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PROOF OF INSURANCE (2021 - 2022) CLOSED (2)OO KRAUACT-01 LORALEEBARLOWBOYES A� Q^ DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 3181202"1 ......_._........ _ ............ 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. _.. _ ........._........ ..._......mm. ........ ....... 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 NFP Property & Casualty Services, Inc. 1551 North Tustin Avenue Suite 500 Santa Ana, CA 92705 14)505-5550 975.8966 INSURED I INSURERS ff19U.F#QL.r 1.r„Vnl�lal,l l en ulr,,,rrca� .n.... .... , +e..... Krause ACT, Inc. DBA Air Cleaning Technology WumRES a . _--- _ ....... — 411 Rowland Ave wMsuR Da _ Santa Ana, CA 92707 INSURER F ; _... - _. __....._ CO�`ERAS- L .......CERTIFICATE fJtJMER':...... 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, PAID CLAIMS. INSARX X U COMMERCIAD F INSU�OC BO n UCH _11,ADDL�SUBR LIMITS SHOWN MAY HAV a POLICY EFF PO4.4CY X ,L� OCC LIMITS �. E BEEN REDUCED PE tTR ENERAL POLICY NUMBER _ EACH OCCURRENCE Vim... 1 000 000 CLAIMS -MADE ..—. ._ occuR PACE4245133R2 3/7/2021 3/7I2022 DAMAGE A RENTED p300 F/$ES4ExsvPr D A_ M� EXPIoneons $50,000gny... -- 1,000,000 POLICY G ELIMITAPPLIESL PERSQNA , ADVINJ, „m 9901AGGRE, ,�, PER: GENERAI�A(_PREGATE ,000,000 PRO- I j 000,000 JECT OC .PRODUCT$ - GOMP/OP, AGG . COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY (,{)mBor„Ipl) $. ANY AUTO .,OLIILYbI`,�JI,I,RY,O?erpersan ..... ..____.� OWNED SCHEDULED AUTOS ONLY AUTOSN-� ROPERTY cadent $ HIRED . NOOWNED 'peracc�dant,� DAMAGE $ AUTOS ONLY AUTOS ONLY •----�----- °° •--- _ -- ...� ........... X EXCESS LIAB CLAIMS -MADE EXC424513R1 3/7/2021 3/7/2022 ACH oCCURRFNCE ;� A _� UMBRELLA LIAR X OCCUR 4,000,00 EGdCF%EGPtiTE4,Ii00,00._ B PER AND KERS COMPENSATION...... ppyy"" y ...._,. .._.. AN MP Y $ YIN _....... 1/1/2021 1/1/2022 .._^ 5TATMTF- _�.-.ETB. ...... 1 000000 ANY PROPRIETOR/PARTNER/EXECUTIVE X 'M1VSD5O5860800 _E L EAQH•mAC,CIDENT „ _ I _ ' ' _ OFFICER/MEMBER EXCLUDED? N / A 0 QOQ (Mandatory in NH) E L, DISEASE EA EM„P,LOYEE._ 10 A Pollution P''L_ If yes, describe under 0,000 DESCRIPTION „OF OPERATIONS below r E.L.. DISEASE.- POLICY LIMIT rof Liab PACE 31712021 3/7/2022 imit 1,00 0,000' DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: El Segundo Fire Department, 314 Main Street, El Segundo, CA 90245. The City of El Segundo is included as Additional Insured with regard to General Liability per attached forms EPACE100-0814 & EPACE101-0814. Waiver of Subrogation applies to Workers' Compensation per attached form WC990634„ 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. 350 Main Street El Segundo, CA 90245---•-•--••••• ._..... __.... __ AUTHORIZED REPRESENTATIVE I U__Av, .....� ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: EnviroPACE Insurance Policy SCHEDULE Name Of Additional Insured Person(s) Location And Description Of Completed Or Organization(s)Operations Where Required By Written Contract Where Required By Written Contract A. Section XX. WHO IS AN INSURED, Coverage Part 1 and Part 2 is amended to include as an additional insured the person(s) or organization(s) shown in the SCHEDULE above, but only with respect to liability for bodily injury, property damage, environmental damage, or cleanup costs 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 XXI. LIMITS OF LIABILITY AND DEDUCTIBLE: 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 Liability shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Liability shown in the Declarations. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED, EPACE100-0814 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 1 with its permission. POLICY NUMBER: THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ■ o 16101 . * T This endorsement modifies insurance provided under the following: EnviroPACE Insurance Policy SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Locations Of Covered Operations Where Required By Written Contract Where Required By Written Contract A. Section XX. WHO IS AN INSURED, Coverage Part 1 and Part 2 is amended to include as an additional insured the person(s) or organization(s) shown in the SCHEDULE above, but only with respect to liability for bodily injury, property damage, personal and advertising injury, environmental damage, or cleanup costs 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. EPACE1 01 -0814 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 2 with its permission. C. With respect to the insurance afforded to these additional insureds, the following is added to section XXI. LIMITS OF LIABILITY AND DEDUCTIBLE: 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 Liability shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Liability shown in the Declarations. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. EPACE1 01 -0814 Includes copyrighted material of Insurance Services Office, Inc., Page 2 of 2 with its permission. CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 03/05/2021 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: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must 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 Dan Rickabus Statefiarm State Farm Insurance 30131 Town Center Drive, Suite 275 Laguna Niguel, CA 92677 INSURED Krause A C T DBA Air Cleaning Technology 411 Rowland Ave Santa Ana, CA 927073445 COVERAGES CERTIFICATE NUMBER: WI.9��..,.,.....-_ ............ No 949.,...,,�, 36 49 363-7100 -363-18 l katherine pmerry it:h@statefarm n1.......� �. �.-. �..�... �_..�.. State Farm Mutual Automobile Insu rance nc 25178 "m°"' INSURERS AFFORD .. RA A e Company 5178 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. .. ..... „ __. ........... POLIC..�........-----....WIWWOX.m. _ .... .... ..I___ INSR TYPE OF . ....... ---'�NO'D4 SUER POLICY EFFPOLICY YY LTR.. INSURANCE POLICY NUMBER 'MMBD dY' Y MMIDDIYYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ --- i4ff0 ref RE"N1Eb- ..... CLAIMS -MADE E....�� OCCUR .MED EXP (And one pe. ....... rson) $ ..... PERSONAL & ADV INJURY $ ..w. ......... GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE ------....... $ ,.. .. -._._ P'RO- POLICY � ,pEOT (�1 h.0-C PRODUCTS -COMP/OP AGO $ _r„r„ $ OTHER: A AUTOMOBILE LIABILITY Y 545 8874-001-75 03/01/2021 09/01/2021 COMBINED SINGLE Llnnu $ 1,000,000 _.. X , '.. ANY AUTO Per person) BODILY INJURY e , ( p ) _ $ ALL OWNED p SCHEDULED X ( accident) BODILY INJURY Per c $ AUTOS AUTOS 5451763-001-75 03/01/2021 09/01/2021 - NON -OWNED X PROPEI'7"Yf�A'VdAGE HIRED AUTOS AUTOS 497 1093-001-75 03/01/2021 09/01/2021-(?�aca�9tt UMBRELLA LIAB�OCCUR EACHOCCURRENCEI_ $ EXCESS LIAB DE AGGREGATE : $ DED RETENTION $ $ WORKERS COMPENSATION PER OTH- TF� AND EMPLOYERS' LIABILITY YIN --- ANY ECUTIVE E.L. EACHACCIDENT,mmR CLUI OFFICER/MEMBER EXRTNERI ? NSA (Mandatory in NH) DISEASE EA EMPLOYEE --- $ If yes, describe underEL- DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ A ENOL Y 507 2152-001-75 J. 03111/2021 09/01/2021 1,000.000 L $250 Physical Damage deductible DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD101, Additional Remarks Schedule, may be attached if more space is required) City of El Segundo, its officials and employees are named additional insured Location: El Segundo Fire Department Ell Segundo Fire Department 350 Main St Ell Segundo, CA 90245 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 ll�,,�� 42.2!5 �%%ili ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD 1001486 132849.9 02-04-2014 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 nand 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 2% of the total California Workers' Compensation premium otherwise due. Schedule Person or Onganiggtion J�ob Description ANY PERSON / ORG ALL CA OPERATIONS WHEN REQUIRED BY WRITTEN CONTRACT Policy Number: WSD 5058608 00 Insured: Krause ACT, Inc. Endorsement Effective: 01/01/2021 Coverage Provided by: Insurance Co of the West Issue Date: Countersigned by: WC 99 06 34 (Ed. 8-00)