PROOF OF INSURANCE (2025 - 2025)Ef DATE ACC>R" CERTIFICATE OF LIABILITY INSURANCE
11 /25/2024
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 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).
F
NAME; Kyle artier
nty Insurance Center PHONE xr (281) 427-6511 FAX Nd , (281) 422-0554
brook ��,, kyle@harriscounlyinsurance.com
INSURER(S)AFFORDING COVERAGE NAIC #
Baytown TX 77521 INSURERA : Lloyds of London
INSURED INSURER B : Risk Transfer Partners
Industrial Maintenance Service LLC INSURER C :
4515 W 166 St INSURER D :
INSURER E :
Lawndale CA 90260 INSURER F.-
COVERAGES CERTIFICATE NUMBER: CL24112526350 REVISION 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 CONTRACTOR OTHER DOCUMENT
WITH RESPECT TO WHICH THIS
CERTIFICATE MAYBE 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.
LTR
TYPEOFINSURANCE nn
wyn
POLICYNUMBER
Mr�yfYY'YY
MMDDfYYYY'
LIMITS
)<
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$ 1.000,000
CLAIMS -MADE ❑ OCCUR
PREMISER IFa le orrunc
. 0
S 100,000
MED EXP (Any one person)
$ 5,000
A
Y
0100170427-3
11/19/2024
11/19/2025
PERSONAL &ADV INJURY
S 1,000,000
GENERAL AGGREGATE
s 2,000.000
GEN'LAGGREGATE
LIMIT APPLIES PER:
�w
POLICY O JE(T El LOC
PRODUCTS - COMP/OP AGG
S 2,000,000
$
OTHER.,
AUTOMOBILE
LIABILITY
COMBINEOSINGLELIMlT
$ 1,000,000
..„
BODILY INJURY (P
(Per person)
S
ANYAUTO
OWNED SCHEDULED Y
AUTOSED ONLY AUTOS
II INAU570817
11/19/2024
11/19/2025
BODILY INJURY (Per accident)
5
HIRw NON -OWNED
AUTOS ONLY �'' AUTOS ONLY
1
1III
ERTYDAMAGE
Poracckdeatt
S
UMBRELLA LIAR OCCUR
HCLAIMS-MADE
EACH OCCURRENCE
s
EXCESS LIAB
AGGREGATE
$
DED RETENTION S
S
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
PER TH-
STATUTE E
OFFICERIMEMBEREARTNERIEXEXCLUDED7ECUTIVE ❑ NIA
CEAEMPLOYEE
M$
(Mandatory In NH)
E.L.DISEASE
If yes, describe under
(DESCRIPTION OF OPERATIONS below
E: L DISEASE - POLICY LIMB
S
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required)
Certificate Holder is named as Additional Insured with Primary and Non -Contributory. wording when required by contract.
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of El Segundo ACCORDANCE WITH THE POLICY PROVISIONS.
3500 Main Street
AUTOO ' , EPA F.NTA
ElSegundo CA 90245
@ 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
1
POLICYHOLDER COPY
SC
P.O. BOX 8192, PLEASANTON, CA 94588
CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
ISSUE DATE: 04-03-2025 GROUP:
POLICY NUMBER: 1435108-2024
CERTIFICATE ID: 244
CERTIFICATE EXPIRES: 06-01-2025
06-01-2024/06-01-2025
CITY OF EL SEGUNDO SC
350 MAIN ST 06-01-2024
EL SEGUNDO CA 90245-3813 HO
This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the
California Insurance Commissioner to the employer named below for the policy period indicated,.
This policy is not subject to cancellation by the Fund except upon 30 days advance written notice to the employer.
We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration.
This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded
by the policy listed herein, Notwithstanding any requirement, term or condition of any contract or other document
with respect to which 'this certificate of insurance may be issued or to which it may pertain, the insurance
afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy.
Authorized Representative President and CEO
EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE.
ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 06-01-2024 IS
ATTACHED TO AND FORMS A PART OF THIS POLICY.
— ENDORSEMENT #1951 - JOE ELLIOT MGRMBR - EXCLUDED.
EMPLOYER
INDUSTRIAL MAINTENANCE SERVICE, LLC SC
4515 W 166TH ST
LAWNDALE CA 90260
[P1V,HOI
(REv.7-2014) PRINTED : 04-03-2025