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PROOF OF INSURANCE (2023) CLOSEDGMUGEOT-01 m MC-COYP"A,r At+C]R CERTIFICATE OF LIABILITY INSURANCE 1 DATE(MMIDD/YYYY) ................1..2/27/2022 THIS CERTIFICATE IS ISSUEDLLONLY AND CONFERS NO R AS A MATTER OF INFORMATION O LL..... ...__-I RGHTS 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 confer rights t _ eu of such endorsement(s _.......... m. 6......-...... o the certificate holder In II„mm this certificate RLicense # OE67768� � CONTACT Dana Schwartz PRODUCER Mq¢4.ME IDA Insurance Services PHONE 61574 6288 43'70 La Jolla Village Drive Aac Nv.�a ip.m(619) 574 6223 50203 A c Nol 9 ) 7 Suite 600 APP.,,s: Dana.Schwa 0oausaxom San Diego, CA 92122 NNSURE�E,4',,�si F,xF77R17tln9� C1'YVEIt,CJGE NAiC f9........ INSURER _ ,_ ... � .. A : �.I I,r�s a ra n0e Com,�aa n 305611 INSURED INSURER a : Fireman's F 1,... m...,,..,., . and Indemnity Corporation 11380 11 GMU Geotechnical, Inc. 23241 Arroyo Vista Rancho Santa Margarita, CA 92688 INSURER F t)�"'E�AGES ._._.. CERTIFICATE — ........ .. .._ -. I CA I E NUMBE--._ ... 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, JSR Y W ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY INSD WVR . 4.F?.��!YXIX)mlA7(KI162i�YYYY1 _..... 1,000,000 TYPE OF INSURANCE TY TO RENTED S X X ,DAMAGE RENTED 1,000,000 CLAIMS -MADE X OCCUR PSB0005783 12/31/2022 12/31/2023 DAMAGET r ® a .IFS PFP�CL�nP�l � X Cont Liab/Sev of Int MED EXP (Apy ane person) S 10,000 PERSnNAL & AOV INJURY S 1,000,000 C:C NIL HOGREEATE UIVIII APPLES PER: -., POLICY X... PRO- LOC w JECT ,.,m„ , A AUTOMOBILE LIABILITY X ANY AUTO .........' OWNED .'.. SCHEDULED . ... AUTOS ONLY AU LOS f4IRE, Atldi�10NtY 4ED AUfO'd,NL'Y X X IPSA0002105 X Ded. X� Y, orl LAed $1.DOD A UMBRELLA LIAB X. OCCUR '.. X EXCESS LIAB �.. CLAIMS -MADE 1)I D X '.. RETENTIONS 0 A '.. WORKERS COMPENSATION WWWWWWWWW ..._..� TION AND EMPLOYERS' LIABILITY hi' IN ANY PROPRIETOR/PARTNER/EXECUTIVE X 'i"FFICER/MEMBER EXCLUDED? NIA' I�andatory in NH) If yes, describe under nFCnRIPTInN nF nPFRATIONS helow B Professional Liab. PSE0002541 2,000,000 2,000,000 PRODUCT, _CC7AdIPPk)PAGG S Ded ...,� , S 0 Cp�OMBMIED- IIWGral. E LtlC�lli 11000,000 •'aaF,^� �47�I ..... 12/31/2022 12/31/2023 rp y Jw v INJY,, RY {Pcr„ eu iip._ .A.e„_ soo l ru II�JIJIy'RY (HeraccA lem) S„.�...,,� ... _ P+OPER$YDAMAGE ,P 5,000, ! EACH OCCURRENCE G_, _ _ 12/31/2022 12/31/2023 AGGREGATE 5,000,000 X w Lr< ...,.. _ .$1I lTU.l E... 1 12/31/2022 12/31/2023 EL EACH ACC '.. E L DISEASE„w E L --- 12/31/2022 12/31/2023 Per Claim B Ded.: $50K Per Claim USF00625422 12/31/2022 12/31/2023 ,Aggregate DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if mo re space is required) Re: Proof of Insurance. City of El Segundo are Additional Insureds with respect to General and Auto Liability per the attached endorsements as required by written contract. Insurance is Primary and Non -Contributory. Waiver of Subrogation 30 Days Notice of Cancellation with 10 Days Notice for Non -Payment of Premium in accordance with the policy provisions. 1,000,000 1,000,000 ,000,000 2,000,000 2,000,000 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 City of Segundo I/ lw� 1350 Mainin Street oI1 ACORD 25 EL M.D.�iO ;A,%! �... _�. .....�, ©1988-2015 ACORD CORPORATION. All rights re .... _. (2016/03) g served. The ACORD name and logo are registered marks of ACORD Named Insured: GMU Geotechnical, Inc. This endorsement modifies insurance provided under the following BUSINESS AUTO COVERAGE FORM A. Broad Form Named insured The following is added to the SECTION II — LIABILITY Coverage, Paragraph A.I. Who Is An Insured Provision: Any business entity newly acquired or formed by you during the policy period, provided you own fifty percent (50%) or more of the business entity and the business entity is not separately insured for Business Auto Coverage Coverage is extended up to a maximum of one hundred eighty (180) days following the acquisition or formation of the business entity. This provision does not apply to any person or organization for which coverage is excluded by endorsement, B. Employees As Insureds The following is added to the SECTION 11 — LIABILITY COVERAGE, Paragraph A.1. Who Is An Insured Provision. - Any "employee" of yours is an "insured" while using a covered "auto" you don't own, hire or borrow in your business or your personal affairs. C. Blanket Additional Insured The following is added to the SECTION II — LIABILITY COVERAGE, Paragraph A.O. Who Is An Insured Provision: Any person or organization that you are required to include as an additional insured on this coverage form in a contract or agreement that is executed by you before the "bodily injury" or "property damage" occurs is an "insured" for liability coverage, but only for damages to which this insurance applies and only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in SECTION II — LIABILITY COVERAGE. The insurance provided to the additional insured will be on a primary and non-contributory basis to the additional insured's own business auto coverage if you are required to do so in a contract or agreement that is executed by you before the "bodily injury" or "property damage" occurs. D. Blanket Waiver Of Subrogation The following is added to the SECTION IV — BUSINESS AUTO CONDITIONS, A. Loss Conditions, 5. Transfer Of Rights Of Recovery Against Others To Us: PPA 300 03 11 Policy Number: PSA0002105 We waive any right of recovery we may have