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PROOF OF INSURANCE (2025 - 2025) CLOSEDGLADGOV-01 GONAI ACORO` DATE (MMMDNYYY) CERTIFICATE OF LIABILITY INSURANCE 10/22/2024 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 certificatemholder is an ADDITIONAL ..._..,.,_ ........_. �............ ...... AL 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). �._ T Bartleson PHUB O Box 534 International nsurance PHONE Jordan FAX PRODUCER License I NAME Insurance Services Inc. PHSA Jordan. 77?-8 N� 951 231-2565 yA�c r � (51 779 8575 .. .....—L�..... ......._. - Riverside, CA 92517 AIL ADDRESS son@iTubinternational.com INSURED INSURER. B Hartford c en t and Indernnit iaGi'N a'n 57 Gladwell Governmental Services, Inc. IN tjg ert� Hartford Casuik( gn k Tncq C9rnlp rl 29da 4 P.O. Box 62 INSURER D :United States LlabiNi Insurance 2585 Lake Arrowhead, CA 92352 INSUR7tE ........ ... .,,,,,.., ........,.,..� .......,.._............... . .�...... _..�_. ............. _... � INSURER.F.:........ COVERAGES 'C I TIFIC&T kUM_ ER........ .....� .. ...... R VISION 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 POLICYMAY HNUMBER BEEN REDUCED F POLICY CLAIMS. TYPE OFINSURANCE OF C POLICIES. --.. rIC F .{ C Xn. ..-. .. �., .. ... . ...DL $UBR POLICY inF II�.Y EitP LIMITS EAC CLAIMS-MADE � X ! OCCUR X 72SBABF4UK2 10/31/2024 10/31/2025 DAMAGE RE T rr m y� m 2000 000 A X COMMERCIAL GENERAL LIABILITY 2,000,000 _...... w. m 10,000 TF LIMIT APPLIES PER: ...... cf~;�a� Al��ra;� _ PER: GrrarRAi A�;cRrOAr. � 4 000 000 POLICY X1 spC1:1 LOC ,P,Si�0�74tCA6..; 9gMP1OPAgq A: ,... yy 4,000,000 ,,,,.,. "w'rHEPi.: .........r B AUTOMOBILE LIABILITY CM N?EDS iNGLF i cMIT $ ...� ,000 000 X ANY AUTO 72UECPT0490 10/31/2024 10/31/2025 B2DIL, !N�fhR�Y(Pcr won-) OWNED SCHEDULED AUTOS ONLY AUTOS f,7PcRTY �tfAGlm _ ryg�� O OO AUTOS ONLY ATOLNtJYDaceirlflRar sucwdent,ILY IN, ,..' .................. ........._............... .......... .: ,.....,,....�.. _ EACH4`�CChfRRPNLE. '$ L EXCESS LIABAB .... OLAIMS MADE Ar'REC'F1V ... e..,......,,, . yyy,y,y. DED RETENTION $ C WORKERS COMPENSATION PER AND EMPLOYERS' LIABILITY X ETA "LVN L .„,i„'.RI vela 72WECAV7EWT 2/1/2024 2/1/2025 W. 1 ANY PROPRIETOR/PARTNER/EXECLITIVE ,illlt),tllll OOF6'.gCEi?.�hl •:MBER EXCLUDED? N N / A E'L EJ4Cf 8 AirCIOE.N'r $ (hAaurdafarry n NH) ��. , . _ 1,000,000 E.L.DISEA,Sir„,�, A EMPLOYEE S Id rtus,descnbeundaT D cRIPTION fail gLPga �Tfc��us ianlow _ E.L MSEA,1E - POUC'Y UMI r � 1,000„000 D Professional L)ab. SP 1020955N 1013112024 10131/2025 Per Occurrence _ 1,000,000 D Professional Liab. SP 1020955N 10/31/2025 Aggregate 2,000,000 .__ .... �.........._. .�_ [10/�311/2024 ......... .... ,........._....--------- �..� DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional RemarUs Schedule, may be attached It more ssPace Is requlrod) City of El Segundo Is Additional Insured with regard to General Liability when required by written (contract per the attached endorsement form SL3042 10118. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of El Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ty g ACCORDANCE WITH THE POLICY PROVISIONS. City Clerk 350 Main Street ....... ............ ..... „.. ...... ......... El Segundo, CA 90245 AUTHORIZED REPRESENTATIVE 4'l r�.'__.m. . . ........ . . ............... .. . ...... . .................. . ACORD 25 (2016/03) ©1988 2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD INSURED: Gladwell Governmental Services, Inc. POLICY NUMBER: 72SBABF4UK2 EFFECTIVE DATES: 10/31/2024 to 10/31/2025 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, THE HARTFORD ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: BUSINESS LIABILITY COVERAGE FORM Except as otherwise stated in this endorsement, the terms and conditions of the Policy apply. A. The following is added to Section C. WHO IS AN INSURED: Designated Person Or Organization a. The person(s) or organization(s) shown in the Declarations as Additional Insured — Designated Person Or Organization is also an additional insured, but only with respect to liability for "bodily injury', "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: (1) In the performance of your ongoing operations; or (2) In connection with your premises owned by or rented to you. b. If coverage provided to these additional insureds is required by a written contract or written agreement, or when required by a written permit issued by a state or governmental agency or subdivision or political subdivision, the insurance afforded to these additional insureds will not be broader than that which you are required by the contract, agreement, or permit to provide for these additional insureds. c. The insurance afforded to these additional insureds only applies to the extent permitted by law. B. With respect to the insurance afforded such additional insured(s) by this endorsement, the following additional exclusion is added to Section B. EXCLUSIONS: This insurance does not apply to "bodily injury" or "property damage" included within the "products -completed operations hazard". Form SL 30 42 10 18 © 2018, The Hartford (May include copyrighted material of Insurance Services Office, Inc., with its permission) Page 1 of 1 INSURED: Gladwell Governmental Services, Inc. POLICY NUMBER: 72SBABF4UK2 EFFECTIVE DATES: 10/31/2024 to 10/31/2025 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. THE " HARTFORD ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS POLICY NUMBER: 72 SBA BF4UK2 This endorsement modifies insurance provided under the following: BUSINESS LIABILITY COVERAGE FORM Except as otherwise stated in this endorsement, the terms and conditions of the Policy apply. The following is added to Section C. WHO IS AN INSURED: Additional Insured — Owners, Lessees Or Contractors — Completed Operations a. The person(s) or organization(s) shown in the Schedule on the Declarations is also an additional insured, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" and at the location designated and described in the Location And Description Of Completed Operations Schedule in the Declarations performed for that additional insured and included in the "products -completed operations hazard". b. With respect to the insurance afforded to these additional insureds, this insurance does not apply to "bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of, or the failure to render, any professional architectural, engineering or surveying services, including: (1) The preparing, approving, editing of or failure to prepare or approve, shop drawings, maps, opinions, reports, surveys, change orders, field orders, designs, drawings, specifications, warnings, recommendations, permit applications, payment requests, manuals or instructions; (2) Supervisory, inspection, quality control, architectural, engineering or surveying activities or services; (3) Maintenance of job site safety, construction administration, construction contracting, construction management, computer consulting or design software development or programming service, or selection of a contractor or programming service; (4) Monitoring, sampling, or testing service necessary to perform any of the services included in (1), (2) or (3) above; (5) Supervision, hiring, employment, training or monitoring of others who are performing any of the services included in (1), (2) or (3) above; c. The insurance afforded to these additional insureds only applies to the extent permitted by law. d. If coverage provided to these additional insureds is required by a written contract, agreement or written permit issued by a state or governmental agency or subdivision or political subdivision, the insurance afforded to these additional insureds will not be broader than that which you are required by the contract, agreement or permit to provide for these additional insureds. Form SL 30 36 10 18 Page 1 of 1 Process Date: 08/07/2024 © 2018, The Hartford Policy Expiration Date: 10/31/2025 (May include copyrighted material of Insurance Services Office, Inc., with its permission) CITY OF EL SEGUNDO WORKERS' COMPENSATION DECLARATION WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SUBJECTS AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN LABOR CODE § 3706, INTEREST, AND ATTRNEY'S FEES. I affirm under penalty of perjury under the laws of California one of the following declarations: U I have and will maintain a certificate of consent of self -insure for workers' compensation, issued by the Director of Industrial Relations as provided for by Labor Code § 3700 for the performance of the work set forth the agreement with the City of El Segundo. Policy No. (__) I have and will maintain workers' compensation insurance as required by labor Coats. § 3700 for the performance of the 'work for which the agreement with the City of El Segundo is executed. My workers' compensation'insurance carrier and policy number are: Carrier Name of Agent Policy Number Expiration Date Phone # alI certify that, in the performance of the work set forth in the agreement with the City of SI Segundo„ I will not p any person in any manner so as to become subject to the workers' compensation laws of California,. and agree that, It I should become subject to the workers' compensation provisions of Labor Code 3700 f rmuat. immediately comply with those provisions or the agreement will, automatically become void. Signature of Applicant Print Name Agreement for: tledwell Iomrerrmmermtei services, Inca. Reviewed by: �— --� Dated: 9