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PROOF OF INSURANCE (2023 - 2023) CLOSEDCERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 5/17/2022 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 ERM Insurance Brokers LLC 3000 W. MacArthur Blvd., Suite 120 Santa Ana CA 92704 INSURED Excelsior Elevator Corp. 1961 Blair Ave. Santa Ana CA 92705 Heather Soriano ..,• 949-596-0357 ce.com ISl AFFORDING C Great American Ins Co Libertv Insurance Underwriters State Compensation Ins Fund COVERAGES CERTIFICATE NUMBER:1490211433 REVISION UMBER: 16691 19917 35076 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, CONDITIONS OF SUCH POLICIES.MAY HAVE BEEN REDUCEDeM/ BY PAID CLAIMS. LIMITS SHPoucrNUM ... . ...... rUCY LIMITS ILTRXCLUSIONSTMPD ERN D,ryYYy A X COMMERCIAL Y Y GLP132442605 4/1/2022 4/1/2023 EACH OCCURRENCE $1000000 �. . 100 000 CLAIMS -MADE � X OCCUR ,1?REr IwSES„(Ea occurrence ,$ . one person) $ 5 000 _PER...SONA L"8 AqVINJURY $ 1 000 000 GEN'L AGGREGATE'. LIMIT APPLIES PER: GENERAL----- ATE .,mm $4000,mmm 000 ".. ..__.. POLICY + M JPRO,., � � LOC ,PRODUCTS - COMP/OP AGG 1111­1111...... $ 4 000 000 _........,.. $ OTHER'; AUTOMOBILE LIABILITY COMBINED SINGLE t.NMIT' . (Ea a�cudan.l) ....... $ ._..... ....... ANY AUTO BODILY INJURY (Per ( person) $ __ OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS ONLY „„ „„„„„„' AUTOS HIRED NON -OWNED �'RONIngT'Y'DAMAGE;.. - ($ ....""""".. ..,, _ AUTOS ONLY ... AUTOS ONLY ..�..I ..Q,Pov accdd,,emud ,,,..,.,,, . ._ .............. . ....... $ B X UMBRELLA LIAB X OCCUR 100047312202 4/1/2022 4/1/2023 EACH OCCURRENCE ,$ 1 000 000 EXCESS LIAB E _ ....... CLAIMS -MAD.. AGGREGATE $ 1,000.000 ........� ,._._.."..... ..EX _ . ... .._m DE D RETENTION $ C WORKERS C COMPENSATION Y 9277824-2021 6/12/2021 6/12/2022 OTH X TE ER H TA U CALIFORNIA AND EMPLOYERS LIABILITY YYN ....-...._-_ ......,...� ANYPROPRIETOR/PARTNER/EXECUTIVE E.L EACH ACCIDENT $ 1 000 000 OFFICERIMEMBER EXCLUDED? (Mandatory in NH) N / A ....E,L..,DISEASE ..-..EA,.EMPLOYEE $ 1.000.000............ If yes, describe under DESCRIPTION OF OPERATIONS below E..I_ 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) The certificate holder is additional insured (GL) per form CG2010 12/19 CG2037 12/19 primary/non-contributory wording per form CG9053 04116 - if required by contract; Workers Compensation Waiver of Subrogation per form 10217 04/18 - if required by contract LCKI IrllrAI t City of El Segundo Public Works Department 350 Main Street El Segundo CA 90245-3813 USA 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 U 19BB-ZU15 AGUKU GUKl-UKA I IUN. Au rignis reservea. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD * HB * 04/04/2022 * GLP 1324426 05 GREAT AMERICAN INSURANCE COMPANY 108429 CG 20 10 (Ed. 12/19) 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 0 �3:IJBill 4 Name Of Additional Insured Person(s) Location(s) Of Covered Operations Or Organization(s) ANY PERSON OR ORGANIZATION THAT YOU ARE ANY LOCATION WITHIN THE "C .._--- OVERAG.____ E REQUIRED AND AGREED TO NAME TERRITORY". AS AN ADDITIONAL INSURED ON YOUR POLICY UNDER: 1. WRITTEN CONTRACT OR AGREEMENT THAT IS IN EFFECT DURING THE TERM OF THIS POLICY AND SUCH CONTRACT IS ENTERED INTO PRIOR TO THE "OCCURRENCE" OF ANY "BODILY INJURY", "PROPERTY DAMAGE", "PERSONAL INJURY" OR "ADVETISING INJURY", OR 2. AN ORAL CONTRACT OR ORAL AGREEMENT WITH A PERSON OR ORGANIZATION WHEN A CERTIFICATE OF INSURANCE SHOWING THAT PERSON OR ORGANIZATION AS AN ADDITIONAL INSURED HAS BEEN ISSUED; AND SUCH ORAL CONTRACT OR ORAL AGREEMENT IS IN EFFECT DURING THE TERM OF THIS POLICY AND IS ENTERED INTO PRIOR TO THE "OCCURRENCE" OF ANY "BODILY INJURY" "PROPERTY DAMAGE", "PERSONAL INJURY", OR "ADVERTISING INJURY". Information required to compl.................�...ete this Schedule, if not shown above, will be shown in the Declarations. 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 © Insurance Services Office, Inc., 2018 CG 20 10 (Ed. 12/19) (Page 1 of 2) * HB * 04/04/2022 * GLP 1324426 05 GREAT AMERICAN INSURANCE COMPANY 108429 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. 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; whichever is less. This endorsement shall not increase the applicable limits of insurance. © Insurance Services Office, Inc., 2018 CG 20 10 (Ed. 12/19) (Page 2 of 2) * H13 * 04/04/2022 * GLP 1324426 05 GREAT AMERICAN INSURANCE COMPANY 108429 CG 20 37 (Ed. 12/19) 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 Organization(s) Location And Description Of Completed Operations: ��111,111__ ..... ANY PERSON OR ORGANIZATION THAT.� YOU ARE ANY LOCATION WITHIN THE "COVE11RAGE- REQUIRED AND AGREED TO NAME TERRITORY", AND FOR ALL COMPLETED AS AN ADDITIONAL INSURED ON YOUR POLICY OPERATIONS. UNDER: 1. A WRITTEN CONTRACT OR AGREEMENT THAT IS IN EFFECT DURING THE TERM OF THIS POLICY AND SUCH CONTRACT IS ENTERED INTO PRIOR TO THE "OCCURRENCE" OF ANY "BODILY INJURY", "PROPERTY DAMAGE", "PERSONAL INJURY", OR "ADVERTISING INJURY", OR 2. AN ORAL CONTRACT OR ORAL AGREEMENT WITH A PERSON OR ORGANIZATION WHEN A CERTIFICATE OF INSURANCE SHOWING THAT PERSON OR ORGANIZATION AS AN ADDITIONAL INSURED HAS BEEN ISSUED; AND SUCH ORAL CONTRACT OR ORAL AGREEMENT IS IN EFFECT DURING THE TERM OF THIS POLICY AND IS ENTERED INTO PRIOR TO THE "OCCURRENCE" OF ANY "BODILY INJURY", "PROPERTY DAMAGE", "PERSONAL INJURY", OR "ADVERTISING INJURY". Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II - Who Is An Insured is amended to include as an additional insured the person(s) or or 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". © Insurance Services Office, Inc., 2018 CG 20 37 (Ed. 12/19) (Page 1 of 2) * HB * 04/04/2022 * GLP 1324426 05 GREAT AMERICAN INSURANCE COMPANY 108429 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 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; whichever is less. This endorsement shall not increase the applicable limits of insurance. © Insurance Services Office, Inc., 2018 CG 20 37 (Ed. 12/19) (Page 2 of 2) HB * 04/04/2022 * GLP 1324426 05 GREAT AMERICAN INSURANCE COMPANY 108429 CG 90 53 (Ed. 04/16) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ELEVATOR CONTRACTOR PLUS ENDORSEMENT This endorsement modifies insurance provided under the following: COMMON POLICY CONDITIONS COMMERCIAL GENERAL LIABILITY COVERAGE PART This is a summary of the various additional coverages and coverage modifications provided by this endorsement. For complete details on specific coverages, consult the actual policy wording. Coverage Limit of Insurance Page Non -Owned Aircraft Included 2 Non -Owned Watercraft Included 2 Property Damage Elevators Included 3 Property Damage Liability - Borrowed Equipment Included 3 Damage to Premises Rented to You Medical Payments Extension $300,000 $10,000 3 4 Supplementary Payments - Bail Bonds $1,000 5 Supplementary Payments - Loss of Earnings $500 5 Broadened Named Insured Included 5 Newly Formed or Acquired Organization Additional Insureds When Required by Written Contract, Written Agreement or Permit Included Included 5 6 Primary and Non -Contributory Additional Insured Extension Included 10 Additional Insureds - Limits of Insurance Included 11 Knowledge of Occurrence, Claim or Suit Included 11 Unintentional Failure to Disclose Hazards Included 11 Notice of Occurrence Included 11 Amended Bodily Injury Definition Included 12 Broadened Mobile Equipment Included 12 Includes copyrighted material of Insurance Services Office, Inc., with its permission. CG 90 53 (Ed. 04/16) (Page 1 of 14) HB * 04/04/2022 * GLP 1324426 05 GREAT AMERICAN INSURANCE COMPANY 108429 Coverage Limit of Insurance Page Personal and Advertising Injury Definition Amendment of Discrimination and Humiliation Included 12 Incidental Malpractice Liability Included 12 Waiver of Transfer of Rights of Recovery Against Others to Us Amended Insured Contract Definition Included Included 13 13 Notice of Cancellation to Certificate Holder(s) Included 14 A. Non -Owned Aircraft Under paragraph 2. Exclusions of SECTION I - Coverage A - Bodily Injury and Property Damage Liability, exclusion g. Aircraft, Auto Or Watercraft does not apply to an aircraft provided: 1. It is not owned by any insured; 2. It is hired, chartered or loaned with a trained paid crew; 3. The pilot in command holds a currently effective certificate, issued by the duly constituted authority of the United States of America or Canada, designating him or her a commercial or airline pilot; and 4. It is not being used to carry persons or property for a charge. However, the insurance afforded by this provision does not apply if there is available to the Insured other valid and collectible insurance, whether primary, excess (other than insurance written to apply specifically in excess of this Policy), contingent or on any other basis, that would also apply to the loss covered under this provision. B. Non -Owned Watercraft 1. Under Paragraph 2. Exclusions of SECTION I - Coverage A - Bodily Injury and Property Damage Liability, Subparagraph (2) of exclusion g. Aircraft, Auto Or Watercraft is replaced by the following: This exclusion does not apply to: (2) A watercraft you do not own that is: (a) Less than 51 feet long; and (b) Not being used to carry persons or property for a charge; However, the insurance afforded by this provision does not apply to watercraft 27 to 51 feet long if there is available to the Insured other valid and collectible insurance, whether primary, excess (other than insurance written to apply specifically in excess of this Policy), contingent or on any other basis, that would also apply to the loss covered under this provision. Includes copyrighted material of Insurance Services Office, Inc., with its permission. CG 90 53 (Ed. 04116) (Page 2 of 14) * HB * 04/04/2022 * GLP 1324426 05 GREAT AMERICAN INSURANCE COMPANY 108429 2. The following is added to SECTION II - WHO IS AN INSURED: With respect to watercraft you do not own that is less than 51 feet long and is not being used to carry persons or property for a charge, any person is an insured while operating such watercraft with your permission. Any other person or organization responsible for the conduct of such person is also an insured, but only with respect to liability arising out of the operation of the watercraft, and only if no other insurance of any kind is available to that person or organization for this liability. However, no person or organization is an insured with respect to: a. "Bodily injury" to a co -"employee" of the person operating the watercraft; or b. "Property damage" to property owned by, rented to, in charge of or occupied by you or the employer of any person who is an insured under this provision. C. Property Damage - Elevators 1. Under Paragraph 2. Exclusions of SECTION I - Coverage A - Bodily Injury and Property Damage Liability, Subparagraphs (3), and (4) of exclusion j. Damage To Property do not apply if such "property damage" results from the use of elevators. 2. The following is added to SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS, Condition 4. Other Insurance, Paragraph b. Excess Insurance: The insurance afforded by this provision of this endorsement is excess over any property insurance, whether primary, excess, contingent or on any other basis. D. Property Damage Liability - Borrowed Equipment 1. Under Paragraph 2. Exclusions of SECTION I - Coverage A - Bodily Injury and Property Damage Liability, Subparagraph (3), and (4) of exclusion j. Damage To Property do not apply to "property damage" to borrowed equipment while not being used to perform operations at a job site. The insurance afforded by this provision of this endorsement is excess over any property insurance, whether primary, excess, contingent or on any other basis. E. Damage To Premises Rented To You If Damage to Premises Rented to You is not otherwise excluded from this Coverage Part: 1. Under Paragraph 2. Exclusions of SECTION I - Coverage A - Bodily Injury and Property Damage Liability: 3. The last paragraph of Paragraph 2. Exclusions is deleted in its entirety and replaced by the following: Exclusions c. through n. do not apply to damage by fire, lightning, or "explosion" to premises while rented to you or temporarily occupied by you with permission of the owner. A separate limit of insurance applies to this coverage as described in SECTION III - LIMITS OF INSURANCE. Includes copyrighted material of Insurance Services Office, Inc., with its permission. CG 90 53 (Ed. 04/16) (Page 3 of 14) " HB * 04/04/2022 * GLP 1324426 05 GREAT AMERICAN INSURANCE COMPANY 108429 2. Paragraph 6. under SECTION III - LIMITS OF INSURANCE is deleted in its entirety and replaced with the following: 6. Subject to Paragraph 5. above, the most we will pay under COVERAGE A for damages because of "property damage" to any one premises, while rented to you, or in the case of damage caused by fire, lightning, or "explosion" while rented to you or temporarily occupied by you with the permission of the owner, for all such damage caused by fire, lightning, or "explosion" proximately caused by the same event, whether such damage results from fire, lightning, or "explosion" or any combination of the three, shall be the greater of: a. $300,000; or b. the amount shown in DAMAGE TO PREMISES RENTED TO YOU -INCREASED LIMIT, CG8449, if attached to the Policy. 3. Under SECTION IV - Commercial General Liability Conditions, Subsection 4. Other Insurance, Paragraph b. Excess Insurance, item (ii) where the words "Fire insurance" appear they are changed to "insurance for fire, lightning, or "explosion."" 4. As regards coverage provided by this provision E. DAMAGE TO PREMISES RENTED TO YOU, Paragraph 9.a. of SECTION V - DEFINITIONS is replaced with the following: a. A contract for a lease of premises. However, that portion of the contract for a lease of premises that indemnifies any person or organization for damage by fire, lightning, or "explosion", to premises while rented to you or temporarily occupied by you with the permission of the owner is not an "insured contract". 5. As regards coverage provided by this provision E. DAMAGE TO PREMISES RENTED TO YOU, SECTION V - DEFINITIONS is amended by the addition of the following definition: "Explosion" means a sudden release of expanding pressure accompanied by a noise, a bursting forth of material and evidence of the scattering of debris to locations further than would have resulted by gravity alone. Explosion does not include any of the following: (a) artificially generated electrical current including electrical arcing, that disturbs electrical devices, appliances or wires; (b) rupture or bursting of water pipes; (c) explosion of steam boilers, steam pipes, steam engines or steam turbines owned or leased by you, or operated under your control; or (d) rupture or bursting caused by centrifugal force. F. Medical Payments Extension If Coverage C - Medical Payments is not otherwise excluded, the Medical Payments provided by this policy are amended as follows: Under paragraph 1.a. Insuring Agreement of SECTION I - Coverage C - Medical Payments, paragraph 1.a.(b) is amended as follows: Includes copyrighted material of Insurance Services Office, Inc., with its permission. CG 90 53 (Ed. 04/16) (Page 4 of 14) * HB * 04/04/2022 * GLP 1324426 05 GREAT AMERICAN INSURANCE COMPANY 108429 (b) The expenses are incurred and reported to us within three years of the date of the accident; and The Medical Expense Limit in paragraph 7. of SECTION III -LIMITS OF INSURANCE is replaced by the following Medical Expense Limit: The Medical Expense Limit provided by this Policy shall be the greater of: a. $10,000; or b. the amount shown in the Declarations for Medical Expense Limit. This provision 7. is subject to all the terms of SECTION III - LIMITS OF INSURANCE. G. Supplementary Payments 1. In the Supplementary Payments - Coverages A and B provision, paragraph 1.b. is replaced with: b. Up to $1,000 for the cost of bail bonds required because of accidents or traffic law violations arising out of the use of any vehicle to which the Bodily Injury Liability Coverage applies. We do not have to furnish these bonds. 2. In the Supplementary Payments - Coverages A and B provision, paragraph 1.c. is replaced with: c. The cost of appeal bonds or bonds to release attachments, but only for bond amounts within the applicable Limit of Insurance. We do not have to furnish these bonds. 3. In the Supplementary Payments - Coverages A and B provision, paragraph 1.d. is replaced by the following: d. All reasonable expenses incurred by the Insured at our request to assist us in the investigation or defense of the claim or "suit," including actual loss of earnings up to $500 a day because of time off work. H. Broadened Named Insured Under SECTION II - WHO IS AN INSURED, the following item 2.e. is added: e. Any subsidiary and subsidiary thereof, of yours which is a legally incorporated entity of which you own a financial interest of more than 50% of voting stock on the effective date of this Coverage Part. The insurance afforded' herein for any subsidiary not named in this Coverage Part as a Named Insured does not apply to injury or damage with respect to which an insured under this Coverage Part is also an insured under another policy or would be an insured under such policy but for its termination or the exhaustion of its Limits of Insurance. 1. Newly Formed or Acquired Organizations Paragraph 3. of SECTION II - WHO IS AN INSURED is replaced by the following: 3. Any organization you newly acquire or form 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: Includes copyrighted material of Insurance Services Office, Inc., with its permission. CG 90 53 (Ed. 04/16) (Page 5 of 14) HB * 04/04/2022 * GLP 1324426 05 GREAT AMERICAN INSURANCE COMPANY 108429 a. coverage under this provision is afforded only until the 180th day after you acquire or form the organization or the end of the policy period, whichever is earlier; b. coverage A does not apply to "bodily injury" or "property damage" that occurred before you acquired or formed the organization; c. coverage B does not apply to "personal and advertising injury" arising out of an offense committed before you acquired or formed the organization; and d. records and descriptions of operations must be maintained by the first 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 or qualifies as an insured under this provision. J. Blanket Additional Insureds When Required by Written Contract, Written Agreement or Permit The following is added to SECTION II - WHO IS AN INSURED: 4. Additional Insureds When Required by Written Contract, Written Agreement or Permit a. The persons or organizations described in paragraphs b. through g. below are also insureds (and may also be referred to below as additional insureds), but only if: (1) either: (a) you have agreed, in a written contract or oral agreement, to have such person or organization added as an additional insured under this Policy; or (b) a permit issued to you by a state or political subdivision requires such person or organization to be added as an additional insured under this Policy; and (2) the "bodily injury," "property damage," or offense causing "personal and advertising injury" occurs subsequent to execution of the contract or agreement, or issuance of the permit. No person or organization is an additional insured under paragraphs b. through g. if such person or organization is an insured by virtue of an endorsement issued by us and attached to this Policy. b. Vendors (1) Subject to a., above, any person or organization that distributes or sells "your product" in the regular course of that person's or organization's business (referred to below as vendor) as an additional insured, but only with respect to "bodily injury" or "property damage" arising out of "your products" which are distributed or sold in the regular course of the vendor's business, and only if this Policy provides coverage for "bodily injury" or "property damage" included within the "products -completed operations hazard." Includes copyrighted material of Insurance Services Office, Inc., with its permission. CG 90 53 (Ed. 04/16) (Page 6 of 14) * HB * 04/04/2022 * GLP 1324426 05 GREAT AMERICAN INSURANCE COMPANY 108429 However: (a) the insurance afforded to such vendor only applies to the extent permitted by law; and (b) the insurance afforded to such vendor will not be broader than that which you are required by the contract or agreement to provide for such vendor. (2) No vendor is an insured with respect to any: (a) "bodily injury" or "property damage" for which the vendor is obligated to pay damages by reason of the assumption of liability in a contract or agreement. This exclusion does not apply to liability for damages that the vendor would have in the absence of the contract or agreement; (b) express warranty unauthorized by you; (c) physical or chemical change in the product made intentionally by the vendor; (d) repackaging, except when "your product" is unpacked solely for the purpose of inspection, demonstration, testing or the substitution of parts under instructions from the manufacturer, and then repackaged in the original container; (e) failure to make such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the product; (f) demonstration, installation, servicing or repair of "your product," except such operations performed at the vendor's premises in connection with the sale of the product; (g) product which, after distribution or sale by you. Has been labeled or relabeled or used as a container, part or ingredient of any other thing or substance by or for the vendor; or (h) "bodily injury" or "property damage" arising out of the sole negligence of: (i) the vendor for its own acts or omissions; or (ii) the vendor's employees or anyone else acting on its behalf. However, paragraph (h) does not apply to: (i) the exceptions contained in subparagraphs (d) or (f); or (ii) such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products. (3) The coverage afforded for vendors under paragraph b. does not apply to any person or organization from whom you have acquired either such products, or any ingredient, part or container, entering into, accompanying or containing such products. Includes copyrighted material of Insurance Services Office, Inc., with its permission. CG 90 53 (Ed. 04/16) (Page 7 of 14) * HB * 04/04/2022 * GLP 1324426 05 GREAT AMERICAN INSURANCE COMPANY 108429 c. Lessors of Equipment (1) Subject to a., above, any person or organization from whom you lease equipment is an additional insured, but only with respect to liability for "bodily injury," "property damage" or "personal and advertising injury" caused, in whole or in part, by your maintenance, operation or use of equipment you lease from that person or organization. However: (a) the insurance afforded to such additional insured only applies to the extent permitted by law; and (b) 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. (2) No such person or organization is an additional insured as respects any: (a) "occurrence" which takes place before the equipment lease begins or after the equipment lease expires, or (b) "bodily injury," "property damage," or "personal and advertising injury" arising out of the sole negligence of such person(s) or organization(s). d. Lessors of Land or Premises (1) Subject to a., above, any person or organization from whom you lease land or premises is an additional insured, but only with respect to liability arising out of the ownership, maintenance or use of that part of the land or premises leased to you. However: (a) the insurance afforded to such additional insured only applies to the extent permitted by law; and (b) 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. (2) No such person or organization is an additional insured as respects any: (a) "occurrence" that takes place before you lease that land or premises; or (b) "occurrence" that takes place after your lease ends; or (c) structural alteration, new construction or demolition operation performed by or on behalf of such person(s) or organization(s). e. Architects, Engineers or Surveyors (1) Subject to a., above, any person or organization you engage as an architect, engineer, or surveyor is an additional insured, but only with respect to liability for "bodily injury," "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf in connection with your premises or in the performance of your ongoing operations: Includes copyrighted material of Insurance Services Office, Inc., with its permission. CG 90 53 (Ed. 04/16) (Page 8 of 14) HB * 04/04/2022 * GLP 1324426 05 GREAT AMERICAN INSURANCE COMPANY 108429 However: (a) the insurance afforded to such additional insured only applies to the extent permitted by law; and (b) 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. (2) No such person or organization is an "additional insured" with respect to any: (a) "bodily injury," "property damage" or "personal and advertising injury" arising out of the rendering of or the failure to render any professional service by or for you, including: (i) the preparing, approving, or failing to prepare or approve, any map, shop drawing, opinion, report, survey, field order, change order, drawing, specification; or (ii) any supervisory, inspection, architectural or engineering activity, f. Permits Or Authorizations Relating To Premises Issued By State Or Governmental Agency Or Subdivision Or Political Subdivision (1) Subject to a., above, any federal, state, or local government or governmental agency or subdivision or political subdivision that issues you a permit. (2) No such government or agency is an additional insured with respect to any: (a) "bodily injury," "property damage" or "personal or advertising injury" arising out of operations performed for that government or agency; or (b) "bodily injury," "property damage" or "personal or advertising injury" including within the products -completed operations hazard." g. Any Other Party (1) Subject to a., above, any person or organization described neither: (a) as an insured in SECTION II - WHO IS AN INSURED, 1. through 3., nor (b) as an additional insured in b. through f. above, is an additional insured, but only with respect to liability for "bodily injury," "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: (i) in the performance of your ongoing operations; (ii) in connection with premises owned by or rented to you; or (iii) in connection with "your work" and included within the "products -completed operations hazard," but only if: Includes copyrighted material of Insurance Services Office, Inc., with its permission. CG 90 53 (Ed. 04/16) (Page 9 of 14) ' HB * 04/04/2022 * GLP 1324426 05 GREAT AMERICAN INSURANCE COMPANY 108429 L the written contract or agreement requires you to provide such coverage to such additional insured; and ii. this Coverage Form provides coverage for "bodily injury" or "property damage" within the "products -completed operations hazard." However: (a) the insurance afforded to such additional insured only applies to the extent permitted by law; and (b) 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." (c) with respect to the insurance afforded these additional insured(s), this insurance does not apply to "bodily injury," "property damage," or "personal and advertising injury" arising out of an architect's, engineer's, or surveyor's rendering or failure to render any professional architectural, engineering or surveying services, including: (i) the preparing, approving, or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; and (ii) supervisory, inspection, architectural or engineering activities. 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. K. Primary and Non -Contributory Additional Insured Extension This provision applies to any person or organization who qualifies as an Additional Insured under any form or endorsement under this Policy. Condition 4. Other Insurance of SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS is amended as follows: a. The following is added to Paragraph a. Primary Insurance: This insurance is primary to and will not seek contribution from any other insurance available to an Additional Insured under your policy provided that: (1) the Additional Insured is a Named Insured under such other insurance; and (2) you have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the Additional Insured. Includes copyrighted material of Insurance Services Office, Inc., with its permission. CG 90 53 (Ed. 04/16) (Page 10 of 14) HB * 04/04/2022 * GLP 1324426 05 GREAT AMERICAN INSURANCE COMPANY 108429 L. Additional Insureds - Limits of Insurance The following is added to SECTION III - LIMITS OF INSURANCE: Additional Insureds - Limits of Insurance The most we will pay on behalf of any additional insured described in J., above is the amount of insurance: a. required by contract or agreement; or b. available under the applicable Limits of Insurance shown in the Declarations whichever is less. Such amounts shall not increase the applicable Limits of Insurance shown in the Declarations. M. Knowledge of Occurrence, Claim or Suit Under SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS, the following is added to Condition 2. Duties in the Event of Occurrence, Offense, Claim or Suit: Knowledge of any 'occurrence"; claim, or "suit' by any agent, servant or "employee" of the Named Insured does not in itself constitute knowledge by the Insured unless notice of such "occurrence", claim or "suit' shall have been received by: a. you, if you are an individual; b. a partner, if you are a partnership; or c. an executive officer or insurance manager, if you are a corporation; d. a manager, if you are a limited liability company; e. a trustee, if you are a trust; f. an elected or appointed official, if you are a political subdivision or public entity. N. Unintentional Failure to Disclose Hazards Under SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS, the following is added to Condition 6. Representations: Failure of the Insured to disclose all hazards existing as of the inception date of this Policy shall not prejudice the insurance with respect to the coverage afforded by this Policy, provided such failure or omission is not intentional on the part of the Insured. O. Notice of Occurrence The following is added to SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS, 2. Duties in the Event of Occurrence, Offense, Claim or Suit, a.: Failure of the insured to give first report of a claim to us shall not invalidate coverage under this Policy if the loss was inadvertently reported to another insurer. However, you shall report any such occurrence to us as soon as practicable once you become aware of such an error. Includes copyrighted material of Insurance Services Office, Inc., with its permission,. CG 90 53 (Ed. 04/16) (Page 11 of 14) * HB * 04/04/2022 * GLP 1324426 05 GREAT AMERICAN INSURANCE COMPANY 108429 P. Amended Bodily Injury Definition Under SECTION V - DEFINITIONS, Definition 3. Bodily Injury is replaced by the following: 3. "Bodily injury" means bodily injury, sickness, or disease or "incidental medical malpractice" sustained by a person, including death of a person. "Bodily Injury" also means mental anguish, mental injury, or shock, if directly resulting from physical injury, sickness, or disease to that person. Q. Broadened Mobile Equipment 1. Under SECTION V - DEFINITIONS, Definition 12. Mobile Equipment, the following is added under 12.f.(1): Provided that the vehicles have a Gross Vehicle Weight of 1,000 pounds or greater, 2. The following is added to SECTION II - WHO IS AN INSURED: With respect to "mobile equipment" registered in your name under any motor vehicle registration law, any person is an insured while driving such equipment along a public highway with your permission. Any other person or organization responsible for the conduct of such person is also an insured, but only with respect to liability arising out of the operation of the equipment, and only if no other insurance of any kind is available to that person or organization for this liability. However, no person or organization is an insured with respect to: a. "Bodily injury" to a co -"employee" of the person driving the equipment; or b. "Property damage" to property owned by, rented to, in charge of or occupied by you or the employer of any person who is an insured under this provision. R. Personal and Advertising Injury Definition Amendment of Discrimination or Humiliation Under SECTION V - DEFINITIONS, Definition 14. Personal and Advertising Injury, item 14.h. is added: h. discrimination or humiliation that results in injury to the feelings or reputation of a natural person, but only if such discrimination or humiliation is: (1) not done intentionally by or at the direction of; (a) an insured; or (b) any "executive officer" director, stockholder, partner or member of the Insured; and (2) not directly or indirectly related to the employment, prospective employment or termination of employment of any person or persons by any insured. S. Incidental Malpractice Liability 1. SECTION II - WHO IS AN INSURED is amended by deleting item 2.a.(1)(d) in its entirety and replacing it with the following: (d) Arising out of his or her providing or failing to provide professional health care services. However, this exclusion does not apply to physicians, dentists, nurses, emergency medical technicians or paramedics who are employed by you to provide medical or paramedical services. Includes copyrighted material of Insurance Services Office, Inc., with its permission. CG 90 53 (Ed. 04/16) (Page 12 of 14) * HB * 04/04/2022 * GLP 1324426 05 GREAT AMERICAN INSURANCE COMPANY 108429 2. Under SECTION V - DEFINITIONS is amended by the addition of the following definition: "Incidental medical malpractice" means bodily injury arising out of the negligent rendering or failure to render medical or paramedical services to persons by any physician, dentist, nurse, emergency medical technician or paramedic who is employed by you to provide such services provided you are not engaged in the business or occupation of providing any services referred to in this definition. T. In SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS, the following is added at the end of Condition 8. Transfer of Rights of Recovery Against Others to Us: We waive any right of recovery we may have against a person or organization because of payments we make for injury or damage arising out of: a. your ongoing operations; or b. "your work" pursuant to a written contract between you and that person or organization and included in the "products -completed operations hazard"; but only if: c. you and that person or organization have agreed, in a written contract or agreement, that you waive such rights against that person or organization; and d. the injury or damage occurs only after you and that person or organization have signed the written contract or agreement described in c. U. Amended Insured Contract Definition 1. Under SECTION V - DEFINITIONS, 9. "Insured Contract", c. is replaced by the following, c. any easement or license agreement, except in connection with construction or demolition operations on or within 50 feet of a railroad; 2. Under SECTION V - DEFINITIONS, 9. "Insured Contract", f. is replaced by the following: f. that part of any other contract or agreement pertaining to your business (including an indemnification of a municipality in connection with work performed for a municipality) under which you assume the tort liability of another party to pay for "bodily injury" or "property damage" to a third person or organization. Tort liability means a liability that would be imposed by law in the absence of any contract or agreement. Paragraph f. includes that part of any contract or agreement:. (1) that indemnifies a railroad for "bodily injury" or "property damage" arising out of construction or demolition operations, within 50 feet of any railroad property and affecting any railroad bridge or trestle, tracks, road -beds, tunnel, underpass or crossing; However, Paragraph f. does not include that part of any contract or agreement: (1) that indemnifies an architect, engineer or surveyor for injury or damage arising out of: (a) preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or Includes copyrighted material of Insurance Services Office, Inc., with its permission. CG 90 53 (Ed. 04/16) (Page 13 of 14) * HB * 04/04/2022 * GLP 1324426 05 GREAT AMERICAN INSURANCE COMPANY 108429 (b) giving directions or instructions, or failing to give them, if that is the primary cause of the injury or damage; or (2) under which the Insured, if an architect, engineer or survey or, assumes liability for an injury or damage arising out of the Insured's rendering or failure to render professional services, including those listed in (1) above and supervisory, inspection, architectural or engineering activities. V. The following Conditions are added to the COMMON POLICY CONDITIONS: 1. In the event of a cancellation, we will give written notice of such cancellation to certificate holder(s) at least 10 days before the effective date of cancellation if we cancel for nonpayment of premium or 30 days before the effective date of cancellation if we cancel for any other reason. The notice to the certificate holder(s) will state the effective date of the cancellation. However, such notice of cancellation is solely for the purpose of informing the certificate holder(s) of the effective date of cancellation and does not grant, alter, or extend any rights or obligations under this policy. 2. This endorsement does not entitle the certificate holder(s) to any benefit, rights or protection under this policy. 3. Notices will be sent to the certificate holder(s) according to the information on file with the agent of record or with us. If the information provided for said certificate holder(s) is not accurate we assume no responsibility for the failure to notify. We will assume that all information pertaining to the certificate holder(s), including the mailing or email address, is accurate and correct as provided to the agent of record or to us. 4. Failure to give notice in accordance with the terms of this Condition does not - a. Alter the effective date of policy cancellation, nonrenewal or expiration; b. Render such cancellation ineffective; c. Grant, alter, or extend any rights or obligations under this policy; or d. Extend the insurance beyond the effective date of cancellation or policy expiration, whichever comes first. e. Impose any obligations or liability of any kind upon us, our agents or representatives. Includes copyrighted material of Insurance Services Office, Inc., with its permission. CG 90 53 (Ed. 04/16) (Page 14 of 14) ACCOReCERTIFICATE OF LIIABILITY INSURANCE DATE 5j2o 2 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 terns 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 Neu of such endorsement(s). PAOOUCER IN Insurance Center_�47-8068 try... 626 4 F 626-447-6068 4115 E LIVE OAR AVWM SUITE 4 INSURERS AFFOROM COVERAGE NAICY MYRERA.Infinity Select Insurance Com an 20260 ARCADIA CA 92006 INSURED INSURER B Excelsior Elevator Corp. INSURERc; INSURHt D 1961 Blair AvenueRERec Santa Ana CA 92705 INSURER F: QF VIti If IN MIINFlFM• 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. INSR LTR WPE OF INSURANCE ffiff �` z...IT POLICY NUMBER OIDVfrY F P LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE s ......._ CLAIMS -MADE OCCUR '.. MED EXP Arltov"C— 8 PERSONAL& ADV INJURY s GENY. AGGfFoGATE LIMIT APPLIES PER: GENERAL AGGREGATE S — A UCTS _.__-.._M_______POLI:Y S _. JT ❑ LOC 0EG TH k b AUTOMOBI.ELU60.1TY 504-59867-2275-007 06/11/2022 0e/11/2923 teal rs tl,_. L LIMIT 3 11000,000 ANY AUTO f BODILY INJURY(Per person) S A ALL OWNED "" SCHEDULED g .BODILY INJURY (Per eeddenq v 5 AUTOS HIRED AUTOS t AO�kIOOS r pPCRq &. . ......... . �b UMBRELLA LIAR HCLAMS-MADE OCCUR EACH OCCURRENCEEXCESSLIAR AGGREGATE i DED n. 4 RETENTIONS b WOW COMPENSATION 9 r STATLITE E R EL EACH ACCIDENT 5... ADEMPLOYERVLABLnY YIN ANYN PROPRIETORIPARTNER/EXECunVE OFFICER/MEMBER EXCLUDED? NIA (daww"y b NH) I ELL DISEASE - EA EMPLOYEE b .._ ...... I s. d lit o under O�SCRIPTION OF OPERATIONS. dekHnr. E.L DISEASE - POLICY LIMIT b DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, AddWonal Remarks Schedul% may to amadled I dlora space Is required) City of El Segundo - Public Works Department is named as Additional Insured per Form 50461AIS01. 30 days notice of cancellation. All terms and conditions are based upon the actual policy form. CERTIFICA City of El Segundo - Public Works Department 350 Main Street E1 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. AUTHOR® REPRESENTATIVE 01908-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD It DATE (MMIDDIYYYY) �'► " CERTIFICATE OF LIABILITY INSURANCE OV05/2022 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 NA'MEm Certificates Dept. Colony West Financial Insurance Services, Inc. PHONE ('714) 542-4870 (714) 542-4871 License # OC42420 AOORESS: certificates cc IDny westl oom tAtC 17875 Von Kerman Ave, STE 150 114WRER(S)AFFORDING COVERAGE NAILS Irvine CA 92614 INSURERA: CompWest Insurance Company 12177 INSURED'.... ium loco rs Excelsior Elevator Corp INSURER C : 1961 Blair Ave INSURERD: Santa Ana CA 92705 1 INSURERF COVERAGES CERTIFICATE NUMBER: 22.23 Master Cert 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. �I k(-Tlg' TYPE OF INSURANCE POLICY NUMBER imMIDLYdYYYY) JMwoc"YYYJ LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE s ' CLAIMS -MADE ' OCCUR PRt<MI$ESI)n rrenca)....... a S MED EXP (Any one person) S PERSONAL&ADV INJURY s GENT-AGGREGATELIMITAPPLIESPER: GENERAL AGGREGATE $ POLICY 1-1JECT LOC PRODUCTS -OOMP/OP AGG S $ OTHER..:: AUTOMOBIIJ=LIABILITY CORSBENE'O' IN 'q.&.II' S BODILY INJURY (Per person) S ANYAUTO OWNED SCHEDULED '.. AUTOS ONLY AUTOS BODILY INJURY (Per accident) -5 S 'tkA,MALaE Eel acr ggr.t. 5 '. HIRED NON -OWNED AUTOS ONLY AUTOS ONLY 5 'UMBRELLA LIAB OCCUR EACH OCCURRENCE 5 AGGREGATE 3 EXCESS LIAR CLAIMS -MADE S I DED RETENTIONS .... A WORKERS COMPENSATIONAND EMPLOYERS'LIABILITY �EX.ECUTIVE YIN OFFICE MI BER L EDT �Y (Mandatory In NH) 'NIA Y CW WCP 1D0056512 0611?J2022 O6/12/2D23 P OY"t7- STATUTE ER E..L. EACH ACCIDENT 5 1,000,000 E.L.. DISEASE - EA EMPLOYEE $ 1,000,000 E.L.. DISEASE- POLICY LIMIT S 1,000,000 It yes, describe under DESCRIPTION OF OPERATIONS below i DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space 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 REPRESENTATIVE 198E-2015 ACORD CORPORATION. All rights reserved. ACORD 26 (2016103) The ACORD name and logo are registered marks of ACORD WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 0313 C (Ed. 7-09) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT — CALIFORNIA 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.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be $ 500. Schedule Person or Organization Description Any person or organization for whom the Named Insured has agreed by written contract to fumish this waiver. 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 0611212022 Policy No. CW WCP 100056512 01 Endorsement No. Insured EXCELSIOR ELEVATOR CORPORATION Premium: $0 Insurance Company COMPWEST INSURANCE Countersigned by COMPANY WC 99 0313 C (Ed. 7-09)