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PROOF OF INSURANCE (2024 - 2024) CLOSEDBREAT-1 OP ID: SP �. CERTIFICATE OF LIABILITY INSURANCE (MMIDD/YYYY) 10/13/2023 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 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 y CONTNLAMEACT Jack Tahanian 848 EISU-The Ulti ado enc # 2 PHONE E, 626 " . _ _ 792-5000 Nei 626-792-.... Pasadena, CA 91107 EMAIL JaOk ulttmamsuance.com Tahanian Insurance Services ......... ... INSURER(SI AFFORDING COVERAGE NAIC # INSURER A: Crum & Foster S1 INSURED BREATHE SAFE ENVIRONMENTAL INSURERB:Guard Insurance 3010 Wilshire Blvd., #260 .n.n.n.n.n..... ............................. Los Angeles, CA 90010 INsuRERc: INSURER D INSURER E : t%e%%irnA,nee !`COTICl/`ATC AilIFU1rt1=0- RFVICIr)NI NIIIII 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. I0R IsliL 'U� ppYYY LIMITS LTR TYPE OF INSURANCE POLICY NUMBERMOt NPoed`1('Y'... GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY EPK-138429 01 /16/2023 01 /16/2024 O'AMXGF TO RENTED PREM LFa gacugence ..... _. ........ 50,00 CLAIMS -MADE X OCCUR MED EXP (A . ny one person)_ $ 10,00 &ADVINJURY $ 1,000,00 _- GENERAL AGGREGATE $J 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER. - CCOMP/OP AGG PRODUCTS - T $ 2,000,00 X POLICY F1 LOC $ AUTO MOBILE LIABILITY COMBINED SINGLE, aMIT 1,000,00 B ANY AUTO BRAU417461 01/01/2023 01/01/2024 BODILY INJURY ( person) erson) $ ALL SCHEDULED BODILY INJURY (Per accident) AUTOS AUTOS NON -OWNED X AUTOS X " l'i ' I T°Y r)tAhIA4a $ HIRED ......... _......,..., AUTOS mQ,r LR ACr(,,gDEIVT .... Comp/Coll I $ 1000/100 UMBRELLACCUR EACH $ _ EXCESS -� �Lp,IMS-MADE .. �� AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION WC STATU f7'1`V-I- AND EMPLOYERS' LIABILITY Y / N ........�T�I;,xI....�..I'. . ...., . _"""""....... ANY PROIaRIETORIPAR"�TNFRJG�YECUTIVE CCIDENT ............. ❑EACH OFF"BCER�MJpE':MF9ER E�X{'Ltp&7CDT NIA (Mandatory In NH) E L DISEASE - EA EMPLOYE ......, $ If yes, describe under DESCRIPTION OF OPERATIONS below E L DISEASE - POLICY LIMIT $ A Pollution Liab EPK-138429 01/16/2023 01/16/2024 Condition 1,000,00 A !Professional Liab EPK-138429 01/16/2023 01/16/2024'Per Claim 1,000,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Certificate Holder is named as Additional Insured on General Liability policy where requred by a written contract. nw.r,rrrrA V, nA^1 Mw M t%ANIrCI.. r AT'Ie%KI'.. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of El Segundo tY g THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street El Segundo, CA 90245 AUTHORIZED REPRESENTATIVE W 1J88-Lulu A%_UMLJ l.UmrUKA i IVIV. All r19nLS re5erveu,. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD r C R ,. (MMIDD/YYYY)- CERTIFICATE OF LIABILITY INSURANCE IDATE 1o/2o/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 NAME CT Paychex Insurance Agency, Inc. PHONE .... ............ F�iX PAYCHEX INSURANCE AGENCY, INC. [AWp K E4 877-266 6850 M We Nab 225 KENNETH DRIVE ILFlexCerts@payc hex.com ss ROCHESTER, NY 14623 j" ..... INSURED BREATHE SAFE ENVIRONMENTAL, INC 3010 WILSHIRE BLVD STE 260 LOS ANGELES, CA 90010 INSURERA: Technology Insurance Company INSURER B INSURER C INSURER D INSURER E INSURER F : ..ram f%0OT101f1ATC duIa11DCD• RFVICIAN NIIMRFR- 42376 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�..........-,...._. �, @ INS;R-._.............. TYPE OF INSURANCE_......... .... ADDa'. StlYBFt¶............ ...POLICX NUMBER ............ ..MM DDY/YEFF YYY (I,PIVIIOAilLD1)YfM'EYXY .. _.. LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS -MADE E-1 OCCUR J .....--............. M.Ep !.E .P..(Any ane person) _w M $.., ........... ......................................_..............--..... PERSONAL&ADVINJURY $ G'ECrILAC.GREG/+ ii' LIMIT APPLIES PER GENERAL AGGREGATE $ POLICY � � ECTD LOC PRODUCTS - COMPIOP AGG OTHER, $ -- COMBINED 8N 1 B IMY7 AUTO MOBILELIABILITY ANY AUTO BODILY INJURY (Per person) II$ 999 „m mmm µWry. OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS .... HIRED NON -OWNED Dwfrrfr'aGE....... ... _ $ AUTOS ONLY AUTOS ONLY (V'tM accrdpnl) .........a UMBRELLALIAB OCCUR .EACH,OCCURRENCE $ __ ,.„ .......„,,,_ ... _ EXCESS LIAB CLAIMS -MADE, „ - AGGREGATE..............................,- $..,..,...................,.,......— DED RETENTION"$ WORKERSCOMPENSATION PER X P,TA uTCID � 0� ��_�� -1 .- A LOYERS'LIABILITY. Y�N104/06/2024 R/E ANYPROPRI ETOR/PARTNER/EXECUTIVE NA N TWC4237618 04/06/2023 EL,EACH A; ENT,$ _ 00000 J OFFFIICMR/MEMBEREXCLU II ••-.l SE EA EMPLOYEE 10�� (Mandatory m NH) ._0 �Ifyes, describe under DESCRIPTION OF OPERATIONS below EL. DISEASE POLICY LIMIT $ 10000— ''.. DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of El Segundo 350 Main Street El Segundo, CA 90245 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 i V IVt%U-LUIb AL UKLJ 6UMI UKA I IUN. All rlgnLS reburveu. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD