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PROOF OF INSURANCE (2024 - 2025) CLOSED�H CERTIFICATE OF LIABILITY INSURANCE DATEIMMYYYYI 09/O6/20,024 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 pollcy(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 an this certificate does not confer rights to the certificate holder in lieu of Such endorsement(s). PRODUCER NANATt CLIENT CONTACT CENTER FEDERATED MUTUAL INSURANCE COMPANY la'R'Ti'NE "" "" Tr=AX HOME OFFICE: P.O. BOX 329 IA/C, No, Ext): 888-3334949 (AIC, Not: 507-446-4664 _PalOWATONNA, MN 55050 ssm�LPEW �sIN�sCT�LNT�.R FEDINS.C-OM ".... ..�,,� AFFORDING COVERAGE NAIC // INSURER A:FEDERATED MUTUAL INSURANCE COMPANY 13935 INSURED INSURER B: C J CONCRETE CONSTRUCTION, INC. INSURER.. c......................"""� 10142 SHOEMAKER AVE """"""'—' SANTA FE SPRINGS, CA 90671 -3404 INSURER D: INSURER E: .................... .............. INSURER R COVERAGES CERTIFICATE NUMBER: 143 REVISION NUMBER:2 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATE6. 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. IN4R @ TYPE OF INSURANCE ADOL i PO(�NCY NUMBER POOOY EFF ROUCY EXP' LIMITS LTN & INSR MmmwYYYY'. MOUDDIYYYY X COMMERCIAL OENERAL LIABILITY EACH OCCURRENCE $1,000,000 —1 Ww�.. CLAIMS -MADE ❑X OCCUR 1AeNMAOE. TO EYiiO"Ea PkiElMl;$ES $100,000 sd dcaa TO �. MED EXP (Any one pcm.n) $10.000 A Y Y 1845023 11/12/2023 11/12/2024 "" " PERSONAL & PDV IHJURY $1,000,000 _GENERALACGREGATE $2 000 000 OEN'L AOOREOATE LIMIT APPOI�ES �PE.R:; X POLICY p l l'wOC PRODUCTS & COMPIOP ACC $2,000,000 OTHER: COMBINED O C AUTOMOBILE LIABILITY MBINED SINGLE LIMIT ccident $1 D00 000 CO B X AilY AlfrO BODILY INJURY (Per Person) EO AUTOS ONLY .�.... Accident .. A DWw ti�T�T Y IN1845023 11/12/2023 11/12 BODILY INJURY (Per HIRED AUTOS rJWNL:Y X U"ERELIA LIAR X O=UI% EACH OCCURRENCE $8,000,000 A EXC SSLM13 CN AIMB"MADE Y N 1845025 11112,2023 11112/21124 'AGGREOATE $8,000,000 DED REreNnav WORKERS COMPENSATION PER STATUTE THER AND EMPLOYb ERS' UABIUrV YINI ANY PROPRIETORIPARTNER1 EXECUTIVE EL EACH ACCIDENT OFFICERIMEMBER EXCLUDED? '— . """"""""""""""""" m. _ """"""""" (Mandatory In NH) N/A .... E.L DISEASE EA EMPLOYEE If Yes, describe under .. DESCRIPTION OF OPERATIONS below E.L DISEASE POLICY LIMIT DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101. Additlonai Remares Schedule, may be attached If mare space Is required) SEE ATTACHED PAGE CERTIFICATE HOLDER CANCELLATION CITY CLERK CITY OF EL SEGUNDO 1432 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 350 MAIN ST EL SEGUNDO, CA 90245-3813 BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE A'UL M G O 1=-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD AGENCY CUSTO ORCID*. ADDITIONAL REMARKS SCHEDULE Page 1 or 1 _.. AGENCY NAMEDINSURED FEDERATED MUTUAL INSURANCE COMPANY C J CONCRETE CONSTRUCTION, INC. 10142 SHOEMAKER AVE POLICY NUMBER SANTA FE SPRINGS, CA 90670-3404 SEE CERTIFICATE # 1432 _._. CARRIER NAIL CODE EFFECTIVE DATE: SEE CERTIFICATE # 143.2 SEE CERTIFICATE # 143.2 ADDITIONAL REMARKS . .. ... — ...... _.. THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICAQ S.-.._ 8 PW 24-05 PROJECT: CSBG ADA CURB RAMP INSTALLATION, 350 MAIN STREET, EL SEGUNDO, CA 90245 SUBJECT TO THE TERMS AND YOINDIT'30NS OF THE POLICY, ADDITIONAL INSUREDS ALSO INCLUDES THE CITY OF EL SEGUNDO, ITS OFFICERS, EMPLOYEES, AGENTS, AND VOLUNTEERS, SUBJECT TO THE TERMS AND CONDITIONS OF THE POLICY, WAIVER OF SUBROGATION ALSO INCLUDES THE CITY OF EL SEGUNDO, ITS OFFICERS, EMPLOYEES, AGENTS, AND VOLUNTEERS. THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED ON GENERAL LIABILITY SUBJECT TO THE CONDITIONS OF THE ADDITIONAL INSURED - OWNERS, LESSEES, OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION ENDORSEMENT. THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED ON GENERAL LIABILITY SUBJECT TO THE CONDITIONS OF THE ADDITIONAL INSURED - OWNERS, LESSEES, OR CONTRACTORS - COMPLETED OPERATIONS ENDORSEMENT. THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED SUBJECT TO THE CONDITIONS OF THE ADDITIONAL INSURED BY CONTRACT ENDORSEMENT FOR BUSINESS AUTO LIABILITY. INSURANCE PROVIDED BY THE GENERAL LIABILITY COVERAGE IS PRIMARY AND NONCONTRIBUTORY OVER OTHER INSURANCE. INSURANCE PROVIDED BY THE BUSINESS AUTO LIABILITY IS PR334ARY AND NONCONTRIBUTORY OVER OTHER INSURANCE. GENERAL LIABILITY CONTAINS A WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) - AUTOMATIC ENDORSEMENT COMMERCIAL UMBRELLA FOLLOWS FORM ACCORDING TO THE TERMS, CONDITIONS, AND ENDORSEMENTS FOUND IN THE COMMERCIAL UMBRELLA POLICY. FOR NON-PAYMENT OF PREMIUM, 10 DAYS NOTICE WILL BE PROVIDED TO THE CERTIFICATE HOLDER IN THE EVENT THAT THE ISSUING COMPANY CANCELS THE POLICY BEFORE THE EXPIRATION DATE OF THE POLICY. FOR REASONS OTHER THAN NON-PAYMENT OF PREMIUM, 30 DAYS NOTICE WILL BE PROVIDED TO THE CERTIFICATE HOLDER IN THE EVENT THAT THE ISSUING COMPANY CANCELS THE POLICY BEFORE THE EXPIRATION DATE OF THE POLICY. ACORD 101 (2008/01) O 2008 ACORD CORPORATION, All rights reserved. The ACORD name and logo are registered marks of ACORD COMMERCIAL AUTO CA 04 49 11 16 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION 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. A. The following is added to the Other Insurance Condition in the Business Auto Coverage Form and the Other Insurance - Primary And Excess Insurance Provisions in the Motor Carrier Coverage Form and supersedes any provision to the contrary: This Coverage Form's Covered Autos Liability Coverage is primary to and will not seek contribution from any other insurance available to an "insured" under your policy provided that: 1. Such "insured" is a Named Insured under such other insurance; and 2. You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to such "insured". B. The following is added to the Other Insurance Condition in the Auto Dealers Coverage Form and supersedes any provision to the contrary: This Coverage Form's Covered Autos Liability Coverage and General Liability Coverages are primary to and will not seek contribution from any other insurance available to an "insured" under your policy provided that: 1. Such "insured" is a Named Insured under such other insurance; and 2. You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to such "insured". © Insurance Services Office, Inc., 2016 Page 1 of 1 CA 04 49 11 16 Policy Number: 1845023 Transaction Effective Date: 11/12/2023 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED BY CONTRACT ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE PART With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. A. WHO IS AN INSURED for "bodily injury" and "property damage" liability is amended to include: Any person or organization other than a joint venture, for which you have agreed by written contract to procure bodily injury or property damage "auto" liability insurance arising out of operation of a covered "auto" with your permission. However, this additional insurance does not apply to: (1) The owner or anyone else from whom you hire or borrow a covered "auto". This exception does not apply if the covered "auto" is a "trailer" connected to a covered "auto" you own. (2) Your "employee" if the covered "auto" is owned by that "employee" or a member of his or her household. (3) Someone using a covered "auto" while he or she is working in a business of selling, servicing, repairing, parking or storing "autos" unless that business is yours. (4) Anyone other than your "employees", partners (if you are a partnership), members (if you are a limited liability company), or a lessee or borrower or any of their "employees", while moving property to or from a covered "auto". (5) A partner (if you are a partnership), or a member (if you are a limited liability company) for a covered "auto" owned by him or her or a member of his or her household. B. The coverage extended to any additional insured by this endorsement is limited to, and subject to all terms, conditions, and exclusions of the Coverage Part to which this endorsement is attached. In addition, coverage shall not exceed the terms and conditions that are required by the terms of the written agreement to add any insured, or to procure insurance. C. The limits of insurance applicable to such insurance shall be the lesser of the limits required by the agreement between the parties, or the limits provided by this policy. D. Additional exclusions. The insurance afforded to any person or organization as an insured under this endorsement does not apply: 1. To "loss" which occurs prior to the date of your contract with such person or organization; 2. To "loss" arising out of the sole negligence of any person or organization that would not be an insured except for this endorsement. 3. To "loss" for any leased or rented "auto" when the lessor or his or her agent takes possession of the leased or rented "auto" or the policy period ends, whichever occurs first. Includes copyrighted material of Insurance Services Office, Inc. with its permission. CA-F-127 (03-03) Policy Number: 1845023 Transaction Effective Date: 11/12/2023 COMMERCIAL GENERAL LIABILITY CG 20 01 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. iWE911#4:9 91 11 • 1 • This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS 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 your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and (2) You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. © Insurance Services Office, Inc., 2018 Page 1 of 1 CG 20 01 12 19 Policy Number: 1845023 Transaction Effective Date: 11/12/2023 POLICY NUMBER: 1845023 COMMERCIAL GENERAL LIABILITY CG 20 10 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OIL CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization (s): Location(s) Of Covered Operations City Clerk City of El Segundo Any coverage provided by this endorsement 350 Main St applies only to Project: ## PW 24-05, CSBG ADA El Segundo, CA 90245-3813 Curb Ramp Installation, 350 Main Street, El Segundo, CA 90245. Subject to the terms and conditions of the policy, Additional Insureds also includes The City of El Segundo, its officers, employees, agents, and volunteers. Information required to complete this Schedule„ xf not shown above, will be shown in the Declarations. A. Section 11 - Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following additional organization(s) shown in the Schedule, but only exclusions apply: with respect to liability for "bodily injury", This insurance does not apply to "bodily " y y injury or "property damage" or "personal and advertising�� property damage occurring after: in injury" caused, in whole or in part, by: 1. All work, including materials, parts or 1. Your acts or omissions; or equipment furnished in connection with such 2. The acts or omissions of those acting on your work, on the project (other than service, behalf; maintenance or repairs) to be performed by or in the performance of your ongoing operations for on behalf of the additional insured(s) at the the additional insured(s) at the location(s) location of the covered operations has been designated above. completed; or However: 2. That portion of "your work" out of which the injury or damage arises has been put to its 1. The insurance afforded to such additional intended use by any person or organization insured only applies to the extent permitted by other than another contractor or subcontractor law; and engaged in performing operations for a 2. If coverage provided to the additional insured principal as a part of the same project. is required by a contract or 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. © Insurance Services Office, Inc., 2018 Page 1 of 2 CG 20 10 12 19 Policy Number: 1845023 Transaction Effective Date: 09/06/2024 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 Insured: C J Concrete Construction, Inc. 10142 Shoemaker Ave Santa Fe Springs, CA 90670-3404 2. Available under the applicable limits of insurance; whichever is less. This endorsement shall not increase the applicable limits of insurance. Page 2 of 2 © Insurance Services Office, Inc., 2018 CG 20 10 12 19 Policy Number: 1845023 Transaction Effective Date: 09/06/2024 POLICY NUMBER: 1845023 COMMERCIAL GENERAL LIABILITY CG 20 37 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURE - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations _~ City Clerk City of El Segundo See IL-F-40-00015 50 Main St I Segundo, CA 90245-3813 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 B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following is added to organization(s) shown in the Schedule, but only Section III - Limits Of Insurance: with respect to liability for "bodily injury" or If coverage provided to the additional insured is "property damage" caused, in whole or in part, by required by a contract or agreement, the most we your work" at the location designated and will pay on behalf of the additional insured is the described in the Schedule of this endorsement amount of insurance: performed for that additional insured and included in the "products -completed operations hazard". 