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PROOF OF INSURANCE (2023) CLOSEDJLEEENG-01 _ Y�E ,4 c RvP CERTIFICATE OF LIABILITY INSURANCE �_ DATDIYYYY) 8130/230t2022 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 License # OE67768 CONTACT Glgl Yuen IOA Insurance Services �Ph� " " c MAIL ) 08 No (925) 416 7869 PHONE 925 660 3514 500 38T5� Hoppyard Road (A�c No, Et):( " (,,,,,. ",.,,R Suite 200 I 4AIL ,.._g" YuenCwoausa.com Gw I Pleasanton, CA 94588 — - _ ........ ..., Insurance C"ompany 113056 INSURED INSURERB Arch Insurance Company_,111111111 i111_50 JLee Engineering,Inc. INsuREc �'IN'S'U­R­E­R­D,_: ._............. _.. ... ............. ....... ----- 430 S. Garfield Avenue, #301 Alhambra, CA 91801 mm' '"" �.�. S E c INSURER F WWWWWWWW _REVISION COVERAGES CERTIFICATE NUMBER: �........ _._m... m .. ..a._........ W� 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, INS11 R I F IADDLS'U11 BR TYPE OF INSURANCE ! POLICY NUMBER L:T_..... _ ....... _.... __....��.II pp POLICY EFF POLICY EXP I; I I LIMITS ..................... A X COMMERCIAL GENERAL LIABILITY EAOH OCOURRENCE ;g 2,000,000 MADE IX occuR PSB0010319 "_J ..� 9/1/2022 9/1/2023PSF A 1 000,000cLlMs ® MEDEXP(yoneA. n) 10 000 PE sQr wa � e A"DV IIv�"ur v ........ 2 000,000 ...0 LN LIMIT APPLIES PER: GENERAL"AGGREGAT,E 41 OOO OOO PR POLICY pp ��II LOC JECT ..". _ ... PRODUCTS, COMPIOP AGG 5 4 OOO OOO ��rHER, ....._.....�.,�.,_,.... MOSILE A AuroNYYAUTOAeIUTY $ I COMBINED SINGLE LIMIT � Ida lls E) 1,000,000. .. PSA0003335 9/1/2022 9/1/2023 B DLLY"�NJURY per erson 5.... --- OWNED I SCHEDULED AUTOS ONLY AUTOS I I.X.. N' w D "�� BODILY INJURY Perarcident S j mm PROP AMAGE ....._ X HIRED W AUTOS ONLY AC� C��Y I r- 1, „(.?era"cEcRderat ! � ..... ..1.$........ .... ---. ..... ...............................r............... M................m.—­— i UMBRELLA LIAB OCCUR IEACH OCCURRENCE - I EXCESS LIAB CLAIMS -MADE, I L „ AGGREGATE g ......- DED RETENTION: [ ............ .. .......................................................... A ERS COMPENSATION ' .......I......,_._....... ..:.., ER I ..AND EMPLOYERS' LIABILITY PSWOOO$561 CE PLOYER .E � ,...,....__ 9l1/2022 9/1I2O23 ��"�"�" "" "STATIµ.I?,F""'"",OTH 1,000,000 AAN EXCLUDED? ECUTIVE N / A ; �Y"' ...E(L EACH ACCIDENT .,,. (Mandatory in NH) E.I EA EMPI 1,000,000 If yes, describe under _DISEASE - QYEEJ $--- 1 DESCRIPTg ProfessilON QF onal LiabRATIONs below �PAAEP00102504 9/1/2622 9/1/2023 Per Claim POLIOY uMlr $ 1,000�00� g Professional Liab. PAAEP00102504 9/1/2022 9/1/2023 Aggregate 2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS IWVEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) All Operations of the Named Insured. General Liability: See Additional Insured Endorsement attached; such coverage is Primary & Non -Contributory with Separation of Insureds and Waiver of Subrogation included, as required by written contract. NOTE: No company -owned vehicles. General Liablity includes coverage for Hired & Non -Owned Auto Liability. Workers' Compensation: Please see attached Waiver of Subrogation Endorsement, as required by written contract. GENERAL LIABILITY ADDITIONAL INSURED INCLUDES THE FOLLOWING PERSON(S) OR ORGANIZATION(S): City of El Segundo, its officers, officials, employees, and authorized volunteers SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 11 AUTHORIZED REPRESENTATIVE,, City of El Segundo 350 Main Street IEI6ML1d9,CA 9 _.............................. ................... ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Policy Number: PSB0010319 RLI Insurance Company Named Insured: Kee Engineering, Inc. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. RLIPack° FOR PROFESSIONALS BLANKET ADDITIONAL INSURED ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM - SECTION II — LIABILITY 1. C. WHO IS AN INSURED is amended to include as an additional insured any person or organization that you agree in a contract or agreement requiring insurance to include as an additional insured on this policy, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused in whole or in part by you or those acting on your behalf: a. In the performance of your ongoing operations; b. In connection with premises owned by or rented to you; or c. In connection with "your work" and included within the "product -completed operations hazard". 2. The insurance provided to the additional insured by this endorsement is limited as follows: a. This insurance does not apply on any basis to any person or organization for which coverage as an additional insured specifically is added by another endorsement to this policy. b. This insurance does not apply to the rendering of or failure to render any "professional services". c. This endorsement does not increase any of the limits of insurance stated in D. Liability And Medical Expenses Limits of Insurance. 3. The following is added to SECTION III H.2. Other Insurance — COMMON POLICY CONDITIONS (BUT APPLICABLE ONLY TO SECTION II — LIABILITY) However, if you specifically agree in a contract or agreement that the insurance provided to an additional insured under this policy must apply on a primary basis, or a primary and non-contributory basis, this insurance is primary to other insurance that is available to such additional insured which covers such additional insured as a named insured, and we will not share with that other insurance, provided that: a. The "bodily injury" or "property damage" for which coverage is sought occurs after you have entered into that contract or agreement; or b. The "personal and advertising injury" for which coverage is sought arises out of an offense committed after you have entered into that contract or agreement. 4. The following is added to SECTION III K. 2. Transfer of Rights of Recovery Against Others to Us — COMMON POLICY CONDITIONS (BUT APPLICABLE TO ONLY TO SECTION II — LIABILITY) We waive any rights of recovery we may have against any person or organization because of payments we make for "bodily injury", "property damage" or "personal and advertising injury" arising out of "your work" performed by you, or on your behalf, under a contract or agreement with that person or organization. We waive these rights only where you have agreed to do so as part of a contract or agreement with such person or organization entered into by you before the "bodily injury" or "property damage" occurs, or the "personal and advertising injury" offense is committed. ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED. PPB 304 02 12 Page 1 of 1 Policy Number: PSE0005052 RLI Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. RLIPack® SCHEDULE OF UNDERLYING INSURANCE This endorsement modifies insurance provided under the following: COMMERCIAL EXCESS LIABILITY COVERAGE FORM Item 4. of the declarations is amended to include Type of Covera a Carrier Eff. Date Exp._uDate Limits Business Liability Occurrence $ 2,000,000 RLI Insurance Company 09/01/2022 09/01/2023 Aggregate $ 4,000,000 Employee Benefits _. ............... .... ......., ......_ .............. ._. Each Employee $ Liability N/A Aggregate $ Employers' Liability Each Accident $1,000,000 RLI Insurance Company 09/01/2022 09/01/2023 Disease Each Employee $1,000,000 _. Disease Polic Limit $1,000,000 ... Business Auto _..........._ ............. Liability RLI Insurance Company1 09/01/2022 09/01/2023_ Each Accident $1,000,000 ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED. PPU 110 06 10 Page 1 of 1 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 4-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT—CALIFORNIA 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. Person or Organization Schedule Job Description All persons or organizations that are party to a contract that Jobs performed for any person or organization that you requires you to obtain this agreement, provided you have agreed with in a written contract to provide this executed the contract before the loss. agreement. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 09-01-2022 Policy No. PSW0005581 Endorsement No. Insured Insurance Company JLee Engineering, Inc. RLI Insurance Company Countersigned By ©7998 by the Workers' Compensation Insurance Rating Bureau of California. All rights reserved.