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PROOF OF INSURANCE (2024) CLOSEDPolicy Number: VARIOUS Date Entered: 11/2/2023 AC" RV CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 11/2/2023 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). ONTACT PRODUCER C.,...�. Diane DeSilva Mary Barnard Insurance 2190 Stokes Street Suite 201 San Jose, CA 95128 INSURED Range Maintenance Services, L.L.C. Donna Foggiato 2 Mesquite Drive Copperopolis, CA 95228 40......) - 334................................._�. F°xa���Q�...�.� 408) 286-6425, jennie@barnardinsurance.com INSURER A: Evanston Insurance Company 35378 INSURERS REDWOOD FIRE AND CASUALTY .. 11673 INS ....,.,..... S.-...... .... ....• ..... .. ,.,.,. uRERc,3TATE COMPEN ATION INSURANCE FUND 35076 INSURER D l _ r�.i�owr_�c f`coTlCIf ATC KII IIU 12CD• RFVISION 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 OF INSURANCE •..A DL .• .. ...... POLICY NUMBER �_.._MMICY EFFY-, ._ I INTR ""I AOOL SUBR.. POLICY EFF PMI DI EXP T IYYYY .... .... LIMITS A COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1 , 000 , 000 CLAIMS -MADE ®OCCUR 3AA720444 11/01/23 11/01/2024 DAMA iISViEN E� , 00 PR�MIS��C.(Eanr�prrencg,�,,,_ $ .. 105,000 MED EXP (Any one persons $ _ .W......_ PERSONAL__& A_DV INJURY $ 1 , 000 , 000 .._ . ��......, GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $20000 00 POH.tCY „.. PRO- JECT . LOC r PRODUCTS COMP/OPAGG W w$mm, INCLUDED -- $ IIS O f H•IERi , AUTOMOBILE LIABILITY COMBINED LIMIT 1 , 000 , 000 B �.._ ANY AUTO 01APM039834-01 11/1/2023 1/1/2029 , BODILY INJURY (Per person) .. $ ... OWNED SCHEDULED BODILY INJURY (Per acci dent) $ ��� HIREDS ONLY I, AUTOS _ NON -OWNED PkdFPE TY DAMAGE $ AUTOS ONLY AUTOS ONLY _ Irr cr rlenl, „-. mm„,_„� .-.,.,.,, ................ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ .... EXCESS LAB _— CLAIMS -MADE AGGREGATE m, $ .. ........ ..m,,,,,e DED RETENTION $ $ WORKERS COMPENSATION PER rH AND EMPLOYERS' LIABILITYYIN __..L. - 00 ... .,,,,,.m..—. $ r OOO , OOO `. ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUE N/A 1760432 11/01/2023 1/01/2024 EACH ACCIDENTER E„ 000, 000 (Mandatory in NH) E EA EMPLOYEE $ , If yes, describe under DESCRIPTION OF OPERATIONS below E..L. DISEASE -POLICY LIMIT $ 1 , 000 , 000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) *TEN DAYS NOTICE OF CANCELLATION APPLIES FOR NON-PAYMENT OF PREMIUM 30 DAYS FOR ALL OTHER. RE: ALL CALIFORNIA OPERATIONS. CERTIFICATE HOLDER IS NAMED AS ADDITIONAL INSURED. 111061�I CITY OF EL SEGUNDO, CITY CLERK ATTENTION: BRIAN EVANSKI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 350 MAIN STREET THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. EL SEGUNDO, CA 90245 AUTHORIZED REPRESENTATIVE nn ©1988-2015 AC RD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABILITY 111 POLICY NUMBER: 3AA720444 (E EVANSTON INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM LIQUOR LIABILITY COVERAGE FORM OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE FORM PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE FORM SCHEDULE Additional Premium $Included (Check box if fully earned ®) Please refer to each Coverage Form to determine which terms are defined. Words shown in quotations on this endorsement may or may not be defined in all Coverage Forms. A. Who Is An Insured is amended to include as an additional insured any person or entity to whom you are required by valid written contract or agreement to provide such coverage, but only with respect to "bodily injury", "property damage" (including "bodily injury" and "property damage" included in the "products -completed operations hazard"), and "personal and advertising injury" caused, in whole or in part, by the negligent acts or omissions of the Named Insured and only with respect to any coverage not otherwise excluded in the policy. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. The insurance afforded to such additional insured will not be broader than that which you are required by the valid written contract or agreement to provide for such additional insured. Our agreement to accept an additional insured provision in a valid written contract or agreement is not an acceptance of any other provisions of such contract or agreement or the contract or agreement in total. When coverage does not apply for the Named Insured, no coverage or defense will apply for the additional insured. No coverage applies to such additional insured for injury or damage of any type to any "employee" of the Named Insured or to any obligation of the additional insured to indemnify another because of damages arising out of such injury or damage. B. With respect to the insurance afforded to these additional insured, the following is added to limits of insurance: The most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the valid written 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 unchanged. MEGL 0009-01 09 18 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 1 with its permission. COMMERCIAL GENERAL LIABILITY III POLICY NUMBER: 3AA720444 (EI EVANSTON INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM SCHEDULE ................... Name Of Person Or Organization: Any person(s) or organization(s) with whom the Named Insured agrees, in a written contract executed prior to the 'occurrence", to waive rights of recovery Additional Premium: $ Included The following is added to Condition 8. Transfer Of Rights Of Recovery Against Others To Us under Section IV — Commercial General Liability Conditions: We waive any right of recovery we may have against any person or organization shown in the Schedule of this endorsement. This waiver applies only to the person or organization shown in the Schedule of this endorsement. All other terms and conditions remain unchanged, MEGL 0241-01 05 16 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 1 with its permission. ENDORSEMENT AGREEMENT :.,�91 m ■.. WAIVER OF SUBROGATION BLANKET BASIS HOME OFFICE SAN FRANCISCO EFFECTIVE NOVEMBER 1, 2023 AT 12.01 A.M. ALL EFFECTIVE DATES ARE AND EXPIRING NOVEMBER 1, 2024 AT 12.01 A.M. AT 12:01 AM PACIFIC STANDARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME RANGE MAINTENANCE SERVICE, LLC 301 MARY BELLE WAY ANGELS CAMP, CA 95222 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. THE ADDITIONAL PREMIUM FOR THIS ENDORSEMENT SHALL BE 2.00% OF THE TOTAL POLICY PREMIUM. SCHEDULE PERSON OR ORGANIZATION JOB DESCRIPTION ANY PERSON OR ORGANIZATION BLANKET WAIVER OF FOR WHOM THE NAMED INSURED SUBROGATION HAS AGREED BY WRITTEN CONTRACT TO FURNISH THIS WAIVER 1760432-23 RENEWAL SC 6-17-16-03 PAGE 1 OF 1 NOTHING IN THIS ENDORSEMENT CONTAINED SHALL BE HELD TO VARY, ALTER, WAIVE OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS POLICY OTHER THAN AS STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR LIMITATIONS OF THIS ENDORSEMENT. COUNTERSIGNED AND ISSUED AT SAN FRANCISCO: 2572 AUTHORIZED REPRESENT KIVE SCIF FORM 10217 (REV.7-2014) NOVEMBER 2, 2023 PRESIDENT AND CEO OLD DP 217