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PROOF OF INSURANCE (2023 - 2024) CLOSEDS&SLA-1 QE I!D; DIYYYY) (MMID CERTIFICATE OF LIABILITY INSURANCE DATE TE(MMI2023 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 877-242-9600 ,CT Central Insurance Agency Central Insurance Agency, Inc. PO Box 1047 Smithtown, NY 11787 Stephen Ormsby Force, Inc DBA JRM Rd. #413 877-242-9600 nsures.com Peleus Insurance Company , C'or ePoint Insurance Company Sentinel Insurance Company rrl,a oerz CERTW!C ATE NI IIVIIRPIP• REVISION NUMBER: NAIC # 34118 10499 _.... ......----- ----- - 11000 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, ......, 1 TYPE OF INS ... gyp` . , ....... NUMBER _...------�— ....._. ....... `.. ...,.,.,.,.... ......- --- .............. .�.�........ INSR DDL&I POLICY EFF POLICYEXP LIMITS INSURANCE I f POLICY V - A X I COMMIAIMIAL X... (ABILITY I TO RENTEEACH D DAMAGE TO RENTED 000 � 1,000 250,000 S-MADEE OCCUR I X X GLV0001060 I 08/30/2022 O8/3O/20231 .,DAMAGE $�..m..... ,. . X Assault & Battery 5 000 X Professional Liab a...._ PERSONAL a ADV IURY $ . ... G_EN'L. •.., AGti"a'i�"E.C"A`f PER: APPL❑IESLOC ENERAL 3 000,000 000 POLICY X E®T ICTS-COMP/AOPAGG },5,....... ..........3,000000. v „PROD I AUTOMOBILE LIABILITY ....-...... COMONIND SW GL E UWT $ ....... ANY AUTO UODILY INJURY Per arson ) $............ ---,. OWNED SCHEDULED �,... BODILY IN�I-URY (Per �_$ A�UppTOS ONLY _.-.. AUTOS ......� AU�S ONLY NO�N.:�j p} �AURVs�SUY accident) P PFR) DAMAGE (�+e�cCtrciertt .... 1..�_..,..., ... $ A X X �OCCUR UMBRELLA LI EACH RENCE ,000 CLAIMS MADE, I EXCESS LIABAB---� UMV0000262 08/30/2022 08/30/2023 AGGREGATE - $, 5'000 OOO DED X I RETENTION$ 10,0001. { $ B WORKERS COMPENSATION �CPW1001050 X I PER STAT ITF 1�H AND EMPLOYERS'UOO Y / N 01/05/2023 01/05/2024I 0OO' $ PROPRIETOR/PARTNER/EXECUTIVE ANCYIICFR/M NIA M ERExcLu o? �snatiavy'E� n NH) E L DySEAS,EE.A. EMPLOYEF� $ 1,000,000 If yes, describe under ...,�CCIDENT 1,000,000 DESCRIPTION F OPERATIONS below E.L. DISEASE POLICY (MIT $ C BPP 12SBAF0808 04/22/2023 04/22/2024 Contents 200,000 Leas/rent 20,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The Cit of El Segundo its officers,officials,employees,a eats, & volunteers are Incl"U ded as additional insured under the general iiab lity V�lth respect to the liability created by the negli,gDnt acts, errors and omissions of the General Liability named insured herein as required fay written contract.The includes a Waiver of subrogation as required by Written contract. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE The City of El Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN tY g ACCORDANCE WITH THE POLICY PROVISIONS. 3501 Main St. El Segundo, CA 90425 AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: GLV0001060 COMMERCIAL GENERAL LIABILITY CG 20 10 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURE - OWNERS, (LESSEES OR CONTRACTORS - SCHEDULED PERSON OIL ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Location(s) Of Covered Operations Automatic Status Included Where Required by Written Automatic Status Included Where Required by Contract. Written Contract. Information required to complete 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" 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) desig- nated above. B. With respect to the insurance afforded to these additional insureds, the following additional exclu- sions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equip- ment 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 in- tended use by any person or organization other than another contractor or subcontractor en- gaged in performing operations for a principal as a part of the same project. CG 20 10 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 0 POLICY NUMBER: GLV0001060 COMMERCIAL GENERAL LIABILITY CG 20 37 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES O CONTRACTORS S - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Or anization s : Location And Description Of Completed Operations Automatic Status Included Where Required by Written Automatic Status Included Where Required by Written Contract. Contract. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. 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" or "property dam- age" caused, in whole or in part, by "your work" at the location designated and described in the sched- ule of this endorsement performed for that additional insured and included in the "products -completed operations hazard". CG 20 37 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 0 POLICY NUMBER: GLV0001060 COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY Y AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: Any Person or Organization for whom the insured, prior to a claim, occurrence or incident for which the insured could reasonably expect a claim or occurrence to arise, was required via written agreement or contractual obligation, to waive such rights. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV —Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products - completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 1 0