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PROOF OF INSURANCE (2024 - 2025)DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 07/18/2024 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 ALTERTHE COVERAGE AFFORDED BYTHE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), IMPORTANT. If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have p AUTHORIZEDREPRES�NTATIVEP RPRODUyER,Areanendarsement.Astatementtrn�th�scertifiwtedoesnotconfern htstothecertficateholdermheuofsuchWAIVED,subjecttothetermsand AND THE CERTIFICATE _ ADDITIONAL rowsionsorbeendorsed.IfSUBROGATIONIS conditionsofthepolic,certain policies may require g endorsement(s). __. ........ _ ........ ....... — PRODUCER CONTACT NAME: GARETH NICKERSON Gareth Nickerson 27194 Baseline St St C9V to/c, No Err): ( PHONE =(A/C, 909-385-3200909-839-4372 E-MAIL Highland CA 92346-3197 ADDRESS: gnickerson@farmersagent.com ....... - INSURER(S) AFFORDING COVERAGE NAIC # ....._...... ............. ...... .._. ._.._ ........ INSURED INSURERA: NORTHFIELD INSURANCE 27987 - _ ...... ....... INSURERB KIN'SALE 38920 IWATER INC INsuRERc. MID CENruRY COMI ANY...... ..... - 21687 12 GOODYEAR SUITE 130 INSURERD: TRUCK INSURANCE EXCHANGE 21709 .. ................... IRVINE CA 92618 I. .. .. .. ....... .. ..... . ...... NSURERE: INSURER F: .............. ...... _...._....... ......... �� COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS ABOVE FORTHE POLICY PERIOD STO C . E .. RTIFYTHATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN REQUIREMENT, MORCONDITIONOFANYCONTRACTOROTH RDOCUMENTWITHISSUED CSE EINDICATED. NOTWITHSTANDING RESPECTTOWHHTHRTFIS SUED EDORMAYPE PERTAIN, REQUIRINSURANCE AFFORDED DED BYTHE POLICIES DESCRIBED HEREIN IS SUBJECTTO ALLTHEITERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. .............. ................. ................. ............. _.. ..._. ....-.. ..... INSR ADDTL SUBR POLICYEFF POLICYEXP LIMITS TYPE OF INSURANCE POLICY NUMBER LTR INSD WVD (MM/DD/YYYY) (MM/DD/YYYY) ...... ........ COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X OCCUR DAMAGETO (EaOccED $ CLAIMS -MADE PREMISES (Ea Occurrence) 100„000 MED EXP (Any one person) $ 5"000 p Y WH008 18 10/27/2023 10/27/2024 1 PERSON AL&ADVINJURY $ 1„000,000 GEN L AGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY [] PROJECT LOC PRODUCTS-COMP/OPAGG $ 2,000,000. OTHER: $ I............. .............. ._...m..__ .._.. ......... .._..._ - ......... �-............... AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANYAUTO BODILY INJURY (Per person) $ 0 OWNEDAUTOS SCHEDULED BODILY INJURY (Per accident) $ ONLY AUTOS Y Y 605861543 09/04/2023 09/04/2024 HIREDAUTOS X NON -OWNED PROPERTY DAMAGE ONLY AUTOS ONLY (Peraccident) $ ...._.. ........-.-....... ......_ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 5,000,000 E EXCESS uns CLAIMS -MADE 0100212520-1 02/15/2024 02/15/2025 AGGREGATE $ 5,000„000 DED RETENTION $ $ WORKERS COMPENSATION PER OTHER $ AND EMPLOYERS' LIABILITY STATUTE ........ ..... ANY PROPRIETOR/PARTNER/ Y/N E.L.EACH ACCIDENT $ 1,000„000 EXECUTIVE OFFICER/MEMBER Y N/A A09505451 02/15/2024 02/15/2025 C EXCLUDED? (Mandatory in NH) E.L. DISEASE EA EMPLOYEE 1,000,000 Ifyes, describe under DESCRIPTION OF E.L. DISEASE -POLICY LIMIT 'I- 1,000,000' OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101, Addit ional Remarks Schedule, may beattached ifmore space is required) CERTIFICATE HOLDER IS ADDITIONAL INSURED CERTIFICATE HOLDER CANCELLATION ......L ..... ........ CITY OF ESEGUNDO SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION 350 MAIN STREET DATE THEREOF, NOTICE WILL BE DEL E A ANCE WITH THE POLICY PROVISIONS. EL SEGUNDO CA 90245 AUTHORIZED REPRESENTATIVE " ACORD 25 (2016/03) @1988-2015 ACORD CORPORATION. All Rights Reserved 31-1769 11-15 The ACORD name and logo are registered marks of ACORD POLICY NUMBER: WH008318 COMMERCIAL GENERAL LIABILITY CG20100413 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 SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location(s) Of Covered Operations City of El Segundo, 350 Main Street, 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 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 04 13 Copyright, 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. CG 20 10 04 13 Copyright, Insurance Services Office, Inc., 2012 Page 2 of 2 DD AC CERTIFICATE OF LIABILITY INSURANCE DATE /09/20 YYYY) 10/09/2023 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 CONTACT Fred Dean NAME; Premier One Insurance Services PHONPc. (949) 727-2025 , Na (949) 727-9219 �1 V 100 Pacifica Ste 480 �n�A-11, Ffed.Dean(,,ot' Premier0ile.conl INSURER( NAIC # Irvine CA 92618 INSURERA: Beazley Insurance Company 37540 INSURED WSURfR B iWater, Inc. INSURER C q 12 Goodyear #130 INSURER D INSURER E,. Irvine CA 92618 INSURER F CI 93Q9R19100 RFVIRIAN NIIMRFR, 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. 4NSR' LTR'� TYPE OF INSURANCE WVD POLICY NUMBER MM/DDY F MMIDDPOL Y EXP .. LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ $ CLAIMS -MADE E OCCUR PREMISES Esoccung" _ MED EXP (Any one person) $ PERSONAL &ADV INJURY $ GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ PRODUCTS-COMPIOPAGG $ ❑ JIRO- ECT LOG POLICY JEGT OTHER: tlNW E LghtgT $ AUTOMOBILE LIABILITY 1" ou^cl@deq,) ANY AUTO BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED PROPERTY DAMA�GL. Pei , dent' $ AUTOS ONLY AUTOS ONLY $ UMBRELLA LIAB=0CCUREACH OCCURRENCE AGGREGATE $ EXCESS LIAB $ DED RETENTION $ OTH WORKERS COMPENSATION ER AND EMPLOYERS'LIABILITYPARTNER YIN PROPRIETOR/PARTNER/EXECUTIVE ID 7EACH OFFICER/MEMBER EXCLUDED?(Mandatory NIAIDENT in NH) EMPLOYEE $ANY Ifyes, describe underDESCRIPTION OF OPERATIONS below POLICY LIMIT $OCC $2,000,000 A Professional Liability IV1307D231201 10/04/2023 10/04/2024 DEDUCTIBLE $15,000 RETRO DATE 08-04-2011 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) 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 Street AUTHORIZED REPRESENTATIVE El Segundo CA 90245 V 1!J0tf-ZU10A1,VKu t-VKt-VKAIIUnI. All rlyms I6 VINFuu. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD