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PROOF OF INSURANCE (2021 - 2021) CLOSEDALOHDOO-01 —_ESOLOR'ZA,IQ, CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) .-.. ' ............ 9/29120.2.0 THIS C......_.._._.... �... i ERTIFICATE 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($), PRODUCER License i 0633339 CNrcT (AIC', N _................. Olson Duncan Insurance Service Inc. (AIC, No ExQi (310 373-6441 I PAX 310 378-5336 25550 Hawthorne Blvd. Suite 203 _•-•°- (NX, N.):(310) Torrance, CA 90505L,; ins co' oIsonduncan.com INSURERy ) AFFORDING COVERAGE NAIC d INSURER A : Mesa Underwriters I)ec Ins Co, 36838 .......... - INSURED JM§UR ER B : .,.,.. .. �........... _.... Aloha Doors, Inc.LN-s-0 t1 c: 214 Main St #119 INSURER D: _ ................. EI Segundo, CA 90245 INSURER E r. INSURER F: COVERAGES CERTIFICATE NUMBER:REV., )ON 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 30LICIES. LIMITS SHOWN MAY HAVE BEEN PEDUCED BY 'AID CLAIMS. _... IN�TSR lust) SUBR POLICY EFF POLICY EXP TYPE OF INSURANlust)WV0 - POLICY NUMBER l.t�I.D.l�ln'YYy eMMIDD,nIY,�'I m LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 'S 2,000,000 CLAIMS -MADE FxIOCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY ❑ JE0 ❑ LOC OTHER' AUTOMOBILE LIABILITY ANY AUTO OWNED - SCHEDULED _ AUTOS ONLY AUTOS k . A J IN ONLY -••• IN N3'S O 5 UMBRELLA LIAB OCCUR EXCESS LIAB HCLAIMS-MADE _._. .....................w DED V RETENTION $ ......... _.o ........ ,.._... WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ NIA t7PFICERRMF�MBER EXCLUDED? (Ma,nd'alory n NH) If yes, describe under DESCRIPTION OF OPERATIONS below MP0004016005354 3/14/2020 3/14/2021 ..C'fM,MAG'E TCa RENTE',D ocradrrenreu '$ MEDPEXP (A�i _,,, „_ v one person) $ PERSONAL & ADV INJURY S GENERAL AGGREGATE $ PRODUCTS -COMPIOPAGG $ S COMBINED LIMIT ISINGLE $ BODILY INJURY (Pe, r,erson) $ BODILY INJURY (Per accident) ,$ PRO'PEli 'v r1ANIACeE _(Per ac�ci pant $ ,,,EACH OCCURRENCE _$ AGGREGATE $ ........ A OTH- __19A UTF. ER E.L EACH ACCIDENT S _IT_,,,,, E L DISEASE—EA EMPLOYEE S E.L DISEASE -POLICY LIMIT $ 50,000 5,000 1,000,000 2,000,000 2,000,000 ................. ........................ DESCRIPTION' OF OPERATIONS I LOCATIONS f VEHICLES (ACORO 101, Adddb'onal Remarks Schedule, may be attached If more space Is roqulred) With 'regards to General Liability The City of EI Segundo„ its officers, officials, employees, agents„ and volunteers are named as additional insured, if required by contract, with regard to ongoing operations. Certificate holder is additional l insured, with regard to completed operations, if required by contract. Coverage is primary and non Con'tribu'tory. Waiver of subrogation in favor of named insured, if required by contract per attached MUS 010120127 0316. Policy terms apply 30 notice of cancelation; 10 days for non payment; policy terms apply. ...... . �.....• ....................... CERTIFICATE HOLDER_,. CAN LLATION 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 n .....•.. AUTHORIZED REPRESENTATIVE � ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD MESA UNDERWRITERS SPECIALTY INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. LIMITED Al - PRIMARY NON-CONTRIBUTORY - WAIVER OF SUBROGATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM Blanket Additional Insureds - As Required By Contract A. Subject to the Primary and Non -Contributory provision set forth in this endorsement, SECTION II - WHO IS AN INSURED is amended to include as an additional insured any person or organization whom you have agreed in a written contract, written agreement or written permit that such person or organization be added as an additional insured on your policy. Such person or organization is an additional insured only with respect to liability for "bodily injury" or "property damage" or, to the extent applicable under the Coverage Part to which this endorsement applies, "personal and advertising injury" caused, in whole or in part, by: 1. Your ongoing operations, "your product", or premises owned or used by you; With respect to the insurance afforded to these additional insureds, the following additional exclusion applies: This insurance does not apply to "bodily injury", "property damage" or, to the extent applicable under the Coverage Part to which this endorsement