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PROOF OF INSURANCE (2024) CLOSEDDATE (MMIDD/YYYY) ACC CERTIFICATE OF LIABILITY INSURANCE " 4/1412023 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 CONTACT AM9r Account Managers ....... Alera-Adamson McGoldrick Insurance Agency' LLC PHONE FAX Adamson & McGoldrick Insurance Solutions IN teas, FA*. . 714 2 7 9644.. FAX I.---- ..714 2 '3B33 E-MAIL ... ...... g pe Ave., Suite 100 rstsR s cart(6r Ites anrsonmogoldrick clam — 1150 E. Oran ethtor , Placentia, CA 92870 INSURER-(S�AFFORDING COVE ..... www.adamsonmcgoldrick.com INSURER A. Travelers Indemnitv COmoanv of CT 25682 INSURED Ramona, Inc. PO Box 660219 Arcadia CA 91006 14016I /=ft TeT*9 CERTIFICATE NUMBER: 7,AQn?9A1 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. _....----......---_.... LIMITS .... ......... ..... -----.. INSRI TYPE OF INSURANCE ('`ODL SC.�NBR' POLICY EFF - POLICY EXP TR ( POLICY NUMBER MMrDD..... MMlD A COMMERCIAL GENERAL LIABILITY DT22-CO-81<179447-TCT-23 4/17/2023 4/17/2024 j bEACH i�IJGiI�CCUIRNi"Eb a r _ ....., CLAIMS -MADE hl OCCUR A?IR.EMISES (Ea p uCEenP,) $ 300o000QOX ✓ Ded: $...10,000 PD per occ ............................_, MED..EXP..{An.Y one person..............$...re.Q�.Q................................................ PERSONAL & ADV INJU.R�Y................��,QQQ l)OO..........-............. GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 PRO_......_..._ .. POLICY ✓ PRO, LOC _ ___ .. ........................ -PRODUCTS- COMP/OP AGG .._ . S2,0001000 .$_B O'THERi AUTOMOBILELIABILITY DT-810-8K073930-TIL-23 4/17/2023 4/17/2024 COMElNEDSINGLE UMIi t- cr*I41) $ 1 0_00 000 .,. ANY AUTO _.__ BODILY INJURY (Per person) I ..._. _ .._..� r $ OWNED SCHEDULED 1 AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ P $ _,.....� AUTOS ONLY `.,_. AUUTOS ONLY _fEer gcmden0)AMAGE ...... $ Il B �/ LLAuaB UMBR � ,( OCCUR CUP-BK188456-23-26 4/17/2023 4/17/2024 EACH OCCURRENCE $5 000 1 I QQQ EXCESS LI CLAIMS MADE AGGREGATE $ 000QQQ rAB DED ." ✓ 4 RETENTION $10,�... """"" "" 000 � $ B WORKERS COMPENSATION ✓"""—"—"" UB-81<156679-23-26-13 4/17/2023 4/17/2024 PTATU�T.€ OTH AND EMPLOYERS' LIABILITY Y/N `.. .-. -""` . "...."..... ANYPROPRIETOR/PARTNER/EXECUTIVE ""'"' E L EACH ACCIDENT 1,000�OQO OFFICERIMEMBER EXCLUDED? NIA"... .$ - "" (Mandatory in NH) E L, DISEASE - EA EMPLOYEE S. JyQQQ�QQQ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1 000 000 A Installation Floater QT-630-7P504116-TIL-23 4/17/2023 4/17/2024 Limit $1,000,000 / Ded $1,000 A 'Leased/Borrowed/Rented Equipment QT-630-7P504116-TIL-23 4/17/2023 4/17/2024 Limit $350,000 / Ded $1,000 C Pollution Liability G-71513798-004 4/17/2023 4/17/2024 Limit:$1,000,000 A ''Scheduled Equipment QT-630-7P504116-TIL-23 4/17/2023 4/17/2024 Limit: $2 506 275 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: All operations City of El Segundo, its officers, officials, employees, agents, and volunteers are named additional insured. This insurance is primary and non-contributory, and waiver of subrogation applies per endorsements attached. *10 days notice of cancellation for non-payment. 30 days otherwise. LK I fEI(;A I t HU RE: All operations Clty of Eli Segundo 350 Main Street. El Segundo 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 Brian McGoldrick ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 73902261 123-24 All Lines I Evett Lam 14/14/2023 1:45:23 PM (PST) I Page 1 of 7 Ramona, Inc. COMMERCIAL GENERAL LIABILITY tn� tt�xr�r�;lfssrcti�retr�xl THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURE (Includes Products -Completed Operations If Required By Contract) This endorsement modifies insurance provided under the. following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PROVISIONS The following is added to SECTION II — WHO IS AN INSURED: Any person or organization that you agree in a written contract or agreement to include as an additional insured on this Coverage Part is an insured, but only: a. With respect to liability for "bodily injury" or "property damage" that occurs, or for "personal injury" caused by an offense that Is committed, subsequent to the signing of that contract or agreement and while that part of the contract or agreement is in effect; and b. If, and only to the extent that, such injury or damage is caused by acts or omissions of you or your subcontractor in the performance of "your work" to which the written contract or agreement applies. Such person or organization does not qualify as an additional insured with respect to the independent acts or omissions of such person or organization. The insurance provided to such additional insured is subject to the following provisions: a. If the Limits of Insurance of this Coverage Part shown in the Declarations exceed the minimum limits required by the written contract or agreement, the insurance provided to the additional insured will be limited to such minimum required limits. For the purposes of determining whether this limitation applies, the minimum limits required by the written contract or agreement will be considered to include the minimum limits of any Umbrella or Excess liability coverage required for the additional insured by that written contract or agreement. This provision will not increase the limits of insurance described in Section III — Limits Of Insurance. (1) Any "bodily injury", "property damage" or "personal injury" arising out of the providing, or failure to provide, any professional architectural, engineering or surveying services, including: (a) The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders or change orders, or the preparing, approving, or failing to prepare or approve, drawings and specifications; and (b) Supervisory, inspection, architectural or engineering activities. (2) Any "bodily injury' or "property damage" caused by "your work" and included in the "products -completed operations hazard" unless the written contract or agreement specifically requires you to provide such coverage for that additional insured during the policy period. c. The additional insured must comply with the following duties; (1) Give us written notice as soon as practicable of an "occurrence" or an offense which may result in a claim. To the extent possible, such notice should include: (a) How, when and where the "occurrence" or offense took place; (b) The names and addresses of any injured persons and witnesses; and (c) The nature and location of any injury or damage arising out of the "occurrence" or offense. b. The insurance provided to such additional (2) If a claim is made or "suit" is brought against insured does not apply to: the additional insured: CG D2 46 0419 ©201B The Travelers Indemnity Company. All rights reserved. Page 1 of 2 73902261 123-24 All Lines I Evett La"i 1 4/14/2023 1:45:23 PM (PST) I Page 3 of 7 COMMERCIAL GENERAL LIABILITY (a) Immediately record the specifics of the claim or "suit" and the date received; and (b) Notify us as soon as practicable and see to it that we receive written notice of the claim or "suit" as soon as practicable. (3) immediately send us copies of all legal papers received in connection with the claim or "suit", cooperate with us in the investigation or settlement of the claim or defense against the "suit", and otherwise comply with all policy conditions. Page 2 of 2 (4) Tender the defense and indemnity of any claim or "suit" to any provider of other insurance which would cover such additional insured for a loss we cover. However, this condition does not affect whether the insurance provided to such additional insured is primary to other insurance available to such additional insured which covers that person or organization as a named insured as described in Paragraph 4., Other Insurance, of Section IV — Commercial General Liability Conditions. © 2018 The Travelers Indemnity Company. All rights reserved. CG D2 46 04 19 7:3.962261 1 2:3...24 Id:D Lines I watt LaYn 1 4/:1.4/2023 1. 41S:23 PM (PST) I Page 4 of 7 Ramona, Inc. DT22-CO-8K] 79447-TCT-23 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART GENERAL DESCRIPTION OF COVERAGE — This endorsement broadens coverage. However, coverage for any injury, damage or medical expenses described in any of the provisions of this 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 description only. Read all the provisions of this endorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered. A. Who Is An Insured —Unnamed Subsidiaries B. Blanket Additional Insured — Governmental Entities — Permits Or Authorizations Relating To Operations PROVISIONS A. WHO IS AN INSURED — UNNAMED SUBSIDIARIES The following is added to SECTION II — WHO IS AN INSURED: C. Incidental Medical Malpractice D. Blanket Waiver Of Subrogation E. Contractual Liability —Railroads F. Damage To Premises Rented To You a. An organization other than a partnership, joint venture or limited liability company; or b. A trust; as indicated in its name or the documents that govern its structure. Any of your subsidiaries, other than a partnership, B. BLANKET ADDITIONAL INSURED — joint venture or limited liability company, that is GOVERNMENTAL ENTITIES — PERMITS OR not shown as a Named Insured in the AUTHORIZATIONS RELATING TO OPERATIONS Declarations is a Named Insured if. a. You are the sole owner of, or maintain an ownership interest of more than 50% in, such subsidiary on the first day of the policy period; and b. Such subsidiary is not an insured under similar other insurance. No such subsidiary is an insured for "bodily injury' or "property damage" that occurred, or "personal and advertising injury" caused by an offense committed: a. Before you maintained an ownership interest of more than 50% in such subsidiary; or b. After the date, if any, during the policy period that you no longer maintain an 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 Declarations as: The following is added to SECTION II — WHO IS AN INSURED: Any governmental entity that has issued a permit or authorization with respect to 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 an Insured, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising 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 injury" arising out of operations performed for the governmental entity, or b. Any "bodily injury' or "property damage" included in the "products -completed operations hazard". CG D316 0219 ® 2017 The Travelers Indemnity Company. All rights reserved. Includes copyrighted material of Insurance services Office, Inc., with Its permission. Page 1 of 3 73902261 1 23-24. All Li.- ( 13—Itt:: Lam 1 4/14/2023 I:4523 AM (PST) I na5...e+ 5 f 7 COMMERCIAL GENERAL LIABILITY C. INCIDENTAL MEDICAL MALPRACTICE 1. The following replaces Paragraph b. of the definition of "occurrence" in the DEFINITIONS Section: b. An act or omission committed in providing or failing to provide "'incidental medical services", first aid or "Good Samaritan services" to a person, unless you are in the business or occupation of providing professional health care services 2. The following replaces the last paragraph of Paragraph 2.a.(1) of SECTION II — WHO IS AN INSURED: Unless you are in the business or occupation of providing professional health rare services, Paragraphs (1)(a), (b), (c) and (d) above do not apply to "bodily injury" arising out of providing or failing to provide: (a) "Incidental medical services" by any of your "employees" who is a nurse, nurse assistant, emergency medical technician or paramedic; or (b) First aid or "Good Samaritan services" by any of your "employees" or "volunteer workers", other than an employed or volunteer doctor. Any such "employees" or "volunteer workers" providing or failing to provide first aid or "Good Samaritan services" during their work hours for you will be deemed to be acting within the scope of their employment by you or performing duties related to the conduct of your business. 3. The following replaces the last sentence of Paragraph 5. of SECTION III — LIMITS OF INSURANCE: For the purposes of determining the applicable Each Occurrence Limit, all related ads or omissions committed in providing or failing to provide "incidental medical services", first aid or "Good Samaritan services" to any one person will be deemed to be one "occurrence". pharmaceuticals committed by, or with the knowledge or consent of, the insured. 5. The following is added to the DEFINITIONS Section: "Incidental medical services" means: a. Medical, surgical, dental, laboratory, x-ray or nursing service or treatment, advice or instruction, or the related furnishing of food or beverages; or b. The furnishing or dispensing of drugs or medical, dental, or surgical supplies or appliances. 6. The following is added to Paragraph 4.b., Excess Insurance, of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: This insurance is excess over any valid and collectible other insurance, whether primary, excess, contingent or on any other basis, that is available to any or your "employees" for "bodily injury" that arises out of providing or failing to provide "incidental medical services" to any person to the extent not subject to Paragraph 2.a.(1) of Section II — Who Is An Insured. D. BLANKET WAIVER OF SUBROGATION The following is added to Paragraph 8., Transfer Of Rights Of Recovery Against Others To Us, of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: If the insured has agreed in a contract or agreement to waive that Insured's right of recovery against any person or organization, we waive our right of recovery against such person or organization, but only for payments we make because cf. a. "Bodily injury" or "property damage" that occurs; or b. "Personal and advertising injury" caused by an offense that is committed; 4. The following exclusion is added to subsequent to the execution of the contract or Paragraph 2., Exclusions, of SECTION I — agreement. COVERAGES — COVERAGE A — BODILY E. CONTRACTUAL LIABILITY— RAILROADS INJURY AND PROPERTY DAMAGE LIABILITY: 1. The following replaces Paragraph c. of the Sale Of Pharmaceuticals definition of "insured contract" in the "Bodily injury" or "property damage" arising DEFINITIONS Section: out of the violation of a penal statute or c. Any easement or license agreement; ordinance relating to the sale of Page 2 of 3 ® 2017 The Travelers Indemnity Company. All rights reserved. CG D3 16 02 19 Includes copyrighted material of Insurance Servloes Office, Inc., with Its permission. 73902261 1 23-24 All trines: I Evett Lam � 4/1.9(2623 1:45M PM (PAST) I Page 6 of. 7 2. Paragraph L(1) of the definition of 'Insured contrail" in the DEFINITIONS Section is deleted. F. DAMAGE TO PREMISES RENTED TO YOU The following replaces the definition of "premises damage" in the DEFINITIONS Section: "Premises damage" means "property damage" to: COMMERCIAL GENERAL LIABILITY 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 D316 0219 ® 2017 The Travelers Indemnity Company. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 3 of 3 73902261 1 23-24 All. Lines I EvYett Lam 1 4/1.4/202.3 1:45:23 PM (PST) ( Page 7 of. 7 TVil.�"�� WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 99 03 76 ( A) — POLICY NUMBER: WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA (BLANKET WAIVER) 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. The additional premium for this endorsement shall be 2 % of the California workers' compensation pre- mium. Schedule Person or Organization City of El Segundo, its officials and employees Job Description This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective Insured Ramona, Inc. Insurance Company DATE OF ISSUE: Policy No. 1_113-81<156679-23-26-G Endorsement No. Premium Countersigned by Page 1 of 1 73902261 1 23 -24 Al.l. Lines I E; e_tt Lam 1 4/1.4/202.3 1:4. :23 PM (PST) I Page 2 of 7