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PROOF OF INSURANCE (2026)rr...sx. 4ae042 rMR1ISIN -----_-- -- -_ -- DATE(MM/DD/YYYY) ACORD. CERTIFICATE OF LIABILITY INSURANCE 1 9/17/2025 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAME: T Sue Nisoff EPIC Insurance Midwest - ..__.... NAME _ '--'•- user rr..s. 560 5th Street, Suite 202 EMAIL MAp okers Corry sue.nisoff a Icbr -- Grand Rapids, MI 49504 UR AFFORDINGCOVERE _ NA _.....w...-......._�....-..._......... National Union Fire Ins INSURER A: Pittsburg 19445C# INSURED INSURER 9 Goforth & Marti Inc. dba GM Business . - � INSURER C : GM Business Interiors INSURER D : 1099 W. La Cadena Dr.'� INSURERE......_......:...... Riverside, CA 92501 ............ .... ...,..,,,,�» INSURER F COVERAGES CERTIFICATE 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. LTFN R TYPE OF INSURANCE INSR BURR POLICY NUMBER _ diP4rOJk1DkC7YdY" "P' " l�PIM 1'DO?YEYYY LIMITS �... �.._..............._ LTR i#MS D ..�_ �..... COMMERCIAL GENERAL LIABILITY URRENCE $ 2r000000 { �.�­ A �X� _ X X 5180177 3/01/2025 03/01/202 EACHoc y-� - �y 7c CLAIMS -MADE AlX OCCURh I S„Eaocu�'rgnca $3QO,000- MED EXP (Any one person) $25 000 L 2 000,000 .PERSONA,,mm8 ADV INJURY � $,. ��,,... _ GEN'L AGGREGATE LIMIT APPLIES PER; .GENERAL AGGREGATE $4 OOP O.�OO POLICY PROJECT LOC PRODUCTS -COMP/OPAGG $4,000.,000 OTHER; $ A AUTOMoeuEuaealry X X 2961606 3/01/2025 03/01/202 &,M,, kN ELkCCIT 2 000 000 a ar ?�1�. ..IL..a_.. X' ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY INJURY (Per accident) $_H AUTOS ONLY AUTOS R050 R 'FAAGC HIRED NON-OWNEDSLY (,RerPc dnl $ ._..-.. $ ,.,..w....,,.. ,,..,-... X AUTOS ONLY X AUTOS ONLY UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE _..,, ....,-.. ,.......,,m.,�..._ ».,...,.. W DED RETENTIONSPER Y / A COMPENSATION N X WC031566216 3/01/2025 03/01/202 � X T ER — AND WORKERS k'X qL DE T Ed UTI E ._ E.L, DISEASEL EACH EMPLOYEE $2 OOOaIDENT OOO ND EMPL YERS• L ANY fMEETORIPAR [ ) N I A (Mandatory In NH) 000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE POLICY LIMIT $2.000 OOO DESCRIPTION OF OPERATIONS! LOCATIONS / VEHICLES (ACORD 101,Additional Remarks Schedule, maybe attached If more space Is required) Certificate holder is named as additional insured (on a primary and non-contributory basis) with respects to General Liability and Auto Liability as required by written contract; A Waiver of Subrogation is issued in favor of certificate holder with respects to General Liability, Auto Liability and Workers' Compensation as required by written contract; All policies contain a 30 day notice of cancellation (10 days for non -pay) subject to policy terms and conditions; GL additional insured endorsements include ongoing and completed operations. BE City Of El Segundo - City Clerk THE SHOULD EXANY OFPIRATIIONH DATE V T EREOFDESCRE NOTICEI WILL BE CANCELLEDES CDELIVERED NE 350 Main Street, Room 5 ACCORDANCE WITH THE POLICY PROVISIONS. El Segundo, CA 90245-3813 AUTHORIZED REPRESENTATIVE EP -li'p ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) 1 of 1 The ACORD name and logo are registered marks of ACORD #S7947528/M7375192 KWI01 POLICY NUMBER: 518-01-71 COMMERCIAL GENERAL LIABILITY CG 20 10 12 19 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 d Persons) Or Organiation(s) Location(s) Of Covered Operations ANY PERSON OR ORGANIZATION WHOM YOU PER THE CONTRACT OR AGREEMENT. BECOME OBLIGATED TO INCLUDE AS AN ADDITIONAL INSURED AS A RESULT OF ANY CONTRACT OR AGREEMENT YOU HAVE ENTERED INTO. _ p above, will be shown in the " s Schedule, if not shown ab Information req uired to __.._ _.__ complete this ions, CG 20 10 12 19 0 Insurance Services Office, Inc., 2018 Pagel of 2 0 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. C. 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. 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. Page 2 of 2 0 Insurance Services Office, Inc., 2018 CG 20 10 12 19 POLICY NUMBER: 518-01-77 COMMERCIAL GENERAL LIABILITY CG 20 37 12 19 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 Odr Organization(s) Person(s) Aditional Insured nlsl _ Location And Description Of Comp__ ttI_Operations ANY PERSON OR ORGANIZATION WHOM YOU PER THE CONTRACT OR AGREEMENT. BECOME OBLIGATED TO INCLUDE AS AN ADDITIONAL INSURED AS A RESULT OF ANY CONTRACT OR AGREEMENT YOU HAVE ENTERED INTO. I � p Schedule,if not shown above, ............... • .._ Declarations. Information required to com complete this �� will be shown m the A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organizationls) 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 0 Insurance Services Office, Inc., 2018 Page 1 of 1 POLICY NUMBER: 518-01 -77 COMMERCIAL GENERAL LIABILITY CG24531219 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) AUTOMATIC 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 The following is added to Paragraph B. Transfer Of Rights Of Recovery Against Others To Us of Section IV — Conditions: We waive any right of recovery against any person or organization, because of any payment we make under this Coverage Part, to whom the insured has waived its right of recovery in a written contract or agreement. Such waiver by us applies only to the extent that the insured has waived its right of recovery against such person or organization prior to loss. CG 24 53 12 19 0 Insurance Services Office, Inc., 2018 Page 1 of 1 POLICY NUMBER; 518-01-77 COMMERCIAL GENERAL LIABILITY CG 20 01 12 19 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 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 0 Insurance Services Office, Inc., 2018 Page 1 of 1 ENDORSEMENT This endorsement, effective 12:01 A.M. 03/01 /2025 forms a part of Policy No. 296-16-06 issuedto GOFORTH & MARTI - DBA GM BUSINESS INTERIORS by NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA. ADDITIONAL INSURED - WHERE REQUIRED UNDER CONTRACT OR AGREEMENT This endorsement modifies insurance provided under the following; BUSINESS AUTO COVERAGE FORM SCHEDULE ADDITIONAL INSURED: ANY PERSON OR ORGANIZATION FOR WHOM YOU ARE CONTRACTUALLY BOUND TO PROVIDE ADDITIONAL INSURED STATUS BUT ONLY TO THE EXTENT OF SUCH PERSON'S OR ORGANIZATIONS LIABILITY ARISING OUT OF THE USE OF A COVERED "AUTO". I. SECTION II - LIABILITY COVERAGE, A. Coverage, 1. - Who Is Insured, is amended to add: d. Any person or organization, shown in the schedule above, to whom you become obligated to include as an additional insured under this policy, as a result of any contract or agreement you enter into which requires you to furnish insurance to that person or organization of the type provided by this policy, but only with respect to liability arising out of use of a covered "auto". However, the insurance provided will not exceed the lesser of: (1) The coverage and/or limits of this policy, or (2) The coverage and/or limits required by said contract or agreement. Authorized Representative or Countersig,gnature (in States Where Applicablel 87950 0 0/05) Includes copyrighted material of Insurance Services Office, Inc. with its permission. Page 1 of 1 ENDORSEMENT This endorsement, effective 12:01 A.M. 03 /01 / 2025 forms a part of Policy No. 296-16-06 issued -to GOFORTH & MARTI - DBA GM BUSINESS INTERIORS by NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM Section IV - Business Auto Conditions, A. - Loss Conditions, 5. - Transfer of Rights of Recovery Against Others to Us, is amended to add: However, we will waive any right of recover we have against any person or organization with whom you have entered into a contract or agreement because of payments we make under this Coverage Form arising out of an" accident' or" loss" if: (1) The "accident' or "loss" is due to operations undertaken in accordance with the contract existing between you and such person or organization; and (2) The contract or agreement was entered into prior to any "accident" or " loss" . No waiver of the right of recovery will directly or indirectly apply to your employees or employees of the person or organization, and we reserve our rights or lien to be reimbursed from any recovery funds obtained by any injured employee. AUTHORIZED REPRESENTATIVE 62897 (6/95) Includes copyrighted material of Insurance Services Office, Inc. with its permission. Page 1 of 1 ENDORSEMENT This endorsement, effective 12:01 A.M. 03/ 01 / 2025 forms a part of Policy No. 296-16-06 issued to GOFORTH & MART - DBA GM BUSINESS INTERIORS by NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA. INSURANCE PRIMARY AS TO CERTAIN ADDITIONAL INSUREDS This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM Section IV - Business Auto Conditions, B., General Conditions, 5., Other Insurance, c., is amended by the addition of the following sentence: The insurance afforded under this policy to an additional insured will apply as primary insurance for such additional insured where so required under an agreement executed prior to the date of accident. We will not ask any insurer that has issued other insurance to such additional insured to contribute to the settlement of loss arising out of such accident. All other terms and conditions remain unchanged. Authorized Representative or Countersi nature (in States Where App(icaie 74445 (10/99) Includes copyrighted material of Insurance Services Office, Inc. with its permission. Page 1 of 1 BLANKET WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different date is indicated below. (The following "attaching clause" need be completed only when this endorsement is issued subsequent to preparation of the policy), This endorsement, effective 12:01 AM 03/01 /2025 forms a part of Policy No. WC 031-56-6216 Issued to GOFORTH & MART - DBA: GM BUSINESS INTERIORS By NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA. We have a right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against any person or organization with whom you have a written contract that requires you to obtain this agreement from us, as regards any work you perform for such person or organization. The additional premium for this endorsement shall be 2.00 % of the total estimated workers compensation premium for this policy. WC040361 Countersigned by - - - - - - - - - - - - - - - - - - - - - - - - - - - - - (Ed. 11 /90) Authorized Representative