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PROOF OF INSURANCE (2021 - 2023) CLOSEDINSURANCE BINDER i ISSUE DATE 7/21/2022' PLEASE NOTE THAT THIS BINDER IS FOR TEMPORARY INSURANCE FOR A TWELVE -DAY PERIOD. THIS BINDER EXISTS ON ITS OWN TERMS AND EXPIRES ON ITS OWN TERMS. WHEN A BINDER EXPIRES ON ITS OWN TERMS, NO COVERAGE EXISTS THEREAFTER. REQUIREMENTS FOR NOTICE OF CANCELLATION TO INSUREDS DO NOT APPLYTO EXPIRED BINDER. PRODUCER INSURER(S) AFFORDING COVERAGE Northeast Agency Insurance Services INSURER A: Covington Specialty Insurance Company 7349 IBM Dr., Ste 103 Charlotte, NC 28262 INSURER B: N/A INSURED Bayshore Water Conditioning, (See GBA904017) 10611 Calle Lee Ste 113 Los Alamitos, CA 90720 INSURER C: INSURER D: INSURER E: Covington Specialty Insurance Company BINDER TERMS: THE FOLLOWING COVERAGE HAS BEEN BOUND PROVIDED TAPCO RECEIVES A PROPERLY COMPLETED APPLICATION AND A PREMIUM PAYMENT WITHIN 12 DAYS OF THE EFFECTIVE DATE. FAILURE TO REMIT PREMIUM AND APPLICATION WITHIN 12 DAYS OF THE EFFECTIVE DATE SHOWN BELOW WILL NULLIFY AND VOID THIS BINDER. INSR LTR COVERAGES BINDER ID PROPOSED EFFECTIVE DATE PROPOSED EXPIRATION DATE LIMITS A GENERAL LIABILITY SYCGL-O 7/1/2022 7/1/2023 GENERAL AGGREGATE 2,000,000 2,000,000 2,000,000 2,000,000 100,000 5,000 PRODUCTS-COM/OP AGG, PERSONAL & ADV INJURY EACH OCCURRENCE DAMAGE PREM RENTED TO YOU MED EXPENSE (Any one person) B PERSONAL LIABILITY COMBINED SINGLE LIMIT i MEDICAL PAYMENTS TO OTHERS C EXCESS LIABILITY EACH OCCURRENCE AGGREGATE D E PROPERTY SYCGL-O 1 7/1/2022 7/1/2023 BUILDING 100,000 CONTENTS LOSS OF USE DESCRIPTION OF OPERATIONS / SPECIALTY ITEMS Water Softening Equipment rented to others, Water Softening Equipment installation, servicing or repair, Banks and Offices other than Governmental NAME AND ADDRESS City of El Segundo Fire Department 314 Main St El Segundo, CA 90245 AUTHORIZED SIGNATURE IMPORTANT NOTICE 1. THE INSURANCE POLICY THAT YOU HAVE PURCHASED IS BEING ISSUED BY AN INSURER THAT IS NOT LICENSED BY THE STATE OF CALIFORNIA. THESE COMPANIES ARE CALLED NONADMITTED" OR "SURPLUS LINE" INSURERS. 2. THE INSURER IS NOT SUBJECT TO THE FINANCIAL SOLVENCY REGULATION AND ENFORCEMENT THAT APPLY TO CALIFORNIA LICENSED INSURERS. 3. THE INSURER DOES NOT PARTICIPATE IN ANY OF THE INSURANCE GUARANTEE FUNDS CREATED BY CALIFORNIA LAW. THEREFORE, THESE FUNDS WILL NOT PAY YOUR CLAIMS OR PROTECT YOUR ASSETS IF THE INSURER BECOMES INSOLVENT AND IS UNABLE TO MAKE PAYMENTS AS PROMISED. 4. THE INSURER SHOULD BE LICENSED EITHER AS A FOREIGN INSURER IN ANOTHER STATE IN THE UNITED STATES OR AS A NON -UNITED STATES (ALIEN) INSURER. YOU SHOULD ASK QUESTIONS OF YOUR INSURANCE AGENT, BROKER, OR "SURPLUS LINE" BROKER OR CONTACT THE CALIFORNIA DEPARTMENT OF INSURANCE AT THE TOLL -FREE TELEPHONE NUMBER: 1-800-927-4357. OR INTERNET WEBSITE WWW.INSURANCE.CA.GOV ASK WHETHER OR NOT THE INSURER IS LICENSED AS A FOREIGN OR ON -UNITED STATES (ALIEN) INSURER AND FOR ADDITIONAL INFORMATION ABOUT THE INSURER. YOU MAY ALSO CONTACT THE NAIC'S INTERNET WEB SITE AT WWW.NAIC.ORG THE NAIC--THE NATIONAL ASSOCIATION OF INSURANCE COMMISSIONERS --IS THE REGULATORY SUPPORT ORGANIZATION CREATED AND GOVERNED BY THE CHIEF INSURANCE REGULATORS IN THE UNITED STATES. D-2 (01/20) Effective January 1, 2020 Page 1 of 1 5. FOREIGN INSURERS SHOULD BE LICENSED BY A STATE IN THE UNITED STATES AND YOU MAY CONTACT THAT STATE'S DEPARTMENT OF INSURANCE TO OBTAIN MORE INFORMATION ABOUT THAT INSURER.YOU CAN FIND A LINK TO EACH STATE FROM THIS NAIC INTERNET WEBSITE: HTTPS://CONTENT.NAIC.ORG/STATE WEB MAP.HTM. 6. FOR NON -UNITED STATES (ALIEN) INSURERS, THE INSURER SHOULD BE LICENSED BY A COUNTRY OUTSIDE OF THE UNITED STATES AND SHOULD BE ON THE NAIC'S INTERNATIONAL INSURERS DEPARTMENT (IID) LISTING OF APPROVED NONADMITTED NON -UNITED STATES INSURERS. ASK YOUR AGENT, BROKER, OR "SURPLUS LINE,, BROKER TO OBTAIN MORE INFORMATION ABOUT THAT INSURER. 7. CALIFORNIA MAINTAINS A "LIST OF APPROVED SURPLUS LINE INSURERS(LASLI)."ASK YOUR AGENT OR BROKER IF THE INSURER IS ON THAT LIST, OR VIEW THAT LIST AT THE INTERNET WEBSITE OF THE CALIFORNIA DEPARTMENT OF INSURANCE: WWW.INSURANCE.CA.GOV/01-CONSUMERS/120-COMPANY/ /07-LASLI/LASLI .CFM. 8. IF YOU, AS THE APPLCIANT, REQUIRED THAT THE INSURANCE POLICY YOU HAVE PURCHASED BE EFFECTIVE IMMEDIATELY, EITHER BECAUSE EXISTING COVERAGE WAS GOING TO LAPSE WITHIN TWO BUSINESS DAYS OR BECAUSE YOU WERE REQUIRED TO HAVE COVERAGE WITHIN TWO BUSINESS DAYS, AND YOU DID NOT RECEIVE THIS DISCLOSURE FORM AND A REQUEST FOR YOUR SIGNATURE UNTIL AFTER COVERAGE BECAME EFFECTIVE, YOU HAVE THE RIGHT TO CANCEL THIS POLICY WITHIN FIVE DAYS OF RECEIVING THIS DISCLOSURE. IF YOU CANCEL COVERAGE, THE PREMIUM WILL BE PRORATED AND ANY BROKER'S FEE CHARGED FOR THIS INSURANCE WILL BE RETURNED TO YOU. D-2 (01/20) Effective January 1, 2020 Page 2 of 2 Fold here Cut along edge V 9e Allstate. You're in good hands. Please use the printed Insurance Cards below. Please use the printed Insurance Cards below. Allstate. You're in good hands. Please use the printed Insurance Cards below. Please use the printed Insurance Cards below. California Proof of Allstate, If you have an accident or loss: Auto Insurance Card You're in good hands • Get medical attention if needed. Allstate Northbrook Indemnit Company PO Box 660598, Dallas, TX 7266•D596 NAIC# 36455 • Notify the police immediately. Nick and Pamela Lendirro 10542 Sausalito Ct • Obtain names„ addresses, hone numbers (work home) and P Los Alamitos CA 90720-2129 license plate numbers of all Persons involved„ including passengers and witnesses. This policy meets the requirements of the applicable California financial responsibility law(s). • Call 1-800-ALLSTATE (1-800-255-7828), POLICY NUMBER YEAR / MAKE / MODEL logon to allstate.com or contact your Allstate agent 024 630 771 2017 Acura Mdx as soon as possible. EffECTIVE DATE VEHICLE tD NUMBER B T McMahon Ins Svc OV24/21 EXPIRATION DATE (562) 493-2963 07/24/21 309 Main Street This card must be carried in the vehicle at all times as evidence o f insurance. Seal Beach, CA 90740 California Proof of