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PROOF OF INSURANCE (2023) CLOSED'a' lf9/2212022
(MM/DD/YYYY)
C< CERTIFICATE OF LIABILITY INSURANCE
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
_ ........
NAletOm,,, „
HUB International Midwest Limited PHONE _ FAx
DowlneOrP Grove I, Suite 50 �D�li�s IC SIICo66tru��ion@hutJinlerllal'
ionat.com
__ ..._.....�... __-.......... __ w __..,_ a Company 23035
al Fire Insuranc I ertt! u uIT.....-_.____,_ ._-m-�,___....-.
ENSURED TEC7AME-01 INSURERC American G_ _
Guarantee & Llabdit Insurance Com an 26056ITmm_ m
INSURER B Navi atOfS _
Tecta America Southern California, Inc. _. 247
1217 East Wakeham Avenue ,4 �...-_.�..Y,......—_-.__ P.�.Y �.
Santa Ana CA 92705 wsuRERD: Starr indemnity and Liablllt m.mmT m _m 38318
INSURER E LM Insurance Carporatlon mmm ..d _ _ 33600
INSURER F:. Libea Insurance Corporation 42404
f'nVFRArZF! C r-PTIFIf ATF NIIMRF:R-9;111r0'i1R RFVI_SIrIN 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 1S SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
, �_...AD'f11..tuff, _.... OOLICEW YEXp._li,.....,.�....... _m_.....•..__-.,...,�. ..m._.._.w,.a.._�._..
POLICY
XIOL9
TYPEOFINSURANCE OLICYNUMBERLIMITS
A
X
COMMERCIAL GENERALLIABILITY
Y
E62-641435467-43
3131022
3131/2023
EACH OCCURRENCE
3,000,00 __-
CLAIMS -MADE �OCCUR
WEWf
_500,000
000
PERSONAL & ADV INJURY
s 2,000,000 �X m-
G'EN'L.
AGGREGATE LIMITAPPLIESPER:
GENERAL AGGREGATE
54000000
_
PE
POLICY LOC
PRODUCTS - COMP/OP AGG
S 4 000,000
OTHER;
S
A
AUTOM_X
LIABILITY
AS2-fik1�3546714
3131/2022
3/3112023
•BODILY dNJIUR(Perpersonl
000
�521100
ANOYBAUTOABtu
OWNED SCHEDULED
AUTOS ONLY AUTOS
BODILY INJURY (Per accident)
mmXmm
s
X
RED X
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$
B
uMeRELLALIAe X 'OCCUR
LA22EXCZ04Q521C
3/3112022
3/31/2023
EACH OCCURRENCE
S 13,000,000
O
D
° "
X
_"
EXCESS LIAR
AEC924243fi
3/3i12022
3/31/2023
— °-. ..-
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......_
CLAIMS -MADE
10005869732
3131/2022
3/31/2023
AGGREGATE
,�.. ,,..-,.m ....._._
$13,000.000
DEO� XX�RETEN710NS.•..._.____�_.
S...m,�.,.�..-......�__
WORKERS COMPENSATION
P ASS-640435^4fi7.392 AOS)
(((WA
3131/2022
3/3112023
X PER OTY-f
F
E
AND EMPLOYERS'1JABILITY Yi NF
-435467-412
ANYPROPRIETORIPARTNEFt/EXECLfnVE
OFFICERIMEMBEREXCLUDEO? y N"
NIA'
WC5-64 MN
( )
3/3112022
3131/2023
E.L.STD,
_ EACH ACCIDENT
51 000000 _ ...m
(Mandatory in NH) """ ""
E.L. DISEASE -EA EMPLOYEE
S 1,000,000
� M..,-,.
DIf ESCRI TION OF OPERATIONS below
E.L. DISEASE POLICY�._......_._
LIMIT
00,
$1,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
Contractors Equipment Coverage, Carrier: Travelers Property Casualty Co, of Am,: NAIC #: 25674; Policy# QT-630-OT985565; Eff Date: 3/31/2022 to
3131/2023; Limit: $45,251,486; Ded; $25,000, except Flood - $100,000, Named Storm - $100,000,
Leased/Rented Equipment Coverage; Carrier: Travelers Property Casualty Co. of Am.; NAiC #. 25674; Policy# QT-630-OT985565; Eff Date: 3/31/2022 to
313112023: Limit: $2,500,000; Ded: $25,000, except Flood - $100„000, Named Storm - $14]10,000.
See Attached...
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
City of El Segundo
350 Main Street AUTHORIZED RIEPRESENTATIVE.
El Segundo CA 90245
©1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
AGENCY CUSTOMER ID: TECTAME-01
LOC #:
ACC ADDITIONAL REMARKS SCHEDULE Page 1 of 1
AGENCY
NAMED INSURED
HUB International Midwest Limited
Tecta America Southern California, Inc.
_
1217 East Wakeham Avenue
POUCYNUMSER
�
Santa Ana CA 82705
CARRIER NAIC CODE
EFFECTIVE DATE:
ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
POLICY NUMBER: EB2-641-435487-43
COMMERCIAL GENERAL LIABILITY
CG 20 10 0413
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS -- SCHEDULED PERSON OR
ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person(s)
Or Organization(s) Locations Of Covered O erations
Any person or organization for whom you have All locations where required by written contract or
agreed in a written contract or agreement prior agreement.
to loss.
Information required to complete this Schedule, if not
above, will be shown in the Declarations.
A. Section II — Who Is An Insured is amended to B. With respect to the insurance afforded to these
include as an additional insured the person(s) or additional insureds, the following additional
organization(s) shown in the Schedule, but only exclusions apply:
with respect to liability for "bodily injury", "property This insurance does not apply to "bodily injury" or
damage or personal and advertising injury' "property damage" occurring after:
caused, in whole or in part, by:
1. Your acts or omissions; or 1. All work, including materials, parts or
equipment furnished in connection with such
2. The acts or omissions of those acting on your work, on the project (other than service,
behalf; maintenance or repairs) to be performed by or
in the performance of your ongoing operations for on behalf of the additional insured(s) at the
the additional insured(s) at the location(s) location of the covered operations has been
designated above. completed; or
However: 2. That portion of "your work" out of which the
injury or damage arises has been put to its
1. The insurance afforded to such additional intended use by any person or organization
insured only applies to the extent permitted by other than another contractor or subcontractor
law; and engaged in performing operations for a
2. If coverage provided to the additional insured is principal as a part of the same project.
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.
CG 20 10 0413 © Insurance Services Office, Inc., 2012 Page 1 of 2
C. With respect to the insurance afforded to these
additional insureds, the following is added to
Section III — Limits Of Insurance:
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
Insurance shown in the Declarations;
whichever is less.
This endorsement shall not increase the
applicable Limits of Insurance shown in the
Declarations.
Page 2 of 2 0 Insurance Services Office, Inc., 2012 CG 2010 04 13