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PROOF OF INSURANCE (2025)HAMPTED-01 RBANUELO ACORO' CERTIFICATE OF LIABILITY INSURANCE DAT111.2DmrY) 111 /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 n lieu of such endorsement(s). this certificate does not confer rights to the certificate holder it _ PRODUCER gggT�:CT 'Retie+ a Banuelos.,, ... ......w . ........ ......... .. __........--- Fresno CSG-Alliant Insurance Services, Inc. !PHONE FAX 9 E River Park Place East Ste 310 gArc CIF, atq (8 374 3560 _-(Acc N�j; Fresno, CA 93720 E-MAIL _.. . ......--- - INSURERS AFFORDING COVERAGE C INSURER A..Starr Indemnity_& Llablli.ty Company ....-.. „138318 INSURED INSURERB:AXIS Surplus Insurance Com an 28&20 ..... ------- -.. - - - --------- -------h ................ ., ... .... Hampton Tedder Electric Co. JNSURER c : _.... __ P.O. Box 2128 INSURER D: Montclair, CA 91763 - ---- INSURER 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 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- � .. ............ ....TYPE OF INSURANCE ........ ........_ WVO� ......... POLICY NUMBER ...... ..------ --------- ., .---...- -------� EACH pCGURRENCE LIMITS$ ---..... ... INSR ADDL SUER POLICY EFF POLICY EXP MMERCIAL GENERAL LIABILITY 1,000,000 O� CLAIMS -MADE XI OCCUR 1000025639241 4/1/2024 4/1/2025 DAMAGE TO RENTED SO,000 A X c.. _ d X ..QED,i��lr���.d��..I�ld�r�n��1----- ---................................. cc- MED EXP kAnyqpe_tmon) PERspNALFApvINJURY $ 1,000,000' t>ENL.... ...... ......... .... _..__.._. _.----..._ �AGGREGAB°ELIMITAPPLIESPER: ...GENERAL AGGREGATE $ 2,000,000 ..�POLICY �.. ECOT LOC PRODIf TSQMI'./OP AGG ._$ 2,000,000 01"HEI" . A AUTOMOBILE LIABILITY . COMBINED SINGLE LIMIT $ 2,000,000 ANY AUTO 1000198602241 4/1/2024 4/1/2025 BpDILYINJURY�Perperson) .$ X OWNED SCHEDULED I,_ X AUTOS ONLY I AUTOS i� IIf BppILY INJURY (Per accident), $ „ AUTOS ONLY X I AU70 Wi. N k_ LPROPERTY r ar de IOAMAGE - $ .............. .........._ .... r. ... ................... -----__.._.._-- $.... A UMBRELLA LIAB X OCCUR EACH OCCURRENCE 5,000,000 xcess ua6 CLAIMS MADE' 1000588314241 4/1/2024 4/1/2025 AGGREGATE �$ .X E., .... .�.. .. ..-.- --------------------------- - ................ -- --- ,_ ....... DED ( � RETENTION -$ Aggregate $ 5,000,000 A WORKERS COMPENSATION N EACH ACCIDENT OTH J$ — AND EMPLOYERS' LIABILITY �TAT�IT,.F ImR. OFFICER/MEMBER EXCLUD ANY PROPRIETOR/PARTNER/EXECUTIVE Y d X 1000001878 4/1/2024 4/1/2025 1,000,000 (Mandato DESCRIPTION OF OPERATIONS below N / A E L DISEASE POLICY LIMIT E� 1,000,000 If yes, describe under $ B ,Prof/Pollution Liab CM005545-02-2024 4/1/2024 411/2025 Each Claim/Aggregate 5,000,000 B Excess Comml Liab P-001-003646857-01 4/1/2024 4/1/2025 Limit x/s Gen Liab 1,000,000 . . .... . ..... .. . . . . . . ............................ ........................... DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) _ .10 days notice of cancellation will be given for non-payment of premium, 30 day notice of cancellation will be given for other reasons" Re: Named Insured Operations The City of El Segundo is included as Additional Insured as required by written contract, but limited to the operations of the insured under said contract, per the applicable endorsement with respect to General Liability. City of El Segundo Attn: Dept. of Public Works 350 Main Street 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 ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: COMMERCIAL GENERAL LIABILITY CG 20 37 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. 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) Location And Description Of Completed Operations Where Required By Written Contract Where Required By Written Contract 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 include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" 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 III — Limits Of Insurance: 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 Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 37 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 POLICY NUMBER: COMMERCIAL GENERAL LIABILITY CG20100413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Omanization(s) Location(s) Of Covered Operations Where Required By Written Contract Where Required By Written Contract 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 include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" 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. CG 20 10 0413 © Insurance Services Office, Inc., 2012 Page 1 of 2 C. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: 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 Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. Page 2 of 2 © Insurance Services Office, Inc., 2012 CG 2010 0413 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 04-84) 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 2.0% of the California workers' compensation premium otherwise due on such remuneration. Schedule Person or Organization Job Description Where required by contract Any person or organization to whom you become obligated to waive your rights of recovery against, under any contract or agreement you enter into prior to the occurrence of loss. 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: 04/01 /2024 Insured: Hampton Tedder Electric Co. Insurance Company: Starr Indemnity & Liability Company Policy No.: Endorsement No.: Premium: Countersigned by: WC 04 03 06 (Ed. 04-84) Page 1 of 1