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PROOF OF INSURANCE (2023) CLOSEDla DATE (MMIDDIYYYY) AC"R " CERTIFICATE OF LIABILITY INSURANCE 6/1012022 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 c� ( ev Sandoval _________ 119Q00 MacArthur Blvd. PH Floor ( )PHONE 17-9153 FaX Ed eWood Partners Insurance Center EPIC CONTACT AME r shlrl Irvine, CA 92612 E%IAIL s49 4 INSURED JM Diaz, Inc. DBA: JMD 18645 E. Gale Ave., Ste #212 City of Industry CA 91748 INSURERAmm-TraVeleSSPrOs�„AFFO,RDIUaI C, CEORAGE ry „m,m„ „T, NAIC# INSURER B Travelers.p y 31194 Casua tv and Suretv Co America w m _ _ _________ N V _. ca 31194 F: rnVI=RAGFC rFRTIFICATF NIIMRFR• rmm7aani4,z RFVI.RIAN NIIMRFR- 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 TYPEOFINSURANCE... ......... A DT"�,.0, .---...-..,......- ........... .. POLICYE F POUCVEIC9P.... ........ ......... ..-.,-n..w. ,..m.n..... POLICY NUMBER LIMITS A COMMERCIAL GENERAL LIABILITY 6802J3309942247 6/27/2022 6/27/2023 EACH OCCURRENCE $ 0 � DAMAGE `rC RLN'fEI 000 000 CLAIMS -MADE OCCUR L .p P., GP) ... .PRE.MISES„ Ea oc� n, , , $1 ,,.,myyyy...w-yn,n, ..� .. � n.n --------............................................................... MED EXP (Any one person) ...5 000 $„ i mm,,,,,mmmmmmmmmm .... .PERSONAL & ADV INJ .. URY...... ,OOOm 00 111 $ �� - 0 �., ....................,...... GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY F,/ JEC;7° D LOC PRODUCTS COMPIOPAGG $2-,000,000 1 OIHER: Deductible $ None A AUTOMOBILELIABILITY BA8R7053252247 6/27/2022 6/27/2023 COMBINED BI NED9SINGLE LIMIT mm $1 000 000_ _ ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED w+°AUTOS ONLY I AUTOS -..... BODILY INJURY (Per r ) A $ .. . . HIRED NON -OWNED PROPEggaccident AUTOS ONLY,., AUTOS ONLY .. P A UMBR LLALIAB f OCCUR CUP7E6067642247 6/27/2022 6/27/2023 EACH OCCURRENCE s5,000,000 EXCESS LIAB CLAIMS -MADE.. 5...- AGGREGATE,yyyy 1 $5 00O 000 ..... DED RETENTION $O Prod/Co-Ops s5,000,000 A WORKERS COMPENSATION U136K8694022247 6/27/2022 6/27/2023 PER ORH AND EMPLOYERS' LIABILITY i ANYPROPRIETOR/PARTNERIEXECUTIVE ��Y--�I—N�� OFFICERIMEMBEREXCLIJ E.L. EACH ACCIDENT ----- _. - ------ - -------- $1 000,000 " ..,..,°°... "' i •• (Mandatory in NH) .NIA E.L. DISEASE - EA EMPLOYEE $1 f�QQ�,QQQ If yes, describe under DESCRIPTION OF OPERATIONS below E.L DISEASE - POLICY LIMIT $1 000 000 B Professional Liability 105263164 6/27/2022 6/27/2023 $3,000,000 per Claim Claims Made Form $4,000,000 Aggregate Knowledge Date: 4/8/2005 $10,000 Per Claim Deductible DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: ENG 21-31 On -Call Traffic Engineering Services The City of EI Segundo and all its officers„ employees, representatives and certified volunteers are included as Additional Insureds as respects G-eneral Liability and Automobile Liability per attached endorsements. Primary & Non -Contributory Wording applies per attached endorsement (s). Workers Compensation Waiver of Subrogation per the attached WWC99 03 76 (A) 30 Days Notice of Cancellation except for 10 Days Novice for Non Payment. rFRTIFIrATF wni nFR r'.ANrFl I ATION. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Ci%y Of El Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Public Works Deppartment ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Arianne Boia 350 Main Street AUTHORIZED REPRESENTATIVE El Segundo CA 90245 Todd Holliday 9 19SS-2U15 AGOKV CORPORATION. All rignts reserves. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 6870e112 22-23 GL, AU, w/AI, WC, UMb, Prof. I Shirley Sandoval 16/10/2022 9u24:35 PM (PDT) I Page 1 of 11 This certificate cancels and supersedes ALL preVIOUSI.y issued certificates. JM Diaz, Inc. 6802J3309942247 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL I S RED (A C ITECTS, ENGINEERS AND SURVEYORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 1. The following is added to SECTION II — WHO IS AN INSURED: Any person or organization that you agree in a "written contract requiring insurance" to include as an additional insured on this Coverage Part, but: a. Only with respect to liability for "bodily injury", "property damage" or "personal injury"; and b. If, and only to the extent that, the injury or damage is caused by acts or omissions of you or your subcontractor in the performance of "your work" to which the "written contract requiring insurance" applies, or in connection with premises owned by or rented to you. The person or organization does not qualify as an additional insured: c. With respect to the independent acts or omissions of such person or organization; or d. For "bodily injury", "property damage" or "personal injury" for which such person or organization has assumed liability in a contract or agreement. The insurance provided to such additional insured is limited as follows: e. This insurance does not apply on any basis to any person or organization for which coverage as an additional insured specifically is added by another endorsement to this Coverage Part. f. This insurance does not apply to the rendering of or failure to render any "professional services". g. In the event that the Limits of Insurance of the Coverage Part shown in the Declarations exceed the limits of liability required by the "written contract requiring insurance", the insurance provided to the additional insured shall be limited to the limits of liability required by that "written contract requiring insurance". This endorsement does not increase the limits of insurance described in Section III — Limits Of Insurance. h. This insurance does not apply to "bodily injury" or "Property damage" caused by "your work" and included In the "products - completed operations hazard" unless the "written contract requiring insurance" specifically requires you to provide such coverage for that additional insured, and then the insurance provided to the additional insured applies only to such "bodily injury" or "property damage" that occurs before the end of the period of time for which the "written contract requiring insurance" requires you to provide such coverage or the end of the policy period, whichever is earlier. 2. The following is added to Paragraph 4.a. of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: The insurance provided to the additional insured is excess over any valid and collectible other insurance, whether primary, excess, contingent or on any other basis, that is available to the additional insured for a loss we cover. However, if you specifically agree in the "written contract requiring insurance" that this insurance provided to the additional insured under this Coverage Part must apply on a primary basis or a primary and non-contributory basis, this insurance is primary to other insurance available to the additional insured which covers that person or organizations as a named insured for such loss, and we will not share with the other insurance, provided that: (1) The "bodiiiy injury" or "property damage" for which coverage is sought occurs; and (2) The "personal injury" for which coverage is sought arises out of an offense committed; after you have signed that "written contract requiring insurance". But this insurance provided to the additional insured still is excess over valid and collectible other insurance, whether primary, excess, contingent or on any other basis, that is available to the additional insured when that person or organization is an additional insured under any other insurance. CG D3 81 09 15 © 2015 The Travelers Indemnity Company. All rights reserved. Includes the copyrighted material of Insurance Services Office, Inc., with its permission Page 1 of 2 68706118 1 22-23 GL, AU, w/AIWC, Umb, Prof. I Shirley Sig KIOV'81 1 6/1.0/2022 4;;J .35 PM (PDT) I Page 2. of 5 This certificate cancels and supersedes ALL preva.au.sly issued certificates. COMMERCIAL GENERAL LIABILITY 3. The following is added to Paragraph 8., Transfer Of Rights Of Recovery Against Others To Us, of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: We waive any right of recovery we may have against any person or organization because of payments we make for "bodily injury", "property damage" or "personal injury" arising out of "your work" performed by you, or on your behalf, done under a "written contract requiring insurance" with that person or organization. We waive this right only where you have agreed to do so as part of the "written contract requiring insurance" with such person or organization signed by you before, and in effect when, the "bodily injury' or "property damage" occurs, or the "personal injury' offense is committed. 4. The following definition is added to the DEFINITIONS Section: "Written contract requiring insurance" means that part of any written contract under which you are required to include a person or organization as an additional insured on this Coverage Part, provided that the "bodily injury' and "property damage" occurs and the "personal injury' is caused by an offense committed: a. After you have signed that written contract; b. While that part of the written contract is in effect; and c. Before the end of the policy period. Page 2 of 2 ©2015 The Travelers Indemnity Company. All rights reserved. Includes the copyrighted material of Insurance Services Office, Inc., with its permission CG D3 81 09 15 014149 63'"N Pk611B 122-23 GL, AU, w/AI, WC, Umb, Prof. I Shirley $`W4d,*Val 1 6/10/2022 1.2'4x35 PM (PDT) I Page 3 of 5 This certificate cancels and supersedes ALL pre%uous,l,y issued certificates. COMMERCIAL GENERAL LIABILITY JM Diaz, Inc. 6802J3309942247 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. XTEND ENDORSEMENT OR ARCHITECTS, ENGINEERS AND SURVEYORS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART GENERAL DESCRIPTION OF COVERAGE — This endorsement broadens coverage. However, coverage for any injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsement to this Coverage Part, and these coverage broadening provisions do not apply to the extent that coverage is excluded or limited by such an endorsement. The following listing is a general coverage description only. Read all the provisions of this endorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered. A. Non -Owned Watercraft — 75 Feet Long Or Less B. Who Is An Insured — Unnamed Subsidiaries C. Who Is An Insured — Retired Partners, Members, Directors And Employees D. Who Is An Insured — Employees And Volunteer Workers — Bodily Injury To Co -Employees, Co - Volunteer Workers And Retired Partners, Members, Directors And Employees E. Who Is An Insured — Newly Acquired Or Formed Limited Liability Companies F. Blanket Additional Insured — Controlling Interest G. Blanket Additional Insured — Mortgagees, Assignees, Successors Or Receivers PROVISIONS A. NON -OWNED WATERCRAFT — 75 FEET LONG OR LESS 1. The following replaces Paragraph (2) of Exclusion g., Aircraft, Auto Or Watercraft, in Paragraph 2. of SECTION I — COVERAGES — COVERAGE A — BODILY INJURY AND PROPERTY DAMAGE LIABILITY: (2) A watercraft you do not own that is: (a) 75 feet long or less; and (b) Not being used to carry any person or property for a charge; H. Blanket Additional Insured — Governmental Entities — Permits Or Authorizations Relating To Premises I. Blanket Additional Insured — Governmental Entities — Permits Or Authorizations Relating To Operations J. Incidental Medical Malpractice K. Medical Payments — Increased Limit L. Amendment Of Excess Insurance Condition — Professional Liability M. Blanket Waiver Of Subrogation — When Required By Written Contract Or Agreement N. Contractual Liability — Railroads uses or is responsible for the use of a watercraft that you do not own that is: (1) 75 feet long or less; and (2) Not being used to carry any person or property for a charge; B. WHO IS AN INSURED — UNNAMED SUBSIDIARIES The following is added to SECTION II — WHO IS AN INSURED: Any of your subsidiaries, other than a partnership or joint venture, that is not shown as a Named Insured in the Declarations is a Named Insured if: 2. The following replaces Paragraph 2.e. of a. You are the sole owner of, or maintain an SECTION II —WHO IS AN INSURED: ownership interest of more than 50% in, such e. Any person or organization that, with subsidiary on the first day of the policy your express or implied consent, either period; and CG D3 79 02 19 © 2017 The Travelers Indemnity Company, All rights reserved. Page 1 of 6 Includes copyrighted material of Insurance Services Office, Inc. with its permission, 68'108112 1 22-23 GL, Ail, w/Al, WC, Umb, Prof. I Shirley y Sanr3.Cavil 1 6/10/2022 4iZI 35 PM (PDT) I Page 4 of 11 This certificate cancels and supersedes ALL previously issued certificates. COMMERCIAL GENERAL LIABILITY b. Such subsidiary is not an insured under similar other insurance. No such subsidiary is an insured for "bodily injury" or "property damage" that occurred, or "personal and advertising injury" caused by an offense committed: a. Before you maintained an ownership interest of more than 50% in such subsidiary; or b. After the date, if any, during the policy period that you no longer maintain an ownership interest of more than 50% in such subsidiary. For purposes of Paragraph 1. of Section II — Who Is An Insured, each such subsidiary will be deemed to be designated in the Declarations as: a. A limited liability company; b. An organization other than a partnership, joint venture or limited liability company; or c. A trust; as indicated in its name or the documents that govern its structure. C. WHO IS AN INSURED — RETIRED PARTNERS, MEMBERS, DIRECTORS AND EMPLOYEES The following is added to Paragraph 2. of SECTION II — WHO IS AN INSURED: Any person who is your retired partner, member, director or "employee" that is performing services for you under your direct supervision, but only for acts within the scope of their employment by you or while performing duties related to the conduct of your business. However, no such retired partner, member, director or "employee" is an insured for: (1) 'Bodily injury": (a) To you, to your current partners or members (if you are a partnership or joint venture), to your current members (if you are a limited liability company) or to your current directors; (b) To the spouse, child, parent, brother or sister of that current partner, member or director as a consequence of Paragraph (1)(a) above; (c) For which there is any obligation to share damages with or repay someone else who must pay damages because of the injury described in Paragraph (1)(a) or (b) above; or (d) Arising out of his or her providing or failing to provide professional health care services. Unless you are in the business or occupation of providing professional health care services, Paragraphs (1)(a), (b), (c) and (d) above do not apply to "bodily injury" arising out of providing or failing to provide first aid or "Good Samaritan services" by any of your retired partners, members, directors or "employees", other than a doctor. Any such retired partners, members, directors or "employees" providing or failing to provide first aid or "Good Samaritan services" during their work hours for you will be deemed to be acting within the scope of their employment by you or performing duties related to the conduct of your business. (2) "Personal injury": (a) To you, to your current or retired partners or members (if you are a partnership or joint venture), to your current or retired members (if you are a limited liability company), to your other current or retired directors or "employees" while in the course of his or her employment or performing duties related to the conduct of your business, or to your other "volunteer workers" while performing duties related to the conduct of your business; (b) To the spouse, child, parent, brother or sister of that current or retired partner, member, director, "employee" or "volunteer worker" as a consequence of Paragraph (2)(a) above; (c) For which there is any obligation to share damages with or repay someone else who must pay damages because of the injury described in Paragraph (2)(a) or (b) above; or (d) Arising out of his or her providing or failing to provide professional health care services. (3) "Property damage" to property: (a) Owned, occupied or used by; or (b) Rented to, in the care, custody or control of, or over which physical control is being exercised for any purpose by; you, any of your retired partners, members or directors, your current or retired "employees" or "volunteer workers", any current partner or member (if you are a partnership or joint venture), or any current member (if you are a limited liability company) or current director. Page 2 of 6 © 2017 The Travelers Indemnity Company. All rights reserved, CG D3 79 02 19 Includes copyrighted material of Insurance Services Office, Inc. with its permission, 6V06112 1 22-23 GL, AU, w/AI, WC, Umb, Prof. I Shia:`ey '8S��ax¢ti�DVAI I 6/10/2022 9e24I 35 PM (PDT) I Page 5 of 11 This certificate cancels and supersedes ALL grx:r.•.^wious'].y issued certificates. COMMERCIAL GENERAL LIABILITY D. WHO IS AN INSURED — EMPLOYEES AND organization will be deemed to be VOLUNTEER WORKERS — BODILY INJURY designated in the Declarations as: TO CO -EMPLOYEES, CO -VOLUNTEER a. A limited liability company; WORKERS AND RETIRED PARTNERS, b. An organization other than a partnership, MEMBERS, DIRECTORS AND EMPLOYEES joint venture or limited liability company; The following is added to Paragraph 2.a.(1) of or SECTION II — WHO IS AN INSURED: c. A trust; Paragraphs (1)(a), (b) and (c) above do not as indicated in its name or the documents apply to "bodily injury" to a current or retired co- that govern its structure. "employee" while in the course of the co - "employee's" employment by you or performing F. BLANKET ADDITIONAL INSURED — duties related to the conduct of your business, or CONTROLLING INTEREST to "bodily injury" to your other "volunteer 1. The following is added to SECTION II — workers" or retired partners, members or WHO IS AN INSURED: directors while performing duties related to the conduct of your business. Any person or organization that has financial control of you is an insured with respect to E. WHO IS AN INSURED — NEWLY ACQUIRED liability for "bodily injury", "property damage" OR FORMED LIMITED LIABILITY COMPANIES or "personal and advertising injury" that The following replaces Paragraph 3. of arises out of: SECTION II — WHO IS AN INSURED: a. Such financial control; or 3. Any organization you newly acquire or form, b. Such person's or organization's other than a partnership or joint venture, and ownership, maintenance or use of of which you are the sole owner or in which premises leased to or occupied by you. you maintain an ownership interest of more than 50%, will qualify as a Named Insured if The insurance provided to such person or there is no other similar insurance available organization does not apply to structural to that organization. However: alterations, new construction or demolition operations performed by or on behalf of such a. Coverage under this provision is person or organization. afforded only: 2. The following is added to Paragraph 4. of (1) Until the 180th day after you acquire SECTIO N II — WHO IS AN INSURED: or form the organization or the end of This paragraph does not apply to any the policy period, whichever is premises owner, manager or lessor that has earlier, if you do not report such financial control of you. organization in writing to us within 180 days after you acquire or form it; G. BLANKET ADDITIONAL INSURED — or MORTGAGEES, ASSIGNEES, SUCCESSORS (2) Until the end of the policy period, OR RECEIVERS when that date is later than 180 days The following is added to SECTION II — WHO IS after you acquire or form such AN INSURED: organization, if you report such Any person or organization that is a mortgagee, organization in writing to us within assignee, successor or receiver and that you 180 days after you acquire or form it; have agreed in a written contract or agreement b. Coverage A does not apply to "bodily to include as an additional insured on this injury" or property damage" that Coverage Part is an insured, but only with occurred before you acquired or formed respect to its liability as mortgagee, assignee, the organization; and successor or receiver for "bodily injury", "property damage" or "personal and advertising injury" c. Coverage B does not apply to "personal that: and advertising injuryarising out of an offense committed before you acquired a. Is "bodily injury" or "property damage" that or formed the organization. occurs, or is "personal and advertising injury" caused by an offense that is committed, For the purposes of Paragraph 1. of Section II — Who Is An Insured, each such CG D3 79 0219 © 2017 The Travelers Indemnity Company. All rights reserved. Page 3 of 6 Includes copyrighted material of Insurance Services Office, Inc. with its permission. 60")08112 1 22-23 GL, AD, o/Al, WC, Umb, Prof. I ShixleV "nfvdovAl 1 6/10/2022 4^,24.,35 PM (PDT) I Page 6 of 11 This certificate cancels and supersedes ALL previously issued certiti.cates. COMMERCIAL GENERAL LIABILITY subsequent to the signing of that contract or agreement; and b. Arises out of the ownership, maintenance or use of the premises for which that mortgagee, assignee, successor or receiver is required under that contract or agreement to be included as an additional insured on this Coverage Part. The insurance provided to such mortgagee, assignee, successor or receiver is subject to the following provisions: a. The limits of insurance provided to such mortgagee, assignee, successor or receiver will be the minimum limits that you agreed to provide in the written contract or agreement, or the limits shown in the Declarations, whichever are less. b. The insurance provided to such person or organization does not apply to: (1) Any "bodily injury" or "property damage" that occurs, or any "personal and advertising injury" caused by an offense that is committed, after such contract or agreement is no longer in effect; or (2) Any "bodily injury", "property damage" or "personal and advertising injury" arising out of any structural alterations, new construction or demolition operations performed by or on behalf of such mortgagee, assignee, successor or receiver. H. BLANKET ADDITIONAL INSURED — GOVERNMENTAL ENTITIES — PERMITS OR AUTHORIZATIONS RELATING TO PREMISES The following is added to SECTION II — WHO IS AN INSURED: Any governmental entity that has issued a permit or authorization with respect to premises owned or occupied by, or rented or loaned to, you and that you are required by any ordinance, law, building code or written contract or agreement to include as an additional insured on this Coverage Part is an insured, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" arising out of the existence, ownership, use, maintenance, repair, construction, erection or removal of any of the following for which that governmental entity has issued such permit or authorization: advertising signs, awnings, canopies, cellar entrances, coal holes, driveways, manholes, marquees, hoist away openings, sidewalk vaults, elevators, street banners or decorations. I. BLANKET ADDITIONAL INSURED — GOVERNMENTAL ENTITIES — PERMITS OR AUTHORIZATIONS RELATING TO OPERATIONS The following is added to SECTION II — WHO IS AN INSURED: Any governmental entity that has issued a permit or authorization with respect to operations performed by you or on your behalf and that you are required by any ordinance, law, building code or written contract or agreement to include as an additional insured on this Coverage Part is an insured, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" arising out of such operations. The insurance provided to such governmental entity does not apply to: a. Any "bodily injury", "property damage" or "personal and advertising injury" arising out of operations performed for the governmental entity; or b. Any "bodily injury" or "property damage" included in the "products -completed operations hazard". J. INCIDENTAL MEDICAL MALPRACTICE 1. The following replaces Paragraph b. of the definition of "occurrence" in the DEFINITIONS Section: b. An act or omission committed in providing or failing to provide "incidental medical services", first aid or "Good Samaritan services" to a person, unless you are in the business or occupation of providing professional health care services. 2. The following replaces the last paragraph of Paragraph 2.a.(1) of SECTION II — WHO IS AN INSURED: Unless you are in the business or occupation of providing professional health care services, Paragraphs (1)(a), (b), (c) and (d) above do not apply to "bodily injury" arising out of providing or failing to provide: (a) "Incidental medical services" by any of your "employees" who is a nurse, nurse assistant, emergency medical technician, paramedic, athletic trainer, audiologist, dietician, nutritionist, Page 4 of 6 © 2017 The Travelers Indemnity Company. All rights reserved. CG D$ 79 02 19 Includes copyrighted material of Insurance Services Office, Inc. with its permission. CR'108112 I 22-23 GL, AU, w/AI, Wc, u b, Prof. I Shia'."7,Kuyr Sandoval 1 6/10/2022 4u247 35 PM (PDT) I Page 7 of 11 This certificate cancels and supersedes ALL previously issued certificates. COMMERCIAL GENERAL LIABILITY occupational therapist or occupational therapy assistant, physical therapist or speech -language pathologist; or (b) First aid or "Good Samaritan services" by any of your "employees" or "volunteer workers", other than an employed or volunteer doctor. Any such "employees" or "volunteer workers" providing or failing to provide first aid or "Good Samaritan services" during their work hours for you will be deemed to be acting within the scope of their employment by you or performing duties related to the conduct of your business. 3. The following replaces the last sentence of Paragraph 5. of SECTION III — LIMITS OF INSURANCE: For the purposes of determining the applicable Each Occurrence Limit, all related acts or omissions committed in providing or failing to provide "incidental medical services", first aid or "Good Samaritan services" to any one person will be deemed to be one "occurrence". 4. The following exclusion is added to Paragraph 2., Exclusions, of SECTION I — COVERAGES — COVERAGE A — BODILY INJURY AND PROPERTY DAMAGE LIABILITY: Sale Of Pharmaceuticals "Bodily injury" or "property damage" arising out of the violation of a penal statute or ordinance relating to the sale of pharmaceuticals committed by, or with the knowledge or consent of the insured. 5. The following is added to the DEFINITIONS Section: "Incidental medical services" means: a. Medical, surgical, dental, laboratory, x- ray or nursing service or treatment, advice or instruction, or the related furnishing of food or beverages; or b. The furnishing or dispensing of drugs or medical, dental, or surgical supplies or appliances. that is available to any of your "employees" for "bodily injury" that arises out of providing or failing to provide "incidental medical services" to any person to the extent not subject to Paragraph 2.a.(1) of Section II — Who Is An Insured. K. MEDICAL PAYMENTS — INCREASED LIMIT The following replaces Paragraph 7. of SECTION III — LIMITS OF INSURANCE: 7. Subject to Paragraph 5. above, the Medical Expense Limit is the most we will pay under Coverage C for all medical expenses because of "bodily injury" sustained by any one person, and will be the higher of: a. $10,000; or b. The amount shown in the Declarations of this Coverage Part for Medical Expense Limit. L. AMENDMENT OF EXCESS INSURANCE CONDITION — PROFESSIONAL LIABILITY The following is added to Paragraph 4.b., Excess Insurance, of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: This insurance is excess over any of the other insurance, whether primary, excess, contingent or on any other basis, that is Professional Liability or similar coverage, to the extent the loss is not subject to the professional services exclusion of Coverage A or Coverage B. M. BLANKET WAIVER OF SUBROGATION — WHEN REQUIRED BY WRITTEN CONTRACT OR AGREEMENT The following is added to Paragraph 8., Transfer Of Rights Of Recovery Against Others To Us, of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: If the insured has agreed in a written contract or agreement to waive that insured's right of recovery against any person or organization, we waive our right of recovery against such person or organization, but only for payments we make because of: 6. The following is added to Paragraph 4.b., a. "Bodily injury" or "property damage" that Excess Insurance, of SECTION IV — occurs; or COMMERCIAL GENERAL LIABILITY CONDITIONS: b. "Personal and advertising injury" caused by This insurance is excess over any valid and an offense that is committed; collectible other insurance, whether primary, subsequent to the signing of that contract or excess, contingent or on any other basis, agreement. CG D3 79 02 19 © 2017 The Travelers Indemnity Company. All rights reserved. Page 5 of 6 Includes copyrighted material of Insurance Services Office, Inc. with its permission. 6�000112 22-23 GL, AU, w/AI, WC, Umb, Prof. I Shirley 5'amd9araval 6/10/2022 4:e?. �7 ;35 PM (PDT) I Page B of 11 This certificate cancels and supersedes ALL previously issued certificates. COMMERCIAL GENERAL LIABILITY N. CONTRACTUAL LIABILITY — RAILROADS 1. The following replaces Paragraph c. of the definition of "insured contract" in the DEFINITIONS Section: c. Any easement or license agreement; 2. Paragraph f.(1) of the definition of "insured contract" in the DEFINITIONS Section is deleted. Page 6 of 6 © 2017 The Travelers Indemnity Company. All rights reserved. CG D3 79 02 19 Includes copyrighted material of Insurance Services Office, Inc, with its permission. 6070813.2 122-23 GL, AU, w/AI, WC, U b, Prof. I Shi�x':1eyr Sandoval 1 6/10/2022 9r7�5;35 PM (PDT) I Page 9 of 11 T%g."1. EY certificate cancels and supersedes ALL previously issued certificates. BA8R7053252247 6/10/2022 JM Diaz, Inc. DBA: JMD C. Take all or any part of the damaged or while a covered "auto" which Is a stolen property at an agreed or ap- "trailer" is connected to another praised value. vehicle, the Covered Autos Liability If we pay for the "loss", our payment will Coverage this Coverage Form provides include the applicable sales tax for the for the "trailer" is: damaged or stolen property. (1) Excess while it is connected to a 5. Transfer Of Rights Of Recovery Against motor vehicle you do not own; or Others To Us (2) Primary while It Is connected to a If any person or organization to or for covered "auto" you own_ whom we make payment under this Cov- b. For Hired Auto Physical Damage erage Form has rights to recover damages Coverage, any covered "auto" you from another, those rights are transferred lease, hire, rent or borrow Is deemed to to us. That person or organization must do be a covered "auto" you own. How - everything necessary to secure our rights ever, any "auto" that is leased, hired, and must do nothing after "accident" or rented or borrowed with a driver Is not "loss" to impair them, a covered "auto". B. General Conditions C. Regardless of the provisions of Para- 1. Bankruptcy graph a. above, this Coverage Form's Bankruptcy or insolvency of the "insured" Covered Autos Liability Coverage is primary for any liability assumed under or the "insured's" estate will not relieve us an "Insured contract'. of any obligations under this Coverage Form. d, When this Coverage Form and any 2. Concealment, Misrepresentation Or Fraud other Coverage Form or policy covers on the same basis, either excess or This Coverage Form is void in any case of primary, we will pay only our share. fraud by you at any time as it relates to Our share Is the proportion that the this Coverage Form. It is also void if you or Limit of Insurance of our Coverage any other "insured", at any time, inten- Form bears to the total of the limits of tonally conceals or misrepresents a ma- all the Coverage Forms and policies terial fact concerning: covering on the same basis. a. This Coverage Form; 6. Premium Audit b. The covered "auto"; a. The estimated premium for this Cov- e. Your Interest in the covered "auto"; or erage Form is based on the exposures you told us you would have when this d. A claim under this Coverage Form. policy began. We will compute the final 3. Liberalization premium due when we determine your If we revise this Coverage Form to provide actual exposures. The estimated total premium will be credited against the more coverage without additional premium charge, your policy will automatically pro- final premium due and the first Named vide the additional coverage as of the day Insured will be billed for the balance, if any. The due date for the final premium the revision is effective in your state. or retrospective premium is the date 4. No Benefit To Bailee — Physical Damage shown as the due date on the bill. If Coverages the estimated total premium exceeds We will not recognize any assignment or the final premium due, the first Named grant any coverage for the benefit of any Insured will get a refund. person or organization holding, storing or b. If this policy Is Issued for more than transporting property for a fee regardless of one year, the premium for this Cov- any other provision of this Coverage Form. erage Form will be computed annually 5. Other insurance based on our rates or premiums in ef- a. For any covered "auto" you own, this fect at the beginning of each year of the policy. Coverage Form provides primary in- surance. For any covered "auto" you don't own, the insurance provided by this Coverage Form is excess over any other collectible insurance. However. CA 00 01 10 13 0 Insurance Services Office, Inc., 2011 Page 9 of 12 6V0811.2 1 22-23 GI„ A.U, w/AI, WC, Umb, Prof. I Shirl.oy S.a.nrl.f2vsal 1 6/10/2022 4224 r3.5 PM (PDT) I Page 2 of 1.1. This certificate Cancels and supersedes ALL previously issued certifS.cates. 6802,13309942247 JM Diaz, Inc. DBA: JMD 11-1KI �z6y0*: COMMERCIAL GENERAL LIABILITY c. Method Of Sharing If all of the other insurance permits contribution by equal shares, me will follow this method also. Under this approach each insurer contributes equal amounts until it has paid its applicable limit of insurance or none of the loss remains, whichever comes first. If any of the other insurance does not permit contribution by equal shares, we will contribute by limits. Under this method, each insurers share is based on the ratio of its applicable limit of insurance to the total applicable limits of insurance of all insurers. d. Primary And Non -Contributory Insurance If Required By Written Contract If you specifically agree in a written contract or agreement that the insurance afforded to an insured under this Coverage Part must apply on a primary basis, or a primary and non- contributory basis, this insurance is primary to other insurance that is available tosuch insured which covers such insured as a named insured, and we will not share with that other insurance, provided that: (1) The "bodily injury' or "property damage" for which coverage is sought occurs; and (2) The "personal and advertising injury' for which coverage is sought is caused by an offense that is committed; subsequent to the signing of that contract or agreement by you. 5. Premium Audit a. We will compute all premiums for this Coverage Part in accordance with cur rules and rates. b. Premium shown in this Coverage Part as advance premium is a deposit premium only. At the close of each audit period we will compute the earned premium for that period and send notice to the first Named Insured. The due date for audit and retrospective premiums is the date shown as the due date on the bill. If the sum of the advance and audit premiums paid for the policy period is greater than the earned premium, we will return the excess to the first Named Insured. c. The first Named Insured must keep records of the information we need for premium computation, and send us copies at such times as we may request. 6. Representations By accepting this policy, you agree: a. The statements in the Declarations are accurate and complete; b. Those statements are based upon representations you made to us; and c. We have issued this policy in reliance upon your representations. The unintentional omission of, or unintentional error in, any information provided by you which we relied upon in issuing this policy will not prejudice your rights under this insurance. However, this provision does not affect our right to collect additional premium or to exercise our rights of cancellation or ncnren&APA in accordance with applicable insurance laws or regulations. 7. Separation Of Insureds Except with respect to the Limits of Insurance, and any rights or duties specifically assigned in this Coverage Part to the first Named Insured, this insurance applies: a. As if each Named Insured were the only Named Insured; and b. Separately to each insured against whom claim is made or "suit' is brought. 8. Transfer Of Rights Of Recovery Against Others To Us If the insured has rights to reoaver all or pat of any payment we hake made under this Coverage Part, those rights are transferred to us. The insured must do nothing after loss to impair them. At our request, the insured will bring "suit" or transfer those rights to us and help us enforce them. 9. When We Do Not Renew If we decide not to renew this Coverage Part, we will mail or deliver to the first Named Insured shown in the Declarations written notice of the nonrenewal not less than 30 days before the expiration date. If notice is mailed, proof of mailing will be sufficient proof of notice. SECTION V —(DEFINITIONS 1. "Advertisement" means a notice that is broadcast or published to the general public or specific market segments about your goods, products or services for the purpose of attracting customers or supporters. For the purposes of this definition: a. Notices that are published include material placed on the Internet or on similar electronic means of communication; and b. Regarding websites, only that part of a website that is about your goods, products or services for the purposes of attracting customers or supporters is considered an advertisement. Page 16 of 21 © 2017 The Travelers Indemnity Company. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc. with its permission. CG T1 00 0219 6R`708112 1 22-23 GL, AU, w/A1, WC, Dab, Prof. I Shirley ;SFardoval 1 6/10/2022 4t;.l :.35 PM (PDT) I Page 3 of 11 T9JiB certificate cancels and supersedes ALL prvicqusl:.y issued certificates. JM Diaz, Inc. BA8R7053252247 COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM The following is added to Paragraph c. in A.1., Who Is An Insured, of SECTION 11 — COVERED AUTOS LIABILITY COVERAGE in the BUSINESS AUTO COVERAGE FORM and Paragraph e. in A.1., Who Is An Insured, of SECTION II — COVERED AUTOS LIABILITY COVERAGE in the MOTOR CARRIER COVERAGE FORM, whichever Coverage Form is part of your policy: This includes any person or organization who you are required under a written contract or agreement between you and that person or organization, that is signed by you before the "bodily injury" or "property damage" occurs and that is in effect during the policy period, to name as an additional insured for Covered Autos Liability Coverage, but only for damages to which this insurance applies and only to the extent of that person's or organization's liability for the conduct of another "insured". CA T4 37 02 16 © 2016 The Travelers Indemnity Company. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc. with its permission. Page 1 of 1 69"OU112 i 22-23 GL, AU, W/AI, WC, Umb, Prof. I Shirley Sandoval i 6/10/2022 1:24n35 PM (PDT} I Page 10 of 11 This certificate cancels and supersedes ALL previously issued certificates. T VELERSJ AW WORKERS COMPENSATION MpENSATIor� ONE TOWER SQUARE EMPLOYERS LIABILITY POLICY HARTFORD, CT 06183 ENDORSEMENT WC 99.03 76 ( A) — 001 POLICY NUMBER: UB6K8694022247 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT — CALIFORNIA (BLANKET WAIVER) We have the right to recover our payments from anyone liaNe for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. The additional prernium for this endorsement shaft be % 6f the California workers' compensation pre- mium, Schedule Person ar organization Job Description ANY PERSON OR ORGANIZATION FOR WHICH THE INSURED HAS AGREED BY WRITTEN CONTRACT EXECUTED PRIOR TO LOSS TO FURNISH 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 Effective6/27/2022 Policy No, UB6K8694022247 Endorsement No. Insured JM Diaz, Inc. DBA: JMD w:... Insurance Company Countersigned by DATE OF ISSUE: 6/10/2022 ST ASSIGN: Page I of 1 ]aNcc 48-100112 122-23 GL, AU, W/AI, WC, Umb, Prof. I Shirley gandoval 16/10/2022 4;2�4 �a35 PM (PDT) I Page 11 of 11 This certificate cancels and supersedes ALL pr.evicusly issued certificates.