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PROOF OF INSURANCE (2021) CLOSEDARISINC-02 DELETOU RNEAU HC vKL! CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) `.� 7/27/2020 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 Denise Letourneau NAME: Wyoming Financial Insurance PHONE FAX 400 E 1st St, Ste 105 (A/C, No, Ext): (307) 233-8301 (A/C, No): Casper, WY 82601 E-MAIL dietourneau@wercs.com ADDRESS: weres.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Admiral Insurance Company 24856 INSURED INSURER B: Arista Tek, Inc. INSURER C: 710 Garfield Street, #220 INSURER D: Laramie, WY 82070 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 CONTRA:T OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLIC ES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH 'OLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY 'AID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER LTR INSD WVD POLICY EFF POLICY EXP (MM/DD/YYYYI (MM/DD/YYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 OCCURRENTED CLAIMS -MADE FIV -1 OCCUR FEIECC1648507 7/13/2020 7/13/2021 DAMAGE 50000 PREMISES (Ea occurrence) $ 5,000 MED EXP (Anv one person) $ 1,000,000 PERSONAL & ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY ❑ PRO ❑ LOC JECT PRODUCTS - COMP/OP AGG $ 2,000,000 OTHER $ A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) 1,000,000 $ ANY AUTO FEIECC1648507 7/13/2020 7/13/2021 BODILY INJURY (Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ X HIRED X NON -OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident) $ A X UMBRELLA LIAB X OCCUR1,000,000 EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE FEIEXS2310104 7/13/2020 7/13/2021 AGGREGATE $ 1,000,000 I I DED RETENTION $ $ A WORKERS COMPENSATION PER AND STATUTE EORH Y/N FEIECC1648507 STOP GAP 7/13/2020 7/13/2021 1,000,000 ROPRIETOR/P RTNEY ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? N / A in NH) E.L EACH ACCIDENT $ 1,000,000 (Mandatory E.L DISEASE - EA EMPLOYEE $ If yes, describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L DISEASE - POLICY LIMIT $ A Professional Liab FEIECC1648507 7/13/2020 7/13/2021 Claim Expense Limit 1,000,000 A Professional Liab FEIECC1648507 7/13/2020 7/13/2021 Claim Expense Aggr 2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) When required by written contract or agreement additional insured applies under the General Liability per forms ECC -319-0712. Primary & Non contributory additional insured per form ECC -548-0317. Thirty (30) days notice of cancellation applies. Ten (10) days for non payment of premium. Forms attached. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cit of EI Segundo Fire Department THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Y 9 p ACCORDANCE WITH THE POLICY PROVISIONS. 314 Main St EI Segundo, CA 90245 AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AristaTek, Inc.; Albany County Research Corp. Endorsement Number: 6 ADMIRAL cax:A.vr Automatic Additional Insured — Owners, Lessees or Contractors This endorsement, effective 7/13/2019 attaches to and forms a part of Policy Number FEI-ECC-16485-06. This endorsement changes the Policy. Please read it carefully. In consideration of an additional premium of $Avolied, this endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: Any person(s) or organization(s) whom the Nalned Insured agrees, in a written contract, to name as an additional insured. However, this status exists only for the project specified in that contract. The person or organization shown in this Schedule is included as an insured, but only with respect to that person's or organization's vicarious liability arising out of your ongoing operations performed for that insured. ECC -319-0712 AristaTek, Inc.; Albany County Research Corp. Endorsement Number: 15 AOM/RAL Automatic Primary and Non -Contributory Insurance Endorsement Designated Work Or Project(s) This endorsement, effective 7/13/2019 attaches to and forms a part of Policy Number FEI-ECC-16485-06. This endorsement changes the Policy. Please read it carefully. This endorsement modifies insurance provided under the Coverage Part(s) indicated below: COMMERCIAL GENERAL LIABILITY COVERAGE SCHEDULE Name of Person or Organization: Any person(s) or organization(s) whom the Named Insured agrees, in a written contract, to provide Primary and/or Non-contributory status of this insurance. However, this status exists only for the project specified in that contract. In consideration of an additional premium of $Applied and notwithstanding anything contained in this policy to the contrary, it is hereby agreed that this policy shall be considered primary to any similar insurance held by third parties in respect to work performed by you under any written contractual agreement with such third party. It is further agreed that any other insurance which the person(s) or organization(s) named in the schedule may have is excess and non- contributory to this insurance. ECC -548-0317