applies, "personal and advertising injury" arising out of the rendering of, or the failure to render, any professional architectural, engineering or surveying services by or for you, including: a. The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; and b. Supervisory, inspection, architectural or engineering activities. This exclusion applies even if the claims against any insured allege negligence or other wrong -doing in the supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence" which caused the "bodily injury" or "property damage", or, to the extent applicable under the Coverage Part to which this endorsement applies, the offense which caused the "personal and advertising injury", involved the rendering of, or failure to render, any professional architectural, engineering or surveying services. 2. Your maintenance, operation or use of equipment, other than aircraft, "auto" or watercraft, rented or leased to you by such person or organization. A person or organization's status as an additional insured under this endorsement ends when their contract, or agreement with you for such rented or leased equipment ends. With respect to the insurance afforded to these additional insureds, this insurance does not apply to any "occurrence" which takes place after the rental agreement or equipment lease expires. The provisions of this coverage extension do not apply unless the written contract or written agreement has been executed (executed means signed by the named insured) or written permit issued prior to the "bodily injury" or "property damage" or, to the extent applicable under the Coverage Part to which this endorsement applies, "personal and advertising injury". MUS 0101 20127 0316 Insured Copy Page 1 of 2 Primary and Non -Contributory Provision The following is added to Paragraph 4. Other Insurance, b. Excess Insurance under SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS: This insurance shall be excess with respect to any person or organization included as an additional insured under this policy, any other insurance that person or organization has shall be primary with respect to this insurance, unless: 1) The additional insured is a Named Insured under such other insurance; 2) You have agreed in a written contract, written agreement or written permit to include that additional insured on your General Liability policy on a primary and/or non-contributory basis; 3) The written contract or written agreement has been executed (executed means signed by the named insured) or written permit issued prior to the "bodily injury' or "property damage" or, to the extent applicable under the Coverage Part to which this endorsement applies, "personal and advertising injury'; and 4) With respect to indemnity, you have been adjudicated liable in full for the "bodily injury' or "property damage" or, to the extent applicable under the Coverage Part to which this endorsement applies, "personal and advertising injury". Waiver Of Transfer Of Rights Of Recovery The following is added to Paragraph 8. Transfer of Rights Of Recovery Against Others To Us under SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS: We will waive any right of recovery we may have against a person or organization because of payments we make for "bodily injury" or "property damage" arising out of your ongoing operations or "your work" done under a written contract or written agreement and included in the "products -completed operations hazard", if: 1. You have agreed to waive any right of recovery against that person or organization in a written contract or written agreement; 2. Such person or organization is an additional insured on your policy; or 3. You have assumed the liability of that person or organization in that same contract, and it is an "insured contract". The section above only applies to that person or organization identified above, and only if the "bodily injury' or "property damage" occurs subsequent to the execution of the written contract or written agreement. All other terms and conditions of this policy remain unchanged. MUS 0101 20127 0316 Page 2 of 2 ALOHDOO-01 r ESOLORZAN CERTIFICATE OF LIABILITY INSURANCE DATE g/(MMIDD (MMIDDIYYYY) 0 .............. 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 _11.1_1_ 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). 