1. Required by the contract or agreement; or However: 2. Available under the applicable limits of 1. The insurance afforded to such additional insurance; insured only applies to the extent permitted by whichever is less. law; and This endorsement shall not increase the applicable 2. If coverage provided to the additional insured is limits of insurance. required by a contract or 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. Insured: C J Concrete Construction, Inc. 10142 Shoemaker Ave Santa Fe Springs, CA 90670-3404 © Insurance Services Office, Inc., 2018 Page 1 of 1 CG 20 37 12 19 Policy Number: 1845023 Transaction Effective Date: 09/06/2024 IL-F-40-00015 Extension Endorsement Any coverage provided by this endorsement applies only to Project; # PW 24-05, CSBG ADA Curb Ramp Installation, 350 Main Street, E1 Segundo, CA 90245. Subject to the terms and conditions of the policy, Additional Insureds also includes The City of E1 Segundo, its officers, employees, agents, and volunteers. IL-F-40-00015 (06-10) Policy Number: 1845023 Transaction Effective Date: 09/06/2024 COMMERCIAL GENERAL LIABILITY CG24531219 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBL ROGATION) - AUTOMATIC This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART ELECTRONIC DATA LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART DESIGNATED SITES POLLUTION LIABILITY LIMITED COVERAGE PART DESIGNATED SITES PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART UNDERGROUND STORAGE TANK POLICY DESIGNATED TANKS The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV - Conditions: We waive any right of recovery against any person or organization, because of any payment we make under this Coverage Part, to whom the insured has waived its right of recovery in a written contract or agreement. Such waiver by us applies only to the extent that the insured has waived its right of recovery against such person or organization prior to loss. © Insurance Services Office, Inc., 2018 Page 1 of 1 CG 24 53 12 19 Policy Number: 1845023 Transaction Effective Date: 11/12/2023 Federated Mutual Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. LIMITED AMENDMENT OF CANCELLATION PROVISIONS All Coverage Parts included in this policy are subject to the following conditions: If we cancel this policy, we will mail advance notice to the person(s) or organization(s) as shown in the Schedule. SCHEDULE Insured: C J Concrete Construction, Inc. 10142 Shoemaker Ave Santa Fe Springs, CA 90670-3404 Includes copyrighted material of Insurance Services Office, Inc., with its permission. IL-F-50 (04-13) Policy Number: 1845023 Transaction Effective Date: 08/29/2024 DATE (MMIDD/YYYY) C" CERTIFICATE OF LIABILITY INSURANCE 9/13/2024 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("tes) 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 endorsem,ent(s). PRODUCER NAME:: rMUNc888-988-2347 (AIC,.No Behr Insurance Services Inc. AIC No Ext 1420 E Los Angeles Ave #203 ADDRESS. servtccCccbciutlrls coin INSURER('Sl AFFORDING COVERAGE NAIC # Simi VAtlley CA 93065 INSURER A: COREPOINTE INS CO 10499 INSURED INSURER B : CJ Concrete Construction Inc INSURER C 10142 SHOEMAKER AVE INSURER D : INSURER E SANTA FE SPRINGS CA 90670-3404 INSURER F' i COVERAGES CERTIFICATE NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAM INDICATED. NOTWITHSTANDING ANY REQUIREMENT„ TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUM CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREII EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OF INSURANCE IN30 WVD POLICY NUMBER COMMERCIAL GENERAL LIABILITY CLAIMS -MADE DIOCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY J PEC"r RO. LOC .. OTHER: AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED '..AUTOS ONLY R AUTOS ONLY UMBRELLA LIAB OCCUR EXCESS LIAB CLAIMS -MADE DED RETENTION $ ' WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N NYPRoPRET"OrUPART'NEfVEXECU'PIVE A FFICERIMEMBER EXCLUDEDs w NIA Y CTP1002477 05/08/2024 05/08/2025 IMandatory'in NH) If yea, desonbe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is rer PROJECT NO..: PW 24-09 Waiver Of Subrogation applies to workers compensation per attached WC 04 03 06 endorsement. GCVICrlW hli IRAM11=10. ED ABOVE FOR °I HE POLICY PERIOD ENT WITH RESPECT TO WHICH THIS I IS SUBJECT TO ALL THE TERMS, LIMITS EACH OCCURRENCE $ PREMISES IEa ocxurrencei $ MED EXP (Any one pw=0 $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ $ ¢Ea accaderwl) BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ (Pw accjderut) $ EACH OCCURRENCE $ AGGREGATE $ STATUTE ER y E.L. EACH ACCIDENT $ 1,000,000 E.L., DISEASE -EA EMPLOYEE $ 1,000,000 '..E.L,DISEASE -POLICY LIMIT $ 1,000,000 wired) CERTIFICATE HOLDER ""'• ' "`'"""' 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. 350 Main Street AUTHORIZED REPRESENTATIVE Jo+.aiHaw Bcl+r El Segundo, CA 90245 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD