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PROOF OF INSURANCE (2022 - 2023) CLOSEDClient#: 12362 ROBELIQU ACORD- CERTIFICATE OF LIABILITY INSURANCE °ATE(MM7DDlYYYY) 3/09/2022 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 to certificate holder is an ADDITIONAL INSURED the If SUBROGATION IS WAIVED, subject to the terms and conditions oft eopolicy,(certain policies °maq require an endorsement A statement anNAL INSURE"rovisio-ns or be d this certificate does not confer any rights to the certificate holder in lieu of such endorsement(s). PRODUCER N Christina McMullen Edgewood Partners Ins. Center Ps°vE 94 0. 9 205-7912 19000 MacArthur Blvd. Penthse FL ADDMcMullen@eplcbrokers.com Nojz 949-266-5860 i , r � �,MAC .com Lic#OB29370 949-263-0606 as' Christina. McMullen Icbrokers Irvine, CA 92612 INSURER(S) AFFORDING COVERAGE NAICM _.,. �. INSURER A . GuideOne National Insurance Company 14167 INSURED — INSURER B .... Robert's Liquid Disposal, Inc. 14018 Carmenita Road INSURER C : . Santa Fe Springs, CA 90670 INSURER D li INSURER E INSURER F o 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. TYPE OF INSURANCE .....18X e,. -_ ) I Yl uMlrs A X COMMERCIAL GENERAL LIABILITY ENV56200005304ER(3/05/ 022i0310 5/2023; EACH OCCURRENCE $1,000,( CLAIMS MADE X] OCCUR FOwNSFNTncel $50,000 .... - ..1 MEDEXPWiy one per n) $5,000 - PERSONAL & ADV INJURY $11000r( GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $2%000,( PRo- r 41 LICY JECT LOC PR"ODUCTS-COMPIOPAGG $2 000 ( OTHER. AUTOMOBILE LIABILITY , - (X$M8III,iED'„J�INGLE LIMIT (Ea aruosprul) .... Y AUTO BODILY INJURY (Per n) $ 1 OWNED AUTOS ONLY ,. SCHEDULED AUTOS ... BODILY INJURY (Peraccident) $ HIRED e .„..... AUTOS ONLY NON -OWNED AUTOS ONLY r�h7t+Ir R t Sr Kt.R:ArtGE „ - $ A UMBRELLA LIAR�X,j X CUR ENV56200006404 310512022 03/05/2023 EACH OCCURRENCE �, $ t4 A000&O I SS LIAS CLAIMS -MADE AGGREGATE t 000.0 h�wJ PEP RETENTION ........�. 1 WORKERS COMPENSATION � _. PERH- qL,YTI ANDEMPLOYERS' LIABILITY YIN E7� -S9A)„)�,. EREKECUTIVE� DEN/A E L EACH ACCIDENTOFFI (Mandatory In NH) i E.L. DISEASE - EA EMPLOYEE If yes. describe under DESCRIPTION OF OPERATIONS DISEASE - POLICY LIMIT A Pollution ENV66200005304 , ,E;L. W016/2022 03/0512023` Each Pollution Liability I Condition Limit: $5M DESCRIPTION OF OPERATIONS 1 LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) *Pollution Liability Ded: $2,600 Certificate holder is named as additional insured as respects the general liability, but only if required by written contract with the named insured, prior to an occurrence, per form CG 2010 07/04 & CG2037 07/04 subject to all policy terms and conditions. ,TE CANCELLA City of Lakewood SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 5050 Clark Ave. ACCORDANCE WITH THE POLICY PROVISIONS. Lakewood, CA 90712 AUTHORIZED REPRESENTATIVE F a 4 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) 1 of 1 The ACORD name and logo are registered marks of ACORD #S3145479/M3143130 KNAK1 SAGITTA 25.3 (2016103) 2 of 2 #S3145478/M3143130 POLICY NUMBER: «polnum» COMMERCIAL GENERAL LIABILITY CG 20 37 07 04 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 SCHEDULE Name Of Additional Insured Person(s) Or Or anization s : Location And Description Of Completed Operations Any person or organization for whom you are performing In respect to any location where the named insured is operations when you and such person or organization have performing "your work". agreed in writing in a contract or agreement, effected prior to the date your operations for that person or organization commenced, that such person or organization be added as an additional insured on your policy. ............... Information required to com fete this Schedule, if not shown above, will be shown in the Declarations, 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". CG 20 37 07 04 0 ISO Properties, Inc., 2004 Page 1 of 1 COMMERCIAL GENERAL LIABILITY CG 20 10 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR 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) _.... Location(s) Of Covered Operations Or Or anization s Any person or organization for whom you are performing In respect to any location where the named insured its operations when you and such person or organization performing "your work". have agreed in writing in a contract or agreement, effected prior to the date your operations for that person or organization commenced, that such person or organization be added as an additional insured on your policy. Information re wired to com Aete this Schedule, if not shown above„ will be shown in the Declarations. A. Section 11 - 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 omissions of those acting• in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. B. With respect to the insurance afforded to these additional insureds, the following additional exclu- sions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: I, All work, including materials, parts or equip- ment 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 in- tended 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 CGkRV CERTIFICATE OF LIABILITY INSURANCE DATE (MMMO YYYY) 02/16/2022 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 pollcy(ies) must be endorsod. If SUBROGATION IS WANED, subject to the terms and conditions of the polley, certain policies may require an endorsement. A statement an this certificate does not confer rights to the Certificate holder In lieu of such endomement(s). PRODUCER Beth Bettger Insurance Agency, Inc. StateFarm 20220 State Road A. Cerritos, CA. 90703 INSURED Robert & Peggy Herricks DBA Roberts Liquid Disposal 14018 Cannenita Rd Santa Fe Springs, CA 90670-4919 COVERAGES CERTIFICATE NUMBER: hley Gale 562-496-1000 I ;State Form Mutual Automobile Insurance REVISION NUMBER.. 562-809.9559 Nact 2517a IS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD D)CATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS RTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, L CLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLI Y E'rF POLIC' ex.P L TYPE OF DISURANCE... p�Y NUMBETt LoiR8 MMkrTM Hal)a'.. COMMERCUIL GENERAL LIABILITY EACH OCCURRENCE I CLAKSMADE OCCUR iY70 II 7 r ^ ,%,�„ f I MED EXP one � PERSONAL A ADV INJURY f GENERALAGGREGATE f GENLAGGREGATE LIMIT APP.I,EfPER: PRODUCTS- COMPIOP AGG I POLICY LOC I' OTHER . RSET I AUrOMOBILELIABDm ANY AUTO MMTI IIeI 24306"01-75 P73-6862-A06-75 02101/2022 01/06/2022 081/2023 0710612022 cEN7 r BODILY INJURY (Per person) 2,000.000 t ALL AUTO NED M AUUTOS AUTOS 413-8508-B03-75 244-3052�01-75 0=312022 0210112022 08/0312022LF0 06J01it022 BODILY INJURY (Pw °0)I %�HIREDAUTOS � I UMBRELLA LIAB OCCUR EACH OCCURRENCE f AGGREGATE f EXCESS LIAR CLAIMS4AADE I DIED I I RETENTION V40"EM CO MPE'NSAnON AND EMPLOYERS'UAB[IJTY VIN ANY PROPR O IET0W�a � M A (MAM rY M s a NN) NIA E E.LEACH ACCIDENT •-�^^•----^�^. f E.L DISEASE • EA EJAMOYEE I UOMM . doac o onder S6106 DN OF OPERATMONS Wow E.L. DISEASE - POLICY LIMIT I DESCRIPWON OF OPERATtONS I LOCATIONS I VEHICLES (ACORD 101, Addnlenal Ramarka Schadula, may be aeached If more spats Is required) City of El Segundo 350 Main Street El Segundo, CA 90245 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 REPRESCWATI*1 Electronic Signature Not Avail le. Please Print and Sign. 01988-2014 ACORD CORPORATION. All chats reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD 1001486 132949.9 02-04.2014 ENDORSEMENT AGREEMENT WAIVER OF SUBROGATION REP 02 1446891-21 RENEWAL SC 1-37-56-44 PAGE 1 HOME OFFICE SAN FRANCISCO EFFECTIVE FEBRUARY 16, 2022 AT 12.01 A.M. ALL EFFECTIVE DATES ARE AND EXPIRING DECEMBER 31, 2022 AT 12.01 A.M. AT 12:01 AM PACIFIC STANDARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME ROBERT'S LIQUID DISPOSAL, INC. 14018 CARMENITA RD SANTA FE SPRINGS, CA 90670 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, ROBERT'S LIQUID DISPOSAL, INC. 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 1"�^ AUTHORIZED REPRESENT pVE SCIF FORM 10217 (REV.4-2018) FEBRUARY 18, 2022 PRESIDENT AND CEO OLD DP 217