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PROOF OF INSURANCE (2022 - 2024) CLOSEDa DATE(MMIDDIYYYY) "R EO CERTIFICATE OF LIABILITY INSURANCE 04/21/2023 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 CONTACT Carmen Josef NAME: The Liberty Company Insurance Brokers PHONE (909) 498-9151 Y AX (909) 498-9151 Lic #OD79653 E-MAIL carmen.josef@libertycompany.com ADDRESS: 5955 De Soto Ave, Ste 250 INSURER(S) AFFORDING COVERAGE NAIC # Woodland Hills CA 91367 INSURERA: Lloyd's of London 15792 INSURED INSURERB: Evanston Insurance Co 35378 Performance Truck Repair, Inc. INSURER C : DBA: P.A.R.T.S. INSURER D: 892 W 10th Street INSURER E : Azusa CA 91702 INSURER F COVERAGES CERTIFICATE NUMBER: 23-24 Master 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 _ .._______________ POEICY EFFEFF POLIdY EXP LTR TYPE OF INSURANCE POLICY NUMBER MMIDD MMIODIYYYY LIMITS X1 COMMERCIAL GENERAL LIABILITY '.. EACH OCCURRENCE $ 1.000,000 CLAIMS -MADE Fx_] OCCUR Rrage A PREMISES Ea occunance $ 100,000 X VIED EXP (Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 A Y Y GLL-11095-00 04/14/2023 04/14/2024 AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 ++C�E,�Nr'L r+""ww3,000,000 FO'L.I�CY P'Fdf�k• LOG ' ' � JEG'T PRODUCTS-COMP/OPAGG $ $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 BODILY INJURY (Per person) $ ANY AUTO A OWNED SCHEDULED GLL-11095-00 04/14/2023 04/14/2024 BODILY INJURY (Per accident) '... $ AUTOS ONLY AUTOS HIRED HNON-OWNED PR06'EfiTYDAMAGE.AUTOS $ ONLY AUTOS ONLY IPer ac6dont $ UMBRELLA LIAB '. OCCUR EACH OCCURRENCE 1 ,000,000 AGGREGATE $ 1,000,000 B X EXCESSLLIIAB CLAIMS -MADE MCGX100558-00 04/14/2023 04/14/2024 DED I X RETEENTION $.. NIL $ WORKERS COMPENSATION PER O"'_ AND EMPLOYERS' LIABILITY YIN STATUTE ANY PROPRIETOR/PARTNER/EXECUTIVE N A E..L.. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? I (Mandatory in NH) E..L.. DISEASE - EA EMPLOYEE If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ Each Location $1,000,000 GarageKeepers Liability A Deductible: $5,000 1 GLL-11095-00 04/14/2023 04/14/2024 Each Auto $500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Whereby required by written contract or agreement, Certificate Holder is included as an Additional Insured under the Commercial General Liability on a Primary/Non-Contributory basis. Waiver of Subrogation in favor of the Additional Insured applies to the General Liability. l.tK I Irn.Al t SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of El Segundo Police Department ACCORDANCE WITH THE POLICY PROVISIONS. 348 Main Street AUTHORIZED REPRESENTATIVE El Segundo CA 90245 @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. GENERAL LIABILITY ELITE EXTENSION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM The COMMERCIAL GENERAL LIABILITY COVERAGE FORM is amended to include the following clarifications and extensions of coverage. The provisions of the Coverage Form apply unless modified by endorsement. A. EXPECTED OR INTENDED INJURY The aggregate limit listed above is the most we will Section I — Coverage A, Exclusion a. is amended pay for all damages because of "property damage" as follows: to property in the care custody and control of or property loaned to an insured during the policy a. "Bodily injury" or "property damage" expected period. or intended from the standpoint of an insured. This exclusion does not apply to "bodily injury" Any payment we make for damages because of or "property damage" resulting from the use of "property damage" to property in the care, custody reasonable force to protect persons or property. and control of or property loaned to an insured will B. NON -OWNED WATERCRAFT apply against the General Aggregate Limit shown in the declarations. Section I — Coverage A, Exclusion g.(2) is amended as follows: (2) A watercraft you do not own that is: (a) Less than 60 feet long; and (b) Not being used to carry person(s) or property for a charge; C. EXTENDED PROPERTY DAMAGE COVERAGE Section I — Coverage A, Exclusions j.(3) and (4) is amended to add the following: Paragraphs (3) and (4) of this exclusion do not apply to tools or equipment loaned to you, provided they are not being used to perform operations at the time of loss. SCHEDULE Limits Of Insurance J Deductible $5,000 Each Occurrence $250 Per Claim $10,000 Annual Aggregate a. The each occurrence limit listed above is the most we will pay for all damages because of "property damage" to property in the care, custody and control of or property loaned to an insured as the result of any one "occurrence", regardless of the number of: (1) insureds; (2) claims made or "suits" brought; (3) persons or organizations making claims or bringing "suits". b. Our obligation to pay damages on your behalf applies only to the amount of damages in excess of the deductible amount listed above. We may pay any part or all of the deductible amount listed above. We may pay any part or all of the deductible amount to effect settlement of any claim or "suit" and upon notification by us, you will promptly reimburse us for that part of the deductible we paid. c. If two or more coverages apply under one "occurrence", only the highest per claim deductible applicable to these coverages will apply. d. Insurance provided by this provision is excess over any other insurance, whether primary, excess, contingent or any other basis. Since insurance provided by this endorsement is excess, we will have no duty to defend any claim or "suit" to which insurance provided by this endorsement applies if any other insurer has a duty to defend such a claim or "suit". If no other insurer defends, we will undertake to do so, but we will be entitled to the insured's rights against all those other insurers. D. PROPERTY DAMAGE — ELEVATORS Section I — Coverage A.2. Exclusions paragraphs j.(3), j.(4), j.(6) and k. do not apply to use of elevators. This insurance afforded by this provision is excess over any valid and collectible property insurance (including any deductible) available to the insured and Section IV — Commercial General Liability Conditions Paragraph 4. Other Insurance is changed accordingly. CG7578(2-19) Includes copyrighted material of ISO Properties, Inc. with its permission. Page 1 of 6 E. FIRE, LIGHTNING OR EXPLOSION DAMAGE a. Currently in effect or becomes effective Except where it is used in the term "hostile fire", the during the policy period; and word fire includes fire, lightning or explosion wherever b. Executed prior to an 'occurrence" or it appears in the Coverage Form. offense to which this insurance would Under Section I — Coverage A, the last paragraph apply. (after the exclusions) is replaced with the following: However, the insurance afforded to such Exclusions c. through n. do not apply to damage by additional insured: fire, smoke or leakage from automatic fire protection a. Only applies to the extent permitted by law; systems to premises while rented to you or and temporarily occupied by you with permission of the b. Will not be broader than that which you are owner. A separate limit of insurance applies to this required by the contract or agreement to coverage as described in Section III — Limits of provide for such additional insured; and Insurance. F. MEDICAL PAYMENTS c. Applies only if the person or organization is not specifically named as an additional If Section I —Coverage C. Medical Payments insured under any other provision of, or Coverage is not otherwise excluded from this endorsement added to, Section II — Who Coverage Form: Is An Insured of this policy. The requirement, in the Insuring Agreement of 2. As provided herein, the insurance coverage Coverage C., that expenses must be incurred and provided to such additional insureds is limited reported to us within one year of the accident date is to: changed to three years. G. SUPPLEMENTARY PAYMENTS a. Any Controlling Interest, but only with respect to their liability arising out of their Supplementary Payments — Coverages A and B financial control of you; or premises they Paragraphs 1.b. and 1.d. are replaced by the own, maintain, or control while you lease or following: occupy these premises. 1.b. Up to $5,000 for cost of bail bonds required This insurance does not apply to structural because of accidents or traffic law violations alterations, new construction and arising out of the use of any vehicle to which the demolition operations performed by or for Bodily Injury Liability Coverage applies. We do that person or organization. not have to furnish these bonds. b. Any architect, engineer, or surveyor 1A.All reasonable expenses incurred by the insured engaged by you but only with respect to at our request to assist us in the investigation or liability for "bodily injury", "property defense of the claim or "suit", including actual damage" or "personal and advertising loss of earnings up to $500 a day because of injury" caused, in whole or in part, by your time off from work. acts or omissions or the acts or omissions H. SUBSIDIARIES AS INSUREDS of those acting on your behalf: Section II — Who Is An Insured is amended to add (1) In connection with your premises; or the following: (2) In the performance of your ongoing 1.f. Any legally incorporated subsidiary in which you operations. own more than 50% of the voting stock on the With respect to the insurance afforded to effective date of this policy. However, insured these additional insureds, the following does not