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PROOF OF INSURANCE (2023 - 2023) CLOSEDCERTIFICATE OF LIABILITY INSURANCE
DATE(MMIDD/YYYY)
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 Bolton Insurance Services LLC
3475 E. Foothill Blvd., Suite 100
Pasadena, CA 91107
www.boltonco.com
6004772
INSURED
Intelligent Fire Systems & Solutions, Inc.
28338 Constellation Rd., iLnit 910
Valencia CA 91355
799-7000
RAGE
)ecialty Insurance C(
COVERAGES CERTIFICATE NUMBER: 7.1R34873 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.
_ w
,A�ftiL.'t/ ......... .....----
ifdSNr.� _.�.
EFF`m O9.IDCY'
TYPE OF INSURANCEvv-..... ...MM/D LIMITS
LTRINSDPOLICY NUMBER
A
✓' COMMERCIAL GENERAL LIABILITY
✓
PPK2481533
11/5/2022
11/5/2023
100 0000
CLAIMS -MADE 10 OCCUR
PREMISES5,.(Jm..@ (I0Vff0„2e. $100 000
✓ Errors & Omissions
m....._ .... ......._ ,.
MED EXP (Any one person) mm$ 5 000
PERSONAL&�ADVIN JURY $1,,000,000
-
...GEN'L.A.......
GGREGATELIMITAPPLIESPER:
GENERAL AGGREGATE $2,000,000
PRO -
POLICY ❑ IECT ❑ LOC
.......�„
PRODUCTS -COMP/OP AG
..._............. G $2 000 000 ...
�I�RY
AUTOMOBILE LIABILITY
mm
COMBINED SINGLEa.IMIT
J,Ei e/a;rl1 ........... ..
$
.... ._... ...
ANY AUTO
BODILY INJURY (Per person)
$
OWNED .............
SCHEDULED
........................�...........,,,
BODILY INJURY ( accident) nl
w,..........................-
._.. ...
$
AUTOS ONLY „_,_ AUTOS
HIRED NON -OWNED
pR06 ER GY DAMAGE a
.$
AUTOS ONLYAUTOS ONLY
.,...... .,.
A
✓
UMBRELLA LIAB �/ OCCUR
PUB838190
11 /5/2022
11 /5/2023
EACH OCCURRENCE
$ 5
EXCESS LIAB CLAIMS -MA DE
AGGREGATE
$5 000 000
7DED � RETENTION$10,000
$
B
WORKERS COMPENSATION
✓
MST5001026
5/22/2022
5/22/2023
IPER
STATUTE ER
YIN
.Ty
.._..... ......
ANYPROPRIETO PARTNER/EXECUTIVE
OFFFIICER/MEMBEREIXCCLUDED? Y
NIA
E.L,,,,.,m,.......... EACH
.. __„ ....... .........
(Mandatory
SEASE❑A EMPLOYEE
.. -, D .............0.0.000�...
$1,,000,000
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
$ 1 000.000
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
GL Additional Insured applies per CG20101185 attached, only if required by written contract/agreement.
WC Waivers of Subrogafion applies per WC040306484 attached. Re: City of El Segundo„ 350 Main Street, El Segundo, CA 90245.
Additional lnsured(s): City of El Segundo, 350 Main Street, El Segundo, CA 90245.
City of El Segundo
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Cltx Of El Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
35U Main Street ACCORDANCE WITH THE POLICY PROVISIONS.
El Segundo, CA 90245
AUTHORIZED REPRESENTATIVE w
Vanessa Ramos
©1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
73834873 I INTEFIR-01 1 22-23 GL & UMB, & WC Holton Certificate Processing 4/11/2023 7:59:18 AM (PST) I Page 1 of 3
PPK2481533
PI-MANU-1 (01/00)
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY
ADDITIONAL INSURED -OWNERS, LESSEES OR CONTRACTORS (FORM B) CG 2010 11/85
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
Schedule
Name and Address of Person or Organization:
Any Person or Organization Subject to Section II (Who is an Insured)
As required by written contract or agreement prior to loss.
(If no entry appears above, information required to complete this
endorsement will be shown in the Declarations as applicable to this
endorsement.)
WHO IS AN INSURED (Section II) is amended to include as an insured the
person or organization shown in the Schedule, but only with respect to
liability arising out of "your work" for that insured by or for you.
CG 2010 11/85
All other terms and conditions of this Policy remain unchanged,
Page I of 1
73834873 1 INTEFIR-01 1 22-23 GL & UMB, & WC I Bolton Certificate Processing 1 4/11/2023 7:59:18 AM (PST) I Page 2 of 3
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 2.0 % of the California workers' compensation premium
otherwise due on such remuneration.
Schedule
Person or Organization Job Description
Any person or organization as required by written contract
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 Date: 5/22/2022 Policy No. MST5001026 Endorsement No.
Policy Effective Dates: 5/22/2022
Insured: Intelligent Fire Systems & Solutions, Inc.
Carrier Name / Code: Benchmark Insurance Company B
WC040306
(Ed. 4-84)
Premium $
Countersigned by
Page 1 of 1
73834873 1 INTEFIR-01 12a-23 GL & Urns, & WC I Holton Certificate Processing 1 4/11/2023 7:59:18 AM (PST) I Page 3 of 3
,-� DATE (MMIDD/YYYY)
.fir "+C OR0 CERTIFICATE OF LIABILITY INSURANCE
04/03/2023
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).
PROm" m Rf TIA F�tJD: ARI SHIMA
ONE 6612601FA661 260 2787DARIN TSUKASHIMA
STATE FARM INSURANCE MAIL DARIN@DARINTSUKASHIMA COM
ADDRAn:.," ... ......... ..
26650 THE OLD ROAD SUITE 205 INSUREjI§JAFFORDING COVERAGE NAicn. _
VALENCIA CA 91381 _ _ INSURER A. State Farm General Insurance Company { 25151
INSURED iusiwao w
INTELLIGENT FIRE SYSTEMS & SOLUTIONS, INC
28338 CONSTELLATION ROAD UNIT 910
VALENCIA CA 91355
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.
,., .........,... �....,..- ......m
._ TYPE OF INSURANCE .. Ada
., POLICY
INTR I_,_. ....— ....... _ �AOt1L SUB i Y NUMBER ......... M1M/Dg EFF POLICY EXP LIMITS
iNqn
COMMERCIAL GENERAL LIABILITY
I
EACH OCCURRENCE
$
".......
_,
...DAMAGE i`i;S tiENftb
$
__
CLAI
CLAIMS OCCUR
.. C
P rr,n
_ .. ........
�.-M D EIXP�(Any prep arson
P �..
$ NN
.. ...
PERSONA L 8 ADV I„
r
$
�.. TT
_
GEN
L AGGREGATE LIMIT APPLIES,R
PER:
ATE
GENERAL AGGREGATE
$
_ ,
r I LOC,
Im,PRODUCTS -COMP/OP AGG
OOFHEAEJECT
CC
AUTOMOBILE LIABILITY
Y
Y
OOMWNEO SINGLE LIMIT
$ 1 000,000
ANY AUTO
687 0181-F20-75
12/20/2022
12/20/2023
BODILY INJURY (Per per)
... son
$ — ....•• ..
A
AUTOS ONLY K], SCHEDULED
I AUTOS
BODILY INJURY (Per accident)
$
„
" HIRED NON -OWNED
722 2729-F20-75A
12/20/2022
12/20/2023
..
""'pROPBR r�r "'
DAMAGE
..
$
AUTOS ONLY „ I AUTOS ONLY
a„pG ilp .......... ...
.... .
F
$
UMBRELLA LIAR OCCUR
EACH OCCURRENCE
$
EXCESS LIAB CLAIMS -MADE
i AGGREGATE
,$
DED d RETENTION $OT
$
WORKERS COMPENSATION
PTATUTE EERH
AND EMPLOYERS' LIABILITY Y/
_
E , ACH ACCIDENT
$
OFFICER/MEMBER EXCLUDED?PROPRIETOR/PARTNER/EXECUTIVEANY
N/A''.....
(Mandatory in NH)
ELL. DISEASE EA EMPLOYEE"
$
If yes, describe under
DESCRIPTION OF OPERATIONS below
E L. DISEASE -POLICY LIMIT
$
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
CERTIFICATE HOLDER LISTED AS ADDITIONAL INSURED
City of El Segundo
350 Main Street
El Segundo, CA 90245
ACORD 25 (2016/03)
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
Completed by an authorized State Farm representative. If signature
is required, please contact a State Farm agent.
@ 1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
1001486 132849.13 04-22-2020