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PROOF OF INSURANCE (2023 - 2024) CLOSED.✓ KRAUACT-01 LORALEEBARLOWBOYES
A CERTIFICATE OF LIABILITY INSURANCE DATE(MM/D2�)
...........�._............._-2 ......._
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 CONTACT _
NAME;
NFP Prope & Casualty Services, Inc. PHONE N5550 fiF 714 975-8966
1551 Nort,h7ustln Avenue (.• .,-q Ext:.�4� 505-N°I-...,.
ac 1.... ....
Suite 500 AE IkMAI PR
s
Santa Ana, CA 92705
INStIRER(S�AFFORDING COVERAGE _ � �NAIC #
INS,URERA COI Insurance Company 39993
INSURED Krause ACT, Inc. DBA Air CleaningTechnology � INsuRER c C ress Insurance Com�an� __ 10855
9Y___-__ - ----- -----
411 Rowland Ave ..INSURER ps........................................................................................................... � ,,,,,,,_, � ,,,_,_,_,..
Santa Ana, CA 92707
INSURER E
........ ......
INSURER F r
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.
.._ .� m....m.............. — .. ".".".......
IN5R ADDL-SUBR".. POLICY EFF POLICY EXP
T TYPE OF INSURANCE IN • IA POLICY NUMBER LIMITS
A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
CLAIMS -MADE X occuR xPACE4245133114 3/7/2023 3/7/2024
DAMAGE TO RENTED 100,000
MED EXP Any one perspn.. $...-,,.-.-.. m__
50,000
PERSONALBADVINJURY $ 1,000,000
Gr,N'IL AGGREGATE LIMIT APPLIES PER: $ GENERAL AGGREGAT_
E
2,000,000
�� ,actor � LOC PRODUCTS COMP/O,PAGG 8
2 000,000
OTF9EI�'
...._
$
COMBINED SINGLE LIMIT
AUTOMOBILE LIABILITY
ANY AUTO L
OWNED SCHEDULED
AUTOS ONLY AUTOS
AUTOS ONLY NON-OWNED
SPROPFRTY DA'Ia4AGlr•'.: --
PercirlYnk,� ---- -------------- $
.._. ._." ..__._.._.._.�._._ $
A UMBRELLA LIAB X OCCUR AGGREGATERRENCE$ 10 000 00
X DEDEETENTION $mm CLAIMS - MADE EXC424513R4 3/7/2023 3/7/2024 10,000,000
B WORKERAND EMPSO ERSELIA ILIITYSATION X PER ,ST TI-ITE ----..... .. O
ANY PROPRIETOR/PARTNERIEXECUTIVE ("""" X KRWC422876 1/1I2023 1/112024 EACH ACCIDENT OTH $ OOO OOO
`YIN
OFFICER/MEMBER EXCLUDED? NIA $ 1
(Mandatory ) E L DISEASE EA EMPLOYEE '
Mandato m N
If yes, describe under 1,000,000
DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY OLICY LIMIT $.............
'
A Pollution Prof Liab PACE4245133114 317/2023 3/712024 Limit 1,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
RE: El Segundo Fire Department, 314 Main Street, El Segundo, CA 90245.
The City of El Segundo is included as Additional Insured with regard to General Liability per attached forms EPACE100-0814 & EPACE101-0814. Waiver of
Subrogation applies to Workers' Compensation per attached form WC990410C.
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City of El Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Y 9 ACCORDANCE WITH THE POLICY PROVISIONS.
350 Main Street
El Segundo, CA 90245 �—
AUTHORIZED RI�jREPRESENTATIVE
........ I __. _. ---....................................................................................... V"`•
ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
POLICY NUMBER: PACE4245133R4
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
0 E -*J*; I s 0 1 Wa-
This endorsement modifies insurance provided under the following:
EnviroPACE Insurance Policy
SCHEDULE
Name Of Additional Insured Person(s)
Or Oraanization(s) I Location(s) Of Covered Operations
Where Required By Written Contract I Where Required By Written Contract
A. Section XX. WHO IS AN INSURED, Coverage Part 1 and Part 2 is amended to include as an
additional insured the person(s) or organization(s) shown in the SCHEDULE above, but only with
respect to liability for bodily injury, property damage, personal and advertising injury,
environmental damage, or cleanup costs 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.
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 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.
EPACE101-0814 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 2
with its permission.
C. With respect to the insurance afforded to these additional insureds, the following is added to section
XXI. LIMITS OF LIABILITY AND DEDUCTIBLE:
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 Liability shown in the Declarations;
whichever is less.
This endorsement shall not increase the applicable Limits of Liability shown in the Declarations.
ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED.
EPACE101-0814 Includes copyrighted material of Insurance Services Office, Inc., Page 2 of 2
with its permission.
