto", then the Physical Damage Coverage is extended to "autos" that you hire, rent or borrow subject to the following: (1) The most we will pay for "loss" to any one "auto" that you hire, rent or borrow is the lesser of: (a) $50,000- (b) The actual cash value of the damaged or stolen property as of the time of the "loss"; or (c) The cost of repairing or replacing the damaged or stolen property with other property of like kind and quality. (2) An adjustment for depreciation and physical condition will be made in determining actual cash value in the event of a total "loss". (3) If a repair or replacement results in better than like kind or quality, we will not pay for the amount of betterment. (4) A deductible equal to the highest Physical Damage deductible applicable to any owned covered "auto". (5) This Coverage Extension does not apply to: (a) Any "auto" that is hired, rented or borrowed with a driver; or (b) Any "auto" that is hired, rented or borrowed from your "employee". G. PHYSICAL DAMAGE — TRANSPORTATION EXPENSES — INCREASED LIMIT The following replaces the first sentence in Paragraph A.4.a., Transportation Expenses, of SECTION III — PHYSICAL DAMAGE COVERAGE: We will pay up to $50 per day to a maximum of $1,500 for temporary transportation expense LINK BUSINESS AUTO PLUS ENDORSEMENT M P L -CA -0416 incurred by you because of the total theft of a covered "auto" of the private passenger type. H. AUDIO, VISUAL AND DATA ELECTRONIC EQUIPMENT — INCREASED LIMIT The first sentence in paragraph C.1.b. of SECTION III — PHYSICAL DAMAGE COVERAGE is deleted and replaced with the following: b. All electronic equipment that reproduces, receives or transmits audio, visual or data signals in any one "loss" is $5,000, if at the time of " loss", such electronic equipment is: I. WAIVER OF DEDUCTIBLE — GLASS The following is added to Paragraph D., Deductible, of SECTION III — PHYSICAL DAMAGE COVERAGE: No deductible for a covered "auto" will apply to glass damage. J. PERSONAL PROPERTY COVERAGE The following is added to Paragraph A.4., Coverage Extensions, of SECTION III — PHYSICAL DAMAGE COVERAGE.- d. OVERAGE: d. Personal Property Coverage We will pay up to $400 for "loss" to wearing apparel and other personal property which a re: (1) owned by an "insured"; and (2) in or on your covered "auto"; in the event of a total theft "loss" of your covered "auto". No deductibles apply to Personal Property Coverage. MPL-CA-0416 (Ed 04-2016) Includes copyrighted material of Insurance Services Offices, Inc., Page 2 of 3 with permission. K. AIRBAG COVERAGE The following is added to Paragraph B.3., Exclusions, of SECTION III — PHYSICAL DAMAGE COVERAGE: Exclusion 3.a. does not apply to "loss" to one or more airbags in a covered "auto" you own that inflate due to a cause other than a cause of "loss" set forth in Paragraphs A.1.b. and A.1.c., but only: (a) If that "auto" is a covered "auto" for Comprehensive Coverage under this policy; (b) The airbags are not covered under any warranty; and (c) The airbags were not intentionally inflated. We will pay up to a maximum of $1,000 for any one "loss". LINK BUSINESS AUTO PLUS ENDORSEMENT M P L -CA -0416 L. BLANKET WAIVER OF SUBROGATION The following replaces Paragraph A.S. Transfer Of Rights Of Recovery Against Others To Us, of SECTION IV — BUSINESS AUTO CONDITIONS: S. Transfer Of Rights Of Recovery Against Others To Us We waive any right of recovery we may have against any person or organization to the extent such waiver is required of you by a written contract executed prior to any "accident" or "loss", provided that the "accident" or "loss" arises out of the operations contemplated by such contract. The waiver applies only to the person or organization designated in such contract. MPL-CA-0416 (Ed 04-2016) Includes copyrighted material of Insurance Services Offices, Inc., Page 3 of 3 with permission. ALCOR®- CERTIFICATE OF LIABILITY INSURANCE 08tO 2020 IYYYY) 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„ sub'ect to the terms and conditions of the policy, certain policies may require an endorsement„ A statement on u this certificate does not. confer rift is to the certificate Molder in Ilea„ of such endorsement(s). DUCER CONTACT Paychex PR P CHERSAWINSURANCE DRIVE AGENCY, INC. HONE FAX EXXT). 877 266-6850ance Agency Inc NA.MF• .. .. 585-389-7426 ..�..(AI.C..Me)' ROCHESTER, NY 14620 E-MAIL Certs@paychex.com .�LD .-,AREsq ................... . INSURED J & L BUILDING MAINTENANCE LLC 6635 EAST FLORENCE AVE SUITE 337 BELL GARDENS, CA 90201 INSURER(S) AFFORDING COVERAGE INSURER A: NorGUARD Insurance Company INSURER B: INSURER C: INSURER D: INSURER E: NAIC # ............ ','----l �., mm.... 31470 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 PE 2TAIN THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCHCOLIC ES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. .. ........................a................. INSR TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSR WVD (MWDD/YYYY) (MM/DDIYYYY) GENERAL LIABILITY _ EACH OCCURRENCE $ —^ COMMERCIAL LIABILITYOCCUR bjk9>ct;ure) $ C �_ sL u�riYs PR ISE L.AIMS••MADERAL _ MED EXP (Any one person) $ ................ ............................. PERSONAL & ADV INJURY $ GENERALAGGREGATE $ IES PER: GE'N`LII .... ...•.....•...........................•.•.•.•.•.•.•.•.•.•.•.•.•.•.•.•., PRODUCTS - COMP /OP AGG .......... $ PouREGCY �LIMIT i. Pl ujc,-T Loc ......................................................................... $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ......,.. ANY AUTO (Ea accident) it n'ALL OWNED SCHEDULEDperson) BODILY INJURY (Per $ AUTOS AUTOS No l-jV'NED BODILY INJURY $ i HIRED AUTOS I AtV OS (Peracoldent) 1111-- PROPERTY DAMAGE (Per accident) UMBRELLA LIAR ( OCCUR EACH OCCURRENCE $ EXCESS LIABCLAIMS-MADE AGGREGATE ...•.•.•.•.•.•.•.•.•.•.•.•.•.•.•.•.•.•.•.•.•.•.•.•.•.• $ DED RETENTION $ $ WORKERS COMPENSATION ANDX JLWC112477 WC STATU- O7H- 07/10/2020 07/10/2021 • TORx dT •-••�,-••1111•t•••za11111111 — q EMPLOYC RS'aNAB1LlrM E.L. EACH ACCIDENT $ 1,000,000.00 ANY PROPRIETORIPARTNERIEXECUTIVE E, L DISEASE - EA EMPLOYEE $ 1,000,000.00 OFFICERIMEMBER EXCLUDED? (Mandatary in NH) N/A X E L, DISEASE - POLICY LIMIT $ 1,000,000.00 If yes, describe under DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Waiver of Subrogation is in favor of the City of EI Segundo, its officials, officers, agents and employees RE: Engineering Plan check services, City of Segundo CERTIFICATE HOLDER City of Segundo Attn: PW Dept 350 Main Street EI Segundo, CA 90245 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) @1988-2016 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 4.84) 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. The additional premium for this endorsement shall be 1-R-% of the California workers' compensation premium otherwise due on such remuneration. Person or Organization Schedule Job Description Blanket Waiver - Any person or organization for whom the All CA Operations Named Insured has agreed by written contract to furnish this waiver. 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 Policy No. JLWC112477 Endorsement No. Insured Insurance Company Countersigned By 01998 by the Workers' Compensation Insurance Rating Bureau of California. All rights reserved.