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PROOF OF INSURANCE (2024 - 2025)a I DATE (.MIDDIYYYY) ACCORL> CERTIFICATE OF LIABILITY INSURANCE II*.� 9/5/2024 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_ IfSUBROGATION 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....._ NAm � TACI Andrea Baer eI1 Arthur J. Gallagher Risk Management SeFViGes LLC g .. ..... P�(r'j, EID 55B 750-54192 559-750-5442 ,A � 501 W Main Street E-MAIL Visalia CA 93291 ADORESS:; andrea-bur gen(Majocom INSYRKR(S). AFFORDING COVERAGE NAJC # License# 0JI3052 INSURER A: Burlington Insurance Company 23620 INSURED FAJLTES-01 INSURERi: E lovers Preferred Insurance B FailSafe Testing, LLC '_ 2037 W. Bullard Ave. #253 _LNIVR Flq: AXIS U Us Insurance _.L _qT2#ny_,,_ 26620 Fresno CA 93711 INSURER D: Nationwide Mutual Insurance qq!pp�ap y 23787 INSURER F: COVERAGES CERTIFICATE NUMBER! 17991111CI4n 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 'pNSRMr . ............... PUD'Iffy'Eff- --puck"Y Ew" nVWY1Vg[R ...... . . .. ... - LTR TYPE OF INSURANCE I N S 1) 1 POLICY NUMBER 1MWDDrYYYY) (MWDDryYM T LIMITS A X COMMERCIAL GENERAL LIABILITY 788BG0442604 8/1/2024 8/11/2025 EACH OCCURRENCE $1000,000 CLAIMSDE=X OCCUR I Q RUN a hu ut Eaz= _�f ftL m$ ­ $ 100,000 Mtl2atLAnj2ne2e sonmm$5,000 PERSONAL & ADV INJURY $1 000000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2_00O.OG0 POLICY = '1`E"C0T_ = LOG PRODUCTS - COMPIOP.AGG $ 1,000 000 4DTHER $ D AUTOMOBILE LIABILITY ACPBA3059592483 1215/2023 12/5/2024 S i,000,000 X ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ rx HIRED NON -OWNED $ AUTOS ONLY AUTOS ONLY .±Lr ncd& A UMBRELLA LIAB X OCCUR 788BE0342704 811/2024 8/1/2025 EACH OCCURRENCE $2,000,000 EXCESS LIAB CLAIMS -MADE AGGREGATE $2,000000 DED RETENTION $ $ B WORKERS COMPENSATION Y EIG290476705 811/2024 8/1/2025 TA R_._ AND EMPLOYERS' LIA BILfrY YIN � ANYPROPRIE-TOR/PARTNERJEXECUTIVE [— OFFICERIMEMBER EXCLUDED NIA E L EACH ACCIDENT $1000000 (Mandatory in NH) E L DISEASE - EA EMPLOYEEF. 1000 000 Dee, describe under ................ D-SCRIPTIO, OPERATIONS below - 'N OF OFF I E L DISEASE -POLICY LIMIT 1,000.000 C Professional Liability ENN611074 8/1/2024 811/2025 PerClaim $2 000, 00o 1 Aggregale $2X.)00,000 L_ DESCRIPTION OF OPERATIONS I LOCATIONS [VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) Waiver of subrogation for workers' compensation applies in favor of City of El Segundo per attached form 4_'WC 040306 Ed- 4-84 City of El Segundo 350 Main Street El Segundo CA 90245 ACORD 25 (2016/03) CANCELLATION 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 @ 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 4-84) 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 0 % of the California workers' compensation premium otherwise due on such remuneration. Schedule Person or Organization CITY OF EL SEGUNDO 350 MAIN ST. EL SEGUNDO, CA 90245 The charge for this endorsement is $ 250 Job Description 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.) This endorsement, effective 08/01/2024 Policy No. EIG 2904767 05 Issued to FAILSAFE TESTING LLC Premium $10,126 Countersigned at at 12:01 AM standard time, forms a part of Of the EMPLOYERS PREFERRED INS. CO. on Carrier Code 00920 0 Endorsement No. Authorized Representative C 04 03 06 (Ed. 4-84) © 1998 by the Workers' Compensation Insurance Rating Bureau of California. All rights reserved.