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PROOF OF INSURANCE (2023 - 2023) CLOSEDCERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 2/25/2022 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 riahts to the certificate holder in lieu of such endorsementfsl. PRODUCER '""*""''"'""" _Laura Gross Tegner-Miller Insurance Brokers PHONE 2001 Wilshire Blvd, Suite 101 1AIC,Ar.gxt1<_310782871 Santa Monica CA 90403 E-MAIL insure(rDtmi ......._....... ............. _.._............. ...._____............. ... ____—.... _. Llggnse# pR.4?SEi.R INSURER.A....Nationwide Mutual Insurance Company ....................2...3787 INSURED WESTIND-02 surance Company 14167 Western Indoor Environmental Services INsuReRa GuldeOne National In... ___ _ 2609 W. Beverly Blvd. Suite 6 INsuReRc Montebello CA 90640 INSURERD: COVERAGES CERTIFICATE NUMBER:2064259198 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 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,. 'INSRT jAD'fiLS�ktt ......... ...I EFF EXP ..... .......---- ------------ ----.. POLICYNUMBER... MPOLICY M/DD TR TYPE OF INSURANCE LIMITS MMIDDY B X COMMERCIAL GENERAL LIABILITY Y ENV562008594-00 2/6/2022 2/6/2023 EACH OCCURRENCE � $_1.000.000 _ ..ff X J _ OAFWtG 1 O R g1Y CLAIMS -MADE OCCUR PRL,IygMES LEa occurrenn $ 50.0 00 f _........ „ „ ( MED EXP (Any one person) $ 5 000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE , $ 2.000.000 P PRO- X PRO- ..... ----- POLICY LOC PRODUCTS COMP/OPAGG "Aggregate $2,000,000 OTHER: Over $ 3.000,000 A AUTOMOBILE LIABILITY ACP3048130234 3/2/2022 3/2/2023 OM INIEDntSINGLE &.p6"i6RT I $ 1,000,00o X ANY AUTO BODILY INJURY (Per person) $ OWNED SCHOSEDULED AUTOS ONLY AUT „ ___,__.,, BODILY INJURY (Per accid ent)HIRED $ PERTY I]AdWtAGE......... $ ....................� AUTOS ONLY .. AUTOS ONLDY,MO.0 B UMBRELLA LIAB X I OCCUR ENV562008594-00 2/6/2022 2/6/2023 EACH OCCURRENCE $ 1,000,000 X EXCESS LIAB CLAIMS -MADE AGGREGATE $ 1 000000 .. .. .. � .. $._.. ..,..... DED { RETENTION $ WORKERS COMPENSATION tt'. AND EMPLOYERS' LIA, ILITY YIN I. ERPER 1STATUTE I.OT RID' ECUTIVE �E O ICERIMEMBE EXCBLU N / A CEA ................... (Mandatory in NH) L DISEASE EMPLOYEE $ If yes, describe under ._......_._.._......... ..................... ......... ........,,................................................................. DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT '...... $ B Pollution ENV562008594-00 2/6/2022 2/6/2023 Per Occurrence 1.000,000 B Professional Liability ENV562008594-00 2/6/2022 2/6/2023 Per Claim 1,000.000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of El Segundo is included as additional insured with regards to General Liability per attached forms including Primary & Non -Contributory wording and Waiver of Subrogation. Ldllrkl w twl R IA:I�r11 � CdN] �" SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of El Segundo ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street El Segundo CA 90245 AUTHORIZED REPRESENTATIVE USA ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: ENV562008594-00 COMMERCIAL GENERAL LIABILITY CG 20 37 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSU - OWNERS, LESSEES O CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following. - COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Or anization : Location And De mri tion Of Completed O erations Any person or organization for whom you are In respect to any location where the named insured is performing operations when you and such person or performing "your work". organization have agreed in writing in a contract or agreement, effected prior to the date your operations for that person or organization commenced, that such person or organization be added as an additional insured on your policy. Information required to complete this Schedule, if not shown above, will be shown in the Declarations.. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the schedule of this endorsement performed for that additional insured and included in the "products - completed operations hazard". CG 20 37 07 04 C ISO Properties, Inc., 2004 Page 1 of 1 POLICY NUMBER: ENV562008594-00 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 �....... ww_......................................................... _......... ... Name Of Additional Insured Person(s) Location(s) Of Covered Operati Or Organization1s) Any person or organization for whom you are performing In respect to any location where the named insured is operations when you and such person or organization have performing "your work", agreed in writing in a contract or agreement, effected prior to the date your operations for that person or organization commenced, that such person or organization be added as an additional insured on your policy. his Schedule, if not show , will be shown in 6�.......�...�..................................... Declarations. ImmmmmmITITmmmmmITITITITmmmITITminformation required to complete t S n above, ..............................................the mmmmmmmmmmmmmITIT_mITITm A. Section II - Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. B. With respect to the insurance afforded to these additional insureds, the following additional exclu- sions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1� 2. All work, including materials, parts or equip- ment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or That portion of "your work" out of which the injury or damage arises has been put to its in- tended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. CG 20 10 07 04 C ISO Properties, Inc., 2004. Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRIMARY/NON-CONTRIBUTORY — If required by written contract or agreement, effected prior to the date your operations for that person or organization commenced and named below, such insurance as is afforded by this policy to any additional insureds under this policy shall be primary insurance, and any insurance or self-insurance maintained by such additional insured(s) shall not contribute to the insurance afforded to the named insured. All other terms and conditions remain unchanged. SCHEDULE Any person or organization that is: 1. An owner of real or personal property on which you are performing operations, but only at the specific written request by that person or organization to you, and only if: a. That request is made prior to the date your operations for that person or organization commenced; and b. A Certificate of Insurance evidencing that request has been issued by your authorized insurance agent or broker: or 2. A contractor on whose behalf you are performing operations, but only at the specific written request by that person or organization to you, and only if: a. That request is made prior to the date your operations for that person or organization commenced; and b. A Certificate of Insurance evidencing that request has been issued by your authorized insurance agent or broker GO 0216 — 4YP 10-17 Includes Copyrighted Material of Insurance Services Office, Page 1 of Inc. with its permission POLICYHOLDER COPY Sc P.O. BOX 8192, PLEASANTON, CA 94588 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 07-15-2022 CITY OF EL SEGUNDO Sc 350 MAIN ST EL SEGUNDO CA 90245-3813 GROUP: POLICY NUMBER: 9128780-2022 CERTIFICATE ID: 220 CERTIFICATE EXPIRES: 03-07-2023 03-07-2022/03-07-2023 This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 30 days advance written notice to the employer. We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance pollicy and does not amend, extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirement„ term or condntion of any contract or other document with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy. Authorized Representative President and CEO EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 03-07-2022 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. ENDORSEMENT #2572 ENTITLED BLANKET WAIVER OF SUBROGATION EFFECTIVE 2022-03-07 IS ATTACHED TO AND FORMS A PART OF THIS POLICY ENDORSEMENT #1651 - ANTONIO ROSARIO P,T - EXCLUDED. ENDORSEMENT #1851 - ALBERT TORRES S - EXCLUDED. EMPLOYER WESTERN INDOOR ENVIRONMENTAL SERVICES (A CORP) 2609 W BEVERLY BLVD STE 6 MONTEBELLO CA 90640 [P13,HO] (REV.7-2014) PRINTED : 07-15-2022