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PROOF OF INSURANCE (2024 - 2025)DATE (MM/DDffYYY) A4C" " CERTIFICATE OF LIABILITY INSURANCE 04/01/2024 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 CONTACT PHONE Ashley Mack .:q FXt) 15 NAM, Newfront Insurance Services, LLC (mac N (415) 754 3635 450 Sansome Street E-MAIL ashley sack newfront,com Suite 300 INSURERS AFFORDING COVERAGE RAGE _..... _. '.......... N. ........... __ . ,S.....an Francisco..CA 94111 INSURER Mt Hawleynsurance Company .......37974 - _ _---...----- .... -------. INSURED INSURERS Everest Premier Insurance Company 16045 ..., ....m.,. ...-_ ....�...._... ... ---- Cornerstone Construction Group, Inc. INSURERC: Underwriters at Lloyd's, London 105 W. Torrance Blvd., Suite 202 INSURER E : ............ _.... Redondo Beach CA 90277 [INSURER F nw�ewwr+•cc P%0E2T1C11%ATC d111RADC10• RFVICIr11d IdllmRFR• 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 CONTRACT OR 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. .... .._ ....�, TYPE OF INSURANCE -- )..W.e...aPOLICY NUMBER... .....�..MMIDDrYX-- ...... ... ......_. -... 1LN.TR AODL�SURR POLNCY6�flwF ^POLICYEXP LIMITS MdMwpn YYM COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 I CLAIMS -MADE F I OCCUR PG"kAFMNS 5 (Ea cxprrary, 1 50,000 MED EXP (An one perso 5,000 A X MGL0197888 08/04/2023 08/04/2024 PERSONAL. ADV INJURY . Y $ 1,000,000 _ - �....... „ „ GEN'LAGGREGATE LIMIT APPLIES PER: G ENERALAGGREGATE �$ 000 00O 2 ---- X ❑ PRO ❑ POLICY JECT LOC PRODUCTS COMPIOP AGG ....._ .. $ OOO OOO ........._ . OTHER, AUTOMOBILE LIABILITY 1C LE �� D"�tlNGLE�LNM. $ .......a.. ... � ANY AUTO INJURY (Per person) 8... $ I.," _............ .. 1 OWNED SCHEDULED .,.ODICOMBINED .dent) ..".. ........ .. $ 4 .AUTOS ONLY -....... 4 AUTOS HIRED I NON -OWNED 1' Ru k6'�ERi"k' D,hdw�AGC J $ �-----.. AUTOS ONLY.......... AUTOS ONLY ,(herc denll .."...� ....II " I$ _ ..... .., ., uMBRE LALIAB X...00CUR-------� EACH U RENCE $ 1 A X LIAR EXCESS. CLAIMS -MADE' MXL0438838 08/04/2023 08/04/2024 TE AGGREGATE �... GA - 10,000,0000 .... ... _ ...� DED RETENTION $ WORKERS COMPENSATION q M STATAa1rE OTH R . B AND EMPLOYERS' LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICER/MEMBER EXCLUDED? ❑ N/A X 7600022028241 01/01/2024 01/01/2025 , " ' EACHACCIDENT --' ------- """ """"""'""'"""- $ 1,000,000 (Mandatory in NH) EMPLOYEE E,L. D OYEE. $ 00 If yes, describe under DESCRIPTION OP OPERATIONS below EL. DISEASE- POLICY LIMIT $ 1.000,000 Each Claim 1,000,000 Errors and Omissions Claims -made C B0621 PCORN008523 08/04/2023 08/04/2024 General Aggregate 2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The City of El Segundo City, its officials, and employees are included as an additional insured as required by a written contract with respect to General Liability. Waiver of subrogation applies in favor of the certificate holder with respect to Workers Compensation. City of El Segundo Public Works Department Engineering Division 350 Main St ElSegundo CA 90245 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE © 1988-2015 ACORD CORPORATION. All ngnts reservea. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Policy Number: MGLO197888 Mt. Hawley Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 4'I9:I4 Bill I y Name Of Additional Insured Person(s) Or Organization(s) Location(s) Of Covered Operations All persons or organizations where required All Locations by written contract executed prior to the commencement of your work. 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 in- clude as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property dam- age" or "personal and advertising injury" caused by: 1. Your negligence; or 2. The negligence of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. 2. If coverage provided to the additional insured is required by a contract or agreement, the insur- ance 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 addi- tional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: However: 1. All work, including materials, parts or equipment furnished in connection with such work, on the 1. The insurance afforded to such additional insured project (other than service, maintenance or re - only applies to the extent permitted by law; and pairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or CGL 20 10 08 15 Contains copyrighted material of Insurance Services Office, Inc. with its permission. Page 1 of 2 Insured 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. C. With respect to the insurance afforded to these addi- tional insureds, the following is added to Section III — Limits Of Insurance: The most we will pay on behalf of the additional insured is: 1. The minimum amount required by any contract or agreement you have entered into to provide additional insured coverage; 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. ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED,. CGL 20 10 08 15 Contains copyrighted material of Insurance Services Office, Inc. with its permission.. Page 2 of 2 Insured WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 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. (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 % of the California workers' compensation premium otherwise due on such remuneration. SCHEDULE PERSON OR ORGANIZATION JOB DESCRIPTION ANY :PERSON OR ORGANIZATION FOR tifl[ M BLANKET WAIVER OF' SUBROGATION THE NAMED INSURED HAS AGREED BY WRITTEN CONTRACT To FURNISH -T THIS WAIVER -1998 by the Workers' Compensation Insurance Rating Bureau of Califomia. All rights reserved. From the WCIRB's Califomia Workers' Compensation Insurance Fours Manual - 1999. Policy Number: MGLO197888 Mt. Hawley Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS 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) (Vendor) Location And Description Of Completed Operations All persons or organizations where required All Locations by written contract executed prior to the commencement of your work. 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 in- clude as an additional insured the person(s) or organi- zations) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused by your negligence 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 B. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: The most we will pay on behalf of the additional in- sured is: 1. The minimum amount required by any contract or agreement you have entered into to provide addi- tional insured coverage; or 2. Available under the applicable Limits of Insurance shown in the Declarations; 2. If coverage provided to the additional insured is whichever is less. required by a contract or agreement, the insur- ance afforded to such additional insured will not This endorsement shall not increase the applicable be broader than that which you are required by Limits of Insurance shown in the Declarations. the contract or agreement to provide for such additional insured. ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED. CGL 20 37 08 16 Contains copyrighted material of Insurance Services Office, Inc. with its permission. Page 1 of 1 Insured F LIABILITY INSURANCE °"o4o5/2024Y""' ..-,- CERTIFICATE O "`H TSUPONTHECERTIFICATEHOLDER.THISCERTIFICATEDOESN O AFFIRMATIVELY THIS CE�RTIFI ATE IS ISSUED ASAMATTER OF---... INFORMATIONrv°° ~MM °° m T. F ONLYANDCONFERSNORIGH YORNEGATIVELY AMEND, EMEND 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* Ifthecertificateholder isanADDITIONAL INSURED, the olic ies must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATIONISWAIVED,sentedtothetermsa A stat ) ..w. t and ernghtstothecertificate ------ riinlieuofsuchendorsem (s) .°.... Policy,cert..,.. _ nthiscertificatedoesnotconf.....�...__ ..... ... ..... - .... .,... _ _.. condrtionsofthe ainpoliciesmayregwreanendorsement.�atemento PRODUCER CONTACT NAME Sergio Hernandez Mendoza -- (A/C, No EXT) 310 939-7600 (A/c ND) 310 939 76 Sergio Hernandez Mendoza Agency PHONE FAX 1020 Manhattan Beach Blvd Ste 104 11 E-MAIL ADDRESS: Shernandezmendoza@tarmersagent.com Manhattan Beach CA 90266-5129 -- "".__ _ .. ....-.... INSURER(S) I NAIL# INsuRR� CERTIFICATE HOLDER CANCELLATION _ R PT•[SiHOU FNOTICEWILLBEDE.IIV RED IN ACC WITH THE POLICY PROVISIONS ENGINEERING DCITY OF EL I�VISIONNDO UBLIC WORKS DE DATE THEREOF, LPOLICIES BE CANCELLED BEFORE THE EXPIRATION ACCORDANCE �""- 4-44'a'4j EL SEGUNDO CA 90245 Epf1LSENT p 350 MAIN STREET AUTHORIZED R eve ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All Rights Reserved 31-1769 11-15 The ACORD name and logo are registered marks of ACORD