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PROOF OF INSURANCE (2024) CLOSEDClient#: 35044 PILCO DATE (MM/DD/YYYY) ACORDTM CERTIFICATE OF LIABILITY INSURANCE 04/28/2023 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 endor sed, 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER NANTACT Kristen A. Wade„ CIC Ross & Yer er Insurance Inc. PHONE 60 9 rA 9 1 00 y g (AIr N�, 601 355 3227 ' AfOt No Fxt P.O. Box 1139 ADDRESS: kwade@ros......___ _ Jackson, MS 39215 INSURERS AFFORDINGO COVERAGE E NA _ Ic u 601 948-2900 ...M............ T I..........D..rt_...r. ]AI h tt 2567...._.....� INSURED Pileum Corporation 190 East Capitol Street Suite 175 Jackson, MS 39201 INSURER A: rave ers rope y as. p are a __............. Travelers Casual Ins. Co. of America INSURER B : Casualty 19046 ....674 INSURER .................... . Travelers Property & Casualty Co.of Am. Charter Oak Ire Ins CO/AI haretta INSURER D : F P 25615 INSURER E 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 CONTRACTOR 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. LTR snlR.ydyr �ZLP`ION176702MSER .... t5/06/2l 23 05/OCYEXIy kiAR POLICY EFF POLI' TYPE OF INSURANCE pryyyY LIMITS COMM�IMS MADEE�XLIOCCUR EACH OCCURRENCE. $1 rOOOtOOO 61202 DAMAGE TO RENTED .,,...... ,.� �... PREMISESEa occurrence $300�000 . GEN'L AGGREGATE LIMIT APPLIES PER: PRO- EPOLICY X JECT ,,,� LOC .D ....,_ OTHER:......e.___ ..,- mm..-.... ...... BA9.--.�.,.,.�., AUTOMOBILE LIABILITY M607761 X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY X AUTOS ONLY UMBRELLA A X ExcessLIABAB _ � aCCURLainns-nnaDe CUP1N462581 DFD X RETENTION $1,0,,000 mm ... B WORKERS COMPENSATION UB5K974216 AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ N / A (Mandatory in NH) If yes, describe under C Professional Liability ZPL14R391022 MED ,...EXP (Any one person) $1 .,.,.�..�.��.ONAL 8 ADV INJURY ....,�.-_.. GENERAL AGGREGATE $2 ..........................................................................�. -- PRODUCTS COMP/OP AGG II $2 3 05/06/202 � � D,& INGLI t $1 000 BODILY INJURY (Per person) $ ...............-LY.i....................,(.,... ................. NJURY PRrrPdfant cadent) $ XPR®PERTr'OA6WNAGE'Per a $ ...... �. .................. $ 31 05/06/2024 EACH OCCURRENCE _ $ 5/06/2023 05/06/202 X PER �oTH- E.L.. EACH ACCIDENT $,1,000 EL„ DI,S,EASE - EA EMPLOYEE .,$1,000 E.L,DISEASE-POLICY LIMIT $1,000 .. 5/06/2023 .................................05.... .m.000............ ..._. /06/202 2,000,000/2,000, DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Subject to policy terms, conditions, and exclusions. The General Liability policy includes Blanket Additional Insured per written contract and Blanket Waiver of Subrogation, Primary and Non -Contributory. City of El Segundo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Y g THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 350 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. El Segundo, CA 90245 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) 1 of 1 The ACORD name and logo are registered marks of ACORD #S897139/M897122 KAW COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT ICARIEIFULLY, XTEND ENDORSEMENT FOR TECHNOLOGY This endorsement modifies insurance Iplrovided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART GENERAL DESCRIPTION OF ICOVEIRAGE - This endorsement broadens coverage. However, coverage for any injury, damage or imedical expenses descriibed in any of the provisions of thiis endorsement may be excluded or limited by another endorsement to this, Coverage Part, and these coverage broadening provisions do not apply to the extent that coverage is excluded or limited by such an endorsement. The following listing is a general coverage descripflon only. Read all the provisions of this endorsement and the rest of your policy carefully to determine rights, duties, and what lis and is not covered. A. Non -Owned Watercraft - 75 Feet Long Or Less B. Who Is Ain Insured - Unnamed Subsidiaries C. Who Is Ain Insured - Employees - Supervisory Positions D. Who