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PROOF OF INSURANCE (2022) CLOSEDClient#: 1778682 GALLSLLCI I ACORDn, CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 3/02/2021 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:WIf 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCERCCr NAGAE. USI Insurance Services LLC PFItNt� .___ �� farc_No, Erct 513 852-6300 (rc Ravi 513 852-6428 312 Elm Street, 24th Floor E-MAIL — ADDRE S INSURERS AFFORDING -- Cincinnati, OH 45202 COVERAGE I NAIC# �� 513 852-6300 INSURER A : OBE Insurance Corporation m.w ._ ..... 39217 INSURED ......_.... __ --_- ..w„� .. ..-:-.. ... INSURER_0 . etOrlan InSUr... C H Praetorian General Casualty Company of Wisconsin 24414 CB General Holdings, LLC; Galls LLC INSURER a Gen p ... Company r ........., .. 3..2 ' 7257 1340 Russell Cave Road INSURER D : The Cincinnati Insurance Company 10677 _ Lexington, KY 40505 INSURER Regent Insurance Company ...�� RE: 9 pany 24449 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 CONTRACTOR 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 LTR SURANCE INSR wv (POLICl/Y F PO/D / EXP ADDL SIJB�R: POLICY NUMBER MM/DD/YYYY) (MM/DD/YYYY), LIMITS A X COMMERCIAL GENERAL LIABILITY X X CGA1365959 3/01/2021 03/01 /202 EACH OCCURRENCE $1,000,000 , pp II DAMAGE TO RENTED X OQ0 CLAIMS -MADE OCCUR ,tea 4GFlJ Egagpl $1 ..f000 MED EXP (Any one ,person) .. PERSONAL,&ADVINJURY $1000,000 , GEN L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE ...1 PRO- .. ..........--- �... ,_.. POLICY LOC PRODUCTS -COMP/OP AGG X$2,000,000 $ 2,000000 OTHER $ AUTOMOBILE LIABILITY 60M a, D�SPNC+k.i: LIglIT E X X CBA1365959 3/01/2021 03/01/202 (a�lr ML ..... $1,000,000 X.I. ANY AUTO BODILY INJURY (Per person) $ ...,..� OWNED SCHEDULED BODILY INJURY (Per accident) AUTOS ONLY 'AUTOS ...e,u $ iHIRED NON -OWNED PROPiRG"YDAMAGE X _ $ IT! I US ONLY AUTOS ONLY Prrr rccadonk ( ee._... m_ � _.. $.....,, - ----- ..... .. ... .. ..� ....n ,..3/Oi /2021 O3/Oi /2O2 B X UMBRELLA LIAB X occuR CCU1365959 EACH OCCURRENCE '— $10,000,000 EXCESS LIAB CLAIMS MADE .....'. A GGREGAT„ e ..- ... ---- DED X l N $10 OOO ���� $ .. .._..— ..mm ..� KERB OMP NATION CWC1365959 _ � � 3/01/2021 03...... - WORKERS COMP ENSAT O � �OTH .. ..,. ...-, � /01 /202 X PEAT�l.TE C AND EMPLST v / N ANY PROPAIETOSI PART'NERdE'XECUTIVE $1,000,000 ❑ N / A In NH) L.. DISEASE $�OOO,OOO „E , .,. yes describe under if DESCRIP(MandaloTION n OPERATOIONS below E.L. DISEASE- EC POEA LICY LIMIT _., _ -------- — _,. $1 000 000 D Excess Liability EXS0570374 3/01/2021 03/01/2022 $15,000,000 I ,. DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: Contract #3957, City of El Segundo. The General Liability policy includes an automatic Additional Insured endorsement that provides Additional Insured status to Certificate holder, only when there is a written contract that requires such status, and only with regard to work performed on behalf of the named insured. The General Liability and Workers Compensation policies include a Waiver of Subrogation endorsement in favor of the Certificate Holder as referenced above. The City of El Segundo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 348 Main St ACCORDANCE WITH THE POLICY PROVISIONS. El Segundo, CA 90245 '. AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved ACORD 25 (2016/03) 1 of 1 The ACORD name and logo are registered marks of ACORD #S31355072/M31323006 PVRZP This page has been left blank intentionally, CGA1365959 COMMERCIAL GENERAL LIABILITY CG 2010 0413 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 Organization(s) Location(s) Of Covered Operations WHERE REQUIRED BY WRITTEN CONTRACT OR AGREEMENT 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 CG 20 10 0413 0 Insurance Services Office, Inc., 2012 Page 1 of 2 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. 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 0 Insurance Services Office, Inc., 2012 CG 2010 0413 (iv) If the loss arises out of the maintenance or use of aircraft, "autos", or watercraft to the extent not subject to Para- graph 2. g. Aircraft, Auto Or Watercraft under COVER- AGE A. BODILY INJURY AND PROPERTY DAMAGE LIABILITY of SECTION I — COVERAGES within the COMMERCIAL GENERAL LIABILITY COVERAGE FORM. O. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS The following is added to Paragraph 6. Representations of SECTION IV — COM- MERCIAL GENERAL LIABILITY CONDITIONS within the COMMERCIAL GENERAL LIABILITY COVERAGE FORM: Any unintentional failure to disclose all exposures or hazards existing as of the effective date of the Commercial General Liability Coverage Form or at any time during the policy period will not invali- date or adversely affect the coverage for such exposure or hazard. However, you must report the undisclosed exposure or hazard to us as soon as reasonably possible after the exposure or hazard is discovered. P. WAIVER OF SUBROGATION The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS within the COMMER- CIAL GENERAL LIABILITY COVERAGE FORM: This condition does not apply to any person or organization to which you waived this condition by written contract or agreement, but only to the extent that subrogation is waived prior to the "bodily injury" or "property damage" under a contract with that person or organization. 0. LIMITED WORLDWIDE LIABILITY COVERAGE The following is added to SECTION IV — CONDITIONS within the COMMERCIAL GEN- ERAL LIABILITY COVERAGE FORM: Expanded Coverage Territory 1. If a "suit" is brought in a part of the "coverage territory" that is outside the United States of America (including its territories and posses- sions), Puerto Rico or Canada, and we are prevented by law, or otherwise, from defend- ing the insured, the insured will initiate a de- fense of the "suit". We will reimburse the in- sured, under Supplementary Payments, for any reasonable and necessary expenses in- curred for the defense of a "suit" seeking damages to which this insurance applies, that we would have paid had we been able to ex- ercise our right and duty to defend. If the insured becomes legally obligated to pay sums because of damages to which this insurance applies in a part of the "coverage territory" that is outside the United States of America (including its territories and posses- sions), Puerto Rico or Canada, and we are prevented by law, or otherwise, from paying such sums on the insured's behalf, we will re- imburse the insured for such sums. 2. All payments or reimbursements we make for damages because of judgments or settle- ments will be made in U.S. currency at the prevailing exchange rate at the time the in- sured became legally obligated to pay such sums. All payments or reimbursements we make for expenses under Supplementary Payments will be made in U.S. currency at the prevailing exchange rate at the time the expenses were incurred. 3. Any disputes between you and us as to whether there is coverage under this policy must be filed in the courts of the United States of America (including its territories and possessions), Puerto Rico or Canada. 4. The insured must fully maintain any coverage required by law, regulation or other governmen- tal authority during the policy period, except for reduction of the aggregate limits due to pay- ments of claims, judgments or settlements. Failure to maintain such coverage required by law, regulation or other governmental authori- ty will not invalidate this insurance. However, this insurance will apply as if the required coverage by law, regulation or other govern- mental authority was in full effect. Includes copyrighted material of Insurance Services Office, Inc., CG 81 79 01 11 with its permission. Page 5 of 6 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 0313 (Ed. 4-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT 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.) This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule Any person or organization for which you have agreed to waive your rights of recovery in a written contract, provided such contract was executed prior to date of loss. 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 03/01/2021 Policy No. CWC1365959 Endorsement No. Insured CB GENERAL HOLDINGS LLC Premium Insurance Company PRAETORIAN INSURANCE COMPANY Countersigned by ._.........._. �_�. WC 00 03 13 (Ed. 4$4) C iM National Council on Compensation Insurance.