Loading...
PROOF OF INSURANCE (2025 - 2026)M/DDIYY ACC CERTIFICATE OF LIABILITY INSURANCE DATEIM0/2024 Y, 10/30/2024 THIS CER71FICATE IS ISSUEDASA 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 CONSTITUTEA 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 NONE, Jhosel, Crenshaw Chesapeake Insurance Services inc. PHONE �. (818) 898-1043 1 FAX 151 arc N 16654 Soledad Canyon Rd., #540 ADDRESS: INSURERS) AFFORDING COVERAGE NAIC N Canyon County CA 91387 INSURERA: Mount Hawley Insurance Company 37974 INSURED INSURERS: Indian Harbor Insurance Company 36940 Morillo Construction Inc INSURER r 227 N. Holliston Ave INSURER INSURER E r. Pasadena CA 91106 INSURER F: nr., .re Aire noeror+ATo Museeeo• 9n9d RFV1AIr1N NIIMRFR* THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITH STANDING ANY REQUIREMENT, TERM OR CONDITION OFANY 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, EXCLUSIONSAND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE INSD yyVD _ POLICY NUMBER MMIDDNYYY) 'L-1 DNYW LIMITS X COMMERCIALGENERALUABILITY EACHOCCURRfINCE $ 1,000,000 50,000 CI...A91vl�:r-MAL}E � OCCUR I��IrF'1W E'slf; Yi rr,�� $ 1,000 MED EXPtAnv one rrerson) $ I:>wP>K)NALAAD`mINJURY $ 1,000,000 A MGL0200854 10/29/2024 10/29/2025 aFt I L AI a;taR2n i C 9auo,nlT AI u L pl�.A r Ga GENERAL.. AOURLG; �V E $ 2,000,000 1cc" ;rw' JECT ac�7uCT.�. COMPIOP ACC, $ 2,000,000 1 M@,Ih_Qn_rL AUTOMOBILE LIABILITY ff'2182.1 ANY AU 1.0 ' BODI L..Y OWJt.1TY`( (Isoir person BODILY @INJURY(Per @ccice,0 ' $ OWNED `3C:1-Iliii:[LUL.ED AUIOSONLY �ULC7.:.-, �I�IRi L) NCiuR ()W�iNir.'.L.1' P I PER ��-.: Id'wry An;4., R c , rl•itl5fYt4 �. AU I OS ONO' AU'COS ONLY UMBRELLA UAB OCCUR EAt:I I Ot' Q IRRENQ E $ 5,000,000 AGGREGATE $ 5,000,000 A x' EXCESS LIAB C[.AIM-a-Mi0E MXL0439482 10/29/2024 10/29/2025 CDED RE"E"ELATION WORKERS COMPENSATION „s rI'4" PER FI AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNERIEXECUTIVE N!A E L EACH AC:C'If 7G V�In• °G 017PC'ERIME...MBERII'X4CLUDEI::Y� (IlYardatory M Nll Q E L DISEASE EA EMPLOYEE. $ E L DISEASE - POLIC'( L.IhM r $ If' we Ilar cribo under OESC RIFMON OF OPERATIONS, hutla n Policy General Aggregate $4,000,000 B Professional Liability and 10/29l2024 10/29l2025 Professional Liability $2,000,000 Contractors Pollution Liability [P7EC005790904 Pollution Liability $2,000,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) [Job #: PW 24-02 Job Type: Urho Saari Swim Stadium] Project No, PW 24-02 - Urho Saari Swim Stadium City of El Segundo, its officers, officials, employees, agents, and volunteers are named as additional insured. See attached for Al status Issuing insurer will endeavorto mail 30 days notice of cancellation, 10 days for non-payment of premium CERTIFICATE HOLDER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of El Segudo City Clerk ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street AUTHORIZED REPRESENTATIVE ElSegundo CA 90245 �� T ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Mt. Hawley Insurance Company 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) Location(s) Of Covered Operations All persons or organizations where required All Locations by written contract executed prior to the commencement of your work. 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 in- clude as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property dam- age" or "personal and advertising injury" caused by: 1. Your negligence; or 2. The negligence of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. 2. If coverage provided to the additional insured is required by a contract or agreement, the insur- ance 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. B. VVdh respect to the insurance afforded to these addi- tional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: However: 1. All work, including materials, parts or equipment furnished in connection with such work, on the 1. The insurance afforded to such additional insured project (other than service, maintenance or re - only applies to the extent permitted by law; and pairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or CGL 20 10 08 15 Contains copyrighted material of Insurance Services Office, Inc. with its permission„ Page 1 of 2 Insured 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. C. With respect to the insurance afforded to these addi- tional insureds, the following is added to Section III — Limits Of Insurance: The most we will pay on behalf of the additional insured is: 1. The minimum amount required by any contract or agreement you have entered into to provide additional insured coverage; 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. ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED. CGL 20 10.08 15 Contains copyrighted material of Insurance Services Office, Inc. with its permission, Page 2 of 2 Insured Mt. Hawley Insurance Company 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) (Vendor) Location And Description Of Completed Operations All persons or organizations where required All "Commercial Construction Projects'. For by written contract executed prior to the the purpose of this Endorsement, "Commercial commencement of your work. Construction Projects" are defined as buildings or structures constructed for commercial use and also include apartments, hotels, homes for the aged, dormitories or barracks. However, "Commercial Construction Projects" shall not include any building or structure which, in whole or in part,contains individual owner occupied units or dwellings. 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 in- clude as an additional insured the person(s) or organi- zation(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused by your negligence 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 B. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: The most we will pay on behalf of the additional in- sured is: 1. The minimum amount required by any contract or agreement you have entered into to provide addi- tional insured coverage; or 2. Available under the applicable Limits of Insurance shown in the Declarations; 2. If coverage provided to the additional insured is whichever is less. required by a contract or agreement, the insur- ance afforded to such additional insured will not This endorsement shall not increase the applicable be broader than that which you are required by Limits of Insurance shown in the Declarations. the contract or agreement to provide for such additional insured. ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED. CGL 20 37 08 16 Contains copyrighted material of Insurance Services Office, Inc. with its permission. Page 1 of 1 I nsu red Mt. Hawley Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance Condition (2) You have agreed in writing in a contract or agree - and supersedes any provision to the contrary: ment that this insurance would be primary and would not seek contribution from any other in - Primary And Noncontributory Insurance surance available to the additional insured. This insurance is primary to and will not seek con- tribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and CG 20 01 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 Insured Mt. Hawley Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART ELECTRONIC DATA LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART DESIGNATED SITES POLLUTION LIABILITY LIMITED COVERAGE PART DESIGNATED SITES PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART UNDERGROUND STORAGE TANK POLICY DESIGNATED TANKS SCHEDULE Name of Person(s) or Organization(s): All persons or organizations where required by written contract executed prior to the commencement of your work. B Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV — Conditions: We waive any right of recovery against the person(s) or organization(s) shown in the Schedule above because of payments we make under this Coverage Part. Such waiver by us applies only to the extent that the insured has waived its right of recovery against such person(s) or organization(s) prior to loss. This endorsement applies only to the person(s) or organization(s) shown in the Schedule above. CG 24 04 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1 Insured AtCC REP cI DATE (MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE N 06/30/2025 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: If the certificate holder is an ADDITIONAL INSURED, the pollcy(i'es) 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 r1 ills to the certificate holder in lieu of such endorsements � m_ PRODUCER �lCONTAOT NORTHEAST AGENCIES 1414 S TRYON ST, CHARLOTTE, NC 28203 FAX INSURERS) AFFORDING COVERAGE NA$C 9 ...,.....,....... -.. - A : UCtli1DC� %1riancial Casu3aNi"�. 