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PROOF OF INSURANCE (2021 - 2022) CLOSEDKRAUACT-01 LORALEEBARLOWBOYES CERTIFICATE OF LIABILITY INSURANCE DATE 12(MM//22/2020Y) 020 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 olic ies) must have ADDITIONAL INSURED provisions or be enm-.. rsed... 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 N,F9_E NFP Property& Casualty Services, Inc. 1551 North Tustin Avenue PHONE (Arc sir Ex*(714 505-5550 aAr:! Nory�(71 ) 975-89 6 Suite 500 E-MAIL Santa Ana, CA 92705 INSURE.R(S) AFFpRDING COVERAGE NAIC,� INSURER A: Colony, Ins„yrance Coman.,.. P Y . 39993 e, INSURED .�..�.....,.,, I,NSURER8 i Insurance Comp 811„y( Of the_West ,......,... 27847 M Krause ACT, Inc. DBA Air Cleaning Technology JNSURER C ... 411 Rowland Ave INSURER D : Santa Ana, CA 92707 INSURER E .............. INSURER F 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. __1A�lO.I?/YNYY! rM 1,011 00,000 INSD YA)ll�__._...._... CY EXP LIMITS A _ X COMMERCIAL GENERAL LIABILITY ADDL SUBR POLICY EFF POLI TYPE OF INSURANCE POLICY NUMBER ,EACH OCCURRENCE 50 000 CLAIMS -MADE X ,OCCUR X PACE4245133 3/7/2020 3/7/2021 EREMI9ES IFa �r�„ �n,��1 � DAMAGE TO RENTED 300,000 I j („ny, one person) S EDBXP A „®..., ,,PERSONAL,,. ADV INJURY $ 1,000,000 _ N t. AGGREGATE LIMIT APPLIES PER: ,GENERAL AGGREGATE $ 2,000 000 POLICY X JERCOT° D LOG PRODUCTS-COMP/OPAGG $ 2,000000 01"HER:' "............�.,.._ .,.._._._ .......... w... .........,..............._. .._.... _....._...._. 'COM#dfMYED SII..GLI, L...lr AUTOMOBILE LIABILITY ANY AUTO BODILY,INJURY (Per, person) T ,,,,„, OWNED ' SCHEDULED AUTOS ONLY AUTOS —BODILY INJURY (Per, accident), $ .. , AUTOS ALlTN47Gy4,FS.Y V�i�tOPERIY $ (&e.r�accrrleantlUAMA'F ONLY S A UMBRELLA LIAB X OCCUR ".� EACH OCCURRENCE 5.._ 4 X EXCESS LIAB CLAIMS -MADE „ ..... i EXC4245134 i 3/7/2020 I 3/7/2021 i 4 AGGREGATE . ...., � � _ DED RETENTION$ ... .. .... B WORKERS COMPENSATION X PER OTH STATUTE ER ND EMPLOYERS' LIABILITY / A Y.. N X WSD505860800 1/1/2021 1l1/2022 , . 1 ANY PROP RIETOR/PARTN ER/EXECUTIVE %CJJ� FFPCER/MEMBER EXCLUDED? N / A : F L EACH ACCIDENT $, m, ' ,.1 ndatory in NH) B_ SE, EA EMPLOYEE° $.._. .L RISEA,,,. If yes, describe under DESCRIPTION OF OPERATIONS below ....................F ............_..... 1 1. DISEASE a.- Pollution Prof Liab .._ _ ...__ ,. ..�.. ,PACE4245133 3/712020 3/7/2021 (Limit 1 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101„Additional Rommks Schedule, may be attached it more space is required) RE: El Segundo Fire Department, 314 (Main Street, El Segundo„ CA 90245. The City of El Segundo is included as Additional Insured with regard to General Liability per attached forms EPACE100-0814 & EPACE101-0814. Waiver of Subrogation applies to Workers' Compensation per attached form WC990634. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of El Segundo ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street El Segundo, CA 90245 ..............-.m......_.....................�. .._..... w......._.,. AUTHORIZED REPRESENTATIVE t4a U_AoA ACORD 25 (2016/03) .... _.._........ _. _.....--......... © 1988-2..._.. _.._.......... ...- 015 ACORD CORPORATION. All rights reserved.. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: PACE4245133 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: EnviroPACE Insurance Policy SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations Where Required By Written Contract Where Required By Written Contract A. Section XX. WHO IS AN INSURED, Coverage Part 1 and Part 2 is amended to include as an additional insured the person(s) or organization(s) shown in the SCHEDULE above, but only with respect to liability for bodily injury, property damage, environmental damage, or cleanup costs 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. B. With respect to the insurance afforded to these additional insureds, the following is added to section XXI. LIMITS OF LIABILITY AND DEDUCTIBLE: 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 Liability shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Liability shown in the Declarations. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. EPACE100-0814 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 1 with its permission. POLICY NUMBER: PACE4245133 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. • r • This endorsement modifies insurance provided under the following: EnviroPACE Insurance Policy SCHEDULE Name Of Additional Insured Person(s) Or Or anization s Locations Of Covered O erations Where Required By Written Contract Where Required By Written Contract A. Section XX. WHO IS AN INSURED, Coverage Part 1 and Part 2 is amended to include as an additional insured the person(s) or organization(s) shown in the SCHEDULE above, but only with respect to liability for bodily injury, property damage, personal and advertising injury, environmental damage, or cleanup costs 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. EPACE1 01 -0814 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 2 with its permission. C. With respect to the insurance afforded to these additional insureds, the following is added to section XXI. LIMITS OF LIABILITY AND DEDUCTIBLE: 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 Liability shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Liability shown in the Declarations. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. EPACE101-0814 Includes copyrighted material of Insurance Services Office, Inc., Page 2 of 2 with its permission. C4: DATE (MMlDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE F08/13/2020 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(ies) must 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). T ER Da.�rAx Dan Rickabus r NAIL 363 7100 949 .. ����� • Xa949 Perry LNg'No), 363 1836. . PRODUCER State Farm Insurance (09 �.rllll ' 5.1 )I ' 1 4. DfeEss, kaih ne pe .itff( statetarm com 30131 Town Center Drive, Suite 275 - - - - M� - ---m- "y. Laguna Niguel, CA 92677__,,_WnIN§9RgR(1IAFFORD INGCOVERAGE NAICO INSURER a State Farts Mutual Automobile Insurance Company 25178 Krause A C T INSURED ��m.,w... INSURE.. RB. DBA Air Cleaning Technology INSURERC: 411 Rowland Ave INSURERD: Santa Ana, CA 927073445 rNBNURERE: COVERAGES rFRTIPCr.AT r- MIIII RFR- RFVISIntd MI IMRFR- 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 S11 UCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. .lim ...,_,.m..._...._.TYPEOFINSURANCE Ab'DC3'0� ..,�.... .. m_._..,�-, .aA -- POt,10Y��_� t"tii.p0"N EXP .,.�._ ....... ,_ , ........- __... POLICY NUMBER MM! ODP1fYi" M ODlY 1''.. LIMtlTS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ a AMACF70'99NY90 . CLAIMS -MADE u OCCUR Ckasocc arro $ .. MED EXP (Any one person) $ .. , I1E!q QNAL11AOV' IIbUURY $ . GFN L AGGREGATE LIMITI APP L❑IESLOC l 6 CC6 PRODUCTS COMP,IOPAGG $......... WHER A AUTOMOBILE LIABILITY Y 545 8874-001-75 09/01/2020 03/01/2021 D �NGL LIMIT � $ 1 000 000 ANY 5191539-001-76 09/01/2020 03/01/2021 JURY (Per person) $ NED SCHEDULED AUTOS 545 1763-CD1-75 INJURY (Peraccidenl) 09/0112020 03/01/2021 _. - _ BODILY INJ.Ii.. $ NON OWNED HIRED AUTOS AUTOS 4971093-001-75 PROPC 09/0112020 03/01/2021 DAMAI`�E F?r accddrrn , ... 6, U .__. $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR E D... ; AGGREGATE $ _ .... . T....-_..._RETENTION. ._.L�CLAIMS-MA DEO V $ $ WORKERS COMPENSATION PEfS 14, AND EMPLOYERS' LIABILITY y! N '���... S„rF,k',l"I .. _— ANY PROPRIETOR/PARTNER/EXECUTIVE N ! ;.E,L. EACH ACCIDENT OFFICERIMEMBER EXCLUDED? (Mandatory In NH) A E.L DISEASE - EA EMPLOYE $ If ea, dascAbo under yy • ..... . , ..�. ... ............... _._.�.._....-. DESCRIPT90h1 OF OPERATIONS below EL DISEASE -POLICY LIM11' $ A ENOL Y 507 2162-001-75 09/01/2020 03/0112021 $250 Physical Damage deductible DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached N more space Is required) City of El Segundo, its officials and employees are named additional insured Location: El Segundo Fire Department L;1zK1It1UAIIE I ULtJt:K CANCELLATION F3Main egundo Fire Department SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE St THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN egundo, CA 90245 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 6 ©1988-2014 ACORD CORPORATION. All ghte reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD 1001486 132849.9 02-04-2014 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 06 34 (Ed. 8-00) 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 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% of the total California Workers' Compensation premium otherwise due. ANY PERSON / ORG WHEN REQUIRED BY WRITTEN CONTRACT Schedule e- NM ALL CA OPERATIONS .W,,, ,,,,.,.... , .. .. ,...w...,,. „... ,.,s Policy Number: WSD 5058608 00 Insured: Krause ACT, Inc. Endorsement Effective: 01/01/2021 Issue Date: WC 99 06 34 (Ed. 8-00) Coverage Provided by: Insurance Co of the West Countersigned by: