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PROOF OF INSURANCE (2023 - 2023) CLOSEDADLER-1 OP ID; RORO OATE(MMIDDIYYYY) �.r CERTIFICATE OF LIABILITY INSURANCE 0712.512022 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 certificate holder in lieu of such endorsement(s). PRODUCER VAMP T Roberta R Rosas Loomis PO BOX 3128ance Services i ONE E��t 951-685-7478 mm µm ... ... ,. FAX BAIL is4 (AxC N�1 951-685 0665 Riverside, CA 92519 otg�s�m rrosastir II joolTl' insurance.com Michael J Runner INSURER(S) AFFORDING COVERAGE NA1C q INSURER Northfield Insurance Comoanv 27987 INSURED Adlerhorst International, LLC INSURER B: 3951 Vernon Avenue _ .�.....®. Riverside, CA 92509 „wiNsuRER c ...... INSURER D INSURER E: INSURER F : i.nVFttiAr;Ffi r:FRTIFIr ATF NI)MRFR 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. ............ ...OFINSURANCE. .............. ,. ......"`POUCYNUMBER ........,._.�.�........... ....... .......... POLICYEY POL1D)YY P 1,. I NTS'RR TYPE { �� ' MMrDr#rYYYY1 A ATDAYVYYI LIMITS GENERAL LIABILITY EACH OCCURRENCE ; 2,000,00 G.,COMI,MF.HOAb„GENp:fs,�lu�."ILITr" X �IVS5505395 08/08/2022 0810612023 ONWA ONTED I UEWf , ( y 10000_ CLAIM'S,MAU[ OCCUR MED EXP (Anyone person) .-...$ _._.ITITITIT 5,00 ,....,., PERSONAL& ADV INJURY $ 2,000,0011 GENERAL AGGREGATE $ 2,000,00 NPAGGREGATE APTA05S PER: � PRODUCTS-COMP/OP AGGw EXCLUDEFD. X � 'LIMIT ,s � R57F ET.I s7N 0E L'.RFf AUTOMOBILE LIABILITY 0Eo macldr:¢rI'b $ ANY AUTO BODILY INJURY (Per person) $ �'. ALLOWNED "SCHEDULED 4 BODILY INJURY (Per accident) $ .v,.. AUTOS AUTOS NON --OWNED '. ' Ri»✓ RT''"D�A."'d»N: $ ..... HIRED AUTOS AUTOS (PERACC(DENT) UMBRELLA UAB OCCUR EACH OCCURRENCE '$ .EXCESS UAB CLAIMS -MA DEpp AGGREGATE AG,m,,,,, $ ... DED RETENTIONS 9 $ WORKERS COMPENSATION ' WCSTA'TU• LOTH - TORY UhdR P'.............. AND EMPLOYERS'LIABILITY YIN - ...ER ECUTIVE ANFICMandate EACH ACCIDENT $ E.L._ ER/MEMBER EIXIRCTLNERJ ❑ ...NIA . ..... .................. rn NH ( ry ) E L DISEASE EA EMPLOYEE $ _._ ..�...� DESCR4P TB07N OF OPERATIONS below E L DISEASE - POLICY LIMB $ DESCRIPTION OF OPERATIONS) LOCATIONS! VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) City of E1 Segundo is named as Additional Insured with respect to ,work/services provided by the Named Insured. 10 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cif of El Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Y 9 ACCORDANCE WITH THE POLICY PROVISIONS. 348 Main Street El Segundo, CA 90245 AUTHORIZED REPRESENTATIVE pick':Iv 1_ , . Q)oia41'w © 19BB-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD W5505395 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED (NON -CONTRACTORS) This endorsement modlfies Insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PROVISIONS 1. The following is added to SECTION Il - WHO IS AN INSURED: Any person or organization that you agree In a written contract or agreement to include as an additional insured on this Coverage Part Is an insured, but only: a. With respect to liability for "bodily injury" or "property damage" that occurs subsequent to the signing of that contract or agreement and while that part of the contract or agreement Is In effect; b. If, and only to the extent that, the injury or damage is caused by your acts or omissions in the performance of your ongoing operations to which that written contract or agreement applies or by the acts or omissions of any person or organization performing such ongoing operations on your behalf; and c. Subject to the following limitations and conditions on the insurance provided to such additional Insured: (1) If the Limits of Insurance of this Coverage Part shown in the Declarations exceed the minimum Ilinits required by the written contract or agreement, the insurance provided to the additional insured will be limited to such minimum required limits. For the purposes of determining whether this limitation applies, the minimum limits required by the written contract or agreement will be considered to include the minimum limits of any Umbrella at, Excess liability coverage required for the additional Insured by that written contract or agreement. This provision will not increase the limits of insurance described in SECTION lit - LIMITS OF INSURANCE. (2) The insurance provided to such additional insured is excess over any valid and collectible other insurance, whether primary, excess, contingent or on any other basis, that is available to the additional insured for a loss we cover. However, if the written contract or agreement requires that the insurance provided under this Coverage Part apply on a primary basis or a primary and non-contributory basis, then this insurance is primary to other insurance available to the additional insured which covers that person or organization as a named insured for such loss, and we will not share with that other Insurance. But, the insurance provided to the additional insured still is excess over any valid and collectible other insurance, whether primary, excess, contingent or on any other basis, that Is available to the additional insured when that person or organization is an additional insured under such other insurance. (3) The insurance provided to such additional insured does not apply to: (a) Any person or organization for which coverage as an additional Insured specifically is scheduled by attachment of an endorsement under this Coverage Part, or for whom you have purchased an Owners And Contractors Protective Liability policy; (b) Any person or organization who distributes or sells "your products" in the regular course of that person's or organization's business with respect to liability arising out of "your products"; (c) Any person or organization from whore you have acquired "your products", or any ingredient, part or container entering into, accompanying or containing such product with respect to liability arising out of "your products"; (d) Any premises owner, manager or lessor with respect to liability arising out of the ownership, maintenance, or use of that part of any premises leased to you; S2863-cG (3120) © 2020 The Travelers Indemnity Company. All rights reserved„ Page 1 of 2 WS505395 (e) Any equipment lessor with respect to liability arising out of the maintenance, operation or use of equipment leased to you by such equipment lessor; (f) The Independent acts or omissions of such additional insured; or (9) "Bodily injury" or "property damage" arising out of the providing, or failure to provide, any professional architectural, engineering or surveying services, including: (1) The preparing, approving or falling to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders or change orders, or the preparing, approving, or failing to prepare or approve, drawings and specifications; and (Pi) Supervisory, inspection, architectural or engineering activities. (4) The additional Insured must comply with the following duties: (a) Give us written notice as soon as practicable of an "occurrence" which may result in a claim. To the extent possible, such notice should Include: (i) Flow, when and where the "occurrence" took place; (11) The names and addresses of any injured persons and Witnesses; and (lit) The nature and location of any injury or damage arising out of the "occurrence". (b) If a claim Is made or "suit" Is brought against the additional insured: (1) Immediately record the specifics of the claim or "suit" and the data received; and (H) Notify us as soon as practicable and see to it that we receive written notice of the claim or "suit" as soon as practicable- (c) Immediately send us copies of all legal papers received In connection with the claim or "suit", cooperate with us In the Investigation or settlement of the claim or defense against the "suit", and olhar%Mse cornpiy with all policy conditions. (d) Tender the defense and indemnity of any claim or "suit" to any provider of other insurance which would cover such additional Insured for a loss we cover. However, this condition does not affect whether the Insurance provided to the additional insured is primary to other- Insurance available to the additional insured which covers that person or organization as a named Insured. 82653-CG (312a) © 2020 The Travelers Indemnity Company. All rights reserved, Page 2 of 2 � � ►� b CERTIFICATE OF LIABILITY INSURANCE DATE (MMfODIYYYY) 7/25/2022 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 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 'ON hC Patricia Detwiler IIAmr- p pPrHONIr lk ,Ftiiy (909)792-8950 Y iPAIC Idea le091792-2030 Kellogg 6 Moreland Agency, Inc. DBA t A,MAIL pariciad@arroyoins.com Arroyo Insurance Services INSURER(S) AFFORDING COVERAGE NAIC If 1654 Plum Lane INSURER A:AmGUARD insurance Company 42390 Redlands CA 92374-4532 INSURED INSURER B : Adlerhorst International, LLC INSURER Cr INSURER D: 3951 Vernon Avenue INSURER E: INSURER F: Riverside CA 92509 COVERAGES CERTIFICATE NUMP ER:21-22 Auto 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 INOICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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. PNSR „TR TYPE OF INSURANCE AUU&. INcn SU8K WVn POLICY NUMBER POLICY E.FF IMMADOYYYYYI, POLICY EXP fmrxO0YYYYyY LIMITS COMMERCIAL GENERAL LIABILITY '.. EACH OCCURRENCE CLAIMS -MADE OCCUR 'Dx,y. ;.F' U Pti'PPAISES fEA atoim rmft'ol S .Y '.. MED EXP Any one person) $ - _ PERSONAL B ADV INJURY S '', GENERAL AGGREGATE S GEt4"L.AGGAtGA1E.LIMITAPPLIES PER: (PRODUCTS -COMPIOPAGG S POLICY f_� PROJECT ❑ LOC S OTHER AUTOMOBILE LIABILITY NGeYNE47 S40` I"'"I"tI'Iri E°3 tnuuodmrUD 'S 1,000,000 BODILY INJURY (Per person) '.. S A '.. ANYAUTO . ALL OWNED x SCHEDULED AUTOS AUTOS NON -OWNED x HIRED AUTOS i. x AUTOS ADAU256776 8/29/2021 8/29/2022 BODILY INJURY (Per accident) 6i47'PER PY I7Ah*,A ; IPpr arr`sderat�, S S ' S UMBRELLALIAB .00CUR EACH OCCURRENCE S AGGREGATE S EXCESS LIAR CLAIMS -MADE S DED RETENTION I WORXERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANN.P'R(?P'Np,"."6"C1�RPI'+i�yRTNERtE1CF, CR„NT OFki1ME.RdwMISMi4Ei#EXCLUOED'7i'j NIA'.., 4TATIITE ER E.L EACH ACCIDENT S (Mandatory In NHI E.L DISEASE- EA EMPLOYEE S „ .. EL DISEASE - POLICY UPAT ..,. S Ilyyvvzzz. dousflm uu%r v DRIP'TIONOFOPERATIONS LoNve DESCRIPTION OF OPERATIONS t LOCATIONS t VEHICLES (ACORD 101, Addltlonal Remarks Schedule, may 6o attached If more space Is required) Verification of Insurance CERTIFICATE HOLDER CANCELLATION City of El Segundo City Clerk 350 Main Street Room 5 El Segundo, CA 90245-3813 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 ricia Detwiler/PAT !^.-.�.f�fk>r�:'d ....r. p..u. Q 1988.2014 ACORD CORPORATION. All rights ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD INS025 (201401) A7�1 CERTIFICATE OF LIABILITY INSURANCE DATE (MM DONYYY) 0c7/25, 11 1 12022 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 CONIACI' NAME. Automatic Data Processing Insurance Agency, Inc. , 1-800-524-7024 1 t-� Automatic Data Processing Insurance Agency, Inc. 1,1121�1E—Z. (Nc. Netts 1 Adp Boulevard INSURER(S)AFFORDING COVERAGE NAIC # . . . ....... .. Roseland NJ 07068 INSURER A; Trumbull Insurance Company 27120 INSURED Adlerhorst International LLC INSURER B; .. . . . ....... . . INSURER C; 3951 Vernon Ave _INSURER D1INSURER E Jurupa Valley CA 926092924 INSURER F; A - e•CDTIUIrATC MI111AQ=0- 95,451FIS Pr_VIqInw NtIMIRFIR. 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 RESPECTTO 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. wtf __ . . .......... . .. . FG-LXTVW- -TOEMYT-w- LIR TYPE OF INSURANCE uusn n POLICY NUMBER (MMIDONYYYI IM"On)CLI LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 'DAMAGE­TCC'AENrEM — — — ---- CLAIMS -MADE 1-1 OCCUR PREMISES (Ea occurrence) MED EXP (Any one person) PERSONAL �OV� INJURY GENILAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE PA POLICY [._1 JECTO. E] LOG PRODUCTS - COMPIOP AGG I ...... ....... OTHER: . AUTOMOBILE LIABILITY ........... . COMB RETMR—GE iRT a acoldera.._­ ANY AUTO BODILY INJURY (Per person) $ OWNED ]SCHEDULED BODILY INJURY (P.r.ccllwl) AUTOS ONLY 'UT.' HIRED NON -OWNED AUTOS ONLY AUTOS ONLY r—_1 I jPeracddont) $ UMBRELLA L OCCUR EACH OCCURRENCE ............... BAB EXCESS LIA CLAIMS -MADE AGGREGATE r__J DEO RETENTION S WORKERS COMPENSATION TE 'ER AND EMPLOYERS'LIABILITY YdN E.L, EACH ACCIDENT S 1,000,000 A ANY PROPRIETORPARTNEWEXECUTIVE NIA N 76WEGAL4NDU 07/01/2022 07/01/2023 1000000 Uuvvuu OFF(CEPJMEMBER EXCLUDED? (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE i , , If yes, doscribo under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional R,rnwii. Schedule, may be attached 1(or. space Is required) CERTIFICATE HOLDER UANIL;hLLA I IrJN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN El Segundo Police Department ACCORDANCE WITH THE POLICY PROVISIONS. 348 Main Street AUTHORIZED REPRESENTATIVE ElSegundo CA 90245 0 1986-2015 ACORD CORPORATION, All rights reservec ACORD 25 (2016103) 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: 76 WEG AL4NDU Endorsement Number: 1 Effective Date: 07!01;21 Effective hour is the same as stated on the Information Page of the policy, Named Insured and Address: Adlerhorst international LLC 3951 VERNON AVtL JURUPA VALLEY CA 92509 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 MLISt 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 WMZ333• = Any person or organization for whom you are required by written contract or agreement to Obtain this waiver of rights from us SMESEMEM Authorized Representative Form WC 04 03 06 (1) Printed in U.S.A. Process Date: 06/07/21 Policy Expiration Date: 07/01/22