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PROOF OF INSURANCE (2025)CERTIFICATE OF LIABILITY INSURANCE DATE 4(MMIDD/YYYY) /30/2024 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(les) 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 endorsernent'(s), PRODUCER reylirg OI Ins Brokerage/EPIC PHONE T FAx 3780linMansell Road, Suite 370 qEM�JtX,0 770 670�ectla&Ist GreIMF) 770-67 4 Alpharetta GA 30022 AooREss• greyhng,c�rRst greyfin Onn INSURED KOA Corporation 1100 Corporate Center Drive, Suite 201 Monterey Park, CA 91754 The continental I nce CompaLny . F 35289 National Fide Insurance Co of Hartford .. 20478 Amer.CasualtyCo of PA ....... 20427 Llovd's of London 85202 r`.nVFRAC'F;q r:FRTIFt('ATF NIIMRFR• )Q9A1RHn1; RFVIRIAN NUMRFR- 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. �, ... .... _..� t ----._... ----- ........ -,._. �..LIMITS$ RNSR ADD r,1U' "R POLICY E.F „���d� PE I POLICY., UTR 'NUMBE'.R M5111�� RCIALOGENERA N�......... A COMMERCIAL X IA LIABILITY � C,.,7092014905 5/1/2024Y 1...,. 2025 EACH OCCURRENCE 000 00�0 202 C RRENCE .....p... CLAIMS-MADEOCCUR l 04TE.D _ 61...Jd)(y h�OtY ---....� ( J, ..._ MERSONAIAnyl I $ 1fr,000 „ ..., .... one personl 'j P'L & ADV INJURY 5 1,000' �iC101 ,......... ,......... ..�..---- GE... 'AGGREGATE GCR TI LIMIT . ....... __ ... ... .,.�""......:. ..... . GENERAL AGGREGATE 2, 000 000XTPO OC ROD "SCOMP/OPAGGP1$ OTHER: $ B AUTOMOBILE LIABILITY ..--- 7091863062 5/1/2024 5/1/2025 CU acrNrED MIT C+OFuVBINL.L'1 IN6,.C6,'Lk�..,.-.,....... $ 1,000,000 ................�...,_ ........ ANY AUTO ODILY INJURY (Peres.,, pr) $ OWNED SCHEDULED I f BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS X� HIRED X NON -OWNED �. AUTOS ONLY AUTOS ONLY I I5IFZOPERTY0,AMA'( Leer 94Odangl...., .....,.,� $ '- � _- .....,. 4 I ! I I, $ A X UMBRELLA LIAR X J OCCUR 7092036547 5/1/2024 5/1/2025 EACH OCCURREN4 E S 1�i,000 000 EXCESS LIAR I CLAIMS MADE AGGREGATE $ 1$m000 000 _.j ....... RED �,...X RETFINITIONS I 4 $ C WORKERS COMPENSATION 7092004665 5/1/2024 PER � K1 511 /2025 STA rU y E D 1 H A AND EMPLOYERS' LIABILITY YIN J 7092009168 5/1/2024 5/1 /2025 �X ANYPROPRIETOR/PARTNER/EXECUTIVE"""" N EACH ACCIDENT $1 000000 '•I OFFICERIMEMBEREXCLUDED? (Mandatory�ifm NH f NIA E •-- "". $ 1, 000 0iY0 (t '$4RIPdesN OF OPERATIONS below I E.L DISEASE POLICYLOYrf� LIMiIT .mm ......... $1,000.000 D Professional Liabilityincl. B0146LDUSA2405260 1 5/1/2024 I 5/1/2025 Per Claim $10.000,000 Pollution Liability I Aggregate $10,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) RE: KOA: JB86053 El Segundo On Call CM & Inspection Service. City of El Segundo, its officials, and employees are named as Additional Insured as respects General and Auto Liability as required per written contract or agreement. General Liability is Primary/Non-Contributory per policy form wording. City of El Segundo Attn: Orlando Rodriguez 350 Main Street El Segundo CA 90245-3813 Loll 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® °yp. ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD DATE (MM/DD/YYY` ) CERTIFICATE OF LIABILITY INSURANCE 8/27/2024 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 CONTd#CT NAMEGreyllnC01 Specialist _ Edgewooc Partners Insurance Agency PH�ImIE 77omms7om5324 3780 Mansell Rd. Suite 370 &. N�. g,0 770.w670.5324 _ _ �� ............... E fdAIL re tln cep re fin com Alpharetta GA 30022 op 9.....,y.. A . �9� M.. _."m �... INSURER�StAFFORDING COVERAGE NAIC # INSURER A: The Continental Insurance Compny a�35289 ,.,... .. INSUREHWLOCHNE INSURED R B : National Fire Insurance Co of Hartford_ 20478 H. W. Lochner Inc. IgsuRER c : American Casualty Co of Reading PA 20427 225 W Washington St. _ .. Floor 12 r 42307 INSURER D" Navigators Insurance Company! .... ..._.._". Chicago IL 60606 9 INSURERE: Continental Casual Company .... . 20443 _.� INSURER F : Lloyd's of London 85202 COVERAGES CERTIFICATE NUMBER.' 1656349610 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. .... INSR TYPE OF INSURANCE D L SUaR POLICY NUMBER L'wyn .... _._..____. EXP hPMM OpCY EFf MMLDDYIYYI'Y LIMITS A X COMMERCIAL GENERAL LIABILITY 7092014905 5/1/2024 5/1/2025 0.,000 EACH OCCURRENCE $ 1,00 ....... CLAIMS -MADE OCCUR ! �....... I? FhIiSFS 'RENTED REN. ,: . person) $15,000 MED EXP (An one ....... .................. '..PERSONAL&ADVINJURY $1,000,000 ._ __."RA -_ .. �"-� " GEN'L AGGREGATE LIMIT"A PPLIES PER: E GENERAL AGGREGATE $2,000,000 ....... _ POLICY PRO ❑ LOC PRODUCTS COMP/OP AGG $ 2,000,000 .......... OTHER; B AUTOMOBILE LIABILITY 7091863062 5/1/2024 5/1/2025 COMBINEs GLEL�9T _.$ .m Hem... 1,000,000 ANY AUTO person) BODILY INJURY (Per ... $ ................ X OWNED SCHEDULED BODILY INJURY (Per a $ AUTOS ONLY AUTOS NON -OWNED X ,_-- PROPERTYDAIti«1AGEccident) ............. $ XHIRED _. AUTOS ONLY AUTOS ONLY ide�n' [I!,+r a 11 - .................. A X ALIAB X OCCUR 7092036547 5/1/2024 5/1/2025 EACH OCCURRENCE $15,000,000 D AB CLAIMS -MADE 5DEDXT NY24RXSZOB7XAIV 5/1/2024 5/1/2025 "'mm"�"'� """"""""""""""". _,AGGREGATE $ 15,000,000 RETENTION $ 1 Each OcRLA qre ate $ 10,000,000 C WORKERS COMPENSATION 7092004665 5/1/2024 5/1/2025 OTH- X STATUTE ER kT A AND EMPLOYERS'LIABILITY YIN 7092009168 5/1/2024 5/1/2025 . _ ANYPROPRIETOR/PARTNER/EXECUTIVE Y. N/A E,L. EACH ACCIDENT_ ' m$ 1 000,000 OFFICERIMEMBEREXCLUDED? (Mandatory in NH) ., E.L, DISEASE - EA EMPLOYEE ._.._ W.._ $1 000,000 .-. .. � .. If yes, describe under DESCRIPTION OF OPERATIONS below ... E.L.. DISEASE- POLICY LIMIT $ 1,000,000 F ProfessionaUPollutionLiability B0146LDUSA2405260 5/1/2024 5/1/2025 Per Claim $10,000,000 Aggregate $10,000,000 E Excess Professional EXN288395183 5/1/2024 5/1/2025 Per Claim/Aggregate $10,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: Job Project Number.. JC21188, City of El Segundo Traffic Engineering On -Call„ PS Agreement #6573. City„ its officials and employees are included as Additional Insured in accordance with the policy provisions of the General Liability and Automobile Liability policies, General Liability policy evidenced herein is Primary and Non -Contributory to other insurance available to Additional Insured„ but only in accordance with the policy's provisions. A Waiver of Subrogation is granted in favor of Certificate Holder in accordance with the policy provisions of the General Liability, Automobile Liability and Workers' Compensation policies. CERTIFICATE MOLDER 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. Attn: Lifan Xu 350 Main Street AUTHORIZED REPRESENTATIVE El Segundo CA 90245 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Business Auto Policy Policy Endorsement It is understood and agreed that this endorsement amends the BUSINESS AUTO COVERAGE FORM as follows: SCHEDULE Name of Additional Insured Person Or Organization ANY PERSON OR ORGANIZATION THAT YOU ARE REQUIRED BY WRITTEN CONTRACT OR WRITTEN AGREEMENT TO NAME AS AN ADDITIONAL INSURED. 1. Paragraph A.1. Who Is An Insured of Section II - LIABILITY COVERAGE is amended to include as an additional insured the person or organization scheduled above, but only if you are required by "written contract" to make that person or organization an additional insured under this policy. 2. The insurance provided to the additional insured is limited as follows: a. The person or organization is an additional insured only with respect to "bodily injury" or "property damage" arising out of a covered "auto" and caused by your negligent acts or omissions or the negligent acts or omissions of someone, other than the additional insured, for whom you are legally liable. b. The person or organization is not an additional insured for the person or organization's own acts or omissions, nor those of anyone, other than you, for whom the person or organization is legally liable. c. We will not provide the additional insured any broader coverage or any higher limit of liability than the least that is: (1) Required by the "written contract"; or (2) Afforded to you under this policy. 3. Condition 2. Duties In the Event of Accident, Claim, Suit or Loss of Section IV - BUSINESS AUTO CONDITIONS is amended to add the following conditions applicable to the additional insured: An additional insured under this endorsement will as soon as practicable: a. Give us written notice of an "accident" which may result in a claim or "suit" under this insurance, and of any claim or "suit" that does result; b. Agree to make available any other insurance the additional insured has for a loss we cover under this policy; c. Send us copies of all legal papers received, and otherwise cooperate with us in the investigation, defense, or settlement of the claim or "suit"; and d. Tender the defense and indemnity of any claim or "suit" to any other insurer or self insurer whose policy or program applies to a loss we cover under this policy. But if the "written contract" requires this insurance to be primary and non-contributory, this provision d. does not apply to insurance on which the additional insured is a Named Insured. We have no duty to defend or indemnify an additional insured under this endorsement until we receive from the additional insured written notice of a "suit". 