Allstate, If you have an accident or loss: Auto Insurance Card Ycube in good hands. • Get medical attention if needed. Allstate Northbrook Indernnlly Co m� pany PO Box 66OS98.Dallas, '1X 25266uilsa NAVC# .364.55 Notify the police immediately. Nick and Pamela Lendino 10542 Sausalito Ct • Obtain names, addresses, hone numbers (work & home) and P Los Alamitos CA 90720.2129 license Plate numbers of all persons involved, including; passengers and witnesses. This policy meets the requirements of the applicable California financial responsibility law(s). Call 1-800-ALLSTATE (1-800-255-7828), POLICY NUMBER YEAR / MAKE / MODEL logon to allstate.com or contact your Allstate agent 024 630 771 2020 Mercedes-B Gk300 as soon as possible. EFFECTIVE DATE 01d24/21 ,VEHICLE ND 1ttNMBER B T McMahon Ins Svc EXPIRATION DATE (562) 493 2963 309 Main Street 07124R1 This card must be carried in the vehicle atoll times as evidence of insurance. Seal Beach, CA 90740 A0948-82-84 DATE (MMIDDNYYY) ACCORV CERTIFICATE OF LIABILITY INSURANCE 01104/2021 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). CON PRODUCER Becky Huddle Insurance Agency NAMEE ,, Rebecca Huddle 729 Sunrise Ave Ste 504 Ax IN PHONE F0; 916-789-7500 R iN p, 916 789 2545 Roseville CA 95661 [MM-kQz. Staff.rhuddleO.farmerS aaencV.Com INSURED Bayshore Water Conditioning DBA Elite Water Systems 10611 CALLE LEE SUITE 113 LOS ALAMITOS, CA 90720 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 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. _.. w .. _ ........ .. � INSR _ ... AfIJL4S414iR: ( Pt7/DDYEFF' CY E7(P TYPE OF INSURANCE ( POLICY NUMBER D LIMITS l MM/D. COMMERCIAL GENERAL LIABILITYLi Li EACH OCCURRENCE $ C199A TU Ri �R `Lti ..... CLAIMS -MADE OCCUR PREMISES,(Eaoccufreme. „ .. ......... .......... y one person) $ PERSONAL& ADV INJURY $ G'E d MIT APPLIES PRO - '� „�............... .. POLICY ROT OC PRODUCT,SGCOMP P AGG ... O „ 1 � $$ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT a..Nxa gqv"r $ �., ---------------------- - - - - - - - -------------- ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY INJURY (Per accident) _ $ AUTOS ONLY AUTOS, HIRED NON -OWNED hp�Paz�ca.a.�d10)AMAC, $... AUTOS ONLY AUTOS ONLY .._ ----- $ UMBRELLA LIAB OCCUR �. EACH OCCURRENCE ---...,. ... .... ...... I-$ .... -----... __........ EXCESS LIAB CLAIMS -MADE r [AGGREGATE $ RETENTION $ I 1 $ WORKERS COMPENSATION ST TUTE �1/1/2022 A AND EMPLOYERS' LIABILITY YIN AN PROPRIETO A0948-82-84 ....ERH 1/1/2021 E.L. EACH ACCIDENT „ $ 1,000,000 REXCLUDED?ECUTIVE (Mandatory in NH) N/A ..... .... ... EL.DISEASE - EA EMPLOYEEI ... .. $ 1,000,00� If yes, describe under DESCRIPTION OF OPERATIONS below LE.L, DISEASE - POLICY LIMIT $ 1,000,000 EJO DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) License # 704860 CERTIFICATE HOLDER CANCELLATION CONTRACTORS STATE LICENSE BOARD WORKERS COMP UNIT P.O. BOX 26000 SACRAMENTO, CA 95826 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ,.RIZED REPRESENTATIV n,I e Rebecca Huddle ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD