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PROOF OF INSURANCE (2025 - 2026)BREAT-1 OP ID: SP ,a►�oRo CERTIFICATE OF LIABILITY INSURANCE 1 DATE(MMDD 01 /3012025 025 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 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 g NAME, 626-792 500 ISU-The Ultitmla Agency CONTACT _ FAx 639 3848 E. Colorado Blvd. # 2 PHONE , ExJja6 k Taham 0 p Nip 626 792 5 Pasadena, CA 91107 E-MAIL Jack@ultimainsurance.com Tahanian Insurance Services ADDRESS, IN:S.UR.EWS) AFFORDING COVERAGE NAIC # 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. �, .,�. ILTR TYPE OF INSURANCE ADDL SI)eR I, POLICY NUMBER -� WVDDr'p°YYY �� .....,_,., _ ..�-(MM DDYIYYYY MMPD Y EXP LIMITS )PTOLIC IF m... GENERAL LIABdLITY ', I ',., EACH OCCURRENCE $ 1,000,00'. A X COMMERCIAL GENERAL LIABILITY X 6K-150692 DAMAGGETOmRENTED , µ.... .. 01/16/2025 01/16/2026 PI•xEMISEs {Ira caccnuran e) $ 50,00 CLAIMS -MADE OCCUR I MED EX_P (Arty one pt;a»t�rra) $ 10,00 PERSONAL & ADV INJURY S 1,000,00 GENERAL$ 2,000,00 ✓ .( GEN L AGGREGATE L PER. . LIMIT _AGGREGATE PRODUCTS -COMP/OP AGG... S 0 2,000,00 _ X POLICY ICI PRi1•, �I LOG ........ $ AUTOMOBILE LIABILITY ! COMBINED SINGLE I iMiT (Ea acrldenll, $ 1 O00n0O. B ANY AUTO ;BRAU653817 01 /01/2025 01/01/2026 BODILY INJURY (Per person) $ ,. _,. ,.,., ..... ..,. NED SCHEDULED BODILY INJURY raccident) $ AUTOS 'ALLOW X HIRED AUTOSXNON-0WNED A 'VUbLR9YDAMAGE d PER ACQICEN &I . .....� !Comp/Coll S 1000/100 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS MADE AGGREGATE $ DED RETENTION $ WORKERS COMPENSATION xWC STAIU� On"d R TQRY_i iMITSCID AND EMPLOYERS' LIABILITY C ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N ITWC4407849 04/06/2024 04/06/2025 E L, EACH ENT w 1_,000e00 __ OFFICERIMEMBER EXCLUDED? .N / A` (Mandatory in NH) E L DISEASE EA 5MPI.,OYEE S ,.. .._ 1,000,00 _... „ IF yes, describe under DESCRIPTION OF OPERATIONS below E.L DISEASE POLICY LIMIT $ 1,000,000 A Pollution Liab EPK-150692 01/16/2025 01/16/2026 Condition 1,000,00 A Professional Liab EPK-150692 01/16/2025 01/16/2026 Per Claim 1,000,00 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) City of El Segundo is named as Additional Insured on the General Liability policy when required by a written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE ATE THEREOF, City of El Segundo ACCORDANCEION WITH THE POLICY PROVISIONSE WILL BE DELIVERED IN 350 Main Street El Segundo, CA 90245 AUTHORIZED REPRESENTATIVE M ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 04-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA 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.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 2% of the California workers' compensation premium otherwise due on such remuneration. Schedule Person or Organization Job Description Any person or organization as required by written contract. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 4/6/2024 Policy No. TWC4407849 Endorsement No_ 0 Insured BREATHE SAFE ENVIRONMENTAL, INC Premium $ 5,044 Insurance Company Technology Insurance Company, Inc - Countersigned by WC 04 03 06 (Ed. 04-84)