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PROOF OF INSURANCE (2025 - 2026)CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDmYY) A 12/19/2024 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 CON ACT ..... NANM1E in D DIBZ „_,_,, D&C Insurance Solutions PHONE 888 457 4426 AIC N _w 323.576.4552 _.... E �psmm conlactdc! insurance.com 300 S. Atlantic Blvd., Ste 201-B •••w, INSURER(S)AFFORDING COVERAGE- � .jMIC# Monterey Park _.....CA 91754 .... .............. INSURERA: Western World Insurance Company 13196 INSURED INSURER B: ..........._ _....�.�.�...... ..... ......... Tillmann Forensic Investigations, LLC. INSURERC:W .............. ........ _• INSURER D i _ -.. °,, PO BOX 4373 INSU_..RER E : ................. ......... ..._... ................. ........ Covina CA 91723 INSURER F: nnvooAnec eFRTIICIrteTE 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. _ .._..,. ............LIMIT .. .., ° VI ..... AOtSL SUBR POLICY EFF PiYLICY EXP d 4 TYPE OF INSURANCE RANCE w.... POLIC'W'NI9MBER MM/ rt5/YYYY MMLD.P )ff1........ S _ X COMMERCIAL GENERAL LIABILITY A NPP6081725 12/17/2024 12/1712025 EACH OCCURRENCE ($ 1,000 OOOm .... DIAL FURENNT ,� 100„000 CLAIMS -MADE � OCCUR M-III, °I'.-� :.�(.FIN+'Ia^cidrcst*nic,e) .......�°..._. MED EXP (Any oou Pol'$E!) $ 5„000 PERSONAL B ADV INJURY $ 1,IOO,000 '. ....................�_. ....... ._�.,..-.� ..... .,.,..,,,.,_ _. ....... GEN"L AGGREGATE LIMIT APPLIES PER: _ GENFRALAGGREGATE $ 2,000„000 �y /+,.. POLICY ❑ JECT ❑ LOG GG .........._ - .�._.. Included Errors & Omissions $ Included OTHER, w .. - - acG1cDrESINGLIw LIMIT $ AUTOMOBILE LIABILITY ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS HIRED NON -OWNED"( ••••—• — $ AUTOS ONLY AUTOS ONLY PI.PA ucIYoMA'E -- --••• .. ...... UMBRELLA LIAB '.00CUR EACH OCCURRENCE $, EXCESS LIAB CLAIMS -MADE ACCRCGAI°E DED RETEN11ONS $ WORKERS COMPENSATION ---._.......... AND EMPLOYERS' LIABILITY YIN ... �. ANYPROPRJETORVPARI'�NERJEXECIJTIVE EACH ACCIDENT $ .—._.. ..-........_._.. OFFICERWE-M'BE> EXCLUDED't ❑ NIA (Mandatory in NH,I E.L. DISEASE - EA EMPLOYEE S ..... ....._. _-. .... I! yyes, drsscr6he nawdol 0 SCRII'�'I°lON OF t 1PERATIONS hoiaw E.L. DISEASE -POLICY LIMIT S (ACORD 101, Additional Remarks Schedule, may more ... DESCRIPTION OF OPERATIONS (LOCATIONS /VEHICLES h� attached if oro space is required)) Regarding the above referenced General Liability policy, olic , the certificate holder Is included asadditional insured, but only with respect to the negligent acts, errors or omissions of the named insured. CERTIFICATE HOLDER UANUtLL44IIU114 City of El Segundo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 348 Main Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN El Segundo, CA 90245 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Lin Dau Diaz - l7 Tbaa-Zt) ID M%,Vrcv a,vrcrvrcn w.. nu ynw .cao..c... ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: NPP6081725 COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 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) Location(s) Of Covered Operations Or Organ ization(s): City of El Segundo "carious Locations 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", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. 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 additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 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. CG 20 10 04 13 Copyright, Insurance Services Office, Inc., 2012 Page 1 of 2 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 additional insured is the amount of insurance: 1. Required by the contract or agreement; 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. Page 2 of 2 Copyright, Insurance Services Office, Inc., 2012 CG 20 10 04 13 � T CALIFORNIA. INSURANCE CARD Stato Farm Mutual Automobile Insuranes Company PO INURED TILLMAN!, STEV1E 8 MUTL VOL POLIOY NUMBER -75G EFFECTIVE YA 2019 MAKE JEI=P S912 09 2025 TO MAR 29 2020 MODEL WRAMt I-r:1t VIN 789 ANENT 1317-AEI PHONE NAIC 28178 �"ERAE� �� CiD THE � RRUOU +"� MEETS THE MINIMUM LIABILITY LIMITS 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: U 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 s bYect to the workers' compensation provisions of Labor Code § 3700 1 must i g will automatically become void. 9 immediatelyppcomply �010i/0 Signature Applicant Date ith those pr sons o e agreement Agreement for: Dated: Reviewed by: