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PROOF OF INSURANCE (2023 - 2024) CLOSEDa DATE(MMIDD/YYYY) ,� CERTIFICATE OF LIABILITY INSURANCE a/lo/zo22 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 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 NAMF, Xanh Tran IQ Risk Insurance Services, LLC PHONE �, (949) 679-3700 FAX, e4sleaq-sao AEG, No):17 8881 Research Dr E"fNAll" xtran@igrisk.com ADORESS: COVERAGE •••••• INSURERS) AFFORDINGNAIC # _......•_• Irvine CA 92618 INSURERA:James River Insurance Com an 12203 ........ ....... _.. INSURER _.. ._ INSURED ER8:Everest Premier Insurance Com an 16045 CC LAYNE & SONS INC.INSURERCERG 216 Standard Street INSURER D: El Segundo CA 90245 1 INSURER F: nnvoo Ar_oc /`coTIClf^ATC AIIIMR9=I?•cT.99R1n0915'4 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, �_ POIeICY EFC° POLICY E%P TYPE OF INSURANCE A L U POLICY — " _..... INSR YNUMBER Mfrt'I Y'YYYi MMIDD/YYYY LIMITS TR JUL Em X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 _. MAu O N" D $ 100,000 A CLAIMS -MADE X OCCUR PREMISES Ea cGGurrence X 001202011 8/10/2022 8/10/2023 MED EXP (Any one person) S 5, 000 PERSONAL & ADV INJURY S 1,000,000 ........ GEN LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000000 'PRO- UCTS - COMPIOP AGG S _. POLICY � JEST LOC _P..............ROD 2,000,000, $ OTHER COMBINED SIN 'LE LIM S AUTOMOBILE LIABILITY A Ea accident. BODILY INJURY (Per person) ANY AUTO """""•• ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY _DAMAGE_'__ _ $ HIREDAUTOS AUTOS Per accident S UMBRELLA LAB OCCUR I EACH OCCURRENCE S EXCESS LIAB CLAIMS -MADE AGGREGATE S DED RETENTION $ $ WORKERS COMPENSATION P OTH TAT 1TE ER, AND EMPLOYERS' LIABILITY y / N .._..__ kEL�EACH ANY PROPRIETOR/PARTNER/EXECUTIVE """""'""p__,,,"",,, ACCIDENT S 1,000,000 B OFFICER/MEMBER EXCLUDED? •mm—II (Mandatory in NH) J NIA 7600024105231 2/1/2023 2/1/2024 E L DISEASE EA EMPLOYEE S ",,,,,_ 11000,000 If yes desrnlnQ under DESCRIPTrON OF OPERATIONS below E.L DISEASE -POLICY LIMIT $ ''.. DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) Days Notice of Cancellation for Non -Payment of Premium. RE: Covered CA Operations Performed By Or On Behalf of the Named Insured. �*10 The City of E1 Segundo, its officers, officials, employees, agents, and volunteers are named additional insured as respects general liability and this insurance is primary and noncontributory with any other insurance of the additional insured; and waiver of subrogation applies as respects workers compensation as required by written contract, per endorsements attached. CERTIFICATE HOLDER GANGtLLAI IUN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of El Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street E1 Segundo, CA 90245 AUTHORIZED REPRESENTATIVE Yank ' rarl/X'F4;NH © 1988-2014 ACORD CORPORATION. All rights ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS025 (201401) POLICY NUMBER: 001202011 COMMERCIAL GENERAL LIABILITY CG 2010 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OFF 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 Oraanization(s): I Location(s) Of Covered Operations Any person or organization to whom the Named Insured has agreed by a fully executed written contract that such person or organization be added as an Additional Insured, but only with respect to operations performed by or on behalf of the Named Insured and only with respect to occurrences subsequent to the making of such fully executed written contract otherwise covered by this insurance. Where specified by fully executed written contract.] 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) desig- nated above. B. With respect to the insurance afforded to these additional insureds, the following additional exclu- sions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equip- ment 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 in- tended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a princi- pal as a part of the same project. CG 20 10 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 13 POLICY NUMBER: 001202011 COMMERCIAL GENERAL LIABILITY CG 20 37 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES O CONTRACTORS - COMPLETED TED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Descri !ion Of Completed Operations Any person or organization to whom the Named Where specified by fully executed written contract Insured has agreed by a fully executed written contract that such person or organization be added as an Additional Insured for Completed Operations performed by or on behalf of the Named Insured and only with respect to occurrences subsequent to the making of such fully executed written contract otherwise covered by this insurance. 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" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the Schedule of this endorsement performed for that additional insured and included in the "products -completed operations hazard". However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is 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. B. 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. CG 20 37 0413 © Insurance Services Office, Inc., 2012 Page 1 of 1 POLICY NUMBER: 001202011 COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: Any person or organization against whom you have agreed to waive your right of recovery in a written contract or written agreement, provided such contract or agreement was executed prior to the date of loss, injury or damage. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 8. 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. CG 24 04 06 09 © Insurance Services Office, Inc., 2008 Page 1 of 1 ❑ Policy No.: 001202011 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY •CONTRIBUTORY ENDORSEMENT This endorsement modifies insurance provided under the following: ALL COVERAGE PARTS Any coverage provided to an Additional Insured under this policy shall be excess over any other valid and collectible insurance available to such Additional Insured whether primary, excess, contingent or on any other basis unless a written contract or written agreement specifically requires that this insurance apply on a primary and noncontributory basis. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. AP5031 US O4-10 Page 1 of 1 DATE(MMIDDIYYYY) ACOPRe CERTIFICATE OF LIABILITY INSURANCE 11/10/2022 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 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 0 hts to the certificate holder in lieu of such endorsements , PRODUCER. C1= Eck ONTACTNANIFPBUI Kagan Agent I FAX Sbtefdf7Tt Paul Kagan Ins and Fin Svs Inc P 562-421-5300 562 6IS SS11 2750 N. Bellflower Blvd Ste 206 E a1AiL aul aull<a pn.00m Long Beach, Ca 9DB15 INSURE S.AFFORDING COVERAGE NAICfI INSURER A: State Farm Mutual Automobile Insurance Com n 25178 INSURED I INSURER B o -. f NSURER C : CC Layne 8 Sans Inc. INSURER D 216 Standard St INSURER E: EI Segundo, Ca 90245-3834 INSURER F. ............. -�.,......,W......,..p'.".47r'R°.tlY'1VM MIIMRFR- THIS IS TO CERTIFY THAT THE POLICIESOFINSURANCE 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 MICH 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 BEENREDUCED BY PAID CLAIMS. LTR TYPEOFINSURAN,'C'E INSD VA'VD'. POLICY NUMBER 'MteaDOVYYYY fir fiDCp�^rYYY LIMITS. COMMERCIAL GENERAL LIABILITY OCCURRENCE 9 M ETE E CLAIMS -MADE 0 OCCUR MED EXP (Any c...,ne p alsc-w) +� PER:SONAL,11ADVINJURY S GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ PRO- ❑ POLICY JECT LOC PRODUCTS-COMPIOPAGG S OTHER.r. C pMEINED SpNGL : L Mp AUTOMOBILE LIABILITY 6681653-012-75 10/12/2022 04/12/2023 %. aOC LY NdtI.VURY T�etl" 8m8pGu ^S 1,D l,GNoo ANYAUTO 6681702-D12-75 10/1212022 Q4/1?J2023 BODILY NNJUrFY (Per etcUeM) 0 $ 1,LOO,ODO A OWNED SCHEDULED Y Y AUTOS ONLY AUTOS HIRED NON -OWNED 6815158-818-75A 08/18/2022 02/18/2023 ,_. s.1.0 AUTOSONLY AUTOS ONLY i ""�'" UMBRELLA LIAR I OCCUR EACH CmCCURRENCE S EXCESS LIAB CLAIh$-MADE AGGREGATE 'S DED RETENTION WORKERS COMPENSATION PET OTH- S ANDEMPLOYERS'LIABILITY ANY PROPRIErOR(PARTNERlEXECUTIVE YIN E.L... 64CH ACCIDENT S .. E.L. DISEASE.-. EA EMPLOYE 5Ut OFFICERIMEMBER EXCLUDED? NIA INdMSlary 1n NH) E:.L.. DISEASE- POLICY LIMIT S... yee, dascxlbs under CraP.I011OF 2 htM DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101. AddNlonel Remarks Schedule, may be atleched If more apace It required) Additional Insured: The City of El Segundo, its officers, officials, employees, agents and Volunteers. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of EI Segundo ACCORDANCE %WITH THE POLICY PROVISIONS. 350 Main Street AUTHARRED REPRESENTATIVE El Segundo, Ca 90245 @ 1988-20ig ACORD CORPORATION. All rights reserved. ACORD 26 (2016103) The ACORD name and logo are registered marks of ACORD 1001486 132849.14 04-132022 AGENCY CUSTOMER ID. LOC #: Act>R ADDITIONAL REMARKS SCHEDULE Page of AGENCY NAMED INSURED Paul Kagan Ins and Fin Sus Inc CC Layne & Sons Inc. POUCY NUMBER 216 Standard St See Below FJ Segundo. Ca 90245-3834 DARNER NAIL CODE State Form Mutual Automobile Insurance Company 25178 EFFECTIVE DATE; 11/1012022 The ACORD name and logo are registered marks of ACORD 1004382 142991.2 07-26-2021 page 1 of 1 Automobile liability Policy Number: 6681653-D12-75 668 1702-D12-75 6815158-1318-75A NAMED INSURED: SR MAINTENANCE & MANAGEMENT SERVICES INC. WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS All operations performed by CC LAYNE & SONS INC. the current policy period project: Additional Insured: The City of El Segundo its officers, officials, employees, agents and volunteers This insurance is primary and non-contributory with respects to claims arising out of the operation of the described vehicle. 6196A.1 5 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 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 2% of the California workers' compensation premium otherwise due on such remuneration. SCHEDULE PERSON OR ORGANIZATION JOB DESCRIPTION ANY PERSON OR ORGANIZATION FOR WHOM THE BLANKET WAIVER OF SUBROGATION NAMED INSURED HAS AGREED BY WRITTEN CONTRACT TO FURNISH THIS WAIVER This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective: 02/01/2023 Insured: Cc Layne & Sons Inc. Policy No. 7600024105231 Endorsement No. 001 Premium $ INCL. Insurance Company: Everest Premier Insurance Company Countersigned By: -1998 by the Workers' Compensation Insurance Rating Bureau of California. All rights reserved. From the WCIRB's California Workers' Compensation Insurance Forms Manual -1999.