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PROOF OF INSURANCE (2022 - 2023) CLOSEDk CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDNYYY) 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 N/UNE: ..........1 .......... Ferrante Insurance Services, Inc. PHO (925)674-1755 I FAXWE ,q9:(925 674-'1663 1401 Willow Pass Road, Ste 880 -MML s; ai &err nteiinsLurance.com Concord, CA 94520 INSURERS) AFFORDING COVERAGE _--_ NAIC /I OD91034 INSURERA: Scottsdale Insurance,_Com an 41297 INSURED I INSURER B : Mercury Insurance Co. 27553 Dash Construction Company, Inc. INSURER D : PO Box 261321 1 INSURER E : t^r%W 10A1^_=Q rFRTIFIrATF MIIURFR• RFVISInN NUMBER: 37974 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. _..� ......... ........ �� R ADDt S,UBR POLICY Ef F POLICY E'XP LIMITS TYPE OF INSURANCE POLICY NUMBER MO YYYY MMID COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1 00O 000 CLAIMS -MADE FXOCCUR PR. MI E. Ea occurrence ° $ 50,000 MED EXP An " oneerson) $ 5 000 A Y Y RBS0180613 09106/22 09/06/23 PERSONAL & ADV INJURY $ 1000,000 AGGREGA-T-�ELIMIT APPLIES PER: GENERAL AGGREGATE $ 2.000.000 +GENT. ,Cr G POLICY F� JEPRCO-T LOC PRODUCTS - COMP/OP AGG $ 2 000 O00 $ OTHER,°: AUTOMOBILE LIABILITY SINGLE LIMIT Me accident $ ........1 000000 ANY AUTO BODILY INJURY (Per person) $ B .._ OWNED X SCHEDULED BA040000030801 12/22/21 12/22/22 BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS HIRED NON -OWNED PROPERTY DAMAGE $ '.. AUTOS ONLY AUTOS ONLY Per„.ifcvml.J..... ._. X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2000 OOO C EXCESS LIAB CLAIMS -MADE GXS0009157 09/12/22 09/12/23 AGGREGATE $ 2 000 000 DED RETENTION$ Products/Completed $ 2.000,000 WORKERS COMPENSATION PER OTH- T EB AND EMPLOYERS' LIABILITY YIN _".J. ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? ❑ (Mandatory In NH) N / A E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE -POLICY LIMIT $ If yes, describe under (DESCRIPTION OF OPERATIONS below _F DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached If more space Is required) Certificate holder is named as additional insured and waiver of subrogation applies on the general liability insurance policy per the attached endorsements. City of El Segundo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 350 Main Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN El Segundo, CA 90245 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD DATE (MMIDDIYYYY) ^'•.""MV CERTIFICATE OF LIABILITY INSURANCE 09/29/2022 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 CONTACT NAMESimon ShlraZl Golden Capital Insurance PHONE FAX 21250 Califa St Ste #113 E-MAIL Extl. (s8e'8u)6e54 60985 Apc. Na! Woodland Hills, CA 91367 ss:g delacapiCaVins com NSURE..... ......... .. Phone: (818) 654-6985 Fax: L_) - ERA Falls AFFORDING COVERAGE NAIC # s Lake Fire and Casualty Company 15884 INSURED INSURER B DASH CONSTRUCTION COMPANY INC INSURER C r INSURER D PO BOX 261321 INSURER ._ E: Encino CA 91426- INsuRER P rnv00Ar_0c t r—oTlct�e-A Tt= miii gar;P- RF:VI:wkCJ...lhli N11MiAF1PRI 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. _._. YNSR TYPE OF INSURANCE A POLICY NUMBER l4PM/DDN EFF MMOA0 YY LTR LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS -MADE O OCCUR 9Nqufi+�urran,�j, $ MED EXP (Any one person) $ .............. PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S .... PCL.CY PRO-LOC JECT PRODUCTS -COMP/OPAGG $ OTHER' $ AUTOMOBILE LIABILITY COMBINED SINGLE LBMIiT _Igp B.O.Ld9no._ ... $ ANY AUTO BODILY INJURY (Per person) S � ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS -.A NON -OWNED P'ROPER"IYDAMAACE $ HIRED AUTOS ... AUTOS ;Pv r accidenC .. ....................._. UMBRELLA LIAB OCCUR ACH OCCURRENCE $ EXCESS LIAB CLAIMS_ MA .':.AGGREGATE $ '.., DED .RETENTIONS $ A WORKERS COMPENSATION X FLA016529-01 03/01/2022 03/01/2023 ERH� AND EMPLOYERS' LIABILITY YIN ANY OFFICER/MEM ER EXCLUDED? ECUTIVE N / A E.L EACH ACCIDENT $ 1,000,000 (Mandatory in NH) E,.L. DISEASE - EA EMPLOYEE--$ 1,000,000 IF yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT S 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) CSLB# 869505 Waiver of Subrogation is in favor of the Certificate Holder per attached form. CERTIFICATE City of El Segundo 350 Main Street SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN El Segundo, CA 90245 1 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 1411� ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD Underwritten by Scottsdale Insurance Company ENDORSEMENT NO. ATTACHED TO AND FORMING A PART OF ENDORSEMENT EFFECTIVE DATE NAMED INSURED AGENT NO. POLICY NUMBER (12:01 A.M. STANDARD TIME) RBS0180613 09/06/2022 Dash Construction Company, Inc, 047BZ THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED -ONGOING OPERATIONS - OWNERS, LESSEES OR CONTRACTORS This endorsement modifies insurance provided under the following; COMMERCIAL GENERAL LIABILITY COVERAGE FORM SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Location(s) Of Covered Operations Any "additional insured" person, entity or Any location of "additional insured" person, entity or organization where work is performed by you if organization where work is performed by you if ongoing operations coverage is required by insured ongoing operations coverage is required by insured contract contract. SECTION II —WHO IS AN INSURED, is amended to include, for COVERAGE A —BODILY INJURY AND PROPERTY DAMAGE LIABILITY, only, as an additional insured, the person, entity or organization des- ignated in this endorsement for whom the Named Insured is performing ongoing operations only when the Named Insured has agreed with the person, entity or organization in an "insured contract" to name the person, entity or organization as an "additional insured." 1. Such person, entity or organization is only an "additional insured" with respect to liability for "bodi- ly injury' or "property damage" caused, in whole or in part, by the ongoing operations of the Named Insured performed for the "additional insured" at the designated location. 