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PROOF OF INSURANCE (2024 - 2024) CLOSED0 DATE (MM/DD/YYYY) ,L CERTIFICATE OF LIABILITY INSURANCE 5/1/2023 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). PRODUCER AMTE Marie Swaney AssuredPartners Design Professionals Insurance Services, LLCACT PHONE"" FAX ......''''" (AIC,No ) 3697 Mt Diablo Blvd, #230 ®W� y ,Eatt ,626-696-1890 Lafayette CA 94549 E-MAIL ADDRESS: _CerlsDeslgnPro@AssuredPartn+ers moan . _ INSURER(&) AFFORDING COVERAGE NAIC # _ ."_ .._�.....__��........��...�_�...�...... ....� _ _. �..�...I,is�l.�: E.QQ.�7� INSURER A: Crum & Forster S eCial Insurance Company�....... �_.��...���_......... � � � ., 44520........ INSURED GALEASS-01 INSURER B Gale/Jordan Associates, Inc. -INsuRER.m.................................................... �.�..._...........�... 310-316-4377 _.NSU!.��........:............................................................"."......... _............,.......................�...... 3868 Carson Street, Suite 328 INsuRERD: mm_-IT---mm------ITITIT---------m Torrance CA 90503-5613 INSURERE: INSURER F :.1. COVERAGES CERTIFICATE NUMBER:2085769277 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. ,TYPEOFINSURANCE.....-- ..- ..___„_ ._..--..... ....... .._,,,,_A,,,,,.,-... .... INSR-- - ,,,�-. A"aL'UBR' 4LtCYE'FF"- POLtCYE7i}w POLICYNUMBER..... MMPDD/Y LIMITS T. YYY MM/DD A X COMMERCIAL GENERAL LIABILITY Y Y EPK143700 4/28/2023 4/28/2024 EACH OCCURRENCE $10,000.000 - �MAGE T T .,. ---.,.... CLAIMS -MADE %( OCCUR PR,EM�ISES IEa �ccunecr". m, $ 100,000 X Contractual Liab MED EXP (Any one person) $ 5.000 X XCU.Included PERSONAL & ADV INJURY $ 3 000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $10,000,000 X .w PRC� OP POLICY LOC J81 PRODUCTS -COMP/OP AGG $10 000 000 OTHER: $ A AUTOMOBILE LIABILITY Y EPK143700 4/28/2023 4/28I2024 COMBINED SINGLE LIMIT $1,000,000 ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS HIRED X � .� $ ,...X AUTOS ONLY ...,... AUTOS ONLY k?�r a cwentj_" ___�.,,........ ..... X i NoOwned Auto i $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIABCLAIM&MADE "AGGREGATE DED RETENTION $ $ WORKERS COMPENSATION PER OTH 9R.. AND EMPLOYERS' LIABILITY YIN -REUTE ° • •••••••••• __ ANYPROPRIETOR/PARTNERIE M BE EXCLUDED? ECUTIVE N/A E,L. EACH IDENT �EA $ ............... m (Mandatory ) E.L, DISEASE EMPLOYEE "LIMIT $ - - If yes, describe under - $ DESCRIPTION OF OPERATIONS below 11 E.L., DISEASE POLICY A Prolessceonal Liability & EPK143700 4/28/2023 4/28/2024 Per Claim/3,000,000 $3,000,000/agg Imt A Contractors Pollution Liab EPK143700 4/28/2023 4/28/2024 Per Claim/$3,000,000 $3,000,000/agg Imt Deductible 5,000 each claim" DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Auto LiabiliIy is follow -farm to the General Liability. Insured owns no company vehicles; therefore, hired/non-owned auto is the maximum coverage that applies. `PL Deductible each claim: $5,000 & CPL Deductible each pollution condition. $5,000 RE: Al Operations — City of El Segundo, its officers, agents and employees are named as additional insured as respects general and auto liability as required per written contract or agreement. CERTIFICATE. HOLDER CANCELLATION 30 Day Notice Wit be sent to hotder SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of El Segundo, Public Works Dept. 350 Main Street REPRESENTATIVE El Segundo CA 90245 ''. AUTHORIZED ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Policy # EPK143700 CR V & FOR'ST ER" THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL CONTRACTORS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART CONTRACTORS POLLUTION LIABILITY COVERAGE PART SCHEDULE Of Additional Insured Person(s) or Organization(s) nket when specifically required in a written contract with the named insured. SECTION III — WHO IS AN INSURED within the Common Provisions is amended to include as an additional insured the person(s) or organization(s) indicated in the Schedule shown above, but only with respect to liability caused, in whole or in part, by "your work" for that insured which is performed by you or by those acting on your behalf. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. EN0111-0211 Page 1 of 1 Policy # EPK143700 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NON-CONTRIBUTORY ADDITIONAL INSURED WITH WAIVER OF SUBROGATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART CONTRACTORS POLLUTION LIABILITY COVERAGE PART ERRORS AND OMISSIONS LIABILITY COVERAGE PART THIRD PARTY POLLUTION LIABILITY COVERAGE PART SCHEDULE Name of Additional Insured Person(s) or Orcianization(s Blanket when specifically required in a written contract with the named insured A. SECTION III — WHO IS AN INSURED within the Common Provisions is amended to include as an additional insured the person(s) or organization(s) indicated in the Schedule shown above, but solely with respect to "claims" caused in whole or in part, by "your work" for that person or organization performed by you, or by those acting on your behalf. This insurance shall be primary and non-contributory, but only in the event of a named insured's sole negligence. B. We waive any right of recovery we may have against the person(s) or organization(s) indicated in the Schedule shown above because of payments we make for "damages" arising out of "your work" performed under a designated project or contract with that person(s) or organization(s). C. This Endorsement does not reinstate or increase the Limits of Insurance applicable to any "claim" to which the coverage afforded by this Endorsement applies. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED, EN0118-0211 Page 1 of 1 DATE CERTIFICATE OF LIABILITY INSURANCE 02/01/2023DmrY) 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 N AT NAME: EJMS Insurance Services PHONE m.. _. M No,,Ex" .... ( N�9 . .aa . PO Box 33289 E-MAIL ACYA?ESS'x. _ �. _a w... _ ... Los Gatos„ CA 95031 INSURER($) AFFORDING COVERAGE NAIL 0 Chubb National Insurance Comnanv 10052 INSURED gale/jordan associates 3585 W. Carson Street, Suite 200 Torrance, CA 90503 COVERAGES CERTIFICATE NUMBER: RFV[glnN 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 EDUCED BY PAID CLAIMS. ILSR, _.TYPEOFINSURANCE,,."Afflil�it ,, —...........V jR� 7 F�OLItYE7Cp _ _ ,,,,,, .. ®, POLICY NUMBER �17C2YFF INS M12 Y'YY 1 MWDD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ _ COMMERCbAL GENERAL -� _. ......... CLA)MSttn7ADE,...-LNA$ILITY' ,. OCCUR MED EXP (Any one person) $ Y $ PERSONAL 8 ADV INJU, .... w._ .. .r ... � � ... , GENERAL AGGREGATE AGGREGATE IT APPLIES S PER. � � PRODUCTS - COMPIOP AGG � $ .� PR LOC POLICY $ AUTOMOBILE LIABILITY C60NED SINGLE ILt I. _ (agcd!tt1 — — �A ANYAUTO BODILYINJURY (Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS i _.,. BODILY INJURY (Per accident) $ y,ym„ NON -OWNED"' HIRED AUTOS rw .... AUTOS ROERTY W�{,rt-(,.F $ ........................ _... g UMBRELLALLAB OCCUR j EACH OCCURRENCE $ EXCESS LIAR CLAIMS-0AADE { AGGREGATE $ DED RETENTION $ g A WORKERS COMPENSATION AND EMPLOYERT VIABILITY YIN (24) 7178-54-63 2/01/2023 � 2/01 /2024 WC STATU ... 07H X... � TOSY-LIMITS ..-0 ANY PROPRIETORIPARTNERIEXECUTIVE E L EACH ACCIDENT $ 1, OQO�O,OQ OFFICER/MEMBER EXCLUDED? Y N A j �m (Mandatory In NH) E L DISEASE -EA EMPLOYEE, $ 1 QOQ 000.._ H yes. describe underDESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT S 1,000,000 i r DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, H more space Is required) Christopher K Gale - President: Excluded / Thomas A Jordan - Secretary / Treasurer: Excluded City of El Segundo, Public Works Dept. 350 Main St. El Segundo, CA 90245-3813 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 Daniel J. Cloud ©1988-2010 ACID ORPORATION. � 11 rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD Workers' Compensation and Employers' Liability Policy Named Insured Endorsement Number GALE/JORDAN ASSOCIATES, INC. Policy Number S bol: Number: 24 7178-54-63 Policy Period Effective Date of Endorsement 02/0112023 TO 02/0112024 02/01/2023 Issued By (Name of Insurance Company) Chubb National. Insurance Com an Insert the number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparain of the oli CALIFORNIA WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement applies only to the insurance provided by the policy because California is shown in Item 3.A. of the Information Page. 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, but this waiver applies only with respect to bodily injury arising out of the operations described in the Schedule, where you are required by a written contract to obtain this waiver from us. You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. Schedule Specific Waiver Name of person or organization: ( X ) Blanket Waiver Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. 2. Operations: 3. Premium: The premium charge for this endorsement shall be 1 % percent of the California premium developed on payroll in connection with work performed for the above person(s) or organization(s) arising out of the operations described. 4. Minimum Premium: WC 90 03 75 (05/1 B) Insured Copy Authorized Representative