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PROOF OF INSURANCE (2023) CLOSEDO �® ACC� �V/CERTIFICATE OF LIABILITY INSURANCE DATE /YYYY) 02/24/2023/2023 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 endorsement(s). PRODUCER ""Marsh USA, Inc. 501 Merritt 7 CONTACT NAME: PHONE FAX A/c No Ext : A/C No): E-MAIL ADDRESS: Norwalk, CT 06856-0770 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Starr Indemnity & Liability Company 38318 CN 133249025-Trini-GAWU-22-23 X INSURED TRITON WATER HOLDINGS, INC. INSURER B : Starr Specialty Insurance Company 38318 INSURERC: BLUETRITON BRANDS, INC. INSURER D 900 LONG RIDGE RD STAMFORD, CT 06902 INSURER E INSURER F : COVERAGES CERTIFICATE NUMBER: NYC-011075505-24 REVISION NUMBER: 12 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 LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICYNUMBER POLICY EFF MM/DD POLICY EXP MM/DD LIMITS A X COMMERCIAL GENERAL LIABILITY 1000100162221 03/31/2022 03/31/2023 EACH OCCURRENCE $ 2,000,000 CLAIMS -MADE 1OCCUR DAMAGE PREM SESOEa oocur ence $ 1,000,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ 4,000,000 POLICY ❑PRO JECT ❑ LOC X PRODUCTS - COMP/OP AGG $ 4,000,000 $ OTHER: A AUTOMOBILE LIABILITY 1000639318221 (AOS) 03/31/2022 03/31/2023 COEaMBINED ident SINGLE LIMIT acc $ 5,OOQ000 A ANY AUTO 1000639319221 (MA) 03/31/2022 03/31/2023 X BODILY INJURY (Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY X UMBRELLALIAB X OCCUR 1000589671211 03/31/2022 03/31/2023 EACH OCCURRENCE $ 10,000,000 AGGREGATE $ 10,000,000 EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ B B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N ANYPROPRIETOR/PARTN ER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N /'�` 100 0004563 (AOS) 1000004564 (AZ, CT, IA, NJ, NY, NC, TX) 03/31/2022 03/31/2022 03/31/2023 03/31/2023 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 A If yes, describe under DESCRIPTION OF OPERATIONS below 100 0004565 (FL) 03/31/2022 03/31/2023 E.L. DISEASE - POLICY LIMIT 1,000,000 $ B WORKERS COMPENSATION 100 0004566 (WI, MA) 03/31/2022 03/31/2023 LIMITS SEE ABOVE CONTINUED DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) City of El Segundo is included as additional insured (except workers compensation) where required by written contract. Waiver of Subrogation is applicable where required by written contract. CERTIFICATE HOLDER CANCELLATION City of El Segundo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Attn: Maria Cerritos THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 350 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. El Segundo, CA 90245 AUTHORIZED REPRESENTATIVE © 1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD IK Starrlindemility, & Liability Conipany COMMERCIAL AUTO SICA-1020 (091::9) THIS ENDORSEMENTCHANGES THE IPOLICY. IPLIEASIE IRIEAD ITCAREFULLY. 9 W 0 1 W IWO 19 6=4 AWA 11,1110, IL "M 1 _6 1:4 "L4M J[Qt1 &W'VI a 1 0 Jjj :1 &1jTfAj . j 26111M]"LOWC13111019ii F11 �T & ] Policy Number: 1000639318221 Named Insured: Triton Water Holdings, Inc. Effective Date: 3/31/2022 This endorsement modifies the insurance coverage form(s) listed below that have been purchased by you and evidenced as such on the Declarations page. Please read the endorsement and respective policy(ies) carefully. AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM A. It is hereby agree that SECTION IV — BUSINESS AUTO CONDITIONS, A. Loss Conditions, 5. Transfer Of Rights Of Recovery Against Others To Us of the Business Auto Coverage Form, and SECTION V — MOTOR CARRIER CONDITIONS, A. Loss Conditions, 5. Transfer Of Rights Of Recovery Against Others To Us of the Motor Carrier Coverage Form are deleted in their entirety and replaced with the following: If any person or organization to or for whom we make payment under this Coverage Form has rights to recover damages from another, those rights are transferred to us. That person or organization must do everything necessary to secure our rights and must do nothing after "accident"' or "loss" to impair them. However, we waive any right of recovery we may have against any person or organization to the extent required of you by a written 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. B. It is hereby agreed that SECTION IV — CONDITIONS„ A. Loss Conditions, 5. Transfer Of Rights Of Recovery Against Others To Us of the Auto Dealers Coverage Form is deleted in its entirety and replaced by the following: If any person or organization to or for whom we make payment under this Coverage Form has rights to recover damages from another, those rights are transferred to us. That person or organization must do everything necessary to secure our rights and must do nothing after "accident" or "loss" to impair them. However, we waive any right of recovery we may have against any person or organization to the extent required of you by a written 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. This condition does not apply to damages under Paragraph C. Locations And Operations Medical Payments Coverage of Section 11 — General Liability Coverages. All other terms and conditions of this Policy remain unchanged. SICA-1020 (0919) Copyright 9 Starr Indemnity & Liability Company. All rights reserved. Page I of I Includes copyrighted material of Insurance Services Office, Inc., with its permission. POLICY NUMBER: 1000100162221 COMMERCIAL GENERAL LIABILITY CG 24 04 12 19 10 0 Z I BIG] *1 :1 iyi 1:1,1, 1 KM 0. Z Eel *a 0 0 1:8:1011 Dym;j 4 41M A :4:F-,l Rj III Ill 0:1 a 1] 4• A L 20MOM This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART ELECTRONIC DATA LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART DESIGNATED SITES POLLUTION LIABILITY LIMITED COVERAGE PART DESIGNATED SITES PRODUCT S/COM PLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART UNDERGROUND STORAGE TANK POLICY DESIGNATED TANKS SCHEDULE Name Of Person(s) Or Orgianizationi(s): Any person or organization to whom you become obligated to waive your rights of recovery against, under any contract or agreement you enter into prior to the occurrence of loss. I Information required to complete this Schedule, if not shown above, will be shown in the Declarations. I The following is added to Paragraph S. Transfer Of Rigihts Of Recovery Against Others To Us of Section: IV — Conditions: We waive any right of recovery against the person(s), or organization(s) shown in the Schedule above because of payments we make under this Coverage Part. Such waiver by us applies only to the extent that the insured has waived its right of recovery against such person(s) or organization(s) prior to loss. This endorsement applies only to the person(s) or organization(s) shown in the Schedule above. CG 24 04 12 19 @ Insurance Services Office, Inc., 2018 Page 1 of 1 Issuing Starr Company A Member of Starr Companies Dallas, TX 1-866-519-2522 We agree to give thirty (30) days' notice of cancellation to the following certificate holder(s) in the event that we cancel the policy for any reason other than non-payment of premium: SCHIIEDULE Any certificate holders a nid or organiizationis where required by contract We will endeavor to provide advice of cancellation (the "Advice") to the certificate holders listed in the schedule by e-mail. Certificate holders include only those entities for which thirty (30) days' notice of cancellation is required by an "insured contract" but only with respect to an entity for which you are directly or indirectly performing your work. This advance notification of a pending cancellation of coverage is intended as a courtesy only. Our failure to provide such Advice will neither extend the policy cancellation nor negate cancellation of the policy; nor will such failure result in obligation or liability of any kind upon us, our agents or representatives. This endorsement does not affect, in any way, coverage provided under this policy, the cancellation of this policy or the effective date of cancellation. 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: 3-31-2022 Policy No.: 100 0004564 Endorsement No.: Insured: Triton Water Holdings, Inc. Premium: Insurance Company: Starr Specialty Insurance Co. Countersigned by: WC 99 06 1!8 Pagie I of I (Ed. 4-15) Copyright Starr Indemnity & Liability Company. All rights reserved.