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PROOF OF INSURANCE (2025 - 2025) CLOSEDa DATE (MMIDD/YYYY) ACCO�'"�'" CERTIFICATE OF LIABILITY INSURANCE 1. 11 /22/2024 'A *W— 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 Sierra Oak Insurance Services Inc CONTACT ..� __"... . NAME ..., Daniel Brock 'FAX ..... PHONE 9163647380 9700 Business Park Drive Suite 105 C-MAIL Sacramento CA 95827 Dakirlc corn ss��cer9�r��ae�rr�,_- _�__..... .._ .._ ..... m ._... i'NSURGR(SI AF�'OItLiING COVN:.RAGE _ ,,,,, NA&C � ... gNSUREiiA: Nava 0rS §p ial� �nS C0 36056 FSCONTA? INSURED... .. ..... INSURER National Ins Co �..... 14167 FS Contractors, Inc. aOne INsuReRc. Insurance dam an o the West 27847 14838 Bledsoe St Sylmar CA 91342 URER D Securlt National) sur w. _ ... _. once o — 19879-...... ,. Insurance srt�ur� E Llat� of Londvrro Insva.-_ Co .... ......—. � ......52,02 , INSUREIRF. Mt. Havdey Insurance Company 37974 COVERAGES CERTIFICATE NUMBER: 1593246636 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR I FIL FOLICY rLKIOU 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, POLICIES.LIMITS SHOWN D CLAIMS. OF SUCH ~J BEEN RED�cLTEX INrREXCLUSIONSTMPDCONDITIONS �.. LlMtrs Abby uMVE viv BER A X COMMERCIAL GENERAL LIABILITY Y LA24CGLZOD4RWIC 1/13/2024 1/13/2025 EACH OCCURRENCE $1 0001,000 ..� . - CLAIMS -MADE X OCCUR nREdagiSESa ��';nlr¢'k'aarmat,) .. $' 100,000 .. MED EXP (Any ono parson) ...PERSONAL ,.__...... ........m _..... ........._. dI ADV INJURY . $1,0001000 .00 - GEN1 AGGREGATE LIMIT APPLIESAG", PER: GRE GATE GENEfkAL... � � $ 2 000„000 ..� POLICY X J ;t;T LLOC PRODUCTS-COMP/OPAGGmm m$„,000,0if0 mm ,m $ OTHER: D AUTOMOBILE LIABILITY Y SPP181596601 8/26/2024 8/26/2025 COMBNEDSINCaLSL.Ip6gT $1,000,000 ANYAUTO BODILY INJURY (Per person) $OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTO 11-x­ HIRED S ONLY AUTOS X NON -OWNED �ac�laCurt,'h $ AUTOS ONLY AUTOS ONLY _.,,,,�� -°°-- ••�° A UMBRELLA LIAB X OCCUR SF24EXCZOD40LIC 1/13l2024 1/13/2025 EACHOCCUR,RENCE _.. .._. ,000,000 5a�,mmmm,� mm X EXCESS LIAB � CLAIMS -MADE. .... AGGREGATE $8 O'0,000 mmm,,,l7 ..,._. CIEO RETIENTI N ....._. C WORKERS COMPENSATION WSA503277109 7/31/2024 7/31/2025 X T.�'(Uj �1�i^d AND EMPLOYERS' LIABILITY Y P N ANYPROPRIETOR/PARTNER/EXECUTIVE Y ,,,, ,.,, $1 000 000 .,...—.�..-...,-.. ... OFFICER/MEMBEREXCLUDED? ('Ma,ndato ry In NH) N / A E.L, D SEASECID EMq' U.C3YE.E ... ., ... $1 00 000 If yes, describe under DESCRIPTION OF OPERATIONS' b0owY E.L.DISEASE POLICYLIMIT $ B Uabdity ENV56201286901 1/13/2024 1/13/2025 Poll. Each Occurrence2,000,000 Rented/Leased 2.000,000 25,000 F E rPolluuon latgatgon Fwat ofess)onal Uebi ty ILM0718456 ANE5470677.24 8/26/2024 8/13/2024 8/26/2025 8/13/2025 Prof. Each Occurrence 2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Various Locations in the City of El Segundo FY 24-25 ON -CALL CONCRETE SERVICES PROJECT NO. PW 24-12. City of El Segundo to be named additional insured on the general liability & auto. CERTIFICA City of El Segundo 350 Main St. El Segundo, CA 90245 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 EPRESENrAT'UE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD POLICY NUMBER:LA24CGLZOD4RWIC COMMERCIAL GENERAL LIABILITY CG 20 37 04 13 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) Location And Description Of Completed Operations Any person or organization for whom you are performing "commercial construction" during the period of this policy and have agreed in a contract to add as an additional insured for products -completed operations. "Commercial construction" does not include any written habitational or residential construction other than hotels or apartments 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 include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work' 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 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured B. 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 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. CG 20 37 0413 © Insurance Services Office, Inc., 2012 Page 1 of 2 will not be broader than that which you are required by the contract or agreement to provide for such additional insured. CG 20 37 0413 0 Insurance Services Office, Inc., 2012 Page 2 of 2 POLICY NUMBER: LA24CGLZOD4RWIC COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 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) Locations Of Covered Operations Any person or organization for whom you are performing operations during the policy period when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy; and any other person or organization you are required to add as an additional insured under the contract or agreement described above. 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 include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions 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 With respect to the insurance afforded to these additional 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 repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 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. CG 2010 04 13 0 Insurance Services Office, Inc., 2012 Page 1 of 2 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. 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 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. CG 2010 0413 0 Insurance Services Office, Inc., 2012 Page 2 of 2 Policy Number SPP181596601 COMMERCIAL AUTO CA990187 0715 This Endorsement Changes The Policy. Please Read It Carefully BUSINESS AUTO COVERAGE EXPANSION ENDORSEMENT This endorsement modifies insurance provided by the following: BUSINESS AUTO COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the COVERAGE FORM apply unless modified by the endorsement, A. Newly Acquired or Formed Organizations, Employee Hired Car Liability and Blanket Additional Insured Status for Certain Entities. Item 1, Who is an Insured of Paragraph A. Coverage under SECTION II — COVERED AUTOS LIABILITY COVERAGE is amended to add: d. Any organization you newly acquire or form, other than a partnership, joint venture or limited liability company, and over which you maintain ownership of a majority interest (greater than 50%), will qualify as a Named Insured; however, (1) coverage under this provision is afforded only until the 180r�' day after you acquire or form the organization or the end of the policy period, whichever is earlier; (2) coverage does not apply to "bodily injury", "property damage" or "covered pollution cost or expense" that results from an "accident" which occurred before you acquired or formed the organization; and (3) coverage does not apply if there is other similar insurance available to that organization, or if similar insurance would have been available but for its termination or the exhaustion of its limits of insurance. This insurance does not apply if coverage for the newly acquired or formed organization is excluded either by the provisions of this coverage form or by endorsement. e. An "employee" of yours is an "insured" while operating an "auto" hired or rented under a contractor agreement in that "employee's" name, with your permission, while performing duties related to the conduct of your business. f. Any person or organization you are required by written contract or agreement to name as an additional "insured", but only with respect to liability created in whole or in part by such agreement. B. Increase Of Loss Earnings Payment Subpart (4) of a. Supplementary Payments of Item 2. (coverage Extensions of Paragraph A. Coverage under SECTION II — COVERED AUTOS LIABILITY COVERAGE is amended to read: (4) We will pay reasonable expenses incurred by the "insured" at our request, including actual loss of earnings up to $1,000 per day because oftimeofffrom work. C. Fellow Employee Injured By Covered Auto You Own Or Hire Item 5. Fellow Employee of Paragraph B. Exclusions under SECTION II — COVERED AUTOS LIABILITY COVERAGE is amended to add: This exclusion does not apply if the "bodily injury" results from the use of a covered "auto" you own or hire. Such coverage as is afforded by this provision is excess over any other collectible insurance. CA990187 0715 Includes Copyrighted Material of Insurance Services Offices, Inc„ Page 1 of 5 Used with permission D. Limited Automatic Towing Coverage Item 2. Towing, of Paragraph A. Coverage, under SECTION III — PHYSICAL DAMAGE COVERAGE is amended to read: 2. Towing We will pay for towing and labor costs each time that a covered "auto" is disabled. All labor must be performed at the place of disablement of the covered "auto". a. The limit for towing and labor for each disablement is $500; b. No deductible applies to this cover- age. E. Item 3. Glass Breakage — Hitting A Bird Or Animal — Falling Objects or Missiles of Paragraph A. Coverage under SECTION III — PHYSICAL DAMAGE COVERAGE, is amended to add: Glass Repair Coverage We will waive the Comprehensive deductible for Glass, if one is indicated on your covered "auto", for glass repairs. We will repair at no cost to you, any glass that can be repaired without replacement, provided the "loss" arises from a covered Comprehensive "loss' to your "auto". F. Increase Of Transportation Expense Coverage Subpart a. Transportation Expenses of Item 4. Coverage Extensions of Paragraph A. Coverage under SECTION III — PHYSICAL DAMAGE COVERAGE is amended to read: a. Transportation Expenses We will pay up to $50 per day to a maximum of $1,000 for temporary transportation expense incurred by you because of the total theft of a covered "auto' of the private passenger type. We will pay only for those covered "autos" for which you carry either Comprehensive or Specified Causes of Loss Coverage or Theft Coverage. We will pay for temporary transportation expenses incurred during the period beginning 48 hours after the theft and ending, regardless of the policy's expiration, when the covered "auto" is returned to use or we pay for its "loss". G. "Personal Effects' Coverage Item 4. Coverage Extensions of Paragraph A. Coverage, under SECTION III - PHYSICAL DAMAGE COVERAGE, is amended to add -- "Personal Effects" Coverage We will pay actual cash value for "loss' to "personal effects' of the "insured" while in a covered "auto" subjectto a maximum limit of $2,500 per "loss', for that covered "auto" caused by the same "accident'. No deductible will apply to this coverage. H. "Downtime Loss' Coverage Item 4. Coverage Extensions, of Paragraph A. Coverage, under SECTION III. PHYSICAL DAMAGE COVERAGE, is amended to add: "Downtime Loss" Coverage We will pay any resulting "downtime loss' expenses you sustain as a result of a covered physical damage "loss" to a covered "auto" up to a maximum of $100 per day, for a maximum of 30 days for the same physical damage "loss", subject to the following conditions: a. We will provide "downtime loss" beginning on the 5`.' day after we have given you our agreement to pay for repairs to a covered "auto" and you have given the repair facility your authorization to make repairs; b. Coverage for "downtime loss" expenses will end when any of the following occur: (1) You have a spare or reserve "auto" available to you to continue your operations. (2) You purchase a replacement "auto'. (3) Repairs to your covered "auto' have been completed by the repair facility and they determine the covered "auto' is road -worthy. (4) You reach the 30 day maximum coverage. CA990187 0715 Includes Copyrighted Material of Insurance Services Offices, Inc. Page 2 of 5 Used with permission I. Item 4. Coverage Extensions, of d. Contraband or property in the course Paragraph A. Coverage, under SECTION of illegal transportation or trade. III. PHYSICAL DAMAGE COVERAGE, is e. "Loss" caused by theft, unless there is amended to add: evidence of forced entry into the We will pay any resulting rental covered "auto." and a police report is reimbursement expenses incurred by you for filed. a rental of an "auto" because of "loss" to a K. Accidental Airbag Discharge Coverage covered "auto" up to a maximum of $100 per day, for a maximum of 30 days for the same Item 3.a. of Paragraph B. Exclusions under physical damage "loss", subject to the SECTION III — PHYSICAL DAMAGE following conditions: COVERAGE is amended to read: a. We will provide rental reimbursement a. Wear and tear, freezing, mechanical incurred during the policy period or electrical breakdown. The beginning 24 hours after the "loss" and exclusion relating to mechanical ending, regardless of the policy break -down does not apply to the expiration, with the number of days accidental discharge of an air bag. reasonably required to repair or replace L. Loan or Lease Gap Coverage the covered "auto'. If the "loss" is Paragraph C. Limit Of Insurance under caused by theft, this number of days is SECTION III — PHYSICAL DAMAGE the number of days it takes to locate the COVERAGE is amended to add: covered "auto" and return it to you or the number of days it takes for the claim to If a covered "auto' is owned or leased and be settled, whichever comes first. if we provide Physical Damage Coverage b. Our payment is limited to necessary and on it, we will pay, in the event of a covered total "loss', any unpaid amount due on the actual expenses incurred. lease or loan for a covered "auto", less: c. This coverage does not apply while a. The amount paid under the Physical there are spare or reserve "autos" Damage Coverage Section of the available to you for your operations. policy; and d. If a "loss" results from the total theft of a "auto" b. Any: covered of the private passenger type, we will pay under this coverage (1 ) Overdue lease or loan only that amount of your rental payments including penalties, reimbursement expenses which is not interest or other charges already provided for under the Physical resulting from overdue Damage Coverage Extension. payments at the time of the J. "Personal Effects" Exclusion "loss"; Paragraph B. Exclusions under SECTION (2) Financial penalties imposed under a lease for excessive use, III — PHYSICAL DAMAGE COVERAGE, is abnormal wear and tear or high amended to add: mileage; "Personal Effects" Exclusion (3) Costs for extended warranties, We will not pay for "loss' to "personal Credit Life Insurance, Health, effects" of any of the following: Accident or Disability Insurance a. Accounts, bills, currency, deeds, purchased with the loan or evidence of debt, money, notes, lease; securities or commercial paper or (4) Security deposits not refunded other documents of value. by the lessor; and b. Bullion, gold, silver, platinum, or other (5) Carry-over balances from precious alloys or metals; furs or fur previous loans or leases garments; jewelry; watches; precious or semi-precious stones. c. Paintings, statuary and other works of art. CA990187 0715 Includes Copyrighted Material of Insurance Services Offices, Inc. Page 3 of 5 Used with permission M. Aggregate Deductible Paragraph D. Deductible under SECTION III — PHYSICAL DAMAGE COVERAGE is amended to add: Regardless of the number of covered "autos" involved in the same "loss", only one deductible will apply to that "loss". If the deductible amounts vary by "autos", then only the highest applicable deductible will apply to that "loss". N. Diminishing Deductible Paragraph D. Deductible under SECTION III — PHYSICAL DAMAGE COVERAGE is amended to add: Any deductible will be reduced by the percentage indicated below on the first "loss" reported during the corresponding policy period: Loss Free Policy Periods Deductible With the Expansion Reduction on the Endorsement first "loss" 1 0% 2 25% 3 50% 4 75%_ 5 100%®% If we pay a Physical Damage "loss" during the policy period under any BUSINESS AUTO COVERAGE FORM you have with US, your deductible stated in the Declarations page of each such COVERAGE FORM will not be reduced on any subsequent claims during the remainder of your policy period and your deductible reduction will revert back to 0% for each such COVERAGE FORM if coverage is renewed. O. Knowledge of Loss and Notice To Us Subsection a. of Item 2. Duties In the Event of Accident, Claim, Suit or Loss of Paragraph A. Loss Conditions under SECTION IV -- BUSINESS AUTO CONDITIONS is amended to add. - However, prompt notice of the "accident", claim, "suit" or "loss" to us or our authorized representative only applies after the "accident", claim, "suit' or "loss" is known to: (1) You, if you are an individual; (2) A partner, if you are a partnership; (3) An "executive officer" or director, if you are a corporation; (4) A manager or member, if you are a limited liability company; (5) Your insurance manager; or (6) Your legal representative. P. Waiver Of Subrogation For Auto Liability Losses Assumed Under Insured Contract Item 5. Transfer Of Rights Of Recovery Against Others To Us of Paragraph A. Loss Conditions under SECTION IV — BUSINESS AUTO CONDITIONS is amended to read: 5. Transfer of Rights of Recovery Against Others To Us If any person or organization to or for whom we make payments under this Coverage Form has rights to recover damages from another, those rights are transferred to us. That person or organization must do everything necessary to secure our rights and must do nothing after an "accident" or "loss" to impair them. However, if the insured has waived those rights to recover through a written contract, we will waive any right to recovery we may have under this Coverage Form. Q: Insurance is Primary and Noncontributory Subpart a. of Item 5. Other Insurance of Paragraph B. General Conditions under SECTION IV — BUSINESS AUTO CONDITIONS is amended to read: a. This insurance is primary and noncontributory, as respects any other insurance, if required in a written contract with you. R. Other Insurance — Hired Auto Physical Damage Subpart b. of Item 5..Other Insurance of Paragraph B. General Conditions under' SECTION IV — BUSINESS AUTO CONDITIONS is amended to read: b. For Hired Auto Physical Damage Coverage., the following are deemed to be covered "autos" you own: (1) Any covered "auto"" you lease, hire, rent or borrow; and CA990187 0715 Includes Copyrighted Material of Insurance Services Offices, Inc. Page 4 of 5 Used with permission (2) Any covered "auto" hired or rented by your "employee" under a contract in that individual "employee's" name, with your permission, while performing duties related to the conduct of your business. However, any "auto" that is leased, hired, rented or borrowed with a driver is not a covered "auto". S. Unintentional Failure To Disclose Hazards Paragraph B. General Conditions under SECTION IV — BUSINESS AUTO CONDI- TIONS is amended to add: 9. Your failure to disclose all hazards existing as of the inception date of this policy shall not prejudice the coverage afforded by this policy, provided that such failure to disclose all hazards is not intentional. However, you must report such previously undisclosed hazards to us as soon as practicable after its discovery. T. Additional Definition SECTION V — DEFINITIONS is amended to add: "Personal effects" means personal property owned by the "insured". "Downtime loss" means actual loss of "business income" for the period of time that a covered "auto": 1. Is out of service for repair or replacement as a result of a covered physical damage "loss" and 2. Is in the custody of a repair facility if not a total "loss'. "Business Income" means: 1. Net Income (Net Profit or Loss before income taxes) that would have been earned or incurred; and 2. Continuing normal operating expenses incurred, including payroll. In this endorsement, Headings and Titles are inserted solely for the convenience and ease of reference. They do not affect the coverage provided by this endorsement, nor do they constitute any part of the terms and conditions of this endorsement. All other policy wording not specifically changed, modified, or replaced by this endorsement wording remains in effect. CA990187 0715 Includes Copyrighted Material of Insurance Services Offices, Inc. Page 5 of 5 Used with permission