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PROOF OF INSURANCE (2024 - 2024) CLOSEDCERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD1YYYY) 5/11/202' THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. eAw CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLI BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHOR 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 endorsementis). PRODUCER Marsh & McLennan Agency LLC Marsh & McLennan Ins. Agency LLC 1 Polaris Way #300 Alisc, Viejo CA 92656 INSURED Efficient X Ray Inc. DBA Efficient X Ray Equipment 9650 Topanga Canyona Place Chatsw6rth CA 91311 E : l�NyRER($)Aff!!2R9!NG ioland Insuran e Company of New York ntic Specialty IT kjnceq9imp rllqy� Arly e Compensation Ins Fund of CA 54 COVERAGES CERTIFICATE NUMBER: 1647666873 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. '(99W 1 -0 Ad . .... .......... . .... LTR Xbb sueRl" LICY EFF TYPE OF INSURANCE POLICY NUMBER 'AAAAAM.—VY LIMITS A X RQn2)ftL COMMERCIAL GENERAL LIABILITY Y N 7930124150000 2120/2023 2/20/2024 EACH OCCURRENCE $1,000,000 CLAIMS -MADE IX-1 OCCUR (90 _Gcounmvj! 5100,000 _MED.Er Ajyone p�f! $10,000 PERSONAL& ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREG $2,000,000 X POLICY PRO- JECT 0 LOG PRODUCTS - COMP/OP AGG $2,000,000 OTHER� L $ B AUTOMOBILE LIABILITY Y N 7930124160000 2/20/2023 2/20/2024 70—FA-81NED SIR GIE LIMIT $1,000,000 ANYAUTO I'llaGl .... . ...... .. .... . .. . . ........... . BODILY IN (Per person) $ OWNED SCHEDULED ... ........ AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ HIRED NON -OWNED _I5R_0"#'E"R'_T Y UMPA-d E, — — - - AUTOS ONLY AUTOS ONLY,Per,accpdp.ril} $ ....... .... A UMBRELLA LIAR , X OCCUR 7930124170000 2/20/2023 2/20/2024 EACH OCCURRENCE $ 1,0K000 EXCEAB­­­ . . . ...... _­­­­ .... ...... . . . . . . ............. [1111­111 — SS LICLAIMS-MADE GGREGATE $ I 000'000 oF0 I FR—ETT-N-TIONS, ............. . C WORKERS COMPENSATION 93376852023 5/1/2024 X PER RTH, $ AND EMPLOYERS'LIABILITY y I N ANYPROPRMTOR)PAR1 NER/EXECILYrIVE [_N OFFICEWMEMBEREXCLUDF07 N/A ,E,.L- EACH ACCIDENT $ 1,000,OOD IMandatory in NH) E,1_.DISEA"S'E-EAEt4PLOYEE $1,000,000 1:1 yes, describe under .......... DESCRIPTION OF OPERATIONS beIow E.L. DISEASE - POUCY LIMIT $1,0,0,0Sd000 DESCRIPTION OF OPERATIONS / LOCATIONS VEHICLES (ACORD 101, Additional Remarks Schedule, nnny be attached if more space 15 required) City of El Segundo is included as Additional Insured with respects to the General Liability per the attached endorsement. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of El Segundo ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main St. El Segundo CA 90245 AUTHORIZED REPRESENTATIVE @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD INSURED: EfficientXRayInc.. Policy Number: 793112415000o POLICY PERIOD: 02/20/2023 TO 02/20/2024 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSESS OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies coverage provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART CONTRACTORS ENVIRONMENTAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Any person or organization that the Named Insured agreed to add as an additional insured in a written contract or written agreement that was fully executed by the Named Insured prior to the performance of the Named Insured's work that is the subject of such written contract or written agreement. Location And Description Of Completed Operations: Any location, and completed operations at such location, where required by the written contract or written agreement in which the Named Insured agreed to add the person or organization qualifying as an additional insured under this endorsement. A. SECTION II — WHO IS AN INSURED is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for bodily injury, property damage or environmental damage 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 contractor 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 1. Limits of Insurance in SECTION III — LIMITS OF INSURANCE 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 Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. All other terms and conditions remain the same. OBENV GE 351 (09 20) Contains copyrighted material of Insurance Services Office, Inc. with its permission. Page 1 of 1 Copyright 2020, Intact Insurance Group USA LLC E-INSURED INSURED: cityofElsegundo POLICY #: 7930124160000 POLICY PERIOD:/10/2023 TO: 02/20/2024 aCOMMERCIAL AUTO CA 20 01 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. LESSOR - ADDITIONAL INSURED AND LOSS PAYEE This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. ...... _.................... _W Named Insured: Endorsement Effective Date: SCHEDULE .. .._.. ........ _ ....__. .............. Insurance Company: Policy Number: Effective Date: Expiration Date: Named Insured: Address: Additional Insured (Lessor): Blanket where required by written contract Address: Blanket where required by written contract Designation Or Description Of "Leased Autos": Blanket where required by written contract CA 20 01 10 13 © Insurance Services Office, Inc., 2011 Page 1 of 2 INSURED: Efficient X Ray Inc. POLICY #: 7930124160000 POLICY PERIOD:/10/2023 A. Coverage 1. Any "leased auto" designated or described in the Schedule will be considered a covered "'auto" you own and not a covered "auto" you hire or borrow. 2. For a "leased auto" designated or described in the Schedule, the Who Is An Insured provision under Covered Autos Liability Coverage is changed to Include as an "insured" the lessor named in the Schedule. However, the lessor is an "insured" only for "bodily injury," or "property damage" resulting from the acts or omissions by: a. You; b. Any of your "employees" or agents; or c. Any person, except the lessor or any "employee" or agent of the lessor, operating a "leasedauto" with the permission of any of the above. 3. The coverages provided under this endorsement apply to any "leased auto" described in the Schedule until the expiration date shown in the Schedule, or when the lessor or his or her agent takes possession of the "leased auto", whichever occurs first. B. Loss Payable Clause 1. We will pay, as interest may appear, you and the lessor named in this endorsement for "loss" to a "leased auto". TO: 02/20/2024 2. The insurance covers the interest of the lessor unless the "loss" results from fraudulent acts or omissions on your part. 3. If we make any payment to the lessor, we will obtain his or her rights against any other party. C. Cancellation 1. If we cancel the policy, we will mail notice to the lessor in accordance with the Cancellation Common Policy Condition. 2. If you cancel the policy, we will mail notice to the lessor. 3. Cancellation ends this agreement. D. The lessor is not liable for payment of your premiums. E. Additional Definition As used in this endorsement: "Leased auto" means an "auto" leased or rented to you, including any substitute, replacement or extra "auto" needed 'to meet seasonal or other needs„ under a leasing or rental agreement that requires You to provide direct primary insurance for the lessor. Page 2 of 2 © Insurance Services Office, Inc., 2011 CA 20 01 10 13 INSURED: Efficient X Ray Inc. POLICY #: POLICY PERIOD: TO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION - FORM III This endorsement modifies coverage provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART CONTRACTORS ENVIRONMENTAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organ' ation(s) Location(s) Of Covered Operations Any person or organization that the Any location, and completed operations Named Insured agreed to add as an at such location, where required by the additional insured in a written contract written contract or written agreement in or written agreement that was fully which the Named Insured agreed to add executed by the Named Insured prior to the person or organization qualifying as the performance of the Named Insured's an additional insured under this work that is the subject of such written endorsement. contract or written agreement. .�....... .......... _ -... - ..... Information re wired to ccGete this Schedule if not shown above„ will be shown in the Declarations. A. SECTION II — WHO IS AN INSURED is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for bodily injury, property damage, environmental damage or personal and advertising injury 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 contractor 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, property damage or environmental 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 locations of the cornered operations has been completed; or OBENV GE 346 (01 19) Contains copyrighted material of Insurance Services Office, Inc. with its permission. Pagel of 2 Copyright 2019, Intact Insurance Group USA LLC E-INSURED 2. That portion of your workout 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. C. With respect to the insurance afforded to these additional insureds, the following is added to SECTION III — LIMITS OF INSURANCE: 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 Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. All other terms and conditions remain the same. OBENV GE 346 (01 19) Contains copyrighted material of Insurance Services Office, Inc. with its permission. Page 2 of 2 Copyright 2019, Intact Insurance Group USA LLC ENDORSEMENT AGREEMENT WAIVER: OF SUBROGATION BLANKET BASIS HOME OFFICE SAN FRANCISCO EFFECTIVE MAY 1, 2022 AT 12.01 A.M. ALL EFFECTIVE DATES ARE AND EXPIRING MAY 1, 2023 AT 12.01 A.M. AT 12:01 AM PACIFIC STANDARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME EFFICIENT X—RAY INC 9650 TOPANGA CANYON PL STE F CHATSWORTH, CA 91311 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. REP 05 9054402-22 RENEWAL NA 2-17-73-22 PAGE 1 OF 1 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 2.00% OF THE TOTAL POLICY PREMIUM. SCHEDULE PERSON OR ORGANIZATION ANY PERSON OR ORGANIZATION FOR WHOM THE NAMED INSURED HAS AGREED BY WRITTEN CONTRACT TO FURNISH THIS WAIVER BLANKET WAIVER OF SUBROGATION NOTHING IN THIS ENDORSEMENT CONTAINED SHALL BE 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 OR LIMITATIONS OF THIS ENDORSEMENT. COUNTERSIGNED AND ISSUED AT SAN FRANCISCO: MAY 3, 2022 2572 AUTH081ZED REPRESENT IVE PRESIDENT AND CEO SCIF FORM 10217 IREV.7.20141 OLD DP 217