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PROOF OF INSURANCE (2026 - 2026)a, DATE (MM/DDIYYYY) ACCIR" CERTIFICATE OF LIABILITY INSURANCE ,.. 8/27/2025 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). NTACT PRODUCER NAME, Danlet Brock Sierra Oak Insurance Services Inc PHONE FAX 9700 Business Park Drive Suite 105 id No,.FxII 91O b47380___ Anc Nap,910 647381 RC MAIL Sacramento CA 95827 ADDRESs certs a slerraoakino com ...,,,.._. , .............. INSURED FS Contractors, Inc. 14838 Bledsoe St Sylmar CA 91342 INSURERS AGE S N 1 NAIC # #, �, RE IW$U,,, _RA — National Ins. Co. GuideOne Na „ m ..... ...,, 1 .,. 14167 FSCONTR-01 INSURER Insurance Com an of the West y 27847 INSURER C: Mt. Ha l INSURER D Navi atoes Specialtyl s. Co. 36056 MS Transverse Specialty Insurance Company.. �- f ,4,1807 INSURER F.' ^C'n*r 01^ATC L11 IIIII12CD•')r1CR'M7')7Q RFVISIAN NIII&IR R° 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. ....................................... _ L..,,e .. ® INSR ,IDDL SU R� OLICY EXP DwYYYy �MDD/YYYY LIMITS LTR TYPE OF INSURANCE POLICY NUMBER IMM D COMMERCIALLIABILITY X CO.� MERCIAL GENERAL GEEADE Y LA25CGLZOD4RWIC I 1/13/2025 1/13/2026 EACH OCCURRENCE � S 1.000.000 ... CLAIMSX OCCUR I J AMA6ETO° i'L.)'kTGEff 9�iw%IPE ( ��Ir�l ) ME D EXP (Any one person) $ 1 ......... ........ ......... - PERSONAL 8 ADV INJURY $ 1,000,000 . �._»� m.....................................-------........ , ..,,.,.........,.,. E AGGREGATE LIMIT APPLIES PER. N GENERAL AGGREGATE ... 000 000 POLICY X - LOC JECti PRODUCTS OP AGG $ 2,,,000 000..__........ ..,, I E MOBILE LIABILITY AUTOMOBILE Y TSRSCA0000342-00 8126I2025 8/26I2026 COMBINED141NGC.E LIMIT .-� $1,C)OO 000 , X ANY AUTO BODILY INJURY (Per person) $ OWNED ? SCHEDULED ` I BODILY INJURY (Per accident) $ X....AUTOS ONLY AUTOS r HIRED NON -OWNED X I { P L $ l AUTOS ONLY � AUTOS ONLY (ROPLRTY' P )A.r4AOF ,wu t1�rKiYP�i�I',,,..m... ------------ . $ ............. ,..... D �X UMBRELLA LIAR ) X OCCUR i SF25EXCZOD4QLIC 1I1312025 1/13/2026 EAACH OCCURRENCE 8 000 000 $ ... EXCESS LIAR r � MAD E. AGGREGATE ---- $ B 000,000 „ ,. RETENTION $ GL CA WC Is B j WORKERS COMPENSATION WSA 5032771 10 7/31/2025 7/31/2026 X PER OTH STATUTE E.R Y / N , EACH ACCIDENT , ._ 000 BUERI� ECUTIVE N E,.L ,$,1,000 OFFICER/METBEREXCDE N /A DISEASE EA EMPLOYEEI S 1.000 000 (Mandatory inNH) If yes, describe under ;L r...,. .....----- m.... , POLICY LIMIT ........, ......... i $ 1,000.000 IJESCRIPI JON OF OPERATIONS below E.L DISEASE - A Pollution Liability ENV562012869-02 1/13/2025 1/13/2026 Poll. Aggrrvgate Rented/Leased 2,000,000 50,000 C Inland Marine ILM0718456 8/26/2025 8/26/2026 Installation Floater 232,400 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may attached if more space is required) Excess over the GL, WC, BAU Various Locations in the City of El Segundo FY 24-25 ON -CALL CONCRETE SERVICES PROJECT NO. PW 24-12. City of El Segundo to be named additional insured on the general liability & auto. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of El Segundo 350 Main St. AUTHORIZED REPRESENTAT'VVE El Segundo, CA 90245 i w V 79t$ 6-ZU10 AL.VI(U 1-UKrVrtAI IVIY. rlu ngnLs reaer veu. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD POLICY NUMBER:LA25CGLZOD4RWIC COMMERCIAL GENERAL LIABILITY CG 20 37 04 13 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 Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations Any person or organization for whom you7areperforming "commercial construction" durge period of this policy and have agreed in a contract to add as an additional insured for products -completed operations. "Commercial construction" does not include any written habitational or residential construction other than hotels or apartments 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 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 shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 37 04 13 0 Insurance Services Office, Inc., 2012 Page 1 of 2 will not be broader than that which you are required by the contract or agreement to provide for such additional insured. CG 20 37 0413 0 Insurance Services Office, Inc., 2012 Page 2 of 2 POLICY NUMBER:LA25CGLZOD4RWIC COMMERCIAL GENERAL LIABILITY CG20100413 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 Organization(s) Locations Of Covered O erations I 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 wwwwww.._ 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 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 0 Insurance Services Office, Inc., 2012 Page 1 of 2 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. C. With respect to the insurance afforded to these 2. Available under the applicable Limits of Insurance additional insureds, the following is added to shown in the Declarations; Section III - Limits Of Insurance: whichever is less. If coverage provided to the additional insured is This endorsement shall not increase the applicable required by a contract or agreement, the most we Limits of Insurance shown in the Declarations. will pay on behalf of the additional insured is the amount of insurance: 1.Required by the contract or agreement; or CG 20 10 0413 © Insurance Services Office, Inc., 2012 Page 2 of 2 COMMERCIAL AUTO CA 04 43 12 23 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) - AUTOMATIC WHEN REQUIRED BY "'WRITTEN CONTRACT OR AGREEMENT This endorsement modifies insurance provided under the following - AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. The Transfer Of Rights Of Recovery Against Others To Us Condition does not apply to any person(s) or organization(s) for whom you are required to waive subrogation with respect to the coverage provided under this Coverage Form, but only to the extent that subrogation is waived: A. Under a written contract or agreement with such person(s) or organization(s); and B. Prior to the "accident' or the 'loss". CA 04 43 12 23 © Insurance Services Office, Inc., 2022 Page 1 of 1 COMMERCIAL AUTO CA04491116 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. A. The following is added to the Other Insurance Condition in the Business Auto Coverage Form and the Other Insurance - Primary And Excess Insurance Provisions in the Motor Carrier Coverage Form and supersedes any provision to the contrary: This Coverage Form's Covered Autos Liability Coverage is primary to and will not seek contribution from any other insurance available to an "insured" under your policy provided that: 1. Such "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 such "insured". B. The following is added to the Other Insurance Condition in the Auto Dealers Coverage Form and supersedes any provision to the contrary: This Coverage Form's Covered Autos Liability Coverage and General Liability Coverages are primary to and will not seek contribution from any other insurance available to an "insured" under your policy provided that: 1. Such "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 such "insured". MS Transverse Specialty Insurance Company CA 04 49 11 16 © Insurance Services Office, Inc., 2016 Page 1 of 1 POLICY NUMBER: TSRSCA0000342-00 COMMERCIAL AUTO CA20481013 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED FOR COVERED AUTOS LIABILITY COVERAGE This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: FS Contractors, Inc Endorsement Effective Date: 08/26/2025 SCHEDULE Name Of Person(s) Or Organization(s): As required by written contract so long as the contract was entered into prior to the date of loss. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Each person or organization shown in the Schedule is an "insured" for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Paragraph A.1. of Section II - Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms and Paragraph D.2. of Section I - Covered Autos Coverages of the Auto Dealers Coverage Form. MS Transverse Specialty Insurance Company CA 20 48 10 13 © Insurance Services Office, Inc., 2011 Page 1 of 1