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PROOF OF INSURANCE (2025)RCSIN-1 CERTIFICATE OF LIABILITY INSURANCE FDATE (MMIDDIYYYY) 1. - 06/20/2024 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 . PRooucER 760-47"1-7116 cON'TACT Michelle NoweUl.... 2 w.wc.. Alliance Mgt. & Insurance Sery 355 Via Vera Cruz #7 CA Agent/Broker Lic# 0737966 'San Marcos„ CA 92078 Michelle A. Nowell nvesti ations & altin TLC )x 2�i 98 sim, CA 92809-9798 PHONE 760-471-7116 F: Sta Ins Com 760-47 44776 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 AN POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CONDITIONS OF SUCH._ .... ..------........---- --- ..�. .... POLICY NUMBER...... ...-e�,.m._..—...� ,.m__� POLICY EFF &COL#CY E%, , .—........ TM.... PE OF SR LIMITS is A X COMMERCIAL GENERAL LIABILITY likril %�( q�� mM.E 5� , _-- ' ° 00 1 000 0.. - CLAIMS -MADE( OCCUR WSGP001O43 06119/2024 06/19/2025 X DAMAGE TO RENTED PRI YEIA=3 tF s�crx�P _ 100 000 _ X 8r Omission Errors...... D MEEXP (AAy 9KY±[ rffiq r%� 5,000 .....__ .. .., 1 000,000'�, P�r� O AI. AL"k iWN„puRY....._,_ � . � � - ' LIMIT APPLIES PER: �Cp�hi`LAGGREGATE �. �PRO ❑ GENERAL AGGREAT#.. COtlwaPFOPA�3G.. S ,000 1,000,000 X POLICY JECT LOG L?RU(7V.�L,6 ..,. .' OTHER: A GOM13INED SINGLE LWI1 1,000,000 AUTOMOBILE LIABILITY ..__ ...., ANY AUTO WSG'POO"1043 06119/2024 06 19 BODII wm A Y' IN IUd��ev N P �9I. � �_._ OWNED SCHEDULED AUTOS ONLY AUTOS 1� ( ) — VVa,�gg� ��yy p H N -C V N m X ALIr R ONLY � X AIY O ON&. P OaPERi "Y DAMAGE ( ? ...—. A UMBRELLA MUR #RE.�...m._. 1,000,000 R MADE EXCESS LIAB],,CLAIMS-MADE ...,... WSGU000396 06/19/2024 06/19/2025X At,R GArE 1 000"000 ^ DED RET'ENT"IONS WORKERS COMPENSATION VTA rEH. 58 AND EMPLOYERS' LIABILITY �" f N I ANY PROPRIETOR/PARTNER/EXECUTIVE II` OFFICER/MEMBER EXCLUDED? J A NIA ' (Mandatoryi ) E L Clq_uSrAEMPtOYE.,,.. FLiab AT/ON Ikal PotIGY .1MWT A PrrofessionalWSGPOO1043 06/19/2024 06/1912025 Occure ce 1,0001,000 Aggregate 4,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of El Segundo, its directors, officers, employees„ and agents,, are named as an additional insured with respects to the work performed by the named insured. Investigation, CA -- CITYELI City of El Segundo Human Resources 1350 S 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 a ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All ngnts reservea. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: WSGP001043 COMMERCIAL GENERAL LIABILITY CIGL 79 03 18 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL AL. INSURED - OWNERS, LESSEES OR. CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location(s) Of Covered Operations Blanket as required by valid written contract. Blanket as required by valid written contract. Additional Information: 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 or organization shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" arising out of: Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your operations for the additional insured at the location shown in the Schedule. However: a. The insurance afforded to such additional insured only applies to the extent permitted by law; b. If coverage provided to the additional insured is required by a contract or agreement, the insurance CIGL 79 03 18 Includes copyrighted material of Insurance Services Office, Inc, Page 1 of 2 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; and c. Regardless of the date of occurrence or when the injury or damage first occurs or is first discovered, a person's or organization's status as an additional insured under this endorsement ends upon the earliest of: (1) The completion or termination of the contract or agreement between you and the additional insured for the location shown in the Schedule; (2) The date you cease actively performing operations for the additional insured at the location shown in the Schedule; or (3) The expiration or termination date of the policy or this endorsement. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to liability or damages for "bodily injury", "property damage", or "personal and advertising injury": 1. Caused by, arising from, or included in the "products -completed operations hazard"; 2. Arising out of the additional insured's sole negligence; 3. Arising out of work or operations performed by you that were completed prior to the effective date of this endorsement; or 4. Which continues or progressively deteriorates after you cease actively performing operations for the additional insured at the location shown in the Schedule, even if the injury or damage first occurred, or is alleged to have first occurred, during the course of your operations for the additional injured. C. Solely for purposes of this endorsement, the following definition is deleted in its entirety and replaced by the following: 1. ""Products -completed operations hazard": a. Includes all "bodily injury" and "property damage" occurring away from premises you own or rent and arising out of "your product" or "your work" except: (1) Products that are still in your physical possession; or (2) Work that has not yet been completed or abandoned. However, "your work" will be deemed completed at the earliest of the following times: (a) When all of the work called for in your contract has been completed; (b) When all of the work to be done at the location shown in the Schedule has been completed if your contract calls for work at more than one location; or (c) When that part of the work done at the location shown in the Schedule has been put to its intended use by any person or organization other than another contractor or subcontractor working on the same project. Work that may need service, maintenance, correction, repair or replacement, but which is otherwise complete, will be treated as completed. D. 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. CIGL 79 03 18 Includes copyrighted material of Insurance Services Office, Inc. Page 2 of 2 CITY OF EL SEGUNDO WORKERS' COMPENSATION DECLARATION WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SUBJECTS AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN LABOR CODE § 3706, INTEREST, AND ATTORNEY'S FEES. I affirm under penalty of perjury under the laws of California one of the following declarations: U I have and will maintain a certificate of consent of self -insure for workers' compensation, issued by the Director of Industrial Relations as provided for by Labor Code § 3700 for the performance of the work set forth the agreement with the City of El Segundo. Policy No. (_) I have and will maintain workers' compensation insurance as required by Labor Code § 3700 for the performance of the work for which the agreement with the City of El Segundo is executed. My workers' compensation insurance carrier and policy number are: Carrier Name of Agent Policy Number Expiration Date Phone # (ZI certify that, in the performance of the work set forth in the agreement with the City of El Segundo, I will not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that, if I should become subject to the workers' compensation provisions of Labor Code § 3700 1 must immediately comply with tho ovisio s or the a ment�wi11 automatically become void. Signature of Applicant Print Name Agreement for: �,' j ye Dated: Reviewed by: 4 Date