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PROOF OF INSURANCE (2026 - 2027)C+ 01/15/2026 " CERTIFICATE OF LIABILITY INSURANCE DATEtMM2026 Y' THIS CERTIFICATE IS ISSUED ASA 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 CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the pollcy(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 .. NAME:jhosel Crenshaw Chesapeake Insurance Services inc. PHONE, (818) 898-1043 c No: 16654 Soledad Canyon Rd., #540 ADO SSu: INSURER(S)AFFORDING COVERAGE _ NAIC N Canyon Count CA 91387 Associated Industries Insurance Company, y Y INsuRERA: y, Inc„ 23140 INSURED INSURERS: Indian Harbor Insurance Company 36940 Morillo Construction Inc INSURERC 227 N. Holliston Ave INSURERD: Pasadena CA 91106 INSURER ...., .r., ..-. �.. neeer01^ATM unaacoo• 9n95 RF -CJON NIIMRFR, THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEDABOVE FOR THE POLICY PERIOD INDICATED. NOTWITH STANDING ANY REQUIREMENT, TERM OR CONDITION OFANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSU RANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECTTOALLTHE TERMS, EXCLUSIONSAND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDDNYYY) MdMWffYYY LIMITS COMMERCIAL GENERAL LIABILITY EACI i 0CCJR1YF-INCE I 1 '00D' 70a u' PREMI iE�S aEA+�r 1 9 00,000 CLAIMS MADE' [96ux;LRI Excluded MrED EA (Av oruo mrson) $ A AES124546100 10/29/2025 10/29/2026 iP:RSONA1...&AL:rVINdl.1RY $ 1,000,000 +EN' AMG EI% TE;,MITAFPUESPER GENERAL AGrREGAIE $ 2,000,000 "'f�ODI.lCw"°[.,.. C:OYeNCylC71'!OG(�, $ 2 000,000 P �.CT $ a rIvt;'R N 7OhwPF.1Y„G,. 9r,II^»a«+».S' k.MI.fMT $ AUTOMOBILE LIABILITY �"�%� ¢n�.,fM1ia'Yri9 BO1:7ILY 14V,.JuRY (6:Ie;r pemony $ ANY AU F0 OWNED SCHEI:Dl.11...ED BODILY INJURY (Per a.cade nt) ..... $ AI Vlr��OIOPAu r o s RED )I-OWN-D I- �w Pra t$:ntl $ AI VS TA AUTOS ON)r $ UMBRELLA LIAR OCCURp.::Pi0 T 0(;CJRRNa::: $ 5,000,000 A X EXCESS LIAB CLAWS MADE EXA1266421 00 10/29/2025 10/29/2026 AG(rl k (),AYE $ 5,000,000 DED R tl.:::NFICrN $ WORKERS COMPENSATION i17l4rIVTCi a&,II AND EMPLOYERS' LIABILITY YIN ANY FIR 01.:IRIETORIPARFNERIEXEC;UTIVE ['---I NIA EL. EACH ACCIDENT � E9_ F)61,,AS E. f"AEMPI OYDE "_ $ 01:::RC1 MErgfiBtr P I XCLUr ED? J (Mandatory lin WD EL DISEASE POUCIY I...IMIT '. $ If Ves, describe undor UEs<_RJPIT 1014 OF OPERATIONS helmv Policy General Aggregate $4,000,000 B Professional Liability and PECO05790905 10/29/2025 10/29/2026 Professional Liability $2,000,000 Contractors Pollution Liability Pollution Liability $2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) [Job*: PW 24-02 Job Type: Urho Saari Swim Stadium] Project No. PW 24-02 - Urho Saari Swim Stadium City of El Segundo, its officers, officials, employees, agents, and volunteers are named as additional insured„ See attached for Al status Issuing insurerwill endeavorto mail 30 days notice ofcancellation, 10 days for non-payment ofpremium CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of El Segudo City Clerk ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street AUTHORIZED REPRESENTATIVE ElSegundo CA 90245 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks ofACORD POLICY NUMBER: AES1245461 00 COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS S - SCHEDULED PERSON OIL ORGANIZATION This endorsement modifies insurance provided under the following; COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE A. Section II — Who Is An Insured is amended to 1. All work, including materials, parts or equipment include as an additional insured the person(s) or furnished in connection with such work, on the organization(s) shown in the Schedule, but only project (other than service, maintenance or with respect to liability for "bodily injury", "property repairs) to be performed by or on behalf of the damage" or "personal and advertising injury" additional insured(s) at the location of the caused, in whole or in part, by: covered operations has been completed; or 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: 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. 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. CG 20 10 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 POLICY NUMBER: AES1245461 00 COMMERCIAL GENERAL LIABILITY CG 20 37 0413 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) All persons or organizations where written contract with the named insured requires additional insured completed operations, This form does not apply to your work on "residential property" Information required to complete this Schedule, if not shown Location And Description Of Completed Operations All locations where the Named Insured is performing operations on behalf of the designated additional insured. above, will be shown in the Declarations. A. Section II —Who Is An Insured is amended to provide for such additional insured. include as an additional insured the person(s) or B. With respect to the insurance afforded to these organization(s) shown in the Schedule, but only additional insureds, the following is added to with respect to liability for "bodily injury" or Section III —Limits Of Insurance: "property damage" caused, in whole or in part, by "your work" at the location designated and If coverage provided to the additional insured is described in the Schedule of this endorsement required by a contract or agreement, the most we performed for that additional insured and included will pay on behalf of the additionalinsured is the in the "products -completed operations hazard". amount of insurance: However: 1. Required by the contractor agreement; or 1. The insurance afforded to such additional 2. Available under the applicable Limits of insured only applies to the extent permitted by Insurance shown in the Declarations; law; and whichever is less. 2. If coverage provided to the additional insured is This endorsement shall not increase the applicable required by a contract or agreement, the insurance afforded to such additional insured Limits of Insurance shown in the Declarations. will not be broader than that which you are required by the contract or agreement to CG 20 37 04 13 0 Insurance Services Office, Inc., 2012 Page 1 of 1 POLICY NUMBER: AES1245461 00 COMMERCIAL GENERAL LIABILITY NX GL 009 08 09 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NON-CONTRIBUTING INSURANCE (THIRD -PARTY) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Third Party: All persons or organizations where required by written contract with the Named Insured (Absence of a specifically named Third Party above means that the provisions of this endorsement apply as required by written contractual agreement with any Third Party for whom you are performing work.) Paragraph 4. of SECTION IV: COMMERCIAL GENERAL LIABILITY CONDITIONS is replaced by the following. 4. Other Insurance: With respect to the Third Party shown above, this insurance is primary and non-contributing. Any and all other valid and collectable insurance available to such Third Party in respect of work performed by you under written contractual agreements with said Third Party for loss covered by this policy, shall in no instance be considered as primary' co-Insurance or contributing insurance, Rather, any such other insurance shall be considered excess over and above the insurance provided by this policy. NX GL 009 08 09 Includes copyrighted material of Insurance Services Office, Inc., with its permission Page I of I POLICY NUMBER: AES1245461 00 COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: _ All Persons or organizations where required written contract with the Named g � Insured Information required to complete this Schedule„ if not shown above will be shown in the Declarations. mmmm 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 we may have against the Erson or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongir operations or "`your work"" done. under a oontract wlt that person or organization and included' in the "products -completed operations hazard", This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 1 Ate" CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDIYYYY) 1 /12/2026 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 IMA, Inc. - Pasadena 3475 E. Foothill Boulevard Suite 100 Pasadena CA 91107 INSURED Morillo Construction Inc 227 N Holliston Ave Pasadena CA 91106 r`ERTIFICATE NUMBER: 1084065657 (A!q tl`q.l11, 626-799 7000 REVISION NUMBER: 626-441-3233 NAIC 119C 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-PM/DDYIYYYX EFF LIMITS fLwa MMIDDOLICY P I TYPE OF INSURANCEAD0415YBR POLICY NUMBER COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 1 $ "j -. "'iSAMAC`a� Iiffl=J ....,.. ._.. CLAIMS -MADE " OCCUR ..,.,.m _PREMISES ( gpc"urrenceZ $ . .... �one person) $ ,.. PERSONAL&ADV INJURY .... _ � $ . ........,... . .- ------ GEN L AGGREGATELIMITAPPLIESPER. GENERALAGGREGA $ POLICY I""&d0,. JEC"r LOC 'PRODUCTS -CO L..$ ._ $ OTHER' A AUTOMOBILE LIABILITY Y BA040000097354 12/23/2025 12123/2026 C'DMB) 4 SdNGI E LIMIT �xn $1,000 000 X ANY AUTO BODILY INJURY (Per person) $ ,,,,,. .......... ....., ..... OWNED SCHEDULED ODILYINJURY Pera dent) BODILY ( cci $ AUTOS ONLY ._ __, AUTOS HIRED''. PERT �,..LR4?PER'rtY DAMAGE D . ,..._.. - ----.. $ X AUTOS ONLY i ,X,..,,. AUTOS ONNON-OWNEDY Per +v Is UMBRELLA LA LIAR OCCUR I EACH OCCURRENCE I $ ._CLAIMS MADE.:. EXCESS LIAR AGGREGATE L,,. ...,....-_ .. ,,, ,�.$ ....... ......" ,_ ...... DED RETENTION$ j $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN PER 0 STATUTE R ... j ANYPROPRIETOR/PARTNER/EXECUTIVE E.L EACH ACCIDENT $ OFFICER/MEMBER EREXCLUDED? N/A jl (Mandatory in NH) „E,,,,L, DISEASE EA EMPLOYEE$ -. _ If yes, describe under f) i EL DISEASE POLICY LIMIT I, $ DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) Certificate Holder and all other parties required by the contract are included as Additional Insured on the Automobile Liability Policy, if required by written contract or agreement, subject to the policy terms and conditions. Re: Scheduled autos only 2008 LAND ROVER RANGE ROVERS..,.... ,...... 9"3"4' ",........... ....... ............ ALME15438A293492 Comprehensive $1,000 Ded Collision $1,000 w/Waiver Ded See Attached... HOLDER CANC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City Clerk City of El Segundo and its officials, employees, ACCORDANCE WITH THE POLICY PROVISIONS. agents & VOLU 350 Main Street AUTHORIZED REPRESENTATIVE El Segundo CA 90245-3813 I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: MORICON-Cl LOC #: .. .......... ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY NAMED INSURED IMA, Inc. - Pasadena Mo"It. Construction Inc ........ .......... 227 N Holliston Ave POLICY NUMBER Pasadena CA 91106 CARRIER NAIC CODE EFFECTIVE DATE: THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY IN SURANCE Rental Relrnburser tent $50 Per Day ($1,500 Max) Medic -al Payments $5,000 each person ... IF6R. 1' . .......... .......... ..... ..................... ..... ........ 20'19 FORD F150 1FTEW1CP8KKE80900 Comprehensive $1,000 Ded Colision $1 „000 w Waiver Ded Rental 86mbursement $50 Per Day ($1,500 Max) Medical Payments $5,000 each person 2018 MERCEDES-BENZ S WDDUG8D84JA367802 Comprehensive $1,000 Ded Collision $1,000 w/Waiver Ded Rental Reimbursement $50 Per Day ($1,500 Max) Medical Payments $5,000 each person 2018 TESLA M.. ......... .. . .....6 JIF0 ,36 .......... ..,............... ODEL 3 5YJ3E1EA8JF033675 Comprehensive $1,000 Ded Collision $1,000 w/Waiver Ded Rental.. Reimbursement $50 Per Day ($1,500 Max) Medical Payments $5,000 each person ................................................. 2008 MERCEDES-BENZ GL 4JGBF71 E58A306008 Comprehensive $1,000 Ded Collision $1,000 w/Waiver Ded Rental Reimbursement $50 Per Day ($1,500 Max) Medical Payments $5,000 each person 2015 TESLA MODELS 5Y..JSA1H28..........FFP74010.............................................. 28 Comprehensive $1,000 Ded Collision $1,000 w/Waiver Ded Rental Reimbursement $50 Per Day ($1,500 Max) Medical Payments $5,000 each person ACORD 101 (2008/01) U 2UU5 AGUKU GUKVUKAI IUN. Au rlgnis reserves The ACORD name and logo are registered marks of ACORD THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. The following is added to the Section II - Liability Coverage, Paragraph A.1. Who Is An Insured Provision: Any person or organization that you are required to include as additional insured on the Coverage Form in a written contract or agreement that is signed and executed by you before the "bodily injury" or "property damage" occurs and that is in effect during the policy period is an "insured" for Liability Coverage, but only for damages to which this insurance applies and only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Section II. MCA20480711 CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 12/31/2025 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 endorsemerl . PRODUCER '­"""`"" IMA Certs Team NAME_. ........... IMA, Inc. - Pasadena �PHONE 3475 E. Foothill Boulevard EMAIL Suite 100 ADD EE* . r�wr�Ift�ate r�:±P7vac o�la.com Pasadena CA 91107 INRIIREWS) AFFORDINI State Compensation Insurance Fund - California 1 35076 INSURED MORICON-C1 INSURER B Morillo Construction IncINSURER C 227 N Holliston Ave°...a.....°..mm m Pasadena CA 91106 HsuaEAq: COVERAGES CERTIFICATE NUMBER., 1943831879 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. INS�S , �__ .,,,. a e,AY11 DDL SIUO '. ` _ ._ ._ POLICY EFL, f, ,POLICY EXP j TR TYPEOFINSURANCE V { POLICY NUMBER MWDD/YYYY I MMIDDdYYYY)1 LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE CLAIMS MADE OCCUR &REfiN1 w arvrc.rr� , „�„$ .... .... ...... _ one person) .. .. PERSONAL & . ......� .. ....�m 11 MED EXP IAn ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER : GENERALAGGREGATE $ PRO POLICY JECT LOC JFCT PRODUCTS COMPiOF AGG $ �� OTHIEIrt: $ AUTOMOBILELIABILITY UOM➢NNEI7 SINGLE i»I14tit ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED AUTOS ONLY �_ _ r AUTOS '= BODILY INJURY (Per accident) $ HIRED I NON -OWNED i Phgriz ,, i Rf GSA AU, $ AUTOS ONLY AUTOS ONLY t( ) - $ UMBRELLA LIAB OCCUR MADE EACH...... OCCURRENCE $ ...... , �,_.. j f EXCESS LAB CLAMS AGGREGATE DED A WORKERS COMP .. � RETENTION $ t COMPENSATION Y 9206372 111/2026 1/1/2027 jX I STATUTE ERH„ AND EMPLOYERS' LIABILITY y / N E L EACH ACCIDENT $1 000 000 ANYPROPRIETOR/PARTNERIEXECUTIVE N / A OFFICERIMEMBEREXCLUDED7 Y ®� (Mandatory In NH) z 000 I II yes, describe under E L. DISEASE - POLICY LIMIT $ 1,000, DISEASE- EA EMPLOYEE $1 000, DESCRIPTION OF OPERATIONS below 000 I DESCRIPTION OF OPERATIONS / LOCATIONS! VEHICLES (ACORD 101. Additional Remarks SRhedule, may be attached if more space Is required) Workers Compensation Information: Proprietors/Partners/Executive Officers/Members Excluded: subject to the policy terms and conditions. RE: Urho Saari Swim Satcliu t„ Project # PW-24-02 A Waiver of Subrogation is provided in favor of Certificate Holder and all other parties required by the contract on the Workers Compensation Policy, if required by written contract or agreement, subject to the policy terns and conditions, r.FRT1r-IrATF Him nER CANCELLATION! SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City Clerk ACCORDANCE WITH THE POLICY PROVISIONS. City of El Segundo 350 Main Street AUTHORIZED REPRESENTATIVE El Segundo CA 90245 USA ?Pl�t 4kVW_LJ_ 01988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 2945: 2 ENDORSEMENT AGREEMENT WAIVER OF SUBROGATION BLANKET BASIS HOME OFFICE SAN FRANCISCO EFFECTIVE JANUARY 1, 2026 AT 12.01 A.M. ALL EFFECTIVE DATES ARE AND EXPIRING JANUARY 1, 2027 AT 12.01 A.M. AT 12:01 AM PACIFIC STANDARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME MORILLO CONSTRUCTION INC 227 N HOLLISTON AVE PASADENA, CA 91106 WE HAVE THE RIGHT TO RECOVER OUR PAYMENTS ., , *N LIABLE FOR AN INJURYCOVERED BY THIS POLICY. WE WILL NOT O .E OUR RIGHT AGAINST THE PERSON OR ORGANIZATION APPLIESTHIS AGREEMENT PERFORMOR s WRITTEN CONTRACTTHAT Q TO OBTAIN THIS AGREEMENT FROM US. I THE ADDITIONAL PREMIUM FOR THIS ENDORSEMENT SHALL BE 2.00%TOTAL ANY PERSON OR ORGANIZATION O. WHOM THE NAMED INSURED HAS • -aaD BY WRITTEN CONTRACT TO FURNISH THIS WAIVER JOB DESCRIPTION 4LANKET WAIVER O SUBROGATION 9206372-26 RENEWAL Sc 4-48-77-29 PAGE 1 OF NOTHING IN THIS ENDORSEMENT SHALL BE HELD TO VARY, ALTER, WAIVE OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS POLICY OTHER THAN AS ABOVE STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR LIMITATIONS IN THIS ENDORSEMENT. COUNTERSIGNED AND ISSUED AT SAN FRANCISCO: JANUARY 6, 2026 / ef, - �' � .. 41 2572 AUTHORIZED REPRESENT IVE PRESIDENT AND CEO SCIF FORM 10217 (REV.4-2018) 0 2945: 3 ` of 3 OLD DP 217