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PROOF OF INSURANCE (2022 - 2022) CLOSEDDATE (MMIDO/YYYY) AC'ICWL> CERTIFICATE OF LIABILITY INSURANCE 12/07/2020 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 this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Sharon Price Jacobs -Weber, Inc. _.. .._.....—.._. PHONE (31)93-35I�FMAXC. N° (361) 293-3074 E-MACE s Y eber.comYoaum, TX 77995 . .-.-.-.. —_- Patrick Hull ......o _ _., INSURERS) AFFORDING COVERAGE NAIL # a, Arch Insurance Company 11150 INSURED Western Extrication Specialists, Inc. 4350 Adam Rd Simi Valley, CA 93063 FT 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 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. _........ .CI _..._. __ INSFt ......._.. ........... ._� ... AMYL.. Uii ,........ ......._ ......... R M/Dg EFF � 1�,NDrY" YY LTRTYPE OF INSURANCE POLICY NUMBER MiNDDIYYYY MM!DDd`dYYY LIMITS A COMMERCIAL GENERAL LIABILITY Y Y MFPK08576001 01/01/2021 '01/01/2022 EACH OCCURRENCE $ 1,000,000 `` 12 I�A>wfA�"i1 100 000 l CLAIMS -MADE OCCURRMIL�h�C�.w. $.... MED EXP (Any one person) $ 10, OOO _ ! PERSONAL & ADV INJURY ......._____ $ 1 OOO,OOO GE_NLA,,..-._....,,...._....m.-w....... GGREGATELIMITAPPLIESPER: .�.m _,.._.,....._..- ! GENERALAGGREGATE ..........2000000 $ _ PRO- t POLICY �. ._.l JECT El LOC P ...._ ..w..... �RODUCTS COMP/OPAGG _._ $ 2,000 OOO OTHER: $ AU .....TOMOBILELIABILITY } C" M91NEDSINGLELIMIT $ r ANYAUO ( I BODILY INJURY (Per person) $ OWNED SCHEDULED AUTOS ONLYAUTOS . BODILY INJURY (Per accident) $ HI RED WNED PROPERTY C'AMAGE $ -...I AUTOS ONLY AUTOS ONLY Par mddoM $ A UMBRELLA une / occuR Y ' Y MFUM10015201 01 /01 /2021 01 /01 /2022 '!; EACH OCCURRENCE $ 1,000,000 EXCESSUAB CLAIMS -MADE I AGGREGATE $ 1,000,000 DED 77 RETENTIONS 0 ''. $ WORKERS COMPENSATION PER ''.. OTH AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETORIPARTNER7EXECUTIVE ^-- STATUTER _ OFFICERIMEMBER EXCLUDED? Li NIA EL EACH ACCI DENT $ (Mandatory in NH) E.L.. DISEASE - EA EMPLOYE $ If yes, describe under p.............m..._..._...__..�...�.,. .._.. _...... .... ._..............-...,.......... w.,•. DESCRIPTION OFOPERATIONS below E,L,DISEASE -POLICY LIMIT $ A JProperty In -Transit I Off Premise Y Y MFPK08576001 01/0112021 01/01/2022 $250,0010 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) City of El Segundo, its officers, officials, employees, agents and volunteers 350 Main Street El Segundo, TX 902453813 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 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: COMMERCIAL GENERAL LIABILITY CG 20 37 0413 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 Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations Any Person or Organization when you are specifically All contracted locations required by a written contract or agreement to include as an additional insured for the "products -completed operations hazard". Any Person or Organization does not include engineers, architects or surveyors. 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" 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 0413 0 Insurance Services Office, Inc., 2012 Page 1 of 1 Policy Number: MFPK08576001 COMMERCIAL GENERAL LIABILITY CG 20 33 0413 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 11 — Who Is An Insured is amended to include as an additional insured any person or organization for whom you are performing operations 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 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. 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 required by the contract or agreement to provide for such additional insured. A person's or organization's status as an additional insured under this endorsement ends when your operations for that additional insured are completed. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to: 1. "Bodily injury", "property damage' or "personal and advertising injury" arising out of the rendering of, or the failure to render, any professional architectural, engineering or surveying services, including: a. The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, 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 ".occurrence" which caused the "bodily injury" or "property damage", or the offense which caused the "personal and advertising injury", involved the rendering of or the failure to render any professional architectural, engineering or surveying services. CG 20 33 0413 C 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 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 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 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: The most we will pay on behalf of the additional insured 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 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 C Insurance Services Office, Inc., 2012 CG 20 33 0413 COMMERCIAL GENERAL LIABILITY THUS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the : COMMERCIAL GENERAL LIABILITY COVERAGE PART A. SectionO—Who Is An Insured is amended to B.With respect to the insurance afforded to these include aoonadditional insured: additional insunado, the following additional 1. Any person or organization for whom exclusions apply: performing operations when you and such This insurance does not apply to: person or organization have agreed in writing 1. "Bodily injury", "property domoge'' or "personal �' p=="'"' in000ntnac�oragreement that such ' and advertising injury" arising out of the organization beadded omanadditional insured rendering of, or the failure to render, any onyour policy; and professional orohibyctunm|, engineering or 2. Any other person or organization you are surveying services, including: required tmadd as an additional insured under m. The preparing, approving or failing to ' the contract or agreement described in � pre e ohopdr�vv/ngo � approve, maps, ' above. Ponagnoph1 ' ' opinions, rapodo, surveys, field nrdama. Such person(s) or organization(s)is an additionalchange orders or drawings and insured only with respect to liability for "bodily specifications; or hnjury^. "property damage" or ''panoona| and b' 8upemimory, inopec'ion, architectural or adva�ieinginjury" caused, invvho|eorinpad.by: engineering activities. m Your ' ' This exclusion applies even if the claims against b. The acts or omissions of those acting on any insured allege negligence other wrongdoing your behalf; inthe supervision, hiring, enpdoymant, training or imLhep��orm�nc�ofyouron�oingopanaU�nafor monitoring of cdhane by that inounod, if the th��ddiUono|inaurad� "occurrence" which caused the "bodily injury" or "property dy damage", the offense which caused However, the insurance afforded to such the"personal and advertisinginjury^, involved the � additional insured described ebova' rendering of, or the toi|uma to render, any a. Only applies tothe extent permitted bylaw; professional architectural, engineering or and surveying services. b' Will not be broader than that which you are 2. "Bodily injury" or "property domaga" occurring required by the contract or agreement to after: provide for such additional insured. a. All work, including moteho|s, parts or A penson'n or organizatipn's status as on equipment furnished in connection with additional insured under this endorsement ends such vvVrh, on the project (other than when your operations for the person or oemioe, maintenance or repairs) to be organization described in Paragraph 1' above are performed by or on behalf ofthe additional completed. insured(s) at the location of the covered operations has been completed; or CG 20 380413 0Insurance Services Office, |mc..2O12 Page iwf2 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 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: The most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement described in Paragraph A.1.; 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 C Insurance Services Office, Inc., 2012 CG 20 38 0413 POLICY NUMBER: MFPK08576001 COMMERCIAL GENERAL LIABILITY CG 20 01 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. (PRIMARY AND NONCONTRIBUTORY - OTNER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance (2) You have agreed in writing in a contract or Condition and supersedes any provision to the agreement that this insurance would be contrary: primary and would not seek contribution Primary And Noncontributory Insurance from any other insurance available to the additional insured. This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and CG 20 01 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 ~ � �^� ���"�K� *�� ��� Automobile Club ��u������������ ���um����� ��u �on� �����������Uu� ��n�y� Automobile Insurance Policy Coverages and Limits —~�~— Renewal Declarations We are pleased to offer you a renewal for your automobile insurance policy. To renew your policy, send at least the minimum payment on or before the due date. Insurance is in effaui only for the vohidma, coverages, and limits of liability shown on this dadano8ono page and as opt forth in the insurance policy and endorsements. These declarations, together with the contract and the endorsements in oMeut, complete your policy. If any change to your policy or to the information wehave on file meu|ta in o premium decrease during the policy period' the |ntorinsurmnoe Exchange rounwao the right to apply any refund due to your outstanding ba|ance. NAMED INSURED (item 1.) AUTO POLICY NUMBER: CAA DANEJACKSON POLICY PERIOD (PACIFIC STANDARD TIME) SIMI VALLEY CA 93063-2344 POLICY EXPIRATION DATE: 04-06-22 12:01 A.M. vE*|oLsm ve* mswnrm��mw vsmc�s m�n�os *mmu��— vsx/p/sn � vs�n m^xs woos� SALVAGE wumese USE ZIP CODE w/Lsa u/Lcxos a 2007 VAR' *waLsY C0wmuTs 93063 150 vsmr|Eo * unnn FORD p2*oCREW cCREW pLEAouns 93083 17.501'20.000 VERIFIED NO r 2014 HARL pL*TKULTRA LIMITED commuTs 93021 3.501'*'500 vER|F|so o 2012 wwm BAY STAR 3nn2 PLEASURE 93021 2.501- 3.580 vEu|p|so COVERAGES AND LIMITS Coverage /onot /neffect unless opremium u,the word ^mwuueo''/oshown, ANNUAL PREMIUMS oovEnAGsu LIMITS orLIABILITY Vehicle u Vehicle voxwe 7 Vehicle u Vehicle Liability Medical Coverage No C No Coverage No overage,, No Coverage. Physical Damage (Actual Cash Value unless otherwise stated, less deductible) Vehicle 3 Vehicle 4 Vehicle 7 Vehicle 8 Vehicle Collision ACV No Coverage ACV $90000 $114 No Coverage: $130 $355 (Less Deductible) $500 No Coverage $500 $500 Car Rental Expense �Per Day) No Coverage No Coverage No Coverage No Covet -age No Coverage! No Coverage! No Coverage No Coverage Unh7sured Motorist Uninsured & Underinsured Vehicles Uninsured Deductible Waiver Included No Coverage: Included Included Uninsured Collision No CoveragnNo No Coverage Coverage No Coverage PREMIUM DISCOUNTS Please refer mthe enclosed document entitled "Premium Discounts Applied mYour Automobile Pmmv^ ~ Vat any time you choose to pay less than the full balance outstanding �finance charges of up to 1.5% per month ofthe balance outstanding wdUapp|; asexplained inyour billing statements, which are part wfthese declarations. ^° To see the annual mileage for your expiring policy, please refer to the "Notice Mil eage" '' containedi | package. "No Coverage" indicates coverage not purchased. Total Annual Premium* $2414 (includes all applicable discounts.) Less Policyholder Savings Dividend $473 Net Premium* $1941 �� PROCESS DATE 02-24-21 PLEASE ATTACH roYOUR POLICY (SEE REVERSE) DATE (MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE _�l 2/19/2020 T .. HIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AN . D CONFERS . . NO RIGHTS UPON THE CERTIFile�ffi' 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 pollcy(ies) must be endorsed. If SUBROGATIONIS 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 ondorsement(s). PRODUCER CONTACT NAME: AP INTEGO INSURANCE GROUP LLC 76250846 PHONE (888) 289-2939 FFAX (888) 289-29,88 (A/C, No, I(AIC, No)- 375 WOODCLIFF DRIVE STE 103 E-MAIL ADDRESS: .... . . . ......... FAIRPORT NY 14450 INSURER(S) AFFORDING COVERAGE NAIC# INSURERA: Hartford Fire and Its P&C Affiliates 00914 INSURED INSURER B WESTERN EXTRICATION SPECIALISTS, INC. ... INSURER C., PO BOX 1065 ............. . . ..... SIMI VALLEY CA 93062-1065 INSURERD: ....... INSURER E: . . . . ....... INSURER F : 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 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 INS R LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF (MWDQn= POLICY EXP K_yM JMWQIX LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE CLAIMS -MADE -1 OCCUR r DAMAGE TO RENTED PREMIFa oowmence) MED EXP (Any one person) PERSONAL & ADV INJURY GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE DPOLICY PRO- LOC El PRODUCTS -COMP/OP AGG JECT OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO BODILY INJURY (Per person) ALL OWNED SCHEDULED BODILY INJURY (Per accident) AUTOS AUTOS HIRED NON -OWNED I I5R_0PF_RT_Y6A_MAGE AUTOS AUTOS (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS - AGGREGATE MADE DE RETENTION $ WORKERS COMPENSATION IP-E R J tIT H - AND EMPLOYERS' LIABILITY a1A ___ 81- ANY YINJ E.L.EACH ACCIDENT $1,000,000 A PROPRIETOR/PARTNER/EXECUTIVE 1 NIA X 76 WEG AFOM4H 01/16/2021 01/16/2022 OFFICER/MEMBER EXCLUDED? E.L_ DISEASE -EA EMPLOYEE $1,000,000 (Mandatory in NH) If yes, describe under E.L DISEASE -POLICY LIMIT $1,000,000 OF - IPTION OF OPERKLOVIbelow . . ............ . DESCRIPTION OF OPERATIONS ILOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) Those usual to the Insured's Operations. Blanket Waiver of Subrogation applies in favor of the Certificate Holder per the Waiver of Our Right to Recover from Others Endorsement WC040306 , attached to this policy. ....... ..... . . . . . . . . . ................. City of El Segundo, its officers, SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED officials, employees, agents and BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED volunteers IN ACCORDANCE WITH THE POLICY PROVISIONS. 350 MAIN ST AUTHORIZED REPRESENTATIVE EL SEGUNDO CA 90245-3813 @ 1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA Policy Number: 76 WEG AFOM41-1 Endorsement Number: Effective Date: 01/16/21 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address: Western Extrication Specialists, Inc. PO BOX 1065 SIMI VALLEY CA 93062 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 2 % of the California workers' compensation premium otherwise due on such remuneration. Person or Organization Job Description Any person or organization for whom you are required by written contract or agreement to obtain this waiver of rights from us Countersigned by Authorized Representative Form WC 04 03 06 (1) Printed in U.S.A. Process Date: 12/07/20 Policy Expiration Date: 01/16/22