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PROOF OF INSURANCE (2024 - 2025)KRAUACT-01 LORALEEBARLOWBOYES ,a►� /e r CERTIFICATE OF LIABILITY INSURANCE DAT3E(MM/DD2 ) 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 • '1: NFP Property & Casualty Services, Inc. 1551 North Tustin Avenue PHONE, No, E r1k; (T'14) 505-5550 �j Nw1. 71 } 975-8966 E MAi ......Suite 500 �. '..... .............. _......___ ...._....�,, Santa Ana, CA 92705 _ .,__.� ....... . . INSURER SS A� FFORDING COVERAGE NAIC INSURER A: COICIPY Insurance COmpd _ 39993 INSURED INNSUR.ER 8 Jnsurance Comi)a.ny Of the. West IT ITITITITITIT.......mm 27847 Krause ACT, Inc. DBA Air Cleaning Technology Y Syndicate„.( rtY gi _g Agency Ltd) XXXXX INSURER C : Lloyds 4472 (Liberty Managing m,ITIT�m � �„w.w �,•... 411 Rowland Ave INSURER D .. _........ Santa Ana, CA 92707 INSURER E INSURER F COVERAGES CERTIFICATE NUMBER _ .. __. REVISION NUMBER IT 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- -I ADD SUER POLICY EFF POLICY EXP EACH TYPE OF INSURANCE POLICY NUMBER LIMITS __m...... ............... .�,_,,,_ INS,O, �....._,... lMli�dRIJ1XIL.Y] .,.LI�IIttd.00! (1D(1. A X COMMERCIAL GENERAL LIABILITY .__ ............ _1,000,000, OCCURRENCE CLAIMS -MADE X OCCUR PACE4245133 3/7/2024 3/7/2025 C It AGE' Ctd1 L(4T��% 16 ,OCl u .. ._ X � I ksTa uatPr�l;w.... . .. .. MED EXP (Any one personr..m 50,000 PERSO & ADV INJURY E 1,000,000 ErJ... .........._...� ,, _ _._ L r.'GREGATE LIMIT APPLIES PER. GENE AGGREGATE $ Z,000,OOO 1POLICY [XI PECT LOC PRODUCTS - COMP/OP AGO 5 2,000,000 .2]THER. ....... AUTOMOBILE LIABILITY.... ......�,. ,,.a..a..A, _.W.. W�................. ...---.... _.__ . ........., I_.�..,� . iCu"rf41E�NEV�'vlfil�+LE�LMI�P m ANY AUTO BODILY INJURY (Per person)_ S, OWNED --I SCHEDULED AUTOS ONLY AUTOS BRO ODILY INJURY (Per accident) `5..� Z S ONLY AK u�O": wh(L I E 6 rntt U 1Ad E .. UMBRELLA LIAB TOO" CmmP...... .. _. .- .---......................... ..... _.....�CH ..s:......_ ...... AUR EACH OCCURRENCE `� 5,000,000 X EXCESS LIAB CLAIMS -MADE F-XC424513 3/7/2024 3/7/2025 AGGREGATE _..$ IT 5,000,000 LIED ENTION $........_ ..... .. w•,•, ...... _.... _ _. PEA_. OTF9 S B WORKERS COMPENSATION �WWWmmmIT� AND EMPLOYERS' LIABILITY I Y (N W SD 5074790 00 1/112024 1/1/2025 E EACH ACCIDENT $ 1,000,000 ANY PROPRIETORIPARTNERdEXECUTIVErFp'II�;ERmEM ER EXCLUDED? NIAXIEL��.___..........�,..�„_...._,......�_W_ ..�....._.._. „�,,,...,,..,.,.. a'.14m in H L DISEASE -EA EMPLOYEE $ 1,000,000 Dyes, describe under 1,000,000 ESCRIPTION OF OPERATIONS below F L DISEASE - POLICY LIMIT $ ..............�� _ .._ ...... _. �_............. .......... C 2nd Layer Excess ECOCXS725838 3/712024 317127 Limit 5,000,000 •,•,•,www www __. DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: El Segundo Fire Department, 314 Main Street, El Segundo„ CA 9024„ The City of El Segundo is included as Additional Insured with regard to General Liability per attached forms EPACE101-0721 and EPACE100-0721. Waiver of Subrogation applies to Workers' Compensation per attached form WC000313. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE of El Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City 9 ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street El Segundo, CA 90245 _... ���... AUTHORIZED REPRESENTATIVE U-44 ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 06/18/2024 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 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 Dan Rickabus StateFarm State Farm Insurance 30131 Town Center Drive, Suite 275 Alk Laguna Niguel, CA 92677 INSURED ....... ----------....................................... Krause A C T DBA Air Cleaning Technology 411 Rowland Ave Santa Ana, CA 927073445 COVERAGES CERTIFICATE NUMBER: 949 363-7100 katherine.perry.i INSURERS) AFFORDING COVERAGE -.-.-.-.. _.-.-.-.- ---------__......._— -------..... INSURERA:State Farm Mutual Automobile Insurance INSURER C : INSURER E : INSURER F : REVISION NUMBER: 949-363-1836 25178 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. ......_%w,otiL�S�t.RBI_. ----.... .^-............ _ ,.,. ....._ ......__ ....,,. t .MMIODfY TR TYPE OF INSURANCE MMfDDM.. POLICY NUMBER YY...L^-' LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ r AMAi '"r0 R6T4T Y - ------------------------- . CLAIMS -MADE �.. OCCUR I?CE.d�.hlSbm:� (' �5.cu[rnEo.. $ MED EXP (Any one person) _$ -- PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO- LOG PRODUCTS COMP/OP 1.AGG$ _ JECT ....... ... ----- OTH•NE.R'. $ A AUTOMOBILE LIABILITY _ Y 545 8874-001-75 03/01/2024 09/01/2024 COMBINED SINGLE LIMIT (I p,,; dO n -- $ 1,000,000 X ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED X BODILY INJURY (Per accident) $ AUTOS AUTOS 5451763-001-75 03/01/2024 09/01/2024 .... . NON -OWNED X PROr"ERrYOAMPnC7E $ HIRED AUTOS ' AUTOS 4971093-001-75 03/01/2024 09I01/2024 I UMBRELLA OCLAIMS-MADECCUR E EACH CURRENC.,....ED 1-1) EXCESS ABAB ATE RETENTION$ L..