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PROOF OF INSURANCE (2021 - 2021) CLOSED�9 DATE (MMIDD/YYYY) ACC>Rp► CERTIFICATE OF LIABILITY INSURANCE 3/30/2021 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 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 NAMEE4c Bny An ttan drakowlcz Wood Gutmann & Bogart PHONE " m _ 15901 Red Hill Ave., Suite 100fss ba �dra 0 bib com Fes'' N° 714 573-17(Y Tustin CA 92780 ADD E u �19... _......... _.. ... S AF ORDING COVERAGE NAIC # .........................„._..... INSURE...,�......F...........,,�,n,-....—..................................--.--..................., m-___ Inlsur ... Vantapro Specialty Ins....°....._ �_... ......44768 INSURED AJFIS-1 INSURER B Travelers Prop r� CBsUalty m eyyyyym... , .., . _ .... 25674 A.J. Fistes Corporation .°° 2214 Atlantic Ave .._ INSURANCE COMPANY 22667 INSURER C : ACE AMERICA Long Beach CA 90806 INsuRERo: Cypress Insurance Co mpany INSURER E : INSURER F COVERAGES CERTIFICATE NUMBER:21'33324054 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. INSR ........ TYPE OF INSURANCE m... AiiLPOLICY. .. , ..N...,'"(' ERF , .,'OLtCY F,.X' LIMITS NUMBER 'MMIO MMID C X COMMERCIAL GENERAL LIABILITY Y Y G71110515003 4/19/2020 4/19/2021 EACH OCCURRENCE $1,000,000 .— _......,,� CLAIMS -MADE OCCUR (.,,,FiM(E,S,(,a occurrenag)_ $.„00 000... _ MEDvEXP,(An)/ one person) _ $ -- ,,,.__ PERSONAL&ADVINJURY $1,000,OODmmmmm^^~^^� G_EN'L AGGREGATE LIMIT m .. .---1.. ,,0 � ����� APPLIES PER. mmmm GGREGATE $2,000,000 i GENERAL A., ..e---_ _...�..,�-... ...e....-- PRO- 2 000,000 POLICY �.X.,] JECT E] LOC PRODUCTS-OOMP/OP _.. $ „. m _ OTHE`W $ gip.# A AUTOMOBILE LIABILITY 5087026902 12I6/2020 12I812021 COMB rdoEll )SIiWGLGLE LIMIT $ 1,..000000 ...... X ANY AUTO BODILY INJURY (Per person) $ X AUTOS ONLY AUTOS accident) $ OWNED X SCHEDULED B1'�OpIEIRT�o' DAMAGEODILY INJURY (Per ......._ HIRED NON -OWNED P $ AUTOS ONLY AUTOS ONLY 95149101. X LALIAB XX� CUR ZUP61N1416220NF 7/11l2020 7/11/2021 EACH OCCURRENCE $1000000 S LIAB CLAIMS -MADE AGGREGATE $ 1 000,000 EXCES..,...,,.__�_...... ..m-----.._ .,,..,.._._ DED RETENTION$ $ D WORKERS COMPENSATION Y AJWC136519 6/30/2020 6/30/2021 X IPER Tl1T OERTH AND EMPLOYERS' LIABILITY YIN RIPARTNERIEXECUTIVE ❑ N I A T $ 1,000 000 OFFICEPRIETIMEMB OFFICE EREXCLUDEE.L. EACH ACCIDENT (Mandatory in NH) E.L. DISEASE EA EMPLOYEE $ 1,000,000,,,,,,,,,,E ....._. If yes, describe under DESCRIPTION OF OPERATIONS below E,L. DISEASE - POLICY LIMIT $ 1,000,000 [T DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE:' CITY HALL WNDOW REPLACEMENT PROJECT,- PROJECT NO. PW 21-04 City of El Segundo, its officials, and employees are reamed as additional insured on the General Liability per attached CG 20 37 04 13 and CG 20 10 04 13 as required by Written contract subject to the terms and conditions of the pofi Primary and Non-Conlributory applies on the General Liability per attacheyCG 20 01 04 13 Waiver of Subrogation applies to the General Liability per attached CG 24 04 05 09 Waiver of Subrogation applies to the Workers' Compensation per attached WC 99 04 1 OC CERTIFICATE HOLDER CANCELLATION W 3­21—.6222� SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of El Segundo, a general law City and municipal ACCORDANCE WITH THE POLICY PROVISIONS. corporation 350 Main Street AUTHORIZED REPRESENTATIVE El Segundo CA 90245 I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Policy Number: G71110515 003 COMMERCIAL GENERAL LIABILITY CG 20 37 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OIL 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 Or anization(s Location And Description Of Completed O rations Blanket when required by written contract and signed by both parties prior to loss. 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: G71110515 003 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 Or anization s Locations Of Covered Operations Blanket when required by written contract and signed by both parties prior to loss. 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 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. CG 20 10 0413 0 Insurance Services Office, Inc., 2012 Page 1 of 1 Policy Number: G71110515 003 COMMERCIAL GENERAL LIABILITY CG 20 01 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY ARY AND NONCONTRIBUTORY - OTHER 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 C Insurance Services Office, Inc., 2012 Page 1 of 1 Policy Number: G71110515 003 COMMERCIAL GENERAL LIABILITY CG 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: Blanket when required by written contract and signed by both 2arties prior to loss. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. 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 organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" 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. CG 24 04 06 09 0 Insurance Services Office, Inc., 2008 Page 1 of 1 C3 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC990410C (Ed. 01-19) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT-CALIFORNIA BLANKET BASIS 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 calculated by applying a factor of 2% to the total manual premium, with a minimum initial charge of , then applying all other pricing factors for the policy to this calculated charge to derive the final cost of this endorsement. This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule 011ani t W Person/Organization Blanket Waiver — Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. Job Description All CA Operations j7L� 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: 06/30/2020 PolicyNo.: AJWC136519 Endorsement No.: Insured: Premium $ Insurance Company: Cypress Insurance Company Countersigned by " awd lewdlel WC990410C (Ed. 01-19)