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PROOF OF INSURANCE (2021 - 2021) CLOSEDSTREE-3 OP ID: KG CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) `� 1 09128/2020 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(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 916-484-1001 CONTACT Chenoa Phillips Roberts & Phillips Insurance PHONE 916.484-1001 FAX 916.484-1018 Services, Inc. (AIC, No, Ext): (AIC, No): 2848 Arden Wa Ste. 110 E-MAIL Y ADDRESS: Sacramento„ CA 95825 Chenoa Phillips INSURER(S) AFFORDING COVERAGE NAIC # INSURERA:Atain Specialty Insurance Co. 17159 INSURED INSURERS: National Union Fire Ins.Co. Streetlight Restoration Specialists, Inc.*Attn: Brian Navigators Insurance Company g p Y 42307 INSURER C, 2828 Cochran Street Unit 360 Simi Valley, CA 93065 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 MAYHAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUER POLICY NUMBER LTR INSD WVD POLICY EFF POLICY EXP (MMIDDIYYYY) (MMIDDIYYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY EACH =,CC! PPENCE 1; 1,000,000 CLAIM' -MADE occ! F X CIP399868 04/28/2020 04/28/2021 cwMACETo FErJTED F'AMA, zT (Fa � NTED cP1 100,000 $ 5,000 MED E''F' (Anv ane nerconV $ 1,000,000 PERSCINAL F ADV INN iRv $ 2,000,000 EN'L A,= ;RE= ATE LIMIT APPLIES FERI . ENERAL A,= ;RE=ATE g POLIO) II JEcT 0 2,000,000 PF'_c! Ts_ , MF'1CF'A;= F -,THER $ AUTOMOBILE LIABILITY - al:I' Ea�_ f�:i EDII'•J= LE LIf 11T dentY ANT' Al TC B=,DILY' INJUPY (R r vers on) F VVPJED 1=HEDLILED AI iT=>=,NL'r ALIT,-,, BliDILY' INJ! PR (F' r accident) HIRE E,CPJ-Cb"1fJED FROFERT'r'DAMA, E AUT—, _,NL'T' ALIT= S ,_ NL'T' IFer accident) B UMBRELLA LIAB EACH =�C=!FFEfCE 1 2,000,000 X EXCESS LIAB CLAIM'_. EBU035901624 04/28/2020 04/28/2021 2,000,000 -MADE A_i RE"ATE g DED I I RETENT1,_1N T WORKERS COMPENSATION AND EMPLOYERS' LIABILITY PER ,TH- ,TAT! ITE EF YIN ANYFE-,P ,RIF'ARTfdERlE:'H=UTNE EL EACH A,==IDEfdT 1-iFFI�- FFERIMEMBEMIEER E''1_L1_IDED'i N I A ❑ (Mandatory in NH) EL DISEA'FE- EA EMF'L,=,'tEE If yes, Jescribe under DE'TCRIPTI,Jfd CIF-,F'EPATI1_1fd> balcw EL E,I EASE- P, LI,.'T' LIMIT 1; C Equipment Floater 041M030019 07/29/2020 07/29/2021 Rent/Lsd 50,000 Installation Float Install F 300,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Certificate holder is named as additional insured per attached endorsement. Digitally signed by Joseph Lillio Joseph L i l l i o ou cn=Joseph Li o=City of EI Segundo, ou=Director of Finance, ce, email=jlillio@elsegundo.org, c=US Date: 2020.10.05 01:30:43 -07'00' 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. EI Segundo, CA 90245 AUTHORIZED REPRESENTATIVE 1.V•tQu wa. `��ItiM1.�4 !mss ACORD 25 (2016103) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERALLIABILITY CG 20 3304 13 THIS ENE)ORSEMEN1 C HAM GEST-IE PCLMCK. FLEASE READ IT CAREFULLY. ADDITIONALIMSURED -OVVINEES, LESSEES DR CONTRACTORS -ALTO MATIC STATUSWHENI This endorsement modifies insurance prowid ed .ander thefollowing CC)AM ERCIAL GENERAL LIABILPYCDVERAGEPART A. Section 11 - Who Is An Insured is ernendec lo B. Vith iespectt:)tha insurance afforded to these ad - include as an additional insured any parson Drar- dtionall insureds, the follovirg additional exclu- garization for whom YOU are pe-fcrning cpera- sionsappy- tions when you and such person ciorgani.xicri Ti is insurance doesnotapply to: have agreed in t,vriting in a contractor agreement that such person or organization be added as 2n 1 "Bodiy injury", "pro perty damage" c)r "personal adc1tioral insured on YCU f POtCy. SOC -1 )Erso r or aid cA-ve'tising injury" arising out cf the ren - organization is an additional insured cmV with re- cl=rn g of, or the failure to render, any profes- spectto liability for "bodily injury", "p no peorty d an- sio nal 2rchitecta rat, engineering or surveying age" or "personal and advertising injLFY' cau*ec, n services, including: whole or in part, by: a Tie preparing , approving, or fading to 1. Your acts or omissions; Or p-eDaire or approve, maps, shop draw- 2. The acts or omissions of those acii ng D r yo ur irgs, opinions, reports, surveys, field or - Bars, �rs, change orders or drawings and specitcations: or in the performance of your ongoing :Dpeiatioisfor lo. Supervisory, inspection, architectural or the additional insured . e!igin eerir gactivides_ However, the insurance afforded to such acdtional Ti is ex, -1 uson applies ever if the claims against insured: aiyirsursed allege negligence or other vvrongd oirg 1. Only applies to the extent perm ited by bar; in th-e sipervision, hiring, employment, training or and monitoring )f others bythat insured; if the -occur - 2. VVillnot be broader than that which you *re re- rencid' vitich caused the "bodily injury" or "prop- quired bythe coritraotcoragreemertlopro-\ide e-ty danage", or the offense which caused the for such additional insured. "personal a nd advertising injury": involved the ren - daring of or the failure to render any professional A person's or organization's stat -AE as an addi- a-chiiib-ctural, engineering Drsurveyirg services. tioral insured under this endorsement -eids-wien your operations for that adiditionia nsur red a ie completed. CG 20 33 04 13 Copy rigi hit, linsiuran-ce Services Ctfi(--E, In (., 2012 Page of 2 2. "Bodily injury"or "p ropeity clar-nege"accir-irg after: a. All work, including materiRls, parts or equipment furnished in corinectioin wilh such work, on the project (.other :hainsary- ice, maintenance or repairs} Ic o -E per- formed by or on behalf cl :he acdti-onal insured(s) at the location o' the covered operations has been comp elect -, Dr b. That portion of "your wor-c" out of which the injury or carnage arise silhas been put to its intended use by anW person or or- ganization other than anctViei contactor or subcontractor engaged in perfo-niring operations for a principal as a part of th-e same project. C_ 'With respect to the insurance afforded to these ad ditb ra I irsureds, the following is added to See- -ti,>r III - Limits Of Insurance: 71 e no5twa will pay on behalf of the add itional in- su red istte amo uritof i nsurance: 1 Re-cuired by the contract or agreement you have ertered into with the additional insured-, 0, 2 Avaii!Ebb under the applicable Limits of Insur- aice shmwn in the Declarations; -whir, he�evi is less. 71 is endorsement sin all not increase the applicable Lmit:E of lisurarce shown in the Declarations. Page 2 oft Cop) riql ht, linsiuran-ce Service: Cffic-_e, In (., 2012 CG 20 33 D4 13 CUSTOMER NUMBER: 1530929 MERTES FINANCIAL 98 LETA YADICY PD SUITE B M&1c P.PAP.F_, CA 930I1 CITY OF EL SEGUNDO 350 MAIN ST EL SEGUNDO, CA 90245-3813 Certificate Copy RUN DATE: 09-28-20 Cl CW A021011 CERTIFICATE OF INSURANCE This certificate is issued for informational purposes only. It certifies that the policies listed in this document have been issued to the Named Insured. It does not grant any rights to any party nor can it be used, in any way, to modify coverage provided by such policies. Alteration of this certificate does not change the terms, exclusions or conditions of such policies. Coverage is subject to the provisions of the policies, including any exclusions or conditions, regard- less of the provisions of any other contract, such as between the certificate holder and the Named Insured. The limits shown below are the limits provided at the policy inception. Subsequent paid claims may reduce these limits. Certificate Holder: CITY OF EL SEGUNDO 350 MAIN ST EL SEGUNDO, CA 90245-3813 Insurer Name: Allstate Insurance Company Policy Number. 648796473 1 -Any Auto 4 - Owned Autos Other Than Priv. Pass. Autos Only Named Insured: STREETLIGHT RESTORATION SPECIALISTS, INC 2828 COCHRAN ST # 360 SIMI VALLEY CA 93065-2780 Automobile Liability 2 - Owned Autos Only 5 - Owned Autos Subject to No Fault 3 - Owned Priv. Pass. Autos Only 6 - Owned Autos Subject to a Compulsory UM Law X 7 - Specifically Described Autos 8 - Hired Autos Only 9 - Non -owned Autos Only Policy Effective Date: 09-11-2020 Policy Expiration Date: 09-11-2021 Limits Of I $ 1, 000, 000 Combined Single Limit (each accident) Insurance: I BI Per Person BI Per Accident Description of Operations/Locations/Vehicles/Endorsements/Special Provisions Interested Party Type: CERTIFICATE HOLDER PD Per Accident THIS CERTIFICATE DOES NOT GRANT ANY COVERAGE OR RIGHTS TO THE CERTIFICATE HOLDER. IF THIS CERTIFICATE INDICATES THAT THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED, THE P0LICY(IES) MUST EITHER BE ENDORSED OR CONTAIN SPECIFIC LANGUAGE PROVIDING THE CERTIFICATE HOLDER WITH ADDITIONAL INSURED STATUS. THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED ONLY TO THE EXTENT INDICATED IN SUCH POLICY LANGUAGE OR ENDORSEMENT. Producer. MERTES FINANCIAL Authorized Representative: Cl CW A021011 Date: 09-28-20 Includes copyrighted material of Insurance Services Office, Inc., with its permission Allstate Insurance Company Certificate Copy Page 1 of 1 4E; DATE NMMrcatal'xx^cYp CERTIFICATE OF LIABILITYINSURANCE 09/28/2020 THIS CERTIFICATE IS ISSUED AS w0. MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOLES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTI'T'UTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER, --FM—PORTANT: If time certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, su 6jec;t ito time terlemms and conditions of time policy, certain pso i ies may require ars endorsement. A statement on this certificate doses not confer rights to the celrtifie,'ate holder In Beau of such endorsemmment(s). P83F'AE3UCEFR CONTACT 1w1P3Nk N'')I,BIltl'1'7rwE"V NAME: v'Wu:utrWli,rAR;+:;' 4::;nntrd:ar:;;lu,ars 11nsu,ar'Gmr`uR'u ",I,H WEnc,I, s,, W...N...+:.:; PHONE.w°1`11) T3415-I'ifD:; 8 FAX (A/C, No, Ex'tl : ... (ABC,INo)n <'21'4 9::':.¢`gc,inmslam;> Bdural, 200 E-MAIL ur:ru.BRlrw`E mrE imWvut;. C sulW;rrrcarwkr'4a,: dcYu=..;irm<>awr'<wrrc;r,.f crur'1 U",' Chcunftw: ,,, (:A 92024 IIFESUREW,,S) AFFORDING ING COV✓'ERAGE NAIL 4 BlW''wa Rr...R A � State Compensation Insurance Fund 35076 BttMUIIR a'w W"SW.En'mEFB B. Streetlight Restoration Specialist, INC nmw=.,U Rm,RC 2828 Cochran Street #360 rRwSuMaa'ER rN Simi Valley CA 93065 "N'`'"'"REE E ......_.,,..........._.......,.._..._._..,..._........._.._..,_w.,.�.._.,,,.,,,.,,�hWskq F ,....,..._�.....,,,.,..,.... COVERAGES CERTIFICATENUMBER-, d,...F..' .,... ..._....,..... W..........,�..��.,,....�,..____..x... ..... ......, Now MBER-, _ REVISION NUMBER: IH • WS Y0 csM;E',I"II II" "m'' '4"MVkI UNNC POI IUP °a 0: MNW',wU.,GRANdl::l. II Il,;;zH.D GSP:':p.Q'"OVl HAVE BEEN uM,,'UFF.f„r I() IIB. ” w iN" 4MJa'SU„MF?I Y;Y NAMED ABOVE N (NiE`ll~N I f -II: knC'A! I+4; N' U'�F"N;16'd9:) ft.;'UP';AW D N'MP';N'U'0IBIN1S'BF4NN"1&W., ANY VZN v.1)011-* W Pq I, N'&' RM r')R" V:;4'.':AN[ M'li{' N Of ANY us P'pUVdVG'fiF!aGII OR 0"y4'hPV,R V:')0(,,4..UtafRl.::NT W1RE:::r9'€.,4:;N TO VVFKl 'TRtlIS V'44q MAY BFV"r''ttVllE,UW 1;7F MAYIF�E::.N?'l'AMIWV '1111,,' II WE `AJRANCF' d"awFF()RTA O BY IM.- I'NE:)l.tlCAE S W.`S(; MBE:k.N HEREIN IS ;:i@.➢E'swtll' CT 'TO ALL THE'' "ME RMS, N': B " „UFW3V')P4,S AND P',(JNM' H R)N s OF SUCH F'BOU, tl('"UI ;:W M. UIoN&V'r `,`r "`i+',WVVNW IWBAle I WA'm L BI FIN FSE; IbW, .A) BY PAID (`AAIMS .._I..tl..4�..F..,......,...,_..._.._._... , ., .,,..........m._............_..,.,.. w. .....__._..r.AkN.7U.tik.S,t):1k!.f!,....v.......w....._................ .'....,..,.w.,..,,._........_.i.,.,t�yl�!BNVµEB1fd'..wn8 .F �E.�r.�'F.`�' ..L, E�EiRUr)A'tP'm'Ap„kdM.dA .;rrIAARM�0.W�ERF�R�M`7..Y .E _....�.�...A._ MV"N'w GENERAL LIABILITY "lo Wfl rY li:.iRUNILL, .. C)P�( ht,I•; r,'. 4,-•C dh ".r,rtil I ANI II'. i I"'r� b M1fld i s I,L : i irY;;>aan 1 1 'C' yr r i is r'dk r'pd '"Ck1 „rl 1'I i Y• C: �; 1Pv,P1.9INkI-Il:r rli Nd+',WI n I, ImlO!'r 4m,+; l„I, rtl J, rii',; Y: Yu11' uPaJ!P,.IPa,r ih"'¢tu'::4^.,aar,;Vr^r rdl 11 UMIF'RE..ILII.An..AS " iw EXCESS UAS 1.:14 41 _.__....... WA!dk'h82RSt. W', 4':ClmYtr"F; N"SA m'WN AND EMPLOYERS' LAABNIt,m'P” M ^m' P Nwg brmr r B., E wr I, Y II'rnuA'' X 9227287-20 P WBNNmnren,Ba9aii uruNM&dE ...,..,... irto ptti I , X 03/06/2020 03/06/2021 I I M 4 ',I,IC 1 mlbF"I 4 d L L L d i r'.., I F1, A l V L 1 r V, DES4:;R9'F"'G'N0N a;:kV' ()PE: RA V KNP S a LOCA NS, Y VV-,MEmf:%,F (A�tAdBi4;6 ACOIR[) 9'tlH, AKdudhmuwnM F'R'maa' m Sa:kpnMr ole....Y......_....................................Y.._.r........ ' 0 H1pY4Yl(N?, space Y4 P'h"". f'd N1Uk'Y,9W:B) Evidence Of Workers Compensation Insurance Includes Blanket Waiver Of Subrogation. 91- 1,000,000 1,000,000 1.000.000 1 C;'E.R1"]FII„ ATE: HOI....DE'R CANCF:R...L..A't10N EX ;�H EIII—D ANY O "E'HE:; ABOVE''. DE:.;�rt�IdUt� ED EnW"mt.,UCff BE CANCELLED BEFORE Cit of EI Segundo E': MRA'n0N ESArE: 'FHEEREOF, N'OTMCE W K.1, BE @�mM:'LAVE REE:1, MN 350 Main Street TH Aa:MCP: RDAN CE.-: WffH T'HE: POtuK'Y PRO VM s 140 EI Segundo, CA 90245 Aalr'Hr:?rk�SUcDRE'E'RE,,, N TAmVaar Ad;mt1N I':;I 2S (2C4'10Nt,IS) ,'.a1988-2010 ACORL,1 CORPORATION. All rights reserved, The AOIt':"IRI;;wI name and IPcmglE: ar,e Iregistd:,wred marks of ACOW.) _T E ENDORSEMENT AGREEMENT BROKER COPY COMPENSATION WAIVER OF SUBROGATION BLANKET BASIS 9227287-20 FUND RENEWAL NA HOME OFFICE SAN FRANCISCO EFFECTIVE MARCH 6, 2020 AT 12.01 A . M. PAGE 1 OF 1 ALL EFFECTIVE DATES ARE AND EXPIRING MARCH 6, 2021 AT 12.01 A.M. AT 12:01 AM PACIFIC STANDARD TIME OR THE TIME INDICATED AT �� PACIFIC STANDARD TIME STREETLIGHT SPECIALISTS, INC. 2828 COCHRAN STREET #360 SIMI VALLEY, CA 93065 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 JOB DESCRIPTION ANY PERSON OR ORGANIZATION BLANKET WAIVER OF FOR WHOM THE NAMED INSURED SUBROGATION HAS AGREED BY WRITTEN CONTRACT TO FURNISH THIS WAIVER NOTHING IN THIS ENDORSEMENT CONTAINED SHALL BE HELD TO VARY, ALTER, WAIVE OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS POLICY OTHER THAN AS STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR LIMITATIONS OF THIS ENDORSEMENT. COUNTERSIGNED AND ISSUED AT SAN FRANCISCO: JANUARY 9, 2�0/2�0 AUTHORIZED REPRESENT IVE PRESIDENT AND CEO SCIF FORM 10217 (REV.7-2014) 2572 OLD DP 217