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PROOF OF INSURANCE (2022) CLOSEDPage 1 of 2 DATE (MM/DD/YYYY) ,4= CERTIFICATE OF LIABILITY INSURANCE 04/30/2021 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 CONTACT Willis Towers Watson Certificate Center Willis Towers Watson Northeast, Inc„. NPHOAMIwN _ _ ........- ........" 1-677-945-7378 $k 1.._.. C 1y 88B 467 2378 AIL P/0.2Hoxentury 305191B1vdpYlcertlfis GFRAf.C1eFFrlRnl rornvFRer.F ......... ..,_,,.- Nashville, TN 372305191 USA fists INSURERA: XL Insurance America Inc 24554 INSURED INSURERB: Travelers Property Casualty Company of Ames 25674 Fieldturf USA, Inc. c/o Sports Division ,w..... INSUREFIC: TravelersnI ndemnity Company of America 25666,- Tarkett Inc. INSURERD: Travelers Indemnity Company 25658 7445 Cote-de-Liesse Road, Suite 200 INSURER E: Montreal, OC H4T 1G2 CAN ...SPR..........".1-_ I.._ .......................... .. .,., .. ........, ,,.... ,,................ ....,.. ......,. INSURER F : COVERAGES CERTIFICATE NUMBER: W20791608 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. ILiR ..... TYPE.. ... RANCE ., AL')DL SUt RL'-. POLICYNUMBER ... ,........ W{10A[IFYYY PPtAd070YYY LIMITS X (COMMERCIAL GENERAL LIABILITY AL EACH OCCURRENCE $ 1,000,000 E C 500,000 CLAIMS -MADE lr x OCCUR PREW (En gr e¢wapce A MED EXP (Any one person) $ 10,000 Y Y US00010327LI21A ..._ 105/01/2021 05/01/20221PERSONAL&ADVINJURY $ 1,000,000 ._. GEN°L-.. AGGREGATE LIMIT APPLIES PER AGGREE GATE $ 2,000,000 GENERAL AGGREGATE X y POLICY LOC PRODUCTS COMP/OP AGG $ 2,000,000 OTHER $ TO AUTOMOBILE 3,000,000 NOBAIUEOUABILITY BODILY NOJII Y (Per person) $' B -OWNED SCHEDULED AUTOS ONLY AUTOS TC2JCAP-823K312A 05/01/2021 05/01/2022I BODILYINJURY (Per accidenl) $ _ HIRED NON -OWNED II-ROPLRTYDAaMMA,GE j AUTOS ONLY AUTOS ONLY $ Is UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAB CLAII'�4�,AIADF AGGREGATE $ DE r> AETENTION S _ _ $ WORKERS COMPENSATION X UT H $TgTIJ?E DER AND EMPLOYERS'LIABILITY C ANYPROPRIETOR!PARTNERIEXECUTIVE �_,,, ,m"m - _--1---- 00 E L EACH ACCIDENT Is ED?Nro N t A Y- OS/O1/2021 DS/01/2022 NH ) E L DISEASE EA EMPLOYEE' $ 1,000,000 IDESCIPOFFICER/ON OF OPERAEMBER TIONS ONS below-BP793534-21-51-K yy(Mandatory ins,describeIn .. LIMIT , S 1,000,000 ' „E.L. DISEASE POLICY"" " r�""" D tWorkers Compensation 6 j Y UH-8P760619-21-51-R i05/01/2021 05/01/20221E.L. Each Accident �$1,000,000 Employer's Liability IE.L. Disease-Pol Lmtl$1,000,000 Work Comp - Per Statute IE.L,.. Disease -Each Emp$1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached 11 more space is required) WC Policies: Policy # U73-BP793534-21-51-K - covers all other states. Policy It UB-BP760619-21-51-R - covers AZ, MA, OR, WI only, Project - City of El Segundo - Repair - 14027122, CERTIFICATE HOLDER CANCELLATION 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 AUTHORIZED REPRESENTATIVE 2261 East Mariposa Avenue El Segundo, CA 90245 01988-2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD sit xD: 21038731 BATcH: 2077416 2 of 6 9036 AGENCY CUSTOMER ID: LOC #: ACC>RV ADDITIONAL REMARKS SCHEDULE Page z of z AGENCY NAMED INSURED Willis Towers Watson Northeast, Inc„ Fieldturf USA, Inc. C/o Sports Division POLICY NUMBER Tarkett Inc. See Page 1 7445 Cote-de-Liesso Road, Suite 2D0 Montreal, QC H4T 1G2 CAN CARRIER See Page 1 NAIC CODE S'ee Page 1 EFFECTIVE DATE: WSee Pagel ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SR ID: 21038731 BATCH:2077416 CERT: W20791608 POLICY NUMBER: US00010327LI21A Effective: 05/01/21-22 COMMERCIAL GENERAL LIABILITY CG20100413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. MlMR *1t14; ' ;1N . This endorsement modifies insurance provided under the following:. COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organizations Location(!) Of Covered O erations Any person or organization that you are required in As required per written contract a written contract or written agreement to include as an additional insured provided the "Bodily Injury" or "Property Damage" occurs subsequent to the execution of the written contract or written agreement. 