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PROOF OF INSURANCE (2024 - 2024) CLOSEDA0948-82-84 C40R "m CERTIFICATE OF LIABILITY INSURANCE ill DATE (MM/DD/YYYY) 1 09/27/2023 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 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). PRODUCER Becky Huddle Insurance Agency NAMEA Rebecca Huddle 729 Sunrise Ave Ste 504 AONE No): 916-789-2545 A C N Ext : 916-789-7500 FAX E-MAIL ADDRESS: staff.rhuddle@farmersagency.com Roseville CA 95661 INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: MID CENTURY INSURANCE 21687 INSURED Bayshore Water Conditioning DBA Elite Water Systems INSURER B : Northfield Insurance Company 27987 10611 CALLE LEE SUITE 113 INSURERC: Nautilus Insurance Company 17370 LOS ALAMITOS, CA 90720 INSURERD: Farmers Insurance Exchange 21652 INSURER E : INSURER F : 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. INSR LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICYNUMBER POLICY EFF MM/DD POLICY EXP MM/DD LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 B CLAIMS -MADE 571OCCUR WS565252 6/29/2023 6/29/2024 DAMAGE TOEa RENTEDoccurrence PREMISES $ 100,000 MED EXP (Any one person) $ 5,000 YGEN-LAGGREGATELIMITAPPLIESPER: PERSONAL & ADV INJURY $ 1,000,000 GENERALAGGREGATE $2,000,000 POLICY ❑ ECT ❑ LOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINEDSINGLE LIMIT Ea accident $ 1000000 > > D AUTO 607046190 08/13/2023 08/13/2024 BODILY INJURY (Per person) $ eANY OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ uHIRED NON -OWNED AUTOS ONLY AUTOS ONLY $ lul u u UMBRELLALIAB OCCUR EACH OCCURRENCE $ 1,000,000 C � �/ EXCESS LAB u CLAIMS -MADE AN1288200 7/5/2023 6/29/2024 AGGREGATE $ 1,000,000 IiL_Jli DED RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE Y/N A0948-82-84 1/1/2023 1/1/2024 PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) N/A E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 A Business Personal Property (BPP) 60704-33-44 7/1/2023 7/1/2024 $30,000 A A Business Income & Extra Expense Extended Business Income 00 60704-33-44 60704-33-44 7/1/2023 7/1/2023 7/1/2024 7/1/2024 18 Months - ALS DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) Workers' compensation waiver of subrogation attached. CERTIFICATE HOLDER CANCELLATION City of El Segundo 35O Main St. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN El Segundo, CA 90245 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE i- ��"•- Rebecca Huddle © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC990631 (Ed. 6-20) BLANKET 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 undera written contractthat requires you to obtain this agreementfrom us.) The additional premium for this endorsement shall be 3.0%ofthe California workers compensation premium otherwise due on such remuneration, subject to a minimum charge of 250 . All written contracts in the state(s) of: CA 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 01 /01 /23 Policy No. A0948-82-84 Endorsement No. Insured BAYSHOREWATER CONDITIONING (DBA) ELITE WATER SYSTEMS 10611 CALLE LEE STE 113 Insurance Company MID-CENTURY INSURANCE COMPANY i r`•�ye� rep �•� � r r•��ye�:z�>.�z�Z:1 r�:> i I Countersigned By WC990631 (Ed. 6-20) Includes copyright material of the Workers Compensation Insurance Rating Bureau of California. All rights reserved.