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PROOF OF INSURANCE (2022 - 2022) CLOSEDACCORD® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 4/30/2021 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 Dealey, Renton & Associates 790 E Colorado Blvd, #460 CA 91101 CONTACT NAME: Marie Swaney PHONE FAX A/c No EXt A/C, No): E-MPasadena ADDRESS: dracertificates@dealeyrenton.com INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: Crum & Forster Specialty Insurance Company 44520 License#: 0020739 INSURED GALEASS-01 Gale/Jordan Associates, Inc. 310-316-4377 INSURER B : INSURER C INSURERD: 3868 Carson Street, Suite 328 Torrance, CA 90503-5613 INSURERE: INSURER F : COVERAGES CERTIFICATE NUMBER: 1951027591 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 LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF MM/DD POLICY EXP MM/DD LIMITS A X COMMERCIAL GENERAL LIABILITY Y Y EPK135195 4/28/2021 4/28/2022 EACH OCCURRENCE $ 10,000,000 CLAIMS -MADE OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ 100,000 X MED EXP (Any one person) $ 5,000 Contractual Liab X XCU Included PERSONAL & ADV INJURY $ 3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 10,000,000 POLICY PRO- JECT LOC PRODUCTS - COMP/OP AGG $ 10,000,000 X Contr. Poll. Liab. $ 3,000,000 OTHER: Contractors Poll A AUTOMOBILE LIABILITY Y EPK135195 4/28/2021 4/28/2022 COMBINED SINGLE LIMIT Ea accident $1,000,000 BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ X PROPERTY DAMAGE Per accident $ HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY X $ NoOwned Auto UMBRELLALIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LAB CLAIMS -MADE DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N PER OTH- STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICE R/M EMBER EXCLUDED? ❑ N/A E.L. DISEASE - EA EMPLOYEE $ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ A ProfessionalLiability EPK135195 4/28/2021 4/28/2022 Per Claim $3,000,000 Aggregate Limit $3,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) Auto Liability is follow -form to the General Liability. RE: All Operations -- City of El Segundo, its officers, agents and employees are named as additional insured as respects general and auto liability as required per written contract or agreement. CERTIFICATE HOLDER CANCELLATION 30 Day Notice will be sent to holder SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of El Segundo, Public Works Dept. 350 Main Street AUTHORIZED REPRESENTATIVE El Segundo CA 90245 ACORD 25 (2016103) @ 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Policy # EPK135195 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NON-CONTRIBUTORY ADDITIONAL INSURED WITH WAIVER OF SUBROGATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART CONTRACTORS POLLUTION LIABILITY COVERAGE PART ERRORS AND OMISSIONS LIABILITY COVERAGE PART THIRD PARTY POLLUTION LIABILITY COVERAGE PART SCHEDULE Name of Additional Insured Person(s) or Oraanization(s) Blanket when specifically required in a written contract with the named insured A. SECTION III — WHO IS AN INSURED within the Common Provisions is amended to include as an additional insured the person(s) or organization(s) indicated in the Schedule shown above, but solely with respect to "claims" caused in whole or in part, by "your work" for that person or organization performed by you, or by those acting on your behalf. This insurance shall be primary and non-contributory, but only in the event of a named insured's sole negligence. B. We waive any right of recovery we may have against the person(s) or organization(s) indicated in the Schedule shown above because of payments we make for "damages" arising out of "your work" performed under a designated project or contract with that person(s) or organization(s). C. This Endorsement does not reinstate or increase the Limits of Insurance applicable to any "claim" to which the coverage afforded by this Endorsement applies. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. EN0118-0211 Page 1 of 1 Policy # EPK135195 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 SCHEDULE Name of Additional Person(s) or Location And Description Of Completed Oraanization(s): Operations Blanket when specifically required in a written contract with the named insured. lInformation required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section III — Who Is An Insured within the Common Provisions is amended to include as an 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". EN0320-0211 Page 1 of 1 a.MI . DATE (MDDIYYYY) L - CERTIFICATE OF LIABILITY INSURANCE 02/15/2021 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 1S WAIVED, subject to the terms and conditions of the policy, certain policiies may requiiire, an endorsement. A statement on this certificate does not confer rights to the certificate holder In Beal of such endorsement(s). PRODUCER CONTACT ..-. NAME: EJMS Insurance Services iION —T - 4P_ _.. �� 'IwP Not. _..... _ _,.... .. .. ... PO Box 33289 E-MAIL ADrsREss: _ Los Gatos„ CA 95031 Chubs b National Insurance Company 10052 INSURED gale/jordan associates 3585 W. Carson Street, Suite 200 Torrance, CA 90503 COVERAGES CERTIFICATE NUMIBER: a:: INSURER D : • T i. 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 SUBJECTTO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE; BEEN REDUCED BY PAID CLAIMS, ILTR ------ _ _..... . .._...... ...... b�3 C S1Ia .w_..._ _ _._ _ __ _ _. .._POLICY EFF ..POLICY EXP — TYPE OF INSURANCE POLICY NUMBER bgMPDDPYYYY MMPDDtYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE COMMERCIAL GENERAL. LIABILTY E. i.Ea oc�urr nce $ CLAIMS -MADE L..,._.r.� OCCUR ..,E'REI�I MED EXP (Any one persons) $ PERSONAL & AOV INJURY $ GENERAL AGGRErATE GEN1 AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG S POLICY PRO- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ......... ._..__.. . — .... ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED AUTOS � ...... AUTOS BODILY INJURY gPer accident) $ NON -OWNED .. PROPERTY DAMAGE ..... $ HIRED AUTOS AUTOS Peracaodervf _ _ .... ....... .... _....._.._. UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS -MADE AGGREGATE $ DE0 RETENTION $ A WORKERS COMPENSATION' AND EMPLOYERS' LIABILITY (22) 7178-54-63 2/01/2021 2/01/2022 WC STATU OTH X... TQi Y..LIMII zw _._ t _'-_---._ _........... Y P N ANY PROPRIETORIPARTNERPEXEOUTIVE E,.L T EACH ACCIDEN.... OFFICERIMEMBER EXCLUDED? V N / A --- IT „1000,000 — (Mandatory in NH) E L DISEASE EA EMPLOYEE $ 1 000,00 df yes, describe under DESCRIPTION CIF OPERATIONS belowr _...� .._�..__-. .__-..__..._ . ....�....�> ..- __--. E L DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION... OF OPERATIONS f LOCATIONS I VEHICLES (Attach ACORD 1E1, Additional Remarks Schedule„ it more space Is required) Christopher K Gale -President: Excluded / Thomas A Jordan - Secretary / Treasurer: Excluded i:tmRTIFICATE HOLDER CANCELLATION City of El Segundo, Public Works Dept. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE350 Main St. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN El Segundo, CA 90245-3813 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTA Daniel J, Cloud 01988-2010 ACOR"ORPORATION, gill rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered' marks of ACORD Workers' Compensation and Employers' Liability Policy Named Insured Endorsement Number GALE/JORDAN ASSOCIATES, INC. Policy Number Symbol; Number: 22 7178-54-63 Policy Period Effective Date of Endorsement 02/01/2021 TO 02/01/2022 02/01/2021 Issued By (Name of Insurance Company) Chubb National Insurance Ccm Insert the Policy nUMbfff. The remainder of the information is to be comPletod on when this endorsement is issued subsequent to the prepaEtier of the CALIFORNIA WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement applies only to the insurance provided by the policy because California is shown in Item 3.A. of the Information Page. 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, but this waiver applies only with respect to bodily injury arising out of the operations described in the Schedule, where you are required by a written contract to obtain this waiver from us. You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. Schedule Specific Waiver Name of person or organization: ( X ) Blanket Waiver Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. 2. Operations: 3. Premium: The premium charge for this endorsement shall be 1% percent of the California premium developed on payroll in connection with work performed for the above person(s) or organization(s) arising out of the operations described. 4. Minimum Premium: WC 90 03 75 (05118) Authorized Representative tnwt-C Copy