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PROOF OF INSURANCE (2022 - 2022) CLOSEDAC RDA �...— DA7E(MM/DD/Y1'YY) CERTIFICATE OF LIABILITY INSURANCE 04/05/21 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. B 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 TRI WORLD INSURANCE AGENCY IN 4000 Birch Street, Ste 201B Newport Beach, CA 92660 800-617-8428 CONTACT NAME: n"DD"No Ext C,ND: 4 7 5 E-MAIL ADDRESS'. INSURER(S) AFFORDING COVERAGE NAIC# INSURER EVEREST INDEMNITY INS. CO. A+XV 108,51 INSURED MARX BROS. FIRE EXTINGUISHERS CO. INSURER EVEREST DENALI INS. CO. A+XV 10644 INSURER C: INSURANCE CO. OF THE WEST A XIII 27847 & COOK FIRE EXTINGUISHERS INSURER D: 1159 S. SOTO STREET INSURER E: LOS ANGELES, CA 90023 INSURER F . COVERAGES CERTIFICATE_ Nl1MRFR' RFVIRICIN NIIMRFR• 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. WSR LTR TYPE OF INSURANCE ADDL INSR SUER MD POLICY NUMBERMWO POLICY EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE E COMMERCIAL GENERAL LIABILITY 703/2y6/21 DAMAGE TO RENTED PREMISES a occurrence $ MED EXP (Any one person) $ CLAIMS -MADE ® OCCUR PERSONAL B ADV INJURY $ A Grp 51GL015658-203/26/22 Y GENERAL AGGREGATE E GEML AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 POLICY PRO- LOC JECT E AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ B ANYAUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS X AUTOS Y 51 CA D 0 0 7 3 0- 211 0 3/ 2 6/2 1 0 3/ 2 6/ 2 2 BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ $ A UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE 51 C C 0 0 6 0 2 0- 211 0 3/ 2 6/ 21 0 3/ 2 6/ 2 2 EACH OCCURRENCE $ AGGREGATE $ DED I Y I RETENTION $ $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y AW PROPRIETOWPARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? N N/A Y W S D 5 0 5 3 6 7 8 01 0 2/ 18 / 2 1 0 2/ 18 / 2 2 WC STATU- OTH- TORY LIMITS ER E.L EACH ACCIDENT $ (Mandatory In NH) _ E.L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT I $ I non. non DESCRIPTION OF OPERATIONS / LOCATIONS! VEHICLES (Attach ACORD 101. Additional Remarks Schedule, if more space Is required) ALL OPERATIONS - SERVICE AGREEMENT CITY OF EL SEGUNDO, ITS EMPLOYEES, REPRESENTATIVES, OFFICERS AND AGENTS ARE ADDITIONAL INSURED PER ATTACHED ENDORSEMENTS. WORK COMP WAIVER OF SUBROGATION ENDORSEMENT ATTACHED. THIRTY (30) DAYS NOC APPLIES TO ALL LISTED POLICIES. r:FRTIFIr:ATF HOI r1FR r:ANr:FI 1 ATICIN CITY OF EL SEGUNDO SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE PUBLIC WORKS DEPARTMENT THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 350 MAIN STREET ACCORDANCE WITH THE POLICY PROVISIONS EL SEGUNDO, CA 90245-3813 AUTNORI20 REPRESENTA AA �'• 01988-2010 ACORD CORPORATION. All rights reserved. ACORD25(2010/05) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: 51GLO15658-211 COMMERCIAL GENERAL LIABILITY CG 20 37 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations Any person or organization where the Named Insured has Agreed to add as an additional insured by written contract or agreement, provided the contract or agreement is executed prior to any occurrence or offense. N/A Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section 11 — 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" 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". 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 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. CG 20 37 04 13 0 Insurance Services Office, Inc., 2012 Page 1 of 1 POLICY NUMBER: 51GLO15658-211 COMMERCIAL GENERAL LIABILITY CG 20 10 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) Locations Of Covered Operations Any person or organization where the Named Insured has N/A Agreed to add as an additional insured by written contract or agreement, provided the contract or agreement is executed prior to any occurrence or offense. 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 B 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. 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 04 13 0 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 0 Insurance Services Office, Inc., 2012 CG 20 10 0413 EVEREST DENALI INSURANCE CO. NAMED INSURED: Marx Brothers Fire Extinguishers Co., Inc. POLICY NUMBER: 51CAD00730-211 COMMERCIAL AUTO - ADDITIONAL INSURED AUTOMATIC STATUS This endorsement modifies insurance provided under the following: Business Auto Coverage Form With respect to coverage provided by this endorsement, the provisions of the Coverage form apply unless modified by the endorsement. SCHEDULE Name of Person or Organization: Any person or organization where the Named Insured has agreed to add as an additional insured by written contract or agreement, provided the contract or agreement is executed prior to any occurrence or offense. Description of Covered "Autos": All Owned Autos, Scheduled Autos, Hired & Non Owned Autos (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) The WHO IS AN INSURED PROVISION UNDER liability coverage is changed to include as an "insured" the person or organization shown in the Schedule, but only with respect to liability arising out of: 1. Your operations or services performed for that person or organization at the location shown in the Schedule; or 2. The ownership, maintenance or use of the covered "autos" described in the Schedule. A person's or organization's status as an additional insured under this endorsement ends when: 1. Your operations or services performed for that person or organization are completed; or 2. That person's or organization's interest in the described "auto" ends. Insurance as is afforded by this policy shall be primary coverage and any other insurance maintained by the additional insured shall be excess and non contributory with the insurance provided hereunder. Insurer will not cancel the Insured's contract without sixty (60) days prior written notice. CA 80 07 02 06 ©Copyright, Insurance Services Office, Inc., 1984, 1996 1 of 1 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 06 34 (Ed. 8-00) WAIVER OF OUR RIGHT TO RECOVERY 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 form us). The additional premium for this endorsement shall be 2% of the total California Workers' Compensation premium otherwise due. SCHEDULE Person(s) or Organization(s) Job Description Any Person or Organization when required All California Operations By Written Contract Policy Number: WSD505367801 Coverage Provided by: INSURANCE COMPANY OF THE WEST WC 99 06 34 (Ed. 8-00) Insured: MARX BROS FIRE EXTINGUISHERS CO. INC.