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PROOF OF INSURANCE (2026 - 2026)DATE (MMIDDNYYY) ACC> '�" CERTIFICATE OF LIABILITY INSURANCE 09/0 l2025 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 poiicy(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 Countryside Insurance Agency 29970 Technology Drive, Suite 214 MURRIETA, CA 92563 Neil Broker neil com 071 NAIC # INSURED RER:California utpmq RERC: ..e nsurance Ompany .41..4E SOUTH COAST PAINTING INC INSy, I 28364 S WESTERN AVE PMB PMB465 INSURER0: ... RANCHO PALOS VERDES, CA 90275-1434 INSURER E INSURER F : I COVERAGES rt.ERTIE'IC:ATE NUMBER: 00004502-250423185418 REVISION NUMBER: 9 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'_ .... .........TYPE OF INSURANCE uA' %' UU��. .. pOLICY....... .. ......... JR NUMBER .. .. .. .......... �•POLYCY�'FF� � POLICYEXP MMIDA,IYYYY �< MMIDOIYYYY LIMITS A COMMERCIAL GENERAL LIABILITY Y U25AC165911-00 05/0112025 `osiovzozs OCCURRENCE 1" fY CLAIMS -MADE AWXfONft- m $ 100,000 I 1 PERSONAL & ADV INJURY $ 1 00000,000 0 0 a GrlV't, AGGREGATE LIMIT APPLIES PER: EN ERAL A .. ... 2, _ Q Q, 000 I PRd.') .... 'T LOC POLICY PRODUCTS -COMP/OP AGG . $ 2,�000rOOO .. , 1CC ......... , OTHER$ AUTOMOBILE LIABILITY Y Y BA040000093535 04/26/2025 04/26/2026 COMB a�,i, 1 000_ 000 $ ANY AUTO BODIBLY INJURY (Per person) OWNED SCHEDULED X. 1 g INJURY (Per I $ AUTOS ONLY AUTOS HIRED 1 NON -OWNED AUTOS ONLY AUTOS ONLY PODILY (ga9a.rr. drvn(�AMAC,af ..................I...$ . ,........ .... ,•+ A UMBRELLA LIAB yk Y U25AC165911-00 05/01/2025 05/01/2026� E OCCURRENCE $ 1 �000'000 �* X EXCESS LIAR OLACURIMS-MADE EACH GGREGAT e $ 1,000,000 ..._. j� I DED..._! RETEN•.. ON $ -.. , TION $ $ WORKERS COMPENSATION PER ( I OTH- STATUTE ER YIN ANY PROPRIETOR/PARTNAND EMPLOYERS' ER EXECUTIVE ANYOF ''., E,L EACH ACCIDENT ,,, ,• � $ . ..,..NIA CER/MEMBER EXCLUDED (Mandatory in NH) "'"""'"'""I E L DISEASE EA EMPLOYEE, $ Byes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ i DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Certificate is subject to policy limits, conditions, and exclusions. The City of El Segundo, its elected and appointed officials, employees, and volunteers as additional insureds. The City of El Segundo will receive thirty (30) days written notice in the event of cancellation, nonrenewed or reduction from Insured. continued on ACORD 101 Additional Remarks Schedule GtK I IhIGA It: HVLU'CK City of El Segundo 150 Illinois Street 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. AUTHOPJZED REPRESENTATIVE � 91ytlS--LU1b AGUKU GUKF'UKAIJUN. AU ngnis reserveu. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD Printed by NPF on 09/03/2025 at 11:44AM AGENCY CUSTOMER ID: LOC #: ADDITIONAL REMARKS SCHEDULE� Page 2 of '... AGENCY NAMED INSURED Countryside Insurance Agency SOUTH COAST PAINTING INC POLICY NUMBER ..............................................,...,.. ..... NIA __....,.... ........................ CARRIER Multiple CarriersNAIC CODE tiFFECTIVE DATE: THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: _..Certificate of Liability Insurance_ (continued from Description of Operations) Primary and Non -Contributory Endorsement is primary and non-contributory such that any other insurance that may be carried by the City will be excess thereto. ACORD 101 (2008/01) v cUUU A6UKU 6VKrUrtA I IVry. no ngnw FUMV1 Vcu. The ACORD name and logo are registered marks of ACORD Printed by NPF on September 03, 2025 at 11:44AM POLICY NUMBER: U25AC165911-00 COMMERCIAL GENERAL LIABILITY CG 20 37 07 04 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 SCHEDULE Name Of Additional Insured Person(s) Location And Description Of Completed Or Organization(s): Operations Any person or organization, when you and such parties have agreed in writing in a contract or agreement pertaining to "your work" performed during the policy period. This additional insured coverage does not apply Ito "excluded residential construction". "Excluded residential construction" means: a) the ground -up construction of any building whose units will be individually owned and titled; and, b) "your work" performed on the conversion of any building into a condominium or townhome. Information required to co m lete this Schedule, if not shown above, will be shown in the Declarations.. 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". CG 20 37 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 13 POLICY NUMBER: U25AC165911-00 COMMERCIAL GENERAL LIABILITY CG 20 10 07 04 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 Or anization s : Locations Of Covered Operations Any person or organization for whom you are performing operations during the policy period when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy. Information re uired to com lete 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. 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 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 DI POLICY NUMBER: U25AC165911-00 COMMERCIAL GENERAL LIABILITY HCS 040 06 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY AND BLANKET WAIVER OF SUBROGATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART A. PRIMARY AND NON-CONTRIBUTORY TO OTHERINSURANCE With respect to any person or organization that is an additional insured under this Coverage Part, the following is added to paragraph 4. of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: If you have agreed in writing in a contract or agreement that this insurance is primary and non- contributory relative to an additional insured's own insurance, then this insurance is primary and we will not seek contribution from that other insurance. For the purpose of this endorsement, the additional insured's own insurance means insurance on which the additional insured is a Named Insured. When this endorsement is attached to the policy it supersedes all other insurance conditions within. HCS 040 06 10 13 B. WAIVER OF SUBROGATION — BLANKET Under SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS, The Transfer Of Rights Of Recovery Against Others To Us Condition is amended by the addition of the following: We waive any right of recovery we may have against any person or organization because of payments we make for injury or damage arising out of: a. Your ongoing operations; or b. "Your work" included in the "products - completed operations hazard". However, this waiver applies only when you have agreed in writing to waive such rights of recovery in a contract or agreement, and only if the contract or agreement: a. Is in effect or becomes effective during the term of this policy; and b. Was executed prior to loss. Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 1 POLICY NUMBER: U25AC165911-00 COMMERCIAL GENERAL LIABILITY HCS 040 02 11 12 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. GENERAL AGGREGATE LIMIT PER PROJECT WITH AN OVERALL GENERAL AGGREGATE LIMIT This endorsement modifies insurance provided under the following. COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designated Construction Project(s): All Projects Information required to complete this Schedule, if not shown above„ will be shown in the Declarations A. For all sums which the insured becomes legally 3. Any payments made under Coverage A for obligated to pay as damages caused by more damages or under Coverage C for medical than one 'occurrence" under Section I — expenses shall reduce the Designated Coverage A, and for all medical expenses Construction Project General Aggregate caused by accidents under Section I — Limit for that designated construction Coverage C, which can be attributed only to project. Such payments shall not reduce the ongoing operations at a single designated General Aggregate Limit shown in the construction project shown in the Schedule Declarations nor shall they reduce any other above: Designated Construction Project General 1. A separate Designated Construction Project Aggregate Limit for any other designated General Aggregate Limit applies to each construction project shown in the Schedule designated construction project, and that above. limit is equal to the amount of the General 4. The limits shown in the Declarations for Aggregate Limit shown in the Declarations. Each Occurrence, Damage To Premises Subject to the application of the General Rented To You and Medical Expense Aggregate Limit to each of your projects, the continue to apply. However, instead of being maximum amount we will pay under the subject to the General Aggregate Limit General Aggregate Limit for all claims shown in the Declarations, such limits will arising from all projects is $10,000,000.00.. be subject to the applicable Designated 2. The Designated Construction Project Construction Project General Aggregate General Aggregate Limit is the most we will Limit. pay for the sum of all damages under Coverage A, except damages because of "bodily injury" or "property damage" included in the "products -completed operations hazard", and for medical expenses under Coverage C regardless of the number of: a. Insureds; b. Claims made or "suits" brought; or c. Persons or organizations making claims or bringing "suits". HCS 040 02 11 12 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 2 B. For all sums which the insured becomes legally C obligated to pay as damages caused by an "'occurrence" under Section I — Coverage A, and for all medical expenses caused by accidents under Section I — Coverage C, which cannot be attributed only to ongoing operations at a single designated construction project shown in the Schedule above: 1. Any payments made under Coverage A for damages or under Coverage C for medical D expenses shall reduce the amount available under the General Aggregate Limit or the Products -completed Operations Aggregate Limit, whichever is applicable; and 2. Such payments shall not reduce any Designated Construction Project General Aggregate Limit. When coverage for liability arising out of the '"products -completed operations hazard" is provided, any payments for damages because of "bodily injury" or "property damage" included in the "products -completed operations hazard" will reduce the Products -completed Operations Aggregate Limit, and not reduce the General Aggregate Limit nor the Designated Construction Project General Aggregate Limit. If the applicable designated construction project has been abandoned, delayed, or abandoned and then restarted, or if the authorized contracting parties deviate from plans, blueprints, designs, specifications or timetables, the project will still be deemed to be the same construction project. E. The provisions of Section III — Limits Of Insurance not otherwise modified by this endorsement shall continue to apply as stipulated. ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED HCS 040 02 11 12 Page 2 of 2 Includes copyrighted material of Insurance Services Office, Inc., with its permission. POLICY NUMBER: U25AC165911-00 Commercial Excess Liability Coverage Schedule of Controlling Underlying Insurance _........................._ ............. Schedule Of Control Iin Uno+ !lying Insurance..... .. Company: Does Not Apply ....._ Policy Number: Commercial PolicymPeriod. Auto Limits Of Insurance: Liability Garage Aggregate Limit For $ Other Than Autos (if applicable) Each Accident $ Type Of Coverage: ILI Occurrence E]Claims-made Company: U.S. Specialty Insurance Company Policy Number: U25AC165911-00 General Policy Period: 05/01/2025 to 05/01/2026 Liability Limits Of Insurance: Each Occurrence $1,000,000 Personal And Advertising Injury $1,000,000 Any one person or organization Products -completed Operations $2,000,000 Aggregate General Aggregate $2,000,000 Type Of Coverage: Occurrence Claims -made Other Company: Does Not Apply Coverage PolicV Number PolicyPeriod: Limits Of Insurance: $ UXC 020 02 04 14 Includes copyrighted material of Insurance Services Office, Inc., With its permission P olicy#B A040000093 53 5 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following:, BUSINESS AUTO COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. SECTION IV — BUSINESSS AUTO CONDITIONS, A. Loss Conditions, 5. Transfer of Rights Of Recovery Against Others To Us, the following is added: We waive any right of recovery we may have against any person or organization to the extent required of you by a written contract executed prior to any "accident" or "loss", provided that the "accident' or "loss" arises out of the operations contemplated by such contract. The waiver applies only to the person or organization designated in such contract. MCA04440913 AtC acctp: sosas CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD,YYYY' st 9/4/2025 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFOR11 MATION 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), C N ACT PRODUCER USI Insurance Services, LLC PHONE EAX cti' "w NO ..... 844ce 2502 N Rocky Point Drive .MAIhLq" com Su & cktonadFnllyx Tampa, FL 33607 Opp" T s COVERAGE NAIC IA IN�MJRF#s}'AFPORDI ..,-,,.. .,... ,�........,... ........a. ,,,,,, ,., _. ..A .... ...............—.....�.-. ... Ace American Insurance C INSURER a : Company 22667 INSURE.. ........ D UNSURE ' B, _ SOUTHCOAST PAINTING, INC. ..... 28364 South Western Avenue #465, INSURkEe4 C,---------------- -- - --------- Rancho Palos Verdes, CA 90275 INSURER D: INSJUi9l! -- ----- ........ ...r ,,,,,,,, ... ............. ... .�,,, ---- .... INSURER F COVERAGES rERTIFICATE 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. ...,. ,,. ... ,.. ---- ......... .� ... .... ..... ..... ....... LICY . �- � YiE'XP �....... LIMITS .... ..TYPE ILTR ......... .�PI'YsOLrS�Jd"h .. ,.......- LIMITS POLICY NUMBER........ OF INSURANCE MHAVD LYAY1"YY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 5 .... I .._ [ CLAIMS -MADE OCCUR i...,,, 4 _...� "MED EXP (Any one person) $ .,m,m ,... _.- f PFRSONAL, & ADV INJURY $ G EN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE', � .... PRODUCTS-COMPAOP,AGG $ $ i POLICY [i LOG OTHER:. ; ff J COFut BINED SINGLE LIMIT $ �.....,. A AUTOMOBILELIABILITY UT O P 1-QSaa cr0PN)— -- _ ,, ,.......... .. -.. BI �EQ -- ON BODILY INJURY (Per person} 1 B .. ,,. `6 .... - OWNED SCHEDULED l AUTOS BODILY INJURY (Per ,cadent) $ AUTOS ONLY ..... ....� HIRED( NON -OWNED I I � OE)L7AMA�"wE $ .,,,,,,,,... .....k AUTOS ONLY ��.,,� ���' AUTOS ONLY t �...) ........ ..... $ UMBRELLA LIAR, I..... OCCURRENCE EACH C9CC..L.m....... $ .... OCCUR . } .. .. ...... $ EXCESS LIAB E m... ..e,.. rCLAIMS MAD �. ------- AGGREGATE .. ...... ...... „ --.. CEO ( I RFTENTION S $ ION X PEi2 CiA H S rA%UTC I ERj i ILIT YERS' LIABILITY AND EMPLOYERS' LIABILITY AND EMPLOYERS' ANY PROPRt ETORJPARTNERJEXECU'FrVE YIN A OV'`FICE:"R,hhM1EMrtfJFR4'XOLUL7'LO'J N / A X C58907868 6l1/2025 6I1I2026 E L EACH ACCIDENTEMPt.OYEEI I ....a._ ............ 2 000 000 .....,000,000 E L. D $ (Mandatory In NH) Fyer descr(iaenAdor ..-- -E.L DISEASE ROL.tld":YLIOullIN 5�...... ...... ..._ .-.. - - 2,000,000 . DESCR IRTION OF <YPERATm NS b�olow 7 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Policy Slate = CA Waiver of Subrogation in favor of certificate holder when required by written contract CERTIFICATE .HOLDER CANCELLATION � . SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED City Of El City I ElS St. IN ACCORDANCE WITH THE POLICY PROVISIONS. El Segundo, CA 90245 ._._._.. ......... AUTHORIZED REPRESENTATIVE ©1588- 015 ACORD CORPORATION. All right mm ...d. ....... s reserve . ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Workers' Compensation and Employers' Liability Policy Named Insured Endorsement Number SOUTH COAST PAINTING, INC.— 28364 South Western Avenue #465, Policy number Rancho Palos Verdes, CA 90275 Symbol: WLR Number: C58907868 Policy period Effective Date of Endorsement 6/1/2025 TO 6/1/2026 9/4/2025 Issued By (Name of the Insurance Company) Ace American Insurance Company Insert the policy number.. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy. This endorsement chancres the policy to which It is ttacktied and is efdeckcve ors the date assucd r n9ess othervvdse sG'eted. CALIFORNIA WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement applies only to the insurance provided by the policy because California is shown in Item 3.A. of the Information Page. 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, but this waiver applies only with respect to bodily injury arising out of the operations described in the Schedule, where you are required by a written contract to obtain this waiver"from us. You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. Schedule Specific Waiver Name of person or organization: (x) Blanket Waiver Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. 2. Operations: ALL CALIFORNIA OPERATIONS 3. Premium: The premium charge for this endorsement shall be 1.0 percent of the California premium developed on payroll in connection with work performed for the above person(s) or organization(s) arising out of the operations described. 4. Minimum Premium: $0 Authorized Agent WC 90 03 75 (05/18)