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PROOF OF INSURANCE (2022 - 2022) CLOSEDCERTIFICATE OF LIABILITY INSURANCE DATE (MMiDD/YYYY) 3/2/2021 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 TliE 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 certfficate holder is an ADDITIONAL INSURED, the policy(les) 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 9XiEz7— Jeremy Ervin Tegner-Miller Insurance Brokers iii4ON - E 2001 Wilshire Blvd, Suite '10i _tjA(7Z"i�_g*q�_310-828-9662 E-MAIL Santa Monica CA 90403 ADDRES& insureetmib.co Upens,eft.OK07568 WSURER-Aneesa unue-roirrEers ZY - ---- ------ INSURED [INSURER B Nationwide Mutual insurance Western Indoor Environmental Services 2609 W. Beverly Blvd. Suite 6 INSURER C Stat-S'tone National Insumance Montebello CA 90640 INSURER 0 COVERAGES CERT r IFICATE NUMBER. 1957401009 REVISION NUMBER: _7 FHIS ITTO CERTFY THAT THE POLICiES OF !NSUR ZANCE LISTED BELOW HAVE BEEN ISSUED -1 0 THE INSURED NAMED ABOVE FOR THE POLK.,Y PERIOD INDICATED. NOTIA4THSTANDINGANY REOUREMENT, TEPhA OR COPJDIT9ON OF ANY CONTFO-iCT OR (YrHER DOCUMENT WITH RESPECT TO WHICi-j 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. lRSki----------'--------- ADDL�SUBR: N EIFF ---PQLIC POLIC LTR TYPE OF INSUIR!!AtN�CE�] POLICY NUMBER LMMiDD[YY LIMITS A X. ICOMMERCIAL GENERAL LIABILITY NIP(?004JI6006107 2162022 1 216,12f)22 s"'ay"xmwo X; CLAIMS-NIADDE OCCUR DTAN -TORE E --NTED ---- ---------------- ------ - ----- PREMISES -(EaLf — --------- ------- - ------ MED EX.PAyy orw person) $5,000 ... ....... - ----- ---- ----- - --- --------------- - - ---- - PERSONAL & ADV INJURY $ 1,000,0001 - -- ----- GEN'L AGGREGKFE LIM11 APPLIES PER: GENERALAGGREGATE $2,0100,000 R, D- i POLICY JECT -OC PRODUCTS - COMP DP AGO S 2,000,000 OTHER 61. AU'rOUOBtLELAal;-tTY '12D22 COMBINED SINGLE "P0.17' IEa - ------- - --- -- ----- - -------- --- X ANY AUTO BODILY INJURY (Per person') $ c- OWNED SCHEDMLED -- ----- --- ----- BODILY INJUR.Y (Per acridw,'I S AUTOSONLY HIRED NON -OWNED PROPERTY DAMAUE- AUTOSONUr' 1 AUTOSONLY C UMBRELLALIAB xi 83148R2115ALI 2i6i2021 2/6 -022 EACHOCCURRENCE X EXCESS LIAB CLAIMS -MADE, -------------- - AGGREGATE DED 1 RETENTION S WORKERS COMPENSATION 1 1 PEP I OTH- 1'rArUT-E ER AND EMPLOYERS'LIAMLITY IN -1 .-- AP f-:tOFRETOPJPARTtJER,'EX,-:<.tiTr;,'E E.L. EACIH ACCIDENT N/A i ------------ (Mandatory in NH) E.L, DISEASE - EA EkAPLCWEE-'. II ves, descnibe under DESCRtP NON OF OPLiRATIIONS bpie E DISEASE - POLICY LIMIT DESCRIPTION OF OPERATIONS! LOCATIONS I VEHICLES (ACORD 101. Additional Remarks Schedule, may, be -attached V more space is required) City of Ei Segundo is Included as additional insured with regards to General Liability per attached forms including Primary & Non. -Contributory wording and Waiver of Subrogation. CERTIFICATE HOLDER CANCELLATION - ----------- SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DEUVIERED IN City of Ei Segundo ACCORDANCE WITH THE POLICY PROWSIONS. 356 Main Street El Segundo CA 9,0245 AUTHORIZED REPRESENTATIVE USA @ 1988-2015 ACORD CORPORATION. All rights resented. AC ORD 2512016193) The ACORD name and to are rkqistered marks of ACORD POLICY NUMBER: MP0004016005275 COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: COMMERCIAL. GENERAL LIABILITY COVERAGE PART Information ill be shown in the Declarations. A. Section 11 — Who Is An Insured is amended to include as art additional inswed the per or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "properly damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions.- or 2. 'The acts or ornissions of those arting 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 onJy 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 prr,wide 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 "bodfly injury" or "property damage" occurring after: I . All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintermnce 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. @ Insurance Services Office, Inc., 2012 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 addWonal 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 Urnits 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 04 13 0 Insurance Services Office, Inc., 2012 Page 2 of 2 POLICY NUMBER- MP0004016005275 MESA UNDERWRITERS SPECIALTY INSURANCE COMPANY This endorsement modifies insurance provided under the following: A. Subject to the Primary and Non-ContributoTy provision set forth in this endorsement, SECTION 11 - WHO IS AN INSURED is amended to include as an additional insured any person or organization whom you have agreed in a written contract, written agreement or written permit that such person or organization be added as an additional insured on your policy. Such person or organization is an additional insured only with respect to liability for "bodily injury" or "property damage" or, to the extent applicabie under the Coverage Part if) which this endorsement applies, "personal and advertising injury" caused, in whole or in part, by: 1, Your ongoing operations, "your product", or premises owned or used by you,, This insurance does not apply to "bodily injury", "property damage"or, to the extent applicable under the Coverage Part to which this endorsement applies, "personal and advertising injury" arising out of the rendering of, or the failure to render, any professional architectural, engineering or surveying services by or for you, including: a. The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; and b. Supervisory, inspection, architectural or engineering activities. This exclusion applies even if the claims against any insured allege negligence or other wrong -doing in the supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence" which caused the "bodily injury" or "property damage". or, to the extent applicable under the Coverage Part -to which this endorsement applies, the offense which caused the "personal and advertising injury", involved the rendering of, or failure to render, any professional architectural, engineering or surveying services. 2. Your maintenance, operation or use of equipment, other than aircraft, "'auto" or watercraft, rented or leased to you by such person or organization. A person or organization's status as an additional insured under this endorsement ends when their contract, or agreement with you for such rented or leased equipment ends. With respect to the insurance afforded to these, additional insureds, this insurance does not apply to any "occurrence" which takes place after the rental agreement or equipment lease expires. The provisions of this coverage extension do not apply unless the written contract or written agreement has been executed (executed means signed by the named insured) or written permit issued prior to the "bodily injury" or "property damage"or, to the extent applicable under the Coverage Part to which this endorsement applies, "personal and advertising injury". MUS 010120128 0316 INSURED Page 1 of 2 The following is added to Paragraph 4. Other Insurance, b. Excess Insurance under SECTION IV - COMMERCIAL GE14ERAL LLABILITY CONDITION& This insurance shall be excess with respect to any person or organization included as an additional insured under this policy, any other insurance that person or organization has shall be primary with respect to this insurance, unless: 2) You have agreed in a written contract, written agreement or written permit to include that additional insured on your General Liability policy on a primary and/or non-contributory basis'. and 3) 'The written contract or written agreement has been executed (executed means signed by the named insured) or written permit issued prior to the "bodily injury" or "property damage" or, to the extent applicable under the Coverage Part to which this endorsement applies, "personal and advertisingInjury'. yymmxjykgmzamx���� The following is added to Paragraph 8. Transfer of Rights Of Recovery Against Others To Us under SECTION, IV - COWMERCIAL GENERAL LIABILITY CONDITIONS: We will waive any right oirecovery we may have against a person or ovganization because of payments we make for "bodily injury" or "property damage" arising out of your ongoing operations or "your work" done under a written contract or written agreement and included in the "products -completed operations hazard", if: You have agreed to waive any right of recovery against that person or organization in a written contract or written agreement; 2a Such person or organization 'is an additional insured on your policy; or 3® You have assumed the liability of that person or organization in that same contract, and it is an "insured Gontracf'. The section above only applies to that person or organization identified above, and only if the "bodily injury" or 11 property damage" occurs, subsequent to the, execution of the written contractor written agreement. MUS 010120128 0316 Page 2 of 2 POLICYHOLDER COPY P.O. BOX 8192, PLEASANTON, CA 94588 Cad:iffy[+%rIII 4KilALT101:1:/:11*41K91i1►TiT:�r:fky _ • ► ► : _ ► ISSUE DATE: 03-07-2021 CITY OF EL SEGUNDO SC 350 MAIN ST EL SEGUNDO CA 90245-3813 GROUP: POLICY NUMBER: 9126780-2021 CERTIFICATE ID: 165 CERTIFICATE EXPIRES: 03-07-2022 03-07-2021/03-07-2022 This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 30 days advance written notice to the employer. We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance afforded by the policy described herein is subject to all the terms exclusions, and conditions, of such policy. 7 Authorized Representative President and CEO EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT #0015 ENTITLED ADDITIONAL INSURED EMPLOYER EFFECTIVE 2020-03-23 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. NAME OF ADDITIONAL INSURED: CITY OF EL SEGUNDO ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 03-07-2016 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. ENDORSEMENT #1651 - ANTONIO ROSARIO, PRESIDENT - EXCLUDED. ENDORSEMENT #1651 - ALBERT TORRES, SEC,TRES - EXCLUDED. EMPLOYER WESTERN INDOOR ENVIRONMENTAL SERVICES SC 2609 W BEVERLY BLVD STE 6 MONTEBELLO CA 90640 M0410 PRINTED : 02-17-2021 MEV.7-2014) ENDORSEMENT AGREEMENT WAIVER OF SUBROGATION BLANKET BASIS HOME OFFICE SAN FRANCISCO EFFECTIVE MARCH 7, 2021 AT 12.01 A.M. ALL EFFECTIVE DATES ARE AND EXPIRING MARCH 7, 2022 AT 12.01 A.M. AT 12:01 AM PACIFIC STANDARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME WESTERN INDOOR ENVIRONMENTAL SVC 2609 W BEVERLY BLVD STE 6 MONTEBELLO, CA 90640 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 2.00% OF THE TOTAL POLICY PREMIUM. SCHEDULE PERSON OR ORGANIZATION ANY PERSON OR ORGANIZATION FOR WHOM THE NAMED INSURED HAS AGREED BY WRITTEN CONTRACT TO FURNISH THIS WAIVER JOB DESCRIPTION BLANKET WAIVER OF SUBROGATION 9126780-21 RENEWAL SC 8-75-66-67 PAGE 1 OF NOTHING••- • TO VARY, ALTER, WAIVE OR EXTEM, ANY OF THE TERMS, CONDITIONS, a OF THIS POLICY ABOVEOTHER THAN AS r NOTHING ELSEWHEREPOLICY HELD TO VARY, ALTER, WAIVE f • LIMIT THE TERMS, CONDITIONS, LIMITATIONS IN THIS ENDORSEMENT. COUNTERSIGNED AND ISSUED AT SAN FRANCISCO: AUTHORIZED REPRESENT /IVE SCIF FORM 10217 (REV.4-2418) MARCH 10, 2021 1 PRESIDENT AND CEO 2572 OLD DP 217