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PROOF OF INSURANCE (2022 - 2022) CLOSEDBREAT-1 OP ID: SP CERTIFICATE OF LIABILITY INSURANCE DA09107/2021Y) 09/0712021 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 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 Jack Tahanian ISU-The Ultima Agency mmc -"""""""""" •'ll"" PHONE 3848 E. Colorado Blvd. # 2 (AlC N , 4;1 626-792-5000 � � gAacn N�rl 626 792-5639 Pasadena, CA 91107 E MAIL ADOREss Jack ultiralnsuran...ce com Tahanian, Jack .a r INSURERISI AFFORDING COVERAGE NA- IL # INSURED 3010 Wilshire Blvd., #260 Los Angeles, CA 90010 A:Crum & FosterSpecia a: Guard Insurance Com CI"1VFRAt11=?A CERTIFICATE Nl1MBER: 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, ,.. IAi7tY'L"�Ui1ii'"'"""�' ---- --- .......... I„. 0�iLl�"Y-EF�,F P01LI!L"M" E,�P 1...... INSFt. " ........ TYPE OF INSURANCE .... .........�. ... LIMITS ......, ......... ...... IN POLICY NUMBER k MMIIDDIYYYY MMNDi,�I" WY GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X � COMMERCIAL GENERAL LIABILITY X EPK-133863 01/16/2021 01/16/2022 UAMEXPS( (Ea,oq CLAIMS MAD E l X.I...,.,...... MED person) 1,$ 10,00 PERSONAL&ADVINJURY $ 1,000,00 .0 GENERAL AGGREGATE $ 2,000,00 _... .. .... ..._...rrrr..... GATE APPLIES GE,N'L AGGREGATE C..O.MPIOPAG.G 0,00 PLIMIT PE�: POLICY IO .P.—RODUCTS ........$ .................................2...,..0,.„0 $X AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT1,000,00 ......... ........ ,.,BODILY BURY B � ANY AUTO BRAU191827 INJURY(Per person) $ $ ....... _...._. `. ALL OWNED SCHEDULED f AUTOS BODILY NJ ............. ,, JURY (Pe accident) $ X HRTEODAUTOS X." NON --OWNED AUTOS PR PERT $ P„I�ICRAC�I'GP' ..._._... I OCCUR EACH OCCURRENCE $ EXCESS LIABAB CLAIMS -MADE AGGREGATE $ ________,__ I , T { DED � .RETENTION $ $ WORKERS COMPENSATION WC S'TATIJj lO rI,-I TwmL13.y' I„IMLT5;i AND EMPLOYERS' LIABILITY YIN _ --- ------ . I 1........ ANY PROPRIETOR/PARTNER/EXECUTIVE E..L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ NIA "" ---.-- ----. - - ------ (Mandatory in NH) - EA EMPLOYEE $ If yes, describe under _E_L.___D_I_S_EASE DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT ,, $ A Pollution Liab EPK-133863 01/16/2021 01/16/2022 Condition 1,000,00 A Professional Liab EPK-133863 01/16/2021 01/16/2022 Per Claim 1,000,00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) City of El Segundo, its official, and employees are named additional insured on the GL policy when required by a written contract, under form SPE0001-0115 attached to policy. r1=RTIr-IrATI='14nl r1... P (ANCF'1 I ATI0NI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE t'.1 of El Segundo City gun THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street El Segundo, CA 90245 AUTHORIZED REPRESENTATIVE t TM) U 1988-2010 AGORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD or performing duties related to the conduct of your business, or to your other 'volunteer workers" while performing duties related to the conduct of your business; (b) To the spouse, child, parent, brother or sister of that co -"employee" or "volunteer worker" as a consequence of Paragraph (1)(a) above; (c) For which there is any obligation to share "damages" with or repay someone else who must pay "damages" because of the injury described in Paragraphs (1)(a) or (b) above; or (d) Arising out of his or her providing or failing to provide professional health care services. (2) "Property damage" or "dean -up costs" to property. (a) Owned, occupied or used by, (b) Rented to, in the care, custody or control of, or over which physical control is being exercised for any purpose by you, any of your "employees", "volunteer workers", any partner or member (if you are a partnership or joint venture), or any member (d you are a limited liability company). b. Any person (other than your "employee" or nvolunteer worked, or any organization while acting as your real estate manager. c. Any person or organization having proper temporary custody of your property if you die, but only. (1) With respect to liability arising out of the maintenance or use of that property; and (2) Until your legal representative has been appointed. d. Your legal representative, if you die, but only with respect to duties as such. That representative will have all your rights and duties under