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PROOF OF INSURANCE (2024 - 2024) CLOSEDDATE (MM/DD/YYYY) CC) CERTIFICATE OF LIABILITY INSURANCE 12/18/2023 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 Certificate Dept. NAME: AP Tutton Insurance Services PHONE Ext(949) 261-5335 'c N (949) 261-1911 AIG No,, 2913 S Pullman St E-MAIL ADDRESS: License #OB89376 INSURER(S) AFFORDING COVERAGE NAIC # Santa Ana CA 92705 INSURERA: Middlesex Insurance Company F23434 INSURED INSURER B : Insurance Company of the West 27847 NKS Mechanical Contracting Inc 2971 E. White Star Avenue INSURER C : Scottsdale Insurance Company 41297 INSURER D INSURER E : Anaheim CA 92806 1 INSURER F COVERAGES CERTIFICATE NUMBER: 23/24 Liab/'Au1o1XSAVC 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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 W TYPE OF INSURANCE '...INSR SUBRI WVD _. _.. POLICY NUMBER POCK{ E MM/DD/YYYY _. C P MMIDD LIMITS _. ... ........ X .... COMMERCIAL GENERAL LIABILITY ....... EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE F OCCUR A �-R" h PREMISES Eaoc4urrewe) $ 500,000 MED EXP (Any one person) $ 15,000 A Y Y A0165544004 02/06/2023 02/06/2024 PERSONAL &ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 POLICY 7 jPELOG PRODUCTS-COMPIOPAGG 2,000,000 $ Employee Benefits $ 1,000,000 WWWW. AUTOMOBILE OTHER: LIABILITY COMBINED SINGLE 6.lMIT Fa accl4lonq $ 1,000,000 X ANYAUTO BODILY INJURY (Per person) $ A _ OWNED SCHEDULED Y Y A0165544001 02/06/2023 02/06/2024 BODILY INJURY (Per accident) $ AUTOS ONLY HIRED AUTOS '.. NON -OWNED PROPERTY DAMAGE. $ AUTOS ONLY '.. AUTOS ONLY Per acddonfii Underinsured motorist $ 1,000,000 X UMBRELLA LIAR X OCCUR E OCCURRENCE EACH OCCURRENCE 5,000,000 $ A EXCESS LIAB CLAIMS -MADE _....... _........ A0165544005 02/06/2023 02/06/2024 AGGREGATE $ 5,000,000 DED RETENTION $ $ WORKERS COMPENSATION v' PER OTH- ER AND EMPLOYERS' LIABILITY .YIN 1,000,000 B ANY PROPRIETOR/PARTNER/EXECUTIVE FYI NIA Y WSD505087904 10/01/2023 10/01/2024 EACH ACCIDENT EJ.EAC AC $ OFFICER/ '....(Mandatory inNH) E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under ''.. DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 Each Occurrence $ 2,000,000 C Sexual Abuse/Molestation EKS3502476 11/15/2023 11/15/2024 Aggregate $ 2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: PW 23-03 City Hall HVAC Replacement Project The City, its officers, officials, employees, agents, and volunteers are named additional insureds per attached CG2010 04/13 & CG2037 04/13. Primary Non Contributory applies per CG2001 04/13. GL Waiver of Subrogation applies per CG2404 05/09. Automobile Additional Insured per CA7601 06/15 including Primary Non Contributory, Waiver of Subrogation per CA0444 10/13. Workers' Compensation Waiver of Subrogation per WC990634. 4,rKIlllm P,A.IC'. MULUCK VNI­L 1V1v SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of El Segundo ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street AUTHORIZED REPRESENTATIVE i ElSegundo CA 90245.�' U 19t5tf-2U10 AGUKU L:UKI-UKAI IUIN. All rlgnis reserves. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: A0165544001 COMMERCIAL AUTO CA 04 4410 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO LIDS (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: NKS Mechanical Contracting Inc Endorsement Effective Date: 02/06/2023 SCHEDULE Name(s) Of Person(s) Or Organization(s): Any person or organization from whom you are required to waive your right to recover under a written contract or agreement in effect prior to any loss or damage Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The Transfer Of Rights Of Recovery Against Others To Us condition does not apply to the person(s) or organization(s) shown in the Schedule, but only to the extent that subrogation is waived prior to the "accident" or the 'loss" under a contract with that person or organization. CA04441013 A0165544 Middlesex Insurance Company 1 00001 0000000000 23034 0 N © Insurance Services Office, Inc., 2011 Page 1 of 1 02/03/2023 32521 b70-d2e 14e8b-af8c-854ca4cf8742 POLICY NUMBER: A0165544001 COMMERCIAL AUTO CA 76 01 06 15 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. • • • i I "" •All • * • This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM AUTO DEALERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated. Named Insured: NKS Mechanical Contracting Inc Endorsement Effective Date: 02/06/2023 SCHEDULE Name Of Person(s) Or Organization(s): Any person or organization you are required to add as an additional insured under a written contract or agreement in effect prior to any accident, injury, loss or damage I information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Each person or organization shown in the Schedule is an "insured" for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in: (1) Paragraph A.1. of Section II - Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms; or (2) Paragraph D.2. of Section I - Covered Autos Coverages of the Auto Dealers Coverage Form. CA 76 0106 15 A0165544 Middlesex Insurance Company 00001 0000000000 23034 0 N B. Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution from any other auto insurance issued to the person or organization in the schedule under your policy provided that: (1) The person or organization is a Named Insured under such other insurance; and (2) Prior to the "accident" 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 person or organization. Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 1 02/03/2023 a8e36b97-6d7f-4e76-8842-caa3f071c3f0 COMMERCIAL GENERAL LIABILITY CG 20 01 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. + +1wa a0 a • "" This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance Condition and supersedes any provision to the contrary: Primary And Noncontributory Insurance 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 CG 20 01 0413 A0165544 Middlesex Insurance Company 1 00001 0000000000 22033 0 N (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. © Insurance Services Office, Inc., 2012 Page 1 of 1 02/02/2022 81b9b2c3-7820-4607-994e-e6644b393bd6 POLICY NUMBER: A0165544004 COMMERCIAL GENERAL LIABILITY CG20100413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) An person or organization y p g on you are required to add as an additional insured under a written contract or agreement in effect prior to any accident, injury, loss or damage Location(s) Of Covered Operations All locations per written contract, agreement or permit Description: All jobs performed that have a written contract, agreement or permit Information required 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. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. CG20100413 A0165544 Middlesex Insurance Company 1 00001 0000000000 23034 0 N 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. © Insurance Services Office, Inc., 2012 Page 1 of 2 02/03/2023 d64495c9-1 da6-4068-9de2-dfbeel c42463 C. With respect to the insurance afforded to these additional insureds, the following is added to Section III - Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. Page 2 of 2 © Insurance Services Office, Inc., 2012 CG 20 10 04 13 A0165544 02/03/2023 Middlesex Insurance Company POLICY NUMBER: A0165544004 COMMERCIAL GENERAL LIABILITY CG 20 37 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations Any person or organization you are required to add as All locations and jobs performed that have a written an contract, agreement or permit additional insured under a written contract or agreement in effect prior to any accident, injury, loss or damage Information required 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" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the Schedule of this endorsement performed for that additional insured and included in the "products -completed operations hazard". However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following is added to Section III - Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 37 04 13 A0165544 Middlesex Insurance Company 1 00001 0000000000 23034 0 N © Insurance Services Office, Inc., 2012 79645a98-e3be-4b08-ad87-8534a763db9a Page 1 of 1 02/03/2023 POLICY NUMBER: A0165544004 COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER OF TRANSFER OF 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: Any person or organization from whom you are required to waive your right to recover under a written contract or agreement in effect prior to any loss or damage Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 8. 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 make 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. CG 24 04 05 09 A0165544 Middlesex Insurance Company 1 00001 0000000000 23034 0 N © Insurance Services Office, Inc., 2008 Page 1 of 1 02/03/2023 68009a77-e3bd-4914-8aeo-ebd40fb12ble WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 06 34 (Ed. 8-00) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - BLANKET 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). The additional premium for this endorsement shall be otherwise due. Person or Organization ANY PERSON OR ORGANIZATION FOR WHOM THE NAMED INSURED IS REQUIRED UNDER WRITTEN CONTRACT TO FURNISH THIS WAIVER 2 % of the total California Workers' Compensation premium Schedule Job Description ALL CA OPERATIONS 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 10/01/2023 Policy No. WSD 5050879 04 Endorsement No. Insured N K S MECHANICAL CONTRACTING Premium $ INCL . Insurance Company INSURANCE COMPANY OF THE WEST WC 99 06 34 (Ed. 8-00) Countersigned By INSURED