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PROOF OF INSURANCE (2023 - 2024) CLOSEDAC RV CERTIFICATE OF LIABILITY INSURANCE oA02ro�023 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 pollcy(les) 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 CONCT NAME Blanca De Le H02 N ('961) 509.0509 i lC No, (961) 509.0515 Denmar Insurance Services Inc. License # OD36873 E-MAIL ADDRSs: 9899 Indiana Avenue, Ste 101 INSUREEISI AFFORDING COVERAGE NAIC0 Riverside CA 92503 INSURERA: Travelers Property Casualty Co ofAmerics 25674 INSURED INSURER B : Pacific Compensation Insurance Company 11555 Denn Engineers, Inc. INSURER C : QBE North America Insurance Group INSURER D : 3914 Del Amo BI., Ste 921 INSURER E : INSURER F: Torrance CA 90503 COVERAGES CERTIFICATE NUMBER: CL2312611290 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 MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONSAND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IN LTR TYPE OF INSURANCE 0 WVD POLICY NUMBER JMMID2= LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE ; $ 1,000,000 CLAIMS -MADE x OCCUR PREMISES Esoccurronca $ 1, 000,000 MED EXP (Any one person) s 5,000 A Y 680-9N963609-22-47 09/01/2022 09/01/2023 PERSONAL & ADV INJURY s 1,D00,000 GENLAGGREOATEUMITAPPUESPER: GENERALAGGREGATE s 2,000,000 POLICY F 8T LOC PRODUCTS-COMPIOPAGG S 2,000,000 S OTHER': AUTOMOBILE LIABILITY COMa%(ll:D StlNOLE UMdT Ea ae danz. S BODILY INJURY(Perperson) S ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ RTY DAMA01: 1a ant $ HIRED PION -OWNED AUTOS ONLY AUTOS ONLY $ I UMBRELLA UAB OCCUR EACH OCCURRENCE S AGGREGATE S EXCESS LIAB CLAIMS -MADE DEC).4I I RETENTION $ S B WORKERS COMPENSATION AND EMPLOYERS" LIABILITY YIN ANY PROPRIETORIPARTNERIEXECUTIVE r--J OFFICERIMEMBER EXCLUDED? t . _ J (Mandatory In NH) NIA 1026061 02/01/2023 02/0V2024 X STATUT ER E,L,EACH ACCIDENT s 1,000,000 - E.L. DISEASE - EA EMPLOYEE S 1,000,000 If yes. describe under DESCRIPTION OF OPERATIONS below E.L, DISEASE - POLICY LIMIT S 1,000,000 C Professional Liability L J_ ANE45692-03 11107/2022 11107/2023 Each Claim Limit Aggregate Limit $1,000,000 $1.000.000 _I DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached U more space Is required) Re: As per Contract or Agreement on file with the insured. City of El Segundo Public Works Department, its officers elected and appointed officials employees and volunteers are included as additional insured on the General Liability policy CGD3810915 endorsement attached.Workers Compensation Waiver of Subrogation endorsement to follow. City of El Segundo, Public Works Department Attn: Tamica Hinkson 350 Main Street ElSegundo CA 90245 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 .01 240 01985-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD WJITM,rr 4, W n ,I "T ae. n i:n Y .r ,.4» WET*; r, „"�^�•" �w� f ax-wr*w, f, asaa+ 'na rr a 19 't i^ ' i aW e «Si. r• r. r aa� re ar ""sasanat and b. t� mas8 I to OWthe ly or of Ymj v to Whkb pplmvntm tnsuraW Was, ocmumft owned by ortow ar d to yu The FAMOn or01B does not quality es an sadwoftmet. o.Wah resped to the Indepenowt so ar Ombshm of such Pemn or , Or d For 40 t► kdwr, d~ or VersoW try W & wift such person or 000has ammed adft to a ccabW oraVveraent The bw2mme FGVMed to such b btWd n .. e. 0. Thb bmmrm does not a on MW to wed by ancum endomerAd to tva Covemp hat Thb ce don not GX4 to the of or fauum to fender any vnat . In the event tarot the Umb of hwimm dthe covmv tit sit to the Dedamfta Owed the bftof ttabimy reqWed by tha, mq,' the Mmance�heitsto*0MfVad totof n ors by Od n COUVA requft bwAmmf. At eme the r t to U CO D8 81 as t8 2oaa ttaar to Page 1 of Z 'quJ ° ... c1 i:J - [i PW2of2 Go Ds of 09 Is flu .� DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURAN 09/15/2022 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLYAND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTI IC .........ATI FICATE DOES NOTAFFIRMATIVELY 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. ...tifi..........._ INSURED, NSUD, the policy(ies) must have ADDITIONAL INSURED provisions orbeendorsed.ifSUBROGATIONISWAIVED,subjecttot and IMPORTANT.Ifthecertificateholder'isanADDITIONALINSURED,mmmWWWWWWWWWWmmWWWWWWWWWW mm the 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- -----------------�-,,,,,, ,,.-,�....- .................. CONTACT..._,,..�..........._.........,,.,. ........ �.�.._.W.....---------..�. NAME: Michael Delaney(2958C5T) PHONE FAx 2340 Plaza Del Amo Ste 200 (A/C, No EXT) 310 782 8586 (A/c NO). 310 787 0039 [---______ E-MAIL Torrance CA 90501-3453 ADDRESS: mdelaney@farmersagent.com ................... mm...... INSURER(S)AFFORDING COVERAGE NAIC# INSURED mm INSURERA: Truck Insurance Exchange 21 ___. 1709 INSURERB Farmers Insurance Exchange . ...............� nge 21652 DENN ENGINEER INC INSURERC Mid Century Insurance Company mmmm 21687 3914 DEL AMO BLVD STE 921 INSURER D: w_..------..._ _............... _.. INSURER E TORRANCECA 90503 ................ ................ __................. _.............. INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: _....m. THIS IS TO CERTIFY THATTHEPOLICIES OFINSURANCE LISTED mBELOW HAVE BEEN ISSUED TOTHEINSURED NAME ABOVE FOR THE POLICYPERIOD INDICATED. NOTWITH STANDING 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 BYTHE POLICIES DESCRIBED HEREIN IS SUBJECTTO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ..�.�.�.. �w..........--___.... �-------- ----- ...................- INSR ADDTL SUBR NUMBER POLICY EFF POLICY EXP LIMITS I TYPEOFIN (MM LILY EFF LTR SURANCE INSD SUB POLICY NUM (MM/DD/YYYY) ---------.. . COMMERCIAL GENERAL-_.. LIABILITY EACH OCCURRENCE $ ............... CLAIMS -MADE OCCUR ............. RENTED DAMAGE TO RE Occurrence) PREMISES (Ea $ ............ y ne person) MED EXP (Anyone PERSONAL&ADVINJURY $ GEN'L AGGREGATE LI...� MITAPPLIESPER: GENERAL AGGREGATE $ POLICY PROJECT LOC PRODUCTS -COMP/OPAGG $ OTHER: ............... $ ............... .......W_ .. AUTOMOBILE LIABILITY A COMBINED SINGLE LIMIT (Ea accident) $ 2,000,0010 ANYAUTO BODILY INJURY (Per person) ............... OWNEDAUTOS SCHEDULED C X BODILY INJURY (Peracadent) $ ONLY AUTOS Y Y 606665017 09/13/2022 09/13/2023 X HIREDAUTOS X NON -OWNED PROPERTY DAMAGE $ ONLY AUTOSONLY (Per accident) _....�.................. _....... UMBRELLALIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE $ D E D I $ w,....-. ................. $ mmnmmRETENTION .W_,,, WORKERS COMPENSATION PER OTHER $ AND EMPLOYERS' LIABILITY STATUTE IT ANY Y�' C D EXECUTIVE OFFICER/MEMBER MBER N/A E.L.WDISEASE-CIENT FA EMPLOYEE Wmmmmmmmmmmm m EXCLUDED? Mandatory in NH) ... Ifyes, describe under DESCRIPTION OF E.L.DISEASE- POLICY LIMIT $ OPERATIONS below .. .--... Additional Remarks Schedule, may be attached if more space is required) DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD101, Add ........_ ...........morespa �� --------- ...^ ................... Job: Topographic Survey Douglas St and Coral St El Segundo, CA 90245 CERTIFICATE HOLDER CANCELLATION ITM.. L� GUN .P`IT LAC V OWK- i7 1 __....... ....� --- ...... SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE _.. EXPIRATION Attn: Ariana Bola DATE THEREOF NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. _...................._..... 350 Main St AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) @ 1988-2015 ACORD CORPORATION. All Rights Reserved 31-1769 11-15 The ACORD name and logo are registered marks of ACORD