against any person or organization to the extent required of you by a contract executed prior to any "accident" or "loss", provided that the "accident" or °loss" arises out of the operations contemplated by such contract The waiver applies only to the person or organization designated in such contract. E. Employee Mired Autos 1 The following is added to the SECTION 11 — LIABILITY COVERAGE, Paragraph A.1. Who Is An Insured Provision: An "employee" of yours is an "insured" whife operating an "auto" hired or rented under a contract or agreement in that "employee's" name, with your permission, while performing duties related to the conduct of your business 2. Changes In General Conditions: Paragraph 5.b, of the Other Insurance Condition in the BUSINESS AUTO CONDITIONS is deleted and replaced with the following: b. For Hired Auto Physical Damage Coverage, the following are deemed to be covered "autos" you own: (1) Any covered "auto" you lease, hire, rent or borrow; and (2) Any covered "auto" hired or rented by your "employee" under a contract in that individual "employee's" name, with your permission; while performing duties related to the conduct of your business. However, any "auto" that is leased, hired, rented or borrowed with a driver is not a covered "auto" F. Fellow Employee Coverage SECTION II — LIABILITY COVERAGE, Exclusion B.5. does not apply if you have workers compensation insurance in -force covering all of your employees. G. Auto Loan Lease Gap Coverage SECTION III — PHYSICAL DAMAGE COVERAGE, C. Limit Of Insurance, is amended by the addition of the following: In the event of a total "loss" to a covered "auto" shown in the Schedule of Declarations, we will pay any unpaid amount due on the lease or loan for a covered "auto". less: Named Insured: GMIJ Geotechnical, Inc. Policy Number: PSB0005783 RLI Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, RLIPack° FOR PROFESSIONALS BLANKET ADDITIONAL INSURED ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM - SECTION It — LIABILITY C. WHO IS AN INSURED is amended to include as an additional insured any person or organization that you agree in a contract or agreement requiring insurance to include as an additional insured on this policy, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused in whole or in part by you or those acting on your behalf: a. In the performance of your ongoing operations; b. In connection with premises owned by or rented to you, or c. In connection with "your work" and included within the "product -completed operations hazard". 2. The insurance provided to the additional insured by this endorsement is limited as follows: a. This insurance does not apply on any basis to any person or organization for which coverage as an additional insured specifically is added by another endorsement to this policy. b. This insurance does not apply to the rendering of or failure to render any "professional services c. This endorsement does not increase any of the limits of insurance stated in D. Liability And Medical Expenses Limits of Insurance 3. The following is added to SECTION III H.2. Other Insurance — COMMON POLICY CONDITIONS (BUT APPLICABLE ONLY TO SECTION II — LIABILITY) However, if you specifically agree in a contract or agreement that the insurance provided to an additional insured under this policy must apply on a primary basis, or a primary and non-contributory basis, this insurance is primary to other insurance that is available to such additional insured which covers such additional insured as a named insured, and we will not share with that other insurance, provided that: a. The "bodily injury" or "property damage" for which coverage is sought occurs after you have entered into that contract or agreement; or b. The "personal and advertising injury' for which coverage is sought arises out of an offense committed after you have entered into that contract or agreement. 4. The following is added to SECTION III K. 2. Transfer of Rights of Recovery Against Others to Us — COMMON POLICY CONDITIONS (BUT APPLICABLE TO ONLY TO SECTION II — LIABILITY) We waive any rights of recovery we may have against any person or organization because of payments we make for "bodily injury', "property damage" or "personal and advertising injury' arising out of "your work" performed by you, or on your behalf, under a contract or agreement with that person or organization. We waive these rights only where you have agreed to do so as part of a contract or agreement with such person or organization entered into by you before the "bodily injury" or "property damage" occurs, or the "personal and advertising injury' offense is committed, ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED. PPB 304 02 12 Page 1 of 1 Named Insured: GMU Geotechnical, Inc. Policy Number: PSW0003341 WORKERS' COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 04-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT-CALIFORNIA 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 ) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be on such remuneration. Person or Organization All persons or organizations that are party to a contract that requires you to obtain this agreement, provided you executed the contract before the loss % of the California workers' compensation premium otherwise due Schedule Job Description Jobs performed for an person or organization that you have agreed with in a written contract to provide this agreement