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PROOF OF INSURANCE (2023) CLOSEDCERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 06/2912022 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 Marsh USA, Inc. 1166 Avenue of the Americas New York, NY 10036 CN 102238245-Cali-GAU-22-23 ...................................................................................... INSURED Avidex Industries, LLC 20382 Hermana Circle Lake Forest, CA 92630 COVERAGES CERTIFICATE NUMBER: NYC-010999870-04 REVISION NUMBER: 2 10945 20362 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. .... ............... IAUC1Li' tdBFE' .... POLICY EFE �.016[i NCY'eko ILTR......TYPE OF INSURANCE POLICY NUMBER.. I(MM1DDfYYYYI ffMdDD1YY"ti'YY LIMITS A X COMMERCIAL GENERAL LIABILITY CLL6403455-12 06/30/2022 06/30/2023 1,000000 CLAIMS-MADE � X OCCUR ..................1,00000 I 0 ..I ..mPRE%a1'RSP .. Iv, 9,PP T1 1....`�.$ MED EXP (And one person} � 5,0 00 $ ... mPERSONAL&ADVINJURY $. 1,000,000 ...._ ...... ...... LIMIT APPLIES � GENERAL AGGREGATE $ 2,000,00 X. ❑ ❑ OC ... S ....... /O PRODUCTS PRODUCT-COMPIOPAGG $1,000,000 �EEGATE��� OTHER G . ........................ . I $ B A U 8VRB407292 106/30/2022 O 6/30I2023 CJIURY X T ANY AUTO i B oDleINJURY (Per person) BODILY ......... OWNESCHEDULED �... I..PIRgPE'."rY BODILY INJURY (Per I $ ... o AUTOS ONLY AUTOS REDD NON OWNED X r�AAaccident) TTT AUTOS ONLY ...X........... AUTOS ONLY I . eff 9990 s , 9).... . !.$............................................... Is X ` UMBRELLA LIAB OCCUR CU6406757-09 i 06/30/2022 06/30/2023 EACH OCCURRENCE Is 5,000,000 m EXCESS I CLAIMS -MADE S LI'FDETENTION I AGGREGATE $ 5 000 DED 1 $ --- $ WORKERS COMPENSATION I PER I I OTH STATUTE ER I. AND EMPLOYERS' LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE Y r N ,._ ....... ......... $ ER EXCLUDED? � NIA ...._._ (MandatoryOFF in in NH) LE DISEASE A EMPLOYEE I $ If yes, describe under [ If ..------- - ---� _..._ _ ....... ............. DESCRIPTION OF OPERATIONS below 7 E,L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of El Segundo, its officials, and employees are included as additional insured where required by written contract. This insurance is primary and non-contributory over any existing insurance and limited to liability arising out of the operations of the named insured subject to policy terms and conditions. CERTIFICATE HOLDER CANCELLATION 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 ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: CLL6403455-12 COMMERCIAL GENERAL LIABILITY CG 20 37 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES O CONTRACTORS S - 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) BLANKET" ENDORSEMENT AS FOLLOWS: ANY PERSON OR ORGANIZATION WHEN YOU AND SUCH PERSON(S)OR ORGANIZATION (S) HAVE AGREED IN WRITING IN A CONTRACT OR AGREEMENT,WHICH WAS EXECUTED PRIOR TO THE TIME Location And Description Of Completed ANY LOCATION DESCRIBED IN THE CONTRACT OR AGREEMENT 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 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". 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. CG 20 37 04 13 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 shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. © Insurance Services Office, Inc., 2012 Page 15 of 52 Insured Copy POLICY NUMBER: CLL6403455-12 COMMERCIAL GENERAL LIABILITY CG20100413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OIL ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) _ Locations Of Covered Operations ANY PERSON OR ORGANIZATION WHEN YOU AND ANY LOCATION IN CONNECTION WITH A WRITTEN SUCH PERSON(S) OR CONTRACT OR ORGANIZATION (S) HAVE AGREED IN WRITING IN A AGREEMENT EXECUTED WITH THE ADDITIONAL CONTRACT OR INSURED SHOWN IN THE AGREEMENT,WHICH WAS EXECUTED PRIOR TO SCHEDULE. THE TIME Information re wired to com lete th is 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 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 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 However: 2. That portion of "your work" out of which the injury or damage arises has been put to its 1. The insurance afforded to such additional intended use by any person or organization insured only applies to the extent permitted by other than another contractor or subcontractor law; and engaged in performing operations for a 2. If coverage provided to the additional insured principal as a part of the same project. 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. CG 20 10 04 13 © Insurance Services Office, Inc., 2012 Page 33 of 120 Insured Copy C. With respect to the insurance afforded to these 2. Available under the applicable Limits of additional insureds, the following is added to Insurance shown in the Declarations; Section III — Limits Of Insurance: whichever is less. If coverage provided to the additional insured is This endorsement shall not increase the required by a contract or agreement, the most we applicable Limits of Insurance shown in the will pay on behalf of the additional insured is the Declarations. amount of insurance: 1. Required by the contract or agreement; or Page 34 of 120 © Insurance Services Office, Inc., 2012 CG 20 10 04 13 Insured Copy This endorsement changes policy CLL6403455-12 to which it is attached and is effective 06/30/2022 at 12:01 a.m. standard time at the Insured's mailing address. Issued to: ITOCHU INTERNATIONAL INC. Issued by: Trans Pacific Insurance Company Producer: MARSH USA INC THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AMEENDMENT -OTTIER. INSUI ANCE PRIMARY AND NON CONTRI BUTORY This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART This endorsement applies to the following states: AL, AK, AZ, AR, CA, CO, CT, DE, DC, FL, GA, HI, ID, IL, IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY, NC, ND, OH, OK, OR, PA, PR, RI, SC, SD,' TN, TX, UT, VT, VI, VA, WA, WV, WI, WY , 0 rp r,.1 jF .] PARAGF�.Allfl. A, . OF CONDITION 4 . I ( INSURANCE, OF CONDITIONS SECTION IS R.EE:'[.,A.CED BY TH.E FOL.E.,OTAIING., 4:. Or NIEI.-� INS( J RAN C E A. PRIMARY INSURANCE, 1111S INSURANCE, INCLUD.ING INSURANCE: AFFORIDED 10 AN ADDIT.I.ONA.1 INSURED, IS PRIMARY EXCEPT WHEN PAIRAGRAP11 B. BEI..,0T/\T APP.T I E; S ][TIE INSURANCE]AFFORDED 'TO AN ADI..)ITIONAL INS[JR.ED IS NON CONTRIBUTORN V(Irj,f..l Or.1711EP, INSURANCE VATHEN YOU HAVE AGREED 'TO DO THAT IN A WIRITTEN CONTRACT OR. AGRE1. VIENrj, THAT WAS EXEC U'.FE 1.) pj.[OR vTO - 1HE "BODII-N INJUR.1(","PFI OPERTY DAMAGE" OR "PERSONA1 ANI) ADVERTISING INJURY". IF' THIS INSURANCE IS PRIMARY, OUR. OBLIGATIONS A.11.�.E NOT AFF,j.�"Crj,Ei.,D UNLESS ANY 01.' THE OTHER 1NSU111,..A.NC11...',, E......)(CEprI., TIII:I ADDITIONAL INSUIRED . C..NSURANCE DESCRIBEE. �D GI-9 99 001 09 11 Tokio Marine Management, Inc. 2011 Page 1 Insured Copy POLICY NUMBER: CLL6403455-12 AMENDMENT —OTHER INSURANCE PRIMARY AND NON ABOVE, IS ALSO PRIMARY. THEN, WE WILL SHARE WITH AIA, T[lAT OTHER INSURANCE BY rflllo METHOD DESCRIBED IN PARAGRAPH C.BEL,OW. GL9 99 001 09 11 Tokio Marine Management, Inc. 2011 Page 2 Insured Copy DATE(MM/DD/YYYY) C"^R" CERTIFICATE OF LIABILITY INSURANCE 6/28/2022 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 NAME LoCT riStaples Arthur J. Gallagher Risk Management Services, Inc. RHONE FAX 4700 Homewood Court, Suite 260 E MA , eft) 336 217 57 67 tAo No ,336 275-1776 Raleigh NC 27609-5732 ADDRESS, INSL ISI AFFORDING COVERAGE NAIC # INSURED Avidex Industries, L.L.C. 20382 Hermana Cir. Lake Forest, CA 92630 INSURERA: .: Hartford Fire Insurance ................ TELELEA-01 INSURER ......--- anston Insurance Co Evanston ............... ..... INSURER C : Sentinel n. i Insurance Con INSURER D INSURER E Ltd COVERAGES CERTIFICATE NUMBER: 1458973197 REVISION NUMBER: i� 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. ADDL SU'BR .... ................ ............. ---- POLICY EFF ' POLICY EXP l ILTR TYPE OF INSURANCE.. �... ............ ... LIMITS .... ........................ POLICY NUMBER MM/O MIDD COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 6f�' ...... CLAIMS MADE ( OCCUREa PREMISE qqg0@ecpJ ... MED EXP (Any one person) $ PERSONAL &ADVINJURY ....... GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ ❑ E CT O ❑ LOC PRODUCTS COMP/OP AGG ... OPOLICYTHER: F AUTOMOBILE LIABILITY COa,�B,CPtlt°."11,S SINGLE LIMIT $ ANY AUTO BODILY INJURY Perperson) $ OWNED SCHEDULED .............................---------............,,........... ............................................... AUTOS ONLY AUTOS J (Per accident BODILY INJURY (P ) $ ���������� HIRED NON -OWNED �_ DAMAGE $ AUTOS ONLY AUTOS ONLY LPetr�EFdT1' i Is UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAB _H ...... -MADE, C AGGREGATE {____ $ {{ BED f, RETENTION $ } p $ C WORKERS COMPENSATION Y 22WBAS2SMX 6/30/2022 6/30/2023 dX 1 PER TH- TEJ,� ER TU AND EMPLOYERS' LIABILITY ANYPROPRI TOR PARTYNER/EXECUTIVE OFFICERIMEMBEREXCLUDED? N/A �, .E E.L. EACH ACCIDENT ( I $ 1,,000,000 (Mandatory in NH) E L DISEASE - EA E MPLOYEEI $ 1.,000,000 If yes, describe under under p ("'" """"""" ��---- DESCRIPTION OPERATIONS below l EL. DISEASE - POLICY LIMIT S 1,000,000 A Professional Liability 22TE029939422 6/30/2022 6/30/2023 Each Wrongful Act $5,000,000 B Excess Professional Liability MKLV2XE0000072 6/30/2022 6/30/2023 Aggregate $5,000,000 Retention $100,000 ea act DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101,Additional Remarks Schedule, may be attached if more space is required) Excess Professional Limit=$5,000,000 xs $5m Aggregate=$5,000,000 xs $5m Waiver of Subrogation under the workers compensation is applicable in favor of the City of El Segundo and its officers, officials, employees, agents, representatives, and certified volunteers per VVC form 04 03 06. The producer Will endeavor to mall 30 days written notice to the certificate holder named on the certificate If any policy listed on the certificate is cancelled prior to the exp0ration date. Failure to do so shalq impose no obligation or liability of any kind upon the Producer or otherMse after the policy term„ IL" q:A112L7_11=111:Lei 1Ili aN City of El Segundo 350 Main Street El Segundo CA 90245 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. ED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA Policy Number: 22 WB AS2SMX Endorsement Number: Effective Date: 06/30/22 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address: AVIDEX INDUSTRIES, LLC 1100 CRESCENT GREEN STE 200 CARY NC 27518 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 2 % of the California workers' compensation premium otherwise due on such remuneration. SCHEDULE Person or Organization Job Description Any person or organization for whom you are required by written contract or agreement to obtain this waiver of rights from us Countersigned by _ Authorized Representative Form WC 04 03 06 (1) Printed in U.S.A. Process Date: 06/29/22 Policy Expiration Date: 06/30/23