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PROOF OF INSURANCE (2025 - 2026)Generated using Certificial's Smart COI Network TM — Track your Suppliers in real-time at certificial.com/coi COI ID: 4MGJH 0 DATE (MM/DD/YYYY) C40R" CERTIFICATE OF LIABILITY INSURANCE a � 07/10/2025 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 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 rww"�`CT Dustin Iwikenf,?y w...e ..... ,w WRIS, Inc. dba Western Republic Insurance Services PHONE 8884671718 19900 Beach Blvd. EMAIL dustin nnsurance.corn Suite F1 _ INSURERS) AFFORDING COVERAGE ............. .„ NAIC # Huntington Beach CA 92648 Col g _ I INSURERA Colony Insurance Company 39993 INSURED INSURER B ! California Automobile Insurance Company 38342 Golden Meters Service, Inc. INsuRERc: Scottsdale Insurance Company 41297 14812 Hunter Ln INSURER Dm. -mmmm Security National Insurance Company ........._ —�1987_9 INSURER E Midway City CA 92655 INSURERF: rani... wrtvnw:nr RFVICICIN NIIIVIRPR , 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. .ITIT...ITmm--�rvmm ..... ..m -.,.-„ -..... TYPE OF ADDL.� POLICY NUMBER MMADCMYIT__.. RNSR SII63R POLICY YY POLICY UP LIMITS TR IYYY MM'D04'YYYY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 mmmmm..m ....._. CLAIMS -MADE FRIOCCUR PREMRSES En ooct+rr MED EXP (Anyone person) $ S,000 A m Y Y 600 GL 0217377-00 09/09/2024 09/09/2025 PERSONAL&ADVINJURY _....._...... $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ 2,000,000 POLICY PROS. LOC JECT PRODUCTS - COMP/OP AGGmm _ �..�.�. $ 2,000,OOO 07 HEST: �N�''LC LIM17 as AC0g9 $ 1,000,000 AUTOMOBILE LIABILITY l] _ ANY AUTO BODILY INJURY (Per person) $ BIx OWNED SCHEDULED BA040000088824 04/15/2025 04/15/2026 BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS HIRED +" NON -OWNED PRS)I� HrYDAMAGE s Irde�ntS $ - „„„„ .............. ._ AUTOS ONLY AUTOS ONLY -�,(Pe¢ -- ••••. • • UMBRELLALIAB X '...., OCCUR m71 EACHOCCURRENCE ...... $ 4,000,000 C X EXCESS LIAR'. pLAIM$-MADE ,_...... - _.._........„_ CXS4032619 09/09/2024 O9/09/2025 AGGREGATE __.. $ 4,000,000 pEp RETENTION $ -- $ WORKERS COMPENSATION �/ PER OTH- D AND EMPLOYERS' LIABILITY YIN ANYPROPRIETOR/PARTNER/EXECUTIVE � NIA Y SWC1540465 03/07/2025 03/07/2026 %� STATUTE""". R EL EACH ACCIDENT - $ 1 OOO,OOO OFFICEF2IMEMBEREXCLUDED? (Mandatory in NH)•- E„L.DISEASE-EA EMPLOYEE•mmm1,000,000•^.......,- If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) Those usual to the insured's operations. The certificate holder is named as additional insured per the attached CG 20 10 12 19 & CG 20 37 12 19. Waiver of subrogation applies per the attached CG 24 04 12 19 & WC 04 03 06. Insurance is primary and noncontributory per the attached CG 20 01 12 19. CERTIFICATE HOLDER CAN'CbLL.A11iRt. N City of El Segundo 350 Main St. 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 ElSegundo CA 90245 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD COI ID: 4MGJH Generated using Certificial's Smart COI Network"^' — Track your Suppliers in real-time at certificial.com/coi 600 GL 0217377-00 POLICY NUMBER: 600 GL 0217377-00 COMMERCIAL GENERAL LIABILITY CG 20 10 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. • • • 1 :11.11101 its] Z04: 80 14,111 :1 loll :J Z&191 INk 1[91 This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Any person or organization required to be included as an Additional Insured on this policy pursuant to written p Y p contract with the Named Insured, that is fully executed prior to the commencement of the work that is called for in the contract. Where no coverage under this policy shall apply for the Named Insured, no coverage or defense shall be afforded to the Additional Insured. Location(s) Of Covered Operations All locations as required by written contract with the Named Insure d. 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 B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following additional organization(s) shown in the Schedule, but only exclusions apply: with respect to liability for "bodily injury", "property This insurance does not apply to "bodily injury" or damage or personal and advertising injury "property damage" occurring after: caused, in whole or in part, by: 1. Your acts or omissions; or 1. All work, including materials, parts or equipment furnished in connection with such 2. The acts or omissions of those acting on your work, on the project (other than service, behalf; maintenance or repairs) to be performed by or in the performance of your ongoing operations for on behalf of the additional insured(s) at the the additional insured(s) at the location(s) location of the covered operations has been designated above. completed; or However: 2. That portion of "your work" out of which the 1. The insurance afforded to such additional injury or damage arises has been put to its intended use by any person or organization insured only applies to the extent permitted by other than another contractor or subcontractor law; and engaged in performing operations for a 2. If coverage provided to the additional insured is principal as a part of the same project. required by a contract or agreement, the insurance 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. CG 20 10 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 2 600 GL 0217377-00 C. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: if coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the addiitional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable limits of insurance; whichever is less. This endorsement shall not increase the applicable limits of insurance. Page 2 of 2 © Insurance Services Office, Inc., 2018 CG 20 1012 19 600 GL 0217377-00 POLICY NUMBER: 600 GL 0217377-00 COMMERCIAL GENERAL LIABILITY CG20371219 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES O 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) Location And Description Of Completed Operations Any person or organization required to be included as All locations as required by written contract with the an Additional Insured on this policy pursuant to written Named Insured. contract with the Named Insured, that is fully executed prior to the commencement of the work that is called for in the contract. Where no coverage under this policy shall apply for the Named Insured, no coverage or defense shall be afforded to the Additional Insured. 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 include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" 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 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance 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. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable limits of insurance; whichever is less. This endorsement shall not increase the applicable limits of insurance. CG 20 37 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1 600 GL 0217377-00 POLICY NUMBER: 600 GL 0217377-00 COMMERCIAL GENERAL LIABILITY CG24041219 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): Any person or organization required to be included as an Additional Insured on this policy pursuant to written contract with the Named Insured, that is fully executed prior to the commencement of the work that is called for in the contract. Where no coverage under this policy shall apply for the Named Insured, no coverage or defense shall be afforded to the Additional Insured. Information reQUired to complete this Schedule, if not shown a 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. will be shown in the Declarations. CG 24 0412 19 © Insurance Services Office, Inc., 2018 Page 1 of 1 600 GL 0217377-00 COMMERCIAL GENERAL LIABILITY CG 20 01 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance Condition and supersedes any provision to the contrary: Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution 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 (2) You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. CG 20 01 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 04-84) WAIVER OF OUR RIGHT TO 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.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 2% of the California workers' compensation premium otherwise due on such remuneration. Schedule Person or Organization Job Description Any person or organization as required by written contract. 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 3/7/2025 Policy No. SWC1540465 Endorsement No. 1 Insured Golden Meters Service, Inc. Premium $ 12,721 Insurance Company Security National Insurance Company Countersigned by —.— WC 04 03 06 (Ed. 04-84)