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PROOF OF INSURANCE (2023 - 2023) CLOSEDDATE (MM/DDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 11 /2/2022 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 rights to the certificate holder in lieu of such endorsements . PRODUCER CONTACT NAME.: Certificates Orr & Associates Insurance Services PHONE FAk 28780 Single Oak Dr wr. ..M _800 rc311-3081 w uw ,wb3CNC �t7+t�30p3 E-MAIL orrandassociales,com Ste 255 �.���rls .,..� Temecula CA 92590 INSURER(S) AFFORDING COVERAGE NAIC # License#:OE63493 INSURER A: U.S. SpecialSpecialtv Insurance Co. 29599 INSURED SOUTCOA-04�-�� South Coast Painting Inc. INSURER e : AmGuard Insurance Compant� 42390 28364 S Western Ave. #465 INSURER C : State Compensation Ins Fund _www 35076 Rancho Palos Verdes CA 90275 INSURER D „ INSURERE: . .................. . INSURER F : COVERAGES CERTIFICATE NUMBER: 1879047971 REVISION 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. ...........�...... _... . .. ... ......... .___ INSR TYPE OF INSURANCE........ "a" LR POLICY E�FF POLICY EXP LIMITS LTR POLICY NUMBER MM/i1DlY'N"YY MMIDD7YY'YY' A '.. X COMMERCIAL GENERAL LIABILITY U22AC87006-07 5/1/2022 5/1/2023 EACH OCCURRENCE $1,000,000 ... CLAIMS -MADE OCCUR PREMISES & o=ufrMceli $100,000 MED EXP (Any one person) $ 5.000 PERSONAL & ADV INJURY $ 1,000.000 .. _........._....-........................................ GENERALAGGREGATE $2.000.000 E......._.� AGGREGATE LIMIT APPLIES PER: .........eN,L -G POLICY j t,q LOC _.._.._..____-. ____._.._.._.._.._...-.,-.._____..... PRODUCTS-COMPIOPAGG $2,000.000 OTHER: $ B AUTOMOBILE LIABILITY SOAU398522 4/26/2022 4/26/2023 SINGLE LIMIT E�l accgfta„tl ........................ $1,000,000 ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED X AUTOS ONLY AUTOS IAUTOS ..................._.....__ .._............ .._.................. BODILY INJURY (Per accident) .. $ .$...._._. XIHIRED X NON -OWNED ONLY _ AUTOS ONLY PRC IPERfFbWAGE A (Par accident„„„„„„„„,__ A UMBRELLA LIAB '.. X OCCUR U22AC87006-07 5/1/2022 5/1/2023 EACH OCCURRENCE $1.000,000 .............. X EXCESS LIAB CLAIMS -MADE AGGREGATE $1,000.000 DED I RETENTION $ $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N Y 1125712 6/1/2022 6/1/2023 ',X PER OTH- STATUTE. ER. .......... ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.. EACH ACCIDENT $ 1,000.000 OFFICERIMEMBER EXCLUDED? ❑ NIA (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE'.. $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT .... $ 1,000.000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) Certificate is subject to policy limits, conditions and exclusions. City of El Segundo Public Works Department is named as Certificate Holder. CERTIFICA I E HOLDER. City of El Segundo Public Works Department 350 Main Street 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 9Cj ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD ENDORSEMENT AGREEMENT WAIVER OF SUBROGATION BLANKET BASIS HOME OFFICE SAN FRANCISCO EFFECTIVE JUNE 1, 2022 AT 12.01 A.M. ALL EFFECTIVE DATES ARE AND EXPIRING JUNE 1, 2023 AT 12.01 A.M. AT 12:01 AM PACIFIC STANDARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME SOUTH COAST PAINTING INC 28364 S WESTERN AVE # 465 RANCHO PALOS VERDES, CA 90275 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 2.00% OF THE TOTAL POLICY PREMIUM. SCHEDULE PERSON OR ORGANIZATION ANY PERSON OR ORGANIZATION FOR WHOM THE NAMED INSURED HAS AGREED BY WRITTEN CONTRACT TO FURNISH THIS WAIVER JOB DESCRIPTION BLANKET WAIVER OF SUBROGATION 9125712-22 RENEWAL SP 5-15-53-97 PAGE 1 OF 1 NOTHING IN THIS ENDORSEMENT CONTAINED SHALL BE HELD TO VARY, ALTER, WAIVE OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS POLICY OTHER THAN AS STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR LIMITATIONS OF THIS ENDORSEMENT. COUNTERSIGNED AND ISSUED AT SAN FRANCISCO: JUNE 2, 2022 2572 AUTHORIZED REPRESENT IV'E PRESIDENT AND CEO SCIF FORM 10217 (REV.7.2014) OLD DP 217