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PROOF OF INSURANCE (2022 - 2022) CLOSEDClient#: 1291580 04CORRACON YYY) ACORD. CERTIFICATE OF LIABILITY INSURANCE 12/1 DATE (M7/2021 M/DD/YMIDD/Y 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. .......................................................................................................... ..-_________ t .I'.c.. (ie............Inust have ADDITIONAL INS...................................'....'............................,...----d,..,....sIed. IMPORTANT. If the certificate holder is an ADDITIONAL INSURED, he po cy('es) URED prov""sons 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONT CT NAME:. McGriff Insurance Services PHONE E, 888 743-2217 J ( C No) 8888279861 T.._..,..,.... 7701 Airport Center Dr E-MAIL Suite 1800 ADDRESS .. ....... .. .. ......... INSURER�Si AFFORDING COVERAGE NAIC # Greensboro, NC 27409 INSURER A: Colony Insurance Company 39993 -------------------------------- INSURED INSURER B : Nautilus Insurance Company 17370 Corral Construction & Development Inc INSURER C :µState Compensation Ins. Fund of CA 35076 5211 E. Washington Blvd. #2-122 Ohio Securit Insurance Company 24082mmmmmmm Commerce, CA 90040 INSURERD: _Y Y INSURER E;, COVERAGES CERTIFICATE NUMBER: 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 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. (... LTR LTR ... TYPE OF INSURANCE ADDL M{71.�.ft SUt1R �................POLICY NUMBER.... .. „.. POLICYERFJ POmof EXP �MMfDDd7YYY MMIDDA'YYYY. LIMITS ,.,,,,,,,.......... .... A COMMERCIAL GENERAL LIABILITY X X BINDER101GLO190413 12/08/2021 12/08/2O2 EApC.Hq OCgCpURRENCE $2 p00 ppp .� DA r F REN OO mm ...IT.... ..m OOO CLAIMS -MADE OCCUR PBRI,Nd7k 5 ft',9.. t�ttrrrceaacn�'d ," $1 X BI/PD Ded:500 _................................... MED EXP (Any one personl $5,000 PEFISCiPJAL & ADV INJURY O,ppO GATE LIMIT APPLIES PER: GEN'L AGGREGA, G ENERAL AGGREGATE S3000tOOO POLICY 0 PRO I JECT ,... f LOC PRODUCTS - COMP/OP,AGG 53000,000 , OTHER D AUTOMOBILE LIABILITY _.......... BA--.......,..,.,.,.,.,.,.,.,.,.,n..,.,n.nm. --� S57476683 12/08/2021 12/08/202 c0'ndBINLDINLELIwI( �E?�.,�r.�a.fJ�gr� . ........ �1 mm000u000 . ANY AUTO BODILY INJURY (Per person) $ �� OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) _.—.... $ ..................................... ................ HIRED NON -OWNED X PROREAT`Y DAMAUL $ AUTOS ONLY ...X.. AUTOS ONLY _.................................... ............................,,�,,,. B UMBRELLA LIAB OCCUR EZXS3066362 2/08/2021 12/08/202 EACH OCCURRENCE $2,QQOQQO EXCESS LIAB CLAIMS MADE _ .... __....... AGGREGATE ... $2 000 000 DED RETENTION $ $ C WORKERS COMPENSATION���� X BINDER903611821 12/01/2021 12/01 /.�0.� X PER OTH T AND EMPLOYERS LIABILITY •-•----- ANY PIlCp6 FIIEIO,'ldtIART'NER/EXECUTIVE E L.. EACH ACCIDENT I�NDEM,LOYEEl'LIAa_uTY (Mandalory in NH) N/A 11,­S1,000,000 E.L, DISEASE - EA EMPLOYEE S1,000,000 If yes, describe under' DESCRIPTION OF OPERATIONS below -____. ........... DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) ** General Liability Information ** Job#: 1 Job#: 2 Job#: 4 Job#: 5 (See Attached Descriptions) City of El Segundo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE g THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 350 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. El Segundo, CA 90245 AUTHORIZEDREPRESENTATIVE �lai.p _ 1kw{LM ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) 1 of 2 The ACORD name and logo are registered marks of ACORD #S29131169/M29131164 PEMU SAGITTA 25.3 (2016/03) 2 of 2 #S29131169/M29131164 ENDORSEMENT AGREEMENT WAIVER OF SUBROGATION 9036118-21 RENEWAL SP 2-83-35-91 PAGE 1 HOME OFFICE SAN FRANCISCO EFFECTIVE JANUARY 13, 2022 AT 12.01 A.M. ALL EFFECTIVE DATES ARE AND EXPIRING DECEMBER 1, 2022 AT 12.01 A.M. AT 12:01 AM PACIFIC STANDARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME CORRAL CONSTRUCTION & 5211 E WASH BLVD STE 2-122 COMMERCE, CA 90040 ANYTHING IN THIS POLICY TO THE CONTRARY NOTWITHSTANDING, IT IS AGREED THAT THE STATE COMPENSATION INSURANCE FUND WAIVES ANY RIGHT OF SUBROGATION AGAINST, CITY OF EL SEGUNDO WHICH MIGHT ARISE BY REASON OF ANY PAYMENT UNDER THIS POLICY IN CONNECTION WITH WORK PERFORMED BY, CKe7 i i 1dwKe)z&V0 i4100to) zW1 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: 2570 AUTHORIZED REPRESENT IVE SCIF FORM 10217 (REV.4-2018) JANUARY 18, 2022 PRESIDENT AND CEO OLD DP 217