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PROOF OF INSURANCE (2023 - 2024) CLOSEDDATE (MMIDD/YYYY) A C`CORV CERTIFICATE OF LIABILITY INSURANCE L 10/02/2023 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). Summit Partners Insurance Services 1430 Blue Oaks Blvd. Ste. 235 Roseville, CA 95747 INSURED GEM Construction 6510 E. Spring St. Suite. 941 Long Beach, Ca 90815 818 240 7955 G AIr um, 818-484-3005 INSURERA: Gotham Insurance Company 25569 INSURERB: California rn Automobile Insurance Company —� Atom � 38342 INSURER C : Insurance Company 25011 ...........�............ Evanston Insurance.......m.,m_ �............................................ -__ INSURER D s EtCompany 35378 INSURER F : ......... i+r11—w c rcnrrorr Aro r.uuaDOD• RFVI_QInN1 NIIMRFR- 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...�. . . LIMITS�.�..... INSR .. �ADC'SUR .............. .POLICY pM/DDVEFF' POLiCYEX.„ -.-. .--......... LT TYPE OF INSURANCE NUMBER...--. X COMMERCIAL GENERAL LIABILITY EAC HOCCURRENCE $ 1 OOO OOO CLAIMS -MADE OCCUR t5AMA ��t� "Ni'Ei5 PREMiS.ES (,rp �accnunemca $ 100 000 IVIED EXP (Any one person) &� �N $ 5,000 . A �-� � Y Y GL202300016529 07/12/2023 07/12/2024 PERSONAL aADv INJURY .. -_ 00 $ 2,000,000 .m GEN'LAGGREGATE LIMIT APPLIES PER: R.. ._,.,......�, ._,... E ,2,00000..m0 , .......... POLICY R_LOC —ODU- A�-.. PR $ 2,000,000Xf .. _. ._... ...... OTHER; $ AUTOMOBILE LIABILITY . COMBINED SINGLELIMIT $ 1,000,000 ANY AUTO BODILY INJURY (Per person) $ B SCHEDULED OWNED SCHEDULED Y BA040000055182 10/07/2022 i 10/07/2023 INJURY (Per accident). $ AUTOS ONLY !!�, AUTOS.... HIRED NON -OWNED ,BODILY PROPERTY OANlAf,E ._.. ..m,. AUTOS ONLY AUTOS ONLY ...�tPer arc.alenl $ UMBRELLA LIAB X OCCUR EACH OCCURRENCE 00 $ 1,000,0.., D X EXCESS LIAB CLAIMS -MADE ...__..... EZXS3122862 07/12/2023 07/12/2024 AGGREGATE $�1,000,000 .. ._--.. TENTION $ $ WORKERS COMPENSATION PER 1 1 OTH- P�Tp ER C AND Y�ILITY ANYP OPRIE OR/PARTNE EXECUTIVE OFFICERIMEMBEREXCLUDED? N/A Y WWC3628297 12/28/2022 12/28/2023 EP'C ACCIDENT _ $ 0 1 OOOOO (Mandatory in NH) E.L. DISEASE-EAEMP LOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE- POLICY LIMIT $ 1,000,000 Certificate holder is listed as additional insured as required by written contract but only according to policy terms, conditions and exclusions,. Operations performed by cr on behalf of the named insured. We will not cancel or non -renew this policy or make changes that reduce the Insurance afforded by this policy until written notice of cancellation or reduction has been mailed by registered or certified mail or delivered to the ''.. named insured. a) 10 days before the effective dale of cancellation, if we cancel for non-payment of premium. or b) 90 days before the effective date of the cancellation or reduction If we cancel or reduce the insurance afforded by this policy for any other reason. Certificate holder is additional insured per the attached form `10 days notice of cancellation for nonpayment of premium by registered or certified mail. City of El Segundo Public Works Department 350 Main Street El Segundo, Ca 90245 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE (/ ©198%-201! ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: GL202300016529 COMMERCIAL GENERAL LIABILITY CG 2010 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OIL CONTRACTORS - SCHEDULED PERSON O ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): I Location(s) Of Covered Operations City of El Segundo 350 Main St. El Segundo, Ca 90245 Various locations throughout California. Information re uired 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. 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 07 04 0 ISO Properties, Inc., 2004 Page 1 of 1 POLICY NUMBER: GL202300016529 COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER ER OF TRANSFER F 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: City of El Segundo 350 Main Street El Segundo, Ca 90245 Information required to com late this Schedule, it not shown above, will be shown in the Declarations. The following is added to Paragraph S. 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 mare 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. Endorsement Effective: 07/12/2023 CA 00 0 CG 24 04 05 09 ® Insurance Services Office, Inc., 2008 Page 1 of 1 i7