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PROOF OF INSURANCE (2023 - 2024) CLOSEDClient#: 1291580 04CORRACON DATE (MMIDDIYYYY) ACORDTM CERTIFICATE OF LIABILITY INSURANCE 1/oa/2oz4 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. I I tIRTAM C 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 endorserment(s). PRODUCER CONTACT NAME: Commercial Client Center 888 743 2217 McGriff Insurance Services LLC PHONE i 888 743 2217 N�.p 8888279861 AIC No Ext 7701 Airport Center Dr EMAIL Clien .W.r R, R ss tSery ceCentera) rncgrGff com-- Suite 1800 �. _ Greensboro, NC 27409 ________ Evan INSURER(S) AFFORDING CO VERAGE NA C INSURER stop Insurance Company 35378 INSURE".............Corral Construction . ..w....._ .................. ...�.�. R ._ .... Corr E. ons ru ton Blvd. #2-122 to Compensation Ins Fund of CA 35076 D � INSURER B State ... .... ... n & Development Inc INSURER C Commerce, CA 90040 INSURER o INSURER E 1 .... ... rnvooer_cc CERTIFICATE NIIMRFR• 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. LT1 _ TYPEOF.IN. .,..,., .,.SURANCH._. ..,...,.. CADOL.SUBR 1A1 13 I�!)!41, ....._.... - __ POLICY NUMB .._ ,,,,IMra4POO�IXY,YY� . _ POLICY EFF POLICY EXP tMM/DpIYYYY,),„ LIMITS .. ,......__. ......... ..... ... A .......- COMM�IMIS-MADEERAXLIAOBCI 3AA735528 28❑ 12/08/2023 12108/202 R QAI�HCU DRAM a , era � �11PPIPPP EXP (Anyone person) $ 5,000r ,.!�ED.. PERSONAL & ADV INJURY $1 OOO OOO GEN'L AGGREGATE LIMIT APPLIES P ......,. PER: GENERAL $2 OOO,OOO �GEAGGREGATE , PRO - POLICY JFC..T LOC �... ,.PRODUCTS -COMP/OP-AGG OOO OTHER .$2.000 ._.._._ AUTOMOBILE LIABILITY .....- .... .. ... .._--- ----- ------...- .............._. COMBINED SINGLE LIMIT kapo'd"01 .. --- ODILY INJURY (Per person) $ ANY AUTO .. NED {{ SCHEDULED .m� ODILYINJURY Per accident 1� BODILY ).. ....- AUTOS ONLY .. NON -OWNED P DAMAGE $ - '..... AUTOS ONLY AUTOS ONLY ',.,...... ...,.... ... .........m.........,_ . ,. PAr ardarwt ( J . . .. ... .......... ...... .h.$. -------- ......--- .,.�,...."',r.._ ..,. m ,..........._.. -------. .- ... UMBRELLA OCCUR _, -----.. ..................- OCCURRENCE $ . _ EACHGGREGATE EXCESS ABAB 'CLAIMS -MADE $ - DED RETENTION $ $.. B ---------- .. WORKERS COMPENSATION ........ ....... . m._.,. _... 903611823 ..... ................�..,.... ...12/01 ._., /20........ 23 .. 12101 /202 ....... PER OTH X STA .... TATF ...-.,F.B ".._ .. .... AND EMPLOYERS' LIABILITY Y I N E..,,,, ANY PROPRIETOWPA.RT'NERBEXECUTIVE OfFiC04IMEMSER EXCLUDED? F NIAIDENT L EACH ACC $ .. IMapr�datory In NH) E L. DISEASE EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below .L.. _ �m.... E.L. DISEASE POLICY LIMIT $ A Excess iabi BINDEREZXS3098858 12/08/2023 12/08/202 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) ** General Liability Information ** Job#: 1 ** Workers Comp Information ** Proprietors/Partners/Executive Officers/Members Excluded: Ernesto Corral, President (See Attached Descriptions) City of El Segundo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Y g THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 350 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. El Segundo, CA 90245 AUTHORIZED REPRESENTATIVE A 1�kwwtm 91Vt3B-2U1b AGUKLI GUKVUKAIlUN. An rignts reserveu. ACORD 25 (2016103) 1 of 2 The ACORD name and logo are registered marks of ACORD #S33559516/M33559032 6KP SAGITTA 25.3 (2016/03) 2 of 2 #S33559516/M33559032 ENDORSEMENT AGREEMENT WAIVER OF SUBROGATION 9036118-23 RENEWAL SP 2-83-35-91 PAGE 1 HOME OFFICE SAN FRANCISCO EFFECTIVE DECEMBER 1, 2023 AT 12.01 A.M. AND EXPIRING DECEMBER 1, 2024 AT 12.01 A.M. ALL EFFECTIVE DATES ARE AT 12:01 AM PACIFIC STANDARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME CORRAL CONSTRUCTION & 5211 E WASH BLVD STE 2-122 COMMERCE, CA 90040 ANYTHING IN THIS POLICY TO THE CONTRARY NOTWITHSTANDING, IT IS AGREED THAT THE STATE COMPENSATION INSURANCE FUND WAIVES ANY RIGHT OF SUBROGATION AGAINST, CITY OF EL SEGUNDO WHICH MIGHT ARISE BY REASON OF ANY PAYMENT UNDER THIS POLICY IN CONNECTION WITH WORK PERFORMED BY, CORRAL CONSTRUCTION & IT IS FURTHER AGREED THAT THE INSURED SHALL MAINTAIN PAYROLL RECORDS ACCURATELY SEGREGATING THE REMUNERATION OF EMPLOYEES WHILE ENGAGED IN WORK FOR THE ABOVE EMPLOYER. IT IS FURTHER AGREED THAT PREMIUM ON THE EARNINGS OF SUCH EMPLOYEES SHALL BE INCREASED BY 03%. NOTHING IN THIS ENDORSEMENT SHALL BE HELD TO VARY, ALTER, WAIVE OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS POLICY OTHER THAN AS ABOVE STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR LIMITATIONS IN THIS ENDORSEMENT. COUNTERSIGNED AND ISSUED AT SAN FRANCISCO: 2570 AUTHORIZED REPRESENT.: IVE. SCIF FORM 10217 (REV.4-2018) FEBRUARY 15, 2024 PRESIDENT AND CEO OLD DP 217