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PROOF OF INSURANCE (2021) CLOSEDACO CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 03I04I2021 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 9 endorsement( $). certificate does not confer rights to the certificate holder In lieu of such ondorsement s). PRODUCER NAME° Jeffrey Mueller NTIS Group, LLC PHONE (440)471-8220 No (440)471-8225 24610 Detroit Rd, Ste 250 E-MAtLss. JeffM@ntisgroup.com ADDRE INSURER(S) AFFORDING COVERAGE NAIC # Westlake OH 44145 INSURERA: National Interstate Ins Co. 32620 INSURED INSURERS: Vanliner Insurance Co. 21172 Transportation Charter Services, Inc. INSURER C : 1931 N. Batavia St. INSURER D„ INSURER E i Orange CA 92865 INSURER F : �..e— 9n9n_9n91 QGVICInN kit IMRFR• _...__-_. THIS IS TO CERTIFY THATTHE 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. SR LTR TYPE OF INSURANCE AWE IN p SUER MD NUMBER POLICY EFF MMIDD POLIC P MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 5,000,000 CLAIMS -MADE ❑X OCCUR A N PREMISES Esr nCeurcen�ea 100,000 $ HIED EXP (Any one person) $ 5,000 A Y YPP 1124890 15 05/01/2020 05/01/2021 _ PERSONAL &ADV INJURY $ 5,000,000 GENERAL AGGREGATE $ 5,000,000 GENLAGGREGATE LIM1TAPPLIES PER: �w POLICY PR V.C1C PRODUCTS-COMP/OPAGG $ 5,000,000 $ OTHER: CO'M1NGLE LlMrir $ 5,000,000 AUTOMOBILE LIABILITY Ea ryr„t;1ry)prutcckfaM y _ BODILY INJURY (Per person) $ X,, ANYAUTO BODILY INJURY (Per accident) '.... $ A OWNED 'SCHEDULED Y YPP 1124890 15 05/01/2020 05/01/2021 AUTOS ONLY 'AUTOS HIRED NON -OWNED Parac6d"Y .)'!M GE ue,rinsu $ AUTOS ONLY AUTOS ONLY Underinsured motorist BI n $Statutory UMBRELLA LIAB X OCCUR _ EACH OCCURRENCE $ A SS LIAB CLAIMS -MADE YEX 1124890 12 05/01/2020 05/01/2021 X�.Xc AGGREGATE $ AL/GL 5,000,000 RETENTION $ $ WORKERS COMPENSATION X .AND EMPLOYERS' LIABILITY YIN STATUTE EORTH- E.L. EACH ACCIDENT $ 1,000,000 B ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? NIA YWC112489011 05I01/2020 05/01/2021 1,000,000 (Mandatory in NH) EL, DISEASE- EA EMPLOYEE $ E_L DISEASE - POLICY LIMIT 1 000 000 $ If yes, describe under DESCRIPTION OF OPERATIONS below Charter Deductible $10,000 Auto PD (Comprehensive/Collision) YPP 1124890 15 05/01/2020 05/01/2021 A PP/Service Deductible $1,000 Sexual Abuse Liability SAM Combined Single Li $1,000�00 ` DESCRIPTION OF OPERATIONS I LOCATIONS IVEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The City of El Segundo, its officials, and employees are listed as Additional Insured pursuant to the terms and conditions of the basis. poticy and as required by written contract or agreement. These policies are written on a primary and non-contributory CERTIFICATE HOLDER City of El Segundo 350 Main St, ElSegundo 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 REPRESENTATIVE CA 90245 @ 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: YPP 1124890 15 COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSENS OR CONTRACTORS .S - SCHEDULED PERSON O ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART J4 SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) I Location(s) Of Covered Operations The City of El Segundo, its officials, and employees 350 Main St, El Segundo CA 90245 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. CG 20 10 0413 © Insurance Services Office, Inc., 2012 Page 1 of 2 C. 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 © Insurance Services Office, Inc., 2012 CG 20 10 0413 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 Ed. 4-84 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT-CALIFORNIA 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.) 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 _N/A_% of the California workers' compensation premium otherwise due on such remuneration. Person or Organization Schedule Job Description Coverage afforded under this endorsement applies on a blanket basis when required by a written contract 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: 5/1/2020 Policy No. YWC 1124890 11 Endorsement No. Insured: Transportation Charter Insurance Company NATIONAL INTERSTATE INSURANCE COMPANY