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PROOF OF INSURANCE (2025)OCEABLU-06 DA CERTIFICATEDATE (MMIDDmrY) ��'OF LIABILITY INSURANCE 6/28/2024 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 endorsements , PRODUCER License # 0757776 a Davies c TACT Nl HUB International Insurance Services Inc. ONNo>ExtAl(8h Y681 FAX 9855 Scranton Road ...._ . I„551) 231-2572 l 77 825 (c Nrl Suite 100 alwSmmha daVlS�h o, CA 92121 ubin'telrrtatiolnal aCom San Die g 1. asoo>zoiee nrrmruorrdur rrtita�asnr:r �� uaarrk INSURED Ocean Blue Environmental Services, Inc. 925 West Esther Street Long Beach, CA 90813 Gi iTLwT 11 Nor Ii9 �i I.1 SI & Casualty Insurance 11 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 BEEN REDUCED BY PAID CLAIMS. INS& T �,�_... _,. _, _. ADDL � .... SUBR' _HAVE POLICY NUMBER POLICY EFF POLICY EXP � m,,.... LIMBS mEAGH A COMMERCIALGENERAL(ABILITY X COMM URREINCE $ 1000,000 OCCURRENCE _ _ CLAIMS -MADE X gg OCCUR �ll X X G47475843 001 7/1/2024 7l1/2025 DAMAGE 000 i l � RENTED s sEu ?sa�vS $ 100 000 MFD FXP (Any one .A' <co�.., �5 _. ......................................................... PFR$ONALISADVINJURY $. 1'0 — --- 00,000 ,., 0 000 GE, fwI"I AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE.... $ X POLICY PKt". LOC JE T ........_ m.,.w_ _2,000 PRODUCTS COMP/OPAGG $ 2,000 OO X OTHER.. DED: $5,000 $ B COMBINED$ SINGLELIMIT 1,000,000 AUTOMOBILE LIABILITY ......... X ANY AUTO H08886301001 7/1/2024 7/112025 BODILY IN,J�I,RY 8 ANED UyTOSrU/LED AUTOS ONLY RODII X,IN;/URY, Per accidentl $ ._. .--...,..,.., ........ ,.,.., AUTOS ONLY .... AUTO YN Y ..,(Pem ac 9a RAN $.. A UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 91000,000 _ ...,�... X EXCESS LIAB CLAIMS -MADE IDED G47475855 001 7/1I2024 7I1 ............ _......__.�..,. AGGREGATE ATE $ 9,000,000 RETENTION $ $ C WORKERS COMPENSATION X PER OTH LITY YIN BTINER/EXECUTIVE f X WCC340082A 7/1/2024 7/1/2025 ...E 1,000,000 ANYnPRO�PrYRIETT HR/P RAND FA ERIMEMBER EXCLUDED? Y,Ni N / A D SEASE�IEA ""'� EMIR L PLOYEE $ 1,000,000 If yes, describe under$ DESCRIPTION OF OPERATIONS below �E L DISEASE POLICY LIMIT ..$ 1,000,000 A Pollution I Environm G47475843 001 7/1/2024 7/112025 Each Occ/Aggregate 1,000,000 A Professional Liabili G47475843 001 7/1/2024 7/112025 Aggregate 1,000,000 DESCRIPTION OF OPERATIONS i LOCATIONS 1 VEH'iCLES (ACORD 101, Additional Remarks Schedule, maybe attachad If more space is required) The County of Los Angeles and public entity or Special District for which the Los Angeles County Board of Supervisors is the Governing Body, and their Agents, Officers and Employees, City of El Segundo, and its respective elected officials, officers, employees, agents, and representatives are Additional Insured's with regards to the General Liability policy when required by a written contract, per the attached endorsement forms CG2010 04113 and CG2037 04/13 . Waiver of Subrogation applies with regards to the General Liability policy when required by a written contract, per the attached endorsement form ENV3143 03/05. Waiver of Subrogation applies with regards to the Workers Compensation policy when required by a written contract, per the attached endorsement form WC040306 04/84. City of El Segundo its officials, and employees City Clerk 350 Main Street, Room 5 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. AUTHORIZED REPRESENTATIVE ' ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: G47475843 001 COMMERCIAL GENERAL LIABILITY CG20100413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL IS - OWNERS, LESSEES O CONTRACTORS - SCHEDULED PERSONO ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) As required by written contract, prior to a loss to which this insurance applies Locations Of Covered Operations As required by written contract, prior to a loss to which this insurance applies Information require J to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to 1. All work, including materials, parts or include as an additional insured the person(s) or equipment furnished in connection with such organization(s) shown in the Schedule, but only work, on the project (other than service, with respect to liability for "bodily injury", "property maintenance or repairs) to be performed by or damage" or "personal and advertising injury" on behalf of the additional insured(s) at the caused, in whole or in part, by: location of the covered operations has been 1. Your acts or omissions; or completed; or 2. The acts or omissions of those acting on your 2. That portion of "your work" out of which the behalf; injury or damage arises has been put to its in the performance of your ongoing operations for intended use by any person or organization other than another contractor or subcontractor the additional insured(s) at the location(s) engaged in performing operations for a designated above. principal as a part of the same project. However: C. With respect to the insurance afforded to these 1. The insurance afforded to such additional additional insureds, the following is added to insured only applies to the extent permitted by Section III — Limits Of Insurance: law; and If coverage provided to the additional insured is 2. If coverage provided to the additional insured is required by a contract or agreement, the most we required by a contract or agreement, the will pay on behalf of the additional insured is the insurance afforded to such additional insured amount of insurance: will not be broader than that which you are 1. Required by the contract or agreement; or required by the contract or agreement to provide for such additional insured. 2. Available under the applicable Limits of B. With respect to the insurance afforded to these Insurance shown in the Declarations; additional insureds, the following additional whichever is less. exclusions apply: This endorsement shall not increase the This insurance does not apply to "bodily injury" or applicable Limits of Insurance shown in the "property damage" occurring after: Declarations. CG 20 10 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 POLICY NUMBER: G47475843 001 COMMERCIAL GENERAL LIABILITY CG 20 37 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Persons) Or Organizations Location And Description Of Completed Operations As required by written contract, prior to a loss to which this insurance applies As required by written contract, prior to a loss to which this insurance applies 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" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the Schedule of this endorsement performed for that additional insured and included in the "products -completed operations hazard". However: 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 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 1. The insurance afforded to such additional 2. Available under the applicable Limits of insured only applies to the extent permitted Insurance shown in the Declarations; by law; and whichever is less. 2. If coverage provided to the additional insured is required by a contract or agreement, the This endorsement shall not increase the applicable insurance afforded to such additional insured Limits of Insurance shown in the Declarations. CG 20 37 0413 © Insurance Services Office, Inc., 2012 Page 1 of 1 Named Insured Endorsement Number Ocean Blue Environmental Services, Inc. Policy Symbol Policy Number Policy Period Effective Date a GLW I G47475843 001 07/01/2024 to 07/01/2025 07/01/2024 Issued By (Name of Insurance Company) Westchester Surplus Lines Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART CONTRACTORS POLLUTION LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization- As required by written contract, prior to a loss to which this insurance applies (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) The TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Condition is amended by the addition of the following: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or your work done under a contract with that person or organization and included in the products -completed operations hazard. This waiver applies only to the person or organization shown in the Schedule above. All other terms and conditions remain the same. ENV-3143 (03-05) Includes copyrighted material of Insurance Services Office, Inc. with its permission Page 1 of 1 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY 3 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,,,,_,, —% of the California workers' compensation premium otherwise due on such remuneration. Person or Organization Schedule Job Description ANY PERSON(S) OR ORGANIZATION(S) WITH WHOM YOU HAVE AGREED TO SUCH WAIVER, IN A VALID WRITTEN CONTRACT OR WRITTEN AGREEMENT THAT HAS BEEN EXECUTED PRIOR TO LOSS. 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: 07/01/2024 Policy No.: WCC340082A Endorsement No. Insured: Ocean Blue Environmental Services, Inc. Insurance Company: National Casualty Company Countersigned By