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PROOF OF INSURANCE (2024 - 2024) CLOSEDCERTIFICATE OF LIABILITY INSURANCE 1 _.....m Aastrlr�lo+r^x 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 pc N SUBROGATION IS WAIVED, subject to the terms and conditions of the PRODUCER CentE'al lr*taance Agency, Inc. PO Bola 1041 Smithtown, NY 11787 Stephen Ormsby Force, Inc DBA JRM Rd. #413 must have ADDITIONAL INSURED provisions or be endorsed. certain policies may require an endorsement. A statement on COVE)RAGESI 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. TYPE OF INSURANCE Routt POLICY NUMBER Pouc-f ErF Poe y LrNTTS A X, commERcULLGE7IERALLIABLLITY sAt&OE [X]Occurt X GLV0001060 08/30/2023 08130/2024 E4CaOrICUPRENr.E a 1,000,000 MAA&Exi,� r ,r t 300,000' X Assault & Battery r+ D F (A,,t prTm, r, 5'.000 P.ERSaJWAL fS AC/M IlfldllRV 1,000,000 S X Professional Liab GEML _ AGGREGATE UMn APPLIES PER: PGCC;:'Y ® PRO- [:J LOC JECT 5,V4tRAt„A S 3,000,000 ! PRODUr-TS - COMAVI A22 S 3,000,000 A AtT1kRM1WNs&AArMIL4TY C,"eJENED£xVI G ELJ1AI"C 4dw.r' 1,000,000 A YAUI0 GLV0001060 08/30/2023 08/30/2024 11 80EN- .,- R I IF .... 'X' OWNED ULED AU7,0SoNty AUTOS WRE S ONLYa^t NONAUT1OWPl6�ED NUTIqV ONLY '; �i 1CAA'IA(I,E UMBRELLA LWB X OCCUR ^ka'Mt'iA +g11, q r T 5,000,000 EXCESS ILMe CWMSMAOE. IJMV0000262 08/30/2023 08/30/2024 E'rIC X RSTE cr .1q$ 10,000 WORKERS CONS E NSATION AND EMIe'LOYI3L5°LIAiAL1TY YON Arw a Pwru'rant~r aaEP r, , �j--'c.EMEM rCTz Rc'*°�c" IMP w d A I p:PW7001050 01/05/2023 01/05/2024 A E I �A u PN-, 1,000,000' 1,000,000 d y-' dDESCR lP nb..`ION c`�P .. Tr I�- b .. AS ar11T .z C 1,000,000 .. C 112SBAF0809'�. ''. 41�ContenjS'506 [Pp Leas/rent 20,000 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 101, Ad fifi—1 Remad,s SchedWe, may be aK..t d it mme space c regved) The City of EI Segundo fife officers, officials. employees. agents, and volunteers are inclttdec as an additional insured under the general liability with respect to the liability created by the negligent acts,. errors and omissions of the named insured fl-erein as required by written cormalx. IF$CATE HOLDER CANCELLAIIQU THECIEL SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE The City of El Segundo ACCORDANEXPIRATIONWILL BE DELIVERED IN WITH THE POLICY PROVISIONS. 3501 Main st El Segundo, CA 90425 AUTROAM ) REPR'.E:SeR1'AT'ryE: ACORD 25 (2016/03) O 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