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PROOF OF INSURANCE (2022 - 2023) CLOSEDDATE (MM/DDIYYYY) ' CERTIFICATE OF LIABILITY INSURANCE ». 12/31/2022 6/ 22,/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 Lockton Insurance Brokers, LLC CONTACT 777 S. Figueroa Street, 52nd Fl. CA License #OF15767 PHONE FAX ffi L1t..fg)l .......... .. ......... --INC,No: Los Angeles CA 90017 ADORUSSs (213) 689-0065 INSURER(S) AFFORDING COVERAGE NAIC # ......... -- INSURER A : Atlantic S ecialt Insurance Company 27154 _ . INSURED prosrosum Inc. 1302737 INSURER B :Underwriters at Lloyds of London --._ 10736 .____.... 2ParkPl. Ste. 102 INSURER C : Federal. Tri l . ce Co � _ 20281 El Segundo CA 90245 INSURER D : INSURER E INSURER F : COVERAGES PROSU01 CERTIFICATE NUMBER: 2911178 REVISION NUMBER: XXXXXXX 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 ���... .... ......... ......... ADDt,'�INBR.. ......... 1P01.tCYEFF POLNCYEXP' LTR TYPE OF INSURANCE INSO, WVO POLICY NUMBER fd O00 YYY) (MM9PPon LIMITS A X COMMERCIAL GENERAL LIABILITY Y N 7110082470016 6/19/2022 6/19/2023 EACH OCCURRENCE $ 1000000 CLAIMS -MADE I OCCUR -Al -- — DAMAGE fi iiTFtk--­--­ PREMuSE Ep Eao rMcurtseucl $ 1 .000.000 MED EXP (Any one person) $ I0,0,00 $ 1,000,000 ... PERSONAL & ADV INJURY '$ 2,000,000 _ A PER: .GENERAL AGGREGATE PPLIEI _� POLICY JEMI IdOu LOC _ 'm PRODUCTS COMP/OP AGG $ 2,000,000 GATHER: A AUTOMOBILE LIABILITY N N 7110082470016 6/19/2022 6/19/2023 �,,COMSWEDSJNGLE LIMIT t O @s,0.4 li ------------- $ 1 000 000 X ANY AUTO BODILY INJURY (Per person) $ XXXXXXX XXXXXXX OWNED SCHEDULED AUTOS ONLY AUTOS ._._. , ..BODILY INJURY (Per accident) ,.. ....... _,.. 1 $ XXXXXXX HIRED NON -OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Pier _pplrtie, „.,1_ p ntp ...,,,,... ._,,. $,XXXXXXX ... Comp/Coll ed, $ 1,000 A I,X _ UMBRELLA LIAB X OCCUR N N 1 7110082470016 6/19/2022 6/19/2023 EACH OCCURRENCE $y?�000 QQQ EXCESS LIAB '.. CLAIMS -MADE 1 .,AGGREGATE $ 7 000 0,Q0 IT a. -. DED RETENTION $ $ XXXXXXX A WORKERS COMPENSATION ANDEMPLOYER5'LIABI11 Y 4060321310012 12/31/2021 12/31/2022 OTH- -X STATUTE ER E.L. EACH ACCIDENT $ I 000.,000 �,/N ANY PROPRIETOR/PARTNER/EXECUTIVE """""' N / A E L DISEASE EA EMPLOYEE $ 11 pQQ. Q0Q OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below ".. "`.. E.L. DISEASE POLICY LIMIT $ 1.000.000 B PIOfLiab.(TechE&O)/Cyber N N NWL227318522 6/20/2022 6/20/2023 $3,000,000 Lim/Ret. $10,000 C 3rd Party Crime 82429026 6/19/2022 6/19/2023 $3,000,000 Lim/$1 OK Ret. DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) The City, its officers, officials, employees, agents, and volunteers are an Additional Insured to the extent provided by the policy language or endorsement issued or approved by the insurance carrier. Waiver of Subrogation applies to the worker's compensation. 30 Day Notice of Cancellation applies per attached endorsement. GtK 111-IGA I t MULULK 2911178 City of El Segundo City Clerk Attn: Administrative Services 350 Main Street, Room 5 El Segundo CA 90245 lh_\0LhaIII L'11Lei 0 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 ©1 88-20'1MCl'2IZID CORPORATION. All riahts reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Attachment Code: D452802 Certificate ID: 2911178 POLICY NUMBER: 7110082470016 COMMERCIAL GENERAL LIABILITY CG 20 10 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Location(s) Of Covered Operations: Or Organization(s): Project #1906006 Benchmark Contractors, Inc. 3330 Ocean Park Brick & Machine Blvd. Santa Monica, CA 90405, Lot 9735, LLC, 9735 Washington Blvd, Owner's Members, Managers, Partners, Clarett Culver City, CA 90232 West Development, LLC, DLJ Real Estate Capital Partners, Any Lenders With An Interest In Project and Their Parents, Affiliates and Subsidiaries, Employees, and Agents Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section 11 - Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location of the the additional insured(s) at the location(s) designated above. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work including materials parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. CG 20 10 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 Attachment Code: D529981 Certificate ID: 2911178 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT—CALIFORNIA This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different date is indicated below. (The following "attached clause" need be completed only when this endorsement is issued subsequent to This endorsement, effective on12/31/2021 at 12:01 A.M. standard time, forms a part of (DATE) Policy No.4060321310012 Endorsement No. of the Atlantic Specialty Insurance Company (NAME OF INSURANCE COMPANY) issued to PROSUM, INC. Premium (if any) $ Authorized Representative 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 additional premium for this endorsement shall be 2.00 % of the California workers' compensation premium otherwise due on such remuneration. Schedule Person or Oroanizatinn Jnh nesr•.rintinn WC 252 (04 84) Copyright 1984, OneBeacon Insurance Group LLC &INSURED Attachment Code: D566344 Certificate ID: 2911178 POLICY CHANGE 1 Effective 6/19/2022, this endorsement forms a part of Policy No. 7110082470016 (At the time stated in the policy) issued to PROSUM, INC. (See ASC 00 11 01 98, Schedule 2) ATTN: AMIT BHATIA 2201 PARK PL STE 102 EL SEGUNDO, CA 90245-5167 Producer: LOCKTON INSURANCE BROKERS, LLC by Atlantic Specialty Insurance Company In Accordance with this Policy Change Your Premium is Revised as follows: No Change in Premium This Policy Change Amends the Following Policy Provisions: Common Policy Declarations, 4 VIL 100 10 98 Add Form(s): VIL 229 06 12 NOTICE OF CANCELLATION TO DESIGNATED CERTIFICATE HOLDER 3 5-41-0030 07/09/2019 EBC CPW PR 0.984 ASC 00 10 01 98 E-INSURED POLICY CHANGE Page 1 of 1 Attachment Code: D566344 Certificate ID: 2911178 Policy Number: 7110082470016 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Notice of Cancellation to Designated Certificate Holder A. If we cancel this policy for any reason other than nonpayment of premium, we will endeavor to provide notice of such cancellation to the certificate holder(s) at the address(s) shown in the schedule below when notice of cancellation is sent to the first Named Insured. In no event will the timing of notice to a certificate holder exceed the timing of notice to the first Named Insured. B. Our failure to provide notice of cancellation to a certificate holder scheduled below will not amend or extend the effective policy cancellation date or negate policy cancellation. Notice of cancellation is provided solely as a courtesy for the convenience of the first Named Insured and does not constitute a prerequisite to effective policy cancellation or confer any rights whatsoever on the certificate holder(s) scheduled below. SCHEDULE Name of Certificate Holder and Address CITY OF EL SEGUNDO CITY CLERK ATTN: ADMINISTRATIVE SERVICES 350 MAIN ST ROOM 5 EL SEGUNDO, CA 90245-3813 REFERENCE #2911178 RE: 30 DAY NOTICE OF CANCELLATION VIL 229 06 12 Copyright 2012, OneBeacon Insurance Group LLC Page 1 of 1 E-INSURED Attachment Code: D566104 Certificate ID: 2911178 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY NOTICE OF CANCELATION TO DESIGNATED PERSON OR ORGANIZATION Schedule Person or Organization CITY OF EL SEGUNDO CITY CLERK REFERENCE 2911178 ATTN ADMINISTRATIVE SERVICES 350 MAIN STREET, ROOM 5 EL SEGUNDO CA 90245 10 days' notice for cancelation for nonpayment of premium 30 days' notice for cancelation for any other reason The following is added to PART SIX — CONDITIONS: If we cancel this policy, we will notify the Person or Organization shown in the Schedule above the number of days shown in the Schedule before cancelation. Notice to such Person or Organization will not be earlier than to the first named insured. We will not provide notice to such Person or Organization for cancelation for nonpayment of premium if no entry for the number of days' notice appears in the Schedule above. Our failure to provide notice to such Person or Organization will not extend the policy cancelation date or negate cancelation of the policy. 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 06/25/2019 Policy No. 4060321310012 Endorsement No. 6 Insured PROSUM, INC. Premium $ Insurance Company Atlantic Specialty Insurance Company Countersigned By WC 99 06 18 B (03 16) Contains copyrighted material of NCCI, Inc., used with its permission. Page 1 of 1 Copyright 2016, OneBeacon Insurance Group LLC &INSURED