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PROOF OF INSURANCE (2023 - 2023) CLOSEDClient#: 1291580 04CORRACON DATE (MM/DD/YYYY) ACORDTM CERTIFICATE OF LIABILITY INSURANCE 112/22/2022 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 ADD..........._..... AL INSURED, the olic les must a �....�.....................isi..s ' ADDITION p y(' ) have ve 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACI NE: Commercial Client Center 888-743-2217 McGriff Insurance Services PHONE N8888279861888 171am_ 7701 Airport Center Dr E-MAIL ClientServiceCenter@mcgriff.com Suite 1800 INSURER(S) AFFORDING COVERAGE NAIC # Greensboro, NC 27409 INSURER Evanston Insurance Company 35378mm ........................ _........................._........ INSURED INSURER B : State Compensation Ins. Fund of CA 35076 Corral Construction & Development Inc ................__......_ ..... ........... ..__ INSURER G : Ohio Security Insurance Company 24082 5211 E. Washington Blvd. #2-122 _INSURER D.. ... ................. Commerce, CA 90040 INSURER E INSURER F : COVERAGES 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 CONTRACTOR 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 ...NCE ADD tBR� POLICY NUMBE PO�ICY EFF POLICY EXP LIMITS TYPE OF INSURANCE LA . COMMERCIAL GENERAL LIABILITY IN- 3AA624285 121� D[d/Y02 �r�A;dt18l 81202 8 �.y ..... ........�..,.,�., R , ,.. _ .,.__..,. 2/08I2022 12/0$/202 EACH OCCURRENCE $1,000 000 .... CLAIMS -MADE �X Ea_ ... ,_....- _4ESO RENTED DAMAGE T occuR PREMI,_ ..�..._�,�G�,rr�n�e $100 000 ______________ MED EXP(Any one person) $ 5r000 AL & ADV INJURY $1,000,000 .. PERSON .,.........._. ...... POLICY - — 000 000 GATE LIMIT APPLIES PER GENERALAGGREGATE $2, , GEN L AGGREGATE �}� „„„„„„_V ECT � LOC PRODUCTS -COMP/OP AGG $2,000000 OTHER _ $ ._...................................__�........ 6--.................................._..,.,.....� �._. AUTOMOBILE LIABILITY G'OMIStlNEO'ndNGLc L6i@XT C BAS57476683 12/0812022' 12/08/202 �� � adent� � mmm 1,000.000 ANY AUTO BODILY INJURY (Per person) $ ....._. I _ w.w.-. ........................m„-,.� OWNED SCHEDULED _ BODILY INJURY (Per accident) $,m,m,m, AUTOS ONLY AUTOS HIRED NON -OWNED PROPERTY DAMAGE AUTOS ONLY X AUTOS ONLY Reraccide�) . .... $..,W. ........ .... A I OOCCUR-MADE......... EZXS3098858 12108/202.... ---. �... ... .. AGGREGATE $3 A UMBRELLA LIAB rOOO, O ' ...................,....„.„„.. � EXCESS LIAB......................�.�.�,.�............--_.------- A OCCURRENCE $ DEO..,��11. �� 0 BESA _........... ......... 903611821 12/01/2 PER _ RETENTION $ WORKERS COMPENSATION 022 12/01/2O2 mX PER OTH AND EMPLOYERS' LIABILITY � ._. IAILITE 'ER""- ANY (Mandatory in BER EXCLUDED' E L DISEASE H ACCIDENT $1 OOO OOO OFFICEOPRIET ER EXCLUDEDE N / A EA EMPLOYEE,$1 000,000 w If yes, describe under TIONI m ^ mmm W DESGRIPmOF OPERATIONS below -, .. ._..�- ... IE.L. DISEASE - POLICY LIMIT $1 000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) ** General Liability Information ** Job#: 1 Job#: 2 Job#: 4 ** Workers Comp Information ** (See Attached Descriptions) City of El Segundo 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 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) 1 of 2 The ACORD name and logo are registered marks of ACORD #S31261558/M31260621 HOTU DESCRIPTIONS (Continued from Page 1) Proprietors/Partners/Executive Officers/Members Excluded: Ernesto Corral, President Renee Soto, Vice -President ** Supplemental Name ** First Supplemental Name applies to all policies - Doing Business As: Corral Construction & Development Inc License # 928805 City of El Segundo, it's officials & employees are included as insureds with respect to general liability as required by written contract. Primary wording applies. Waiver of subrogation applies to general liability & to Workers Compensation per endorsement ordered & to follow. SAGITTA 25.3 (2016/03) 2 of 2 #S31261558/M31260621 ENDORSEMENT AGREEMENT W&TVBR OF SUBROGATION REP 04 9036118-2022 RENEWAL SP 2-83-35-91 PAGE 1 HOME OfFICE EFFECTIVE JANUARY 3, 2023 AT 12.01 A.M. SAN FRANCISCO AND EXPIRING DECEMBER 1, 2023 AT 12.01 A.M. ALL EFFECTIVE OAT7ES ARE AT 12:01 AM PACIFIC STANDARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME CORRAL CONSTRUCTION & DEVELOPMENT INC 5211 E WASH BLVD STE 2-122 COMMERCE, CA 90040 ANYTHING IN THIS POLICY TO THE CONTRARY NOTWITHSTANDING, IT IS AGREED THAT THE STATE COMPENSATION INSURANCE FUND WAIVES ANY RIGHT OF SUBROGATION AGAINST, CITY OF EL SEGUNDO WHICH MIGHT ARISE BY REASON OF ANY PAYMENT UNDER THIS POLICY INCONNECTION WITH WORK PERFORMED BY, CORRAL CONSTRUCTION & DEVELOPMENT INC IT IS FURTHER AGREED THAT THE INSURED SHALL MAINTAIN PAYROLL RECORDS ACCURATELY SEGREGATING THE REMUNERATION OF EMPLOYEES WHILE ENGAGED IN WORK FOR THE ABOVE EMPLOYER. IT IS FURTHER AGREED THAT PREMIUM ON THE EARNINGS OF SUCH EMPLOYEES SHALL BE INCREASED BY 03%. NOTHING IN THIS ENDORSEMENT CONTAINED SHALL HE 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 ON LIMITATIONS OF THIS ENDORSEMENT, COUNTERSIGNED AND ISSUED AT SAID FRANCtSCO_ JANUARY 27, 2023 2570 AI'f4iR121 l7 IEPRESE IVE' PRESIDENT AND CEO SCIF FORM IG217 MEv.7-2w.4) OLD OF 237