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PROOF OF INSURANCE (2023) CLOSEDTRIASER-01 TL ACORO" �� CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYl'Y)2/15/2022 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 Alliant Insurance Services, Inc. 353 N Clark Street Chicago, IL 60654 INSURER A: Everest National Insurance Comp any............. 10120 INSURED wsURER_B:Everest Denali Insurance Com an _ , _.. o p ®Y 16044, Shelter Clean Services, Inc. INSURER C:AXISSurplus Insurance Company,,, ,, 26620 11065 Penrose St. INSURERD:Lexington Insurance Company, „1943,7 Sun Valley, CA 91352 . INSURER-E,: .... ......... ....... .. INSURER F : _..... ....... C ' E iAGES _ CERTIFICATE NUMB; R: A N.............................._.................. REV ISION NUMBED HAT THE POLICIES OF INSURANCE LISTED BELOW THIS IS TO CERTIFY THAT 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, INSR . ADDL SUER, rr PE OF INSURANCE POLICY NUMBER IL`L��.NIY&�� ..-�. ......... ���.... _ POLICY EFF POLICY EXP LIMITS ... _ �iIM11Vi�17D/YYYVI ..If�l�l•1�i/1'Y.YY1 ,.� .....���� _._....�.A A � X COMMERCIAL......... GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 CLAIMS -MADE X 'OCCUR RM8GL00008221 X 2/28/2022 2/28/2023 i)AMA �L TO RENTED PRk1I CrYF1S aldr�� S 500 000 .. 10,000 '.. MED EXP (Any oneperson� S , 2,000,000 PERSONAL 4.AIaV INJURY S 6,000 OOO GE.N'L AGGREGATE. LIMIT ARPL,, ES PER f ENFRAI AGGREGATE..... ,, 11 POLICY X PEef X LOC : PRODUCTS COMP/OP AGG S ...... 6,000 000 , EBL AGGREAGTE 2 600,000 OTHER, s --- _------ B 2,000,000 AUTOMOBILE LIABILITY ,(r, _W;;0gr4" X ANY AUTO RM8CA00016221 2/28/2022 2/28/2023 Hnm Y INJI„,IRY (Per person) 5 ..,,... m. OWNED SCHEDULED = AUTOS ONLY AUTOS BODILY INJURY (Per accident) - S XX_. HIRED NON -OWNED .....: AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE (Par ar„cadent),. Comp Ded S2,500 X Coll Ded $2,500 X $ C UMBRELLA LIAB X -, OCCUR EACH OCCURRENCE S _ ,...r. 3,000,000 ,,,...... ., X EXCESS LIAB CLAIMS -MADE P00100008343104 _ 2/28/2022 2/28/2023 AGGREGATE $ 3,000,000 D E D RETENTION S S ....... _ .-..,e...,,,, ..... �-��-- A WORKERS COMPENSATION PER OTH X STATUTE R AND EMPLOYERS' LIABILITY RM8WC00031221 YIN X 2/28/2022 2/28/2023 2,000,000 ,ANY P'R�dPiR1ETOR/PARTNERIEXECUTIVE N / A , E. L EACH ACCIDENT S .... Ma C rt�WI NH) EXCLUDED? ,,,,, E L DISEASE - EA EMPLOYEE S 2,000,000 If yes, describe under 2,000 000' DESCRIPTION OF OPERATIONSbelow E.L DISEASE POLICY LIMIT S D ,Excess Liab 5M x 3MW 023627617 2I28/2022 R/ 1-22023 Each Occ./Aggregate 5,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: City of El Segundo. City of El Segundo, its officials, officers, agents and employees are included as Additional Insured in accordance with the policy provisions of the General Liability policy. A Waiver of Subrogation is granted in favor of Certificate Holder in accordance with the policy provisions of the Workers' Compensation policy. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City Of El Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Y 9 ACCORDANCE WITH THE POLICY PROVISIONS. Attn: PW Dept. 350 Main Street ..._..................................... .._........�u-__awm_. El Segundo, CA 90245 AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) ............ ..... ........._ .. . ......... .........._._._.__..... g ©1988-2015 ACORD CORPORATION. 11 rights mm ON. All ri hts reserved. The ACORD name and logo are registered marks of ACORD AGENCY Alliant Insurance Services, Inc. POLICY NUMBER SEE PAGE 1 CARRIER SEE PAGE 1 AGENCY CUSTOMER ID: TRIASER-01 TLOVELL LOC #: 0 ADDITIONAL REMARKS SCHEDULE Page 1 of 1 NAMED INSURED Shelter Clean Services, Inc. 11055 Penrose St. Sun Valley, CA 91352 NAIC CODE SEE P 1 EFFECTIVE DATE: ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: RM8GL00008221 COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PE SO OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organ¢aA on1s) ....._...„ Location(s) Of Covered Operations ALL ORGANIZATIONS WHERE YOUR LOCATIONS REQUIRED BY WRITTEN CONTRACT AND EXECUTED PRIOR TO LOSS 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 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 2 INSURED COPY 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 shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. Page 2 of 2 © Insurance Services Office, Inc., 2012 CG 20 10 04 13 IIVSa!fdED COPY POLICY NUMBER:RM8GL00008221 COMMERCIAL GENERAL LIABILITY CG 20 37 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Or anization s Location And Description Of Com leted O erations ALL ORGANIZATION WHERE REQUI::RED :BY WR:ITTE,N CONTRACT AND :E)C:E,CUTED PRIOR TO LOSS. YOUR LOCATIONS AND COMPLETED OPERATIONS. n required to complete this Schedule„ if not shown above, will be shown in the Declarations. In -formation r ............... 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" or "property damage" caused, in whole or in part, by your work" at the location designated and described in the Schedule of this endorsement performed for that additional insured and included in the "products -completed operations hazard". 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. CG 20 37 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 2 INSURED COPY B. 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 shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. Page 2 of 2 © Insurance Services Office, Inc., 2012 CG 20 37 04 13 ❑ ENSURED COPY WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13 (Ed. 4-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT 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.) This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule ANY PERSON OR ORGANIZATION FOR WHOM YOU ARE REQUIRED BY WRITTEN CONTRACT OR AGREEMENT TO OBTAIN THIS WAIVER OF RIGHTS FROM US. For policies or exposure in Missouri: Any person or organization for which the employer has agreed by written contract, executed prior to loss, may execute a waiver of subrogation. However, for purposes of work performed by the employer in Missouri, this waiver of subrogation does not apply to any construction group of classifications as designated by the waiver of right to recover from others (subrogation) rule in our manual. 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 02-28-22 Policy No. RM8WC00031221 Endorsement No, Insured TRIANGLE SERVICES INC. Premium $ INCL . Insurance Company EVEREST NATIONAL INSURANCE COMPANY Countersigned By WC 00 03 13 (Ed. 4-84) © 1983 National Council on Compensation Insurance.