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PROOF OF INSURANCE (2024 - 2024)0A Tr CER TIH��:ICA TE G�!: ��L 1AB11.1"IFY INSIARAN(", 11111� ;ury .................. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND C0114FERS NO RIGHTS UPOIN THE CERTIFICATE HOL F)E- T THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLI(11EIS BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER�S)i AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. d IMPORTANTe If the certiflcate holder is an ADDITIONAL -the poficy0r--')rnust have ADDITIONAL INSURED pirweisions a� im endorse if SUBROGATIO114 IS WAIVED, subject to the terms and conditions of the pWicy, certain l�O)Iicles rnay require an endorsement, A statement <,]in this certificate does not confer rights to the certificate holder in lieu of such jt, tr, ait!ayav FAX 818 4PA-3005 S I 8� 240 - 7 9 5 -5 (AIC, N.) - ir,'iahi iyan,h� MNM�1�0111!-, l�PI 08 NAX 9 CA NSURLN A : Goflharrl Company 5 � � 5 9 caiiomia /,) wrnolA II v;'uwicv 1 ,,;;„r'lllr I)ap 13342 GFM CansC'njc'lion Inc (Njuf�qj 1. Fv;ms�tvn litsiuMi"CU CtM)1DiPP,' Tbj T'6 6510 F spiirig S" suk 94 1 iq%mEn 0 Insul Arwo i: I ind 2, iOng Beach, CA 90815 . ....... REVISION NUMBER: COVERAGES CERTIFICATE NUMBER: F'(Di�(��ES 01: NSUIRANICE 11S�i 0 IELDNHAVE 6T:1-i4 D TO FIFIE tNSIJ;tT DNAMEDABOVE 1`01P, �Jfl� POU Y iNDICA71:11 ANY REOUIRFMENT, rF11TTK4 OR C01`41 tl I ON O�' ANY GOI`T� (Nel opji,l4 11�,OCUML?41 0TH 141 ���:'ITTTC� IC'0""Kt:'H pl jS CliH�Fi!lf I�D Al I �HE 1i Ci::RTMFICAI- hWY FU ISSIAD OR MAY I::ERIAIN, 11111 INSUIRAINM At i 01W)t L) By rHL POILK."K.s DL�9"RJ1:fl:tD H: A C �' LA F )AFTS ryiP OF INSURANCF X - (�C:W,U�RCUaL Gl M:i4AL UAHV� f 1: AoM�i 0A �k:, X" 011-CU) A frOMOR111 L a.IIAW I Ty X AIIIAOIII�Y M Y i T02�W0'11GJ,,29 P'W"!�V000551 02 UMBIU11 AkAAR x '�� 11'�� N C>< LXC[3,Fi LAB 7t A i M A - — - ------- WORKE IRS COIIAPENSAMON EAAP1,0YtN511 M L V7 i—if Y -2023 y-m 4 14 (Ma"'Joda," in Wlp 5 00� 071?OIV3 02/2024 2,000,000 2, (I0 ") 0 0 0 "d R.l CP1 ()Afi;! 0- FRTW 0A . . ......... i oon 000� 00 11-10;1 - ----- - - ---------- . ..... . . .... 2?8l2023 ,281 02- U0") mow tv 1719011,11 r qpme MIJ.'t'e'P "Y' A r it "Wl :r t' it'e "VC, 'x'4 1, r a a7' e" t"'y Cf, mv cg e v o P e v ay 5 t",.'Io7e yi"„an.�c4 .ate d nun v^, , ^'I orirr t' 'Jn iw rcgj,,,�ufed r1r coN fiud n'iaii CERTIFICATE [HOLD Cj v P F i 5✓-iwnjo RM SHOW 0 M0 OF 'It IHE ABOVL 1314 S(-Rfi`it 0 K)UCIFS W'aCMNCF1, LEIT) BEF ORE THE EXPWATMN DA tt:TI HEREC)IF, NUMIE WH 11 BE DELIVFRIKIN 1N W)KIICl P Pgrr 10A I Nrt ...... . .... �,,) 1988 21515 ACORD CORPORA710114, AH right.:„ 10:»arFvud A('19f?ID2,(2016/03) �o istered rriwks of ACORIDhe AC'ORnairnoarIiq Policy No. GL202300016529 COMMERCIAL GENERAL LIABILITY CG 20 26 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE I Name Of Additional Insured Person(s) Or Organization(s) of El Segundo, Public Works Department, 350 Main Street, El undo, CA 90245 Information required to com lete this Schedule, if not shown above, will be shown in the Declarations. Section II — Who Is An Insured is amended to in- clude as an additional insured the person(s) or or- ganization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property dam- age" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: A. In the performance of your ongoing operations; or B. In connection with your premises owned by or rented to you. CG 20 26 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 0 HOME OFFIlCE SAIN FRANCISCO AILLEFFECTWE DATESAIRE AT 12 01 AIM PAMFIC STANDARD T111MIE OR TH11:: T111MIE. INDIICATED Al PACINC STAINDARD TIME ENDORSEMENT AGREEMUvr WAIVER OF SULP,ROGA,rION BLANKE,r BASIS NEW s c PAGE 1. OF I EFFECTIVE DECEMBER 28, 2023 AT .12,,01 A.M. AND EXPIRING DECEMBEE 28, 2024 AT 1.2.0.1. A.M. GEM CONSTRUCTION INC 3535 FA ATE AVE., STE� 2 LOS ALAMITOS, CA 90720 WE HAVE 'THE RIGHT TO RECOVER OUR PAYMENTS FROM ANYONE, LIABLE FOR AN INTURY COVERED BY T111S POLICY� WE WILL NOT ENFORCE OUR RIGHT AGA.7NST THE PERSON OR ORGANIZATION NAMED IN THE SCHEDULE. THIS AGREEMENT APPLIES ONLY '170 THE EXITNT THAI YOU PERFORM WORK UNDER A, WRITTEN CONTRACT IHAT RIE,(�uIRES YOul F0 OBTAIN THIS AGREIEMENT FROM US. I'H)E'a ADDUIJONAL PREMIUM FOR THIS END0RSI1,JiD'qT SHALL BE 2.00% OF 'FHE TOTAL POLICY FREMPJTIw SCIIEDULE PERSON OR ORGANIZATION ANY PERSON OR ORGANIZATfON FOR WHOM THE NAM.ED INSURED HAS AGREED BY WRIT-17EN CONTRACT TO FURNI.S11 THIS WAIVER .10B DESCRE?rION BLANKET WAIVER OF SUBROGAI'l 0!4 NOTHING IN THIIS ENDORSEMENT CONTAIINEID SHALL BIE HELD 'To VARY, ALTER, WAIVE OR EXTEND ANY OF THE TERMS, CONDIlTIONS, AGREEMENTS, OR IION,S OF THIS POLICY OTHER THAN AS STATED. NorHING ELSEWHERE BN THUS POLICY SHALL BE HELD TO VARY, ALTER, WAIVE OR LIMIIT 'THE TERMS, CONDITIONS. AGREEMENTS OR LIMITATIONS OF rHIIS ENDORSEMENT. COUNTERSIIGNED AND ISSUED AT SAN FRANCIISCO: JANUARY 24, 2024 2572 S1DU'Q7 C 0 I I DIRM �02 1 PE: W M OLn CO P