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PROOF OF INSURANCE (2021 - 2021) CLOSEDKRAUACT-01 LAUIRAARROYO' `�R� CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD0 ffYYY) 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 ray CONTACT 1551 Norah Tustin Avenue 4) 505-6660 1 , Nep;(714) 975-8966 NFP Property & Casual Services, Inc. PHONE) (71 Suite 500 MMn Santa Ana, CA 92705 INSURED Krause ACT, Inc. DBA Air Cleaning Technology 411 Rowland Ave Santa Ana, CA 92707 . , .. (§) I,NG COVERAGE NAIL O__. _ INSURER S AFPOR,o, INSURER A:CoIOnv Insurance Company 39993 INSURER 13: Berkshire Hathaway Homestate Insurance Company 20044 INSURE„R.0 INSURER D: 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, INSR ADDL SUER POLICY EFF POLICY EXP .,QTR.,.... TYPE OF INSURANCE MP WVD POLICY NUMBER 1MMIDDIYYYYI (MMIDDIYYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY _EACHOC_OURRE_NC $ 1,000,000 CLAIMS -MADE X J OCCUR X PACE4246133 3/7/2020 3/7/2021 DAMAGE TO RENTED $ 300,000 P.R F M IS F.S. (Ea, 9ccllfrmcp) EN -L AGGREGATE LIMIT APPLIES PER GENERALAGGREGATE . POLICY „X„ JER0. r LOC OTHER I $ 2,000 000 AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT ..........., OWNED g '.SCHEDULED ('Fa..1c0*nl7.,,,,,,, I� AUTOS ONLY ''AUTOS L...�.�..., BODILY INJURY (Per person), ... HIRED NON OWNED BODILY INJURY (Per accident) - ......_._.. AUTOS ONLY AUTOS ONLY "Or,msr ... .a..... ... _ AUMBRELLA LIABX OCCUR ...... ,� ........ ........ F'_1 SS LIAB � CLAIMS -MADE SE...,, EXC4245134 r."i ..... ...... DED RETENTION $ ........................ ................................................................,.-..,....,..,...................._......_..........._........_.................. 'WORKERS COMPENSATION .. AND EMPLOYERS' LIABILITY YIN X KRWC118387 ANY PROPRIETOR/PARTNER/EXECUTIVE NIA NHS EXCLUDED d s (NOE'andalolry kn If yes, describe under PER OTH- ........._ .. DFSgTETION CSF O,PIERATfONS below X. .....,5TWUTE, ER A Pollution Prof Liab I PACE4246133 MEP_FX„P(Any one, person) $,, ....,50,000 PERSONAL &ADV INJURY $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101„ Additional Remarks Schedule, may be attached if more space is required) RE: EI Segundo Fire Department, 314 Main Street, EI Segundo, CA 90245. The City of EI Segundo is included as Additional Insured with regard to General Liability per attached forms EPACEIOO-0814 & EPACE101-0814. Waiver of Subrogation applies to Workers' Compensation per attached form WC990410B. CERTIFICATE HOLDER '0011[44I!WAdNN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Ci Of EI Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City 9 ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street EI Segundo, CA 90245 --._••••••..-••••• AUTHORIZED REPRESENTATIVE Al ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD GENERALAGGREGATE . $ 2,000,000 PRODUCTS- OP COMPI AGG I $ 2,000 000 $ COMBINED SINGLE LIMIT ('Fa..1c0*nl7.,,,,,,, $ BODILY INJURY (Per person), ... $..................................................... BODILY INJURY (Per accident) - $ "Or,msr .PPdnl,yDAMAGE $ $ 3/7/2020 3/7/2021 4,000,000 AGGREGA ERRENDe d s I $ PER OTH- X. .....,5TWUTE, ER 1/1/2020 1/1/2021 E L EACH ACCIDENT $ pis,EASE-EA EMPIOYEEI $ 11,000,000,000 1,000'000 EL DISEASE - POLICY LIMIT $ 1'000'000 3/7/2020 3/7/2027 Limit _ _1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101„ Additional Remarks Schedule, may be attached if more space is required) RE: EI Segundo Fire Department, 314 Main Street, EI Segundo, CA 90245. The City of EI Segundo is included as Additional Insured with regard to General Liability per attached forms EPACEIOO-0814 & EPACE101-0814. Waiver of Subrogation applies to Workers' Compensation per attached form WC990410B. CERTIFICATE HOLDER '0011[44I!WAdNN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Ci Of EI Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City 9 ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street EI Segundo, CA 90245 --._••••••..-••••• AUTHORIZED REPRESENTATIVE Al ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: PACE4245133 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: EnviroPACE Insurance Policy Name Of Additional Insured Person(s) Or Organization(s) Where Required By Written Contract SCHEDULE Location And Description Of Completed Operations Where Required By Written Contract A. Section XX. WHO IS AN INSURED, Coverage Part 1 and Part 2 is amended to include as an additional insured the person(s) or organization(s) shown in the SCHEDULE above, but only with respect to liability for bodily injury, property damage, environmental damage, or cleanup costs caused, in whole or in part, by your work at the location designated and described in the SCHEDULE of this endorsement performed for that additional insured and included in the products -completed operations hazard. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following is added to section XXI. LIMITS OF LIABILITY AND DEDUCTIBLE: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Liability shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Liability shown in the Declarations. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED, EPACE100-0814 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 1 with its permission. POLICY NUMBER: PACE4245133 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: EnviroPACE Insurance Policy SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location(s) Of Covered Operations Where Required By Written Contract Where Required By Written Contract A. Section XX. WHO IS AN INSURED, Coverage Part 1 and Part 2 is amended to include as an additional insured the person(s) or organization(s) shown in the SCHEDULE above, but only with respect to liability for bodily injury, property damage, personal and advertising injury, environmental damage, or cleanup costs caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to bodily injury or property damage occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of your work out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. EPACE1 01 -0814 Includes copyrighted material of Insurance Services Office, Inc., Pagel of 2 with its permission. C. With respect to the insurance afforded to these additional insureds, the following is added to section XXI. LIMITS OF LIABILITY AND DEDUCTIBLE: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Liability shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Liability shown in the Declarations. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED, EPACE101-0814 Includes copyrighted material of Insurance Services Office, Inc., Page 2 of 2 with its permission. DATE (MMIDD/YYYY) _. TIFICAT LIA ILI INSU NCE � 08,13,2020 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 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 CONTACTKathyPerry Dan Rickabus State Farm Insurance DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 1011, Additional Remarks Schedule, may be attached It more apace is required) City of EI Segundo, its officials and employees are named additional insured Location; El Segundo Fire Department CERTIFICATE HOLDER ► ♦« M-+ 1 Main St ElSegundo,CA 90246 ACORD 25 (2014/01) 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, ri AUTHORIZED rREPRESENTATIVE i � � 01988-2014 ACORD CORPORATION. AIC reghts reserved, The ACORD name and logo are registered marks of ACORD 1001486 132849.9 02-04-2014 PHONE 949-363-7100 ,.Ext);949-aha-7100 (A/C, -363 -1836 Np1:949 w Yr( jCt7ftf 30131 Town Center Drive, Suite 275 E-MAIL katherine.per itff statefarm,com �"oawass: ry I " 11 W„), Laguna Niguel, CA 92677 INSURERM) AFFORDING COVERAGE NAIC# INSURER A:State Farm Mutual Automobile Insurance Company 25176 INSURED Krause A C T INSURER B: DBA Air Cleaning Technology INSURERC: 411 Rowland Ave INSURERD: Santa Ana, CA 927073445 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. INSR AbDL SUSS LTR TYPE OF INSURANCE INSn WVD POLICY NUMBER (MMJ DffMI (MlW D YYVY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ — —� CLAIMS -MADE _....I OCCUR bAMAGEiO11ENTEO FrtE�nlSEs_LEa ogcurronco) $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY JE -_ LOC PRODUCTS • COMP/OP AGO $ OTHER: $ A AUTOMOBILE LIABILITY Y 545 8874-C01-75 09/0112020 03101/2021 COMBINED SINGLE LIMIT $ 1,000,000 ANYAUTO 5191538-C01-75 - _(Eawacc�dent) 09/01/2020 03/01/2021 BODILYINJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS 5451753-C01-75 09/01/2020 03/01/2021 BODILY INJURY (Per accident) $ NON -OWNED HIRED AUTO AUTOS 4971093-C01-75 PRCIPERTY DANIA,GE 09/01/2020 03/01/2021 (Pet° yccldent) $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION PER V OTH- AND EMPLOYERS' LIABILITY Y / N �- STATUTE. I.. ER ANY PROPRIETOR/PARTNER/EXECUTIVE E L. EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? N / A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ If es , ydescribe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ A ENOL y $1,UOU,000 CSL 507 2152-C01-75 09/01/2020 03/01/2021 $250 Physical Damage deductible DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 1011, Additional Remarks Schedule, may be attached It more apace is required) City of EI Segundo, its officials and employees are named additional insured Location; El Segundo Fire Department CERTIFICATE HOLDER ► ♦« M-+ 1 Main St ElSegundo,CA 90246 ACORD 25 (2014/01) 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, ri AUTHORIZED rREPRESENTATIVE i � � 01988-2014 ACORD CORPORATION. AIC reghts reserved, The ACORD name and logo are registered marks of ACORD 1001486 132849.9 02-04-2014 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 0410B (Ed. 9-14) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT -CALIFORNIA BLANKET BASIS 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% of the total manual premium otherwise due on such remuneration. The minimum premium for this endorsement is $350. This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule, SCHEDULE BLANKET WAIVER Person/Organization Blanket Waiver — Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. Job Description All CA Operations Waiver Premium 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 01/01/2020 Policy No. KRWC118387 Endorsement No.. Insured Insurance Company Berkshire Hathaway Homestate Ins Co Countersigned by WC 99 04 10B (Ed. 9-14) Premium $