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PROOF OF INSURANCE (2021 - 2021) CLOSEDAC CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDfYYYY) 0611012020 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, 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 No Hassle Insurance AgencyNHowz JERRY MACIAS FAX 1400 E. Cooley Dr. Ste. 202-A � , 9 tl• lase}44o�osa _.. Acs: I909')' '8 w7'9oD AIL Colton, CA 92324Ball._ _jimacias( nohassleins.not License #: OE74924 INSURER($) AFFORDING COVERAGE mmV NAIC k ..................... iNSURED INSURERA: United Statp L18bi1_.its/�r-ryI.Ja.f).,EQ,_i.,m0111p8n,)(-. „' Christopher Heppell DBA: Precision Reef Systems INSURER B: INSURER C; 3537 Torrance Blvd, #24 INSURERA „. .................. _..... . Torrance, CA 90503 ,INsURERE: INSURER F : COVERAGES CERTIFICATE NUMBER: 00004050-18094 REVISION NU'M'BER: 9 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. fhsit ADUL 4J RPWD4JCY EFF '� POLICY EXP - --- -- ......�� 1.1kTYPE OF INSURANCE W111 -an POLICV NUMBER iMVMDfYY t IMM(DDIYYYYi LIMITS A X COMMERCIAL GENERAL LIABILITY Y CL 1757885D 06111/2020 06111/2021 EACH OCCURRENCE S 1.00Q,WOOO CLAIMS -MADE L �J OCCUR AAC,k TO RENTED ..EM4s�s t��'� s 100,000 MED EXP (Any one pereon .® $ 6 000 PERSONAL& ADVINJURY_ $ 1,000 000 GE"""�ppp6'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGRE'O TE $ 2,000,000 POLICY JECT FI LOC PRODUCTS -COMPIOPAGG $ 2,000 0, 00 - OTHER' Deductible $ 0 AUTOMOBILE LIABILITY 'COMBINED SINGLE LIMIT' ANY AUTO BODILY INJURY (Per person) $ OWNEDSCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Par accident)J S HIRED NON -OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Parr acardenl'S S UMBRELLA LIAR OCCUR EACH OCCURRENCE S EXCESS LIAR CLAIMS -MADE AGGREGATE S DED B RETENTION S $ ANDEMPLOYERS" LIABILITY WORKERS COMPENSATION g PER 1OTH- AI S7ATUTA= .... .L��i...._�... .....-.. YPROPRIETORIPARTNERIEXECUTIVE YIN E,L EACHACCIDENT S OFFICERIMEMBER EXCLUDED? N I A � --- --- (Mandatory In NH) E.L. DISEASE - EA EMPLOYEE S If yyoob, describe under OESC'RIPTION OF OPERATIONS below E.L DISEASE • POLICY LIMIT $ DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached H mors epau k required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN The City of EI Segundo and its employees ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street EI Segundo, CA 90245 AUTHORIZED REPRESENTATIVE (J� 01988-20'15�A4:'ORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD Printed by JMA on June 10, 2020 at 03:42PM Harada, Patricia From: Kristina Kora-Beckman Sent: Thursday, August 20, 2020 12:14 PM To: Harada, Patricia Cc: Shilling, Mona; Le May, Jessie; Lillio, Joseph Subject: Precision Reef System - General Liability Endorsement Insurance Waiver Importance: High Hi Patricia, Hope you and your family are well. Regarding Precision Reef System's insurance, Joe Lilio has approved waiving the GL endorsement this time (please see email below). Please let me know if anything else is needed to process the waiver. Thank you, Kristina Kora-Bechman Senior Librarian, Youth Services EI Segundo Public Library 111 W. Mariposa Avenue EI Segundo, CA 90245 (310) 524-2772 www.elsegundoiibrar.pr, From: Lillio, Joseph Sent: Thursday, August 20, 2020 9:58 AM To: Kristina Kora-Beckman Cc: McCollum, Melissa Subject: RE: Insurance Cost Relative to Service Agreement Value The liability exposure seems very low. I am okay with waiving the endorsement this time. The reason I asked about the technician being supervised is, there is risk of kids in the library being exposed to the technician's equipment or chemicals and possibly being injured. I would like to have assurance that staff is taking a proactive approach and ensuring curious children are not permitted near the tank while it is being cleaned. If the company had the endorsement, I would not be asking this question. Thanks! 1 '* I CERTIFICATE OF LIABILITY II ANC OATeANCE I O�PAO 112020W0OiVYVV 7lil C'ER'TIFICATE' Is ISSUED AS -ROF WFORMAil0 N ONLY ANDONFERS NO RIGHUPO TS N 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), AUTHOALZED REPRESENTATIVE OR PRODUCER, ANOTHE CERTIFICATE HOLDER, IMPORTANT. If rho Certiflicate holder Is, am ADDITIONAL INSURED, the Po0cy(;Osj must have ADDIT10NAL INSURED provisions or be ondorsed. 111 SUBROGATION IS WAIVED, suh)oct to the terms avid conditions of the policy, cortain policies They require an endorsomont. A statom,ent on this cortificato does not confor rights to the conificato holder in 1111ou of such endorsomonlia). FRCMUCER NAC1004TACr it Dt' ME Brent K Ooh4lock Insumnce Age�ncv Inc 310 -H,21 -U864 310,541-6199 POONE �AX 04, Nq� VxW ipVc. NDN' 0*28441 HighrIdge Rd Ste 50,3 EA#AIL Ro4ing Hft Estates CA 90274 INSUA:fk�f AFFOREANG COVERAGE N,AIC 0 0 25178 INSURER A I - MM M0 1911 AwtomotAo kiswaile Cuinparq INSURED !Nsv"E" a 01104slophet I, ieppell INWRER C I U I.Ard JA— IN%MMFR D INSURFR F INSURER F I,ns Angeles, N A 9(045 . . . . . . . . . ... .. ....... ...... ....... COVERAGES CER'TIFICA T E .......... N"U MB'"i i RE�ISION NU46ii' THIS, IS, TO CERTITY THAT THE POLICIES 6� INOiWNH'6113) 00.,0W HAVE IIT FN ISSUED TO THE INSURED NAI�&�ii(JVL 1'014 1+111;V()qK',"y PERIOD INfKAIED R01011-ISTANDMG ANY PEOUIREMENT TERM OR CONIAHON Or ANY CONTRACT OR OTHER DOCUMEW VOI[H RESPIEGT '10 WHICA-i I'HIS CERNOGAIF MAY BE ISSOED OR! MAY PERTAIN, THE INSURANCL AITORDED BY 1)1�'PNiOES DESCRiBED HEREIN IS SUBJE0 '10 AL I,, THt U.MAS P..IMtTS SH01/04%%Y BEEN HAVE BN I*116CEDBY $,,Afil (AAIMS tlJNS;R POLICY OFF PLXXY„AD. kkp UMI rs T�t.�,q!�!t!UKANCE OR, POLICY NUM"Mt COMMERCIAL GENERAL LIAORLITY MA.",r TliPr, Ntr. E.) 5 0rD:V;0SAL 0 A4,'V'000 �WN k'R 01 HL 4 WJ-10-'M"064, E, L JAftJ I i512 95'14�,C`14-75 M�14d2020 03114,Q(121 oa A 1! 1Iq, 1 000,000 fe.)b S 1 000 ODO A . L5 ML'Y UMBRELLA LIAR CY""JR I EXCESS UAD PMN OR$ COMPENSA I toN ” r rPJI� I A041D EMP1 0YER$'LM64J1`Y re r g..., A 4w NHS E.- S,- LA EWIL P61,1 'dein'cgr DESCRIPTION OF OPERAVIONS a LOCAT1046 dVEHMES tACCA0 101, Adftrmsi Remarks Schedole, m4V bo 004hod 0 mof* $Paco 4 rewimvdl CERTIFICATE HOLDERCANCELLAITO'N, I'w Cry of EI Segundcand IIts employees 350 Main sleeef AUTHORIZED REPRIMN IA WE "OR A. 01 R6��qhts rosorved. Tihe ACORD name and logo are reyli'stored marks of ACORD IW46A, SHOULO ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE MLL BE DELIVERED IN ACCORDANCE, WITH TINE POLICY PROVOSIONS. EI Seqw;vlo, (,'A 1110245 ACORD 26 (2016103) CITY OF EL SEGUNDO WORKERS' COMPENSATION DECLARATION WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SUBJECTS AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN LABOR CODE § 3706, INTEREST, AND ATTORNEY'S FEES. I affirm under penalty of perjury under the laws of California one of the following declarations: (_) I have and will maintain a certificate of consent of self -insure for workers' compensation, issued by the Director of Industrial Relations as provided for by Labor Code § 3700 for the performance of the work set forth the agreement with the City of EI Segundo. Policy No. (_) I have and will maintain workers' compensation insurance as required by Labor Code § 3700 for the performance of the work for which the agreement with the City of EI Segundo is executed. My workers' compensation insurance carrier and policy number are: Carrier Policy Number Expiration Date Name of Agent Phone # (XI certify that, in the performance of the work set forth in the agreement with the City of EI Segundo, I will not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that, if I should become subject to the workers' compensation provisions of Labor Code § 3700 1 must immediately comply with thus , rovisions or the reemen 'ill automatically become void. Signature of Applicant � Date Print Name L ��(_' . . J Agreement for: Dated: Reviewed by: (��e