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PROOF OF INSURANCE (2024 - 2024) CLOSEDHIRSC-1 ACOR CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 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 ri ht's to the certificate holder in lieu of such end7orsement s . PRODUCER 0, ' g Que2ada 909-f390-9707 c ACT An elina ..,�---............ _ ......�.. m.....m_ _ Unickel & Assoc. Lic#0827703 I ss ue2, da-9itnickel nStlrancet.co ' N`� 909-590 92 7 Unickel & Associates Insurance PHONC PAX 3 P.O. Box 10727No _.. San Bernardino, CA 92423-0727,,— MAW A --- IN a l,8. r wvelers P,e a a�CgRCo of,Arnerlca_,-,_,,,,,,m 25674 2221 E..... ................ Aspen American Insurance Compa.... ............_ 434604 HlJrSC & Associates, Inc. IN I/i ER. Travelers Pro Cas Co of Am 2567 Winston Rd. Ste A IIN.az fR.G Anaheim, CA 92806 INSURER D COVERAGES CERTI "ICATNUMBER: 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, LIMITS SHOWN MAY HAVE BEEN REDUCEDP EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. CLAIMS. _ _ _ LICY EXP MJQDNYM LIMITS _ INSRIT9T— TYPE OF IN O,.,_—EACH 1INSP AL'NOLiSUBR POLICY NUMBER A X COMMERCIAL AL GENERAL LIABILITY OGGURRENCE 5,...�� 2,000 000 — CLAIMS -MADE X � OCCUR 680-OS798388-23-47 1011412023 10/14/2024 ._. TO DAMAd E TrJ RENTED wFB�k��S�S.(tm� t7�canr�� S _IT._ 1,000,0005000 ..... MED EXP,(A9ySPe persnn)__ ..------... --------- ... ... ....__......_-- 2,000,000 ADV INJURY S ........ ............. ...— ._PERSONAL,&, _ 4,000 000 GEN L AUORE'ATE�LIML.. TAPPLIES PER: „P,ENERAL AGGREGATE .... S X„ POOICRY PRO- .. _I JECT RODUGTS GOMP/OP AGG 4,000,000 $ „ LMBINED )LELII... 1'000,..0_.-00A AUTOMOBILE LIABILITY .1Fv;2Q_W"I_ _ .. .... ... . ANY AUTO BA-3W47756-23 01/24/2023 01/24/2024 BODILY INJURY ,(,PeroersonZ $ _ -- OWNED .SCHEDULED AUTOS ONLY 'AUTOS ,BODILYIN JURY (Per accident X., AR X AUTOS ONLY Ppp�OPEi'IY DAMAC"E ar ..... .,..... ...... .. S ONLY .Par UMBRELLA LIAB OCCUR EACH OCCLLRRENCE EXCESS LIAB CLAIMS -MADE AGGREGATE. DED RETENTION $ $ C WORKERS COMPENSATION OTH X LP AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/F�(ECUTIVEOFFYIN ANY PROPRIETER EXCLUDED? NIA.... UB-8S799914-23-47-G 10I14I2023 10114/2024 .ST,AT4dT E = EACH AGGIDENT .m.-._.._— $ — 1,000,000 1,000,000 (Mandatory in NH) E,^ L.DISEASE EA,EMPLOYEF�,$ ... If DESCRIPTION das I°be under ON OF. OPERATIONS below E..L�. DISEASE - POLICY LIMIT DI S 1,600,000 B Professional AAAE300078-04 1211212023 12/12/2024 Claim 2,000,000 Liability �Ea Aggregate 2,000,000 DESCRIPTION OF OPERATIONS /LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) Verification of Insurance CITEL-1 City of El Segundo Cheryl Ebert 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. AUTHO RIZED REPRESENTATIVE ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD COMMERCIAL GENEPAL. LIABILITY INS F,.. ICIOR'SEMEHrr a4ANGES THE POLICY. PLEASE READ IT CA,RIUMLY. M T ADDITIONAL INSURED C I EMI TS ENGINEERS SURVEYORS) This endmement modffies fijsjmmcgptovkIedunder1hef0l1VWrig: CCMMERCIAILGEMIR,hL t.lA'BIL.I'7'1t"coVERACE PART 1, The following is added to 'SIX iION It — WHO IS h. AN INWRO-11 Arwyr person Or w�ankz6:wr thall '� aVee to a �� lrik urrst e'� rude as on additlonal Insured on tills Coverage Dart, but: g, 0Tjwrrith respect to Iimr ty for W&Y". ,-propeq dwnaga7 or "personal 10,W)f" r and tr. If. and only to the e*11t that, file *ry or damage is caused bid aucts or Omisrsfruns of you, or your subcOntriacrcr in the pe anCA of'r" work" to o Wkil ft "WrittenCOntrad requiring insurance iup . or in cOrmection with premises owrwd 'bye or rented to YOU. The person or nrganizatkin does not qualifY as an additional Insured: c. Wgh" respect to thi: IrWependent acts or omisslom of such pejjsljn ororoarization,, or d. For ly" lTdury,. '1 Ope ty darnage" or "personal f0f Which swrc:h person or organUation has imm: red W14 itn a contract or aWeernefit The insurance proviul d IID !!.,Wh add£tlonal insured is limited as fo IMS: rm. This Wourance doe rrct e113 on any basis to any or OrSonizabon, for which cover,Mp as an addhojul Insured spe Is added by another endor nt to till's coverage Past. f. This iesur rcer d(; e:, riot aPPIY to the rende of or failure to render any "prof at semcee. ff+ in the ev It the the Lirrhits of Insurance of the C&rage Fart .stiw:r rw in the DeclaratIORs exceed the s cf^ babft required bY the "Otten contra+dl A°Jirog insurance"% the k4mnce prcuvkW, to the a0itional Itisured shall a limited to d'�e f *5 Of " required by" that WrAten cor=tart vatluirkm Inauuritr%W- This endorsement rides not im"29e the fimb of insurance de�%;crlhed to III' limits of Yvawaace, This insurance does not aplilY to "ttodilyl" I��w "pr dna0'" caused by ",Your' Wrrri Lr and indded in the "products- Completed operations hard° unless the .wurttten ca&att feoring insu n e'. $Pedfinily requires you to provide such coverage for that addilkmal insured, and rhea the lnsumMe pwided to the a01110n l Insured aWles only to such " or ""t pr y damage" that Occurs a of the petiod of time for which the " e" contrad requiring insurance`" requires you to provide such coverage or the ehtd of ft poticy period, Wbi hOw Is ear, r, The fofowing is "wed to paragraph 4.a, of SEC71O Ir' — +C00AMEl LIABILfTY Crt #NM S' The insurance jxvvided to the additional Insured excess over any v and and collectible Other' ur l Cher t ornery. s% cwW n o0w baste. a AddiIdowl for a loss was cover. 4ow e"r, If y coritract d agree the " �d g Isisurarrw "Ilia this insurance provided tra tine add"rGorr'at insured uridcr Iliis coverage Part p a heels 4r a lrrmary and runt C tratsis, this raranr a is primary inns r�rlial9ie ttr the additional irusurrruf Wltiii tlrrat or tiln atrts as ab named RMIMSunrd for such loss, and we vrll not share with the other Inrre"provided thiat 11) The .hodipy ioW or "pmPe"Y a °' Ya Which coverWis sought occurs*. and (2) The �sonal rrj* for Which coverage so arisesoutof an Otte carrrndltedf after you love . d#0*wcoact requiring Irwsurarrce% But this Irrsma"CO Pmvlded' to the addliton:01 Insured sti i B o ces's over valid and coitectibie, Oth9r insuamm whether ptiu'. r x�. crawit ear on any other basis. that Is, a� ale to the arlditiorW Insumd wuditn that person or organtgadon is ,an addWonal Insured under ariy Oth' lns CG Q3 91 CM 19 r rw� wind Page 1 of 2 InCNd'1¢tr� � MRlwwi�GlrAriar Samoa r".+dw'rr'SpeplMeWoN CoMmERC1AL GENERAL L,IABILUY 4 The folioWng defmiUon Is added to the DEFINMONS Sectforr. ,written condract MOring € lstAra ne" ns filat part of any w Men Contact under' Which You amMCp*. erg to WJude a PeMOrk, or o"izariion as additonai inwr4d ors the Coverage P provided #tat #to "bod,ly 101W and "property daMaW occurs and the *Persunal iNW wed by an ofknse COMrnitted; a. ARer You have Signed that written contract: b. WhUe that part of ttre written cony is in effeM and _. Before the and of the POkY Period. CG D3 91 091E page 2 of 2 ,15 Tho TrM r,xt A so, our a orb 60. , s r- COMMERCIAL GENERAL LIABILITY TICS ENDORSEME MIT CHAWES THE POLICY. PLEASE READ IT CAREFULLY. T END 'S ENT ARCHI ECTSs ENGINEERS AND SURVEYORS This erdomemeM mo"es ivIgI me provided Arnder" the faitowwinp COirPllw Ra AL GEM---P AI. UAI ILITY COVERAGE PAR" O I AL RiPTI aIwN (,*: CO - This ,eadorsernOrtt lens cmrage too wever, coverage for vI ram tls end - nt m be " "Ury, 'cal e�ea�s� describedin any of " e brio riino pr r�c�lI iirrrll� � an,a }or�rtItt to this coverage Part. and Its a do not apply to the extent tha coverage excluded or *rrited � such an andserndi following ing general coverage descripllo�t only Read all ft rav ions this endo ment and the rest of your policy camfuilyto,dejayrninerights, d anus, and vshat Is and is n covered. A. Nan-Onrned Watercraft - 75 Feet 1-0119 Or Less p, Who Is An Insured - Uni tanned Subsidiaries C. Who Is An In.wred - R,01*19d Pafters, Members, D And pE*MPllrtyr+ 'S D. Who Is Art Insured - EMMal0yees And Volunteer liwloftr, - Bodily InM, 're CO-EM0, CO- Vokrdeer Workers ivrl Retired Partners. l rgrec ors Anti Errrp oyr E. Who Is An Insured - NW11Y Acquired Or Formed Uinlied Liabiky C41np -dfa F. Blanket Additional Insurw - CornrolBng Interest G, Eilankel Additional I p ert -- Mortgagees, Assl , Succe"ors Or F,a ewers PROVISIONS A. tg)"WNgo WA-rE: tcMAF`r - 75 FW Lom OR LESS 1. T4,a ktlloWing rel.ia t Eara (2) of Exclusion g., Alrcra% Auto Of''tltfMQM120w in pa l :I-. of SW OR I C ItA:GE,S, - 4io'vSRAGE A - GODILY It,ULIRY AM III`ItEN'I"wI. U01I1M. A, watemrAytv do riot owam that Is' ( 75 fe2t 1014 ON Miss:. altd () Nvt beft qt d to awy wW lemon orp petyfva e. 2. -the following reolaces Paragraph 2,e. of SIeCVM IN - vo",O 19 AN INLSUROM +e. Any PeMn or "artixa'don that, With your express or Implied consent, rather H, iiartrri insured - GOVenariettfasl ErWt s _ peffnits Or Authorizalians ReIRtirlg To premirAes f. Blat*0 Adocrol "tired GovWmerftl EnWeS - Permlttl Or Autlto ns "g To Operations Incidental Medical MalPrattice K. Medical pgyrn M - increased Urnit L. ++Amendtruedl Of Excess insurance COndidbn professl aw Wabody M. Slan et Wgiver of Subro trtt - Wilerr Regtered By Wrilien Contract Of Agreement N. Contractual Liability - Railroads uses or is resport� " use at I of a watercraft That yctt m (1) 75 feet long or less, and (7) Not being used tD OM any person or pmPerty for a charge: g, WHO IS AN INwSURCO - UNNAMW SUBSIDIARIES Tire tolWin5 i5 adftd to SECTION N -WW IS AN INSUftL,A: Arty of your diarles, other than a p e or rkrt ve , ti t is rga s "r as a figtmed Irroured in the Deciaratiom, is a NameA tns ih a, you are the sor of, or maintain an ,ter Irftre$t of more, "n 10, such subskilavy on the frst day of the p kY period: and �0 � "p NC riots rrucl. Page 7 of B CG D3 79 02 19 tr:dusws wr. err Irtrrtaa , �. rm lbrtr'mrsukm GtWN16RCM GENERAL LWIUTY b. Such subsidiary is nt t an insured under similar Other insurance. Nor such subW&WY is at;: insured fray 'ttWV'� Injury„ or "pro daarra(Ip"' that occurred, Of personal and advertising +(cer' ,caused by an offme s. 'Before you miltUained gin ownership interest of Mot* "n qwin su.!h Wb dam; ,0r b, Air the date, if any, d,rtlog the POkY peflOd brat you no (on" maintain an Owners* rest of more tt m 5i 1 . in such SubsIdiVY. For p s of PaWOO 1;. of , ton tl, — Wo is An Insured, sach such subsdiary VAH be d to be designated it r a,* Declarations as; a. A 0mited 40110 cownpturay; b. An 0ganizdtion ' than a partnefs p. jolm, yonture qrlimite ' kility cOlOPWY, or c. A trust as Indcated is its name car itie docurnents that govem its sbuctwe. C. V040 IS AN IN'SUR1 — Ws -TIRED PARTNIM, .bl9ti BOOS» DIRECTORS AND EWLOYM The fblPorag is added w P WW h of %11« 1jo IS AhiINSURED: �y i rho Is Maur rn reel r m r, ��r ""ca p omaWg services for yroaa urwder yowar eibectuprvlstr bw only for trots rr the cope of ttlr employrra by you tar7Y3:WPM=z"bS:`s-d�=4 ie ethe +c�ctof 'enosmb refiredpa"r of wra�y r for, {1) "BOW +111 (a) TO you, to yotw ajaerwt partners Or nrternbeM (if ym'4 are a padwshlP ar V ), to your t;Vffent` lneMbes of y to a Imiia i V sr'tlty company) or to your current di,r (b) To the SPMM, `-hAd, ant, brothel or meterofthat cur!reInt partner, memo or dretw as a a arts arerace of Paragraph (1)(a) , (c) For rr lch there is anY c lgatiOn to stem damages Vaith or few someone etsr who Mmt pay rna$ps Ibecause of #,a j*,ry de -Abed in Pam(1)(a) or (b) above: or (cq Mshg, vA of his of her Pmvidinp Or laft to provir ; prichissional heaWh care services. Unless you are in tM l s roccupatIOM arc of providing professional se"icesr paragraphs ��)f . (b)r (c) and ( above do not aptaiy to t 1*6" aril out of Mviding or failing to pro" first aid or G004 Samaritan selvicss" byany Of your retired partneM, mer taem or trrPiaayeee, ott'rer than a dcactor. Any such better dlrears or gem '" p San rzrtl�to provide first aid or "" ocsd �rxaaritan strrvtcee WOO th t �� deed10 be act +ttlwirt khe scope of tltetr t�ptoatt youort+trw at3dimes le, ted to the eavrtriuct of Your 'hustneSs. (2) apipwal r (a) TO YOU, to yaw current or rettred partners or is (if you, are a partnership or joint v +e), I yoerr cuoel#or moredmembers OfY a ilmitd Ifal'tty comp ), to ytr rtther ,rMtrefit or refired difeCM Ot .empioyeee wt Nte in the course of his or her employment or perfming dwatles mWed iaa the conduct Of your basin, or to your ether uvoWntw workers" wathlle perfWWng dudes related to tI conduct of your business (b) To ttwe Spomse, chiiif, Parent bvftlr or sister of do current or retired partner, member, dretctor. "eMPIDYe'e'" or %,olunteer workor" as a cotterefte Of Paragraph (2)(a) ahOW (c) For which them is any, otafl9WOn tra sham damages rawer OfTeloWtrue else who must pay �Paragraph ) r. ti'my desc or (b) above; or (d) Ar ing owlt of his, or t Ith 0 or era frt lrIg to provide prr�s servlues. )' -ppedy damage to property"" (a) owned.oaupledear Used, tyf. tar (b) Rented to" In the care, cwr iody or coritml of, or Va is b ex+mised for any purpose YOU, my of your' read, Pa*Ws, tom' or d' , your r.tatt'ent Of any , rernpWeesr or ""vol , e a crawl, pa*w Ofmemr air Of you ar parW,ersttalp or Joint vemm), at M sty cment e you ale a corttapany) or current der- iaudt c AN r CG DI 79 0219 p 2 of fi r7 rhra cam aaca, muhsr r tnW11e"i"c p pi tn xs� COM?AERCIAL GENERAL LIABILITY page 3 af6 OM GGD3TBt1t'{9 t7i�rarralra4NerC�w fi chudeaswabc8 i� 4tap- COMfAERCfAL GF1dF-RAL LlAI;iGLfi'Y $Ubsequag m the signing of that cormact or agreeMent.,and la. f ses our of the OwRe ip,N maintenance or 1. os'e of the prewrtis e"s for ie*kh that mortg . asskPfto BUCCesw rrr receiver is required under, that". WftaCt a aOMMOnt to to included as an i lditional Insured on ft Coverage Part Tile insuranca, provided to %Xb mOd3wAee• asslgrwe , successor or re::11140t is subject to the fdowing provisions: 8b The ilmh of fnsuratbce proWded to such 3 rrt*tee. as�rtetz, sttr�sor or receiver be tf rte tin ' tarsi lit rrAn that you agreed to pmvkle in Jhe vaitten ::tract or agreement or the Ahom in the VedaratWs, whkhevw are less. pmwied to such pemon , oroantrationw' F WY , il) Any w wow opmpeny »- y. w w ' w ,.. . Fy N :w.11 byanR ffMe that is, committed, or agmement IS no w or wr-w w.w. 4 a�a w" s. t N w w:. out alterations, constvUCIjon or ('0maill"Jon Operations perfw w F behalf Of w FSY •''."•"fit, Or r * PREMISES 71 - P" M �^ WMATING • w; r w' s added e�' N Any N,a a •w w or Nh.w r. or omupled by, or w ,.e au w . w w P w zrequired..w Ordinance., w� w A ^' or h , nVad or agreementto IncluN winsured F :. an w, w w ^a a, is nly wM w Nliptapy w w NOw. w ww: lty .. 'personal *wadyedtAnij afi*w OLA Cf u maIntenanM mpalr, c*Isstruction,pF:fl or gloyernmental advertising N F p Nw can ,w M,iesw WNW coal holes, M3**s1 rroquees, w opewnp, sidovm& vaults, 0--mors. street bannem or deeoratfttns. 9LAmmT AvorrioNAL pl!RWM oft AVrHORMT]ONS ftELATING TO OPERAT11 M The folowkV, is added to SECTM It — WHO IS Aft ItMIRSIX. Any etrrorterdal tlty that has aPtrmlt. at,ItftC7rittlrt'r'I with respect W 01MMOOM p rfrrrtt*ed by you or On your behafF andare rerqult'ed by any ordinance. . Ada code ' or coir ra or matt an ad&w Imt �d on i s Coverage owed a W Mdy *Irk'* reel ' t to l y for -logy irt)W, -property .da or M and . *"g arlsfti out ref'Wch opemoons. 1-he lnsettrant a pmkW to such governmental entity does not apply tw. a. Any -btcay injury*,Vmperty damns' or ,Varsottal and advarlising iku'r adsN Otd Of operaftis performed for govemwAn*!al ettw. or b, Any "b "PTOPeq • Included in the "productswcta�r*f operations hazard•, J. IMCMEH'1°`it L MEDICAL MALPRACME 1. "ffte fr*flt Mng replaces path I of the deRnwon of ,OCCWMW in the tblplt*trff 0Ns S ctow.. tort. An act of on issfon committed In prov " g or fang to Provide 10c tat medical r trrf s", first aid, samadtangoviceV to a POwnN urn you are in Me business, or c of providing " heam care swAces. 2. Tilt fOl wing rePIaces the lastparagraph of patapph )ofS @d",..VMO15 AN INSUMP Unia,�-,s you we In tt�lh�qw�..���tppt�uslass or O o 9ALeI"es SIl o�., 'taw 'p" aphs IKO), lit ..(C)" a do not apply to "borfi yWising out cif providing or fWUM to Mv'lde« (90 wrincidentat me&w Service, by any of your oeeee, who Is a nur� nttwyssistrtw�te�t lparamedic, w'✓ w.v.yM1 e..yS GG D3 79 OZ 19 page 4 of a. xta r r rr tea[ s . w a Prr Ind rotas OcC14k10MSJ tt1e0111'St +ar o ."UPa ' ' t &�R physical #WaPW or speech- Efrl rge 0$0100ist Of (b) F#St ald or ,GQ!xi Samar ri service5w by any of your mf!M00yeee or VMU walke"-, other than an employed or volunteer doctGf. Ally such q"ernplopeesr q or "volunteer woi k0W wN or falling ,be pmvidefht lltt or "Good arltan mrvic-ee duft tf'Pif lt0'Uls for you will be deemed to be aC 9 whin the swops of tlf eiVps t by Ym or pWormlling dut+k.s related to the conduct of your business. 3. Tar graphs. oFAsilcrRoN U1 t LI�eOF paragraph INSURANCE: For the s sf determl alr* the appkalAe F.Itch oa wrlence Lint, oil r t a �d or fYn issloos c a nlfll in pyevkOn ft to . e "inci&ntal, me ld �alcee, *St al car "Good '59amaidtan services+' to any Onie pamn wig be deemed to be oft 0=ffi84 0.!- 4. -rhe iouawirig e,cclusion Is added to paragraph 2., 5Xd1w A'Anse Of M1" ON 1.- COVERAGES - C VORAIGs ir+a R-Y iNJrJitY AND PROPERTY DAMAGE UABUM: Sale of phwmacelut!1c4 s .S It or ,,proper damage Wi-'431 a1,lt of tAWr. YAojatISb'J%. U'i aPena, $tam c'r. ordlnafa a relsthi to Halt We phamaceu0cals c orrw` by, or vOth the krtowtedat or cons erlt of the wVd— 5. The inllowing is alided to the 1?1EFINITIONS Section; "Incidental medico I sengices° mearllr 8.Medicaj, surgiaj, dam. Ialbootory. x- ray or rlufsling seA+iOe of 002 advice or crPStluciOn. or the related furnishing of Hood of hevefaggs; or b. The WWI",, cur c'ispensin ofsupplies5 AY medical, dental, Or sub iltal applWoces. S. The fopowing k added to paWaph AUL, I �tGof Swnom IV - COMOMRCIAL ENERAI. LIMP-l" Tw insurance ns rar n t'b excecsover ally o d arld collecoe of f t ence9s. � m or on any other basis. COMMERCIAL GENERAL LIAMILITY that is avaWbjetoanyq, w. .R'rr for R M that k R . a JN or jalfing to provide 4irwide"tal medical to am petswto w- paragraph Of r w° 11 VVho Is An Insured. w, a" w weika Is the mmst we WO PaY under roverage C for, * med1cal expenses r q M .'-be* person,one and WM R• the 1110el'. The w this Coverooe Part for w WMIL • s 'n s r O0.. w The jogowlrig is added to PaYM(aPh .: w COMMERCIAL� CONDITIONS: Thirr" w y' i » ftr r1 IMU101100 is A » . P ?� .. or M other w, 9W Is Pmfft$W*a loss 15 no s4oct to Ifle + w a of Covwaga A of w . w W OF . a w WHp .14 w' r f� w , �;. of ItWft of pwovery of SgCTM%'" MMMOAL GE waltITYCM M w Insuredif ft, q. g: aw ;e agreement recovery �:,R 7 Person o w . rl ♦ ` Our wx w ve3y w a w n of �#,R. because » "Bodily a or q an caused -w » q, Of w ,. suirAquent the agreement 21"F'TheT lafs sff-'*y Al r rl. CIS 03 79 0219 at R a � 1n tse h page 5 of 6 COMMERCIAL GENERAL LIM LITY K CONTRACTUAL LiAM" V — RAILROADS 1. The ing recce! pf graph G. of the nip of vinvxg,d Contact" in the OMMMOM Seeciion: C. Any easement or liee1s2 agrearnent. 2. paragraph Lf1j of #Uf ! daWtion of "Insured cowm& In the OB TMITI NS aedlml Is dewd, 'de -way CMpq- Pao"MIM11,04 CO D3 T9 Oz 19 w S AOW IRJ ` WORKERS COMPENSATION AND ONE TOPER SQUARE EMPLOYERS LIABILITY POLICY HARTFORD CT 06183 ENDORSEMENT WC 04 03 06 (01) - 001 POLICY NUMBER: CTB-SS799914-23-47-G 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 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 5.00% OF THE CALIFORNIA WORKERS' COMPENSATION PREMIUM OTHERWISE DUE ON SUCH REMUNERATION. SCHEDULE PERSON OR ORGANIZATION THE CITY OF LOS ALAMITOS ITS OFFICERS, EMPLOYEES, AGENTS AND VOLUNTEERS AS ADDITIONAL INSUREDS. 3191 KATELLA AVE. LOS ALAMITOS, CA 90720 JOB DESCRIPTION DESIGNING PLANS FOR RENOVATION OF AN EXISTING 0.3 ACRE PARK DATE OF ISSUE: 06-30-23 ST ASSIGN: Page 1 of 1