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PROOF OF INSURANCE (2023 - 2023) CLOSED° DATE (MMIDDIYYYY) AC000CERTIFICATE OF LIABILITY INSURANCE r. 11 103t2022 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 Lisa Anderson NAME: _ PHONE .. ._...�..__.. FAX ( Shaw Moses Mendenhall &Associates Ins Agency dArc N a � (626} 799-7813 PAX L91, (626) 799-8784 License #OD94511 EMAIL ADDREss Iisa@smmainsurance.com 625 Fair Oaks, Suite 158 INSURER(S) AFFORDING COVERAGE NAIL# South Pasadena CA 91030 INSURERA: Ohio Security 24082 INSURED INSURER B : Travelers Cas and Surety Tavi Design Group INSURER C FPLD, Inc., INSURER D : 11529 W Pico Blvd INSURER E : Los Angeles CA 90064 INSURER F : COVERAGES CERTIFICATE NUMBER: 2022-2023 REVISION NUMBER: THIS IS TO CERTIFY THATTHE 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 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 . ........� _rEi INS�iY ... � _ .. POLICY EF POLICYr E'7C _ .. _._. LTR TYPE OF INSURANCE IN D YR POLICY NUMBER MMIDD MMIDD/YYYY """""... _..�.". LIMITS _,,,, ....._ .........�....... X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 2,000,000 CLAIMS -MADE OCCUR aUp RENTED rm-1 10 $F � O Ca ooc:u rrencn 2,000 a00 5 MED EXP (AnV one person) S 15,000 A Y BZS56380079 10/23/2022 10/23/2023 PERSONAL& ADV INJURY S 2,000,000 GEN'LAGGREGATE L. HAl f APIPLIES PER GENERAL AGGREGATE S 4,000000 _.__ 4€.71...If:;Y ACT ......0 L..C)G I ACT � PRODUCTS - COMP(OP AGG S 4,000,000 ..', Of HER: n"._... $ ....__.................._."."..."..._. AUTOMOBILE LIABILITY �;Ct05INELti II`2CkLE L4MI1 9Ea acc,.dcrar 5 2,000,000 ANYAUTO BODILY INJURY (Per person) 5 A OWNED SCHEDULED Y BZS56380079 10/23/2022 10/23/2023 BODILY INJURY (Per accident) S AUTOS ONLY AUTOS _............. ... HIRED X NON -OWNED PROPERTY I)AMAl` E S AUTOS ONLY AUTOS ONLY 5 ......... ........ �. ........... .._........... UMBRELLA LIAB OCCUR E _.............. EAGH OCCURRENCE . S EXCESS LAB CLAIMS -MADE AGGREGATE s ..._.._ ... ............. OF.D RETENTIONS ......_. S vVIORKERS COMPENSATION PER OTH- STATI ITE ER AND EMPLOYERS' LIABILITY Y I N „„ ANY PROPRIETORtPARTNERIEXECUTIVE NIA OFFI CERIMEMBER EXCLUDED? E L EACH ACCIDENT ""E S (Mandatory in NH) E L DISEASE - EA EMPLOYEE L DISEASE s If yes, describe under DESCRIPTION OF OPERATIONS below E L. DISEASE - POLICY LIMIT S Professional Liability B 106186656 10r23(2022 10/23(2023 per occurrence $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) ....... ._ When required by written contract, agreement or permit, The City of El Segundo, its officers, officials, employees and volunteers are named as an Additional Insured as regards to General Liability and those usual to the Insured's Operations. LDER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of El Segundo ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street AUTHORIZED REPRESENTATIVE ElSegundo CA 90245-3895 r•,... y% � � Vr o ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD FPLDINC-01 M ,A.&,kRC ,d► `+C3R0� CERTIFICATE OF LIABILITY INSURANCE DATE 10(MM/2022 ' 10125/2022 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 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 riqhts to the certificate holder in lieu of such endorsement(s). PRODUCER Westlake Risk & Insurance Services 2659 Towns ++� ate Rd 'Ste 103 Westlake Village, CA 91361 Marnie Valcarcel mvalcarcelOwyestlakerisk.com '.. INSURED € INSURERB, FPLD, INC. INSURER ....0.. 11529 W Pico Blvd INSURERD. ---------.----.----.------ ------ ---- Los Angeles, CA 90064 INSURER E ------------- INSURER F . M COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: _ THIS IS TO CERTIFY HE POLICIES 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. -- INSR. TYPE OF INS ADDLI''SUBR POLICY EFF POLICY EX -- 1P M _ _ .. INSURANCE .� akmp POLICY NUMBER � IMMIOO/YYYYI IMMI LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCIJRRENCF $ --- CLAIMS MADE OCCUR DAMAGE TO RENTED ... ....... .,..-,� QfM�rFS..4IP --- �...... �.,.,,. MED EXP fAny one person) - PERSONAL_RADVINJ _ - . ..... .. GEN'L LIMIT APPLIES PER �... �� POLICY (q"":T LOG TE .-.- _._.PRODUCTS_ ('OMP/OP AGG $ --- —.... ........ OTHER, COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY I v (.Ea persd,r�.�J. ...-.. $ ... -_.._ ANY AUTO I ODILY INJURY (Perperson) B �.._.. iI' S. _ OWNED ' �----- EDULED OS ONLY AUTOS .... $ .. 4..---- I AUTOS ONLY L.--- --. A �"I 6i d�Nh k. FIR �dJURY(Peracc.ident) P )DAMAGE �$ -- .... UMBRELLA LIAB OCCUR ..........� 1 U OCC„RRENCE I $ ... DE EXCESS LI C...LAIMS MA AACH A ... ... ..,,OGREGAT.I~ ......... ... i $ ........................... DEC RETENTION $ A WORKERS COMPENSATION ............................................................_:,.,.................m......... ..............._...... _. ,..� ......�..... ,._._......._ I I PER H ...................................... f.............._ ANY PROPRIETOR/PARTNER/EXECUTIVE EMPLOYERS' LIABILITY YIN" ANYPR RIETO OFFICER/MEMBER EXCLUDED'? C Y NIA X WZ3J145646 9/6/2022 9/6/2023 E ACH ATF E L EACH ACCIDENT I $ 1 000 000 (Mandatory in NH) - U DISEASE EA EMPLOYEE�$ 1,000 ��� If yes, describe under DESCRIPTION OF OPERATIONS below ".." E L. DISEASE - POLICY I IMIT .,.,... � $ 1,000 ��� DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) Proof of Insurance SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of El Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Y g 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 Hiin9yer I ri s U ra P W23.1145646 I OC 1734 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSDA ENT-CALIFORNIA We have t he ri cht to recover our payments I rom a nyone li able for an 6ju ry covered by t hi s policy. We wi 11 not enforce ou r 7icht apainst tt:k, person or cr m,- rization named in the SchedtAe. (Thfs acreemert applies only to the extent that stou perform work under a written cortract lbat requires you to obtain tWs acreement from us.) yroll records accurately segregating thee remuneration of your employees vihile engaged in the work L WARS K' " d wo. a. w RIATM-3RIM, ule The additional premium ter this endorsernert sl-zll be 2 due on sLch remunerafion Person or Organization APPLIES AS BLANKET WAIVER FOR THOSE HAVING A WRITTEN CONTRACT WITH THE POLICY- HOLDER REQUIRING WOS FOR VIC POLICYHOLDER EMPLOYEES. '/L of the California workers' compensaticri premium otherwise Sc Vs-dL-1 e Job Description W e., s: l TMS,P-,r,00rwver,tChan9eS tht POKY AM tO Ch It rS attac11 and 13 er 1 'Uve on Ube date ¢Irn'J wA o-noth-" lo, s'e stbtw (The iin(ormation below is reamined only when this endorsement is issued subsequent to Preparation of the policy.) PoIrCY NO. W231145646 NO, sreured insurance Company MASSACHUSETTS BAY INSURANCE COMPANY EMZEM