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PROOF OF INSURANCE (2023 - 2023) CLOSED,b; 61 " CERTIFICATE LIABILITY INSURANCE DATE (MMIDDmrYY) 10/18/2022 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(les) 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 endorsements . PRODUCER 16ONTACT WaterColor Management PHONE I AX P.Q. Box 1132 (15111 Decatur AL 35602- R MAIL A IrI11 1e�t1 t0(!2.N..OId11�11i1g1t ,_.......... .,..._I)VSURCR(51.AFFORDING_COVERAG,... NMhS.. ....... ........ ..- --- --- - ................... w tN ,R p,,Lloyd'sofLondon...._ -_ m.,.,15792.. INSURED Consolidated Water Technologies Inc � RE.fz .. ....... World Laboratories & Hydro -Convergent Technologies rNL:ER--` P.O.Box 1860 Simi Valley CA 93062- 1NINURER.ffa ..... . ............. ....... _ ........w... I COVERAGE$ CERTIFICATE NUMBER, 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 �... POLICYEFF POLICY EXP LIMITS A X GENERAL LIABILITY CIALGENEk._... X X I GI.�EX000340-01 11/01/202211/01/202 FACHOCCIIRRENCF C IMS )E X OCCUR � V ............. C9AMAC`9. P) RFPvTFD ..$ ..,TARR!m0R�.... ... n pnn 1.0.L .e. X 1 Profhessional Li8l) .. 1?LtFEId fS,l wlraa�u�.. MED EXP .. ...... Contractual ,,� t,a( ------------------ Prast�nanL a)rr IN ualr_- s. , , ,1,000,000 GEN'L At I Ri d l'ts LIMIT APPLIES PER: G NERALA REGATE PLICY O .. PRO- Ld JEST PRODUCTS-COMPIOPAG°.�s., „ ..,... a000 AUTOMOBILE LIABILrY COMBINED SINGLE LIMIT $ ,1 ANY AUTO BODILY INJURY (Par person) $ . . ALL OS AUTOS '.. SCHEDULED AUTO., �_ _....,_.... BODILY INJURY Per accident ( } $ �......... �. HIRED AUTOS NON -OWNED AUTIR �� $ A UMBRELLALIAB X OCCUR X X LGLEX000340-01 11/01/21)2211/01/202 EACH pCCURRENCF $ $ 0 1, X EXCESS LIAR CLF9IMS MAd7F AU,Cs6EECxATE „Q011ytl0 ,._ .,. 0(�0 (( ^OTH- WORKERS COMPENSATION PER ry AND EMPLOYERS° L IC. YIN ., ,,,,,,,,. .rTAT,UT�E I ER.,..., , ... Y PRO IETO E XECUTIVE El OFFICERNEMBER EXCLUDED? NIA .. (Mandatory in NH)L. EMPLOY If es. describe � r LIMI .� _._._.. T D S .d2w-- E I . DISDISEASE . POLICY IMI'f DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE. HOLDER (';Aftl''Fl II ATIr)N A 110 1t1A SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City Of El Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Public Works Department ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street El Segundo CA 90245- AUTHORIZED REPRESENTATIVE 01988.2014 ACORD CORPORATION. All rights reserved. ACORD 26 (2014101) The ACORD name and logo are registered marks of ACORD CG 2010 07 04 ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Policy Number: LGL000340-00 SCHEDULE Name of Additional Insured Person(s) Or organization s : Location(s) Of Covered Operations All persons or organizations requiring such Various coverage by any contract entered into by the insured within the coverage period of this policy. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" 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. 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. Page 1 of 1 LLM WCM MANU 19 PRIMARY AND NON-CONTRIBUTING INSURANCE This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART To the extent that this insurance is afforded to any additional Insured under this policy, SECTION 1V - COMMERCIAL GENERAL LIABILITY CONDITIONS, 4. Other Insurance is deleted in its entirety and replaced with the following condition: 4. Other Insurance If all of the other insurance Permits contribution by equal shares, we will follow this method unless the insured is required by written contract signed by both parties, to provide insurance that is primary and non- contributory, and the "insured contract" is executed prior to any loss. Where required by a written contract signed by both parties, this Insurance will be primary and non-contributing only when and to the extent as required by that contract. However, under the contributory approach each insurer contributes equal amounts until it has paid its applicable limit of insurance or none of the loss remains, whichever -comes first. If any of the other insurance does not permit contribution by equal shares, we will contribute by limits. Under this method, each insurers share is based on the ratio of its applicable limit of insurance to the total applicable limits of Insurance of all insurers. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. This endorsement forms a part of the Policy to which attached, effective on the Inception date of the Policy unless otherwise stated herein. (The following information is required only when this endorsement Is Issued subsequent to preparation of the Policy.) Endorsement's effective Policy No. LGLEX000340-00 Endorsement No. Named Insured Countersigned by: Page 1 of 1 CG 2404 05 09 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Policy Number: LGLEX000340-00 This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS COMPLETED OPERATIONS LIABILITY COVERAGE PART ERRORS AND OMISSIONS COVERAGE PART LIMITED POLLUTION COVERAGE PART SCHEDULE Name Of Person Or Organization: Any Person or Organization for whom the Insured had, prior to a Claim, a written agreement or written contractual obligation, to waive such rights. Information required to complete this schedule, if not shown above, will be shown in the declarations. The following is added to Paragraph S. Transfer Of Rights Of Recovery Against Others To Us of Section IV - Conditions: 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 Injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products - completed operations hazard". This waiver applies only to the person or organization shown In the Schedule above. Page 1 of 1 CERTHOLDER COPY P.O. BOX 8192, PLEASANTON, CA 94588 Sc CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 01-01-2022 CITY OF EL SEGUNDO PUBLIC WORKS DEPT SC 350 MAIN ST EL SEGUNDO CA 90245-3813 GROUP: POLICY NUMBER: 0553215-2022 CERTIFICATE ID: 38 CERTIFICATE EXPIRES: 01-01-2023 01-01-2022/01-01-2023 This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 30 days advance written notice to the employer, We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy. 411 e--t6ep", .�- 111111414,4,—� Authorized Representative President and CEO EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT #0015 ENTITLED ADDITIONAL INSURED EMPLOYER EFFECTIVE 2021-06-09 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. NAME OF ADDITIONAL INSURED: CITY OF EL SEGUNDO PUBLIC WORKS DEPT ENDORSEMENT #20S5 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 01-01-1998 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. ENDORSEMENT #2570 ENTITLED WAIVER OF SUBROGATION EFFECTIVE 2022-01-01 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. THIRD PARTY NAME: CITY OF EL SEGUNDO PUBLIC WORKS DEPT ENDORSEMENT #1651 - ARTHUR D SHERMAN, P,S,T - EXCLUDED. ENDORSEMENT #1651 - DONALD, II A OSBORNE, VICEPRES - EXCLUDED. EMPLOYER CONSOLIDATED WATER TECHNOLOGIES INC SC PO BOX 1860 SIMI VALLEY CA 93082 M0408 PRINTED : 12-16-2021 (REV.7-2014)