4. Only for the purpose of the insurance provided by this endorsement, SECTION V - DEFINITIONS is amended to add the following definition: m.............. _ ----------- --- ......__................. .......... Form No: CNA71526XX (10-2012) Policy No: BUA 7091863062 Endorsement Effective Date: Endorsement Expiration Date: Policy Effective Date: 05/01 /2024 Endorsement No: 52; Page: 1 of 2 Policy Page: 228 of 807 Underwriting Company: National Fire Insurance Company of Hartford, 151 N Franklin St, Chicago, IL 60606 Lopyrignt UNA All rugnts rteserved. Material used with permission of ISO Properties, Inc "Written contract" means a written contract or written agreement that requires you to make a person or organization an additional insured under this policy, provided the contract or agreement: 1. Is currently in effect or becomes effective during the term of this policy; and 2. Was executed prior to the accident for which the additional insured seeks coverage under this policy. All other terms and conditions of the policy remain unchanged This endorsement, which forms a part of and is for attachment to the policy issued by the designated Insurers, takes effect on the Policy Effective date of said policy at the hour stated in said policy, unless another effective date (the Endorsement Effective Date) is shown below, and expires concurrently with said policy. Form No: CNA71526XX (10-2012) Policy No: BUA 7091863062 Endorsement Effective Date: Endorsement Expiration Date: Policy Effective Date: 05/01 /2024 Endorsement No: 52; Page: 2 of 2 Policy Page: 229 of 807 Underwriting Company: National Fire Insurance Company of Hartford, 151 N Franklin St, Chicago, IL 60606 Copyright CNA All Rights Reserved. Material used with permission of ISO Propert ies, Inc Business Auto Policy Policy Endorsement It is understood and agreed that this endorsement amends the BUSINESS AUTO COVERAGE FORM as follows. SCHEDULE Name of Additional Insured Person Or ANY PERSON OR ORGANIZATION THAT YOU ARE REQUIRED BY WRITTEN CONTRACT OR WRITTEN AGREEMENT TO NAME AS AN ADDITIONAL INSURED. 1 In conformance with paragraph A.1.c. of Who Is An Insured of Section II - LIABILITY COVERAGE, the person or organization scheduled above is an insured under this policy. 2. The insurance afforded to the additional insured under this policy will apply on a primary and non-contributory basis if you have committed it to be so in a written contract or written agreement executed prior to the date of the "accident" for which the additional insured seeks coverage under this policy. All other terms and conditions of the policy remain unchanged This endorsement, which forms a part of and is for attachment to the policy issued by the designated Insurers, takes effect on the Policy Effective date of said policy at the hour stated in said policy, unless another effective date (the Endorsement Effective Date) is shown below, and expires concurrently with said policy. Form No: CNA71527XX (10-2012) Endorsement Effective Date: Endorsement Expiration Date: Endorsement No: 53; Page: 1 of 1 Underwriting Company: National Fire Insurance Company of Hartford, 151 N Franklin St, Chicago, IL 60606 Policy No: BUA 7091863062 Policy Effective Date: 05/01 /2024 Policy Page: 230 of 807 10 Copyright CNA All Rights Reserved. Business Auto Policy Policy Endorsement THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: H. W. LOCHNER INC Endorsement Effective Date: 05/21 /2024 SCHEDULE Names) Of Person(s) Or Organization(s): ANY PERSON OR ORGANIZATION FOR WHOM OR WHICH YOU ARE REQUIRED BY WRITTEN CONTRACT OR AGREEMENT TO OBTAIN THIS WAIVER FROM US. YOU MUST AGREE TO THAT REQUIREMENT PRIOR TO LOSS. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The Transfer Of Rights Of Recovery Against Others To Us condition does not apply to the person(s) or organization(s) shown in the Schedule, but only to the extent that subrogation is waived prior to the "accident" or the "loss" under a contract with that person or organization. Form No: CA 04 44 10 13 Policy No: BUA 7091863062 Endorsement Effective Date: 05/21 /2024 Endorsement Expiration Date: Policy Effective Date: 05/01 /2024 Endorsement No: 71; Page: 1 of 1 Underwriting Company: National Fire Insurance Company of Hartford, 151 N Franklin St, Chicago, IL 60606 m Copyright Insurance Services Office, Inc., 2011