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PROOF OF INSURANCE (2021 - 2022) CLOSED0 DATE (MMIDD/YYYY) AC40R ► CERTIFICATE OF LIABILITY INSURANCE 1 /14/2021 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 polcy(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). cole PRODUCER Auto Insurance 17785 Center Court Drive PHONE NAME NI 866-570r733 SpecialistsCONTACT PHONE 5 rl N4 800-498-3293 Suite 500 EMAIL ce.com CDR commercial@alsUnsuran Cerritos CA 90703 INSURER SIAFFORDING COVERAGE NAIC# INSURED General Lighting and Electrical Services, Inc. 11823 Slauson Ave Unit 12 Santa Fe Springs CA 90670 X'�L^'MTIEUTA= h1111111QC0- . ...... _PL... — ...... _._ INSURER A: US Specialty Insurance_ Company 29599 INSURER California Automobile Insurance Company 3s .... B: p y 342 RFVICIAN NIHVIR'IFR- 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. ADDL StfFi�..- .' ...,,...POR IbY M POLICY ExP LIMITS INSRTYPE Y MMIDD/YYYY OF INSURANCE Y NUMBER POLIO Y COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE " $ 1,000,000 A CLAIMS -MADE OCCUR U21AC132227-00 01/15/2021 i01/1512022 MA�a .L- RcP4 (,9 0w urry f -� W 1 $ O..... ........_ An one person) $ ,000 PERSONAL&ADVINJURY $ 1.,000,000 11, .000,00" EPECI"APPLIESP -- G T PER: 11 -- GENERAL AGGREGATE $ 2,000,000 MNPOLICYE� T LOC P._PRODUCTS. COMP/OPAGG $ 2, 0.... .........._ 01!HE� : AUTOMOBILE LIABILITYtzi / Y rL ..It I µ[,OMBtI COMBINED .. .._.___ $ 1,000,000 ............... .... B ANY AUTO BA040000064860 01/15/2021 01115/2022 BODILY INJURY (Per person) $ accident) BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS �r HIRED RED NON OWNED PROPER"tlY DAMAGE $ AUTOS ONLY "' AUTOS ONLY (ry�a�r,ay, v�';e„ (}� .�-... .... ...... ....., $ UMBRELLA LIA6 ✓ OCCUR 1 ✓ EACH OCCURRENCE_ ... ....... 2,000,000 S.. ...._ ., .,.. A EXCESS LIA6 _ CLAIMS -MADE ---- .... _ .......'ION$ -QED---' U21AC132227-00 01/15/2021 01/15/2022 AGGREGATE $ 2,0002000 y RETENTION $ WORKERS COMPENSATION IPER $ UT E EORH "" '" AND EMPLOYERS' LIABILITY YIN .. " "' _ ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N / A E L. EACH ACCIDENT EMPLOYEE $ $ (Mandatory in NH) �. — Qp If yes, describe under DESCRIPTION OF OPERATIONS below E L, DISEASE POLICY LIMIT l� $^ DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: Ongoing Projects Whereby required by contract, the City of El Segundo, its Officials and Employees are included as Additional Insured on the General Liability & Auto Liability policies, per attached forms CG 20 10 0704 and MCA20480711. Waiver of Subrogation apply to General Liability and Auto Liability per attached forms HCS 040 06 and MCA04440913. Excess Liability is Follow Form. CERTIFICATE HOLDER 1IaANk t:L.LA a IVN City of El Segundo Its Officials and Employees SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 350 Main St. ACCORDANCE WITH THE POLICY PROVISIONS. El Segundo, Ca 90245 AUTHORIZED REPRESENTATIVE U 1913B-205 AGUKU GUKYUKA I IUN. All ngnis reserves. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: U21AC132227-00 COMMERCIAL GENERAL LIABILITY CG 20 10 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL (INSURED - OWNERS, LESSEES O CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organ izations : Locations Of Covered Operations Any person or organization for whom you are performing operations during the policy period when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy. 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 B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following additional organization(s) shown in the Schedule, but only exclusions apply: with respect to liability for "bodily injury", "property This insurance does not apply to "bodily injury" or damage" or "personal and advertising injury" .'properly damage" occurring after: caused, in whole or in part, by: 1. All work, including materials, parts or 1. Your acts or omissions; or equipment furnished in connection with such 2. The acts or omissions of those acting on your work, on the project (other than service, behalf; maintenance or repairs) to be performed by or in the performance of your ongoing operations for on behalf of the additional insured(s) at the the additional insured(s) at the location(s) location of the covered operations has been designated above. 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 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 C1I POLICY NUMBER: U21AC132227-00 COMMERCIAL GENERAL LIABILITY HCS 040 06 10 13 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 A. PRIMARY AND NON-CONTRIBUTORY TO OTHER INSURANCE With respect to any person or organization that is an additional insured under this Coverage Part, the following is added to paragraph 4. of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: If ,you have agreed in writing in a contract or agreement that this insurance is primary and non- contributory relative to an additional insured's own insurance, then this insurance is primary and we will not seek contribution from that other insurance. For the purpose of this endorsement, the additional insured's own insurance means insurance on which the additional insured is a Named Insured. When this endorsement is attached to the policy it supersedes all other insurance conditions within. HCS 040 06 10 13 B. WAIVER OF SUBROGATION — BLANKET Under SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS, The Transfer Of Rights Of Recovery Against Others To Us Condition is amended by the addition of the following: We waive any right of recovery we may have against any person or organization because of payments we make for injury or damage arising out of: a. Your ongoing operations; or b. "Your work" included in the "products - completed operations hazard". However, this waiver applies only when you have agreed in writing to waive such rights of recovery in a contract or agreement, and only if the contract or agreement: a. Is in effect or becomes effective during the term of this policy; and b. Was executed prior to loss. Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc., with its permission. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Eli This endorsement modifies insurance provided under the following:. BUSINESS AUTO COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. SECTION IV — BUSINESSS AUTO CONDITIONS, A. Loss Conditions, 5. Transfer of Rights Of Recovery Against Others To Us, the following is added: We waive any right of recovery we may have against any person or organization to the extent required of you by a written contract executed prior to any "accident" or "loss", provided that the "accident" or "loss" arises out of the operations contemplated by such contract. The waiver applies only to the person or organization designated in such contract. MCA04440913 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. The following is added to the Section II — Liability Coverage, Paragraph A.1. Who Is An Insured Provision: Any person or organization that you are required to include as additional insured on the Coverage Form in a written contract or agreement that is signed and executed by you before the "bodily injury" or "property damage" occurs and that is in effect during the policy period is an "insured" for Liability Coverage, but only for damages to which this insurance applies and only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Section II. MCA20480711 0 DATE (MMIDDIYYYY) C RU CERTIFICATE OF LIABILITY INSURANCE 03/09/2021 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 Automatic Data Processing Insurance Agency, Inc. Automatic Data ProcessingInsurance Agency, Inc. PHONN E,��.1-800-524-7�....�.........._. 024 r"AX IAIC. N.as 1 Adp Boulevard RER(S AFFORDING COVERAGE NAIC # Roseland NJ 07068 INSURER A : Hartford Fire Insurance Company 19682 .............. ......................----_ . __ ........ _..... ......................... INSURED General Lighting & Electrical Services Inc INSURER B INSURER„G .............- ---- -- ............-....._. 11823 Slauson Ave Ste 12 INSURER D INSURER E : Santa Fe Springs CA 906706544 INSURER F Cf)VFRAnFS CFRTIFICOTF NUMBER- 1879183 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. ....- �'oLICY E7tp W W m..... t C1LIC EFI _ NSFF ' UiR 'LTR AOd9L - TYPE OF INSURANCE � POLICY NUMBER Y MM/DOPMMIDDlYY1CX LIMITS COMMERCIAL GENERAL LIABILITY J EACH OCCURRENCE $ ""151�nMiCG`f='"I CiY=Y3iE0..__.._ F ] CLAIMS -MADE OCCUR PREMISE jl, a occurrence) $ MED EXP (Any one person) ........ _11_ $ .. --- --- -... PERSONAL & ADV INJURY _ ... S .. .. ._. _._._. GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO- D LOC PRODUCTS -COMP/OP AGG $ � AUTOMOBILE LIABILITY .. COM 6NED pN F 1MiT ar. NdaIX'tll� B,� .B' $. -.� ANY AUTO BODILY INJURY (Per person) $ ................ OWNED SCHEDULED ..Ii�a ..........(.,.� BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWND -,. AUTOS ONLY AUTOS ONLY . ........ — PRO RE .>Bnr' r+?C �C4. I � _ GL . .$ $ UMBRELLA AB�. CCUR { ACH OCCIERRENCE _ COLAI,MS-MADE EXCESS L "RETENTION AGGREGAT $ . DIED $III $ WORKERS COMPENSATION STATU E ER AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE -F E L Esc C N S 1,000,000 A (Mandatory in NH) EXCLUDED? N NIA Y 76WEGAA8PJT 10/19/2020 10/19/2021 e L�. DE _ $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below DISEASE� ..... .. ���M ..... �� ��� �� .1 E,.L. -POLICY LIIMITE1 $------------------------- 1 000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) This certificate of insurance includes a Waiver of Subrogation in favor of the certificate holder. CERTIFICATE HOLDER City of El Segundo 350 Main Street ElSegundo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE CA 90245 1 _)� ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA Policy Number: 76 WEG AA8PJT Endorsement Number: 1 Effective Date: 10/19/19 Effective hour is the same as stated on the Information Page of the policy.. Named Insured and Address: GENERAL LIGHTING & ELECTRICAL SERVICES INC 11823 SLAUSON AVE STE 12 SANTA FE SPRI CA 90670 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 5 % of the California workers' compensation premium otherwise due on such remuneration. SCHEDULE Person or Organization Job Description City of El Segundo , 350 main St., El Segundo CA 90245 1 Countersigned by Form WC 04 03 06 (1) Printed in U.S.A. Process Date: 10/17/19 Authorized Representative Policy Expiration Date: 10/19/20