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PROOF OF INSURANCE (2026)-^- 1 DATE (MMIDDIYYYY) ACC>CERTIFICATE OF LIABILITY INSURANCE 0"7 11Q0 5 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 C tI NAME. ......... ,.. „ ...... BIBERK PHONE B4-1 172 0 „➢67 aA , IrvrPp. e c 203-654-3613 (AdG„ Nc+, Exai G P.O. Box 113247 E-MAIL ',t.IEaIrullltl�I^,gerMG�.I�I�4,ry fflFIRIK.a;;oim Stamford CT 06911 ADDRESS, , ' INSURER(S) AFFORDING COVERAGE NAIL # ,,,,, ,,,,,,,,,,__ _,,. INSURER A : Berkshire Hathaway Direct Insurance Company , , 10391 INSURED I INSURER B ..... ....... ........_— Fire Safety Advisors, LLC _ ..... .. ...,,,, INSURER C 9311 Velardo Drive INSURER D: Huntington, CA 92646-2314 INSURER Er INSURERF: rnvFQArZFc ('FRTIFICATF NUMBER: REVISION NUMt3ER: a 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. ;R ACDU fIJEWI POLICY EFF POLICY EXP LIMITS R TYPEOF INSURANCEA.+,. POLICY NUMBER MMIDDIYYYY. MMID.OIW X COMMERCIAL GENERAL LIABILITY E rH T I,rkkf- LE S 1,000,000 CLAIMS -MADE i� OCCUR .i,^"E"C'�li ✓A, Ld.F SltiuraF.,. `t� 9C�''b......... GENII. I Aa; GRf CIA r E LIMIT APF L I I:Llz; 11,R PRO POLICY LOG, -%'`+ O F I ffI R AUTOMOBILE LIABILITY ANY AUTO 47kVINFED AU13,1,C'NLW _. AUI I911;F711D NON ...ila,rvtl`iED ............... ^'eGfrC"RlaCdlNLY AIJIDS :ahll..'p. UMBRELLA LIAR C,,1^ 1 IIR EXCESS LIAR �. I A M.7...00,AC:I DED PIE'C'CfNTIiDINS WORKERS COMPENSATION AND EMPLOYERS'LIABILITY Y I N AN YPR OPRIETORfPARTN ERIEXEC UT I V E OFFICERIM EMBER EXCLUDED NIA (MandatM in NH) If vesdescribe under A Professional Liability (Errors & Omissions): Claims -Made N96P968546 02/02/202.g 02/02/2026 MED IMXP (Auryl 01ne I,ea.1Jrry S 5,000 ralrl�lr�l. A ADV INJURY $ Included r i NERA1L AGGREGAIiE 4 2,000,000 r' Ra j1_AJ ' I',S COMP10111-> AGG $ 2,000,000 w17I„I ..6iPrpl ° 5 ( a iHa,KFICdeAo-1,� °1§'C"}dA_Y INJUIRY (Per IrrvvE n) „iON l_Y INJURY (C'er ac�idc-° P,R0P ERT'W DA ,4A (" F: I .............>..._......_ ............ .._ .............,.,... ..___ �I RiAC Id +CC.[,1kfC'L,NC.:1"c C A0,GREGAI L $ GI:I h. FACH ACIC:)I ra&"'.1 r I E 1 DVSEAS�I Irk NIPI CI I �S E I... I".7iSE^A�S5Fi,:- POL,K,)' I_IILCI.I,. I N9PL818963 102/022025 02/02/2026 Per Occurrence/ $1,000,000/Aggregate $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOL City of El Segundo 350 Main St 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 01988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD DATE (MM/DD/YWY) AGENCY CUSTOMER ID: 07/11/2025 LOC #: mm AC"R" ADDITIONAL REMARKS SCHEDULE AGENCY NAMEDINSURED BIBERK Fire Safety Advisors, LLC ---------- POUCY NUMBER N9BP968546 9311 Velardo Drive . ................. Huntington, CA 92646-2314 CARRIER NAIC CODE Berkshire Hathaway Direct Insurance Company 10391 EFFECTIVE DATE: (MM/DD/YYYY) Page 3of ACORD 101 (2008/01) V 2008 ACORD GURPUKA I 1UN. An rignts reserves. The ACORD name and logo are registered marks of ACORD DATE (MM/DD/YYYY) CERTIFICATE OF PROPERTY INSURANCE 07/11/2025 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. PRODUCER 1, COME CT (8,44) 472-0967 BIBERK ADDRESS 9k 5�P�P CkTFAO I�H£JCiK DPi7 . P.O. Box 113247 CUODUCER STTOMER ID Stamford, CT 06911„ „ INSURER(S) AFFORDING COVERAGE NAIC # INSURED ..... MSI.IREkt,A IHerkshlre Hathaway Direct InsuranceCornflaa 5416,11 Fire Safety Advisors, LLC INSURER 0: 9311 Velardo Drive Huntington, CA 92646-2314 INSURER D. INSURER E, INSURER F �w��w�+�c� I+L DTI CI!`A TG �n �e�oro. RFVICIr1N NIIMRFR• LOCATION OF PREMISES I DESCRIPTION OF PROPERTY (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Location: 9311 Velardo DriveHuntington, CA 92646-2314 Bldg #001: Consultants - All Other - 4167702 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 ILNSR.-.... TYPE OF INSURANCE ... ��.. POLICY NUMBER ........ POE OL DATY EXPIRATION YYYTIVE POLICY COVERED PROPERTY LIMITS (MMrDDI X PROPERTY hIUHI:'kINdCI' 5 Q')�, r,. AUSf ,j UP LC),'SS I1[,iAA'1 I H[ I 'S F:R R SC NAV P HrWIFIRI'Y p GCAlI INO N913P968546 02/02/2025 02/02/2026 l,[[ 1NFsx5IIV,01114, 0 [dftif,'1rNO 2• ....... ....