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PROOF OF INSURANCE (2025 - 2026) CLOSEDA0948-82-84 '" 1, DATE (MMIDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 6/2/2025 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: It 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 CONTACT Rebecca Huddle Becky Huddle Insurance Agency NAME„ 729 Sunrise Ave Ste 604 PHONE 916-789-7500 F"'I . . 916-789-2545 Roseville CA 95661 nicM ul9cc. Staff.rh:udd"-farmersaAency.Com INSURER A: MID CENTURY INSURANCE 21687 INSURED Bayshore Water Conditioning DBA Elite Water Systems INSURER B.. Northfield Insurance Company 27987 10611 CALLE LEE SUITE 113 INSURERWC Nautilus Insurance Company _ ..... m..._. 17370 LOS ALAMITOS, CA 90720 ,u.... ro n . Farmers Insurance Exchange 21652 COVERAGES CERTIFICATE NUMBER: 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 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- w..........�......... . POLIL1 �i' f •fR TYPE OF INSURANCE POLICY NUMBER MM1nnNYYY DD LIMITS ✓ COMMERCIAL GENERAL LIABILITY ✓ EACH OCCURRENCE S 1,000,000 B CLAIMS MADE ✓� OCCUR WS608820 6/2912024 6l29l2025 MTI�, TITTTENTTT7" P a $ 1001 MED EXP $ 5,000 PERSONAL& ADV INJURY $ 1,000,000 GE, 1. AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 7,( POk IICuY � JEC1 T El LOC PRODUCTS - COMP/OP AGG _.. $ 2,000,000 OIHEP $ AUTOMOBILELIABILITYLi Li a'�ua, �1. �. $ 1,000,000 D ANY AUTO 607046190 08/13/2024 08/1312026 BODILY INJURY (Per person) $ OWNED SCHEDULED __ BODILY INJU URY (Per accident) . $ AUTOS ONLY AUTOS HIRED NON -OWNED $ AUTOS ONLY AUTOS ONLY iP? r arx3claIX ....... $ UMBRELLA LIAB ✓ OCCUR LJLJ EACH OCCURRENCE $ 1,000,000 C �/ EXCESS LIAR CLAIMS -MADE AN1317749 6/2912024 6/29/2025 AGGREGATE $ 1,000,000 DED RETENTION $ $ COMPENSATION ✓ ER_.. A AWORKERS EMPLOYERS' LIABILITY YIN �PRET'ORPARTNEPYEXE LCrIUETATUTE g p, �Ry A0948�2�4 1/112025 1/1/2026 �LE'A"CH "0 1,000,000 AND ICERIM FFkd L.RFMfMBERLXCI.UDED'> ' NIA CIEAEMPLOYEE 1,000,000 (Mandatory )' ELDISEASE $ 0ACRdIPTIO'rlN- OF er OPERATIOGrNSkrelovr E.L.DISEASE -POLICY LIMIT S 1,000,000 A Business Personal Property (BPP) 60704-33-44 V112024 7/1/2025 30,WO A Business Income & Extra Expense 60704.33- 4 7/1/2024 7/1/2025 A Extended Business Income 60704-33-44 7/1/2024 7/1/2025 18 Months - ALS 30 dams DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Workers' compensation waiver of subrogation attached. City of El Segundo Fire Department as additionally insured n Ite1Tiela'^u'11.'S'& I.J^1 r"Icm rAlkiriml I AT7r]N City of El Segundo Fire Department 314 Main Street SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN El Segundo, CA 90245 ACCORDANCE WITH THE POLICY PROVISIONS. AD T140AV E D RE'PRE SE NTATI'VE Rebecca Huddle V 7°�fi:I Ab"",L.L7'f r"7 A6.VRV �.V RrV R/111V1`/. P%1111911LW ICbC1 VWU. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED (CONTRACTORS) (Includes Products -Completed Operations When Required By Contract) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PROVISIONS 1. The following is added to SECTION 11 - WHO IS AN INSURED: Any person or organization that you agree in a written contract or agreement to include as an additional insured on this Coverage Part is an insured, but only: a. With respect to liability for "bodily injury" or "property damage" that occurs subsequent to the signing of that contract or agreement and while that part of the contract or agreement is in effect; b_ If, and only to the extent that, the injury or damage is caused by acts or omissions of you or your subcontractor in the performance of "your work" to which the written contract or agreement applies. Such person or organization does not qualify as an additional insured with respect to the independent acts or omissions of such person or organization; and c. Subject to the following limitations and conditions on the insurance provided to such additional insured, (1) If the Limits of Insurance of this Coverage Part shown in the Declarations exceed the minimum limits required by the written contract or agreement, the insurance provided to the additional insured will be limited to such minimum required limits. For the purposes of determining whether this limitation applies, the minimum limits required by the written contract or agreement will be considered to include the minimum limits of any Umbrella or Excess liability coverage required for the additional insured by that written contract or agreement. This provision will not increase the limits of insurance described in SECTION III - LIMITS OF INSURANCE. (2) The insurance provided to such additional insured does not apply to "bodily injury" or "property damage" arising out of the providing, or failure to provide, any professional architectural, engineering or surveying services, including: (a) The preparing, approving or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders or change orders, or the preparing, approving, or failing to prepare or approve, drawings and specifications; and (b) Supervisory, inspection, architectural or engineering activities. (3) The insurance provided to such additional insured does not apply to "bodily injury" or "property damage" caused by "your work" and included in the "products -completed operations hazard" unless the written contract or agreement requires you to provide such coverage for that additional insured, and then the insurance provided to the additional insured applies only to such "bodily injury" or "property damage" that occurs before the end of the period of time for which the written contract or agreement requires you to provide such coverage or the end of the policy period, whichever is earlier. (4) The insurance provided to such additional insured is excess over any valid and collectible other insurance, whether primary, excess, contingent or on any other basis, that is available to the additional insured for a loss we cover. However, if the written contract or agreement requires that the insurance provided under this Coverage Part apply on a primary basis or a primary and non-contributory basis, then this insurance is primary to other insurance available to the additional insured which covers that person or organization as a named insured for such loss, and we will not share with that other insurance. But, the insurance provided to the additional insured still is excess over any valid and collectible other insurance, whether primary, excess, contingent or on any other basis, that is available to the additional insured when that person or organization is an additional insured under such other insurance. S2802-CG (3120) © 2020 The Travelers Indemnity Company. All rights reserved. Page 1 of 2 (5) The additional insured must comply with the following duties: (a) Give us written notice as soon as practicable of an "occurrence" which may result in a claim. To the extent possible, such notice should include: (1) How, when and where the "occurrence" took place; (ii) The names and addresses of any injured persons and witnesses; and (III) The nature and location of any injury or damage arising out of the 'occurrence". (b) If a claim is made or "suit" is brought against the additional insured: (i) Immediately record the specifics of the claim or "suit" and the date received; and (11) Notify us as soon as practicable and see to it that we receive written notice of the claim or "suit" as soon as practicable- (c) Immediately send us copies of all legal papers received in connection with the claim or "suit", cooperate with us in the investigation or settlement of the claim or defense against the "suit', and otherwise comply with all policy conditions. (d) Tender the defense and indemnity of any claim or "suit' to any provider of other insurance which would cover such additional insured for a loss we cover. However, this condition does not affect whether the insurance provided to the additional insured is primary to other insurance available to the additional insured which covers that person or organization as a named insured. s2802-CG (3120) © 2020 The Travelers Indemnity Company. All rights reserved. Page 2 of 2 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 06 31 (Ed. 6-20) BLANKET WAIVER OF OUR RIGHTTO 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.) The additional premium for this endorsement shall be 3.0 %o'f the California workers compensation premium otherwise due on such remuneration, subject to a minirtta.urn charge of s 517. All written contracts in the state(s) of: CA 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 01 /01 /25 Policy No. A0948-82-84 Endorsement No. Insured BAYSHORE WATER CONDITIONING (DBA) ELITE WATER SYSTEMS 10611 CALLE LEE STE 113 Insurance Company MID-CENTURY INSURANCE COMPANY LOS ALAMITOS CA 907206791 Countersigned By WC990631 (Ed. 6-20) Includes copyright material ofthe Workers Compensation Insurance Rating Bureau of California. All rights reserved.