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PROOF OF INSURANCE (2024 - 2025)A0948-82-84 A CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 3/22/2024 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 Becky Huddle Insurance Agency NAMF Rebecca HuddleN CON ACr 729 Sunrise Ave Ste 504 PHONE' 916-789 7500 916-789 2545 (PV6.Nv_kxwb Roseville CA 95661 abn F.ss. staff. rhuddle@farmersagency com INSURED Bayshore Water Conditioning DBA Elite Water Systems 10611 CALLE LEE SUITE 113 LOS ALAMITOS, CA 90720 INSURERtS),AFFORDING COVERAGE ., NAIL A MID CENTURY INSURANCE 2167987 hfleld In„ an Nort suranCe Comp z 87 urance Company � 17370 Farmers Ins........ ... _ urance Exchange z1652 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 NOTWITHSTANDING ANY REQUIREMENT„ TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS INDICATED. MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, CERTIFICATE EXCLUSIONS CONDITIONS OF SUCH H S POLICIES. LIMITS WN E BEEN REMPYIYY DUCED BY PAIDCLAIMS.------ _ .. _ ............._ __ ...... ILT� TYPE OF INSURANCE PE F INSURANCE i .. - ........POI.wCY POLICY NUM9ER. EIwF POLiC D DIYY"Y"r LIMITS _ 1,000,000 EACH OCCURRENCE $ ✓ LIABILITY B occuR '', CLAIMS -MADE OCCUR WS565252 6/29/2023 6/29/2024 wrirJArc F IrTRI N i 61 P,EMISE )ra o�currarLca) $ 100,000 '' MED EXP (An one,pdrsfmn) $ S,OOO ..... .., ................. .................. ........ ... .., INJURY $S'........ ._,.,. 12,,,,..0,�..0...0,„OO...O ._ GENtlAGGREGATE LIMIT APPLIES PER. s . ..PERSONAL&.A.DV .,_,.......... AGGREGATE $2,000 000 .e. .. Poky JECT LOC ,. ,000,000_M OCPDTS �OPRO- AGG UC, ,. $ O✓ IHER COMBINFO slnaw n E awa u� $ 1 fi00 000 AUTOMOBILE LIABILITY �.__IEa � NIL,...... .� _ .._..!,.............. rson)OWNED $ D ANY AUTO 60 7046190 08/13/2023 08/13/2024 -- D SCHED ✓ BPORDOIPLFYRINYJIJGRAYM(APer ° ....., AUTOS ONLY - AUTOS HIRED NON -OWNED Eac $ a�-.exlNruli .. �..-------- AUTOS ONLY AUTOS ONLY ..�Iw?or __._.� .... UMBRELLA LIAB ✓ OCCUR �ACHOCCURRENCE$1,000,000EXCESS LIAB AN12'88200 ✓ CLAIMS -MADE - 7J5/202'�3 6/29/2024 GGREGATC 0 �E. ........ $ .... .... .. .., ........, ... ... Of O RETENTfO WORKERS COMPENSATION R ✓ I„TATu'( A TR.. AND EMPLOYERS LIABILITY YIN A0948-82-84 A ANYPROPRIE r�ORIPARTNEr XEOJ7'I E Of.' "^ICENMEMSEREXC'�LUDED? NIA t'If)0„I'10 1 /1 /2024 1 /1 /2025 I AGH As CIDENT $ 1 0 1 OOO 000 E.L GpSR..A"•TE EA EMPLOYEE $ r Mandde m NF9 (Mandatory ) If as deacrilr� under ...... .... LIw�4GT $ 1,000„000 DISE SE -POLICY - E..L DISEASE L SCRIPTION OF OPERATIONS below A Business Personal Property (BPP) 60704-33-44 $I 711/2023 7/1/2024 A Business Income & Extra Expense 60704-33-44 7/112023 7/1/2024 18 Months - ALS A Extended Business Income 60704-33-44 7/112023 7/1/2024 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Workers' compensation waiver of subrogation attached. CERTIFICATE HOLDER C.AN(;hLLA I wN City of El Segundo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 350 Main St. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN El Segundo, CA 90245 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Rebecca Huddle ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 06 31 (Ed. 6-20) BLANKET 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. (P)is agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreementfrom us.) The additional prerniumfor this endorsementshallbe ofthe California workers compensation premium otherwise due on such remuneration, subject toa minimum charge of 250 All written contracts in the state(s) of: CA 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 01 /01 /24 Policy No. A0948-82-84 Endorsement No. Insured BAYSHORE WATER CONDITIONING (DBA) ELITE WATER SYSTEMS 10611 CALLE LEE STE 113 Insurance Company MID-CENTURY INSURANCE COMPANY LOS ALAMITOS CA 907206791 Countersigned By WC990631 (Ed. 6-20) Includes copyright material of the Workers Compensation Insurance Rating Bureau of California. All rights reserved.