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PROOF OF INSURANCE (2023 - 2023) CLOSEDKRAUACT-01 B YES LORALEEBARL W' ............ ,4c CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) _31412022 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""I"NSURED the olic ies must have ADDITIONAL INSURED provisions or be endorsed.mmmmIT O c p y( ) 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 GYh{ACT NFP Property & Casualty Services, Inc. PHONE, 5550 .,. . 8966 1551 North Tustin Avenue INC,oExt). (714) 505 AMFAXNo) (714) 975 MAIL ..... Suite 500 ADPREss. Santa Ana, CA 92705 INSURER.... lsg AFrORp1NG COVERAGE NAIC � INSURER A:COlony Insurance Company 39993 INSURED INSURER B:CvDress Insurance Cornaanv 10855 Krause ACT, Inc. DBA Air Cleaning Technology MNSUREE o 411 Rowland Ave INSURER D "- Santa Ana, CA 92707 MNSURER E : ..................................................... ......._...._. ... m INSURER F : COVERAGES CERTIFICATE NUMBER: µBELOW _ WHAVEWBEEN REVISION NUMBER:.......... _ THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED 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. INSR ADDL SUBR TYPE OF INSURANCE POLICY NUMBER 11:........_.................................... .Le§. w .................. ._� _ .....__.._ _ POLICY EFF POLICY EXP _:.. !�?la/> � IMMIPP ya. LIMITS A X '.. COMMERCIAL GENERAL LIABILITY �PACE4245133R3 '.. EACH CCCURRENCE S 1,000,000 CLAIMS -MADE X OCCUR X 3/7/2022 3/7/2023 DAMAGE TO RENTED ,.FRE�h1sF5_dF�.��tlrr�ns�1 �S 300,000 � 50'000 .. . ,,, ., ,,,, MED EXP(Any nner�erson) $ ,1,000,000 � ......�. ,PERSONAL ADV INJURY S & _ —, _ ,, .... ,,,, ,, ,,, ,, ..,............................ ''.... 2,000,000 AGGREGATE LIMIT APPLIES PER: '.... GENERA&.. AGGREGATE S , ,PRODUCTS _gEII41 POLICY X P @- Ll LOC COMPIOP AGO $ 4000,000 OTHBEI�I S .............. __.�. ..................... ...... AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT .�...., x ANY AUTO ........._...'. ,.....BODILY INJURY (Per_person) s..., ` OWNED SCHEDULED AUTOS ONLY ! AUTOS INJURY (Per accident) $ , HIRED NON -OWNED .; AUTOS ONLY ..... AUTOS ONLY ,BODILY PROPERTY DAMAGE ,_(Per ac•,rOd t) , ,S ,_ .... .. . S A " UMBRELLALIAB" X OCCUR EACH OCCURRENCE S 10,000,000 .. X EXCESS LIAB CLAIMS -MADE EXC424513R2 3/7/2022 3/7/2023 .... ... AGGREGATE S _ „ „ 10,000,000 DED RETENTION S _..... S B WORKERS COMPENSATION X PER O I H. STAT 0T L tR AND EMPLOYERS' LIABILITY YIN X KRWC321841 1l1 /2022 1/1 /2023 1,000,000 ANY PROPRIETORrPARTNERIEXECUTIVE �� OFFICER/MEMBER EXCLUDED? NIA'... L EAi g4 A.CL,IODNT .,. ,...... " (Mandatory in NH) E I.. DISEASE E,A EMPLOYEE S 11000,000 If yes, describe under 1,000,000 E CftIPTION OF OPERATIONS beMnw E I. DISEASE PO IC'Y LIMIT S .._ ... _r,_ mnm ,_ ..mp.,,...�, ..,_ A ;Pollution Prof Liab PACE4245133R3 3/7/2022 3/7/2023 Limit 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: El Segundo Fire Department, 314 Main Street, El Segundo„ CA 90245. The City of El Segundo is included as Additional Insured with regard to General Liability per attached forms EPACE100-0814 & EPACE101-0814. Waiver of Subrogation applies to Workers' Compensation per attached form WC990634. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City Of El Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Y 9 ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street El Segundo, CA 90245..................._........_.- AUTHORIZED REPRESENTATIVE ACORD 25(2016/03)....._.............--......---_--..----...-_......--_...--_...--_-........--._-........-_....,.,, ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDNYYY) 10/24/2022 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 p9ry1ACTKathy Perry Dan Rickabus State Farm Insurance 30131 Town Center Drive, Suite 275 Laguna Niguel, CA 92677 INSURED Krause A C T DBA Air Cleaning Technology 411 Rowland Ave Santa Ana, CA 927073445 (SAX 949-363-1836...... 949-363 7100 ,per.. _ l,tAdC, N�1p katherine.perry.itff@statefarm.com IN UR R(.s�AFFORDING COVERAGE .......... NAIC # A urance Company 25178 State Farm Mutual Automobile In B. rnVPDAnPS rPRTIFIrATF NIIMRGR• RFVISI0N NIIMRFR- 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..LN ---, _.. --- u._ ............. ...-- INSR1 .. .SURANCE �ADOL�$Y,I POLIGYNUMBER�..... ....-.. �..POLICYEFF FOLICY'EXP. INSDMMIDD MMIDDIYYYY �.�.�. .�.�.. ............... ..,. ---. LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ Y t1A1V�EiifENiEiY CLAIMS MADEOCCUR ) `MED BXP . .................. .. (Any one person) $ Y, � INJURY $ INJU .....EN _ ........ j, ... .....,........