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PROOF OF INSURANCE (2024 - 2024)Client#: 1291580 04CORRACON ACORDn, CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 9/06/2024 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) musthaveADDITIONAL 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER ME: Commercial Client Center 888-743-2217 NAME: McGriff Insurance Services LLC PHONE 888 743 2217 eyyq, 8888279861 7701 Airport Center Dr E-MAIL O S Cl.ie..n.tServ'iceCente_r m_e r�iff.com Suite 1800 _NSURERS)AFFORDINGG COVERAGE ..... NAIC # Greensboro, NC 27409 ...... Evanston InsuranceCompany 35378 INSURED Corral Construction & Development Inc 5211 E. Washington Blvd. #2-122 Commerce, CA 90040 State ConP p B Fund of Compensation Ins. Fu m������.,�emm _y.... CA 35076 c , Ohio Security Insurance Company 24082 � 82 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 CONTRACTOR 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. NTSFR ..__ .. TYPE OF INSURANCE ANODL — POLICYNUmMBER SVWUB1? POLICY' EF' PCSLiCY txY r �,.,.. LIMITSDIVXMD/YY A .. COMMERCIAL GENERAL LIABILITY X X 3AA735528 12/08/202312108/202 ' EACHAp,,OCC77URq&��REN E 1- 1.000 OOO ..,....,.�,) CLAIMS -MADE li„,.X� OCCUR ° ENTFD EIhAhS�pCra�rtaHn_.. $-....... . 1001000 —. MED EXP,,,Any one pprwUaa$...$5.,000 e1 .... — PERSONAL & ADV I,NJURY......,..,—..,..� $1.000 000 .............................................. ... E N'L AGGREGATE LIMIT APPLIES : GENERALAGGREGAPAGG $2 OOO OOO PRO- � POLICY _,__ JECT LOC e._ PRODUCTS COMP/OE .0...�, $2000.000 OTHER: $ C m., . . AUTonnoaaE LIABILITY .. ....� .. BAS57476683 2/08/2 m 023 — 12/08/202 COMBIN SINGLE LtlMNri -( ac�cidgMwt) .1.000 000 ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED AUTOSONLY AUTOS BODILY INJURY (Per accident) .............._ �... X NED AUTOSONLYX ......_..m_.w....._..-..._.-.. eRJdmpD.....,.,� --,..,..,.......�...................,.— $ AUOTO ONLYParrPa ................ A UMBRELLA LIAB OCCUR , � EZXS3139512 ���� 3 12/08/202� 12/08/202 .......... � EACH OCCURRENCE ..a ...... .... ....... $ 3 OOO O O�O EXCESS LIAB CLAIMS MADE AGGREGATE ° O DEDE 1 RETENTION $ $, B w.,...,.... .....,,,.,..___ WORKERS COMPENSATION _ . -.m ... ...-.... .. ......,,,-. X 903611823 .. 12/01/2023 ....__.—' 12/01/202 .....,..._., w... X PER II OTH- . AND EMPLOYERS' LIABILITY Y / N ..�..._..,G�®S,.I.JT ...11 ....e .F-91.. ..... .. ....... .... ANY PR PRMETOWPARTNEFV4EXECUTIVE E.L. EACH ACCIDENT $ OFFICE , EMBER EXCLUDED? r N/A ... -, ... ....... - E.L. DISEASE EA EMPLOYEE describe under If yes desenbN Dyes, OF OPERATIONS below _ E.L, DISEASE POLICY LIMIT $ I DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) ** General Liability Information ** Job#: 1 ** Workers Comp Information ** Proprietors/Partners/Executive Officers/Members Excluded: Ernesto Corral, President (See Attached Descriptions) rl City of El Segundo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE y g THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 350 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. El Segundo, CA 90245 AUTHORIZED REPRESENTATIVE & (koh y ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) 1 of 2 The ACORD name and logo are registered marks of ACORD #S35237819/M34520105 JPS 5AUITTA 25.3 (2016/03) 2 Of 2 #S35237819/M34520105 ENDORSEMENT AGREEMENT WAIVER OF SUBROGATION 9036118-23 RENEWAL SP 2-83-35-91 PAGE 1 HOME OFFICE SAN FRANCISCO EFFECTIVE DECEMBER 1, 2023 AT 12.01 A.M. AND EXPIRING DECEMBER 1, 2024 AT 12.01 A.M. ALL EFFECTIVE DATES ARE AT 12:01 AM PACIFIC STANDARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME CORRAL CONSTRUCTION & 5211 E WASH BLVD STE 2-122 COMMERCE, CA 90040 ANYTHING IN THIS POLICY TO THE CONTRARY NOTWITHSTANDING, IT IS AGREED THAT THE STATE COMPENSATION INSURANCE FUND WAIVES ANY RIGHT OF SUBROGATION AGAINST, CITY OF EL SEGUNDO WHICH MIGHT ARISE BY REASON OF ANY PAYMENT UNDER THIS POLICY IN CONNECTION WITH WORK PERFORMED BY, CORRAL CONSTRUCTION & IT IS FURTHER AGREED THAT THE INSURED SHALL MAINTAIN PAYROLL RECORDS ACCURATELY SEGREGATING THE REMUNERATION OF EMPLOYEES WHILE ENGAGED IN WORK FOR THE ABOVE EMPLOYER. IT IS FURTHER AGREED THAT PREMIUM ON THE EARNINGS OF SUCH EMPLOYEES SHALL BE INCREASED BY 03%. NOTHING IN THIS ENDORSEMENT SHALL BE HELD TO VARY, ALTER, WAIVE OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS POLICY OTHER THAN AS ABOVE STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR LIMITATIONS IN THIS ENDORSEMENT. COUNTERSIGNED AND ISSUED AT SAN FRANCISCO: 2570 AUTHORIZED REPRESENT.: IVE. SCIF FORM 10217 (REV.4-2018) FEBRUARY 15, 2024 PRESIDENT AND CEO OLD DP 217