PROOF OF INSURANCE (2024 - 2025)DATE (MMIDDIYYYYj AC "RO CERTIFICATE OF LIABILITY INSURANCE L� 10r30r2024 THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOTAFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE 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 CONT.,. Jhosel Crenshaw PHONE (818) 898-1043 AIC,, N¢ Chesapeake Insurance Services inc., 16654 Soledad Canyon Rd,., #540 A' RESS INSURER(S) AFFORDING COVERAGE NAIC p Canyon County CA 91387 wsURERA: Mount Hawley Insurance Company 37974 INSURED INSURER B : Indian Harbor Insurance Company 36940 INSURERC: Morillo Construction Inc INSURERD: 227 N. Holliston Ave INSURER E INSURERF: Pasadena CA 91106 nwre A n_ rc I^1=0T1CIf`ATC NI IMIRFR• 2U24 KtviNUN Nuivitirm: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDINGANY REQUIREMENT, TERM OR CONDITION OFANY 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 ALLTHE TERMS, EXCLUSIONSAND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF A O wVD POLICY NUMBER LIMITS COMMERCIAL GENERAL LIABILITY (=.ACHQCCL1RREfdCF q, 1,000,000 ,r FII HI E, C'p ra' �rRrt,�md'ai1 $ 50,000 CL.AIIViS-MADE � OCCUR 7107-PERSONAL 1,000 MED EXP(Anv one person) $ A MGL020OB54 ,Iy,,pooi4lRY $ 1,000,000 BENERALAGGREGATE $ 2,000,000 .,»II181 < Afy4rr?E�.iQ Ftllt'L0lblll"i�APPLIES u'I:iT2' 41 p,UL.iCY ,".. � ..GC: :: I :V L PRODUCTS -COMPf0PAGG $ 2,000,000 $ .... O Y Ir'::R cOM4dT77'SNGL'E (LIMP $ '...... AUTOMOBILE LIABILITY P S$CdeI BOI- P,..Y INJURY PPer porsrony $ ANY AU rO BODILY IINJU:dY IPer racc(dem) ' $ OWNED SCHEDULED iEDUP.F: D AUrU16am..Y AUTO`.; HIFf D NON -OWNED i �rrv�1 �rriV $ AU TOS OINLY AU I OS ONLYW'� UMBRELLA LIAB X .. OCCUR EACH OCCURRENCE $ 5,000 000 A X EXCESS LIAB CLAIMS -MADE MXL0439482 10/29/2024 10/29/2025 AGGREGATE $ 5,000,000 DELI RETENTION $ $ WORKERSCOMPENSATOON fF_I4 VrFI-.. TATL.rt'E ER AND EMPLOYERS" LIABILITY Y 1 N ANY PROPRIEFORIPARTNERIEXECUTIVE EL EACH ACCIDENT _ ..� $ OFFICERIMEMEER EXCLUDED? I (Mandatory in NH) NIA EL.DISEASE . EA EMPLOYEE If yes, describe under DESCRIPTION OF OPERATIONS below E I (.;I , I A. ,6'. - POLICY L..IMI1 ' $ Policy General Aggregate S4,000,000 Professional Liability and B PEC005790904 10l29l2024 10/29/2025 Professional Liability $2,000,000 Contractors Pollution Liability Pollution Liability $2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) [Job #: PW 24-02 Job Type: Urho Saari Swim Stadium] Project No- PVV 24-02 - Urho Saari Swim Stadium City of El Segundo, its officers, officials, employees, agents, and volunteers are named as additional insured. See attached forAl status Issuing insurer will endeavor to mail 30 days notice of cancellation, 10 days for non-payment of premium /'�COTCI ­M U^1 nCD r'ANC.F'I I ATIAN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of El Segudo City Clerk ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street AUTHORIZED REPRESENTATIVE ElSegundo CA 90245 U l!JBU-ZU90 AC:UKLJUUKPCJRAIwN. An nyrns ICa11d1 veu. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD Mt. Hawley Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR 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 All persons or organizations where required All Locations by written contract executed prior to the commencement of your work. 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 in- clude as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property dam- age" or "personal and advertising injury" caused by: 1. Your negligence; or 2. The negligence of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insur- ance 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. B. With respect to the insurance afforded to these addi- tional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or re- pairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or CGL 20 10 08 15 Contains copyrighted material of Insurance Services Office, Inc. with its permission. Page 1 of 2 Insured 2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. C. With respect to the insurance afforded to these addi- tional insureds, the following is added to Section III — Limits Of Insurance: The most we will pay on behalf of the additional insured is: 1. The minimum amount required by any contract or agreement you have entered into to provide additional insured coverage; 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 OF THIS POLICY REMAIN UNCHANGED. CGL 20 10.08 15 Contains copyrighted material of Insurance Services Office, Inc. with its permission. Page 2 of 2 Insured Mt. Hawley Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - 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) (Vendor) Location And Description Of Completed Operations All persons or organizations where required All "Commercial Construction Projects". For by written contract executed prior to the the purpose of this Endorsement, "Commercial commencement of your work. Construction Projects' are defined as buildings or structures constructed for commercial use and also include apartments, hotels, homes for the aged, dormitories or barracks. However, "Commercial Construction Projects" shall not include any building or structure which, in whole or in part,contains individual owner occupied units or dwellings. 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 in- clude as an additional insured the person(s) or organi- zations) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused by your negligence at the location designated and described in the Schedule of this endorsement performed for that additional insured and included in the "products -completed operations hazard". However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and B. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: The most we will pay on behalf of the additional in- sured is: 1. The minimum amount required by any contract or agreement you have entered into to provide addi- tional insured coverage; or 2. Available under the applicable Limits of Insurance shown in the Declarations; 2. If coverage provided to the additional insured is whichever is less, required by a contract or agreement, the insur- ance afforded to such additional insured will not This endorsement shall not increase the applicable be broader than that which you are required by Limits of Insurance shown in the Declarations. the contract or agreement to provide for such additional insured. ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED. CGL 20 37 08 16 Contains copyrighted material of Insurance Services Office, Inc. with its permission. Page 1 of 1 Insured Mt. Hawley Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance Condition (2) You have agreed in writing in a contract or agree - and supersedes any provision to the contrary: ment that this insurance would be primary and would not seek contribution from any other in - Primary And Noncontributory Insurance surance available to the additional insured. This insurance is primary to and will not seek con- tribution 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 CG 20 01 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 Insured Mt. Hawley Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) 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 SCHEDULE Name of Person(s) or Organization(s): All persons or organizations where required by written contract executed prior to the commencement of your work. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. 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 the person(s) or organization(s) shown in the Schedule above because of payments we make under this Coverage Part. Such waiver by us applies only to the extent that the insured has waived its right of recovery against such person(s) or organization(s) prior to loss. This endorsement applies only to the person(s) or organization(s) shown in the Schedule above. CG 24 04 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1 Insured CC_ CERTIFICATE OF LIABILITY INSURANCE DATE(,uo112024 YYYY, i2oza THIS CERTIFICATE IS ISSUED. WAS A MATTER OF INFORMATION ONLY AND CONFERSNORIGHTS UPONTHECERTIFICATE 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 anITAD I ..................""" ._""DDI ..__......... pro ......______ 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 ent�s). _this certificate does not confer rl hts to the certificate holder in lieu of suJA c�eFndPoorseemfmmmIT ........... "" ..................... PRODUCER NTACT ve Commercial Llnes Customee aaud A on, Se ir�tn NORTHEAST AGENCIES ONE FAX 1414 S TRYON ST, CHARLOTTE, NC 26203 p Nst d xtI_1-500 444 44137 is N INSURED MORILLO CONSTRUCTION INC 227 N HOLLISTON AVE Pasadena, CA 91106 INSURER A: INSURER C : INSURER D : INSURER F AFFORDING COVERAGE COVERAGES CERTIFICATE NUMBER: 988571269747551844D110124T213957 REVISION NUMBER: ........... .... —""""" THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE NCE "IT LISTED BELOW HAVE BEEN I 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 _. ':ADDL'SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MMIDDIYYYY) (MMIDD/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS -MADE 1-1 OCCUR R unga:'ce $ - MED EXP (Any one person) PERSONAL & ADV INJURY $ GENERAL AGGREGATE EN"LAG:"aREG�``AT''I'"PLRIIM011TI`APPLIES PER: �mmIT mmmmmmmmmmmmmmmmmmmmm ❑LOG PRODUCTS COMPIOPAGG POLICY �,_ JECT m �............... OTHER: S CO tl SkNGfl.F t.11h4tlT AUTOMOBILE LIABILITY ac E�a tidenarnl .... 51,000 000 ANY AUTO BODILY INJURY Pererson $ OWNED SCY, DULE.O �. ONLY NOI'7 HIRED D N N 902045703 06/03/2024 12/03I2024 B DILX INJURY Per accident ib �l Ai44ACE 1N AUTOS ONLY AtJTaj N Y CP cr ci entp S UMBRELLA LIAB OCCUR EACH OCCURRENCE $........... EXCESS LIAB ,CLAIMS -MADE AGGREGATE $ $ DED RETENTION $ WORKERS COMPENSATION H- AND EMPLOYERS' LIABILITY Y/N ANYPROPRIETOR/PARTNER/EXECUTIVE ❑ N / A E.L EACH ACCIDENT S 0 M B REXCLUDED. '.. (Mandatory n ( rY ) E.L. DISEASE - EA EMPLOYEEmmmIT,........� S ........... If yes, describe under DESCRIPTION OF OPERATIONS below .. _....................................-..,-. _..... .�..�12JO312024----] E.L. DISEASE -POLICY LIMIT ...,. ...See $ .......... _.. ..............,�.. ACORD 101 foradditional coverage details.. A N N 962045703 06/03/2024 , DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City Clrk,City of El Segundo,its Officrs THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Officials, Employees, Agents & Volunteer ACCORDANCE WITH THE POLICY PROVISIONS. 350 MAIN ST EL SEGUNDO, CA 90245-3813 — — •••--- AUTHORIZED REPRESENTATIVE w ......... """ ©1988-2015 ACORD CORPORATION. All reserved. ri hts....... g ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: LOC #: ADDITIONAL REMARKS SCHEDULE Page 1.— of 1 ........... ............................. AGENCY NAMEDINSURED NORTHEAST AGENCIES MORILLO CONSTRUCTION INC ... ._............ .........�........_w......... .,,, ......... 227 N HOLLISTON AVE POLICY NUMBER Pasadena, CA 91106 982045703 CARRIER NAIC CODE United Financial Casualty Company 11770 EFFECTIVE DATE: 0610312024 _... _. ...... ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDU LE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate wofwLiability Insurarroce Additional Coverages Insurance coverage(s) Limits Uninsured/Underinsured Motorist $1,000,000 Combined Single Limit Description of Location/Vehicles/Special Items Scheduled autos only 2008 LAND ROVER RANGE ROVE �' Comprehensive $1,000 Ded Collision $1,000 w/Waiver Ded Rental Reimbursement $50 Per Day ($1,500 Max) Medical Payments $5,000 each person ............ 2019 FORD F150 ............. .......... ......... Comprehensive $1,000 Ded Collision $1,000 w/Waiver Ded Rental Reimbursement $50 Per Day ($1,500 Max) Medical Payments $5,000 each person 2018 MERCEDES-BENZ.S, .......................................... Comprehensive $1,000 Ded Collision $1,000 w/Waiver Ded Rental Reimbursement $50 Per Day ($1,500 Max) Medical Payments $5,000 each person ... ........................ 201 B T't.� MODEL 3 I ............. .. Comprehensive $1,000 Ded Collision $1,000 w/Waiver Ded Rental Reimbursement $50 Per Day ($1,500 Max) Medical Payments $5,000 each person ..... ........ ... 2008 MERCEDES-BENZ GL ....................... ............. Comprehensive $1,000 Ded Collision $1,000 w/Waiver Ded Rental Reimbursement $50 Per Day ($1,500 Max) Medical Payments $5,000 each person ... ... �,.,....., 2015 TESLA MODELS � ..... ........... Comprehensive $1,000 Ded Collision $1,000 w/Waiver Ded Rental Reimbursement $50 Per Day ($1,500 Max) Medical Payments $5,000 each person Liability coverage may not apply to all scheduled vehicles. Additional Information CITY OF EL SEGUNDO, ITS OFFICERS, OFFICIALS, EMPLOYEES, AGENTS AND VOLUNTEERS ACORD 101 (2008101) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD MORICON-Cl AVAAN'T '4` oRo CERTIFICATE OF LIABILITY INSURANCE DATE 10/31/20Y4 _ 1013112024 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICA TE 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 ri hts to the certificate holder In lieu of such endorsement(s) CONTACT IMA, Inc. - Pasadena _. PHONE t5 (626 799-70 T 4 I PRODUCER NAME 00 FA�XArc No 626 33 3475 E. Foothill Boulevard L " E-MAIL Suite 100 i5tM0Rs Pasadena, CA 91107 AFFOett7y, ,....... iNSURwwRi�l_ .._ (fp�Ovtaaa+aE ........... Iw�alc� INSURER..A State Compensation Insurance Fund -California -----{{III ... INSURED T INS URE1.R„6­111 ...•.,...,,......... ,... ........".._, ----.—' ......._ L ......... 0 Morillo Construction Inc 227 N Holliston Ave INSURER INSURER .' Pasadena, CA 91106 ••••••••} INSURER F COVERAGES CERTIFICATE NUMBER _ _ .... REVISIO„IN,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, E BY PAID CLAIMS rNSR AOD StrdR'. SHOWN MAY HAVE BEEN ihfU.. ....... EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS POLICY NUMBER LIMITS �_...... V.Q _ cY F POLICY .:. COMMERCIAL GENERAL LIABILITY F',A "IF9 Off' 94a9iNCT _.-. DAMAGE TO RFNTE0 .•.4 CLAIMS -MADE OCCUR I''tfillNrFS_I<k»; a Kn�m,,,, S DyfHA aycate Purse rut ,.. V INJkV EAkLArtsC'R AGGREGATE LIMIT APPLIES PER: NERA& AC,GUA4P.$ F4rAT_ POI_IC'N' ..,I PRO-ECLOC A•r'"aCa $ __ .:.::. ..,. _.. AUTOMOBILE LIABILITY ... �.•�. 1 ........•_�.......�-..y. OTHER .,.Es1BI'V41DINLC I'GIMgT UR 1PFR7Y"RYIF�ref3r a� S ANY AUTO U�. �V010. Y nNJU .............. _. OWNED SCHEDULED ODI9.Y IN 1LuY (9'+zs'tvardsaatj .._ AUTOS ONLY AUTOS - A T'CY R7�FYV„ g DA..... iC .. HIRED N NH: err+�aaletrtC ...:....._ .. .. . .... .. AUTOS ONLY � $ UMBRELLA LIAR .,..,. OCCUR -.�._.__. .....:...�.. ..... .... P....LLFTER,I,VAlrV£ffL,iNPDiIH � "..,,.. .....,,..-- EXCESS LIAR CLAIM MAOE haGFA.'F ,.".. DED N$. WORKERS COMPENSATION X . AND AT YIN 1r000n00 ANY PROPRIETOR/PARTNER/EXECIVE X ..T' OFFICER/MEMBER EXCLUDED? Y (N/A (Mandatory in NH) E L DOSA«.S'I, EA Cl+1f?l.,'O'Y:Vw 1W,000„000 If as, describe under 1,000,000 If Or OPEki 3TIONS t ulna F-1 DIS£ASr , POL9CY LIfw11 I S __ I mm--- _ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES .....-.. _.... ......_• (ACORD 101, Additional Remarks Scheddulle,., may he attached if more space is required) Re: Urho Saari Swim Satdium, Project # PW-24-02. WC Waiver of Subrogation applies per 2572 attached. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City Clerk ACCORDANCE WITH THE POLICY PROVISIONS. City of El Segundo 350 Main Street El Segundo, CA 90245 AUTHORIZED REPRESENTATIVE �.._... ............. .......................... . ...... ... _ ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ENDORSEMENT AGREEMENT WAIVER OF SUBROGATION BLANKET BASIS HOME OFFICE SAN FRANCISCO EFFECTIVE JANUARY 1, 2024 AT 12.01 A.M. AND EXPIRING JANUARY 1, 2025 AT 12.01 A.M. ALL EFFECTIVE DATES ARE AT 12:01 AM PACIFIC STANDARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME MORILLO CONSTRUCTION INC 227 N HOLLISTON AVE PASADENA, CA 91106 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 ANY PERSON OR ORGANIZATION FOR WHOM THE NAMED INSURED HAS AGREED BY WRITTEN CONTRACT TO FURNISH THIS WAIVER JOB DESCRIPTION BLANKET WAIVER OF SUBROGATION REP 02 9206372-24 RENEWAL SC 4-48-77-29 PAGE 1 OF NOTHING IN THIS ENDORSEMENT SHALL BE HELD TO VARY, ALTER, WAIVE OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS POLICY OTHER THAN AS ABOVE STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR LIMITATIONS IN THIS ENDORSEMENT. COUNTERSIGNED AND ISSUED AT SAN FRANCISCO: 2572 AaT10IED I PRESENT aVE SCIF FORM 10217 IREV.4-2018) JANUARY 4, 2024 PRESIDENT AND CEO 1 OLD DP 217