_. G LIMIT APPLIES PER: GENERAL AGGREGAT E PRO f � I hCy�C. POLICY [] PRI, I' E -- — ---- „-PRODUCTS COMP.. _ _ - . $ OTHER: A AUTOMOBILE LIABILITY Y 5458874-001-75 09/01/2022 03/01/2023 4COMBI"�EDDt] aINGL4LIMIi tEa $ 1,000,000 ............... X �......... ANY AUTO BODILY INJURY (Per person) $ X ALL OWNED SCHEDULED .....- .. ... BODILY INJURY (Per accident) ......_.,..,. $ Auros Auros NON -OWNED X 5451763-001-75 09/01/2022 03/01/2023 •.-.L.... OPElgit" f,1AMAGE... Is HIRED AUTOS AUTOS ...---. 4971093-001-75 09/01/2022 03/01/2023 � l"er pccrrdraa)R>). .... . . . . . .............- -- $ UMBRELLA AB__...--�---- OCCUR r EACH OCCURRENCE RRENCE $ EXCESS LIAB-MA CS LAIMDE AGGREGAT .... ................. ------,. DED RETENTION $ $ WORKERS COMPENSATION PER I OTH rE ER AND EMPLOYERS' LIABILITY YIN __ ... ANY PROPRIETOR/PARTNER/EXECUTIVE E L EACH ACCIDENT $ C OFFICER/MEMBER EXCLUDED? ❑ NIA A - (Mandatory in NH) E L DISEASE EA EMPLOYEE),' $ If yes, describe under I DESCRIPTION OF OPERATIONS below t E.L. DISEASE - POLICY LIMIT $ A ENOL Y 507 2152-001-75 09/01/2022 03/01/2023 $250 Physical Damage deductible DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of El Segundo, its officials and employees are named additional insured Location: El Segundo Fire Department a«�a�rl�,t+�_�r:L•� a �� :� El Segundo Fire Department 350 Main St El Segundo, CA 90245 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 ^ 9)1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD 1001486 132849,.9 02-04-2014 POLICY NUMBER: THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: EnviroPACE Insurance Policy SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) I Location(s) Of Covered Operations Where Required By Written Contract I Where Required By Written Contract A. Section XX. WHO IS AN INSURED, Coverage Part 1 and Part 2 is amended to include as an additional insured the person(s) or organization(s) shown in the SCHEDULE above, but only with respect to liability for bodily injury, property damage, personal and advertising injury, environmental damage, or cleanup costs 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. EPACE101-0814 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 2 with its permission. C. With respect to the insurance afforded to these additional insureds, the following is added to section XXI. LIMITS OF LIABILITY AND DEDUCTIBLE: 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 Liability shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Liability shown in the Declarations. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED, EPACE101-0814 Includes copyrighted material of Insurance Services Office, Inc., Page 2 of 2 with its permission. POLICY NUMBER: THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. *eli I *A ""' • • This endorsement modifies insurance provided under the following: EnviroPACE Insurance Policy SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations Where Required By Written Contract Where Required By Written Contract A. Section XX. WHO IS AN INSURED, Coverage Part 1 and Part 2 is amended to include as an additional insured the person(s) or organization(s) shown in the SCHEDULE above, but only with respect to liability for bodily injury, property damage, environmental damage, or cleanup costs caused, in whole or in part, by your work at the location designated and described in the SCHEDULE of this endorsement performed for that additional insured and included in the products -completed operations hazard. 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 is added to section XXI. LIMITS OF LIABILITY AND DEDUCTIBLE: 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 Liability shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Liability shown in the Declarations. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED, EPACE100-0814 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 1 with its permission. WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 0410 C (Ed. 01-19) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT-CALIFORNIA BLANKET BASIS 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 calculated by applying a factor of 2% to the total manual premium, with a minimum initial charge of $350, then applying all other pricing factors for the policy to this calculated charge to derive the final cost of this endorsement. This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule.. Schedule Blanket Waiver Person/Organization Blanket Waiver — Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. Job Description Waiver Premium (prior to adjustments) All CA Operations 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: 1/1/2022 PolicyNo.: KRWC321841 Endorsement No., Insured: Krause ACT, Inc DBA Air Cleaning Technology Premium $ Insurance Company: Cypress Insurance Company Countersigned by WC990410C (Ed. 01-19)