POLICY NUMBER: PACE4245133R4
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
K*J 9 1 go, Y.A I tri" Lei 4901 J, I :J 4 =1 9 =1 is 1101 :J =1 0
This endorsement modifies insurance provided under the following:
EnviroPACF Insurance Policy
SCHEDULE
Name Of Additional Insured Person(s) Location And Description Of Completed
Or Organization(s) Operations
Where Required By Written Contract Where Required By Written Contract
A. Section XX. WHO IS AN INSURED, Coverage Part 1 and Part 2 is amended to include as an
additional insured the person(s) or organization(s) shown in the SCHEDULE above, but only with
respect to liability for bodily injury, property damage, environmental damage, or cleanup costs
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
XXI. LIMITS OF LIABILITY AND DEDUCTIBLE:
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 Liability shown in the Declarations;
whichever is less.
This endorsement shall not increase the applicable Limits of Liability shown in the Declarations.
ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED.
EPACE100-0814 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 1
with its permission.
` 0 DATE (MM/DD/YYYY)
ACCOR" CERTIFICATE OF LIABILITY INSURANCE 03/20/2023
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 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 I P!qACTKathyPerry
Dan Rickabus
Stat0brm State Farm Insurance
30131 Town Center Drive, Suite 275
Laguna Niguel, CA 92677
INSURED Krause A C T
DBA Air Cleaning Technology
411 Rowland Ave
Santa Ana, CA 927073445
949-363-7100 ...................
.a , No) 949 363 1836
i tetarm corn katherine perry.Ntffsts
State Farm Mutual Automobile _ INSURER(S) AFFORDING COVERAGE _NAIC p
obile Insurance Co _
k: Company 25178
rn%1C0An-1=¢ r1=0TIVI1 ATl= Kill IMRt=R• RFVISIAN NIIMRFR-
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.
.. ...............
;SU`9k..._.._._ ..."........
ItNTNt IN DL
pCb N �"Y' E�FF POLICY EXfA
TYPE OF INSURANCE...........
WVD POLICY NUMBER
fMM1DD1YYYY1 IMMIDOM`Y"LIMITS
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
� $
_.... .,, ..
. .-.. CLAIMS -MADE ..J OCCUR
_,PREM SE$-jEa ou
... .... r .....
MED EX .
PERSONAL & ADV INJURY
..........'. $
GEN L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$
_ (vPRO
FOk8sY IECT IC
PRODUCTS.. COMP/OPAGG
$ .......,_
OTHER
t$
A
AUTOMOBILE LIABILITY
Y
545 8874-001-75
03/01/2023
09/01/2023
COMBINED SINGLE LIMq
_(a�ccidaatr� ...
$ 1,000,000
X ANY AUTO
BODILY INJURY (Per person)
$
X ALL OWNED �SCHEDULED
BODILY INJURY (Per accident)
$
AUTOS , AUTOS
545 1763-001-75
03/01/2023
09/01/2023
— -
„
_
X .HIRED AUTOS NON -OWNED
_ Auros
497 1093-001-75
03/01/2023
09/01/2023
PP&�0PER `�k M'AG'E
._C� __
$ ..
$
'.. UMBRELLA LIAB
........... a ...,.. OCCUR
EACH OCCURRENCE
..$...... _. ...,.
'.. EXCESS LIAB CLAIMS -MADE
--- ,... ....,._.rr_,,. .__
AGGREGATE
....... ......... .. ...
$
DED 'RETENTION $
$...........
WORKERS COMPENSATION
PER OTH
UTE„ �,,, FAR
ANY PROPRIETOR/PARTNER/EXECUTIVE AND ABILITY Y / N
N I A
,w,,,,,,
E L EACH ACCIDENT
„-,-
r
$
OFFICERIMEMBER EXCLUDED?
(Mandatory in NH)
PLOYEEj
EmmL. DISEASE - EA EM m
$
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
A BNOL Y 507 2152-001-75
,
03/01/2023 09/01/2023 $250 Physical Damage deductible
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
City of EI Segundo, its officials and employees are named additional insured
Location: El Segundo Fire Department
Illillw,, •; twaI.Nroi:fmw�lbdT*T
El Segundo Fire Department
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
350 Main St
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
El Segundo, CA 90245
ACCORDANCE WITH THE POLICY PROVISIONS.
f
AUTHORIZED REPRESENTATIVE
U 1988-2014 AGORD GORPORATION. All rights reserved.
ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD 1001486 132849.9 02-04-2014
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY
WC 99 04 10 C
(Ed. 01-19)
WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT-CALIFORNIA
BLANKET BASIS
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.)
The additional premium for this endorsement shall be calculated by applying a factor of 2% to the total manual
premium, with a minimum initial charge of $350, then applying all other pricing factors for the policy to this calculated
charge to derive the final cost of this endorsement.
This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule.
Schedule
Blanket Waiver
Person/Organization Blanket Waiver — Any person or organization for whom the Named Insured has
agreed by written contract to furnish this waiver.
Job Description Waiver Premium (prior to adjustments)
All CA Operations 2036.00
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: 01/01/2023 PolicyNo.: KRWC422876 Endorsement No.
Insured: Premium $
Insurance Company: Cypress Insurance Company
Countersigned by
WC 99 04 10 C
(Ed. 01-19)