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PROOF OF INSURANCE (2025 - 2025)BREAT-1 OP ID: SP DATE (MMIDD/YYYY) .. CERTIFICATE OF LIABILITY INSURANCE 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 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). CONTACT PRODUCER anlan ISU-The Ultima Agency PHONE` 626 792-5000 C FAX 626 792-5639 NAME. g Jac a 3848 E. Colorado Blvd. # 2 tAfc )I,E�wL 4r'G,.�+J--------- ........ Pasadena, CA 91107 EMAIL Tahanian Insurance Services ADDRESS. Jack@ultlmainsurance.Com INSURERS} AFFORDING COVERAGE NAIC # INSURED 3010 Wilshire Blvd., #260 Los Angeles, CA 90010 'AL INSURER A: Crum & Foster Specialty INSURER B Guar d Insurance Company INSURER C : Technology Insurance Compa INSURER D INSURER E : f"lritrcryAr:cc r P0TICIr ATF Idl IMRFR• RiisvI.a iniii MIIIk RFR 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. TYPE OF INSURANCE ... ADDC POLICY NUMBER MMIDDY/YYYY PMi1,i00,YY ...w... ILTR ......... ,. , m Y.................. ............... .-.—.-.......... LIMITS GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 A X COMMERCIAL GENERAL LIABILITY X EPK-146440 01/16/2024 01/16/2025 'DAMAGE "rORFNrF-D...................., ;PREMISES. (Ea necarrrn ges.) S ��. 50,00 CLAIMS -MADE OCCUR ',. MED EXP (Any one person) $ 10,000 ......... j PERSONAL_& ADV INJURY $ 1,000,000 �( GENERALAGGREGATE$ 2 .. ... .... GEN'LAGGREGATELIM A S PER. ,..-.............� ,PRODUCTS - COMPIOP AGG $ , OOO,OO ...... II_ X POLICY Y PR+O• LOC f AUTOMOBILE LIABILITY IBRAU594467 " COMBINED SINGLE LIMIT (Ea accident)1,000,00 $ B ANY AUTO ,'.. 01/01/2024 01/01/2025 BODILYINJ INJURY (Per person) $ _........... ., ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ .,,,. ,..., �,..,,. OWNED X DAMAGE sERACCI+ENrP ,NON Xi HIRED AUTOS AUTOS f ER ACCY e.� w.................. ........... Comp/Coll $ 1000/110011) UMBRELLA LIAB OCCUR '.... EACH OCCURRENCE $ ®,,. ,,,,,,,,...,,, �. �.....- .... ,,,,,,,.. EXCESS LIAB CLAIMS -MADE AGGREGATE $ - — DED ...... RETENTION $ , I ,- $ WORKERS COMPENSATION WC STA AU- O t W I C ANY OPRIET RIE ECUTIVE Y / TWC4407849 04/06/2024 04/06/2025 E, EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER NIA R EXCTU (Mandatory In NH) ". E,L. DISEASE - EA EMPLOYEE:, $ - 1,000,00 If yes, describe under DESCRIPTION OF OPERATIONS below E L DISEASE -POLICY LIMIT $ 1,000,00 A ',Pollution Liab ;EPK-146440 01/16/2024 01/16/2025 !Condition 1,000,00 A Professional Liab EPK-146440 01/16/2024 0111612025 IPer Claim 1,000,00 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) City of El Segundo is named as Additional Insured on the General Liability policy when required by a written contract. Ia:L9J1111JaCI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of El Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN %� 9 ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street El Segundo, CA 90245 AUTHORIZED REPRESENTATIVE © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 04-84) 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 2% of the California workers' compensation premium otherwise due on such remuneration. Schedule Person or Organization Job Description Any person or organization as required by 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 4/6/2024 Policy No. TWC4407849 Endorsement No. 0 Insured BREATHE SAFE ENVIRONMENTAL, INC Premium $ 5,044 Insurance Company Technology Insurance Company, Inc. Countersigned by WC040306 (Ed. 04-84)