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PROOF OF INSURANCE (2023 - 2023) CLOSED�" CERTIFICATE OF LIABILITY INSURANCE oDATE TE(si22YYY) 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 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 PRODUCER 4""°"nwu"N.k..l,r`e Bornstein or Andrea Trejo Eddxngs NAML Bornstein Insurance PHONE I 310 325-4343 FAX (310) 325-7037 22850 Crenshaw Blvd., Ste. 203 MA L great Iorn ns . com or andrea@&bornins.com Torrance, Ca 90505 INSURERS AFFORDING COVERAGE NAIC# INSURERA. Arch Specialty Insurance Company 21199 INSURED EAGLE PROTECTION SERVICE, INC. NSURERB: Integon National Insurance company 29742 DBA: EAGLE PROTECTION OF CALIFORNIA IN : PO BOX 1428 INSURERD: Torrance, CA 90505 , R . 310 320-9100 INSURER F r^.r)w/Pue nrQ i". r.7,nnr'An to ihMaai 003 or-w iczInl,I MI IhA1 PQT 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 BYPAID CLAIMS, INSR LTR TYPE OF INSURANCE p I I POLICY EFF YYYY 'POLICY EXP y Y LIMITS X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE El OCCUR EACH OCCURRENCE '..$ 1 00,000 4 $ 100 000 MEDEXP An oneperson) $ 5 000 A Y BAPKG0002713 4/13/2022 )4/13/2023 PERSONAL & ADV INJURY $ 1 OOO 000 GEGENI AGGREGATE LIMITAPPLIES PER: NI 0 JEZ1:1 LOC GENERAL AGGREGATE � $ 5,000,000 PRODUCTS - COMP/OPAGG� $ 5,0001000 $ AUTOMOBILE LIABILITY MB N£,P ,.IN k.:E LIMY $ BODILY INJURY (Per person) '$ B ANYAUTO ALL OWNED SCHEDULED AUTOS AUTOS X HIRED AUTOS }( NON -OWNED AUTOS 2003901412 06/01/2022 6/01/2023 BODILY INJURY (Per accident) $ P T PERY DAMA g • f acodentl $ $ UMBRELLA LIAR H'.. OCCUR EACH OCCURRENCE Is AGGREGATE Is EXCESS LIAB CLAIMS -MADE R I -NT'.INS WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y ..ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED (Mandatory in NH) NIA PER T H- 4TAT TF. E.L... EACH ACCIDENT $ E L. DISEASE ^ EA. EMPLOYEE .. . $ A I Y !Ml If yes, describe under DESCRIPTION P. 1i I N. DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Certificate Holder is named as Additional Insured with respect to Commercial General Liability for services performed by the Named Insured, per Blanket Additonal Insured Endorsement Form 00 GL0334 00 04 08 City of E1 Segundo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE its officials, and employees City Clerk THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street, Room 5 AUTHORIZED REPRESENTATIVE E1 Segundo, CA 90245-3813 )J © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: BAPKG0002713 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED ENDORSEMENT This endorsement modifies insurance provided under the following: Section II, WHO IS AN INSURED, is amended by adding Any person, organization, trustee or estate: a. to whom "you" are obligated by written contract to provide insurance such as that afforded by this policy, or b. specifically designated as an additional insured on an authorized Certificate of Insurance received by "us" prior to any 'occurrence"; Coverage afforded under (a) or (b) is limited to liability arising out of "your work" for such additional insured(s) and is caused by the negligent acts of the named insured. This endorsement shall be excess of any other insurance available except coverage afforded by this endorsement will be primary and non-contributory, but only if and to the extent required by written contract. All other terms and conditions of the Policy remain the same. 00 GL0334 00 04 08 Page 1 of 1 DATE (MMIDDIYYYY) AR" CERTIFICATE OF LIABILITY INSURANCE 05/19/2022 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 CONTACT Automatic Data Processing Insurance Agency, Inc. Automatic Data ProcessingInsurance Agency, Inc. ( ) 1 7011 24 FAX PHONE ,.N�� Ex4 : 800-524-...,. .. _ . 1_pArce.„ Nral - 1 Adp Boulevard INSURER(s) AFFORDING COVERAGE NAIC 0 Roseland NJ 07068 INSURER A: Eagle Protection S nce Fund � 35076 9 Services Inc. INSURER B INSURED Stale Compensation nsura INSURER C : 2700 W 182ND ST STE 201 INSURER D : INSURER E Torrance CA 90504 INSURER F I'nvCDAr_CC RFRTIFICATF N11MRFR• 2461498 REVISION NLIMRFR: 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 Sl6Sp ..- - 9$1TR POLICY OFPCP(.lCY AzXfa 7 TYPE OF INSURANCE POLL,... INSD CYNUMBER MM6oDaYY'+'Y MMiDDIYYYY' LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ I , CLAIMSMADE OCCUR • . ­ DAMArjrW(TENTED r PREM1�6v�S (F� crr�;audrerr(;e�. I $ ''.. I. 77 (Any Ipei sonr J b09 one _ -- ! PERSONAL & ADV INJURY 7 $ I` GEN'L AGGREGATE LIMIT APPLIES PER: I ATE AGGREGATE a GENERAL v $ ` 1 r(Y II I � Y � PRODUCTS COMPIOP AGG$(JL2t „, .. I Vk I AUTOMOBILE �... r. LE LIABILITY COMBINED SINGLE 9 MI $ f ti�a a,ilgfyryt ANY AUTO BODILY INJURY (Per person) � $ " OWNED SCHEDULED AUTOS ONLY AUTOS ESODILY pNJLNRY (Per aocYdentl) ; $ HIRED NON -OWNED ? i _.., PROPPRT*bAMAGt ! $ AUTOS ONLY 1. AUTOS ONLY 3 I r I(Permcu"I'denll r P f I � .. UMBRELLALIABOCCUR I -i EACH OCCURRENCE ., ,. ..,.,, $ i EXCESS LIAB CLAIMS -MADE ,, , AGGREGATE $ DIED ION $ ! RETEN �Y � WORKERS COMPENSATION` AND EMPLOYERS' LIABITY IL ( [ � I STATUTE FHH m. YIN ANY PROPRIETOR/PARTNER/EXECUTIVE A Y NIA Y 9274922-2022 r I EACH ACCIDENT 1t�t)6 000 05/01/2022-05/01/2023 - Am i'OFFICERIMEMBEREXCLUDED) 1,000,000 Mandatory in NH If describe j _ y es, under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ 1,0010,000 I I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) This certificate has a blanket Waiver of Subrogation for the following state(s) :CA CFRTIFICATF 14OLDFP CANCELLATION 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. 315 Main Street AUTHORIZED REPRESENTATIVE ElSegundo CA 90245•-� V -1115tf-LUID AI,UKU L,VKrUKAIlUrv. mii ngnts reserveu. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD ENDORSEMENT AGREEMENT WAIVER OF SUBROGATION BLANKET BASIS HOME OFFICE SAN FRANCISCO EFFECTIVE MAY 1, 2022 AT 12.01 A.M. AND EXPIRING MAY 1, 2023 AT 12.01 A.M. ALL EFFECTIVE DATES ARE AT 12:01 AM PACIFIC STANDARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME EAGLE PROTECTION OF CALIFORNIA 2700 W 182ND ST TORRANCE, CA 90504 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. THE ADDITIONAL PREMIUM FOR THIS ENDORSEMENT SHALL BE 2.00% OF THE TOTAL POLICY PREMIUM. SCHEDULE PERSON OR ORGANIZATION ANY PERSON OR ORGANIZATION FOR WHOM THE NAMED INSURED HAS AGREED BY WRITTEN CONTRACT TO FURNISH THIS WAIVER JOB DESCRIPTION BLANKET WAIVER OF SUBROGATION 9274922-22 RENEWAL SC 1-84-37-50 PAGE 1 OF NOTHING IN THIS ENDORSEMENT SHALL BE HELD TO VARY, ALTER, WAIVE OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS POLICY OTHER THAN AS ABOVE STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR LIMITATIONS IN THIS ENDORSEMENT. COUNTERSIGNED AND ISSUED AT SAN FRANCISCO: MAY 3, 2022 2572 Al lTun017Cn DCDDCCMUT Z". DDMCInCRJT Arvin 1