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PROOF OF INSURANCE (2022) CLOSEDPolicy Number: VARIOUs Date Entered: 10/27/2021 A C DATE (MWDOIYYYY) �Wa _ CERTIFICATE OF LIABILITY INSURANCE 10/27/2021 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 13ETWEEN 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 provislons or he 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 _ PHONE T Oi(408 ne 286— 334� Fes_ esilva Mary Barnard Insurance NAMP PHONE PvI,AZ (408) 6425-- 2190 Stokes Street +xllc N" Prrtl° ) pr - Suite 201 ADDRESS: j"'_' erLR12giltd nSLlydIlCe CO, .,,... ,... , „ .... I'NSURERIS) AFE'OROENG COVERAGE NAIC a San Jose, CA 95128 Ih11 CI3JRERAp C Evanston Insurance Com any T 3 .. �..._ 78 IRBURED Range Maintenance Services, L.L.C.. '.INSURERS: ALLST 19232 Donna Foggiato INSURER G: STATE COMPENSATION INSURANCE FTIND 35076 301 Mary Belle Way INSURERD:�� ...�.� . W.. a ,......... Angels Camp, CA 95222 INSURSRE: r nVFRAr:FS r IPPTIFICATF NIIMRFR• 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. TYPE OF INSURANCE �.�. ,.�. . ,, _...POLfCYNUMBER__ ...... _iMr,vy" ,tiAwnn p IPTS'Ti kTa LIMITS _..„ CQ 1MEROIALQENERALLL40LITY � EACH00CURRENCE S1,000,000 ....... I CLAIMS-b%M ® OCCUR 3AA513851 1 1/0/21/01/2022 PIaI"wAISE^ rrRI"A'Thb 100 000 .. 5 000 MED EXP (Any one person! $ , ..._W.—.__._.� PF.RSONAI_ &ADV INJURY $1, 000 , 000 PER: GLrN+ra, AGGREGATE LIMITAPPLIES� .... Doo 000 GENERAL AGGREGATE $2 , r —_ PRO- POLICY JECr LOG PRODUCTS - COMPIOPAGG g INCLUDED POIN''Y� $ AUTOMOBILE LIABILITY W.VAdLpr�YEN)S'9hNi�N'Nm' Ll IT I`E�a:a�Mdaral $11000, 000 BODILY INJURY (Per parson) $ ANYAUTO 648827264 11/1/2021 L1/1/2022 �— OWNED SCHEDULED BODILY URYa (Per ) $ HIRE ONLY AUTOS HIRED' NON -OWNED )"JN'LtlmdenlW AUTOS ONLY AUTOS ONLY p rP cr.�rd� ...-.�... S .^..,,...„. UMBRELLA LIAB OCCUR F1�CH 0,...,..—.....ITIT� EXCESSUA13 CLAIMS -MADE AGGREGATE S DED I I RETENTION S WORKERS COMPENSATION U N tt- AND EMPLOYERS' LIABILITY YIN ELeA =1,000,000 C ANYIROPRIETOFVPAaINER UT11lE O NIA 1760432 >a/o1/za tl/D1/zo2z ACCIDENT ^ O I EXCLI1DI3i'I Umawowkso" inEL-DISEASE Ek EMPLOYEE'..$1,000,000 .._...�,� _ CI s,dueacr3tw+raacfer NJESC1pNI" OF ON 'rKllvshaNuu EL DISEASE -POLICY LIMIT $1,000,000 _. DESCR(ON OF OPERATIONS I LOCA71ON51 VEHICLES (ACORD 101, AddRlenal Remarks Schedule, maybe attnhed trmore apace is raqulred) IPT_ *TEN DAYS NOTICE OF CANCELLATION APPLIES FOR NON—PAY14ENT OF PREMIUM 30 DAYS FOR ALL OTHER„ RE: ALL CALIFORNIA OPERATIONS. CERTIFICATE HOLDER IS NAMED AS ADDITIONAL INSURED,. CERTIFICATE HOLDER CANCELLATION CITY OF RL SEGUNDO, CITY CLERK ATTENTION: BRIAN EVANSKI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 950 MAIN STREET ACCORDANCE EXPIRATION DATE THEREOF, NOTICE WILL BE 1)941VERED IN ACCORDANCE WITH THE POLICY PROVISIONS. EL SEGUNDO, CA 90245 AUTHORIZED ReaTW:C9EN'fATi E N 1988-2015 AWRO CORPORATIOK All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORDIV POLICY NUMBER: , 3AA51 3851 COMMERCIAL GENERAL LIABILITY CG 2010 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY ADDITIONAL AL INSURED - OWNERS, LESSEES OR CONTRACTORS m SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organizations) I Location(s) Of Covered Operations All persons or organizations as required by written As designated in written contract with the Named contract with the Named insured Insured 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 organizations) 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. 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. CG 2010 0413 G Insurance Services Office, inc., 2012 Pagel of 2 3AA513851 C. 't4Vit1°r 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. Page 2 of 2 © Insurance Services Office, Inc., 2012 CG 20 10 0413 COMMERCIAL GENERAL LIABILITY NilPOLICY NUMBER:3AA513851 Er ISSUINGCOMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, BLANKET ADDITIONAL INSURED This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM LIQUOR LIABILITY COVERAGE FORM OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE FORM PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE FORM SCHEDULE Additional Premium: $ (Check box if fully earned ❑) Please refer to each Coverage Form to determine which terms are defined. Words shown in quotations on this endorsement may or may not be defined in all Coverage Forms. A. Who Is An Insured is amended to include as an additional insured any person or entityto who n you are required by valid written contract or agreement to provide such coverage, but only with; respect to "bodily injury"' ""property damage" (including "bodily injury" and "property damage" included in the "products -completed operations hazard"), and "personal and advertising injury" caused, in whole or in part, by the negligent acts or omissions of the Named lnsu.¢red and only with respect to any coverage not otherwise excluded in the policy. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. The insurance afforded to such additional insured will not be broader than that which you are required by the valid written contract or agreement to provide for such additional insured. Our agreement to accept an additional insured provision in a valid written contract or agreement is not an acceptance of any other provisions of such contract or agreement or the contract of agreement in total. When coverage does not apply for the Named Insured, no coverage or defense will apply for the additional insured. No coverage applies to such additional insured for injury or damage of any type to any "employee" of the Named Insured or to any obligation of the additional insured to indemnify another because of damages arising out of such injury or damage. 13. With respect to the insurance afforded to these additional insured, the following is added to limits of insurance: The most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the valid written 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. All other terms and conditions remain unchanged. MEGL 0009-01 09 18 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 1 with its permission. COMMERCIAL GENERAL LIABILITY POLICY NUMBER: 3AA513851 M1 (Er EVANSTON INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIAB[LITY COVERAGE FORM SCHEDULE Name Of Person. Or Organize#ion: Any person(s) or organizabon(s) with whore the Named Insured agrees, in a written contract executed prior to the "occurrence", to waive rights of recovery Additional Premium: $ The following is added to Condition 8, Transfer Of Rights Of Recovery Against Others To Us under Section IV — Commercial General Liability Conditions: We waive any right of recovery we may have against any person or organization shown in the Schedule of this endorsement. This waiver applies only to the person or organization shown in the Schedule of this endorsement. All other terms and conditions remain unchanged. MEGL 0241-010516 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 1 with its permission. 3AA513851 COMMERCIAL GENT~ AAL LIAE31LITY CG 20 0104 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CARI�FiILLY. PRIMARY AND NONCONTRIBUTORY T ER INSURANCE CONDITION This endorsement modifies insurance provided underthe folloving: COMMERCIAL GENERAL, LIABILITY COVERAGE PART PRODUCTSfCOMPLETED OPERATIONS LIABILITY COVERAGE PART W The following is added to the Other Insiirallce Condition and -supersedes -any provision to the contrary: Prlmai:y And Noncontributory Insurance This insurance is primary -to-and will not seek contribution from any other frisurance available to an additional insured under your pollcy provided that: (1) The additional insured'Is a Named'insured under sucb 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 avallable to the additional Insured. CG 20 0104 13 0 Insurance Services Office, Inc., 2012 Page 1 of 1 f COMMERCIAL AUTO AA CW 2a 1011 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, BUSINESS AUTO ENHANCEMENT ENDORSEMENT Coverage provided under this policy Is modified by the attachment of This endorsement: If there is any conflict in coverage provisions between this form and any state sperfFic endorsement also attached to this policy, tl-to provWon(s) of the state specific forin shall apply. This endorsement modifies Insurance provided under the fallowing; BUSINESS AUTO COVERAGE FORM In SECTION I - COVERED AUTOS, the Mowing changes are mad w. The following is added: D, Physical Damage Coverage for Temporary Substitute and teased Autos If physical Damage Coverage is provided by this policy, the following kinds of'"autos� are covered "autos°"for the same cova4les provided by the policy: 1. Any private passenger "auto", or other than private passenger vehicle with gross vehicle weight of 20,0001bs. or less, you do not own while used with the permission of the owner as a temporary substitute for a covered "auto" you own that is out of service because of its: a. Breakdown; b. Repair; c. Servicing; d. "Loss"; or o_ Destruction. 2, Private passenger""agates" and other than private passenger vehicies with grass vehicle vw' g t of 10®000 Ibs. or less, leased, hired, rented, or borrowed for a period of 30 days or less. This does not Include any vehicle you lease, hire, rent, or borrow from arty of your "ernployees" or partners or members of (heir households, In SECTION 11 — LIABILITY COVERAGE, the following changes are made: Under A. Coverage, Who Is An Insured, the fallowing is added: d. Any organization, other than a partnership or joint venturaa, over which you malntain ownership or Irr which you hold a majority Interest. This provision appltas only if there Is no slnular Insurance provided to that,, organization. e. Any organization you acquire or form altar palloy Inception, other then a partnership or Joint venture, over, which you maintain ownemlilp, or In which you hold a majority intoresl Coverage under this provision doAs not aagaiily; (t) If there is similar insurance provided to that organization; or (2) To '"bodlly Injury'or "properly damage" that occurred before you acguir°arl or formarl tho organization. f. Any person or organization that you are required to name as an additional Insured under Iha terry►s of a written job contract, or by written insurance requirements executed prior to any covered "'loss" or claim. This protection applies only If the parson or organization is liable for the conduct of an "insured" and only to the extent of that liability. Under A. Coverage, Coveragz Extensions, Supplerr►ahtio payn7anfs, subparagraphs (2) and (4) are replaced unth the following: (2) Up to $5,000 for cost of ball bonds (InChadhig bonds for read traffic Iwi violations) required beoeusa of an "accident" wo cover. We do not have to furnish these bonds, Includes copyrighted material of Insurance Services Office, Inc., With its permission AACW201011 Allstate Insurance Company Innumd FLIT Copy Page 1 of (4) All reasonable expenses Incurred by the "insured" at our request, Including loss of earnings up to $500 a day because of time off from work. Under B. I_7CCILisfons, Fellow Employee, the following paragraph Is added: But this exclusion does not apply to "bodfly injury" to a fellow "employee" caused by any person whaso position within the Insured organization Is at or above the level of manager or supervisor. Coverage afforded by this provision Is excess over any other collectible insurance. in SECTION IiI - PHYSICAL DAMAGE COVERAGE, the following changes are made: Under A. Coverage, Mass Breakage - Hitting A Bird Or Animal - Falling Objects Or Missiles, the following is added: If damage to glass is repaired In lieu of being replaced, no deductbla will apply for repair only, Linder A, Coverage, Coverage Extensions, the following is added: c. Personal Effects Coverage In the event of a total theft of your covered "auto", for which you carry ethic Cotnrohenslve or Specified Causes of toss coverage, we will pay, up to 500 for this personal effects which are: 1, owned by you; and 2, in your covered "auto" at the time of the total theft of such "auto". No deductible applies to Personal Effects Coverage. Under A Coverage, the following is added: S. Lease and Loan Gap Coverage In the event of a total "loss" to a covered "auto" shown in the Schedule or Declarations for which a specific premium charge indicates that physical damage coverage applies, we will pay any unpaid amount due on the lease or loan for a covered "auto", less: a The ainount paid undar the physical Damage Coverage section of the policy; and b. Any- (1) Overdue leasalloan payments at the time of the "loss"; (2) Financial penalties imposed under a lease for excessive use, abnormal wear and tear or high mileage, (3) Security deposits not returned by the lessor; AA CW 20 1011 (4) Costs for extended warranties, Credit Life Insuranco, Health, Accident or Disability insurance purchased with the loan or lease; and {5) Carry-over balances from previous loans or leases. Under D. Deductible, the following paragraph Is added; When Collision Coverage is provided by thfs policy, the deductible amount will not be subtracted from the loss paymerrt In collisions involving your covered "auto" and another auto covered by Allstate insurance Company or any of it's affiliates. In SECTION IV - BUSINESS AUTO CONDITIONS, the following changes are made: Under A. Loss Conditions, Duties In The Event Of Accident, Claim, Suit Or Loss CondfUon, the following Is added under subpart a: Knowledge of an laccident" or "loss" by any of your agents, servants or "employees" shall not in itself cohstituto Imowledga by you, unless you or one of your corporate officers or managers, or any assignee, shall have received such notice from the agent, servant or "employee". When you report an occurrence of any "accident" or loss" to a Worker's Compensation carrier or self insured plan providing the named Insured's Worker's Compensation Insurance which later develops into a claim submitted under this policy, failure to report such "acefdent" or "loss" to us at the same time shall not be deemed a violation of this condition. Alta' you become aware of such liability claim arising from the "accident" or "loss", you must glvo us prompt notice. Under A. Loss Conditions, Transfer of tights of Racovety Against Others To Us, the following is added: we waive any right of recovery we may have against any person or organization because of payrnonts we make for injury or dwnage ai ising out of work you perfhrm under a contract with such person or organization, In which you have agreed to waive your right of such recovery. Included copyrighted material of InsurancoServices Office, inc., with its permission Afistate Insurance Company Page 2 of 3 kw.d F.11 cry Under B, General Conditions, Concealment, Misrepresentation Or Fraud, the following' is added: This condition does not apps y to wry omission or failure b provide malarial facts if the omission or fallure was unintentional. includes copyrighted material of insurance Services Office, Inc,, with Its permission AA CW 20 10 11 Allstate Insurance Company Page 3 of Inured FMI Copy HOME OFFICE SAN FRANCISCO ALLEFFECTIVE DATESAR£ AT 12:01 AM PACIFIC STANDARD TIME 09 THE TIME INDICATED AT PACIFIC STANDARD TIME .FAl0ORSFM12NT AGNEGMENT R- ROKER COPS' WAIVER OF SUBROGATION BLAMXET BASIS 1760432 RENEWAL NA 6--17--16-03 EFFECTIVE NOVEMBER 1,2021 AT 12.01 A.M. PAGE I OF 1 AND EXPIRING NOVEMBER 1,2022 AT 12.01 A.M. RANGE MAINTENANCE SERVICES, LLC 301 MARY BELLE WAY ANGELS CAMP, CA 95222 WE HAVE THE RIGHT TO RECOVER. OUR PAYMENTS VROM ANYONE LIABLE FOR AN INJURY COVERED BY THIS POLICY. WE WILL NOT ENFORCE OUR RIGHT AGAINST THE PERSON Olt ORGANIZATION MANED IN THE SCHEDULE. . THIS AGREEMENT APPLIES ONLY TO THE EXTENT THAT YOU PERFORM WORK UNDER A WRITTEN CONTRACT THAT REQUIRES YOU TO OBTAIN THIS .AGztEWWT F'RO21 US, THE ADDITIONAL PREMIUd FOR THIS ENDORSEMENT 8"LL BE 2.00% OF THE TOTAL POLICY PREMIUM, SGNEDULE PERSON OR ORGANIZATION SOB DESCRIPTION ANY PERSON OR ORGANIZATION BLANKET WAIVER OF FOR WHOM THE NAMED INStRED SUBROGATION HAS AGREED BY WRITTEN CONTRACT TO FORNTSFI THIS WAIVER NOTHING IN THIS ENDORSEMENT CONTAINED SHALL B£ HELD TO VARY, ALTER, WAiV6 OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS POLICY OTHER THAN AS STATED, NOTHING ELSEWHERE IN THIS POLICY SHALL HE HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR LIMITATIQNS OF THIS ENDORSEMENT. COUNTERSIGNED AND ISSUE) AT SAN FRrAWSCO: NOVEMBER 1 2021 AU'llIOT417R) HEPR F NTA '6 PRF l0EKr AND CFO 2572