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: CG 2010 0413 © Insurance Services Office, Inc., 2012 Page 1 of 2 3 of 6 9036 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. Page 2 of 2 0 Insurance Services Office, Inc., 2012 CG 2010 0413 POLICY NUMBER: US00010327LI21A Effective: 05/01/21-22 COMMERCIAL GENERAL LIABILITY CG 20 37 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. 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 Operations Any person or organization that your are required As required per written contract in a written contract or written agreement to Include as an additional insured provided the "Bodily Injury" or "Property Damage" occurs subsequent to the execution of the written contract or written agreement. 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 2. If coverage provided to the additional insured is include as an additional insured the person(s) or required by a contract or agreement, the organization(s) shown in the Schedule, but only insurance afforded to such additional insured will with respect to liability for "bodily injury" or not be broader than that which you are required "property damage" caused, in whole or in part, by by the contract or agreement to provide for such "your work" at the location designated and additional insured. described in the Schedule of this endorsement performed for that additional insured and included in the "products-cornpleted operations hazard". However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and CG 20 37 0413 © Insurance Services Office, Inc., 2012 Page 1 of 2 4 of 6 9036 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 contractor 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. Page 2 of 2 © ISO Properties, Inc., 2004 CG 20 37 0413 POLICY NUMBER: US00010327LI21A COMMERCIAL GENERAL LIABILITY Effective: 05/01 /2021 - 05/01 /2022 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: Any person or organization that you are required in a written contract or written agreement to waive any right of recovery we may have against the person or organization, provided the 'Bodily Injury" or "Property Damage" occurs subsequent to the execution of the written contract or written agreement. Information re wired to com lete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph S. 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. 5 of 6 9036 CG 24 04 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 1 O 11111 WORKERS COMPENSATION TPUVELERS47 AND ONE TOWER SQUARE EMPLOYERS LIABILITY POLICY HkRTFORD, CT 06183 ENDORSEMENT WC 00 03 13 (00) - 01 POLICY NUMBER: UB-8P793534-21-51-K WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT 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.) This agreement shall not operate directly or indirectly to benefit any one not named in the Schedule. SCHEDULE DESIGNATED PERSON: DESIGNATED ORGANIZATION: ANY PERSON OR ORGANIZATION FOR WHICH THE INSURED HAS AGREED BY WRITTEN CONTRACT EXECUTED PRIOR TO LOSS TO DATE OF ISSUE: 05-01-21 STASSIGN: 6 of 6 T L RSJ WORKERS COMDPENSATION ONE TOWER SQUARE EMPLOYERS LIABILITY POLICY RTF'ORD, CT 06183 ENDORSEMENT WC 99 03 76 ( A)- 001 POLICY NUMBER: UB-8P793534-21-51-K WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT- CALIFORNIA (BLANKET WAIVER) 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, The additional premium for this endorsement shall be 0. 00 % of the California workers' compensation pre- mium. Schedule Person or Organization Job Description ANY PERSON OR ORGANIZATION FOR WHICH THE INSURED HAS AGREED BY WRITTEN CONTRACT EXECUTED PRIOR TO LOSS TO FURNISH THIS WAI`iER 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 Policy No. Endorsement No. Insured Premium Insurance Company Countersigned by DATE OF ISSUE: 05-01-21 ST ASSIGN; Page 1 of 1