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PROOF OF INSURANCE (2021 - 2021) CLOSED?" DATE (MMIDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE �.- 01 /2512021 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). CONAc PRODUCER Becky Huddle Insurance Agency Rebecca Huddle NA.NwlE,,,,.,, ,,,,,,,,, ...., ...� ........,�-- ............... ......." 729 Sunrise Ave Ste 504 PHONE 916-789-7500IcFAXNp) 916 789 2545 dA..dY,.l ac(h. __.__ .... _ ----- Roseville CA 95661 A prn z, staff. rhuddl+l aferl er anencV.corn MID CENTURYFINSURANCE FCIRDING GE �21687nic# INSURED Lotus Communications, LLC INSURERS: .INSURE,.µ.. ... .... ..,. 2084-B Central Avenue ....... .. ...- ........ ........... R C INSURER. ,�..- .. ......... _.......................... ........�.�IT ......... ............. Duarte, CA 91010 D INSURER E -- INSURER F CnVI=RAr:FS CFRTIFIrATF Nl1MRFRE 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. -----LTR TYPE OF IN. .... ....... .. _ .SURANCE ,___-----Abac ... ... INSDI'�Ii`i�R .....m..POLICY POLICYI='iaF WVD NUMBER MMIpO .„...�. ...... ... - ....... POLi'CYE?CP MMAODfYYYY �.. LIMITS Y COMMERCIAL GENERAL LIABILITY Li EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADED OCCUR 60669-02-33 10/1/2020 Y7AMAGETtYk NIE0 --- .. 10/1/2021 PREMISES ( a nrcueren.cei $ 100,00 MED EXP (Any one person) s5,000 PERSONAL&ADVINJURY $ 1,000,000 G' LIMIT APPLIES PER EN'L AGGREGATE GENERAL AGGREGATE $ 2,000 ,000 ,r PE^)G- y POUCY LOC �..00, . . PRODUCTS- COMP/OP $ 2,000,000 JE�CT .AGG $ O1HEW AUTOMOBILEANY COMBINED s.NGP..E LIPIT $ 1,000,000 A AUTO 60680-17�7 117/23/2020 7/23/2021 BODILY INJURY (Per; $ i OWNED SCHEDULED BODILY INJURY Peracciden.. Y ._,.... ....................... ........ $ AUTOS ONLY - AUTOS HIRED NON -OWNED PkOPrymu 6E ER $ AUTOS ONLY AUTOS ONLY L,..((aer acnalerf„C,) .... ........ ..... ........... ........ 1 $ ✓ UMBRELLA LIAB UM occuR I EACH I `_ OCCURRENCE,,,, $ 5,000,000 A LESS LIAB CLAIMS MADEI EX____ .... .... � 60669-09-68 f 10/1/2020 -10/1/2021 AGGREGATE f $ 5,000,000 DED RETENTION $ i : $ WORKERS COMPENSATION PER OTH STAT,TE f 1 AND EMPLOYERS' LIABILITY Y / N ANYPROPRIETOR/PARTNER/EXECUTIVE N/A A0949-23-59 10/112020 ,ER 10/1/2021 E L. EACH ACCIDENT ..... .......... $ 1,000, 000 ... ...... .. OFFICER/MEMBEREXCLUDED� Li in E SE EA EMPLOYEE. 1,000,000 $ 000,00 If yes, describetunlder 1,000,000 . DESCRIPTION OF OPERATIONS below E SE - POLICY LIMIT E L DISEASE $ Ell DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) 30-DAY NOTICE OF CANCELLATION, 10-DAY NOTICE OF NON-PAYMENT OF PREMIUM WAIVER OF SUB: workers' comp ADDITIONAL INSURED (COMPLETED OPERATIONS): The City of El Segundo CERTIFICATE HOLDER CITY OF EL SEGUNDO 350 MAIN STREET, ROOM 6 EL SEGUNDO, CA 90245 ACORD 25 (2016/03) 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 REPRESENTATIV i ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: 60669-02-33 COMMERCIAL GENERAL LIABILITY CG 20 37 04 13 Lotus Communications, LLC 2084-B Central Avenue Duarte, CA 91010 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY ADDITIONAL INSURED --- OWNERS, LESSEES OR CONTRACTORS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY Name of Person or Organization: SCHEDULE The City of El Segundo WHO IS AN INSURED (section II) 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". "THE INSURANCE AFFORDED BY THIS POLICY FOR THE ADDITIONAL INSURED (S) IS PRIMARY INSURANCE AND ANY OTHER INSURANCE MAINTAINED BY OR AVAILABLE TO THE ADDITIONAL INSURED (s) IS NON-CONTRIBUTING" CG 20 37 04 13 POLICY NUMBER: 60669-02-33 COMMERCIAL GENERAL LIABILITY CG 20 10 07 04 Lotus Communications, LLC 2084-B Central Avenue Duarte, CA 91010 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 Person(s) or Organization(s): The City of El Segundo CG 20 10 07 04 91-0002 (E 0002) 1.i EDITION 3-88 Printed in U.S.A. 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. 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. CG 20 10 07 04 91-0002 (E 0002) U EDITION 3-88 Printed in U.S.A.. POLICY NUMBER: 60680-17-47 COMMERCIAL AUTOMOBILE LIABILITY CA 35 99 01 07 Lotus Communications, LLC 2084-B Central Avenue Duarte, CA 91010 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY ADDITIONAL INSURED --- PRIMARY COVERAGE This endorsement modifies insurance provided under the following. COMMERCIAL AUTOMOBILE LIABILITY Name of Person or Organization: SCHEDULE The City of El Segundo Each person or organization shown in the Schedule is an "insured" for Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured Provision contained in Section II of the Coverage Form. The inclusion of additional interest or interests will not operate to increase the limit of our liability "THE INSURANCE AFFORDED BY THIS POLICY FOR THE ADDITIONAL INSURED (S) IS PRIMARY INSURANCE AND ANY OTHER INSURANCE MAINTAINED BY OR AVAILABLE TO THE ADDITIONAL INSURED (s) IS NON-CONTRIBUTING" POLICY NUMBER: 60669-02-33 60680-17-47 Lotus Communications, LLC 2084-B Central Avenue Duarte, CA 91010 COMMERCIAL GENERAL LIABILITY COMMERCIAL AUTOMOBILE LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY/ COMMERCIAL AUTOMOBILE LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization-, The City of El Segundo As required by contract, provided the contract is executed prior to loss. (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) The TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Condition (Section IV — COMMERCIAL GENERAL LIABILITY CONDITIONS) is amended by the addition of the following: 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. INSURANCEFARMERt WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY INSURANCE POLICY Named Insured • Lotus Communications, LLC • 2084-B Central Avenue • Duarte, CA 91010 WC 99 06 19 Effective Agent A0949-23-59 2020 Date 10/112020 95-39-36A Policy Number Policy of the Company Year WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - BLANKET 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 for which you perform work under a written contract that requires you to obtain this agreement from us. The additional premium for this endorsement shall be 3.0 % of the Workers' Compensation premium otherwise due for the state(s) listed below on such remuneration, subject to a minimum charge of 250 . All written contracts in the state(s) of: CA This endorsement is part of your policy. It supersedes and controls anything to the contrary. It is otherwise subject to all the terms of the policy. Countersigned Authorized Representative 93-6369 1ST EDITION 9-07 WC990619A J6369111 PAGE 1 OF 1