2. The "insured contract" must be currently in effect or become effective during the policy period, be executed prior to the "bodily injury' or "property damage" first happening and be between the Named Insured and the "additional insured." 3. This coverage does not apply to "bodily injury" or "property damage" after: a. "Your work" for the additional insured has been completed; or b. That portion of "your work" out of which the "bodily injury' or "property damage" arises has been put to its intended use by any person or organization. 4. The applicable limit of our liability shall not be increased by the inclusion of the additional insured under the policy. 5. We shall have no duty to indemnify the additional insured for damages, claims or any other liabili- ties arising from actions, inactions, errors or omissions of the "additional insured." SDS-41 (1-19) Page 1 of 2 y, f ]Nstianwide` r 6. Our duty to contractually indemnify the additional insured under an "insured contract" pursuant to this endorsement shall be limited to that sum derived by applying the percentage of fault of the Named Insured as determined by the trier the trier -of -fact to the total damage sum allocated by the trier -of -fact to the "additional insured." Under no circumstances shall we pay more than this proportionate contractual indemnity share required of the policyholder in the "insured contract." 7. Any contractual indemnity payments made on behalf of any additional insured under an "insured contract" shall reduce the applicable limits of insurance on a dollar for dollar basis. Any contrac- tual indemnity payments paid to or on behalf of the "additional insured" pursuant to this endorse- ment are subject to the terms, conditions and limitations of the policy. 8. This endorsement does not create a duty on our part to defend the additional insured or to partic- ipate in, contribute to, or reimburse any person, organization or entity for any fees or expenses incurred in the defense of the "additional insured." SECTION IV —COMMERCIAL GENERAL LIABILITY CONDITIONS, Condition 2. Duties In The Event Of Occurrence, Offense, Claim Or Suit of the policy is amended to include: An additional insured under this endorsement shall in addition to complying with all provisions of the policy: 1. Give written notice to us of an occurrence or an offense which may result in a claim or "suit" with- in thirty (30) days of notice to the "additional insured." 2. Give written notice to us of a claim or "suit" brought against the "additional insured" within thirty (30) days of the additional insured being served with the claim or "suit." 3. Give written notice to any other insurer who has or may have coverage under its policy or policies for a claim, "suit" or demand for defense or indemnity within thirty (30) days of the "additional in- sured" being served with the claim, "suit" or demand for defense or indemnity. Such notice must demand the full coverage available under the policy. The "additional insured" will not take any ac- tion to waive or limit such other coverage available to it. 4. Obtain and provide to us copies of each and every policy from each and every insurer identified pursuant to the preceding paragraph. The followingis added to SECTION V—DEFINITIONS: ADDITIONAL INSURED "Additional insured" means any person or organization that the Named Insured has agreed in an "in- sured contract" to name as an "additional insured" and has been named or identified by description in an "additional insured" endorsement issued and attached to the policy. Coverage is afforded under this policy for an additional insured for Coverage A liability only. "Bodily injury" and "property damage" coverage is afforded to the "additional insured(s)" as provided in the insuring agreement and subject to all policy provisions, provided that the "bodily injury" or "property damage" also: 1. First takes place after the execution of the "insured contract"; and 2. Arises from "your work" performed for the "additional insured"(s) during the policy period or arises from "your" "ongoing operations." This endorsement is subject to all terms, conditions and exclusions of the policy, which remain unchanged. (�e_741 / 09/15/2022 AUTHORIZED REPRESENTATIVE DATE Natiorywide SDS-41 (1-19) Page 2 of 2 A� SCOTTSDALE INSURANCE COMPANY ENDORSEMENT NO. ATTACHED TO AND FORMING A PART OF ENDORSEMENT EFFECTIVE DATE NAMED INSURED AGENT NO. POLICY NUMBER (12:01 A.M. STANDARD TIME) RBS0180613 09/06/2022 Dash Construction Company, Inc. 047BZ 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 LIABILITY COVERAGE FORM SCHEDULE Name of Person or Organization: Designated Construction Project: Any person or organization against whom Any construction project performed by you for any subrogation is required to be waived by an person or organization against whom subrogation is "insured contract". required to be waived by an "insured contract". SECTION IV —COMMERCIAL GENERAL LIABILITY CONDITIONS, 8. Transfer Of Rights Of Recovery Against Others To Us is deleted in its entirety and replaced by the following: 8. Transfer Of Rights Of Recovery Against Others To Us If any insured has rights to recover all or part of any payment we have made under the applicable Coverage Part, those rights are transferred to us. The insured must do nothing after loss to impair such rights. At our request, such insured will bring "suit" or transfer those rights to us and help us enforce them. We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for "bodily injury' or "property damage" arising out of "your work" done under an "insured contract" with that person or organization at the designated construction project. This waiver applies only if the designated construction project shown in the Schedule above is completed and only to the construction project designated in the above Schedule. All other terms, conditions and exclusions of the policy remain unchanged. / 09/15/2022 AUTHORIZED REPRESENTATIVE DATE SDS48 (1-18) Page I of 1