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PROOF OF INSURANCE (2022 - 2022) CLOSEDDATE (MMIDDIYYYY) + " CERTIFICATE OF LIABILITY INSURANCE 02/15/2021 THIS CERTIFICATE IS ISSUED A MATTEROOF INFORMATION ONLY AND CONFERS NO R NEGATIVELY Y AM ND, EXTEND OR ALT RTIHE COVERAGE AFFORDEDUPON THE ABY THE POLIC ETE HOLDER. IS CERTIFICATEATEDOES NOT AFFIRR MATIVELY BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZE 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 rl hts to the certificate holder in lieu of suchcoNTdcTsement PRODUCER Inc PHe w__ ... ONE 31C4ji ?1John t14480 FAQ (310)521 0111 �. J (Ap9 Ncl. Bettis Insurance Services, PO Box 2816 M,AI„ I'L s Ins Com ..— •. I . be�ti ---..—"_ San Pedro CA 90731-0197 �4Y r IN vE E' — ° St�eDialty Insurance 17159 .. JNIUwAta6n Insurance m p Y e es ... 27847 wsuRe°idike ICI, _ ._ Ore on Mutual Insurance Co (Rated A VII) ns a 1490 90 Erland ` t fNd City,Plumbmg N�F� .�.°_.-M _ Scotts rance Company .�. Scottsdale Insurance 1297 525 W. Mariposa St. CA 90245- NM _. _. _. ... .. .. �.... ..w ..—.. ... .. ElSegundo REVISION NUMBER, COVERAGES D ABOVE FOR THE POLICY PERIOD OF NtSUURANC�E LISTED HAVE BEEN ISSUED TO THE INSURED NAMED A RESPECT THAT THE POLICIESCT TO WHICH THIS OR OTHER DOCUMENT THIS IS TO CERTIFY INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT BY THE POL ED HEREIN IS SUBJECT TO THE TERMS, XALL XES BE IS CONDITIONSOFSUCH PERTAIES THEINSURANCE CERTIFICATE MAY M PAID S SHOWN MAY HAVE BED N REDUCED EXCLUSIONS AND AODLSu— MAeOB EBYIOCLAIMS� IM I�PSAUN---- INSR r�IraapFR 02.1'15/2021 2115/2022 ...�. � •---- 1000,000 /� X COMMERCIAL GENERAL LIABILITY X CIP412113 DAMEACE, iU�+RCL�9C'E ' DAMAGE, To RFNTi s P,SF�t�trrrrv.a��sk� 50 000 CLAIMS -MADE a OCCUR Ia'61a'6ED E P LA9„ gn"9evscn1_ _5,000 ...�,�....r..�..�..�.......�-... .`G31,rkC;fi3 2,000,000 .. GENT. AG RECW E'. LIMIT APPLIES PER: °P'Rt'IDLLCIS A°„ G '$ _.,,...�. 00 2 000,000 POLICY PRO- LOC ECT I, C. SINGLE LIMIYr 0712412021 2�2482022 .amwa t._••- $ 100 0,000 C AUTOMOBILE LIABILITY �xh+10920869 m BODILY INJURY (Per patso ) $ ANY AUTO BODILY INJURY (Per accident) $,ww, SCHEDULED " AUTOS ONLY X AUTOS NON P'rCJPCI;'6Y OAMA'CaE g. g,P OP�'Ldl.,[Il,t A XX� �' � ..- -OWNED HIRED ONLY X AUTOS ONLY AUTOSX $ 1000000 XBS0131432 02d"1512021 21 I5/2022 CH ol,cLIBEL E _ $ 1 000 000 D UMBRELLA LtAB OCCUR X EXCESS LIAR OLAIM'S hgrrnV£'°� S .... B WORKERS COMPENSATION WPL. 5054200 0 1 000,000 AND EMPLOYERS' LIABILITY ESL EACfi ACC�OENT .S ' ,'tN;�' ia±�l ippP 7reor19 ART` iERJFXE�CUTIVE Y� NIA 1,000,000 OFFVCE'RdMEhIBEREXCV.kBOEO'IL �km°SFS,.EAFPNFLi7YLE SITm ._ (bland.", IlwNH) 1,000,000 Il ae, describe under s, I I � B,..q. �"EASi='. - POLICY L,pM1T ° 5 Pfi A�°I N CMOg20869 9V 12021 2124124722 Comp Ded $500 t Auto Physcal Damage Colt Dec $1000 City of EI Segundo is named as additional Insured a$ per additional insured d end o s eY a attached CG2 1i a3 0 ' ace h rre rlreq DESCRIPTION OF OPERATIONS I LOCATIONSIVEHICLES (ACORDper AdciitlOnal Insured endorsement CG2033 le a a e where quip by written contract with the named y g V insured subject to the terms and conditions set forth in the policy. 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. 150 Illinois Street ElSegundo CA 90245- AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABILITY CG 20 33 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -OWNERS, LESSEES OR CONTRACTORS -AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section li - Who Is An Insured is amended to include as an additional insured any person or or- ganization for whom you are performing opera- tions when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy. Such person or organization is an additional insured only with re- spect to liabipity for "bodily injury"" ""property dam- age" 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. However, the insurance afforded to such additional insured: 1. Only applies to the extent permitted by law; and 2. Will not be broader than that which you are re- quired by the contract or agreement to provide for such additional insured. A person's or organization's status as an addi- tional insured under this endorsement ends when your operations for that additional insured are completed. B. With respect to the insurance afforded to these ad- ditional insureds, the following additional exclu- sions apply: This insurance does not apply to: 1. "Bodily injury", "property damage" or "personal and advertising injury" arising out of the ren- dering of, or the failure to render, any profes- sional architectural, engineering or surveying services, including: a. The preparing, approving, or failing to prepare or approve, maps, shop draw- ings, opinions, reports, surveys, field or- ders, change orders or drawings and specifications; or b. Supervisory, inspection, architectural or engineering activities. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the "occur- rence" which caused the "bodily injury" or "prop- erty damage", or the offense which caused the "personal and advertising injury"involved the ren- dering of or the failure to render any professional architectural, engineering or surveying services. CG 20 33 04 13 Copyrig ht, Insurance Services Office, Inc., 2012 Page 1 of 2 2. 'Bodily injury" or "property damage" occurring after: a. All work, including materials, parts or equipment furnished in connection with such work„ on the project (other than serv- ice, maintenance or repairs) to be per- formed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or b. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or or- ganization 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 Sec- tion III - Limits Of Insurance: The most we will pay on behalf of the additional in- sured is the amount of insurance: 1. Required by the contract or agreement you have entered into with the additional insured; or 2. Available under the applicable Limits of Insur- ance shown in the Declarations; whichever is less, This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. Page 2 of Copyright, Insurance Services Office, Inc., 2012 CG 20 33 04 13 COMMERCIAL GENERAL LIABILITY POLICY NUMBER: CIP399564 CC, 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: VE ANY PERSON OR VERY PROVIDED SUCH AGREEMENT MADE IN WRITING AND ND PRIOR TO THE LOSS The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV - Conditions: We waive any right of recovery we may have against the person or organl?ation shown in the Schedule above because of payments we make for injury or damage" k" arising out of your ongoing operations or "your 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. Page 1 of 1 CG 24 04 05 09 Insurance services Office, Inc., 2008 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 otherwise due. Person or Organization ANY PERSON / ORG WHEN REQUIRED BY WRITTEN CONTRACT 2 % of the total California Workers' Compensation premium Schedule Job Description ATZ -CA OPERATIONS 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 _ _ 2 r Policy No. WeL 5 Qa 4 2 n n Endorsement No. Insured Premium $ INCL. . Second City Plumbing Insurance Company INSURANCE COMPANY OF THE WEST WC 99 06 34 (Ed. 8-00) Countersigned By INSURED