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PROOF OF INSURANCE (2024) CLOSEDCERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDNYYY) 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... CONTANAML ,�.T....,_,.. Cert.Request' Newfront Insurance Services PHONE m FAX 777 Mariners Island Blvd Suite 250 .tr.. 650-4ss $5s5m FAX N)._ E-MAIL ss, Tec w ertRe ues� ajl�ewfr°oint.com San Mateo, CA 94404 �......... www.newfront.com INSURED Fair Software Holdin LLC 382 NE 191 st Streets, B 58356 Miami, FL 33179-3899 INSURER B INSURER D INSURER E : INSURER F : AFFORDING COVERAGE CnVFRAnFS CFRTIFICATF NUMBER' T7 d iR REVISION NUMBER: NAIC # 20281 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. _..... ... ............................ _. OLICYEXP ILT R TYPE OF INSURANCE JM WVD S R POLICY NUMBER MMIDD EFF MMIDDY� LIMITS LTR A / COMMERCIAL GENERAL LIABILITY �/ �/ 3606-7534 9/1/2023 9/1/2024 EACH OCCURRENCE $1,000,000 ---- $ 11000,000 ,J mm CLAIMS -MADE ✓ OCCUR PREM91f',Es Ea acc�Irrencn ..- ✓ Contractual Liability_,MED ............ _............ _...... _. EXP (Any one person) $10,000 _ PERSONAL & ADV INJURY $1,000,000 _. _................ ........ GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $2,000,000 ✓ 1:1PryR• POLICY EC.•� EI LOC PRODUCTS -COMP/OP AGG . $ 1,000,000 OTHER, $ A AUTOMOBILE LIABILITY 7361-8838 9/1/2023 ' 9/1/2024 . _COMBINED SINGLE.LIPw IT .tg acciden41 _..$... $ 1 000,000 ANY AUTO BODILY INJURY (Per person) OWNED SCHEDULED( BODILY INJURY Per accident ) $ AUTOS ONLY AUTOS HIRED NON -OWNED PROPI Ri"YOAfXAGE $ ✓ '.. AUTOS ONLY ✓ '.. AUTOS ONLY 2r acE)Iwnt $ A �/ UMBRELLALIAB �/ OCCUR 7819-3888 9/1/2023 9/1/2024 EACH OCCURRENCE $11000,_000......................_ EXCESS LIAB CLAIMS -MADE AGGREGATE $ 1 r000,000 DED I ''.... RETENTION $ $ WORKERS COMPENSATION PER TH- STATUTE ERA, AND EMPLOYERS' LIABILITY Y / N ANYPROPRIETOR/PARTNER/EXECUTIVE I E.L. EACH ACCIDENT $ OFFICER/MEMBEREXCLUDED? N / A _....-. -.-- """"""""""""""""""- --- .....®�-- (Mandatory In NH) E.L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: All Operations of the Named Insured. City of El Segundo Police Department is included as additional insured as respects to General Liability policy, but only to the extent required by written contract or written agreement. Waiver of Subrogation applies to General Liability policy. City of El Segundo Police Department 348 Main Street El Segundo CA 90245 LOY-V Ly a R+J l NL` 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 Rod Sockolov ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 7722451.6 123....24 A:I.:I. L.!.nes/BPP/E&0 $10M I Pat.ra (t) 1 1.1/16/2023 9:4:.:01. AM (PST) I Pane :I. of 3 3606-7534 C H U B B° General Liability Who Is An Insured (continued) Volunteers Persons who are volunteer workers for you are insureds; but they are insureds only for acts within the scope of their activities for you and at your direction. Real Estate Managers Persons (other than your employees) or organizations acting as your real estate managers are insureds; but they are insureds only with respect to their duties as your real estate managers. Permissive Users Of With respect to mobile equipment registered in your name under a motor vehicle registration law: Mobile Equipment A. persons driving such equipment on a public road with your permission are insureds; and B. persons or organizations responsible for the conduct of such persons described in subparagraph A. above are insureds; but they are insureds only with respect to the operation of the equipment and only if no other insurance of any kind is available to them. However, no person or organization is an insured with respect to: • bodily injury to any co -employee of the person driving the equipment; or • property damage to any property owned or occupied by or loaned or rented to you, or in your charge or the charge of the employer of any person who is an insured under this provision. Vendors Persons or organizations who are vendors of your products are insureds; but they are insureds only with respect to their liability for damages for bodily injury or property damage resulting from the distribution or sale of your products in the regular course of their business and only if this insurance applies to the products -completed operations hazard. However, no such person or organization is an insured with respect to any: • assumption of liability by them in a contract or agreement. This limitation does not apply to the liability for damages for bodily injury or property damage that such vendor would have in the absence of such contract or agreement; • representation or warranty unauthorized by you; • physical or chemical change in your products made intentionally by the vendor; • repackaging, unless unpacked solely for the purpose of inspection, demonstration or testing, or the substitution of parts under instruction from the manufacturer and then repacked in the original container; • failure to make such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business in connection with the distribution or sale of your products; • demonstration, installation, servicing or repair operations, except such operations performed at the vendor's premises in connection with the sale of your products; or • of your products which, after distribution or sale by you, have been labeled or relabeled or used as a container, ingredient or part of any other thing or substance by or for the vendor. Liability Insurance F® 0-02-20(Rev. 4-01) Coniract Page 7 of 32 77224516 1 23-24 All Lines/SPP/E&O $10M 1 Patra (1) 1 11/16/2023 9:41:01 AM (PST) I Paqe 2 of 3 Who Is An Insured Vendors Further, no person or organization from whom you have acquired your products, or any container, (continued) ingredient or part entering into, accompanying or containing your products, is an insured under this provision. Lessors Of Equipment Persons or organizations from whom you lease equipment are insureds; but they are insureds only with respect to the maintenance or use by you of such equipment and only if you are contractually obligated to provide them with such insurance as is afforded by this contract. However, no such person or organization is an insured with respect to any: • damages arising out of their sole negligence; or • occurrence that occurs, or offense that is committed, after the equipment lease ends. Lessors Of Premises Persons or organizations from whom you lease premises are insureds; but they are insureds only with respect to the ownership, maintenance or use of that particular part of such premises leased to you and only if you are contractually obligated to provide them with such insurance as is afforded by this contract. However, no such person or organization is an insured with respect to any: • damages arising out of their sole negligence; • occurrence that occurs, or offense that is committed, after you cease to be a tenant in the premises; or • structural alteration, new construction or demolition operations performed by or on behalf of them. Subsidiary Or Newly If there is no other insurance available, the following organizations will qualify as named insureds: Acquired Or Formed Organizations 0 a subsidiary organization of the first named insured shown in the Declarations of which, at the beginning of the policy period and at the time of loss, such first named insured controls, either directly or indirectly, more than fifty (50) percent of the interests entitled to vote generally in the election of the governing body of such organization; or • a subsidiary organization of the first named insured shown in the Declarations that such first named insured acquires or forms during the policy period, if at the time of loss such first named insured controls, either directly or indirectly, more than fifty (50) percent of the interests entitled to vote generally in the election of the governing body of such organization. Limitations On Who Is An A. Except to the extent provided under the Subsidiary Or Newly Acquired Or Formed Insured Organizations provision above, no person or organization is an insured with respect to the conduct of any person or organization that is not shown as a named insured in the Declarations. B. No person or organization is an insured with respect to the: 1. ownership, maintenance or use of any assets; or 2. conduct of any person or organization whose assets, business or organization; Liability Insurance Form 80-02-2000 (Rev. 4-01) Contract Page 8 of 32 ..7722,151.6 1 23.._24 All Lines/BPP/E°&0 $101.o 1 Patra (1) 1 11/16/2023 9:41:01 AM (PST) I Page 3 of 3 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: L_) 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. (X) 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 The Hartford Policy Number Expiration Date Name of Agent Pa cor Insurance Agency LLC Phone # 877-287-1316 76 WEG AM5MYN L) I 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 jhose provisions or.the agreement will automatically become void. Signature of Applican Agreement for: Dated. 1 Reviewed by: Date 7/17/2024