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PROOF OF INSURANCE (2021) CLOSEDCERTIFICATE OF LIABILITY INSURANCE DATE(1vM'ODr'YYYY) 09.'t 7; 2020 F 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. 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). PRODUCER Aon Risk insurance Services West, Inc. LOS Angeles CA Office 707 Wilshire Boulevard Suite 2600 CONTACT N---(866} Z83-7122 TAX (800) 363-0105 (AIQ No. Exl): A+C. No. E-14AIL ADDRESS: LOS Angeles CA 90017-0460 USA INSURER(S) AFFORDING COVERAGE NAIC it INSURED INSURER A: Arch insurance Company 11150 ACCO Engineered Systems, Inc. 888 East walnut Street Pasadena CA 91101 USA INSURERS: Arch Indemnity insurance Company 30830 INSURERC: Berkley Assurance Company 39462 INSURERD: steadfast Insurance Company 26387 INSURER E: National Fire & Marine Ins Co 20079 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. Limits shown are as requested LS TYPE OF INSURANCE INSO WVD POLICY NUMBER MM;ppryYY MNVDDtYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY PKG t7U7UTT= EACH OCCURRENCE 52,000,000 OLAiMSF.iADE X OCCUR AMA RENTED PREP."ISES Ea nccurrenccl .�.,,..-___ $300,000 MED EXP {Any one person) -.,,.... $ 5 , 000 M. PERSONAL$ ADV INJURY $2,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S4,000,000 POLICY II JEC7 PRO- a LOC PRODUCTS-COMR OPAGO S4,000,000 OTHER' A AUTOMOBILE LIABILITY Y Y 71PKG8949203 10/01/2020 10,/01/2021 COM IN ED SINGLE LIMIT IEa accld - n€ S2,000,000 BODILY INJURY I Per mrson) x ANYAUTO OWNED SCHEDULED BODILY INJURY (Per accident` AUTOS ONLY AUTOS HiREDAILROS NON•OWNEO PROPERTY DAMAGE ONLY AUTOS ONLY Per acrido+�tl E UMBRELLALIAB X OCCUR 42xsF3o305805 1O/0112020 1Qi01J20?1 EACH OCCURRENCE S4,000,000 X EXCESS LIAR CLAWSWADE AGGREGATE S4,000,000 DED I RETENTION ....___ A WORKERS COMPENSATION AND Y 71WC28949103 1.010112020 1010112021 X PER STATUTE I OTW ER EMPLOYERS' LIAR€LITY Y i N ADS E.L. EACH ACCIDENT $1,000,000 _..,.., B ANY PROPRIETOR, PARTNER %EXECUTIVE OrriCEn+II�EV,BEF exC} UpEO4 N N r A 74WCT8949003 l0/01/2020 10/0112021 E.L. DISEASE -EA EMPLOYEE $1,000,000 (Mandatory €nNH) CA, OR If es, describe under E.L. DISEASE -POLICY LIMIT S1,000,000 DESCRIPTION OF OPERATIONS below C Env Contr Prof PCADB50128221020 10/01/2020 10101/2021 Aggregate/Each Loss S11000,000 I Claims Made Agg STR $600,000 SIR applies per policy terns & cond. JProf ions Prof Each Claim SIR $200,000 DESCRIPTION OF OPERATIONS LOCATIONS VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) [Re: service, All operations at the City of E1 Segundo] [AI: City of E1 Segundo, its officials, officers, agents, and employees) are included as Additional insured with respect to the General Liability, Automobile Liability and umbrella Liability policies; granted a waiver of Subrogation for General Liability, Automobile Liability, Umbrella Liability and workers' Compensation policies; and the General Liability policy evidenced herein is Primary and Non-contributory insurance to other available, as required by Written contract, but limited to the operations of the insured under said Contract. m CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of El Segundo AUTHOR12Ep REPRESENTATIVE ~ its officials, officers, agents and employees �r� Public Works Department 350 Main Street, �6 " Gat+ =i El Segundo CA 90245 USA 01988 2Q15 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: 71PKG8Q4A2O3 COMMERCIAL GENERAL LIABILITY CG2DiOB413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Name Of Additional Insured Pers Location(s) Of Covered Operations All parties where required by a written contract Where required by written contract Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section U—Whm 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 ^pemmnsd and advertising injury" caused, |nwhole orinpart, by� 1. Your acts or omissions; - . 2. The acts cxomissions ofthose 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 o contract or agreemen8, the insurance afforded \n such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured, BL With respect to the insurance afforded to these additional |naureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after 1. All mmrk, including nnatarials, pads or equipment furnished in connection with such m/nrk, on the project (other than servima, maintenance orrepairs) k/beperformed byoron behalf of the additional insured(s) at the location of the covered operations has beanoomp|ated� or 2. That portion of "your wmrk" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor orsubcontractor engaged in performing operations for a principal as a part of the same project. CG 20 10 04 13 @ Insurance Services Office, |no,2D12 Page imf2 C. With respect to the insurance afforded to these additional insurede. the following is added to Section III — Limits 0f Insurance: If coverage provided to the additional insured is required by contract oragreement, Uhe most we will pay on behalf ofthe additional insured is the amount of insurance: 1.Required bythe contract oragreement or Available under the applicable Limits of Insurance shown in the Declarations-, whichever imless. This endorsement mhoU not increase the applicable Limits of Insurance shown in the Declarations. C@2O10O413 @ Insurance Services Office, |mz'2012 Page 2of2 POLICY NUMBER: 71PKG8A4Q203 COMMERCIAL GENERAL LIABILITY CG 20370413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ilm WON, l V "lol, This endorsement mod ifieoinsurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Peraqn(s)Or Organization(s) required byawritten contract required bywritten contract I Information required to complete this Schedule, if not shown above, will be shown in the Declarations. I A. Section U — Who Is An Insured is amended to include as on additional insured the person(s) or organization(s) shown in the Schmdu|e, 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". 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 /s required by m 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, BiWith respect to the insurance afforded to those additional insureds, the following is added N Section III — Limits Of Insurance: K coverage provided to the additional insured is required bye contract oragreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required bythe contractor agreamentor 2. Available under the applicable Limits of Insurance shown inthe Declarations; whichever isless. This endorsement shall not increase the applicable Limits ofInsurance shown inthe Declarations, CG 2037 0413 @ Insurance Services Office, |nc.2Ui2 Page 1mJI WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 04-84) 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 contractthat requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be INCL % of the California workers' compensation premium otherwise due on such remuneration. Person or Organization ANY PERSON OR ORGANIZATION WHERE WAIVER OF OUR RIGHT TO RECOVER IS PERMITTED BY LAW AND IS REQUIRED BY WRITTEN CONTRACT PROVIDED SUCH CONTRACT WAS EXECUTED PRIOR TO DATE OF LOSS Schedule Job Description This endorsement changes the policyto which it is attached and is effectiveon 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 10-01-20 Policy No. 74WC1894 9003 Endorsement No. Insured ACCO ENGINEERED SYSTEMS, INC. Premium $ INCL. Insurance Company ARCH INDEMNITY INSURANCE COMPANY Countersigned By @ 1998 by the Workers' Compensation Insurance Rating Bureau of California. All rights reserved. From the WCIRB's California Workers Compensation Insurance Forms Manual C 1999.