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PROOF OF INSURANCE (2025)" CERTIFICATE OF LIA THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTE BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A C REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. WPORTANM If the certificate holder Is an ADDITIONAL INSURED, the polil If SUBROGATION IS WAIVED, subject to the terms and conditions of the pc this certificate does not confer rights to the certificate holder in lieu of sue ?RODUCER NTIS Group, LLC 24610 Detroit Rd, Ste 250 Westlake OH 44145 INSURED Transportation Charter Services, Inc. 1931 N. Batavia St. Orange CA 92865 BILITY INSURANCE EATE (MM/DD/YYYY) 04/19/2024 CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS 4D OR ALTER THE COVERAGE AFFORDED BY THE POLICIES ONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED y(ies) must have ADDITIONAL INSURED provisions or be endorsed, licy, certain policies may require an endorsement. A statement on I endorsement(s). NAME T Jeffrey Mueller PHONE (440) 471-8220 FAX (440) 471-8225 A C N Exk ` AIC No :. E-MA J'eRM(fttisgr'oup.corn ADDRESS• %%SURER.t'S)AFFORDING COVERAGE NAIC # INSURERA: National Interstate Ins Co. 32620 INSURER B : Vanliner Insurance Co. 21172 INSURER C : INSURER 0 ; INSURER E : I'N2URER F COVERAGES CERTIFICATE NUMBER: 2U24-2025 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 REQUIIREMENT, 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 SHO'v WN fv1AY HF{JE BEEN REDUCED BY PAID CLAIMS. IN R.' TYPE OF INSURANCE INSD UWVD POLICYNUMBER POLICYIEFF MMWDrYYYY POLICY MMIDDdYYYY' LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE ' ' $ 5,000,000 CLAIMS -MADE I 'I'll OCCUR PREMISES fEa occurrence, S 250,000 MED EXP (Anyone personij 3 5,000 r- + SAM Sublimit- $1,000,000 CSL PERSONAL&ADVIikI UR' $ 5,000,000 A Y XPP 1124890 00 05/01/2024 02/01/2025 GENE:RALAGO.REGATE g, 5,000,000 In7V:°.N'L!' QGRE('aA.'I`E LIMIT APPLIES PER: POLICY � JECT LOC JE'CT PRODUCTS-COM'WOPAGG S 5,000,000 OTHER, Employee Benefits $ 1,000,000, _1 AUTOMOBILE LIABILITY COMBINI:()SlrgC,a ELIMIr Ea accddent $ 5,000,000 BODILY INJURY (Per person) $ ANY AUTO A OWNED SCHEDULED AUTOS ONLY AUTOS HIRED w,,�+ NON -OWNED ONLY x AUTOS ONLY Y XPP112489000 05/01/2024 02/01/2025 BODILY INJURY (Per accident) $ PROPERTY DAtrorAGE Per lacedderfl $ Underinsured motorist fi81 $ Statutory JAUTOS UMBRELLA LIABX OCCUR EACHti7iC:CURrdEN1NEAEXCESS AGGREGATE S' LIAR CI a,'MS-N�IAI:PF' XEX 1124890 00 05/01/2024 02/01/2025 AUGL tYTH- w STATUTE ER S $5,000,000 B DED RETENTION $ WORXERS COMPENSATION AND EMPLOYERS LIABILITY E YIN ° BeINW �+hiL)r RIETI,�RII�"Aff8TY1E°F�.dCdILL"aJTIL?' OFF'ICL.R)MEMB'ER EXCLUDED. Y Mandatcr In NH NIA Y XWC 1124890 00 05/01/2024 02/01/2025 D I EACHACCIrdEhY"r $ 1,000,000 C` I , DISEASE - EA EMPLOYDE S 1,000,000 E,LDISEASE- IOLICYLIMI'r 1 000^ '$ ,000 If yes, describe under DESCRIPTION OF OPERATIONS bolow, Charter Deductible $10.000 A Auto PD (Comprehensive/Collision) XPP 1124890 00 05/01/2024 02/01/2025 PP/Service Deductible 1,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) The City of El Segundo, its officer, officials, employees, agents, and volunteers are listed as Additional Insured pursuant to the terms and conditions of the policy and as required by written contract or agreement. These policies are w ttten on a primary and nor-cantfi utor�basis. --------------- CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of El Segundo ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main St, AUTHORIZED REPRESENTATIVE ElSegundo CA 90245 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: XPP 1124890 00 COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OIL 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) I Location(s) Of Covered Operations The City of El Segundo, its officer, officials, employees, agents, and volunteers 350 Main St, El Segundo, CA 90245 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 B 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. 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 04 13 © 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 20 10 0413 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 Ed. 4-84 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 _N/A % of the California workers' compensation premium otherwise due on such remuneration. Person or Organization Schedule Job Description Coverage afforded under this endorsement applies on a blanket basis when required by a written contract 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: 5/1/2021 Policy No. YWC 112489012 Endorsement No. Insured: Transportation Charter Insurance Company NATIONAL INTERSTATE INSURANCE COMPANY