$ WORKERS COMPENSATION TUTS �RH AND EMPLOYERS' LIABILITY Y / N I STATUTE l ,,;,,,,,,,,,, , ---- - ANY PROPRIETOR/PARTNER/E $. OFFICER/MEMBER EXCLUDED?ECUTIVE N / A _ w v - (Mandatory ) MPLOYE E.L. D SEASECIEA ET $ If yes, describe under "'""'"" """'" """�'""-""""' "' . DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ A ENGL Y 1, 0 ,00 L 507 2152-001-75 03/01/2024 09/01/2024 $250 Physical Damage deductible DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of El Segundo, its officials and employees are named additional insured Location: El Segundo Fire Department CERIIhI(;AIE HOLDER GANGELLATIUN El Segundo Fire Department 350 Main St El Segundo, 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 �i 01988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD 1001486 132849.9 02-04-2014 Policy Number: PAGE4245133 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL AL INSURED -OWNERS, LESSEES OR CONTRACTORS - SCHEDULED This endorsement modifies insurance provided under the following: EnviroPACE Insurance Policy SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Locations Of Covered O erations Where Required By Written Contract Where Required By Written Contract A. Section XX. WHO IS AN INSURED, Coverage Part 1 and Part 2 is amended to include as an additional insured the person(s) or organization(s) shown in the SCHEDULE above, but only with respect to liability for bodily injury, property damage, personal and advertising injury, environmental damage, or cleanup costs caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance 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 additional insureds, the following additional exclusions apply: This insurance does not apply to bodily injury or property damage occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 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. EPACE101-0721 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 2 with its permission. C. With respect to the insurance afforded to these additional insureds, the following is added to section XXI. LIMITS OF LIABILITY AND DEDUCTIBLE: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable limits of liability; whichever is less. This endorsement shall not increase the applicable limits of liability. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED, Page 2 of 2 © Insurance Services Office, Inc., 2012 CG 20 10 04 13 Policy number: NAUL424bldd THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ................ This endorsement modifies insurance provided under the following: EnviroPACE Insurance Policy Name Of Additional Insured Person(s) Or Oraanization(s) Where Required By Written Contract SCHEDULE Location And Description Of Completed Operations Where Required By Written Contract A. Section XX. WHO IS AN INSURED, Coverage Part 1 and Part 2 is amended to include as an additional insured the person(s) or organization(s) shown in the SCHEDULE above, but only with respect to liability for bodily injury, property damage, environmental damage, or cleanup costs caused, in whole or in part, by your work 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 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance 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 additional insureds, the following is added to section XXI. LIMITS OF LIABILITY AND DEDUCTIBLE: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable limits of liability, whichever is less. This endorsement shall not increase the applicable limits of liability. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. EPACE100-0721 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 1 with its permission. WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13 (Ed. 4-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT 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.) This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule ANY PERSON OR ORGANIZATION FOR WHOM THE NAMED INSURED IS REQUIRED UNDER WRITTEN CONTRACT TO FURNISH THIS WAIVER, FOR NEVADA OPERATIONS ONLY. 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. WSD 5074790 00 Insured Krause ACT, Inc. Insurance Company INSURANCE COMPANY OF THE WEST Countersigned By WC 00 03 13 (Ed. 4-84) m 1983 National Council on Compensation Insurance. Endorsement No. Premium $ INCL .