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PROOF OF INSURANCE (2025 - 2026)AC CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) Mom.»--' 05/06/2.025 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 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 NAME.. I I I I ,____ BIBERK x4)r 844-..... 967 4N FAX Nol 203-654-3613 PHONE P.O. Box 113247 E-MAIL Stamford, CT 06911 ADD (s , customerservice@biBERK.com 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, POLICY EFF INSR TYPE OF INSURANCE ,INSD V1fVD POLICY NUMBER MM DDIXYYY " MMI ICY EXP LTR I DDIYYYY ,,,, ..- LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X ', 50,000 w. CLAIMS -MADE OCCUR PREMISES (Ea acGurr nre�e ..... A N9BP207167 07/17/2024 07/17/2025 MED EXP (Any one Per on] 9S 5,000 - PERSONAL & ADV INJURY G Included GEN'L AGGREGATE LIMIT APPI.flES PER: '.. GENERAL AGGREGATE $ 2,000,000 ......PRODUCTS »uECOC I LOGPR GOMPIOP AGG $ 2 OOO,OOO,_,.,, AUTOMOBILE LIABILITY '.. " COMBINED SINGLE LIMI T $ ...... :.....(Ea acrOpn,t) n.n.n „... ... ANY AUTO BODILY INJURY (Pei neinon) S OWNED SCHEDULED - BODILY INJURY (Per accident) $ AUTOS ONLY , AUTOS , HIRED NON -OWNED PROPER'1TU'DAhr5/'GE ....,,; AUTOS ONLY p AUTOS ONLY UMBRELLA LIAR OCCUR - EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE '... AGGREGATE DED RE'PpENr8 0t45 $ WORKERS COMPENSATION PER OTH STATI,JTlS FIR i AND EMPLOYERS' LIABILITY YIN _ E L EACH ACCIDENT $ ANYPROPRIETOR/PARTNER/EXECUTIVE ,OFFICER/M EMBER EXCLUDED? NIA (Mandatory in NH) E L DI EASE EA EMPLOYEE ,... ,. ®A.,. ..E ,If yes, de,3,nbe under DESCRIPTION OF OPERATIONS below i � POLICY LIMIT L DLsEA5E POLL, j Professional Liability (Errors & Per Occurrence/ Omissions): Claims -Made Aggregate DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Central Valley Regional Center is listed as additional insured as it pertains to general liability. Alliance College Ready Public Schools is listed as additional insured as it pertains to general liability. l..tKI IrK.A 11 t MIJLILICK l.fa lVI.CLLFi I IVIV City of El Segundo 350 Main Street 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 REPRESENTATIVE di @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 6/26/2025 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: the certificate holder is an ADDITIONAL INSURED, the_p_o1_icy(i_e_sT must Be endorsed, 11 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 MTACT Certificate Department Teresa Clutter Insurance Services LLC PHONE 836-0719 �,209 855 879 4374 40012th St, Ste 26 TPrpcnf'aCli nt-l—vnna rnm Modesto INSURED Green USA LLC dba Global Transportation Services 701 S Santa Fe Ave CA 95354 Compton CA 90221 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: NAIC # 22608 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. A DL"S'UtdP&; Ptti t YEFF P'd'L:ICY'EXP.-_-.-. fNSRi ( LTR TYPE OF INSURANCE INSD WVD I POLICY NUMBER (MMIDDIYYYY) J (MMIDDIYYYY, LIMITS ! COMMERCIAL GENERAL � LIABILITY EACH OCCURRENCE $ I CLAIMS -MADE . OCCUR TJA1VdAUFT0 RENTED--- PREMMES (Ea ou urroncc) $ ) MED EXP (Any one person-------------------------------- $ _ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ PROW ...... .� POLICY JECT LOC ..... .......... PRODUCTS COMP/OPAGG ,. .,.......... $ L OTHER $ r. AUTOMOBILE LIABILITY i acodont) (__ $ 5000000 ANY AUTO BODILY I INJURY (Per person) 1 $ A v-"" ALL OWNED SCHEDULED AUTOS X AUTOS 1 CAR0400000171-1 7/1/2024 ....... 7/112025BODILY �JURY(Per acadent)� . _. $ .. NON -OWNED .... AUTOS HIRED AUTOS I h" G/1MAG -.-. ..,..., ......, ............ $ _..�.gaart�alleral) ...... ------ --- 1 UMBRELLA LIAB OCCUR EACH OCCURRENCE 1$ EXCESS LIAB lJ CLAIMS -MADE ` - ......., �. `, ,p A AGGREGATE .... ............... .. $ ..... RETE,.. RKERS NSATION ILITY STATUTE I I YIN ANY PROPRIETOR/PARTNER/EXECUTIVE ANY PER/MEMB REEXCB NER/E OFF NIA -ER L . ! ,._.-.m. ........... E L EACH ACCIDENT (Mandatory m NH f L... L DISEASE EA EMPLOYEE,,' $ If yes, describe under i F _...... ._. ....... _._.. DESCRIPTION OF OPERATIONS below ;. ! j E.L. DISEASE -POLICY LIMIT = $ I DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of El Segundo Departments of Recreation, Parks and Library 6tK I It-IGA I t HULUtK CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Khan Watson 1 Senior Administrative Analyst ACCORDANCE WITH THE POLICY PROVISIONS. 401 Sheldon St AUTHORIZED REPRESENTATIVE El Segundo CA 90245 ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 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 I",OW mey Horn C/O DeC)SxOnHR Holding Inc ( ) E-MAILo .... 888 828 5511 (� N SUN Insurance Solutions, LLC ID: DecisionHR PHONE" 5t30 i Postal Road, P��oX 15020 An aEs r l) �.. _s _...... ",P,pq§,@DecisionHR.com Cleveland, OH 44101 mm INSURER(S) AFFORDING COVERAGE I 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. n CY EFF P P �ADDL SVk6'dfi� ILTR j TYPE OF INSURANCE POLICY NUMBER MMIDD MMIDDLfCYµEXP LIMITS COMMERCIAL GENERALLIABILITY I EACH OCCURRENCE _ I [PREMISESfEa CLAIMS -MADE$ --m--l........ .. OCCUR OCAW re,091 . $ ...,, ........ (Any one person) $ 1 ..... . .. ........... ... ... PERSONAL &ADVINJURY ...$........... . G N'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE_ $FG ❑ _ ...E. POLICY JR CT LOC PRODUCTS - COMPIOP AGG $ ----._ .._._ I J OTHER: v �---- $ 1 AUTOMOBILE LIABILITY D OMSINED SINGLE LIMIT I $ ANY AUTO I,a_aeddseu6,)„„„ .. ........ .. BODILY INJURY (Per person) ...... „ ........... $ OWNED SCHEDULED AUTOS ONLY AUTOS ODILYNoJURY Per ac ( cadent) $ .I HIRENON-OWNED D 1 PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY aqq6o UMBRELLA LIAB OCCUR 1 i EACH OCCURRENCE $ -- ---------- EXCESS LIAB CLAIMS MADE AGGR........,...m,,.,,..,,, ___T ,..DED __ 1._.._. 1...RETENTION$ pp I ........ .....EGATE ........................,,,�,$ $ A WORKERS COMPENSATION �WC042-00113-025 6/1/2U25 6/1/2026 I SPERTATUTE l AND EMPLOYERS' LIABILITY Y I N ' WC042-00113-024 6/1/2024 6/1 /2025 „/ FRH ANYPROPRIETOR/PARTNEI EXECUTIVE f NIA l l E L EACH ACCIDENT $ 1,000 000 (Manclato DISEASE - 000,000 ibe DESCRIPTION 1 OF OPERATIONS below EL. DISEASE - POLICY LIMIT $ 1 000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Coverage provided for all leased employees but not subcontractors of: Green USA LLC dba Global Transportation Services Client Eff Date: 10/1/2022 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City Of El Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Dep artment Of Recreation, Parks and Library ACCORDANCE WITH THE POLICY PROVISIONS. 401 Sheldon St El Segundo CA 90245 ' AUTHORIZED REPRESENTATIVE Rick Leonard ©1988-2015 ACORD CORPORATION, All rights reserved. ACORD 25 (21/3) The ACORD name and logo are registered marks of ACORD 836773B4 I B78601 I (MCP) Mu1-i Ple Coordina Led Policy I Decis_on [IR Holdi-igs I Carts Depa'Lmer.L 6/6/2025 4:09:52 PM (EDT) I Page 1 of 1 CITY OF EL SEGUNDO WORKERS' COMPENSATION DECLARATION WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SUBJECTS AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN LABOR CODE § 3706, INTEREST, AND ATTORNEY'S FEES. I affirm under penalty of perjury under the laws of California one of the following declarations: L_) I have and will maintain a certificate of consent of self -insure for workers' compensation, issued by the Director of Industrial Relations as provided for by Labor Code § 3700 for the performance of the work set forth the agreement with the City of El Segundo. Policy No. (X) I have and will maintain workers' compensation insurance as required by Labor Code § 3700 for the performance of the work for which the agreement with the City of El Segundo is executed. My workers' compensation insurance carrier and policy number are: SUNZ Insurance Solulions LLC ID: (DebwonHR) c/o DecisionHR Holdings Inc Carrier 5801 Postal Road, Rc Box 818020 Cleveland OH 44181 Policy Number Expiration Date wC042-00113-023 Exp 6/1125 Name of Agent Cortney Horn Phone # 888-828-5511 (_) I certify that, in the performance of the work set forth in the agreement with the City of El Segundo, I will not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that, if I should become subject to the°workers' compensation provisions of Labor Code § 3700 1 must immediately comply with those provisions or the agreement will automatically become void. Signature of Applicant Dma. 151a,14% Date 5/6/25 Print Name Omar Sadek Agreement for: Dated: Reviewed by: