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PROOF OF INSURANCE (2022) CLOSEDOCEABLU-06 ACOR®� YYY) MIDD/Y �� CERTIFICATE OF LIABILITY INSURANCE 2/2021 1s/2 DATE (MMIDD/Y THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION .,....,... TION 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 d.. 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 n lieu of such endorsement(s). this certificate does not confer rights to the certificate holder.. „ PRODUCER License # 0757776 C TACT Alisha Davis HUB International Insurance Services Inc. A 9855 Scranton Road PHONE No, E# W7) 825-2681 �..I l (951) 231-2572 -..... EMAIL il..... Suite 100 ash a davia�hiubinternat)onai com San Diego, CA 92121 ...9mNSuRE,ISI.AFFORDING COVERAGE ......... ............ ...�..... N,AP�..�__.. m.. INSURERA„ T"emtWnwichInSiU!1�a(GtmCi1mpAp ................ ,223 2 ------ .......... INSURED INSIIR,E,RB .XL..Spg!pia!t tjnSIlian!;e Co,mpgp.y.............. .�IT885..------ Ocean Blue Environmental Services, Inc. INstlr:ERc Indian Halrb,,,,, _ _ ance C,pmpany or Insur, 925 West Esther Street wsuRER D Long Beach, CA 90813 COVERAGES 11 CE T FICAT NIjiMBER: 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 F SUCH LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR ...... �ADDLISUBR TYPE OF INSURANCE I ) yMy POLICY NUMBER -- - POLICY EFF `__� ............... f+OLICY EXP LIMITS A X COMMIAL GENERAL LIABILITY .,, $ 00,000 X.]OCCURX XGEC300156801 7/1/2021 DAMAGE 100 000LAMS-MADE 7/112022 )$ ......... 5 000 .... ..... MED EXP (An one person), 5 PERSONAL & ADV INJURY $ 1,000,000 ( is 2,000,000 S X NROIG.u3R FLAT J C A P JE�.��.PER: P LOC CENERALAGf RELATE PRODUCTS COM,PIOP AGG, $ 2,000,000 .._ XrHER:DE'O. $6.000 B AU T ABILITY COMBINED Si NGLE LIMO $ 1,000,000 X ANY AUTO AECO05699101 7/1/2021 7/1/2022 BODILY INJURY (per ffr M) s scHEDULED AUTOS ONLY AUTOS _ E30DILYINJURY(PrarcdentJ.... _... AUTOSONLY A f6i PROR'rY DAMAGE... P'E ',.GPe�aScimlel'i,$ .... MCS-90 Pollution .............. .�..._.. _._._.— ........ Waste 5,000,000 X 1 (Hazardous $ C UMBRELLA LIAB X OCCUR _ ..... . .� --� 6. EACH Of CIJRRFNCE5 9 000 000 EXCESS LIAB CLAIMS -MADE X ------ I UEC005699201 7/1I2021 7/1/2022 9,000,000 AGGREGATE._, .._ «=—....._. ,..,. . ..�............,.. ........ DED X RETENTION $ 10,000 v pp $ B WORKERS COMPENSATION f I W.......WW.. ....__ a.,...X...pER 4 AND VI N. J WEC300156701 7/1/2021 ......._.HRH 7/1/2022 1,000,066 ROPRIETOR/P RTNEY ANY PROPRIMB R/PARTNDED? CUTIVE r OFFICER/MEMBER EXCLUDED ( Y I N/ A d E L EACH ACCIDENT $ ACHACC — - ((Mandatory in NH) .. IP 1,000,000 E L DISEASE aEA EMIPLOYEE $ ,.... If yes describe under 4 1,000,000 DESCRIPTION OF OPERATIONS below W.. . .. M ...���. E L DISEASE POLICY LIMIT $ „ ,,, .......... C Pollution / Environm i PEC005703301 �PECO05703301 7/1/2021 7/1/2022 Each Occ/Aggregate 5,000,000 C Professional Liab 7/1/2021 7/112022 Each Occ/Aggregate 5,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) City of El Segundo its officials„ and employees are Additional Insure-d"s with regards to the General Liability policy when required by a written contract, per the attached endorsement form CG2010 12/19. Waiver of Subrogation applies with regards to the General Liability policy when required by a written contract, per the attached endorsement form CG2404 12/19. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of El Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN tY 9 ACCORDANCE WITH THE POLICY PROVISIONS. its officials, and employees City Clerk 350 Main Street, Room 5 AUTHORIZED REPRESENTATIVE El Segundo, CA 90245 ..... ...__..... _.........._. � (201©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) g The ACORD name and logo are registered marks of ACORD POLICY NUMBER: GEC300156801 COMMERCIAL GENERAL LIABILITY CG 20 10 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED ED - OWNERS, S, LESSEES O CONTRACTORS - SCHEDULED PERSON OIL ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Oroanization(s) I Location(s) Of Covered Operations Any person or organization where required by written I All Locations as required per written contract. contract provided that such contract was executed prior to the date of loss. 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. CG 20 10 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 2 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 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; whichever is less. This endorsement shall not increase the applicable limits of insurance. CG 20 10 12 19 C Insurance Services Office, Inc., 2018 Page 2 of 2 POLICY NUMBER:GEC300156801 COMMERCIAL GENERAL LIABILITY CG24041219 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) OGATIOI ) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART ELECTRONIC DATA LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART DESIGNATED SITES POLLUTION LIABILITY LIMITED COVERAGE PART DESIGNATED SITES PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART UNDERGROUND STORAGE TANK POLICY DESIGNATED TANKS SCHEDULE Name Of Person(s) Or Organization(s): Any person or organization where required by written contract provided that such contract was executed prior to the date of loss (as permissable by law) Information required to complete this Schedule, if not shown above, will be shown in the Declarations. 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 against the person(s) or organization(s) shown in the Schedule above because of payments we make under this Coverage Part. Such waiver by us applies only to the extent that the insured has waived its right of recovery against such person(s) or organization(s) prior to loss. This endorsement applies only to the person(s) or organization(s) shown in the Schedule above. CG 24 04 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1 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 Where required by written agreement signed prior to loss All California Operations. 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 07/01/2021 Policy No. WEC300156701 Endorsement No. Insured Insurance Company Ocean Blue Environmental Services, Inc. XL Specialty Insurance Company Countersigned By WC 04 03 06 Page 1 of 1 (Ed. 04-84) Copyright 1984 Workers' Compensation Insurance Rating Bureau of California. All Rights Reserved.