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PROOF OF INSURANCE (2025)DATE (MM/DDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 7/26/2024 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(s). CONPRODUCER NAME CT Na pprajas Foundation Risk Partners dba Millennium Risk Mgmt & Ins Services FA a Fxt1 6ia ti44 4f 07 FAX N I g18 638 7907 PUP 301 E Colorado Blvd Ste 205 E-MAIL Pasadena CA 91101 aDDREs : nancyb n csins.com INSURERS►AFFORDING COVERAGE NAIC# �7974 Livens R0� 9or2i o INSURERA Mt Hawley Isurance ompany_ 34082 INSURED � a Com a 2 INSURER B Ohio SecurityInsuranc .p rly Trueline Construction & Surfacing, Inc. INSURER C: Everest Premier Insura nce Company 16045 P.O. Box 70269 Riverside CA 92513- IysuRER D f INSURER E: INSURER F : (-I=0T'ICIrATG 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. �,..., ......... ..... ......,.. IN511 R AODd.�t1 LTR . , i1.; 1 TYPE OF INSURANCE I POLICY NUMBER D.,„ 4, POIJCY YY PI iDD YYP MM/DOIYYYY 1 MMdO ....- ._ LIMITS A X I COMMERCIAL GENERAL LIABILITY Y MGL0200608 7/25/2024 7/25/2025 EACHOCCURRENCE $1,OOQ000 .. CLAIMS -MADE X OCCUR _DAMAGE `rO RE N s PO ,P��iSE�;,.t��-a��CedIVOY,IC!e)e �e$50,000 MED EXP,(Any one person) $ 5,000 PERSONAL & ADV INJURY $1,000,000 ..,,�,.a .,,,,,, ............,,,, ,_. GEN L AGGREGATE LIMIT APPLIES PER ....,,.. .. .... GENERAL, AGGREGATE s 2,000,000 POLICY LOG PRODUCTS - COMPIOP AGG s 2,000,000 ,e.,.. ...,,., VET ..... $ 1,000,000 OTHEREmployee Benefits .....� ,e.�._.....e�,..,._ _�. �.....-.--_"- B AUTOMOBILE LIABILITY BAS56945605 .......�.. 7/25/2024 7/25/2025 &"�OMBGNED)StihPaLP'LkMN7 lea acca E' $1,000,000 X ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS X HIRED NON -OWNED X f Ix„ 1 I ROF�FRTY DAMAGE $ " tPe aenadeflt................I, AUTOS ONLY AUTOS ONLY ,.., m, - $ X 1CoMP.s.'1'K X COLL-S�1K A UMBRELLA LIAR X J OCCUR MXL0439325 7/25/2024 7/25/2025 EACH OCCURRENCE $ 4,000,000 X EXCESS CLAIMS MADE AGGREGATE $4,000,000 "LIAB 1 DED X RETENTION $ C WORKERS COMPENSATION 7600016618241 7/25/2024 7/25/2025 YX PER O1H STATUTE , , , , , AND EMPLOYERS' LIABILITY YIN ANYPROPRIETOR/PARTNER/EXECUTIVE E L EACH ACCIDENT $ 1,000,000 OFFICER/MEMBEREXCLUDED7 NIA E L DISEASE - EA EMPLOYEEa $,1,000,000 (Mandatory in NH) If yes, describe under E L DISEASE -POLICY LIMIT $ 1.000,000 DESCRIPTION OF OPERATIONS below 7I25I2025 Limit 87,272 B Business Pen onal Property BKS56945605 7/25/2024 Deductible 1,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) Subject to all policy terms, exclusions and conditions. Re: 350 Main Street The City of El Segundo, its officers, officials„ employees, agents, and volunteers are included as, additional insureds with for General Liability as respects to the insureds operations and only if required by written contract per the attached endorsement Waiver of subrogalion applies to the Workers Compensation. Should any of the above described policies be cancelled before the expiration date thereof'„ notice will be, delivered in accordance with the policy provisions. City of El Segundo 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. AUTOHDKtE,PRESENTT E ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: LOC #: ADDITIONAL REMARKS SCHEDULE Page of AGENCY NAMED INSURED Millennium Risk Management & Insurance Services POLICY NUMBER CARRIER NAIC CODE EFFECTIVE DATE: AnnITIANAI REMARKS The ACORD name and logo are registered marks of ACORD aiI a DATE (MMIDD/YYYY) ACbRO CERTIFICATE OF LIABILITY INSURANCE 7/26/2024 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(tes) 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 . PRODUCER CONTACT Nancy,Baralas Foundation Risk Partners dba Millennium Risk M mt & Ins Services PHONE . . 301 E Colorado Blvd Ste 205 g E-MAILP"`)A 81$a44-4107 I Nr«I 818-638-7907 IAf t1 Pasadena CA 91101 AooRs. nanc,y_ cstns carry m . 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 AY HAVE BEEN REDUCED CLAIMS ® F i d60 " . CY EXP LIMITS msik TYPE of lNsuRANCE . �AbDL tUBFR — POLu Y NUMBER � MMNDDrY1d1FY MMADDBYYYY COMMERCIAL l A X t CO„ Y MGL0200608 7/25/2024 7/25/2025 EACH OCCURRENCE _ 31 000.t,1t1+J ` CLAIMS MADE X OCCUR �7AN�A� i�761F�1i�C1 E n d aMcurre) 50,000 - — MED EXP,(Any one Personl $5 00D .. ........._ ., ERSONAL & ADV INJURY S 000,000 ,. LIMIT APPLIES PER. GENERAL GGREGAT j A 52,000udi40 N1L GEAGGREGATE POLICY X J PRE. LOC pECT PRODUCTS - OOMPIOP At G I S 2 000,000 - ,.. O"rI�ICR,_ Enr iaa ew BerraTas5 � 81000 000 B AUTOMOBILE LIABILITY BAS56945605 7/25/2024 7/25/2025 L rtelNEGiSiNCLELim, dbi .I�s,ercfrleotiGM . �, .� $1 000 000 X I ANY AUTO BODILY INJURY (Per person) S " OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS HIRED X NON -OWNED X AUTOS ONLY AUTOS ONLY ., Pr CJPI R CY DAMAGE iPel ac6dyn $ �� X [COMP•S1K X COI.L•v'IK A UMBRELLA VAB X OCCUR MXL0439325 7/25/2024 7/25/2025 EACH OCCURRENCE C s4 000,0001 p X EXCESS LIAB AGGREGATE 1 s4,0 i,000 CLAIMS MADEi I X AE'TEN'TIONSCLI DELI C WORKERS COMPENSATION ) 7600016618241 7/25/2024 7/25/2025 X ��ATIs,1TE � I.�.h"H AND EMPLOYERS' LIABILITY YIN E L EACH ACCIDENT 7 'S 1,0'00,00 ANYPROPRIETOR/PARTNER/EXECUTIVE OIfiICERIMAEMB FExCL,(JDFD (Mandatory In NH) NIA I II DISEASE - EA LOYEEjI ®,. S 1,t7�00,00a If es, q aanJeM EL,DISEASE - POLICY LN 51,000,0010 DSrrIPTIOROF CPERATIONSbelow 7/25/2024 7/25/2025 Limit 87,272 B I Business Personal Property BKS56945605 Deductible 1,000 i DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) Subject to all policy terms, exclusions and conditions. Re. City of El Segundo Hockey Rink. The City of El Segundo, its officers, officials, employees, agents, and Volunteers are included as additional insureds With primary & non-contributory Wording for General Liability as respects to the insureds operations and only if required by Written contract per the attached endorsements. 'Should any of the above described policies be cancelled before the expiration date thereof, notice Will be delivered in 'accordance With the policy provisions. City of El Segundo 350 Main St. El Segundo CA 90245 V:M I\ V GLLI'1 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 c+ %W 100O-bu 1.7 MVVnv VVI\r vlv+„v•\, r•••••W.•w ........ ...... ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: LOC M CC>R ADDITIONAL REMARKS SCHEDULE Page of AGENCY NAMED INSURED Millennium Risk Management & Insurance Services POLICY NUMBER CARRIER NA IC CODE EFFECTIVE DATE: A P1111TIf%UA 1 12CUADWQ THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance: Notes Rented/Leased Equipment: Carrier: Ohio Security Ins Company / Policy#: BKS56945605 / Term: 07/25/2024 to 07/25/2025 / Limit: $25,000 with $1,000 deductible Pollution Liability: Carrier: Hanover Specialty Ins Brokers, Inc. / Policy Term: 7/25/2024 - 7/25/2025 / Pol#: SPEC207-02 / Limit: Each Pollution Condition - $1,000,000 w/ $5,000 deductible 101 12008/011 © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Policy Number: MGL0200608 Mt. Hawley Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following„ COMMERCIAL GENERAL LIABILITY COVERAGE PART Name Of Additional Insured Person(s) Or Omanization(s): All persons or organizations where required by written contract executed prior to the commencement of your work. SCHEDULE Location(s) Of Covered Operations: All Locations 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 in- clude as an additional insured the person(s) or organi- zations) 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: 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 re- pairs) to be performed by or on behalf of the addi- tional insured(s) at the location of the covered operations has been completed; or 1. The insurance afforded to such additional insured 2. That portion of "your work" out of which the injury only applies to the extent permitted by law; and or damage arises has been put to its intended use by any person or organization other than another 2. If coverage provided to the additional insured is contractor or subcontractor engaged in performing required by a contract or agreement, the in- operations for a principal as a part of the same surance afforded to such additional insured will project. CG 20 10 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 2 Insured 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. CG 20 10 04 13 © Insurance Services Office, Inc., 2012 Page 2 of 2 Insured Policy Number: MGL0200608 Mt. Hawley Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS 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) Location and Description of or Organization(s) Completed Operations All persons or organizations where required by written All Locations and All Projects contract executed prior to the commencement of your work. 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. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following is added to Section organization(s) shown in the Schedule, but only with III — Limits Of Insurance: respect to liability for "bodily injury" or "property dam- age" caused, in whole or in part, by "your work" at the If coverage provided to the additional insured is re- location designated and described in the Schedule of quired by a contract or agreement, the most we will this endorsement performed for that additional insured pay on behalf of the additional insured is the amount and included in the "products -completed operations of insurance: hazard". 1. Required by the contract or agreement; or However: 2. Available under the applicable Limits of Insurance 1. The insurance afforded to such additional insured shown in the Declarations; only applies to the extent permitted by law; and whichever is less.. 2. If coverage provided to the additional insured is required by a contract or agreement, the insur- This endorsement shall not increase the applicable ance afforded to such additional insured will not Limits of Insurance shown in the Declarations. not be broader than that which you are required by the contract or agreement to provide for such additional insured. CG 20 37 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 Insured Policy Number: MGL0200608 Mt. Hawley Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCO ITRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance Condition (2) You have agreed in writing in a contract or agree - and supersedes any provision to the contrary: ment that this insurance would be primary and would not seek contribution from any other in - Primary And Noncontributory Insurance surance available to the additional insured. This insurance is primary to and will not seek con- tribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and CG 20 01 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 Insured Trueline Construction & Surfacing Inc - Pol#: 7600016618241 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 WAIVER • • RIGHT TO RECOVER FROM • • - 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 % of the California workers' compensation premium otherwise due on such remuneration. SCHEDULE PERSON OR ORGANIZATION JOB DESCRIPTION ANY PERSON OR ORGANIZATION FOR BLANKET WAIVER OF SUBROGATION WHOM THE NAMED INSURED HAS AGREED BY WRITTEN CONTRACT TO FURNISH - 1998 by the Workers! Compensation Insurance Rating Bureau of California. All rights reserved. From the WCIRB's California Workers' Compensation Insurance Forms Manual - 1999. INSURED COPY