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PROOF OF INSURANCE (2023) CLOSED�� MCW1700 . 11. R CERTIFICATE OF LIABILITY INSURANCE UATE,MMIDDIYY_% �� n�ata_�ra�ri� 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(sl. Higgh Ground Insurance Services a tV�� oua� � Ra �aetrrey U. walls . 9 FAX No): � 400 2377 Crenshaw Blvd, #304 Arc Ne, EXt): 310-542-4600 AiC N).310-542-840 Torrance, CA 90501 Jeffrey D. Dalis . E#. &S5..,...... � .................... ........................I. ..... ...... . _._.J.1NApMR,A.:Insurance 2 140 Assocr� Industries Insurance.C.o�.�.�.�.�.�....�.�.�.�.�.��.................................. INSURERB:CA AUTOMOBILE INS COMPANY 38342 linc,..m,,., w........ �-_ INSURER C:GuideOne Specialty Ins Co 14559 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. _._m,.... _. .__ ....., �� _........... ...,ww ��� ...... INSR .... ..� DOL sue, POLICY EFF POLICY EXP TYPE OF INSURANCE POLICY NUMBER LIMITS A X COMMERCIAL GENERAL LIABILITY EA H OpT� RRENCE $ 1,000,000' CLAIMS -MADE X OCCUR X AES122513700 09/01/2022 09/01/2023 DAMAGE TO RENTED 100,000 X $5'IC Deductible "--E....— - ................. M.,E„DEXP .,,..(Ac .one arson $ .^^ PE,R,S,9N,,,,,A AA. DVINJURY .,m..,,,,m,A,...... $ 1,000,000 GroENT AGGREGATE APPLIES PER GENERAL AGGREGATE $ 2,000,000 PLIMIT POLICY � JECT LOC PRODUCTS „- COMP/OP AGG $ 2,000,000 NTH ' R_ B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1EPA, _ t9 1,000,000 $ �..,�.., ,........... ANY AUTO BA040000075725 09/01/2022 09/01/2023 BODILYINJURY Per arson $ OWNED SCHEDULEDAUTOS w m.,. 1�x AUTOS D.YINJURY..(Peraccgent. .�..gSy�..i�.._._..�...�.�........,... $ �p Why gy AN i. Y AbR OS ONLY IXXDed „? dP ntj AMAGE Hired PD $1,000 Hired PD $ 5,000 A . UMBRELLA LIABOCCUR XCLAIMS-MADE OC 3,000,000 X EXCESSLIAB EXA122752400 09/01/2022 09/01/2023 .EACH AGGREGATE 3,000,000 DED X RETENTION$ Nil $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY PER OTH Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE �'�"'� 9 MBER EXCLUDED? N/ A 010021042 09/01/2022 09/01/2023..........1.000000 E,L EACH ACCIDENT $ ........ A�y� �� 2p% NH) ihlandato �in NH) � 1,000,000 If es, desc be under yy DE CRIPTION OF OPERATIONS b Iow E L. DISEASE - EA EMPLOYE ....... ,... E DISEASE POLICY LIMIT $ ''''''i........ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) """ Cert Holder' Cont'd: emplo ees, agents, and volunteers The City of El Segundo its officers, officials, employees, agents and volunteers are include) as Additional Insureds, as respects the beneral Liability , as required by valid written contractor agreement With the Namedlnsured. Subject to policies' forms, terms and conditions, THECITO SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE ATE THEREOF, The City of El Segundo ACCORDANCEIWITHTHE POLICY PROVISIONS. WILL BE DELIVERED IN its officers, officials 250 Main St. El Segundo, CA 90245 AOTMORIZED REPRESENTATIVE..,� ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: AES1225137 00 COMMERCIAL GENERAL LIABILITY CG 20 10 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. to] II _01 tte L, 9, f i 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 All persons or organizations where required by Construction project sites at which you performed written contract with the Named Insured work for such additional insured Information re uired to com lete this Schedule, if not shown above, will be shown in the Declarations. .w. 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: AES1225137 00 COMMERCIAL GENERAL LIABILITY CG 20 37 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OIL CONTRACTORS - COMPLETED OPERATIONS S This endorsement modifies insurance provided under the following; COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE _......................._. ....... Name of Additional Insured Person(s) or Organization(s): Location and Description of Completed Operations All persons or organizations where written contract Construction project sites at which you performed with the Named Insured requires additional insured work for such additional insured completed operations. This form does not apply to your work on new "residential property". ..-..-..- ............................ ................................... _. .. 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 0