1111.. _1111_ PRODUCER License # 0633339 CONTACT NAME,,a....................................... .1111.,., ---- Olson Duncan Insurance Service Inc. PHONE 310, 373-6441 FAX Na X1'0 378-5336 25550 Hawthorne Blvd. Suite 203 (A/C, No, Ext): ( ) ( ,,,,,,,,,,,,, Torrance, CA 90505 insQolsorlduncan.com V INSURER($) AFFORDING COVERAGE 1111 1111, „ NAIC # INSURER 1111. 1111 ...A;Caliform,a, Auto Insurance ..........., 38342 .. _. INSURED INSURER„ B: State Comp Ins Fund 35076,__..—,_ Aloha Doors, Inc. INSURER. C: 214 Main St #119 INSURER D: EI Segundo, CA 90245 INSURER E,: _ INSURER F: 1111 ........................ COVERAGES CERTIFICATE NUMBER: REVISION NUM;( ,E, _._ 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, �EXCLUSIONSTYPE PCONDITIONS OF SUCH POLICIES. LIMITS SHOWN V11E11 BEEN REDUCEPOLD YgPA CLAIMS. ) INSR EOF INSURANDDtLiSUPOLICY NUMBER Y EFF POLICY P LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS -MADE OCCUR p8E1E $ ... .. — MED E,X„P..(Any.9na.persan)„ $ PERSONAL & ADV INJ,,,,,,,w.................. .......... GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE .---„,...,.... E $..................,,, POLICY LOC PRODUCTS - OOMP/OP AGG $ .............................1 ...INFO A AU” COM SINGLE LIMIT 000 00 0 -- BA040000054325 1) 8/13/2020 8/13/2021 BODIBLYdINJ,URY (Per,perso„n) $ .. _ AU EONLYBILITYX SCHEDULED U accident) ef,, AUTOS HIRED X NON -OWNED AMAAGE' �"��rauEniRa1��,�,,,�„ $ AUTOS ONLY AUTOS ONLY _X ...._�I l .nt 1111. __. UMBRELLA LIAB OCCURAGH QCGURRENCE ............................$ . ......... ......... p Y� EXCESS LIAB ICLAIMS-MADE _ RGG,REGATE .. RETENTION $......................................... DED 9___W ORKE OMPELI A ......._. & U (LIT YIN 9253994 _ 5/15/2020 5/15/2021 x... 1 ANY P OPRIEEOR/PARBINER/EXECUTIVE E.L.EACH A CIDEN -$ D...� .�GG(DENT $, FI4E RiMCMBEH EXCLUDED? N / A drkdat'o,y9n BN ) E„L;DISEASE -..EA EMPLOYEE $... 1;000,000 00,000 If yes, describe under DESCRIPTION OF OPERATIONS below _,.... E.L. DISEASE - POLICY, LIMIT $ 1,000,000 1111 ............................... DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional R'omarks Scbedu)o, may be attached it moria space is required) With regard to general liability The City of EI Segundo, Its 'officers, officials, employees, agents, and volunteers are named as additional insured, if required by contract, with regard to ongoing operations. Certificate holder is additional insured, with regard to completed operations, if required by contract. Coverage is primary and non contributory. Waiver of subrogation in favor of named insured, if required by contract per attached CG24040509. Policy terms apply WC waiver of subrogation in favor of named insured, per attached 10217. Policy terms apply. 30 notice of cancelation; 10 days for non payment; policy terms apply. R4 AM TOTEIV U*115811 *4 City of EI Segundo 350 Man Street EI Segundo, CA 90245 ACORD 25 (2016/03) 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 1111 ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ENDORSEMENT AGREEMENT WAIVER OF SUBROGATION 9253994-20 RENEWAL SC 8-71-41-05 PAGE 1 HOME OFFICE EFFECTIVE OCTOBER 8 2020 AT 12.01 A.M. SAN FRANCISCO i AND EXPIRING MAY 15, 2021 AT 12.01 A.M. ALL EFFECTIVE DATES ARE AT 12:01 AM PACIFIC STANDARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME ALOHA DOORS, INC. 214 MAIN ST EL SEGUNDO, CA 90245 ANYTHING IN THIS POLICY TO THE CONTRARY NOTWITHSTANDING, IT IS AGREED THAT THE STATE COMPENSATION INSURANCE FUND WAIVES ANY RIGHT OF SUBROGATION AGAINST, CITY OF EL SEGUNDO WHICH MIGHT ARISE BY REASON OF ANY PAYMENT UNDER THIS POLICY IN CONNECTION WITH WORK PERFORMED BY, ALOHA DOORS, INC. IT IS FURTHER AGREED THAT THE INSURED SHALL MAINTAIN PAYROLL RECORDS ACCURATELY SEGREGATING THE REMUNERATION OF EMPLOYEES WHILE ENGAGED IN WORK FOR THE ABOVE EMPLOYER. IT IS FURTHER AGREED THAT PREMIUM ON THE EARNINGS OF SUCH EMPLOYEES SHALL BE INCREASED BY 03%. NOTHING IN THIS ENDORSEMENT SHALL BE HELD TO VARY, ALTER, WAIVE OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS POLICY OTHER THAN AS ABOVE STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR LIMITATIONS IN THIS ENDORSEMENT. COUNTERSIGNED AND ISSUED AT SAN FRANCISCO: AIJTI�OR6?ED REPRESENT IVE SCIF FORM 10217 (REV.4-2019) OCTOBER 12, 2020 PRESIDENT AND CEO 2570 OLD DP 217