include any subsidiary that is an insured additional exclusion applies: under any other general liability policy, or would This insurance does not apply to "bodily have been an insured under such a policy but for injury", "property damage" or "personal and termination of that policy or the exhaustion of that advertising injury" arising out of the policy's limits of liability. rendering of or the failure to render any I. BLANKET ADDITIONAL INSUREDS — AS professional services by or for you, REQUIRED BY CONTRACT including: 1. Section II — Who Is An Insured is amended to (1) The preparing, approving, or failing to include as an additional insured any person(s) or prepare or approve, maps, shop organization(s) subject to provisions in Paragraph drawings, opinions, reports, surveys, 2. below, (hereinafter referred to as additional field orders, change orders or drawings insured) when you and such person(s) or and specifications; or organization(s) have agreed in a written contract (2) Supervisory, inspection, architectural or or written agreement that such person(s) or engineering activities. organization(s) be added as an additional insured on your policy provided that the written contract or agreement is: CG7578(2-19) Includes copyrighted material of ISO Properties, Inc, with its permission. Page 2 of 6 This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence" which caused the "bodily injury" or "property damage", or the offense which caused the "personal and advertising injury", involved the rendering of or the failure to render any professional services by or for you. c. Any manager or lessor of a premises leased to you, but only with respect to liability arising out of the ownership, maintenance or use of that part of a premises leased to you, subject to the following additional exclusions: This insurance does not apply to: (1) Any "occurrence" which takes place after you cease to be a tenant in that premises. (2) Structural alterations, new construction or demolition operations performed by or on behalf of such additional insured. d. Any state or governmental agency or subdivision or political subdivision, subject to the following: (1) This insurance applies only with respect to the following hazards for which any state or governmental agency or subdivision or political subdivision has issued a permit or authorization in connection with premises you own, rent or control and to which this insurance applies: (a) The existence, maintenance, repair, construction, erection or removal of advertising signs, awnings, canopies, cellar entrances, coal holes, driveways, manholes, marquees, hoist away openings, sidewalk vaults, street banners or decorations and similar exposures; or (b) The construction, erection or removal of elevators; or (c) The ownership, maintenance or use of any elevators covered by this insurance. (2) This insurance applies only with respect to operations performed by you or on your behalf for which any state or governmental agency or subdivision or political subdivision has issued a permit or authorization. This insurance does not apply to: (a) "Bodily injury", "property damage" or "personal and advertising injury" arising out of operations performed for the federal government, state or municipality; or (b) "Bodily injury" or "property damage" included within the "products - completed operations hazard". e. Any vendor, but only with respect to "bodily injury" or "property damage" arising out of "your products" which are distributed or sold in the regular course of the vendor's business. With respect to the insurance afforded to these vendors, the following additional exclusions apply: (1) The insurance afforded any vendor does not apply to: (a) "Bodily injury" or "property damage" for which any vendor is obligated to pay damages by reason of the assumption of liability in a contract or agreement. This exclusion does not apply to liability for damages that any vendor would have in the absence of the contract or agreement; (b) Any express warranty unauthorized by you; (c) Any physical or chemical change in the product made intentionally by any vendor; (d) Repackaging, except when unpacked solely for the purpose of inspection, demonstration, testing, or the substitution of parts under instructions from the manufacturer, and then repackaged in the original container; (e) Any failure to make such inspections, adjustments, tests or servicing as any vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products; (f) Demonstration, installation, servicing or repair operations, except such operations performed at any vendor's premises in connection with the sale of the product; (9) Products which, after distribution or sale by you, have been labeled or relabeled or used as a container, part or ingredient of any other thing or substance by or for any vendor; or CG7578(2-19) Includes copyrighted material of ISO Properties, Inc. with its permission. Page 3 of 6 (h) "Bodily injury" or "property damage" arising out of the sole negligence of any vendor for its own acts or omissions or those of its employees or anyone else acting on its behalf. However, this exclusion does not apply to: (i) The exceptions contained in Subparagraphs (d) or (f); or (ii) Such inspections, adjustments, tests or servicing as any vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products. (2) This insurance does not apply to any insured person or organization, from whom you have acquired such products, or any ingredient, part or container, entering into, accompanying or containing such products. If. Any Mortgagee, Assignee Or Receiver, but only with respect to their liability as mortgagee, assignee, or receiver and arising out of the ownership, maintenance, or use of the premises by you. This insurance does not apply to structural alterations, new construction and demolition operations performed by or for that person or organization. g. Any Owners Or Other Interests From Whom Land Has Been Leased, but only with respect to liability arising out of the ownership, maintenance or use of that part of the land leased to you. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: (1) This insurance does not apply to: (a) Any "occurrence" which takes place after you cease to lease that land; or (b) Structural alterations, new construction or demolition operations performed by or on behalf of such additional insured. In. Any person or organization from whom you lease equipment, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part by your maintenance, operation or use of equipment leased to you by such person(s) or crganization(s). A person's or organization's status as an additional insured under this endorsement ends when their contract or agreement with you for such leased equipment ends. With respect to the insurance afforded to these additional insureds, this insurance does not apply to any "occurrence" which takes place after the equipment lease expires. L Any Owners, Lessees, or Contractors for whom you are performing operations, 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. A person's or organization's status as an additional insured under this endorsement ends when your operations for that additional insured are completed. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to: (1) "Bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of, or the failure to render, any professional architectural, engineering or surveying services, including: (a) The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or (b) Supervisory, inspection, architectural or engineering activities. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence" which caused the "bodily injury" or "property damage", or the offense which caused the "personal and advertising injury", involved the rendering of or the failure to render any professional architectural, engineering or surveying services. (2) "Bodily injury" or "property damage" occurring after: CG7578(2-19) Includes copyrighted material of ISO Properties, Inc. with its permission. Page 4 of 6 (a) 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 (b) 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. j. Any Grantor of Licenses to you, but only with respect to their liability as grantor of licenses to you. Their status as additional insured under this endorsement ends when: 1. The license granted to you by such person(s) or organization(s) expires; or 2. Your license is terminated or revoked by such person(s) or organization(s) prior to expiration of the license as stipulated by the contract or agreement. k. Any Grantor of Franchise, but only with respect to their liability as grantor of a franchise to you. I. Any Co-owner of Insured Premises, but only with respect to their liability as co- owner of any insured premises. m. Any Concessionaires Trading Under Your Name, but only with respect to their liability as a concessionaire trading under your name. 3. Any insurance provided to any additional insured does not apply to "bodily injury", "property damage" or "personal and advertising injury" arising out of the sole negligence or willful misconduct of the additional insured or its agents, "employees" or any other representative of the additional insured. 4. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits of Insurance: This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. J. COVERAGE FOR INJURY TO CO -EMPLOYEES AND/OR YOUR OTHER VOLUNTEER WORKERS Section II — Who is an Insured, Paragraph 2.a. (1) is amended to add the following: e. Paragraphs (a), (b), and (c) do not apply to your "employees" or "volunteer workers" with respect to "bodily injury" to a co -"employee" or other "volunteer worker". Damages owed to an injured co -"employee" or "volunteer worker" will be reduced by any amount paid or available to the injured co - "employee" or "volunteer worker" under any other valid and collectible insurance. K. HEALTH CARE SERVICE PROFESSIONALS AS INSUREDS - INCIDENTAL MALPRACTICE Section II — Who is an Insured, Paragraph 2.a. (1) (d) is amended as follows: This provision does not apply to Nurses, Emergency Medical Technicians, or Paramedics who provide professional health care services on your behalf. However this exception does not apply if you are in the business or occupation of providing any such professional services. L. NEWLY FORMED OR ACQUIRED ORGANIZATIONS Section II — Who Is An Insured, Paragraph 3.a. is replaced by the following: 3.a. Coverage under this provision is afforded until the end of the policy period. This provision does not apply if newly formed or acquired organizations coverage is excluded either by the provisions of the Coverage Form or by endorsements. M. DAMAGE TO PREMISES RENTED TO YOU Section III — Limits of Insurance, Paragraph 6. is replaced by the following: Subject to 5.a. above, the Damage To Premises Rented To You Limit, or $500,000, whichever is higher, is the most we will pay under Coverage A for damages because of "property damage" to any one premises, while rented to you, or in the case of damage by fire, smoke or leakage from automatic protection systems, while rented to you or temporarily occupied by you with permission of the owner. N. MEDICAL PAYMENTS — INCREASED LIMITS If coverage provided to any additional insured Section III — Limits of Insurance, Paragraph 7. is is required by a contract or agreement, the replaced by the following: most we will pay on behalf of the additional 7. Subject to Paragraph 5. above, $10,000 is the insured is the amount of insurance: a. Required b the contract or a reement; or Medical Expense Limit we will pay under q Y 9 Coverage C for all medical expenses because of b. Available under the applicable Limits of "bodily injury" sustained by any one person, Insurance shown in the Declarations; unless the amount shown on the Declarations of this Coverage Part for Medical Expense Limit whichever is less. states: CG7578(2-19) Includes copyrighted material of ISO Properties, Inc. with its permission. Page 5 of 6 (a) No Coverage; or (b) $1,000; or (c) $5,000; or (d) A limit higher than $10,000. O. DUTIES IN THE EVENT OF OCCURRENCE, OFFENSE, CLAIM OR SUIT Section IV — Commercial General Liability Conditions Paragraph 2. is amended to add the following: e. The requirement in Condition 2.a. that you must see to it that we are notified as soon as practicable of an 'occurrence" or an offense which may result in a claim, applies only when the "occurrence" or offense is known to: (1) You, if you are an individual or a limited liability company; (2) A partner, if you are a partnership; (3) A member or manager, if you are a limited liability company; (4) An "executive officer" or insurance manager, if you are a corporation; or (5) A trustee, if you are a trust. f. The requirement in Condition 2.b. that you must see to it that we receive notice of a claim or "suit' as soon as practicable will not be considered breached unless the breach occurs after such claim or "suit' is known to: (1) You, if you are an individual or a limited liability company; (2) A partner, if you are a partnership; (3) A member or manager, if you are a limited liability company; (4) An "executive officer' or insurance manager, if you are a corporation; or (5) A trustee, if you are a trust. P. PRIMARY AND NONCONTRIBUTORY — ADDITIONAL INSURED EXTENSION Section IV — Commercial General Liability Conditions Paragraph 4. Other Insurance is amended to add the following: 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 contribution from any other insurance available to the additional insured. However, if the additional insured has been added as an additional insured on other policies, whether primary, excess, contingent or on any other basis, this insurance is excess over any other insurance regardless of the written agreement between you and an additional insured. Q. UNINTENTIONAL FAILURE TO DISCLOSE EXPOSURES Section IV — Commercial General Liability Conditions Paragraph 6. Representations is amended to add the following: If you unintentionally fail to disclose any exposures existing at the inception date of your policy, we will not deny coverage under the Coverage Form solely because of such failure to disclose. However, this provision does not affect our right to collect additional premium or exercise our right of cancellation or non - renewal. This provision does not apply to any known injury or damage which is excluded under any other provision of this policy. R. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Section IV — Commercial General Liability Condition Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us is amended to add the following: We waive any right of recovery we may have against any person or organization because of payments we make for injury or damage arising out of: 1. Your ongoing operations; or 2. "Your work" included in the "products - completed operations hazard". However, this waiver applies only when you have agreed in writing to waive such rights of recovery in a contract or agreement, and only if the contract or agreement: 1. Is in effect or becomes effective during the term of this policy; and 2. Was executed prior to loss. S. MENTAL ANGUISH Section V — Definition 3. is replaced by the following: "Bodily injury" means bodily injury, sickness or disease sustained by a person, including mental anguish or death resulting from bodily injury, sickness or disease. T. LIBERALIZATION If we revise this endorsement to provide greater coverage without additional premium charge, we will automatically provide the additional coverage to all endorsement holders as of the day the revision is effective in your state. CG7578(2-19) Includes copyrighted material of ISO Properties, Inc. with its permission. Page 6 of 6 ADA1EIIaMDQ1Yk,YY) CERTIFICATE OF LIABILITY INSURANCE 1112112021 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 Aon Risk Services, Inc o1 Florida CONTACT Aon Risk Services, Inc of Florida NAME: .,.- FA AIC, No Ex[): 800-743-8130 IAIC, No]: 800-522-7514 1001 Brickell Bay Drive, Suite #1100 Miami, FL 33131-4937 L ADDRESS: ADP.COI Center@Aon.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : AIU Insurance Company 19399 INSURED INSURER B ; ADP TolalSource DE IV, Inc. INSURER C : 10200 Sunset Drive Miami, FL 33173 INSURER D •. L/C/F Performance Truck Repair Inc INSURER E 892 W 101h St Azusa, CA 91702 INSURER F ; COVERAGES CERTIFICATE NUMBER: 3784814 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, LIMITS SHOWN ARE AS REQUESTED. INSR LTR TYPE OF INSURANCE I ADDL INSR SUBR W1/0 POLICY NUMBER POLICY EFF (MMIDDIYYYY) POLICY EXP MM/DDNYYY) LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ❑ OCCUR EACH OCCURRENCE $ PREMI TO S( RENTED '. PREMISLEa occurrence) -... $ ME EXP (Anyone ,person) , $ PERSONAL 8 ADV INJURY GENERAL AGGREGATE $ $ GEN'L AGGREGATE; LIMIT APPLIES PER: POLICY 7PROJECT LOC OTHER PRODUCTS - COMP/OPAGG $ S AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY YN L L Y ', Ea accident $ ''. BODILY INJURY (Perperson) S BODILY INJURY Per accident. $ PROPERTY DAMAGE Per accident) $ $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAMS -MADE EACH OCCURRENCE $ AGGREGATE $ DEC RETENTION $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? ❑ (Mandatory in NH) If yes, describe under°""""""""'^'^""^""' DESCRIPTION OF OPERATIONS below N/A WC 038392501 CA 09113/2021 07/01/2022 X PER STATUTE OTH- ER E.L EACH ACCIDENT $ 2,000,000 EL. DISEASE - EAEMPLOYEEI $ 2,000,000 E.L. DISEASE - POLICY LIMIT $ 2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) All worksite employees working for PERFORMANCE TRUCK REPAIR INC, paid under ADP TOTALSOURCE, INC's payroll, are covered under the above staled policy, CERTIFICATE HOLDER CANCELLATION City of El Segundo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 348 Main St, THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN El Segundo, CA 90245 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 0i oa pkiak j6e CV1Ce,, qnc of Clotdda ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA This endorsement changes the policy to which it is attached effective on 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 on 12/23/2021 at 12:01 AM, forms a part of Policy No. WC 038392501 Issued to: ADP TotalSource DE IV, Inc. 10200 Sunset Drive Miami, FL 33173 L/C/F Performance Truck Repair Inc 892 W 10th St Azusa, CA 91702 Premium: NIA By: AIU Insurance Company 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 under a written contract that requires you to obtain this agreement from us). You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be Additional Premium Percent% of the California workers' compensation premium otherwise due on such remuneration. Schedule Person or Organization City of El Segundo 348 Main St. El Segundo, CA 90245 WC 04 03 06 (Ed. 4-84) Countersigned by Authorized Representative