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PROOF OF INSURANCE (2021) CLOSEDPage I of 2 ACCW@� 01/o4/2021 CERTIFICATE OF LIABILITY INSURANCE DATE (M/zozl 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). Willis Towers Watson Northeast, Inc. ONE 1-877-945-7378 te Center PRODUCER CONTACT Willis Towers Watson Certifies C/o 26 Century Blvd ES(r _ F Nsl; 1-886-467-2378 �. P.O. Box 305191 [56DMDRESS: ce:rtificatenewillis.com Nashville, TN 372305191 USA INSURER(8)AFFORDING COVERAGE NA)C11 INSURER A: XL Insurance America Inc I 24554 INSURED INSURERB: Travelers Property Casualty Company of Ame 25674 Fieldturf USA, Inc. c/o Sports Division INSURER C: Travelers Indemnity Company of America 25666 Tarkett Inc. INSURER D: Charter Oak Fire Insurance Company 25615 7445 Cote-de-Liease Road, Suite 200 INSURER E: Montreal, OC K4T 1G2 CAN INSURER F: COVERAGES CERTIFICATE .NUMBER. W19749182 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. m R I TYPE OF INSURANCE ADOL SUB''R POLICY EFF POL(CY EX'P I POLICYNUMBER 1'MWDDIYYYY'1', dMMz0IYYYYI LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000' ED CLAIMS -MADE I -' II OCCUR PREWDAMAGE lEaoc uff 500,000', PF'EE��Mr�S�EStEreos'cutrem.cal S A I, MED EXP (Any one person) $ 10,000 Y Y US00010327LI20A 05/01/2020 05/01/2021 ppPERSONAL&ADV INJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: g GENERAL AGGREGATE S 2,000,000 POLICY ❑ PRO- JECT F-]- - - -- - - 2,000,000 LOC PRODUCTS -GOMPIOP AGG $ OTHER, j IS AUTOMOBILE LIABILITY ''I COMBIN'EDSdNOLELIMIT ' Me ar.60anlR $ 2,000,000 -- ANY AUTO BODILY INJURY (Per person) $ ''yy5 B OWNED SCHEDULED TC2ICAP-823K312A-20 09/28/2020 05/01/2021 BODILY INJURY (Per accidenl) S AUTOS ONLY AUTOS HIRED NON -OWNED F"ROPTY OHMAGE $ AUTOS ONLY AUTOS ONLY dear acddenli $ UMBRELLA LIAR T7i' ' OCCUR EACHOCCURRENCE $ EXCESS LIAR CLAIMS -MADE AGGREGATE S DED V RETENTION$ S WORKERS COMPENSATION m PER V DIM AND EMPLOYERS' LIABILITY Y I N C ANYPROPRIETORIPARTNERIEXECUTIVE E.LEACHACCIDENT $ 1,000,000 OFFK:ER/MEMBERExCLUDED7 No NIA Y UB-BP793534-20-51-K 09/28/2D20 05/01/2021 'mm"IT'm'-'-• (Mandatory In NH) £.L. DISEASE - EA EMPLOYEES 1,000,000 I( yes, describe under 1,000,000 ',DESCRIPTIONOFOPERATIONSbelow E.L DISEASE -POLICY LIMIT $ D ',Workers Compensation S Y UB-SP760619-20-51-R 09/28/2020 05/01/2021 E.L. Each Accident $1,000,000 Employer's Liability E -L. Disease-Pol Lmt $1,000,000 Work Comp - Per Statute S.L. Disease -Each EmF $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if mare space Is required) This Voids and Replaces Previously issued Certificate Dated 01/04/2021 WITH ID: W19747877. WC Policies: Policy M UB-BP793534-20-51-K- covers all other states. Policy $ UB-SP760619-20-51-R- covers AZ, MA, OR, WI only CERTIFICATE HOLDER City of E1 Segundo 2261 East Mariposa Avenue El Segundo, CA 90245 ACORD 25 (2016103) Ii 'lp'mUly 1'gyord by jo"r' n r� � i.V !b6u f?R;wrp-rip•.rr�1Y L lilio. ity,.d( Joseph III,,,,,,,, i i r W a , t2I nnri,�f',11-IIIU:Pe��;, u,!is^'ggu'n11G rt.,urta,a I�`� D,,',,: i4MTllll1541-4 �."1 I111,61 '.. 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 ©1988-2016 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SIX ID: 20555982 RKTCH: 1933280 AGENCY CUSTOMER ID: LOC #: ACC>RL> ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED Fieldtur£ USA, Inc. n Northeast, Inc, c/o sports Division Willis Towers Watson -...w �-.......... POLICY NUMBER Tarkett Inc. See Page 1 7445 Cote-de-I,iesse Road, Suite 20D - . ..... -- - ---- Montreal, QC H4T 1628 CARRIER NAIL CODE See Page 1 See Page 1 EFFECTIVE DATE: See Page 1 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance Project - City of El Segundo - Repair - 14027122. City of El Segundo, its officials, and employees are included as Additional Insureds on the General Liability policy, as respects to the liability arising out of ongoing and completed operations performed on the project specified in the construction contract for the period of time required within the contract. It is further agreed that such insurance as is afforded shall be Primary and Non-contributory with any other insurance in force for or which may be purchased by the City, where required by written contract executed prior to loss and permitted by law. Waiver of Subrogation applies in favor of Additional Insureds with respects to General Liability and Workers Compensation coverage where required by written contract subject to policy terms and conditions and as permitted by law. ACORD 101 (2008101) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SR ID: 20555982 BATCH: 1933280 CERT: W29749182 H POLICY NUMBER: US00010327LI20A Effective: 05101120-21 COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 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: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Any person or organization that you are required in a written contract or written agreement to include as an additional insured provided the "Bodily Injury" or "Property Damage" occurs subsequent to the execution of the written contract or written agreement. Location(s) Of Covered Operations As required per written contract Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — 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 injury' 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. C. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: CG 20 10 0413 © Insurance Services Office, Inc., 2012 Page 1 of 2 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 © Insurance Services Office, Inc., 2012 CG 2010 04 13 �7L POLICY NUMBER: US00010327LI20A Effective: 05101120-21 COMMERCIAL GENERAL LIABILITY CG 20 37 04 13 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: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations Any person or organization that you are required As required per written contract in a written contract or written agreement to include as an additional insured provided the "Bodily Injury" or "Property Damage" occurs subsequent to the execution of the written contractor written agreement. .................... Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — 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" or "property damage" 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. CG 20 37 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 2 B. 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 © ISO Properties, Inc., 2004 CG 20 37 0413 9 JL POLICY NUMBER: US00010327LI20A COMMERCIAL GENERAL LIABILITY Effective: 05/01/2020 - 05/01/2021 CG 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following; COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: Any person or organization that you are required in a written contract or written agreement to waive any right of recovery we may have against the person or organization, provided the 'Bodily injury" or "Property Damage" occurs subsequent to the execution of the written contract or written agreement. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph S. 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 Cl Insurance Services Office, Inc., 2008 Page 1 of 1 TRAVELERSJ ' , WORKERS COMPENSATION AND ONE FOSQUARE HARTFORD,RTPORDRD, CT 06189 EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 00 03 13(00)-01 POLICY NUMBER: UB -8P793534 -20-51-K WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT 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.) This agreement shall not operate directly or indirectly to benefit any one not named in the Schedule. SCHEDULE DESIGNATED PERSON: DESIGNATED ORGANIZATION: ANY PERSON OR ORGANIZATION FOR WHICH THE INSURED HAS AGREED BY WRITTEN CONTRACT EXECUTED PRIOR TO LOSS TO FURNISH THIS WAIVER. MEMOM-RIMI �L TRAVELERSJ WORKERS COMPENSATION AND ONE TOWER SQUARE EMPLOYERS LIABILITY POLICY HARTFORD, CT 06183 ENDORSEMENT WC 99 0376 ( A)- 001 POLICY NUMBER: UB-8P793534-20-51-K WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT- CALIFORNIA (BLANKET WAIVER) 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. The additional premium for this endorsement shall be 0. 00 % of the California workers' compensation pre- mium. Schedule Person or Organization Job Description ANY PERSON OR ORGANIZATION FOR WHICH THE INSURED HAS AGREED BY WRITTEN CONTRACT EXECUTED PRIOR. TO LOSS TO FURNISH THIS WAIVER. 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 Policy No. Endorsement No. Insured Premium Insurance Company Countersigned by DATE OF ISSUE: 09-28-20 ST ASSIGN° Page 1 of 1