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PROOF OF INSURANCE (2025 - 2025)CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 8/13/2024 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). PRODUCER Inszone Insurance Services, LLC 2721 Citrus Road, Suite A Rancho Cordova CA 95742 INSURED Yorke Engineering, LLC 31726 Rancho Viejo Rd. #218 San Juan Capistrano CA 92675 rnvconr_o¢ rAzkrxl�kmLriq, �MT-Hri-11 Certificate .,, 877-30 A: Homeland Insurance Company of New York D:. 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 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 O�...........................-.... AO iSUBR,... ..............._ POLICY.._._m ..._..-.,,. ..,. ....._..,,,.m...,. ILTR F INSURANCE POLICY NUMBER M DD. FF MM DD/YYYY LTR LIMBS A X COMMERCIAL GENERAL LIABILITY Y Y 793-00-30-38-0009 2/10/2024 2/10/2025 EACH OCCURRENCE $ 5,000.000 CLAIMS -MADE . OCCUR aR- _EM I u a tEa occ.urma-_J 1100.000 X CPL Pollution MED EXP (Any one person) $ 10 000 PERSONAL & ADV INJURY $ 5,000.000 ITITR..,_... ..... GEN'L AGGREGATE LIMIT -..._._r ...__� APPLIES PER. GENERAL AGGREGATE $ 5 000 000 X PRO- POLICY PRO- JECT LOC PRODUCTS - COMP/OP AGG $ 5,000.000 OTHER. Deductible per Occur $ 2,500 A AUTOMOBILE LIABILITY Y Y 793-00-30-38-0009 2/10/2024 2/10/2025 COMBINED SINGLE LIMIT $1 000 000 '.. ANY AUTO BODILY INJURY (Per person) $ ............--..W. OWNED - SCHEDULED BODILY INJURY (Per accident) AUTOS ONLY AUTOS X HIRED X NON -OWNED PPfi OPI�Rd%DAMAGE: _.... $ AUTOS ONLY AUTOS ONLY -- Deductible er Occur $.2 500 UMBRELLA LIAB .00CUR EACH OCCURRENCE $ _mm EXCESS LIAB CLAIMS -MADE .. AGGREGATE $ DED RETENTION $ $ PER OTH- N WORKERS COMPENSATION STAT. TE ER „ AND EMPLOYERS' LIABILITY Y / N leNYPROPRIETORIPARTNENEXECI.VTIVE ❑ OFFS CERWE MBER EXCLUDED? N / A E.L. EACH ACCIDENT $ ........... (Mandatory In NH) E.L DISEASE EA EMPLOYEE .�. ITITIT.IT..m. $ ...............-. It yyes, doscr9he. uradar rSESCRIP 12bw l OF OP'E.RArIONS below E.L, DISEASE - POLICY LIMIT $ A Professional Liability "Claims 793-00-30-38-0009 2/10/2024 2/10/2025 Each Claim Aggregate $5,000,000 $5,000,000 Made" Subject to GL Agg Deductible per Claim $5,000 - DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Professional Liability Retro Date: 8/27/2015 Certificate Holder is included as Additional Insured on the General Liability and Auto Liability as per written contract. Coverage is Primary and Non -Contributory and a Waiver of Subrogation appliies per written contract. 30 Day Notice of Cancellation is provided to the FIRST' Named Insured. 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. 150 Illinois Street EL SEGUNDO CA 90245 AUTHOR��DREPRESENTATIVE United States r ©1988-2015 ACORD CORPORATION. All rights reserved.. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Policy Number: 793-00-30-38-0009 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies coverage provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART CONTRACTORS ENVIRONMENTAL LIABILITY COVERAGE PART The following is added to the Other Insurance Condition and supersedes any provision to the contrary: Primary And Noncontributory Insurance This insurance is primary to, and will not seek contribution from, any other insurance available to an additional insured under this policy provided that: a. The additional insured is a named insured under such other insurance; and b. The Named Insured has agreed in writing in a contract or agreement that this insurance would: (1) Act primary to any other insurance available to the additional insured; and (2) Would not seek contribution from any other insurance available to the additional insured. All other terms and conditions remain the same. OBENV GE 319 (11 20) Contains copyrighted material of Insurance Services Office, Inc. with its permission. Page 1 of 1 E-INSURED Policy Number: 793-00-30-38-0009 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies coverage provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART CONTRACTORS ENVIRONMENTAL LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: Any person or organization that the "Named Insured" agreed to waive its rights of recovery against in a fully executed written contract. The following is added to the Transfer Of Rights Of Recovery Against Others To Us condition of SECTION IV — CONDITIONS: 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 negligence during: 1. Your ongoing operations; or 2. Your work; performed under a written contract with such person or organization and included in the products -completed operations hazard. Such waiver by us applies only to the extent that the insured has waived its right of recovery against such person(s) or organization(s) in the written contract prior to loss. This waiver applies only to the person or organization shown in the SCHEDULE above. All other terms and conditions remain the same. OBENV GE 320 (11 20) Contains copyrighted material of Insurance Services Office, Inc. with its permission. Page 1 of 1 E-INSURED Policy Number: 793-00-30-38-0009 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION - FORM III This endorsement modifies coverage provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART CONTRACTORS ENVIRONMENTAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location(s) Of Covered Operations Any person or organization that the Any location where required by the Named Insured agreed to add as an written contract or written agreement in additional insured in a written contract which the Named Insured agreed to add or written agreement that was fully the person or organization qualifying as executed by the Named Insured prior to an additional insured under this the performance of the Named Insured@s endorsement, that is the subject of such written contract or written agreement. ,,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 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, environmental 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 contractor 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, property damage or environmental 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 OBENV GE 346 (01 19) Contains copyrighted material of Insurance Services Office, Inc. with its permission. Page 1 of 2 Copyright 2019, Intact Insurance Group USA LLC E-INSURED 2. That portion of your workout 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. 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. All other terms and conditions remain the same. OBENV GE 346 (01 19) Contains copyrighted material of Insurance Services Office, Inc. with its permission. Page 2 of 2 Copyright 2019, Intact Insurance Group USA LLC Policy Number: 793-00-30-38-0009 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies coverage provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART CONTRACTORS ENVIRONMENTAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Any person or organization that the Named Insured agreed to add as an additional insured in a written contract or written agreement that was fully executed by the Named Insured prior to the performance of the Named Insured's work that is the subject of such written contract or written agreement. Location And Description Of Completed Operations: Any location, and completed operations at such location, where required by the written contract or written agreement in which the Named Insured agreed to add the person or organization qualifying as an additional insured under this endorsement. 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 environmental 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: 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 contractor 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 is added to 1. Limits of Insurance in SECTION III - LIMITS OF INSURANCE AND DEDUCTIBLE: 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. All other terms and conditions remain the same. OBENV GE 351 (09 20) Contains copyrighted material of Insurance Services Office, Inc. with its permission. Page 1 of 1 Copyright 2020, Intact Insurance Group USA LLC E-INSURED CERTIFICATE OF LIABILITY INSURANCE t8/1 MM/DD/YYYY) 3/2024 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 INSURERS , AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATIONIS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer ri Itts to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: PAYCOR INSURANCE AGENCY LLC 76250827 PHONE (904) 421-3237 (A/C„ No, Ext): FAX (VC, No): E-MAIL ADDRESS: 10550 DEERWOOD PARK BLVD 206 JACKSONVILLE FL 32256 INSURER(S) AFFORDING COVERAGE NAIC# INSURE RA: Hartford Fire and Its P&C Affiliates 00914 INSURED INSURER B : INSURERC: YORKE ENGINEERING, LLC 131726 RANCHO VIEJO RD STE 218 SAN JUAN CAPISTRANO CA 92675-2735 INSURER D t ''.. INSURER E :. INSURER F : COVERAGES CERTIFICATE NUMBER- 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 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. INS' TYPE OF INSURANCE ADDL SUBR. POLICY NUMBER POLICY EPF POLICY E�XP YYY' LIMITS 1 COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE DAMAGE TO nktm CLAIMS' -MADE OCCUR 11 aro c�:�urssnq&w R MISES IE&gWau MED EXP (Any one person) PERSONAL A ADV INJURY GENERAL AGGREGATE GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG POLICY PRO LOC JECT O'rHEFt; COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY .pg ,, ANY AUTO BODILY INJURY (Per person) ALL OWNED SCHEDULED BODILY INJURY (Per accident) AUTOS AUTOS HIRED NON -OWNED PROPERTY DAA,W�'F4GE AUTOS AUTOS (Per accident) OCCUR. EACH OCCURRENCE. UMBRELLA LIAB '.... AGGREGATE EXCESS LIAB CLAIMS- MADE ,... ED RETENTION $ WORMERS COMPENSATION X PER I OTH. AND EMPLOYERS' LIABILITY STATUTE leg_ E.L. EACH ACCIDENT $1,000,000 ANY YIN A PROPRIETOR/PARTNER/EXECUTIVE N/A X 76WEGAS9SSU 08/12/2024 08/12/2025 E.L.DISEASE-EA EMPLOYEE $1,000,000 OFFICER/MEMBER EXCLUDED? E.L. DISEASE - POLICY LIMIT $1,000,000 (Mandatory In NH) If yes, describe under D SCRIPT ,N E' P RK I DESCRIPTION OF OPERATIONS/LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Those usual to the Insured's Operations. Notice of Cancellation will be provided in accordance with Form WC990394, attached to this policy. Waiver of Subrogation applies in favor of the Certificate Holder per Waiver of our Right to Recover from Others Endorsement WC040306 attached to this policy. CERTiFIGATE HOLt7ImK ti,wkuwa.r-L.L.P%IM01x City of El Segundo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 150 ILLINOIS ST BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED EL SEGUNDO CA 90245 IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE V l`JiStf-2U70 Al.VRU VVRt"VRA�IVIY. rur nynra rcacrvcu.. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD THE HARTFORD BUSINESS SERVICE CENTER THE 3600 WISEMAN BLVD HARTFORD SAN ANTONIO TX 78251 City of El Segundo 150 ILLINOIS ST EL SEGUNDO CA 90245 Account Information: Contact Us Policy Holder Details : YORKE ENGINEERING, LLC Need Help? August 13, 2024 Chat online or call us at (866) 467-8730. We're here Monday - Friday. Enclosed please find a Certificate Of Insurance for the above referenced Policyholder. Please contact us if you have any questions or concerns. Sincerely, Your Hartford Service Team WLTRO05 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTICE OF CANCELLATION TO CERTIFICATE HOLDER(S) Policy Number: 76 WEG AS9SSU Endorsement Number: Effective Date: 08/12/24 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address: YORKE ENGINEERING, LLC 31726 RANCHO VIEJO RD STE 218 SAN JUAN CAPISTRAN CA 92675 This policy is subject to the following additional Conditions: A. If this policy is cancelled by the Company, other than for non-payment of premium, notice of such cancellation will be provided at least thirty (30) days in advance of the cancellation effective date to the certificate holder(s) with mailing addresses on file with the agent of record or the Company. B. If this policy is cancelled by the Company for non-payment of premium, or by the insured, notice of such cancellation will be provided within ten (10) days of the cancellation effective date to the certificate holder(s) with mailing addresses on file with the agent of record or the Company. Form WC 99 03 94 Printed in U.S.A. Process Date: 07/03/24 If notice is mailed, proof of mailing to the last known mailing address of the certificate holder(s) on file with the agent of record or the Company will be sufficient proof of notice. Any notification rights provided by this endorsement apply only to active certificate holder(s) who were issued a certificate of insurance applicable to this policy's term. Failure to provide such notice to the certificate holder(s) will not amend or extend the date the cancellation becomes effective, nor will it negate cancellation of the policy. Failure to send notice shall impose no liability of any kind upon the Company or its agents or representatives. Policy Expiration Date: 08/12/25 © 2011, The Hartford THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA Policy Number: 76 WEG AS9SSU Endorsement Number: Effective Date: 08/12/24 Effective hour is the same as stated on the Information Page of the policy, Named Insured and Address: "YORKE ENGINEERING, LLC 31726 RANCHO VIEJO RD STE 218 SAN JUAN CAPISTRAN CA 92675 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 whom you are required by written contract or agreement to obtain this waiver of rights from us Countersigned by Form WC 04 03 06 (1) Printed in U.S.A. Process Date: 07/03/24 Authorized Representative Policy Expiration Date: 08/12/25