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PROOF OF INSURANCE (2021) CLOSEDPolicy Number. VARIOUS Date Entered: 10/8/2020 DATE (MWDDIYYYY) C40RV CERTIFICATE OF LIABILITY INSURANCE 04a.� 10/8/2020 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 CONTACT Diane DeSiZva Mar Barnard Insurance f1�Tw1E: ( ........... ............................-6 MAIL (408)2B6-1334 425 2190 Stokes Streete no e,@barnardinsurance.com 286mm E O9 HONE ADDRESS, Suite 201 (.............. INSURER(S) AFFORDING COVERAGE NAIL P _............................................................_..... San Jose......... ` CA 95128INSURER,A,...... IN SPECIALTY INSURANCE COtdPANY 15989 INSURED Range Maintenance Services, L.L.C. INSURER B:ALLSTATE 19232 35 NSURERC; 'AlE' 4`O1FiY:N-AYE"iit7i�1 .1ti�'S'i1't't2�NCL FUND ... 076 Donna Foggiato I...m...._m............1. ........................ __ 301 Mary Belle Way Angels Camp, CA 95222 INSURERD: 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. j _vr....... .......... ._.... NSR AbDL SUaR pt]LICY EFF POLICY EXp LIMITS A p'1 NAE OF INSURANCE IM,gp D POLICY NUMBER i I��100lYYXYI(MMIDD_!_YYYY�, COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000 CLAIMS -MADE ® OCCUR 0400702136 11/01/20 _. GEHLREGAFELIMIT APPLIES PER: POLICY F-1 J ? F-1 LOC OMLA: AUTOMOBILE LIABILITY B ANY AUTO 648827264 11/1/2020 OWNED SCHEDULED AUTOS ONLY AUTOS NON -OWNED XHIRED AUTOS ONLY AUTOS ONLY Od�MAGE TO REN fE 11/01/2021 100, 000 MED EXP {Anyone personl_$ 5,000 JI PERSONAL 8 ADV INJURY $1,000,000 GENERALAGGREGATE $2,000,000 ...................................................... PRODUCTS- COMP/OP AGG $ INCLUDED COMBINED SINGLE LIMIT $1,000,000 11/1/2021 BODILY INJURY (Per parson) $ UMBRELLA LIAB OCCUR EXCESS LIAB CLAIMS -MADE OED RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N C ANY PROPRIETORIPARTNEWEXECUTIVE11/01/20 11/01/2021 OFFICERIMEMBER EXCLUDED? ❑ ' NIA 17 6 04 32 (Mandatory In NH) If yes, dnsenbo under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/ LOCATIONSI VEHICLES (ACORD 101, Additional Remarks Schedule, may be ettoohed If more spaoe is required) *TEN DAYS NOTICE OF CANCELLATION APPLIES FOR NON–PAYMENT OF PREMIUM 30 DAYS BODILY INJURY (Per accident) $ �PrllP'�# ;,PITfft5� I�AIa.� _..... ...�......................................mm .$ .............. RYY $ EACH OCCURRENCE $ AGGREGATE$ ................................................_ IER EACHACCIDENTY ERH ..E.L.$..1../.000.�'..O.O....--._._...........Ili 0 E.L. DISEASE -EA EMPLOYEE $1,000,000 E . DISEASE -POLICY LIMIT $11"01000 FOR ALL OTHER.. RE: ALL CALIFORNIA OPERATIONS. CERTIFICATE HOLDER IS NAMED AS ADDITIONAL INSURED. CERTIFICATE HOLDER CANCELLATION CITY OF EL SEGUNDO, CITY CLERK ATTENTION: BRIAN EVANSKI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 350 MAIN STREET ACCORDANCE WITH THE POLICY PROVISIONS. EL SEGUNDO, CA 90245 AUTHORIZED REPRESENTATIVE I ©11986.2 15 A 0CORPORAT11614, All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACO POLICY NUMBER: 0400702136 COMMERCIAL GENERAL LIABILITY CG 2010 0413 This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or OroanlzatlonLs): Locatignis) Of Covered Operations "ALL PERSONS OR ORGANIZATIONS AS 301 MARY BELLE WAY REQUIRED BY WRITTEN CONTRACT WITH THE ARNOLD, CA 95222 INSURED." Jnt[WAfiQn_Mpir s Schedule, if r rig. _%Ligso _wn above. wilLb �jmpkto Rhin i. A. Section It — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown, in the Schedule, but only with respect to liability for "'bodily injury", "property damage" or "personal and advertising 4ijury" caused, in whote 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 forsuch 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. AH work, including materials, parts or equipment furnished in connection with such work, on the project (other than set -vice, 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, CG 20 10 0413 (9 Insurance Services Office, Inc., 2012 Page 1 of 2 C. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: 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 Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. Page 2 of 2 C Insurance Services Office, Inc., 2012 CG 2010 0413 0400702136 COMMERCIAL GENERAL LIABILITY CG 20 01 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAR FULLY. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance Condition and supersedes any provision to the contrary: Primary And Noncontelbutory Insurance This Insuranco Is primary to and will not seek contribution from any other Insurance available to an additional Insured tinder your policy provided that: (1) The additional Insured Is a Named Insured under such other insurance, and a (2) You have agreed in writing in a contract or agi m-ment that this insurance would be primary and would not seek contribution frorn any other Insurance available to the additional insured, GG 20 01 04 13 0 Insurance Services Office, Inc., 2012 Page 1 of 1 POLICY NUMBER: 0400702136 COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 1x'11ZM9T11*1j7J:i41111 0 MIUM EAR 6"19-019: 1 A :4M K6111,64 This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTSICOMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization* "ALL PERSONS OR OR(L:,ANIZATI(.)N AS REQUIRED BY WRITTEN CONTRACT WITH THE INSURED." The following is added to Paragraph 8, Transfer Of Rights Of Recovery Against Others To Us of Section IV --Conditions: We waive any right of recovery we may have against the person, or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products - completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 05 09 a insurance Services Office, Inc., 2008 Page 1 of 1 13 648827264 COMMERCIAL AUTO AA CW20101'1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Coverage provided under this policy is modified by the attachment of this endorsement If there Is any conflict in coverage provisions between this form and any state specific endorsement also attached to this policy, the provislon(s) of the state specific form shall apply. This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM In SECTION I - COVERED AUTOS, the following changes are made: The following is added: D. Physical Damage Coverage for Temporary Substitute and Leased Autos If Physical Damage Coverage Is provided: by this policy, the following kinds of "autos" are covered "autos" for the same: coverages provided by the policy: 1. Any private passenger "auto", or other than private passenger vehicle With gross vehicle weight of 20,000 lbs. or less, you do not own while used with the permission of the owner as a temporary substitute for a covered "auto" you own that is out of service because of its: a. Breakdown; b. Repair, c. Servicing; d. 'Loss", or e. Destruction. 2, Private, passenger "autos" and other than private passenger vehicles with gross vehicle weight of 10,,000 Ibs. or less, leased, hired, rented, ;or borrowed for a period of 30 days or less. This does not include any vehicle you lease, hire, rent, or borrow frorn any of your "employees" or partners or members of their households, d. Any organization, other than a partnership or joint venture, over which you maintain ownership or in which you holda majority interest. This provision applies only if there is no similar insurance provided to that organization. e. Any orgarilzation you acquire or form after policy inception, other than a partnership or joint venture, over which you maintain ownership, or in which you hold a majority interest. Coverage under this provision does not apply; (1) If there is similar insurance provided to that organization; or (2) To 'bodily injury" or "property damage" that occurred before you acquired or formed the organization. Any person or organization that you are required to name as an additional' Insured under the terms of a written job contract, or by written insurance requirements executed prior to any covered loss" or claim. This protection applies only if the person or organization is liable for the conduct of an 'Insured" and only to the extent of that liability. Under A Coverage, Coverage Extensions, Supplementary Payments, subparagraphs (2) and (4) are replaced with the following: (2) Up to $5,000 for cost of bail bonds (including In SECTION 11 — LIABILITY COVERAGE, the bonds for related traffic law violations) required following changes are made- because of an "accident" we cover. We do not Under A. Coverage, Who Is An Insured,' the have to furnish these bonds. following is added., Includes copyrighted material of Insurance Services Office, Inc., with its permission AACW201011 Allstate Insurance Company Insured Full Copy Page I of 3 648827264 (4) All reasonable expenses incurred by the "insured" at our request, including loss of earnings up to $500 a day because of time off from work. Under B. Exclusions, Fellow Employee, the following paragraph is added: But this exclusion does not apply to "bodily injury" to a fellow "employee" caused by any person whose position within the insured organization is at or above the level of manager or supervisor, Coverage afforded by this provision is excess over any other collectible insurance, In SECTION III - PHYSICAL DAMAGE COVERAGE, the following changes are made: it - - -- - I • Animal - Falling •.. • Missiless the rollowi is added: I If damage to glass is repaired in lieu of being replaced, no deductible will apply for repair only, Under A Coverage, Coverage Extensions, the following is added: c. Personal Effects Coverage In the event of a total theft of your covered "auto", for which you carry either Comprehensive or Specified Causes of Loss coverage, we will pay up to $500 for the personal effects which are, 1. owned by you; and 2. in your covered "auto'" at the time of the total theft of such "auto". No deductible applies to Personal Effects Coverage. Under A. Coverage, the following is added: 5. Lease and Loan Gap Coverage In the event of a total "loss" to a covered "auto" shown in the Schedule or Declarations for which a specific premium charge indicates that physical damage coverage applies, we will pay any unpaid amount due on the lease or loan for a covered "auto", less: a. The amount paid under the Physical Damage Coverage section of the policy; and b. Any: (1) Overdue lease/loan payments at the time of the'loss", (2) Financial penalties imposed under a lease for excessive use, abnormal wear and tear or high mileage, (3) Security deposits not returned by the lessor; (4) Costs for extended warranties, Credit Life Insurance, Health, Accident or Disability Insurance purchased with the loan or lease, and (5) Carry-over balances from previous loans or leases. Under D. Deductible, the following paragraph is added: When Collision Coverage is provided by this policy, the deductible amount will not be subtracted from the loss payment in collisions involving your covered "auto" and another auto covered by Allstate Insurance Company or any of it's affiliates, In SECTION IV - BUSINESS AUTO CONDITIONS, the following changes are made: Under A Loss Conditions, Duties In The Event Of Accident Claim, Suit Or Loss Condition, the following is added under subpart a: Knowledge of an "accident" or 'loss" by any of your agents, servants or "employees"' shall not in itself constitute knowledge by you, unless you or, one of your corporate officers or managers, or any assignee, shall have received such notice from the agent, servant or "employed". When you report an occurrence of any "accident" or'los:s" to a Worker's Compensation carder or self Insured plan providing the named insured's Worker's Compensation insurance which later develops into a claim submitted under this policy, failure to report such "accident" or 'loss" to us at the same time shall not be deemed a violation of this condition. After you become aware of such liability claim arising from the "accident" or 'loss", you must give us prompt notice, Under A Loss Conditions, Transfer of Rights of Recovery Against Others To Us, the following is added: We waive any right of recovery we may have against any person or organization because of payments we make for injury or damage arising out of work you perform Linder a contract with such person or organization, in which you have agreed to waive your right of such recovery, Includes copyrighted material of Insurance Services Office, Inc., with its permission AA CW 20 10 11 Allstate Insurance Company Insured Full Copy Page 2 of 3 648827264 Under B. General Conditions, Concealment, Misrepresentation Or Fraud, the following is added: This condition does not apply to any omission or failure to provide material facts if the omission or failure was unintentional. Includes copyrighted material of Insurance Services Office, Inc., with its permission AA CW 20 90 11 Allstate Insurance Company Page 3 of 3 Insured Ful Copy AGREEMENT WAIVER OF SUBROGATION BLANKET B.AS I S HOME OFFICE SAN FRANCISCO EFFECTIVE NOVEMBER I, 2020 AT 12.01 A.M. ALL EFFECTIVE DATES ARFAND EXPIRING NOVE ER 11 2021 AT 12.01 A.M. AT 92:01 AM PACIFIC STANDARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME RANGE MAINTENANCE SERVICES, LLC 301 MARY BELLE WAY ANGELS CAMP, CA 95222 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 2.001 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 1760432-20 RENEWAL NA 6-17-16-03 PAGE I OF 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: NOVEMBER 1,2020 i!I qTE 9fti?97FI 3 (:k I RF4FP+C p P1F PPPO 1FRIT Amn rr-n 2572 I