this Coverage Part 3. Any organization you newly acquire or form, other than a partnership, joint venture or limited liability company, and over which you maintain ownership or majority interest, will qualify as a Named Insured if there is no other similar insurance available to that organization. However. a. Coverage under this provision is afforded only until the 90th day after you acquire or form the organization or the end of the policy period, whichever is earlier, b. Coverage does not apply to "bodily injury", "property damage", "personal and advertising injury", "clean-up costs" or ""damages"" that occurred before you acquired or formed the organization. 4. When specifically required In s written contract, your customer, landlord, franchisor, Iessor of equipment or project owner is an insured but only with respect to liability for 'bodily injury", "property damage", "personal and advertising injury", "clean -costs` or other "damages" caused by. a. Your acts or omissions; or b. The acts or omissions of those acting on your behalf, in the performance of "your worts" or your "professional services", or as included in the "products -completed operations hazard". With respect to insurance provided to such additional insured, it is understood and agreed that the coverage provided to any insured shall in no event be broader than that provided to the Named Insured. To the extent that coverage under any section of this policy is unavailable to the Named Insured for any reason, such overage shall also be unavailable to any other insured. Further, when specifically required in a written contract and solely as respects to such additional insured noted above, this insurance shall be primary and non-contributory, but only in the event of the sole negligence of the named insured. No person or organization is an insured with respect to the conduct of any current or past partnership, joint venture or limited liability company that is not shown as a Named Insured in the Declarations. SECTION III — LIMITS OF INSURANCE AND DEDUCTIBLE 1. Limits Of Insurance a. The Limits of Insurance shown in the Declarations and the rules below floc the most we will pay regardless of the number of: (1) Insureds; (2) "Claims" made or "suits" brought; or (3) Persons or organizations making "claims" or bringing "suits". SPE0001-0115 Page 23 of 36 Includes copyrighted material of Insurance Services Office, Inc. with its permission. 0 DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 08/12/2021 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 LM:. Automatic Data Processing Insurance Agency, Inc. Automatic Data Processing Insurance Agency, Inc. r N r er• 1-800-524-7ONE 024 N*I: 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. � � .� � ........ � � .... .............„ — -- IN§R �U '��FP �POLICDY� POLICY NUMBERee�_^^...._ MM/DDY/YXYY MM/Dro� LTR. TYPE OF INSURANCE LIMITS COMMERCIAL GENERAL LIABILITY E OCCURRENCE $ �.......... .l'' CLAIMS —MADE 1-1 OCCUR PACH .-EACH T �"YIFNTE�� WR,EMISES Ea occurrenoe --- $„ ,,,,µ, ... .. ....- MED EXP (Any one person) _ $ .... .. PERSONAL..-....____ I .....,, .. ..__, __ .. GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE ..... $ POLICY ElJECT D LOC V..... „PRODUCTS-COMP/OPAGG, $ OTHER: AUTOMOBILE LIABILITY . COMBINED Eau))t, SINGLE LIMIT $ ..... ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED ....Y (P __ URY(Peracciden[) BODILY INJURY ..... ...... $ .__ AUTOS ONLY AUTOS HIRED NON -OWNED 16 ROPh RTY CEAIrr`A65- $ AUTOS ONLY AUTOS ONLY Au?f?!t) ........ m ....... __ ---..... UMBRELLA LIAB_ OCCUR EACH OCCURRENCE $ EXCESS LIAB .. CLAIMS -MADE AGGREGATE $ QED RETENTION $ $ WORKERS COMPENSATION TH STATU E AND EMPLOYERS' LIABILITY Y ! N """"'"' _ER 00 $ 1,000,000 A ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED Y N I A Y TWC4003775 06/25/2021 06/25/2022 ,E E.L. EACH ACCIDENT .. .w (Mandatory in NH),000,000 .E E.L.L DISEASE EA EMP ..... EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L DISEASE -POLICY LIMIT $ 1 000 000 '.. DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) This certificate has a blanket Waiver of Subrogation for the following state(s) :CA C;CK I II-IC:A I t MULUCK City of El Segundo 350 Main St. 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 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD