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PROOF OF INSURANCE (2024) CLOSEDClient#: 164812 GMBUSIN DATE (MMIDD/YYYY) ACORD. CERTIFICATE OF LIABILITY INSURANCE 1 02/22/2023 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. .. ................... m,,, .,,,,,,m__..........______ _ P Y( ) — IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the olic 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER N T Sue Nisoff EPIC Insurance Midwest P€loi�._........................................IT^'FAX _.... (A/C, No Extj _ ----. ........ 560 5th Street, Suite 202 E'isMA" .sue„It'➢stiff epicbrf kers.com Grand Rapids, MI 49504...... INSURER(S) AFFORDING COVERAGE INSURER A: National Union Fire Ins Co of Pittsburg 19445 INSURED INSURER B : New Hampshire Insurance Company 23841 Goforth 8r Marti Inc. dba GM Business........................................................................_.._._._._. INSURER C GM Business Interiors —_ 7099 W. La Cadena Dr. INSURER D - ........... ----- - ..�. INSURER E : Riverside, CA 92601 _. ................ ..... ........................... _ COVERAGES CERTIFICATE NUMBER: 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 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. LTR _. TYPE OF INSURANCE p — SUBR w POLICY NUMBER ff (I p 1lYiF^Fi) .LICYEXP (MM/DDIYYYY LIMITS A ')( COMMERCIAL GENERAL LIABILITY 5180 177 3/01/2023 03/01/20241 EACH OCCURRENCE $1 000 000 DAMAGE TO RENTED $300 000 CLAIMS -MADE. OCCUR PREMISES„(,Eaoccunence,,,,)„ MED EXP (Any one person) s26,000 $1 09R 0Ot, 0 '.. ..... ....-.. PERSONAL & ARV INJURY ._.,................ GEN L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2L000OOO PRt3- ❑ POLICY J�Et��T LOC PRODUCTS COMP/OPAGG -- ------.........�... $2 000 000 1 .._-..L�w,_. OTHER: $ p AUTOMOBILE LIABILITY � 2961606........................ .. __ 3101/2023 COMBIINEDCSINGLE��LIMIG 03/01/202JBODILY $1,000,000 X. ANY AUTO ODILY INJURY (Per person) $ OWNED SCHEDULED AUTOS ONLY AS INJURY (Per accident ._...... j $ $ ..... HIRED NON -OWNED X ROPERTY DAMAGE : AUTOS ONLY AUTOS ONLY P+sr q:kdpciC._ .___..................................................................... UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB E CLAIMS -MAD AGGREGATE $ DED RETENTION $ $ A WORKERS COMPENSATION 80756387 3I01/2023 PER OTH 03/01/202 X TI�Tmm. .....---�...mm.._...... ANDEMPLOYERS'LIABILITY Y / N �,,...� ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $1,OOQ Q00 EXCLUDED' (Mandatory In NH) NIA E.L. DISEASE - EA EMPLOYEE $1,000 0-00 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $1 000 000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Additional Insured with regard to the General and Automobile Liability on a primary and non-contributory basis, as required by written contract - City of El Segundo. A Waiver of Subrogation applies to the General Liability and Workers' Compensation policies where required by written contract in favor of the additional insured. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City Of El Segundo — City Clerk ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street, Room 5 El Segundo, CA 90245-3813 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) 1 of 1 The ACORD name and logo are registered marks of ACORD #S5283549/M5283485 KWI01 POLICY NUMBER: GL 518-01-77 COMMERCIAL GENERAL LIABILITY CG20100413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES 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 WHOM YOU PER THE CONTRACT OR AGREEMENT. BECOME OBLIGATED TO INCLUDE AS AN ADDITIONAL INSURED AS A RESULT OF ANY CONTRACT OR AGREEMENT YOU HAVE ENTERED INTO. 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) designated above. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equipment 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 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 04 13 * Insurance Services Office, Inc., 2012 Page 1 of 2 0 C. With respect to the insurance afforded to these additional insureds, the following is added to Section III - Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. Page 2 of 2 0 Insurance Services Office, Inc., 2012 CG 20 10 04 13 ❑ POLICY NUMBER: GL 518-01-77 COMMERCIAL GENERAL LIABILITY CG 20 37 04 13 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 PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations ANY PERSON OR ORGANIZATION WHOM YOU BECOME OBLIGATED TO INCLUDE AS AN ADDITIONAL INSURED AS A RESULT OF ANY CONTRACT OR AGREEMENT YOU HAVE ENTERED INTO. PER THE CONTRACT OR AGREEMENT, 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" 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". However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agree- ment, the insurance afforded to such addi- tional insured will not be broader than that CG 20 37 04 13 which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following is added to Section III - Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insu- rance shown in the Declarations; whichever is less. This endorsement shall not increase the appli- cable Limits of Insurance shown in the Decla- rations. 0 Insurance Services Office, Inc., 2012 PDF created with pdfFactory Pro trial version www.Ddffactory.com Page 1 of 1 ❑ PDF created with pdfFactory Pro trial version www.pdffactory.com POLICY NUMBER: GL 518-01 -77 COMMERCIAL GENERAL LIABILITY CG 02 24 10 93 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EARLIER NOTICE OF CANCELLATION PROVIDED BY US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Number of Days' Notice 90 (If no entry appears above, information required to complete this Schedule will be shown in the Declarations as applicable to this endorsement.) For any statutorily permitted reason other than nonpayment of premium, the number of days required for notice of cancellation, as provided in paragraph 2. of either the CANCELLATION Common Policy Condition or as amended by an applicable state cancellation endorsement, is increased to the number of days shown in the Schedule above. CG 02 24 10 93 Copyright, Insurance Services Office, Inc., 1992 Page 1 of 1 ❑ PDF created with pdfFactory Pro trial version www.pdffactory.com POLICY NUMBER: GL 518-01-77 COMMERCIAL GENERAL LIABILITY CG 20 01 04 13 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 PRODUCTS/COMPLETED OPERATIONS 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 insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and (2) You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribu- tion from any other insurance available to the additional insured. CG 20 01 04 13 0 Insurance Services Office, Inc., 2012 Page 1 of 1 POLICY NUMBER: GL 518-01-77 COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY 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: PURSUANT TO APPLICABLE WRITTEN CONTRACT OR AGREEMENT YOU ENTER INTO, 1I Information required to complete this Schedule, if not shown above, will be shown in the Declarations. 1 The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Sec- tion 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 opera- tions 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 O Insurance Services Office, Inc., 2008 Page 1 of 1 ❑ ENDORSEMENT This endorsement, effective 12:01 A.M. 03/01 /2023 forms a part of policy No.GL 518-01-77 issued to GOFORTH & MART - DBA: GM BUSINESS INTERIORS by NATIONAL UNION FIRE INSURANCE COMPANY OF P I TTSBURGH , PA THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AMENDMENT OF LIMITS OF INSURANCE (Per Project or Per Location Aggregate Limit) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM I. Your policy is amended to include either a Per Project General Aggregate Limit, a Per Location General Aggregate Limit or a Per Project and Per Location General Aggregate Limit. Please select only one of the following: [XI Per Project General Aggregate Limit $ 2,000,000 [ 1 Per Location General Aggregate Limit $ [ 1 Per Project and Per Location General Aggregate Limit $ IF NEITHER OF THESE BOXES ARE CHECKED, THIS ENDORSEMENT IS VOID. IF MORE THAN ONE OF THE THESE BOXES ARE CHECKED, THIS ENDORSEMENT IS VOID. II. SECTION III - LIMITS OF INSURANCE , is amended to include the following-, 1. The Limits of Insurance and the rules below fix the most we will pay regardless of the number of: a. Insureds; b. Claims made or "suits" brought; or c. Persons or organizations making claims or bringing "suits". 2. The General Aggregate Limit is the most we will pay for the sum of: a. Medical expenses under CoverageC; b. Damages under Coverage A, except damages because of "bodily injury" or "property damage" included in the products -completed operations hazard"; and c. Damages under Coverage B. 3. The Products -Completed Operations Aggregate Limit is the most we will pay under Coverage A for damages because of "bodily injury" and "property damage" included in the "products -completed operations hazard". 4. Subject to 2. above, the Personal and Advertising Injury Limit is the most we will pay under Coverage B for the sum of all damages because of all "personal and advertising injury" sustained by any one person or organization. 5. Subject to 2. or 3. above, whichever applies, the Each Occurrence Limit is the most we will pay for the sum of: a. Damages under Coverage A; and b. Medical expenses under CoverageC 86681 (9/04) Page 1 of 2 PDF created with pdfFactory Pro trial version www.pdffacto[y.com because of all "bodily injury" and "property damage" arising out of any one "occurrence". 6. Subject to 5. above, the Damage to Premises Rented To You Limit is the most we will pay under Coverage A because of "property damage" to any one premises, while rented to you, or in the case of damage by fire, while rented to you or temporarily occupied by you with permission of the owner. 7. Subject to 5. above, the Medical Expense Limit is the most we will pay under Coverage C for all medical expenses because of "bodily injury" sustained by any one person. 8. Subject to 2., 4., 5., 6., and/or 7. above, the Per Project Aggregate Limit is the most we will pay under Coverages A, B, and C combined for the sum of: a. Damages under Coverage A; b. Damages under Coverage B; and c. Medical Expenses under Coverage C arising out of any single Project described above. 9. Subject to 2., 4., 5., 6., and/or 7. above, the Per Location Aggregate Limit is the most we will pay under Coverages A, B, and C combined for the sum of: a. Damages under Coverage A; b. Damages under Coverage B; and c. Medical expenses under CoverageC arising out of the any single Location described above. The Limits of Insurance of this Coverage Part apply separately to each consecutive annual period and to any remaining period of less than 12 months, starting with the beginning of the policy period shown in the Declarations, unless the policy period is extended after issuance for an additional period of less than 12 months. In that case, the additional period will be deemed part of the last preceding period for purposes of determining the Limits of Insurance. III. The Limits of Insurance shown in the Declarations are deleted in their entirety and replaced by the Limits of Insurance set forth below. Limits of Insurance General Aggregate Limit $ 10,000,000 Each Occurrence Limit $ 1,000,000 Products -Completed Operations Aggregate Limit $ 2,000,000 Personal & Advertising Injury Limit $ 1,000,000 Damage to Premises Rented to You $ 300,000 Medical Expense Limit $ 25,000 Per Project General Aggregate Limit, Per Location $ 2,000,000 General Aggregate Limit or Per Project and Per Location General Aggregate Limit IV. SECTION V - DEFINITIONS, is amended to include the following: 23. "Location" means premises involving the same or connecting lots, or premises whose connection is interrupted only by a street, roadway, waterway, or right-of-way railroad. All other terms and conditions of this policy remain the same. A+uth ri;zed Representative or Countersie nature (in States Where Appii'caC 86681 (9/04) Page 2 of 2 PDF created with pdfFactory Pro trial version www.pdffactory.com ENDORSEMENT This endorsement, effective 12:01 A.M. 03/01 /2023 forms a part of policy No.CA 2961606 issued to GOFORTH & MART - DBA: GM BUSINESS INTERIORS by NATIONAL UNION FIRE INSURANCE COMPANY OF P I TTSBURGH , PA THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - WHERE REQUIRED UNDER CONTRACT OR AGREEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM SCHEDULE ADDITIONAL INSURED: ANY PERSON OR ORGANIZATION FOR WHOM YOU ARE CONTRACTUALLY BOUND TO PROVIDE ADDITIONAL INSURED STATUS BUT ONLY TO THE EXTENT OF SUCH PERSON OR ORGANIZATIONS LIABILITY ARISING OUT OF THE USE OF A COVERED AUTO. I. SECTION II - LIABILITY COVERAGE, A. Coverage, 1. - Who Is Insured, is amended to add: d. Any person or organization, shown in the schedule above, to whom you become obligated to include as an additional insured under this policy, as a result of any contract or agreement you enter into which requires you to furnish insurance to that person or organization of the type provided by this policy, but only with respect to liability arising out of use of a covered "auto". However, the insurance provided will not exceed the lesser of: (1) The coverage and/or limits of this policy, or (2) The coverage and/or limits required by said contract or agreement. 87950 (10/05) Authorized Representative or Countersi mature (in States Where Applicabfe Page 1 of 1 ENDORSEMENT This endorsement, effective 12:01A.M. 03/01/2023 forms part of policy No. CA 296-16-06 issuedto GOFORTH & MARTI - DBA: GM BUSINESS INTERIORS by NATIONAL UNION FIRE INSURANCE COMPANY OF P I TTSBURGH , PA THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. INSURANCE PRIMARY AS TO CERTAIN ADDITIONAL INSUREDS This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM Section IV - Business Auto Conditions, B., General Conditions, 5., Other Insurance, c., is amended by the addition of the following sentence: The insurance afforded under this policy to an additional insured will apply as primary insurance for such additional insured where so required under an agreement executed prior to the date of accident We will not ask any insurer thathas issued other insurance to such additionalinsured to contribute to the settlement of loss arising out of such accident. All other terms and conditions remain unchanged. l� Authorized Representative or Counters a nature (in States Where Applicable 74445 (10/99) PDF created with pdfFactory Pro trial version www.l)dffactory.com ENDORSEMENT This endorsement, effective 12:01 A.M. 03/01 /2023 forms a part of policy No. CA 296-16-06 issued to GOFORTH & MART I - DBA: GM BUS I NESS I NTER I ORS by NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM Section IV - Business Auto Conditions, A. - Loss Conditions, 5. - Transfer of Rights of Recovery Against Others to Us, is amended to add: However, we will waive any right of recover we have against any person or organization with whom you have entered into a contract or agreement because of payments we make under this Coverage Form arising out of an "accident' or "loss" if: (1) The "accident' or "loss" is due to operations undertaken in accordance with the contract existing between you and such person or organization; and (2) The contract or agreement was entered into prior to any "accident' or "loss". No waiver of the right of recovery will directly or indirectly apply to your employees or employees of the person or organization, and we reserve our rights or lien to be reimbursed from any recovery funds obtained by any injured employee. AUT''' ORIZED REPRESENTATIVE 62897 (6/95) PDF created with pdfFactory Pro trial version www.pdffactory.com BLANKET WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different date is indicated below. (The following "attaching clause" need be completed only when this endorsement is issued subsequent to preparation of the policy). This endorsement, effective 12:01 AM 03/01/2023 forms a part of Policy No. WC 080-75-6387 Issued to GOFORTH & MARTI - DBA: GM BUSINESS INTERIORS By NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA. We have a right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against any person or organization with whom you have a written contract that requires you to obtain this agreement from us, as regards any work you perform for such person or organization. The additional premium for this endorsement shall be 2.00 % of the total estimated workers compensation premium for this policy. WC 04 03 61 Countersigned by - - - - _ _, _ -, - - - _,. _ -- (Ed. 11/90) Authorized Representative