- I XI W"tit" I Xi 1h NI6'I::!: 0 A "`.. I ll I I d1 3 n I"AR"i`l-IC,;[I,AKI,;,l ULANINli!:T[➢Al'Jlf`G n/a WIND BI ANI21Lll PT RSPRR,P , n/a F 1001:x Gi n'PNKI I`o .M I INN Y FT� 11; n/a INLANDMARINE f V"F°I.: OI F'OI..IC;Y 5 NAMED II"" HIL,`°'i I'1OL.IC�.Y V LIIV HC iP'R 5 CRIME 5 TYPE OF POLICY 5 5 BOILER & MACHINERY 9 EQUIPMENT BREAKDOWN 'r r SPECIAL CONDITIONS / OTHER COVERAGES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) f FRTIFICATF N(]I r1FR CANCELLATION 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. 350 Main St El Segundo, CA 90245 AUTHORIZED REPRESENTATIVE h © 1995-ZU15 AGUKU GUKPUKA I IUN. An rignTs reservea. ACORD 24 (2016103) The ACORD name and logo are registered marks of ACORD POLICY NUMBER:N9BP968546 Date Processed: 07/11 /2025 BUSINESSOWNERS BP12010702 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSII ESSOW ERS POLICY CHANGES Fire Safety Advisors, LLC 9311 Velardo Drive Huntington, CA 92646-2314 THIS ENDORSEMENT FORMS A PART OF THE POLICY NUMBERED BELOW. POLICY NUMBER N9BP968546 NAMEDINSURED Fire Safety Advisors, LLC POLICY CHANGES EFFECTIVE 07/10/2025 CHANGES Additional Insured - Designated Person or Organization Added Name of Person or Organization: City of Brea Address: 350 Main St City: El Segundo State: CA Zip: 90245 COMPANY Berkshire Hathaway Direct Insurance Company AUTHORIZED REPRESENTATIVE Policy Forms Added Additional Insured - Designated Person or Organization (BP 04 48 01 06) BP 12 01 07 02 © ISO Properties, Inc., 2001 Page 1 of 2 0 POLICY AMOUNT AND PREMIUM ADJUSTMENT Limits Of Insurance Premiums Coverage Previous Limit New Limit Previous New 0 Add1 Premium Descri tion Of Insurance Of Insurance Premium Premium 0 Return Premium ... _.... $ ........$ _._.$. TOTAL PREMIUM ADJUSTMENTS PREMIUM DUE AT POLICY CHANGE EFFECTIVE DATE ADDITIONAL RETURN $ 0.00 $ 0.00 REMOVAL If Covered Property is removed to a new location that is described on this Policy Change, you may PERMIT extend this insurance to include that Covered Property at each location during the removal. Cov- erage at each location will apply in the proportion that the value at each location bears to the value of all Covered Property being removed. This permit applies up to 10 days after the effective date of this Polic Chan e: after that, this insurance does not a I at the previous location. Page 2 of 2 © ISO Properties, Inc., 2001 BP 12 01 07 02 POLICY NUMBER: N9BP968546 BUSINESSOWNERS BP 04 48 01 06 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE Name Of Additional Insured Person(s) Or Or anizatio City of Brea Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph C. Who Is An Insured in Section II — Liability: 3. Any person(s) or organization(s) shown in the Schedule is also an additional insured, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omis- sions or the acts or omissions of those acting on your behalf in the performance of your ongoing operations or in connection with your premises owned by or rented to you_ BP 04 48 01 06 © ISO Properties, Inc., 2004 Page 1 of 1 ❑ POLICY NUMBER: N9BP968546 BUSINESSOWNERS BP 04 48 01 06 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE Name Of Additional Insured Persons Or Or anization(s City of Brea Information required to complete t mmmITIThis Schedule, if not shown The following is added to Paragraph C. Who Is An Insured in Section II — Liability: 3. Any person(s) or organization(s) shown in the Schedule is also an additional insured, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury' caused, in whole or in part, by your acts or omis- sions or the acts or omissions of those acting on your behalf in the performance of your ongoing operations or in connection with your premises owned by or rented to you. will be shown in the Declarations. BP 04 48 01 06 © ISO Properties, Inc., 2004 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: (®) 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. (®) 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: Carrier Policy Number Expiration Date Name of Agent Phone (X) 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. /2025 Signature of Applicant r''`, f Date Print Name Noah Fisher Agreement for: Dated: Reviewed by: