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PROOF OF INSURANCE (2021 - 2022) CLOSED
/ A� " CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 06/08/2021 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 Laura Aguinaga NAME: Hays Companies Inc. pHONEo (909) 243-8115 FAx (909)438-201 NExf : C, No A/C A/ 4200 Concours, Suite #350 E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # Ontario CA 91764 INSURERA: Lexington Insurance Company INSURED INSURER B : State Compensation Ins Fund 35076 S&S Labor Force, Inc., DBA: JRM INSURER C : 26893 Bouquet Canyon Rd. #413 INSURER D : INSURER E : Saugus CA 91350 INSURER F : COVERAGES CERTIFICATE NUMBER: CL211507204 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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 INSURANCEAUULbUBK INSD WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE FX OCCUR PREM SDA AGES Ea oNcurDrence $ 250,000 MED EXP (Any one person) $ Excluded PERSONAL &ADV INJURY $ 1,000,000 A 080877936 08/30/2020 08/30/2021 LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY ❑ PRO ❑ LOC JECT: MOTHER PRODUCTS-COMP/OPAGG $ 2,000,000 $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANYAUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accide nt) $ PROPERTY DAMAGE Per accident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 A EXCESS LAB CLAIMS -MADE 080877960 08/30/2020 08/30/2021 DED I X1 RETENTION $ 10,000 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABI LI TY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N/A 9223920-2021 01/O5/2021 01/O5/2022 X1 STATUTE EORH E.L. EACH ACCIDENT 1,000,000 $ E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 1,000,000 $ A Professional Liability SIR: $50,000 080877936 08/30/2020 08/30/2021 Each Wrongful Act Aggregate $1,000,000 $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The City of El Segundo, its officers, officials, employees, agents and volunteers and named as additional insured as respects liability arising out of the operations fo the named insured. Waiver of Subrogation applieas as respects Workers Compensation. Endorsement to be issued by carrier. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN The City of El Segundo ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main St. AUTHORIZED REPRESENTATIVE ElSegundo CA 90245 © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD ENDORSEMENT # 012 This endorsement, effective 12:01 AM 08/30/2020 Forms a part of policy no.: 080877936 Issued to: S&S LABOR FORCE INC By: LEXINGTON INSURANCE COMPANY ADDITIONAL INSURED REQUIRED BY WRITTEN CONTRACT ENDORSEMENT This endorsement modifies insurance provided under the following: GUARDSECURE° SECURITY RELATED GENERAL AND PROFESSIONAL LIABILITY POLICY A. Section II - Who Is An Insured is amended to include any person or organization you are required to include as an additional insured on this policy by a written contract or written agreement in effect during this policy period and executed prior to the "occurrence" or "wrongful act". B. The insurance provided to the above described additional insured under this endorsement is limited as follows: 1. COVERAGE A BODILY INJURY, PROPERTY DAMAGE AND PROFESSIONAL LIABILITY (SECTION I - COVERAGES) only. 2. The person or organization is only an additional insured with respect to liability arising out of "your work" or your "professional services". 3. In the event that the Limits of Insurance provided by this policy exceed the Limits of Insurance required by the written contract or written agreement, the insurance provided by this endorsement shall be limited to the Limits of Insurance required by the written contract or written agreement. This endorsement shall not increase the Limits of Insurance shown in the Declarations pertaining to the coverage provided herein. 4. This insurance does not apply to "bodily injury", "property damage" or "professional liability" arising out of: a. "Your work" or your "professional services" unless you are required to provide such coverage by written contract or written agreement and then only for the period of time required by the written contract or written agreement and in no event beyond the expiration date of the policy; or b. The sole negligence of the additional insured for its own acts or omissions or those of its employees or anyone else acting on its behalf. 5. Any coverage provided by this endorsement to an additional insured shall be excess over any other valid and collectible insurance available to the additional insured whether provided on a primary, excess, contingent or on any other basis, unless the written contract or written agreement with the additional insured specifically requires that this insurance be primary and non-contributory with any other insurance issued to the additional insured. In such case, this insurance shall be primary and non-contributory with any other insurance issued to the additional insured. LX4237 (08/13) Page 1 of 2 C. In accordance with the terms and conditions of the policy and as more fully explained in the policy, as soon as practicable, each additional insured must give us prompt notice of any "occurrence" or "wrongful act" which may result in a claim, forward all legal papers to us, cooperate in the defense of any actions, and otherwise comply with all of the policy's terms and conditions. Failure to comply with this provision may, at our option, result in the claim or "suit" being denied. All other terms and conditions of the policy remain the same. Authorized Representative LX4237 (08/13) Page 2 of 2 ENDORSEMENT AGREEMENT WAIVER OF SUBROGATION REP 06 9223920-21 RENEWAL SP 6-05-32-02 PAGE 1 HOME OFFICE SAN FRANCISCO EFFECTIVE JUNE 8, 2021 AT 12.01 A.M. ALL EFFECTIVE DATES ARE AND EXPIRING JANUARY 5, 2022 AT 12.01 A.M. AT 12:01 AM PACIFIC STANDARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME S&S LABOR FORCE, INC. 26893 BOUQUET CANYON RD. SUITE 413 SAUGUS, CA 91350 ANYTHING IN THIS POLICY TO THE CONTRARY NOTWITHSTANDING, IT IS AGREED THAT THE STATE COMPENSATION INSURANCE FUND WAIVES ANY RIGHT OF SUBROGATION AGAINST, THE CITY OF EL SEGUNDO WHICH MIGHT ARISE BY REASON OF ANY PAYMENT UNDER THIS POLICY IN CONNECTION WITH WORK PERFORMED BY, S&S LABOR FORCE, INC. IT IS FURTHER AGREED THAT THE INSURED SHALL MAINTAIN PAYROLL RECORDS ACCURATELY SEGREGATING THE REMUNERATION OF EMPLOYEES WHILE ENGAGED IN WORK FOR THE ABOVE EMPLOYER. IT IS FURTHER AGREED THAT PREMIUM ON THE EARNINGS OF SUCH EMPLOYEES SHALL BE INCREASED BY 03%. NOTHING IN THIS ENDORSEMENT SHALL BE HELD TO VARY, ALTER, WAIVE OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS POLICY OTHER THAN AS ABOVE STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR LIMITATIONS IN THIS ENDORSEMENT. COUNTERSIGNED AND ISSUED AT SAN FRANCISCO: JUNE 14, 2021 2570 AUTHORIZED REPRESENT /IVE PRESIDENT AND CEO SCIF FORM 10217 (REV.4-2018) AM BEST' IMP ESA"' CREDIT RATING I I� SUI .I✓ FOR AMB #: 002350 - Lexington Insurance Company 1. The Symbol, Number, or Score in the Rating Scale used to Denote the Credit Rating Categories and Notches as required by Paragraph (a)(1)(ii)(A) of Rule 17g-7 Lexington Insurance Company AM Best #: 002350 NAIC #: 19437 FEIN #: 25-1149494 Rating: A (Excellent) Affiliation Code: p (Pooled Rating) Financial Size Category: XV ($2 Billion or Greater) Outlook: Stable Action: Affirmed Effective Date: August 19, 2020 Initial Rating Date: June 30, 1966 Long -Term: a Outlook: Stable Action: Affirmed Effective Date: August 19, 2020 Initial Rating Date: April 6, 2005 ( i ) Denotes Indicative Rating u Denotes Under Review Rating pca Best's Preliminary Credit Assessment is an independent opinion on the relative general credit strengths and weaknesses of an issuer, obligor, security, or a proposed transaction or financing structure primarily based on business plans, term sheets, and AM Best's expectations relative to the execution of such business plans. AM Best does not define a PCA as a Credit Rating, however, the assessment is expressed using the existing Best's Credit Rating scales. Rating Issued by: A.M. Best Rating Services, Inc. Ambest Road, Oldwick, NJ 08858 United States +1 908 439 2200 Associate Director : Gregory Dickerson +1 908 439 2200 Ext. 5161 Senior Director : Michael J. Lagomarsino, CFA, FIRM Page 1 of 16