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PROOF OF INSURANCE (2021 - 2021) CLOSEDoR CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 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(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(s). PRODUCER Ed�eWood partners Insurance Center (EPIC) 198100 MacArthur Blvd. PH Floor Irvine, CA 92612 A: GuideOne National INSURED Robert's Liquid Disposal Inc. 14018 Carmenita Rd. Santa Fe Springs CA 9067C COVERAGE-9 CERTIFICATE NUMBER: Add.9;n7A7 REVISION NUMBER: 141 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'.. INSR TYPE OF INSURANCE A POLICY NUMBER MM DD� LTR Y MMIOOPYYYY LIMITS A COMMERCIAL GENERAL LIABILITY ✓ ENV562000053-02 3/5/2020 3/5/2021 EACH OCCURRENCE $1,000000 CLAIMS -MADE � OCCUR ITK'REM.tISE a ar'unnencol ._ $ 50 000 MEO EXP (Any one person) $ 5,000 PERSONAL& ADV INJURY $1,000.000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE 12,000,000- ✓ PR POLICY JN` LOC PRODUCTS -COMP/OP AGG $ 2.000,000 OTHER: $ AUTOMOSIL'ELIABILTrY COMBINED INGLELI IT ka acridenl'I $ - ..... ANY AUTO BODILY INJURY (Per person) $ �m _ CBODILY OWNED .... . (���� B BODILY INJURY Per accident) $ AUTOS ONLY AUTOSSHEDULED HIRED NON -OWNED _"R_0F& NOAMAGE' CPrxr kxdOfhRp $ AUTOS ONLY AUTOS ONLY A UMBRELLA LIAO v OCCUR ENV562000054-02 315/2020 3/5/2021 EACH OCCURRENCE $4,000 000 ,(IEXCESS AGGREGATE $4 000 000 LIAB J_JCLAIMS-MADE OED I ✓ RETENTION$ 10,000 $ WORKERS COMPENSATION OlH STATUTE AND EMPLOYERS' LIABILITY Y❑ ._.-_. ANYPROPRIETOR/PARTNER/EXECUTIVE E,L. EACH ACCIDENT $ OFFICER/M EMBER EXCLUDED? (Mandatory In NH) NIA E,L, DISEASE - EA,EMPLOYEE'! $ If yyes, describe under DESORIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT I $ A Pollution Liability i ENV562000053-02 3/5/2020 3/5/2021 $5,000,000 per Occurrence/Aggregate Limit Transportation Pollution Liability 55,000,000 per Occurrence/Aggregate Limit DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) Certificate holder is named as additional insured as respects the general Iiabli ty;, but only if required by written contract with the named insured, prior to an occurrence, per form CG 2010 071 4 & CG2037 07104 subject to all policy terms and conditions. City City of El Segundo, De artent of Public Works 1 Illinois Street El Segundo CA 902453813 L•a:aaWit 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 D'Asaro W 7JStl-ZUTO AL UKU VVKrVRAI IVIII. All rlgnib reberveu- ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 54450787 1 20-21 GL/UMB AI MAIN MASTER I Tina Coleman 1 3/4/2020 10:51:53 AM (PST) I Page 1 of 4 AGENCY CUSTOMER ID: LOC #: Ate, ADDITIONAL REMARKS SCHEDULE Page of AGENCY NAMED INSURED Ed ewood Partners Insurance Center EPIC 9 (EPIC) Robert's Liquid to . Inc. �94g18 Carmenita �d. Santa Fe Springs CA 90670 POLICY NUMBER CARRIER NAIC CODE EFFECTIVE DATE: ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ADDENDUM 54450787 1 20-21 GL/UME Al MAIN MASTER I Tina Coleman 1 3/4/2020 10:51:53 AM (PST) I Page 2 of 4 Robert's Liquid Disposal Inc. POLICY NUMBER: ENV562000053-02 COMMERCIAL GENERAL LIABILITY CG 2010 07 04 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 Oroanization(s): Any person or organization for whom you are performing In respect to any location where the named insured is operations when you and such person or organization have performing "your work". agreed in writing in a contract or agreement, effected prior to the date your operations for that person or organization commenced, that such person or organization be added as an additional insured on your policy. LE A. Section 11— Who Is An Insured is amended to include as an additional insured the person(s) or organizations) 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. CG 20 10 07 04 a B. With respect to the insurance afforded to these additional insureds, the following additional exclu- sions apply. This insurance does not apply to "bodily injury' or "property damage" occurring after: 1. All work, including materials, parts or equip- ment 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. © ISO Properties, Inc. That portion of "your work" out of which the injury or damage arises has been put to its in- tended use by any person or organization other than another contractor or subcontractor en- gaged in performing operations for a principal as a part cf the same project. 2004 Page 1 of 1 544507B7 1 20-21 GL/UMR Al MAIN MASTER I Tina Coleman 1 3/4/2020 I0:51:s3 AM (PST) I Page 3 of 4 Robert's Liquid Disposal Inc. POLICY NUMBER: ENv562000053-02 COMMERCIAL GENERAL LIABILITY CG 20 37 07 04 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 SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): I Location And Description Of Completed Operations Any person or organization for whom you are performing In respect to any location where the Named insured is operations when you and such person or organization have performing "your work." agreed in writing in a contract or agreement, effected prior to the date your operations for that person or organization commenced, that such person or organization be added as an additional insured on your policy Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section It - Who Is An Insured is amended to include as an additional insured the person(s) or organizations) shown in the Schedule, but only with respect to liability for "bodily injury" or "property dam- age" caused, in whole or in part, by "your work" at the location designated and described in the sched- ule of this endorsement performed for that additional insured and included in the "products -completed operations hazard". CG 20 37 07 04 ® ISO Properties, Inc., 2004 Page 1 of 1 54450787 1 20-21 GL/UMB Al MAIN MASTER I Tina Coleman 1 3/4/2020 10:51:53 AM (PST) I Page 4 of 4 6 DATE(MMIOD/YYYY) CERTIFICATE OF LIABILITY INSURANCE I01/26/2021 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(ies) must be endorsed. It 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). PRODUCERw" Kristina/Marisol Beth Bett er Insurance Agency, Inc. 9WC. ,562-496-1000 � 96 Nob 552 8 "� � W StateFarm 20220 State Road ADOREss: marisol bethbett er.com- 9 Cerritos, CA. 90703 _.1_...... INSURERe(S?AFFORDING COVERAGE NAIC p INSURER A:State Farm Mutual Automobile Insurance Company 25178 INSURED Roberts Liquid Disposal Incorporated orated INSURERS: 14018 Carmenita Rd INSURER C : Santa Fe i s Sp ring CA 90670-4 _ INSURER D919 _.. 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. , INSR TYPE OF INSURANCE IN9D YOM _ POLICY NUMBER 060cf-0 (MMQQ1yyYY1 LIMITS ( COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE. S C'NJlLU ...�.. CLAIMS -MADE OCCUR PR I ; ? 94 iga rran $ MEd EXP {Ar . one person) S PERSONAL 8 ADV INJURY GENERAL AGGREGATE S ' $ r B @ 9 GEN'L. AGGREGATE; LIMIT APPLIES PER: r E] JERQ ❑ s POLICY LOC PRODUCTS -COMPIOPAGG o S S OTKEk mm� nuroMoeILEL1ABILITY j Y 244-3054-B01-75 02/01/2021 08f01/2021l;a�(aGLE L9 s 2,000,000 q ANY auro 6 P73-6862-A06-75 olroelzozl o7rosnozl BODILY INJURY (Per person) I S I BODILY INJURY (Per accident) S mm AUTOS X AUTOSULED 413 8508-B03.75 02/03/2021 0810312021 X X. AUTOSON-OEO u pvaP Fdm' h. 5 HIREDUTOS 244-3052-B01-75 02/01/2021 08101/2021 5 UMBRELLA LIAB I OCCUR EACH OCCURRENCE S EXCESS LIAB CLAIMS -MADE AGGREGATE S DIED RETENTIONS s _E '.. WORKERS COMPENSATION ' TqT TE Eii AND EMPLOYERS' LIABILnY YJ N W ANY PROPRIETORIPARTNER/EXECUTIVE E,L. FJ4CH ACCIDENT S OFFICERIMEMBER EXCLUDED? NIA ' (Mandatory in NH) E.L. DISEASE - EA EMPLOYE S It c!S. doscfte w�dex' DSCR'IPTION OF OPERATIONS below E.L. DISEASE - POLIOY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS! VEHICLES (ACORD 101, Addlaenal Remarke Schedule, may be ettathed If mere space Is roquired) This insurance is Primary and Non -Contributory with the respects to claims arising out of the operation of the described vehicle, WAIVER OF SUBROGATION ADDED 2018 Ford Tank Truck Policy EFF; 01/07/2021 Policy EXP; 01/07/2022; POLICY NUMBER: 603-2889-A07-75C 2003 Ford F250 EFFA 1/20/2020 EXP: 05/2012021; POLICY NUMBER: 296 5590-E20-76T 2020 Freight -liner M2 106 Flat Bed Truck EFF:1210612020 EXP: 061D6J2021- POLICY NUMBER: 663 3372-FO6-75E i CERTIFICATE HOLDER UANULLLA IIUN CITY CLERKS OFFICE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITY OF EL SEGUNDO THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 350 MAIN ST. ACCORDANCE WITH THE POLICY PROVISIONS. EL SEGUNDO, CA 90245 AuTHORVID REPRESENTATIVE a :: iMfwTalrfwT.fItay�iliC+�7► 1 ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD 1001486 132849.9 02-04-2014 CERTHOLDER COPY SC P.O. BOX 8192, PLEASANTON, CA 94588 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 01-25-2021 CITY CLERK'S OFFICE CITY OF EL SEGUNDO SC 350 MAIN ST EL SEGUNDO CA 90245-3813 GROUP: POLICY NUMBER: 1448891-2020 CERTIFICATE ID: 390 CERTIFICATE EXPIRES: 12-31-2021 12-31-2020/12-31-2021 This is to certify that we have issued a valid Workers' Compensation insurance policy in a farm approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 30 days advance written notice to the employer. We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other, document with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy. Authorized Representative President and CEO EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE, ENDORSEMENT ##2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 12-31-1998 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. ENDORSEMENT ##1651 - PEGGY HERRICKS P - EXCLUDED. EMPLOYER ROBERT'S LIQUID DISPOSAL INC SC 14018 CARMENITA RD SANTA FIE SPRINGS CA 90670 [CK6,CN] (REV.7-2014) PRINTED : 01-25-2021