0� ' 117a e ..... NNSURECY ......._"."-,..... �...... ................. ...�.� _gNSUR;E:R ...�......_.�. INSURER B MORILLO CONSTRUCTION INC "" 227 N HOLLISTON AVE INSURERR c " _. Pasadena, CA 91106 dNSURER O ''.., INSURER E _ INSURER F COVERAGE'S CERTIFICATE NUMBER; 988571269747551844D 063025T.... 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. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE ... ..� INSD WVD POLICY NUMBER (gMAMPODfYYYY) (MM)DI)iYYYY) LIMITS - ..,...._ - .,__ „_..... � - �...� COMMERCIAL GENERAL LIABILITY Y OCCURRENCE ...EACH _ TO R-E 4'"BEW CLAIMS -MADE OCCUR E�,.-L .r ^ ila raruca1 .. MED EXP I'Ar,!y we person) :',$:..........._.,. ...._. PERSONAL & ADV INJURY .,.. GFN"LAGGRfGATE'LIMIT APPLIES PER: GENERAL AGGREGATE .... 0 JPE ❑ _PRODUCTS, COMPIOP AGG _. POLICY LOC OTHER: $ AUTOMOBILE LL....... ........�...... ABILITY _ CO MBINED, SINGLE LIMIT Eaaccuieruli $2 OI,OfbOi __IT__ ..._.. _...._... .........F12/03/2025 ANY AUTO dIDDILY CN WURY (Ptltr tpBr'sS'atV.. VaISOiHULFD A 2Y1N 3 NBD ONLY AU`q SAY .,.... ". Y N 982045703 06/03/2025 BODILY INJURYZr acddenT AfE$ A7C} PRY Ahq eracaideruq '$. ONLY S3NNDY _._. UMBRELLA LIAB OCCUR _...�.. ........�..�....... EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE D!ED RETENTIONS $ WORKERO09�PENSATION ....._. Y/N .. . W ..._........._. ...... .... � ... H. AND EMPLOYERS' LIABILITY ANYPROPRBETOMPAR'FNERBEX OUTIVE- ❑ .,... _ Ap �..... .......�.. N/A EACH ACCIDENT $ O Fr9CER1I 1EMBER EX CLUDE 11? (Mandatory In NH) . E - EA EMPIO" YE J �'_ ' IT yes describe under DESCRIPTION OF OPERATIONS below _.m..,......-.,.. DISEASE - POLICY LIMIT $ E .�..........._ .._ See ACORD 101 for additional coverage details, ........ ....._.. ......__..., ........._.... $ A Y N 982045703 06/03/2025 I 12/03/2025 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITY CLERK CITY OF EL SEGUNDO AND THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN IT'S OFFICIALS, EMPLOYEES, AGENTS & VOLU ACCORDANCE WITH THE POLICY PROVISIONS. 350 MAIN STREET EL SEGUNDO, CA 90245-3813 _.... — AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: LOC #: ADDITIONAL REMARKS SCHEDULE Page 1 of 1 ... ... _. ..................... ...... AGENCY NAMED INSURED NORTHEAST AGENCIES MORILLO CONSTRUCTION INC — -- --• ..... 227 N HOLLISTON AVE POLICY NUMBER Pasadena, CA 91106 982045703 CARRIER NAIC CODE ..... United Financial Casualty Company I 11770 I EFFECTIVE DATE: 06/03/2025 .......................... ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE, .Certificate of Liability Insurance Additional Coverages Insurance coverage(s) Limits Uninsured /Underinsured Motorist $2,000,000 Combined Single Limit Description of Location/Vehicles/Special Items Scheduled autos only 2008 LAND ROVER RANGE ROVE Comprehensive $1,000 Ded Collision $1,000 w/Waiver Ded Rental Reimbursement $50 Per Day ($1,500 Max) Medical Payments $5,000 each person 2019 FORD F150 ,,..„.iliNI .................. ........................................ Comprehensive $1,000 Ded Collision $1,000 w/Waiver Ded Rental Reimbursement $50 Per Day ($1,500 Max) Medical Payments $5,000 each person 2018 MERCEDES-BENZ Comprehensive $1,000 Ded Collision $1,000 w/Waiver Ded Rental Reimbursement $50 Per Day ($1,500 Max) Medical Payments $5,000 each person 2018 TESLA MODEL Comprehensive $1,000 Ded Collision $1,000 w/Waiver Ded Rental Reimbursement $50 Per Day ($1,500 Max) Medical Payments $5,000 each person ........................ 2008 MERCEDES-BENZ Comprehensive $1,000 Ded Collision $1,000 w/Waiver Ded Rental Reimbursement $50 Per Day ($1,500 Max) Medical Payments $5,000 each person 2015 TESLA MODEL Comprehensive $1,000 Ded Collision $1,000 w/Waiver Ded Rental Reimbursement $50 Per Day ($1,500 Max) Medical Payments $5,000 each person Additional Information Certificate holder is listed as an Additional Insured. _.._.� ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD MORICON-Cl _.V.QA R1Rll. IC . INSURANCE J.___T1812025 M,DDIYYYY) DATE (MCERTIFICATE OF LIABILITY THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THISmmmmmm" 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. If the IS WAIVED, subject to the terms and conditions of the policy, certain o holder is an ADDITIONAL INSURED, the pollcy(ies) must have ADDITIONAL INSURED provisions or be endorsed. 1 p y, 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 iCONTACT NAME;., Suite 75E F Pasadena MAO 6 X HONE �FA 3475 E. Foothill Boulevard (A�c No, ExGy (2+6} 799 7000 I c, Nop.Q626 "� 441-3233 Pasadena, CA 91107 - 1 m .-,_ ... L RER(S) AFFORDING COVERAGE NA1C #,,,,,,,,,,,, INSURER A: State Compensation, Insurance Fund -California _ ..... mm ,,,,,..., INSURED INSURER B : .r � ____-- . ,- Morillo Construction Inc INSURER C 227 N Holliston Ave INSURER D.,. Pasadena, CA 91106 ..m------- ,...,., m ®.. INSURER E --------- .�.................. .. ...........,�, ................. ! INSURER F ; !COVERAggLS... _ .......CERTIFICATE NUIWCBE'R .............. ..........._..�-_..........m 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. INSk VO , ,IOCY EXP OA7(YYYI ,.�.........T LIMITS ADDL'SUBR POLICYEFF TYPE OF INS j RANCE � 1 POLICY NUMBER " " _� ITITITITITITIT ...... I COMMERCIAL GENERAL LIABILITY ' OCCURRENCEEACH CLAIMS -MADE OCCUR DAMAGE TORENTED I � TO D �� PSEMI E ,dE�.�r�Mdren e) . o $_ n"n" n"®... MED EXP (Any qne person) $ " PERSONAL & ADV INJURY $ G LAGa �Eq I PRODUCTS _GENERALAG COMP/OP QP E� GRE a1T"E LIMIT APPLIES PER. € I POLICYPR LOC AGG $ . $ I AUTOMOBILE LIABILITY ! 1 COMN$LNF..D SINGLE LIMIT $_.. ANY AUTO k AUTOS NED HIRED ODILY INJURY (,Perperson) $ OWNED _ SCHEDULED AUTOS ONLY (OD1LY INJURY PPr ac;crdank) AG CDPFRT'Y DAMAGE. AUTOS ONLY (.., AUTOS ONLY , lor yr„riderRl, $ ..... ., I ,�.,�.................._� .........._....._..... �....v..... - $ UMBRELLA LIAB OCCUR I RRENE Ls EXCESS LIAB - „ CLAIMS -MADE j I AGGR GAT $. ,..�. DIED I RETENTION $ 1 9206 A I WORKERS COMPENSATION _ PER �T OTH AND EMPLOYERS' LIABILITY YYN I E L ` TA ATE `ER 1 t iX ANY PROPRIETOR/PARTNER,EXECUTIVE "° X 372 1/1/2025 1/1/2026 ACCIDENT $ 1,000,000 rMralCEWMEMBER EXCLUDED? NIA I, d Cory- Nnd � E.L. DISEASE-POLICYLOYFE $ 1,000,000 f yes, describe under { 1,000,000 DESCmRIPTION OF OPERATIONS below LIMIT $ .......�............. ......--,....... ._...-............ I DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be �" attached if more space is required) Re: Urho Saari SWir1ti Satdium, Project # PW-24-02. WC Waiver of Subrogation applies per 2572 attached. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City Clerk THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of El Segundo ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street ................. El Segundo, CA 90245 AUTHORIZED REPRESENTATIVE --C:-,_4� ....... ---------- ..... ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ENDORSEMENT AGREEMENT WAIVER OF SUBROGATION BLANKET BASIS HOME OFFICE SAN FRANCISCO EFFECTIVE JANUARY 1, 2025 AT 12.01 A.M. ALL EFFECTIVE DATES ARE AND EXPIRING JANUARY 1, 2026 AT 12.01 A.M. AT 12:01 AM PACIFIC STANDARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME MORILLO CONSTRUCTION INC 227 N HOLLISTON AVE PASADENA, CA 91106 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 2.00% OF THE TOTAL POLICY PREMIUM. IY611 016101 :� PERSON OR ORGANIZATION ANY PERSON OR ORGANIZATION FOR WHOM THE NAMED INSURED HAS AGREED BY WRITTEN CONTRACT TO FURNISH THIS WAIVER JOB DESCRIPTION BLANKET WAIVER OF SUBROGATION 9206372-25 RENEWAL SC 4-48-77-29 PAGE 1 OF NOTHING IN THIS ENDORSEMENT SHALL BE HELD TO VARY, ALTER, WAIVE OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS POLICY OTHER THAN AS ABOVE STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR LIMITATIONS IN THIS ENDORSEMENT. COUNTERSIGNED AND ISSUED AT SAN FRANCISCO: JANUARY 6, 2025 2572 AdNTl1'ORC2ED IEPRESEdVT PVE PRESIDENT AND CEO SCIF FORM 10217 (REV.4-2018) 1 OLD DP 217