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PROOF OF INSURANCE (2023 - 2024) CLOSEDCERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 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 ri hts to the certificate holder in lieu of such endorsements). PRODUCER CONTACT r.-ME.._ Jules Scotia Be..nd r JAMES S BENDER INSURANCE AGENCY PHONE �} (88)"5-4613_a(.No, (144.76 E-MAIL 1641 S Meridian AveaDRss: JamesNardRisks.com S AFFORDING COVERAGE ..... Alhambra, CA91803......................................nusumRERl..d...................................�_�.......... NAlca License #: OD69973 INSURERA: Gemini Insurance Company .............................. 10833 INSURED INSURER B : Evanston Insurance COmnanv 35378 Dash Construction Company, Inc. 6300 Canoga Ave, Unit 530 INSURERE: Woodland Hills CA 91387 INSURERF; rOVFRAn9A t".FRT/Flt!"ATF NI!IMRFRF RFVISION NIJMRFR- 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. _... ............._._. ..._. INSR TYPE OF INSURANCE WD-L SU�BRPOLICY POLICY POLICY NUMBER 1tt7V 'PMOfDY VYOP'.. LIMITS COMMERCIAL IAL GENERAL LIABILITY EACH OCCURRENCE $ 1 ��� 000 mmmm, .�.,... CLAIMS -MADE OCCUR PREMISES (Ea occurrence) $ �.QOr000._. MED EXP (An one person) $ 5rpQ0 $ 1000,000 X X VIGP022773 12/2/2022 12/2/2023 „,EtRSONALBADVINJURY GENERAL AGGREGATE $ 2000.000 GEN'L.AGGREGATE LIMIT APPLIES PER: POLICY jE� LOC PRODUCTS $ 2,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT n, .I��EE.adq $ ANY AUTO BODILY INJURY (Per person) $ .......... OWNED .SCHEDULED BODILY INJURY (Per accident) _.................................................. $ AUTOS ONLY AUTOS HIRED NON -OWNED PROPERTYOAMAGE $ AUTOS ONLY AUTOS ONLY I�er.�sc%9aan ....... „ UMBRELLA LIAB OCCUR _...._ EACH OCCURRENCE $ .......................... _ EXCESS LIAB CLAIMS -MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION PER OTH- STATUTE AND EMPLOYERS' LIABILITY Y / N „„„„„„„„ - _ER,,. ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ .NIA OFFICERIMEMBER EXCLUDED? E.L. EACH ACCIDENT """""""""""""""""""""""" ............................... $ """"" (Mandatory In NH) EL „ DISEASE - EA EMPLOYE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT B Umbrella / Excess Liability X X EZXS3098744 12/2/2022 12/2/2023 Per Occurrence $2,000,000 Aggregate $2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of El Segundo, their officers, agents, employees and voluteers are named as additional insureds. City of El Segundo is afforded Additional Insured Status with Primary 8r Non-Contrubitory, including Waiver of Subrogation. TE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of El Segundo 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 C' CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of A(36RO COMMERCIAL GENERAL LIABILITY COVERAGE PART DECLARATIONS Policy: VIGPO22773 Effective Date: 12/02/2022 Named Insured: Dash Construction Company Inc LIMITS OF INSURANCE Each Occurrence Limit $1,000,000 General Aggregate Limit(Other than Products -Completed Operations) $2,000,000 Products -Completed Operations Aggregate Limit $2,000,000 Personal & Advertising Injury Limit $1,000,000 Damage to Premises Rented to You $100,000 Any one premises Medical Payments $5,000 Any one person RETROACTIVE DATES This insurance does not apply to "bodily injury", "property damage" or "personal and advertising injury" which occurs before the Retroactive Date, if any, shown here: NONE (Enter Date or "NONE" if no Retroactive Date applies) PREMIUM Minimum Class Description Estimated Exposure Premium Basis Audit Rate Premium 91340 Carpentry - construction of residential property Per 1,000 Gross not exceeding threestories in height Sales Comments: Included 92215 Driveway Parking Area or Sidewalk - paving or repaving Per 1,000 Gross Sales THESE DECLARATIONS ARE PART OF THE POLICY DECLARATIONS CONTAINING THE NAME OF THE INSURED AND THE POLICY PERIOD. CGLDEC 07 19 Page 1 of 1 Policy Number: VIGPO22773 Insured Name: Dash Construction Company Inc Number: 31 VE 05 81 07 18 Effective Date: 12/0212022 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. SUBCONTRACTOR AND INDEPENDENT CONTRACTOR CONDITIONAL AMENDMENT OF DEDUCTIBLE This endorsement modifies insurance provided under the following: Commercial General Liability Coverage Part Minimum Subcontractor and Independent Contractor Commercial General Liability Limits of %I Insurance Requirements Each Occurrence Limit $1,000,000 General Aggregate Limits $2,000,000 (Other than Products -Completed Operations) Products —Completed Operations Aggregate Limit $2,000,000 Personal and Advertising Injury Limit $1,000,000 SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS is amended to include the following condition: When work or operations are performed by others, including subcontractors and independent contractors, on any insured's behalf, the insured shall obtain, prior to the start of work or operations, and have record of: A written contract or agreement for the work or operations, that is signed by the person or organization performing operations on the insured's behalf, that: a. Holds the insured harmless and indemnifies the insured for "bodily injury", "property damage" and "personal and advertising injury" arising out of those operations or work, including work included in the "products completed operations hazard"; and b. Specifies the person or organization performing the operations has, and will maintain for the length of the statute of limitations in the jurisdiction in which the operations or work are performed, Commercial General Liability insurance coverage that: (1) Has minimum limits of insurance as shown in the Schedule above; (2) Is issued by a company with a minimum A.M. Best's rating of A VII; (3) Does not contain restrictive or exclusionary language for their performance of the operations and work; (4) Covers the person or organization for their performance of the operations and work, including work included in the "products -completed operations hazard"; VE 05 81 07 18 Included copyrighted material of Insurance Services Page 1 of 2 Office, Inc. with its permission (5) Provides the insured coverage as an additional insured for the same; (6) Covers contractual liability for assumption of liability in an "insured contract," including "bodily injury" claims asserted by any "employee" of the person or organization performing operations or work on behalf of the insured; and (7) Is primary and will not seek contribution from the policy. 2. Certificates of insurance confirming Commercial General Liability insurance coverage as specified above. If a subcontractor or independent contractor's work directly or indirectly gives rise to a claim, and the insured fails to comply with the conditions set forth in this endorsement, coverage for such claim will be subject to the deductibles listed in the schedule below. f Increased Deductible(s) Amount I Coverage Bodily Injury Liability OR Property Damage Liability OR Personal and Advertising Injury Liability OR Bodily Injury Liability; Property Damage Liability and / or Personal and Advertising Injury Liability Combined All other terms and conditions of this Policy remain unchanged. Amount per Occurrence or Offense $Not applicable $Not applicable $Not applicable $15,000 VE 05 81 07 18 Included copyrighted material of Insurance Services Page 2 of 2 Office, Inc. with its permission Policy Number: VIGPO22773 CG 20 10 07 04 Insured Name: Dash Construction Company Inc Number: 32 Effective Date: 12/02/2022 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSORS OR CONTRACTORS - SCHEDULED PERSON OR 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 Any person or organization when you have agreed All locations for which you have agreed in a written in a written and executed contract, prior to an and executed contract prior to an "occurrence "occurrence", that such person or organization be added as an additional insured on your policy 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 B. With respect to the insurance afforded to to include as an additional insured the these additional insureds, the following person(s) or organization(s) shown in the additional exclusions apply: Schedule, but only with respect to liability for This insurance does not apply to "bodily bodily injury", property damage or injury" or "property damage" occurring after: "personal and advertising injury" caused, in whole or in part, by: 1. All work, including materials, parts or 1. Your acts or omissions; or equipment furnished in connection with such work, on the project (other than 2. The acts or omissions of those acting on service, maintenance or repairs) to be your behalf; performed by or on behalf of the in the performance of your ongoing additional insured(s) at the location of the operations for the additional insured(s) at the covered operations has been completed; location(s) designated above. or 2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged 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 Policy Number: VIGPO22773 CG 20 37 07 04 Insured Name: Dash Construction Company Inc Number: 33 Effective Date: 12/02/2022 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: Commercial General Liability Coverage Part SCHEDULE Name Of Additional Insured Person(s) Location And Description Of Completed Or Organization(s): Operations Any person or organization when you have agreed in All locations and completed operations for which a written and executed contract, prior to an you have agreed in a written and executed contract "occurrence", that such person or organization be prior to an 'occurrence." added as an additional insured on your policy. 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 damage" caused, in whole or in part, by "your work" at the location designated and described in the schedule 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 Policy Number: VIGPO22773 Insured Name: Dash Construction Company Inc Number: 34 CG24041219 Effective Date: 12/02/2022 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: Commercial General Liability Coverage Part Schedule Name Of Person(s) Or Organization(s): Any person or organization you have agreed in a written and executed contract, prior to an 'occurrence", that you would provide such person or organization a waiver of transfer of rights of recovery against others to us on your policy. Information re uired 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 against the person(s) or organization(s) shown in the Schedule above because of payments we make under this Coverage Part. Such waiver by us applies only to the extent that the insured has waived its right of recovery against such person(s) or organization(s) prior to loss. This endorsement applies only to the person(s) or organization(s) shown in the Schedule above. All other terms and conditions of this Policy remain unchanged. CG 24 04 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1 Policy Number: VIGPO22773 VE 09 73 04 20 Insured Name: Dash Construction Company Inc Number: 41 Effective Date: 12/02/2022 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: Commercial General Liability Coverage Part The following is added to the Other Insurance Condition and supersedes any provision to the contrary: Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution from any other Commercial General Liability insurance available to an additional insured under your policy, but only if: (1) The additional insured is a Named Insured under such other Commercial General Liability insurance; and (2) You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other Commercial General Liability insurance available to the additional insured. Coverage granted to an additional insured remains subject to all terms, conditions, limitations, and exclusions set forth in the endorsement form that conferred the additional insured status. In the event of conflict between this endorsement and an endorsement conferring additional insured status, then the endorsement conferring additional insured status shall govern the scope of coverage available to the additional insured. All other terms and conditions of this Policy remain unchanged. VE 09 73 04 20 Includes copyrighted material of Insurance Services Office, Inc. Page 1 of 1 with its permission DATE (MM/DDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 06/14/2023 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 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 Simon Shirazi NAME.;... Golden Capital Insurance PHONE 21250 Califa St Ste #113 (818)654 6985 ! dP I Ns Ext1 lA c I�cT Woodland Hills, CA 91367 E-MAIL ADDRESS I^YaI e( . ctdencap('k lgess com ........ Vie.,„ ., m _ Phone: (818) 654-6985 Fax: C_) IN RERJ§) AFF.0RDIN„G COVERAGE .................. �, ,.... .NAIC # — _..�..... INSURER Falls Lake Fire and Casualty Company......_._ 15884 ... ...--- .. INSURED --------- INSURER B : DASH CONSTRUCTION COMPANY INC INSURER C INSURER D PO BOX 261321 ...... .., — — ..... ......................... INSURER E EncinoCA 91426- - p....pe.................... _................_.......................... INSURER F : COVERAGES CFI?TIFIf`..ATF kI11MRFR• or-kil inki kill l"Mr-l0 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. ...NSR ......... ......... .-.....— AD 'L'"S'i.4fEIk° ............... .............-.-.--- __,_._.-L_ 0dLL1dW"EFF . /audLi"bY kko .......... __._._._.............,,.,....................,.,_,.......,_...... VV LTR TYPE OF INSURANCE t POLICY NUMBER MMIOYM'y D/Y @wUI MO D@'dYYY LIMITS COMMERCIALGENERALLIABILITY EACH OCCURRENCE $ ti/�dL I T%tLtafPS .. CLAIMS-MADE ]OCCUR �... id p(.n . Y ) �..� � Ii�� �rccurctri c� $ ..... ED EXP (Any one person) $ PERSONAL & ADV INJURY _._ $ .............. GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ PR .. . POL1 I' Y .�. „ry$'C - ._ I. LOC PRODUCTS - COMP/OP AGG -- -- .$ ...........,M.M. ... ...... OTI^tEI'�: $ AUTOMOBILE LIABILITY COMBINE" D SINGW F UWT $ t.'ra au.c,�dgntl... ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS �..�... .. ._ P BODILY INJURY (Per accident ( ) .. ............... ........... $ NON -OWNED PFat.TPEatYY'CAI�iA.L. $ HIRED AUTOS AUTOS ._.deer k1GCmrrlMt_ ...,........m ...� .. ........................... i! $ UMBRELLA LIAR ACH OCCURRENCE $ ,.....--- EXCESS LIAB CLAIMS MADE y AGGREGATE -._....-.-._ .......... $ _.__... I ,,,,,. .m. .. ,. ,. ^ ,,,,,,,,,,,,,,,,,,,,,,,,,, „ DED 9 RETENTION $ {, $ A ION X FLA016529-02 03/01/2023 03/01/2024 0 PER � AND EMPLOYERS' I� N YERS' LIABILITY _EMI TE ERH '� ANY RIEXECUTIVE .. OFFICER/MEMBER ER EXCLUDED? � N /A E EACH 1,000,000 � W ,(Mandatory in HWEXCLU E.L. SEASECIE.. EMPLOYEE, $ 1,000,000 IIfyes, describe under DESCRIPTION OF OPERATIONS below i ......_._ ............... ..�.__..-. ... E.L DISEASE -POLICY LIMIT 1 $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CSLB #869505 A Waiver of Subrogation is in favor of City of El Segundo. Endorsement form attached. City of El 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 © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 Ed. 4-84 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT-CALIFORNIA 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.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 2,5,% of the California workers' compensation premium otherwise due on such remuneration. Schedule Person or Organization Job Description Blanket Waiver of Subrogation As respects to all CA jobs performed by the named insured during the policy period where by written contract a waiver of subrogation is required prior to the commencement of work. 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 03-01-2023 Policy No. FLA016529-02 Endorsement No. Insured Insurance Company Dash Construction Company, Inc. (A Corp) Falls Lake Fire & Casualty Company Countersigned By ©1998 by the Workers' Compensation Insurance Rating Bureau of California. All rights reserved.