Is Ain Insured - Newly Acquired Or Formed Limited ILlialblilllity Companies E. Who Is Ain Insured - Liability For Conduct Of IUnlnalrned Partnerships Or Joint Ventures F. blanket Addifloinal Insured - Persons Or Organizations For Your Ongoing Operations As Required IBy Written Contract Or Agreement G. Blanket Addifloinal Insured - Broad Form Vendors PROVISIONS A. NON —OWNED WATERCRAFT — 75 FEET LONG OR LESS 1. The following replaces Paragraph 1(2) of Exclusion g., Aircraft, Auto Or Watercraft, i in Paragraph 2. of SECTION I — COVERAGES — COVERAGE A — BODILY INJURY AND PROPERTY DAMAGE LIABILITY: (2) A watercraft you do not own that is - (a) 75 feet Iloing or less; and (b) Not being used to carry any person or property for a charge; 2. The following replaces Paragraph Ze, of SECTION 11 — WHO IS AN INSURED: e. Any person or organization that, with your express or implied H. Blanket Additional Insured Controlling Interest I. Blanket Additional Insured Mortgagees, Assignees, Successors Or Receivers J, Blanket Additional Insured Governmental Entities - Permits Or Authorizat i ons Relating To Premises K. Blanket Additional Insured Governmental Entities - Permits Or Authorizations Relating To Operations L. Medical Payments - Increased Limit M. Blanket Waiver Of Subrogation N. Contractual Liability - RaHroads 0. Damage To Premises Rented To You consent, either U5105 or is responsible for the use of a watercraft that you do not own that 75 feet long or less; and (2) Not being used to carry any person or property for a charge. B. WHO IS AN INSURED — UNNAMED SUBSIDIARIES The following is added to SECTION 11 — WHO IS AN INSURED: Any of your subsidiaries, other than a partineirship or joint venture, that is not shown as a Named Insured in the Declarations is a Named IInslureld if. a. You are the sole owner of, or mailintain an ownership interest of more than 50% in, such subsidiary oin the first day of the policy period; and Chi 1 '17 02 19 @ 2017 The Travelers Indemnity Company. All rights reserved- Page 1 of 5 Includes copyrighted material) of Insurance Services Office, Inc. vviLln its permission. COMMERCIAL GENERAL LIABILITY h. Such subsidiary is not ain insured Linder simiillar other insurance. No such subsidiary is ain insured for "bodily injury" or "property damage" that occurred, or "personal and advertising injury" caused by an offense committed: a. Before you maintained ain owini interest of more than 50% in such subsiidliairy; or h. After the date, if any, during the policy period that you no longer maiiintain ain ownership interest of more than 50% in such subsidiary. For purposes of Paragraph 1. of Section 11 - Who Is An insured, each such subsidiary will be deemed to be designated in the IDecllarations as: a. A limited liability company; b. An organization other than a partnership, joint venture or limited liability company; or V, A trust; as indicated i in its name or the documents that govern its structure. C. WHO IS AN INSURED — EMPLOYEES — SUPERVISORY POSITIONS The following is addled to Paragraph 2.a.0) of SECTION 11 — WHO IS AN INSURED: Paragraphs (1)(a), i(b) and (C) above do not apply to "bodily injury" to a co - "employee" while in the course of the co -"employee's" employment by you arising out of work. by any of your "employees" who hold a supervisory poslition. 0. WHO IS AN INSURED — NEWLY ACQUIRED OR FORMED LIMITED LIABILITY COMPANIES The following replaces Paragraph 3. of SECTION 11 — WHO IS AN INSURED: 3. Any organization you newly acquire or form, other than a partnership or joint venture, and of which you are the sole owner or in which you maiiintain ain ownership interest of more than 50%, will qualify as a Named(insured if there is no other similar insurance avaiillable to that organization. However: a. Coverage Linder this, provision is afforded only: (1) Until the 180th day after you acquire or form the organization or the eind of the policy period, whichever is earlier, if you do not report such organization i in whiting to us w i t ih i ni 180 days after you acquire or form it; or (2) Until the end of the policy period, when that date is later Than 180 days after you acquire or form such orqainlization, if you report such orgainization in writing to us within 180 days after you acquire or form it; h. Coverage A does not apply to "bodily injury" or Irproplerty damage" that occurred before you acquired or formed the organ- ization; and c. Coverage B doles not apply to "personal and advertising injury" arising out of an offense committed before you acquired or formed the organization. For the purposes of Paragraph 1. of Section 11 - Who Is An Insured, each such organization will be deemed to be designated in the lDecllarations as: a. A limited liability company; h. An organization, other than a partnership, joint venture or limited liability company; or C, A trust; as indicated i in its name or the documents that govern its structure. E. WHO IS AN INSURED — LIABILITY FOR CONDUCT OF UNNAMED PARTNERSHIPS OR JOINT VENTURES The following replaces the last paragraph of SECTION 11 - WHO IS AN INSURED: No person or organization is an insured with respect to the conduct of any current or past partnership or joint venture that is not shown as a Named Insured in the Declarations. This paragraph doles not apply to any such partnership or joint venture that otherwise quantifies as ain insured under Sectlion 11 - Who I& An Insured. F. BLANKET ADDITIONAL INSURED — PERSONS OR ORGANIZATIONS FOR YOUR ONGOING OPERATIONS AS REGUIRED BY WRITTEN CONTRACT OR AGREEMENT The following is addled to SECTION 11 WHO IS AN INSURED: Any person or organization that is not otherwise ain insured Linder this Coverage Part and that you have agreed in a written Page 2 of 5 @ 2017 The Travelers Indemnity Company. All rights reserved. CMG 1 '17 02 19 Includes copyriglhited material) of Insurance Services Office, Inc. witin its permission. COMMERCIAL GENERAL LIABILITY cont/act or agreement to include as an additional insured on this Coverage Part is an insured, but only with respect to liability for "bodily injury" or "property damage" that: @L Occurs subsequent to the signing of that contract or agreement; and h. Is caused, in vvho|m or in part' by your acts or omissions in the performance of your ongoing operations to which that cont/act Or agreement applies or the acts. or omUssUona of any person or organization perforrn|ng such operations on your beha|f' The |inniits of insurance provided to such insured will be the rmimUrnurn Unn|ts that you agreed to provide in the written contract or agreement, or the |imilts shown in the DedaratUons, whichever are less. EL BLANKET A000O0AL INSURED — RROA0 FORM VEN0ORS The fm||mvv|ng i& addled to SECTION |U — WHO IS AN INSURED: Any person or organization that is a vendor and that you have agreed in a written contract or agreement to include as an additional insured on this. Coverage Part is aO insured, but only with respect to liability for "bodily injury" or ''property dannaQe" thaL @L Occurs subsequent to the signing of that contract or agreement; and b' Ariieos out of "your produote" that are distributed or sold in the regular course of such vendor's bue|neee' The insurance provided to such vendor is subject to the fo||ovvUng provisions: @L The |irniita of insurance provided to such vendor will be the minimum |imiits that you agreed Lo provide in the written contract or agreement, or the |inniits shown in the Declarations, wKilichiever are less. b' The insurance provided to such vendor does noi apply to: (1) Any express warranty not authorilzed by you or any distribution or sale for a purpose not authorized by you; (2) Any change in "your products" made by such vendor; (3) Repackaging, umUesa unpacked auUe|y for the purpose of in5pection, dernon5tradVn, te5dng^ or the substitution of parts under imetruotiiona from the manufacturer, and then repackaged in the Vr|gUna| conte|ner; WQ Any failure to i such inspections, adjustments, tests or servicing as vendors agree to perform or normally undertake to perform im the regular course of busUneey, in connection with the distribution or sale of your products"; (5) Demonstration, installation, servicing or repair operations, except suc �h operations performed at such vom1dor'n prernUsos im c omne ctiom with the sale of "your products"; or /6> ''Your products" that, that' after distribution or sale by you, have been labeled or relabeled or used as a container, part or ingredient of any Other thing or substance by or on behalf of such vendor. Coverage under this provision does not apply to: a. Any person Or organization from vvhorn you have acquired "your products", or any ingredient, part or container entering into, accompanying or containing such products; or Any vendor for which coverage as, an additional insured specifically is scheduled by endorsement. M. BLANKET ADDITIONAL INSURED — CONTROLLING INTEREST The following is addled to SECTION |U — WHO IS AN INSURED: Any person or organization that has financial control of you is an insured with respect to liability for "bodily |n'ury^, "property dVnnV�e~ or "peraomaU and advertising injury" that arises out of: @L Such financial control; or h. Such pereon'e or urgan|zadon/a ovvmersh|p' maintenance or use of premises leased to or occupied by you. The insurance provided to such person or organization does not apply to structural alterations, noYY construction or demolition operations performed by or on behalf of such person or organization. 2. The fm||mvv|ng ia addled to Paragraph 4. of SECTION U — WHO IS AN INSURED: Thia paragraph dole& not apply to any premises ovvmec manager or lessor that has financial control of you. CG D4 17 02 19 @ 2017 The Travelers Indemnity Company. An r'ymx reserved. Page 3 of 5 COMMERCIAL GENERAL LIABILITY |. BLANKET ADDITIONAL INSURED — MORTGAGEES, ASSIGNEES, SUCCESSORS OR RECEIVERS The following is addled to SECTION |U — WHO IS AN INSURED: Any person or organization that is a mortgagee, assignee, successor Or receiver and that you have agreed in a written contract or agreement to include as an additional insured on this. Coverage Part is an insured, but only with respect to its liability as mortgagee, assignee, successor Or receiver for "bodily |rjwr/^, "property damaBe" or "personal and advertising injury" that: @L Is "bodi|y i'ury" or "property damage" that occurs, or is "pernona| and advertising in'ury^ caused by an offense that is cornrn|tted, subsequent to the signing of that contract or agreement; and �l Arises out of the ownership, maintenance or use of the premises for which that mortgagee, aoo|Qnioe, successor or receiver is required under that contract or agreement to be imoUuded as an additional insured on this Coverage Pert' The insurance provided to such mortgagee, assignee' successor or receiver is subject to the following provisions: a. h. The limits of insurance provided to such mortgagee, assignee, successor or receiver will be the minimum limits that you agreed to provide in the written contract or agreement, or the limits ahum/n in the Declarations, wKilchiever are less. The insurance provided to such person Or organization does not apply to: (7) Any "bodily imiury~ or "property damage" that' occurs, or an "personal and advertising injury^ caused by a� � off�D�that is committed, after such contract or agreement is no longer in effect; or (2) Any "bodily injury", "property damage" or "personal and advertising imjury^ arising out of any structural alterations, new construction or dannoUUbum operations performed by or on behalf of such mortgagee, assignee, successor or receiver. J. BLANKET ADDITIONAL INSURED — GOVERNMENTAL ENTITIES — PERMITS ON AUTHOR |ZATUGNS RELATING TO PREMISES The following is addled to SECTION |U — WHO IS AN INSURED: Any governmental entity that has issued a permit or authorization with respect to premises owned or occupied by. Or rientled or loaned to, you and that you are required by any ordinance, law, building code or written contract or agreement to include as. an additional insured on this. Coverage Part is ain insured, but only with respect 10 liability