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PROOF OF INSURANCE (2024) CLOSEDClient#: 150916 EJWAR DATE (MMIDD/YYYY) ACORD. CERTIFICATE OF LIABILITY INSURANCE 9/01/2023 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER NA. T Danelle Touchstone USI Insurance Services LLC -CL FAX (NHCN R' E�ti. 210 366 0671 Noy 2105242087 4630 North Loop 1604 West E-MAIL danelle.touchstone@usi.com 410 ADDRESS, �tlsi.com j Atlantic Specialty Insurance COVERAGE NAIC # INSURER(S) AFF San Antonio, TX 78249 .. ., , , �. � ., ,,.,,,, . ........ INSURER A: p y anceCompany 27154 ,.......... _._... ,m.m.,....... ,_ .............. ...._......... ,............ INSURED INSURER B E.J. Ward, Inc. _ INSURER C 12621 Silicon Dr., Ste 130 ®�..... INSURER D : ____ ......._ San Antonio, TX 78249 . EE ............. ,—._. INSURERF COVERAGES CERTIFICATE NUMBER: 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 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. TRR ..... .,.............„ .,,. ...... AD 'L't',PBRt ®,,, ....:, POLICY'EFF POLICY EXP LIMITS TYPE OF INSURANCE I iSR POLICY NUMBER-(MM/DD/YYYY)„(MM� q,�AJtY"YYlIa,le,,,, EACH OCCURRENCE f$1,000,000 A XI COMMERCIAL GENERAL LIABILITY 7110163580005 09/0112023 09I01/2024 i R�yOq RENTED s CLAIMS -MADE X:, OCCUR k R lMA13ES aocourrence) € $500,000 .... f .. ,. ,. ..... ... _,., MED EXP (Any one person) 1 $10,000 PERSONAL & ADV INJURY 1 $1,000 000 GEN'L E AGGREGATE LIMIT APPLIES PER: J GENERAL A ... ... GGREGATE j $2.000 000 POLICY JPR- ECT . LOC PRODUCTS-COMP/OPAGG 1 s2,000,000 OTHER,,,,,,,,, .,...__._._._. ,.,_ �� .... ..... ................ A 7110163580005 ..... ,,,... _, AUTOMOBILE LIABILITYOM(�INECJ SVNC'k F LIMIT 1 000,000 9/01/2023 09 01 20 Ea�ccadenl) $ X! ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED ®r BODILY INJURY (Per accident) $ HIRED ..... NON -OWNED PROPERTYAMAGE Is AUTOS ONLY AUTOS ONLY ( AUTOS ONLY AUTOS ) �$ A X UMBRELLA LIAB X OCCUR 7110163580005 9/01/2023 09/01/2024 EACH OCCURRENCE [ $10,000,000 EXCESS LIAB CLAIMS -MADE, ( AGGREGATE f $1r 0 000 000 ®r DED X RETENTION $10000 PER OTH AAND 4060454430005 9/01/2023 09/01/2024 XLITY Y/N r WORKERS COMPENSATION f FR ..._ -- OFFIC RIMEMBE EXCLIU ED? NIA 1 $1,,,000,000 E L. DISEASE EA FM ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.E L EACH ACCIDENT _ ...L DI P mmY LIMIT 00,000 9 0112023 09/01/2024 100 000 ea claim/ag EFJ $ If yes describe under DESCR PT ON OF 00,000 A�Professional L abOPERATIONS below 7600104500005 9l01/2023 09/01/202� 10D000 000 ea cm/agg$1 0 Cyber Liability 7600104500005 laim/agg Retention: $50,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) The General Liability and Auto Liability policy includes an automatic Additional Insured endorsement that provides Additional Insured and a Waiver of Subrogation status to the certificate holder, only when there is a written contract or written agreement between the named insured and the certificate holder that requires such status. The General Liability policy contains "Primary and Noncontributory" endorsement that applies when required by written contract between the named insured and the certificate holder. The Workers (See Attached Descriptions) r'<Fra t fr^Arr- Wnl nFR CANCELLATION City of El Segundo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ty g THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 350 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. El Segundo, CA 90245 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) 1 of 2 The ACORD name and logo are registered marks of ACORD #S41345716/M41345372 SLSZR DESCRIPTIONS (Continued from Page 1) Compensation policy provides a Waiver of Subrogation when required by written contract between the named insured and the certificate holder. SAGITTA 25.3 (2016/03) 2 of 2 #S41345716/M41345372 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT — CALIFORNIA This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different date is indicated below. (The following "attached clause" need be completed only when this endorsement is issued subsequent to preparation of the policy.) This endorsement, effective on September 01, 2023 at 12:01 A.M. standard time, forms a part of (DATE) Policy No. 406-04-54-43-0005 Endorsement No. of the Atlantic Specialty Insurance Company (NAME OF INSURANCE COMPANY) Issued t0 E . J. WARD, INC. Premium (if any) $ Authorized Representative 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 2.00 % of the California workers' compensation premium otherwise due on such remuneration. Schedule Person or Organization Job Description ALL PERSONS OR ORGANIZATIONS ON FILE WITH THE INSURED WC 252 (04 84) Copyright 1984, Intact Insurance Group USA LLC &INSURED