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PROOF OF INSURANCE (2023 - 2023) CLOSEDAC,AMj DATE �MIVUIDWYY) ,0 rIFICA T E 01�I 1AB111 IITYINSUF ANGE......, 1 ()rl2 712022 C ------ - - ---------- .. .... ......... .... .. ....... - PRODUCER,,,,... .... . . .... ............ . . . . . . . . ........................... ...... . . .... .......... THIS--CE'iffIF—I,CAfEii iiSDAS A MATTER OF INFORMATION FIRS I C11`-.:I1 I UR:Y MURANCIE SERV�Cli: ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. — — — — — -------- I'll V; I VI () ku, M VD K, I du TA INSURERS AFFORDING COVERAGE COMPANY NSUIR111D INSURER A. COLONYINSURANCE — PARDESS AIR INC INSURFR R, STARS TONE NATIONAL INSURANCECOMPANY 1769 KELN AVE INSURER C LOS ANGELES, CA 90024 INSWLk 1: COVERAGES . . . . . . . . .......... 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 AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS NSR TYPE OF INSURANCE POLICY NUMBER L— POLICY EFFECTIVE POLICY EXPIRA71ON 'Lim LIMITS _uAl — ---- — ---- --- --- GENERAL LIABILITY s 1,000,0w A X 1 CU 01MMERAL G11 NERAL I MMLJ Vy 600 GIL 0006696-14 10127/2022 10/27/2023 F flRE DAMAGE Wiy orm Nr%,l $ 300, 0: 00 U.AIMS MADE X I OCCUR EXP4Any 0 1 "Ope'T'040 $ 5,000 PFRSONAIL & ADV INJURY , 1,0100,000 2,OGO,000 GENERAL AGGIREGKTE , 1,000,,0100 GEN1. AGGRII::.GAII E. LIMIT APPLES PER- 1 PRODUCTS COMPiOPAG $ x IG7gYCY LOC AUTOMOBILE LIABILITY COMBINED "SING I.E [AW IEa acf Ided) ANYAU T ALL OWNS. D AD � CO3 SOMLY INJURY $ SCHEDULEDAUJOS (�,& HIRED AU TGS BOO ILY INJURY NON OWNED AUTOS PROM R TY DAMAGE (Fleii �cddclrfty ....... . . ...... GARAGE LIABILITY ANY AUT 0 1 AAC S AU � 0 ONLY EXCESS LIABILITY B X ACH Q�cT JRRIE NCE 3 000 00 000- OCCUR CLAWS MAD" 71232M221ALI 10/27/2022 10/27/2023 DEDUCTIBLE R� F11 NflON - — ---- ............... . . .. . . . . . . . ............. ... ----- . . . . ..... . .......... I r) WORKERS COMPENSATION AND T4,I��Y jjv�P-,', � I, EMPLOYERS' LIABILITY E I. EACHACCIDENT .)R,IEAPfl­ - F,A EMWI'-OYfi� 'y 0', --------------- .... . . ................... ... . ....... ............... ...... ....... OTHER - -------- - ----------- - - - ------ - . ........... . . ............. ---------- ---------- ............ AIFAGHID,(X',O 1012'119,C(3�2001 L2 19,20�'11� 19 Te Ghl0e� Unl qilJcTalent ... ......... . . ................. . . . 9 G E IAA 0 1', AYS' 1: 0 R 1',J (l1", 1 P P, C, . . .... . -- - -- ----- — ----- - CERTIFICATE HOLDER AUffIFN0NfU INSIIVI't) INSURER, L.I[..l JER� GI rl( (,i� I. 11 ISI IV III C 3�50 I14MN S III11 1: 1 F—I 1E(,1JN1)0, �'/\ 9T245 CANCELLATION - — - — --- ----------------- — - — --- — ----------- --- . ....... — . .. . .. ........... . S1 �CA I A ANY �)11 � � � � A� 3 0,,' DI .SCIH I B I lot Ii:.[ li S UE t 0, N(,l 11 11 11 ! 1: D FOI7,V V lfl:: F X1IIIA V ION I. JA I OI H 11 FAT', 1111 Y 133ING I Nb I pH:LO Wh P W J 11Y TO I�LAII I ' 30 DAY", %Nll� 1 11 FN NO I ICF I'( I 1 11 C 1:::: R 1 III I �;A Y 1; 11 0A - I', NA Il� 1: TO 11 1: 1 EI::T I-M 11 AN O W1 tl 0 t 9D N "11 OU IVT0711- NO OBI 11�111'�NON OR 11 A0111 Fir OF ANY KIINLJ� I Uqq q 01011 R, W; AiI', II 1411', PA� W: I'RLr III Allf V I tlONIVI 1) H 1! PIU-11 N 11 Ik I C OR ID 25JC� 7 9 7 7� J),COI['010RATION 1988 COMMER0AL GENERAL.... I.....IABILIITY CG 20 01 12 19 +-I I S IE NIE)R S IIE1°,E 111 IIEo;;E' IF C' III...I A G E;; S ..T.III° IE HE" IP EI.....IE . Y „ R11..,,,, IIE°;E AS E READ 11 A IIE .EF-1111,,,,.III..... Y. C 1 RIBUTORY INSURANCE CONDI This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is, added to the Other Insurance Condition and supersedes any provision to the co ntra ry: Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and (2) You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. CG 20 01 12 't ,,) Ilnsi ii inf:x� Sc�rv�es `,W`ice 911.,I(-, , ') 1,8 Page 't of 1 POLICY NUMBER: 600 G� 0006696-14 C0MK1:::::]RCJA1 G1::.::.:]VE'RAI I 1ABILYTY CG 20 10 12 19 TIHIS ENE. )0R&EME:.:]1'qT C! iANG1::.::.::3 THE III,,,.ICY IRIL.1E.ASE IIREA113 ITC AIREFLILI Y. ADDITIONAL INSURED - OWNERS, LESSEES OR i CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION A. Section 11 — Who Is An Insured is amended include as an additional insured the person(s) organization(s) shown in the Schedule, but on with respect to liability for "bodily injury", "prope damage" or "personal and advertising injur caused, in whole or in part, by: r r 1. Your acts or omissions; or 2. The acts or omissions of those acting on yo behalf; in the performance of your ongoing operations f 1`0 the additional insured(s) at the location( designated above. W IM"IMM 1. The insurance afforded to such additional insured only applies to the extent permitted by and 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 tv, 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. CG 20 10 112 19 (c) Iausum�wcic Officc, Vniu , ,10VFlIage 1 of 2 C. 01) iiesp ct to than ir-tsurance afforded to these add t.io nall insureds, the ffaaflowa ng is added to ecdoin 11111 ........ Limits Of Ilinsur rme ffff coverage 1prezvWead to they addit'uonM irn ured is required by a contract or, agreement, t1he rrnost we Will pay on behalf of the ad'atituu nal rurnsurd is the aMOUnt of irnsuairan e 1. URequired Idy tlh�- ce)iritrict air gireeii'verirntx air 2. AvaNRaWe under the aplpfic We Ilimis of insurance; wHche ver its IIe s s.. TNs endorsement haH not increase the appVr allAe ftks of insurance.. �m�te� ruu" Ilu,.0 nnirAirue,ar7 ',u�a office. lune:� 0p8CG 20 10 12 19 COKIMERC�Ai GENERAL[AKUIJI-FY CG 20 11 12 19 �����0�N����N N��������������������� m������m mm��m����� mm�����m��� m�m��w�������m��� ��m� This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designation Of Premises (Part Leased To You): All locations which are afforded coverage under this policy. Name Of Person(s) Or Organization(s) (Additional Insured): As required by written contract with the Named Insured that is executed by the parties to the contract prior to the commencement of work that is called for in the contract. i Additional Premium: Included Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section 11 — Who Is An Unommod is amended to 2. If coverage pruvidedtothe additional insured in include as an additional insured the person(s) or required by a contract, or agreement, the organization(s) shown in the Schedule, but only insurance afforded to such additional insured with respect to liability for"bodily injury", "property will not be broader than that which you are damage" or "personal and advertising injury" required by the contract or agreement to caused, in whole or in part, by you or those acting provide for such additional insured. on your behalf in connection with the ownership, B. With respect to the insurance afforded to these maintenance or use of that part of the Ar»min*u additional inaurado, the following is added to leased to you and shown in the Schedule and Section Ill — Limits OfInsurance: subject tothe following additional exclusions: If coverage provided to the additional insured is This insurance does not apply to: required by a contract or agreement, the most we 1. Any "occurrence" which takes p|noo after you will pay on behalf ofthe additional insured is the cease toboatenant inthat premises. amount ufinsurance: 2' Structural a|terationn, new construction or 1. Required bythe contract oragreement; or demolition operations performed by or on 2. Available under the applicable limits of behalf of the person(s) or organization(s) insurance; shown inthe Schedule. whichever inless. Hovvavac This endorsement uho|| not increase the 1' The insurance afforded to such additional applicable limits ofinsurance. insured only applies tothe extent permitted by 1`10� ICY NL.&8BEIR-�: 600 GL0006696-14 COMMERCIA1 G1:..:.NE1:RA1.. I_JABI� ITY CG 20 371219 ����������������I N����N N������ �� �����������N� N ������������ ���� �����mmm��m���� mm���m��� v���u��m��� �������� ��m� CON r'RAC rORS COMPNETE! ) OPE11A I IONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTSICOMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations As required bywritten contract with the Named Insured All locations which are afforded coverage under this policy. that is executed by the parties to the contract prior to the commencement of work that is called for in the Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section |U —VVho Is An Insured is amended to B. With respect to the insurance afforded to those include uoair�addhiona| insured the rson(a)nr additional insumda, the f6Uowino—is: added to organizaUon(s)shown inthe Schedule, but only SecMonQA—LinoiteQfVnsuronce: with respect to liability for "bodily injury" or If coverage provided to the additional insured is "property damage" caused, in whole orin Part, by required by u contract or agroomant, the most we "your work"' at the location designated and will pay on behalf ofthe additional insured is the described in the Schedule ofthis endorsement amount ofinsurance: performed for that additional insured and imduded inthe"produc�-oomp|e�odnpesdionaha����� 1 Roquir*dbythecontran�oragreemontor ' � However: � 2' Available under the applicable limits of 1' The insurance afforded to such additional insurance-, vvhiuhovariu|euoedby insured only applies hothe extent permiM . law; and This endorsement shall not increase the 2. �coverage provided tothe addiUona|insured iu |imi�sofinouranoe applicable . required by a contract o/ agroemont, the insurance afforded tosuch additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. PARDAIR-01 IMA rl CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 12/14/2022 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(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 endorsements). PRODUCER License # OC36861 _ CONTACT Christina M MOuntZ Inland Empire-Alliant Insurance Services, Inc. PP ONE FAX 665 E, Carne le Dr Ste 266 JAlc No Ext): (909) 886-9861 m ____ _yKgc nlor(909) 886 2013 San iBernard no, CA 92406 �9 63 cmourt� ll�ent.cor ..._. ................. INSURED .INSURER B ; Pardess Air, Inc. INSURER C; 1769 Kelton Ave INSURER D : LosAngeles, CA 90024 INSURERW..;._........m..m_...m..m..m.............._..........m..,..,....,................................................................._........._ . .__.. 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 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 ................... ......... TM_E OF INSURANCE.............__... ................ ADDL SDBR. POLICY EFF POLICY EXP P POLICY NUMBER �.a LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ .. ..3..I EN-..,,.....,..m...em... O RENTED T CLAIMS -MADE OCCUR DA P 41�F� '.. $ ..MEAL txPP ?x.. a Pers�nd..........i:..._-, ..�r... ,.m.. n. PERSONAL 8 AOV INJURY $ GENLAfrfaREGAT'E LIMIT APPLIES PER: GENERAL 4GGREGATE $ _. AGG $ POLICY E� JELO� LOC PRODCCTS COMP(OP„ OThiER" $ AUTOMOBILE LIABILITY CEOMBkN q SINGLE LIMIT $ ANY AUTO BODILY INJURY (Per person _S OWNED SCHEDULED AUTOS ONLY AUT��ggO��Syy ��pp BODILY INJURY Per axident $ AUTOS ONLY AURdO`.�`TE9 RE�ecO r 'arot AMAGE $ i UMBRELLA LIAB OCCUR I EACH OC RRENCE $ .,_..._v, _ ...... EXCESS UAB CLAIMS -MADE AGGREGATE a......... DED RETENTION$.._ ........ ..._..�._,.., ........---- ., _.,.-... A WORKERS COMPENSATION X PER OTH ANY PROPRIETORIPARTNER/F�CECUTIVE X V9WC395764 12/1/2022 12/1/2023 E TAT�I7. ER AND EMPLOYERS' LIABILITY Y t N OFFICER/MEMBER EXCLUDED? NIA ,.;,L EACH ACCIDENT $ 1,000,000 (Mandatory in NH) E..L. DISEASE - EA EMPLOYEE $ ..�1,000,000 DESCRIPTION describe under OPERATIONS below E,LmDISEASE ._ . _. _ _.. m m....._m. DISEASE -POLICY LIMIT $ 1,000,000' WDESCRIPTION OF OPERATIONS I LOCAT1IONS P VEHICLES (ACORD ttlt,. Additional Remarks Schediaeles rrw.. be attached if more space is required) aiver of subrogation as respects to Workers' compensation per endorsement atta,c�ied. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of El Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN tY 9 ACCORDANCE WITH THE POLICY PROVISIONS. Public Works Department 350 Main Street El Segundo, CA 90245 AUTHORIZED REPRESENTATAIE ..... ......... .._. .. ..... ._._. _...�. . ACORD 25 (2016103) ©1988-2016 ACORD CORPORATION. All rights reserved„ The ACORD name and logo are registered marks of ACORD WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 4-84) 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 1,•03 _% of the California workers' compensation premium otherwise due on such remuneration. Schedule Person or Organization Job Description Blanket Waiver - Any person or organization for whom the All CA Operations 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 12/01/2022 Policy No. V9WC395764 Endorsement No. 0 Insured Insurance Company GUARD Insurance Group PARDESS AIR INC Countersigned By 01998 by the Workers' Compensation Insurance Rating Bureau of California. All rights reserved.