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PROOF OF INSURANCE (2021 - 2022) CLOSEDAC CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) 04/22/2021 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. NPORTANT, If the c rtificate Rol er i^s an XODITIONAL IRURED, the po cy d~ must be endorsed. if SUBROGXT16N 1S WAIVED, sub ect 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 NAME: Nick Johnson i Harmon Insurance Agency Inc. 'ONE C N Exc : 805 768 5142 _G N} 877 349-8810 3205 Old Cone'o Rd. g Y ADDRESS iINFO@harmon Insurances enc .com 1 N 'L Y 9 Y Ste. 203 INSURERS) AFFORDING COVERAGE NAIC # Newbury Park CA 91320 INSURER .378 INSURED ..,.. .. ...".".".�.,, INSURERB: Prog".......___ _. INSURED resslve Auto 24260 Advanced Access Controls Inc. INSURER C : Security National Insurance Company 19879 15414 Cabrito Rd. INSURER D : Certain UnderLloyds writers at London AMB# 85202 Unit A INSURER E : Van Nuys CA 91406 INSURERF: 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. ......... TYPE OF IN .... .........,.,,,.--- ....... ....,.,...... ."...,.....,.... ..,,.......,,, ........." ..,,,,"_. �....._, a1 SD S�C$BRa PM/DDI""YY) .."'i�'M/DDI-E'1rP LIMITS LTR INSURANCE INSD� wVD � POLICY NUMBER MMIDDIYYYY ''�. MMIDD/YYYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 .�. CLAIMS-MADE DAMAGE ➢O"REP3"I'ED' ."" ... _.... [-1 OCCUR X X PREMISES (Ea occurrence) $ 50,000 MED EXP (Any one person) $ 5,000 ..... ......... A MKLV5PBC002769 01/17/2021 01/17/2022 PERSONAL & ADV INJURY $ 1,000,000 �GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,.........�...00 000,000 POLICY jECT LOC PRODUCTS COMP/OPAGG $ 2,000,000 OTHER: Is 4'....� ..._ 0 AUTOMOBILE LIABILITY U ttBWEDt) $ 1,000,00 ..... ANY AUTO BODILY INJURY (Per person) $ ALL OWNED - SCHEDULED " ...JU mmmmm .B AUTOS %� AUTOS 02511386-1 02/26/2021 08/26/2021 BODILY INJURY (Per accident) $ _-...... NON -OWNED i CSMO. .. ,, ... HIREDAUTOS AUTOS (Per accident) $ X Med. Pa y men UM $ 1,000,000 E $ 5,000,000 UMBRELLA LIAB X OCCUR EACH OCCURRENCE " ... AB 5,000,000 EXCESS LIAB CLAIMS -MADE MKLVSEUL102987 01/17/2021 01/17/2022 .AGGREGATE $ DED _ RET-"' — $ ENTION $ WORKERS COMPENSATION HER 111 AND EMPLOYERS' LIABILITY NER/ V I N X 04 01 2021 04 O1 2022 E EACH ACCIDENT $ ANY PROPRIETORIPARTNER/EXECUTIVE -"- N / A E STATUTE ER C OFFICER/MEMBER EXCLUDED? SNP1334680 / / / / 1,000,000 fM ndatoonin NH) be under EL DISEASE - EA EMPLOYEE $ 1,000,000 DESCRIPTION OF OPERATIONS below E L DISEASE - POLICY LIMIT $ 1,000,000 D Professional Liability PSJ0126727062 01/17/2021 01/17/2022 Limit:$1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) "CITY OF EL SEGUNDO, ITS OFFICIALS & EMPLOYEES ARE LISTED AS ADDITIONAL INSURED* CERTIFICATE HOLDER CANCELLATION 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 AUTHORIZED REPRESENTATIVE El Segundo CA 90245 ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: MKLV5PBC002769 COMMERCIAL GENERAL LIABILITY CG 20 37 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, S, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Location And Description Of Completed Operations As agreed to by written contract or agreement All locations Information required to complete this Schedule, if not shown above„ will be shown in the Declarations. 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". © ISO Properties, Inc., 2004 CG 20 37 07 04 Page 1 of 1 ❑ POLICY NUMBER: MKLV5PBC002769 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: As agreed to by written contract or agreement Information required to complete this Schedule, if not shown 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. will be shown in the Declarations. © Insurance Services Office, Inc., 2008 Page 1 of 1 CG 24 04 06 09 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 04-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA 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. Schedule Person or Organization Job Description Any person or organization as required by written contract. 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 4/1/2021 Policy No. SNP1334680 Endorsement No. 0 Insured Advanced Access Controls Inc. Premium $ 7,118 Insurance Company Security National Insurance Company Countersigned by WC 04 03 06 (Ed. 04-84)