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PROOF OF INSURANCE (2022 - 2022) CLOSEDACCa [ ' DATE (MM/Y) "~.�",� CERTIFICATE OF LIABILITY INSURANCE 07/01/20212021 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 ONAT Don Kiger„ CSR Strategic Alliance Insurance PHONE y, 800-830-171"2 ) FAX License 0764210 " 1714 Louise Lane ADDRES& donkiger67@yahoo.com Nipomo, CA 93444 INSURER(S)AFFORDINGCOVERAGE NAIC# ___ _................. — INSURER StateCompensationInsurance Fund INSURED LURED EnterNSURERS p. Enterprises incnC INSURER C . �..... IInnsu ace COm any ---------------- ... tus Drive.. 149 Eucalyptus (NsuRER_.... D : El Segundo CA 90245 g un _ INSURER E INSURER F : rnvconr-oc rFRTII=IrATG IU!IIhAIRFR- RFVICInKI NIIIMRFR- 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 CLAIMS. POLICY ILT§klR ............TYPE OF INSURANCE 1�ADDT yS4JBRfl... POLICY NUMBER '... MMADDIY�VYY l MM DD/VYYY '�............... LIMITS .....n... B X COMMERCIAL GENERAL LIABILITY UDC-4234626-EO-2 8-10-2021 8-10-2022 EACHOCCURRENCE $ 2,000,000 CLAIMS -MADE X OCCUR I iAM�r IN 6rY F"REMdSES Fa aaurranr„&r). ... -$ 100 000 . .... ... rson) $ 5,000 Professional SlOnal Liability X... PERSONAL Ne JURY $ 2,000,000 ww _ GEN'LAGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ 2,000,000 ..... .2,000,000... "".X_„� POLICY Ems. LOC PRODUCTS COMP/OPAGG„$ _.. „.,.__ _ OTHER B AUTOMOBILE LIABILITY UDC-4234626-EO-20 2 8-10-2021 8-10-2022 COMBINED SINGLE UNIT � $ 2,000 000 ... ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS HIRED NON -OWNED PROPERTY DAMAGE ..... $ AUTOS ONLY ,._X..-. AUTOS ONLY •„„ Per accid (.....,._ _. ..,_) ------� ., Is OCCUR UMBRELLA LIAB........... EACH OCCURRENCETE $ .... SS LIAB EXCESS CLAIMS MADE AGGREG- ..__�„$__ A .. ------ .......... I Is DED RETENTION $ A WORKERS COMPENSATION 9227676-21 3-9-2021 ` 3-9-2022 X PER TH l STA T ER AND EMPLOYERS' LIABILITY N H U E.. .. _ E L EAC ACCIDENT __' ` I$ 1,000,000 ANYPROPRIETOR/PARTNER/EXECUTIVE NIA OFFICER/MEMBEREXCLUDED? I (Mandatory in NH) ....__ ._... ... ......... If describe under �MITE� 1,000,000 DESCRIPTION OF OPERATIONS below E.L�,�DISEASE - POLICY $ B ADP UDC-4234626-EO-20 2 8-10-2021 8-10-2022 Broad Form $ 20,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Certificate holder named as additional insured per the attached endorsement CERTIFICATE HOLDER L ANk;1=LLW 11UN City of El Segundo City Clerk Office SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 35O Main St. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN El Segundo, CA 90245 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD General Liability Policy: 4234626-EO-2 COMMERCIALGENERAL ! ABILITY THIS ENDORSEMENT CHANGES THE POLICY PLEASE READ CAREFULLY ADDITIONAL INSURED- OWNERS, LESSES, OR CONTRACROR (FORM B) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART. SCHEDULE Name of Person or Organization: City of El Segundo it's Officers, Employees and Agents (If no entry appears above, information required to complete this endorsement will be shown in the Declaration as applicable to this endorsement.) WHO IS AN INSURED: (Section 11) is amended to include as an insured this person or Organization shown in this Schedule, but only with respect to liability rising out of "your work" for the insured by or for you. PRIMARY INSURANCE: Such insurance as is afforded by the General Liability policy is primary insurance and no other insurance of the additional insured will be called upon to contribute to a loss. CG 20 10 11 85 ENDORSEMENT AGREEMENT WAIVER OF SUBROGATION BLANKET BASIS HOME OFFICE SAN FRANCISCO EFFECTIVE MARCH 9, 2021 AT 12.01 A.M. ALL EFFECTIVE DATES ARE AND EXPIRING MARCH 9, 2022 AT 12.01 A.M. AT 12:01 AM PACIFIC STANDARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME LAWLES ENTERPRISES INC 149 EUCALYPTUS DR EL SEGUNDO, CA 90245 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 POLTCY PREMIUM. SCHEDULE PERSON OR ORGANIZATION JOB DESCRIPTION ANY PERSON OR ORGANIZATION BLANKET WAIVER OF FOR WHOM THE NAMED INSURED SUBROGATION HAS AGREED BY WRITTEN CONTRACT TO FURNISH THIS WATVER 9227676-21 RENEWAL NA 9-07-63-69 PAGE 1 OF 1 NOTHING IN THIS ENDORSEMENT CONTAINED SHALL BE HELD TO VARY, ALTER, WAIVE OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS POLICY OTHER THAN AS STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR LIMITATIONS OF THIS ENDORSEMENT. COUNTERSIGNED AND ISSUED AT SAN FRANCISCO: AUTHORIZED REPRESENT WE SCIF FORM 10217 (REV.7-2014) MARCH 11, 2021 2572 PRESIDENT AND CEO OLD DP 217