for "bodily injury^, "property damage" or "personal and advertising |rjury^ arising out of the existence, uvxmerah|p' use, maintenance, repair, construction, erection or removal of any of the following for which that governmental entity has issued such permit or authorization- advertising e|gns~ awnings, canopies, cellar entrances, coal holes, dr|vgwayu' rmanho|ey, marquees, hoist away openings, sidewalk vaults, elevators, street banners or decorations. K. BLANKET ADDITIONAL INSURED — GOVERNMENTAL ENTITIES — PERMITS OR AUTHORIZATIONS RELATING TO OPERATIONS The fo||ovxhm is addled to SECTION |U — WHO IS AN INSURED: Any governmental entity that has issued a permit or authorization with respect tV operations performed by you or on your behalf and that you are required by any ordinance, law, building code or written contract or agreement to include as an additional insured on this Coverage Part is ain insured, but only with respect to liability for "bodily injury",. "property dannaBe" or "personal and advert |s|ng injury" arising out of such operations. The insurance provided to such governmental entity does not apply to: a. Any "bodily injury", "property damage" or "personal and advertising hjury" arising out of operations performed for the governmental entity; or b' Any "bodily hjury^ or "property dannaBe" included in the "products - completed operations hazard". L. MEDICAL PAYMENTS — INCREASED LIMIT The following replaces Paragraph 7. of SECTION III — LIMITS OF INSURANCE: 7. Subject tV Paragraph 5. above, the Medical Expense Limit is the most wVo will pay under Coverage C for all medical expenses because of "bodily injury" sustained sustaimed by any Ono person, Page 4 of 5 @ 2017 The Travelers /ncemn'ty Company. An r'ymx reserved. CG Dl4 17 02 19 COMMERCIAL GENERAL LIABILITY and will Ibe the higher of: a. $10,000; or h. The amount shown in the Declarations, of this Coverage Part for Medical (Expense Limit. M. BLANKET WAIVER OF SUBROGATION The following is added to Paragraph 8., Transfer Of Kights Of Recovery AgMinst Others TO IUS, of SECTION IV — COMMERGIAL GENERAL LIABILITY CONDITIONS: If the insured has agreed in a contract or agreement to waive that insureds right of recovery against any person or orgainlization, we waive our right of recovery against such person or orqanuzation, but only for payments we make because of: a. "Bodily injury" or "property damage" that occurs; or h. "Personal and advert i s i ng injury„ caused by an offense that is committed; subsequent to the executn on of the contract or agreement. N. CONTRACTUAL LIABILITY — RAILROADS 1. The following replaces Paragraph c. of the definition of "insured contract" in the DEFINITIONS Section: v, Any easement or license agreement; 2. Paragraph f.(1) of the def rni It i on o f "insured contract" in the DEFINITIONS Section is deleted, 0, DAMAGE TO PREMISES RENTED TO YOU The following replaces the definition of 11 premnses, damage" in the DEFINITIONS Sectlioin: "Premises damage" means. "property damage" to: a. Any premises while rented to you or temporarily occupied by you with permission of the owner; or b. The contents of any premises while such premises is rented to you, if you rent such premises for a period of seven or fewer consecutive days. CG D4 17 02 '19 @ 2017 The Travelers Indemnity Company. All rights reserved. Pagie 5 of 5 Includes copyrighted material of Insurance Services Office, Inc. vviLh its permission. A01 TRAVELERS'� WORKERS COMPENSATION AND ONE TOWER SQUARE EMPLOYERS LIABILITY POLICY HARTFORD CT 06183 ENDORSEMENT WC 00 03 13 (00) - 001 POLICY NUMBER: UB-5K974216-21-I5-G WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT 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.) This agreement shall not operate directly or indirectly to benefit any one not named in the Schedule. SCHEDULE DESIGNATED PERSON: DESIGNATED ORGANIZATION: ANY PERSON OR ORGANIZATION FOR WHICH THE INSURED HAS AGREED BY WRITTEN CONTRACT EXECUTED PRIOR TO LOSS TO FURNISH THIS WAIVER. DATE OF ISSUE: 04-29-21 STASSIGN: PAGE 1 OF