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PROOF OF INSURANCE (2026 - 2026)DATE fIINMOD16 Mfh '" CERTIFICATE OF LIABILITY INSURANCE 11/10/2025 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 pollcy(les) 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 statemerrt on this certificate does not carder rights to the certificate holder in lieu of such endorsement(s). PRODUCER Nniyrei CLIENT CONTACT CENTER TUAL ANCE COMPANY mm HOME OFFICEFEDERATED : P.O. BOX 328 jg C, No, Ext): 688-333-4949 10 c, NO): 507-446 �664 OWATONNA, MN 55060 E MAIL ADDREss CLIENTCONTACTCENTEROFEDIN.S COM ........, ....... -------_.....------ ......-- - INSURERS AFFORDING COVERAGE NAIC /I INSURER A:FEDERATED MUTUAL INSURANCE COMPANY .......... ._ ........ ....... . 13935 ... ... ................, INSURED '' INSURER B: C J CONCRETE CONSTRUCTION, INC. - INSURER C: 10142 SHOEMAKER AVE SANTA FE SPRINGS, CA 90670-3404 INSURER D: ----- ---- ...--- - - INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 197 REVISION NUMBER: 0 ''. 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. .....�... __....... __� ..._• Y� TYPE OF INSURANCE FL S N POLICY NUMBER h4P1MOML, lY TP PMF�7Of7tlYY�Y ...................................._. LIMITS X ''COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000 CLAIMS -MADE X OCCUR AMAOE 7O EN'4'E0 PREMISES _.______._.____._._._. _.._. $100,000 aocymym'remca�, MED EXP (Any one person) $10,000 A ........................... Y Y 1845023 11 /12/2025 11/1212026 PERSONAL & ADV INJURY 31 OOO O00 OENL AGGREGATE LIadWr Ai"PLNES GEN ERALAGGREGATE ryPER. POLICY �XX� ILOC _ PRODUCTSS�COMP/OP-ACC mmmmmmmm,000000 _. $2,000,000 OTHER: '""".................__..........�........�........�...................... ........................... �. AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) . . $1,000,000 X,.APVY'AUTO BODILY INJURY (Per Person) A ,,. f:"N'NF.0 AUTOS ONLY hU pILLL UI .D ,. ..4018S7S Y Y 1845023 11 /12/2025 11/12/2026 BODILY INJURY (Per Accident' .k .....___..__ ____ ..-- ---_................................._....,, WrtELz aura ONLY OPtL (PPROPERIrY DAMAGE ,O X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $8,000,000 A EXIISSI_IAB CLAIMS -MADE .... Y Y 1845025 11/12/2025 11/12/2026 AGGREGATE $8,000,000 DED Q1 IFN WPW "WORKERS COMPENSATIOR... AND EMPLOYERS' LIABILITY YIN PER STATUTE OTHER E-L EACH ACCIDENT ANY PROPRIETORIPARTNER) EXECUTIVE E. OFFlCERIMEMBER EXCLUDED? N/A E.L DISEASE EA EMPLOYEE (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L DISEASE POLICY LIMIT DESCRIPTION OF OPERATIONS f LOCATIONS 1 VEHICLES (ACORD 101, AddlOonal Remarks Schedule, may be athched If more space Is required) SEE ATTACHED PAGE CERTIFICATE HOLDER CANCELLATION CITY CLERK CITY OF EL SEGUNDO 197 0 350 MAIN ST SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED EL SEGUNDO, CA 90245-3813 BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. O 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD . f AGENCY CUSTOMER ID: Ac".. .. R LOC #: ADDITIONAL REMARKS SCHEDULE Page 1 of 1 ............ ............... ....._ ........ -M . _ .._.............. . � �.......... ......_. AGENCY NAMEDINSURED FEDERATED MUTUAL INSURANCE COMPANY C J CONCRETE CONSTRUCTION, INC. ..........._.... ...... 10142 SHOEMAKER AVE POLICY NUMBER SANTA FE SPRINGS, CA 90670-3404 SEE CERTIFICATE # 197.0 ...._ __ _.. ................ ........... ......... CARRIER NAIL CODE EFFECTIVE DATE SEE CERTIFICATE # 197.0 SEE CERTIFICATE # 197.0 -IT _. _... ...................... .................. .. .....,.�_.. .. ... ..... ,........ ... ..... .... , ___......_........ ........................................... �... ......_ ADDITIONAL REMARKS ......... ........ .-..m................. ...... ... .. . .. THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: ERTIFI'CATE OF,,,,umflATMAVRA BG PROJECT NO.: 602744-24, PROJECT NO.: PW 24-13 .............. ....... . RE: COBG ADA CURB RAMP INSTALLATION PROJECT, INDIANA/GRAND NORTHWEST CORNER, 209 AND 219 W. GRAND, 538 CONCORD ST. (MARIPOSA SIDE), 355 S. DOUGLAS (CORAL CIRCLE SIDE), 515 LOMITA ST, 920 E. MARIPOSA AVE., 206 W. MARIPOSA AVE., 206-208 W. MARIPOSA AVE, 208 W. MARIPOSA AVE., 658 W. MARIPOSA AVE., 658 W. MARIPOSA AVE. PRIVATE WALKWAY, 418 W. PALM AVE., 219 W. PINE AVE., 702 VIRGINIA ST., EL SEGUNDO, CA 90245-3813 CONTRACTUAL, LIABILITY COVERAGE FOR LIABILITY FOR DAMAGES ASSUMED IN A CONTRACT OR AGREEMENT THAT IS AN "INSURED CONTRACT" IS PROVIDED PER THE CC 00 01, COMMERCIAL GENERAL LIABILITY COVERAGE FORM. SUBJECT" TO THE TERMS AND CONDITIONS OF THE POLICY, ADDITIONAL INSUREDS ALSO INCLUDES THE CITY OF EL SEGUNDO, ITS OFFICERS, OFFICIALS, EMPLOYEES, AGENTS, AND VOLUNTEERS SUBJECT TO THE TERMS AND CONDITIONS OF THE POLICY, WAIVER OF SUBROGATION ALSO INCLUDES THE CITY OF EL SEGUNDO, ITS OFFICERS, OFFICIALS, EMPLOYEES, AGENTS, AND VOLUNTEERS THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED ON GENERAL LIABILITY SUBJECT TO THE CONDITIONS OF THE ADDITIONAL INSURED - OWNERS, LESSEES, OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION ENDORSEMENT. THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED ON GENERAL LIABILITY SUBJECT TO THE CONDITIONS OF THE ADDITIONAL INSURED - OWNERS, LESSEES, OR CONTRACTORS - COMPLETED OPERATIONS ENDORSEMENT. THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED SUBJECT TO THE CONDITIONS OF THE ADDITIONAL INSURED BY CONTRACT ENDORSEMENT FOR BUSINESS AUTO LIABILITY. INSURANCE PROVIDED BY THE GENERAL LIABILITY COVERAGE IS PRIMARY AND NONCONTRIBUTORY OVER OTHER INSURANCE SUBJECT TO THE CONDITIONS OF THE PRIMARY AND NONCONTRIBUTORY CLAUSE- OTHER INSURANCE CONDITION. INSURANCE PROVIDED BY THE BUSINESS AUTO LIABILITY IS PRIMARY AND NONCONTRIBUTORY OVER OTHER INSURANCE SUBJECT TO THE CONDITIONS OF THE PRIMARY AND NONCONTRIBUTORY CLAUSE- OTHER INSURANCE COITION. GENERAL LIABILITY CONTAINS A WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) - AUTOMATIC ENDORSEMENT BUSINESS AUTO LIABILITY CONTAINS A WAIVER OF SUBROGATION IN FAVOR OF THE CERTIFICATE HOLDER SUBJECT TO THE CONDITIONS OF THE BLANKET WAIVER OF TRANSFER OF RIGHTS OF RECOVERY ENDORSEMENT. GENERAL LIABILITY COVERAGE CONTAINS CG 25 03 DESIGNATED CONSTRUCTION GENERAL AGGREGATE LIMIT ENDORSEMENT APPLICABLE TO EACH CONSTRUCTION PROJECT AS REQUIRED BY WRITTEN CONTRACT OR WRITTEN AGREEMENT. COMMERCIAL UMBRELLA FOLLOWS FORM ACCORDING TO THE TERMS, CONDI"TIONS, AND ENDORSEMENTS FOUND IN THE COMMERCIAL UMBRELLA POLICY. FOR REASONS OTHER THAN NON-PAYMENT OF PREMIUM, 30 DAYS NOTICE WILL BE PROVIDED TO THE CERTIFICATE HOLDER IN THE EVENT THAT THE ISSUING COMPANY CANCELS THE POLICY BEFORE THE EXPIRATION DATE OF THE POLICY. ACORD 101 (2008/01) O 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Additional Insured Copy POLICY NUMBER: 1845023 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 Person(s) Or Or anization(s): Location(s) Of Covered Operations City Clerk City of El Segundo Any coverage provided by this endorsement 350 Main St applies only to Project ##25-10, RE: FY25-26 El Segundo, CA 90245-3813 CONCRETE IMRPOVEMENTS PROJECT, El Segundo, CA 90245-3813 for concrete work. Subject to the terms and conditions of the policy, Additional Insureds also includes The City of El Segundo, its officers, officials, employees- agents. and volunteers. 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 B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following additional organization(s) shown in the Schedule, but only exclusions apply: with respect to liability for "bodily injury", This insurance does not apply to "bodily injury" or "property damage" or "personal and advertising "property damage" occurring after: injury" caused, in whole or in part, by: 1. All work, including materials, parts or 1. Your acts or omissions; or equipment furnished in connection with such 2. The acts or omissions of those acting on your work, on the project (other than service, behalf; maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the in the performance of your ongoing operations for location of the covered operations has been the additional insured(s) at the location(s) completed; or designated above. 2. That portion of "your work" out of which the However: injury or damage arises has been put to its 1. The insurance afforded to such additional intended use by any person or organization insured only applies to the extent permitted by other than another contractor or subcontractor law; and engaged in performing operations for a 2. If coverage provided to the additional insured principal as a part of the same project. 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. © Insurance Services Office, Inc., 2018 Page 1 of 2 CG 20 10 12 19 Policy Number: 1845023 Transaction Effective Date: 11/12/2025 Additional Insured Copy 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 Insured: C J Concrete Construction, Inc. 10142 Shoemaker Ave Santa Fe Springs, CA 90670-3404 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 © Insurance Services Office, Inc., 2018 CG 20 10 12 19 Policy Number: 1845023 Transaction Effective Date: 11/12/2025 Additional Insured Copy POLICY NUMBER: 1845023 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 IZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Or anization(s): Location(s) Of Covered Operations City Clerk City of El Segundo _ See IL-F-40-00029 350 Main St El Segundo, CA 90245-3813 Information re wired 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. 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. © Insurance Services Office, Inc., 2018 Page 1 of 2 CG 20 10 12 19 Policy Number: 1845023 Transaction Effective Date: 11/12/2025 Additional Insured Copy 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 Insured: C J Concrete Construction, Inc. 10142 Shoemaker Ave Santa Fe Springs, CA 90670-3404 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 © Insurance Services Office, Inc., 2018 CG 20 10 12 19 Policy Number: 1845023 Transaction Effective Date: 11/12/2025 Additional Insured Copy IL-F-40-00029 Extension Endorsement Any coverage provided by this endorsement applies only to CDBG PROJECT NO.: 602744-24, PROJECT NO.: PW 24-13, RE: CDBG ADA CURB RAMP INSTALLATION PROJECT, Indiana/Grand northwest corner, 209, and 219 W. Grand, 538 Concord St. (Mariposa side), 355 S. Douglas (Coral Circle side), 515 Lomita St, 920 E. Mariposa Ave., 206 W. Mariposa Ave., 206-208 W. Mariposa Ave, 208 W. Mariposa Ave., 658 W. Mariposa Ave., 658 W. Mariposa Ave. private walkway, 418 W. Palm Ave., 219 W. Pine Ave., 702 Virginia St., E1 Segundo, CA 90245-3813 for concrete work. Subject to the terms and conditions of the policy, Additional Insureds also includes The City of E1 Segundo, its officers, officials, employees, agents, and volunteers. IL-F-40-00029 (06-10) Policy Number: 1845023 Transaction Effective Date: 11/12/2025 Additional Insured Copy POLICY NUMBER: 1845023 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 Additional Insured Person(s) Or Organization(s) :y Clerk City of El Segundo D Main St Segundo, CA 90245-3813 Location And Description Of Completed Operations ee I L-F-40-00031 ation reauir-d to comr)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" 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. Insured: C J Concrete Construction, Inc. 10142 Shoemaker Ave Santa Fe Springs, CA 90670-3404 © Insurance Services Office, Inc., 2018 Page 1 of 1 CG 20 37 12 19 Policy Number: 1845023 Transaction Effective Date: 11/12/2025 Additional Insured Copy IL-F-40-00031 Extension Endorsement Any coverage provided by this endorsement applies only to Project #25-10, RE: FY25-26 CONCRETE IMRPOVEMENTS PROJECT, E1 Segundo, CA 90245-3813 for concrete work. Subject to the terms and conditions of the policy, Additional Insureds also includes The City of E1 Segundo, its officers, officials, employees, agents, and volunteers. IL-F-40-00031 (06-10) Policy Number: 1845023 Transaction Effective Date: 11/12/2025 Additional Insured Copy POLICY NUMBER: 1845023 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 Additional Insured Person(s) Or Oroanization(s) :y Clerk City of El Segundo D Main St Segundo, CA 90245-3813 nformation required to complete this Schedule, if not shown 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 will not be broader than that which you are required by the contract or agreement to provide for such additional insured. Location And Description Of Completed Operations IL-F-40-00032 will be shown in th- Jeclarations. 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. Insured: C J Concrete Construction, Inc. 10142 Shoemaker Ave Santa Fe Springs, CA 90670-3404 © Insurance Services Office, Inc., 2018 Page 1 of 1 CG 20 37 12 19 Policy Number: 1845023 Transaction Effective Date: 11/12/2025 Additional Insured Copy IL-F-40-00032 Extension Endorsement Any coverage provided by this endorsement applies only to CDBG PROJECT NO.: 602744-24, PROJECT NO.: PW 24-13, RE: CDBG ADA CURB RAMP INSTALLATION PROJECT, Indiana/Grand northwest corner, 209 and 219 W. Grand, 538 Concord St. (Mariposa side), 355 S. Douglas (Coral Circle side), 515 Lomita St, 920 E. Mariposa Ave., 206 W. Mariposa Ave., 206-208 W. Mariposa Ave, 208 W. Mariposa Ave., 658 W. Mariposa Ave., 658 W. Mariposa Ave. private walkway, 418 W. Palm Ave., 219 W. Pine Ave., 702 Virginia St., E1 Segundo, CA 90245-.3813 for concrete work. Subject to the terms and conditions of the policy, Additional Insureds also includes The City of El Segundo, its officers, officials, employees, agents, and volunteers. IL-F-40-00032 (06-10) Policy Number: 1845023 Transaction Effective Date: 11/12/2025 COMMERCIAL GENERAL LIABILITY CG 20 01 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. • "Kill• I� • 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. © Insurance Services Office, Inc., 2018 CG 20 01 12 19 Policy Number: 1845023 Page 1 of 1 Transaction Effective Date: 11/12/2025 COMMERCIAL GENERAL LIABILITY CG24531219 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHT, S OF RECOVERY AGAINST OTHEIRS 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 8. 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. © Insurance Services Office, Inc., 2018 Page 1 of 1 CG 24 53 12 19 Policy Number: 1845023 Transaction Effective Date: 11/12/2025 POLICY NUMBER: 1845023 COMMERCIAL GENERAL LIABILITY CG 25 03 05 09 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED CONSTRUCTION PROJECT(S) GENERAL AGGREGATE LIMIT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designated Construction Project(s): Each construction project as required by written contract or written agreement. 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 damages or under Coverage C for medical "occurrences" under Section I - Coverage A, and expenses shall reduce the Designated for all medical expenses caused by accidents Construction Project General Aggregate Limit under Section 1 - Coverage C, which can be for that designated construction project. Such attributed only to ongoing operations at a single payments shall not reduce the General designated construction project shown in the Aggregate Limit shown in the Declarations nor Schedule above: shall they reduce any other Designated 1. A separate Designated Construction Project Construction Project General Aggregate Limit General Aggregate Limit applies to each for any other designated construction project designated construction project, and that limit shown in the Schedule above. is equal to the amount of the General 4. The limits shown in the Declarations for Each Aggregate Limit shown in the Declarations. Occurrence, Damage To Premises Rented To 2. The Designated Construction Project General You and Medical Expense continue to apply. Aggregate Limit is the most we will pay for the However, instead of being subject to the sum of all damages under Coverage A, except General Aggregate Limit shown in the damages because of "bodily injury" or Declarations, such limits will be subject to the "property damage" included in the "products- applicable Designated Construction Project completed operations hazard", and for medical General Aggregate Limit. 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". CG 25 03 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 2 B. For all sums which the insured becomes legally C. obligated to pay as damages caused by "occurrences" 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 E. 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. The provisions of Section III - Limits Of Insurance not otherwise modified by this endorsement shall continue to apply as stipulated. Page 2 of 2 © Insurance Services Office, Inc., 2008 CG 25 03 05 09 Federated Mutual Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. LIMITED AMENDMENT OF CANCELLATION PROVISIONS All Coverage Parts included in this policy are subject to the following conditions: If we cancel this policy, we will mail advance notice to the person(s) or organization(s) as shown in the Schedule. SCHEDULE Insured: C J Concrete Construction, Inc. 10142 Shoemaker Ave Santa Fe Springs, CA 90670-3404 Includes copyrighted material of Insurance Services Office, Inc., with its permission. IL-F-50 (04-13) Policy Number: 1845023 Transaction Effective Date: 11/12/2025 COMMERCIAL AUTO CA 04 49 11 16 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. 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 B. The following is added to the Other Insurance Condition in the Business Auto Coverage Form Condition in the Auto Dealers Coverage Form and and the Other Insurance - Primary And Excess supersedes any provision to the contrary: Insurance Provisions in the Motor Carrier This Coverage Form's Covered Autos Liability Coverage Form and supersedes any provision to Coverage and General Liability Coverages are the contrary: primary to and will not seek contribution from any This Coverage Form's Covered Autos Liability other insurance available to an "insured" under Coverage is primary to and will not seek your policy provided that: contribution from any other insurance available to 1. Such "insured" is a Named Insured under an "insured" under your policy provided that: such other insurance; and 1. Such "insured" is a Named Insured under 2. You have agreed in writing in a contract or such other insurance; and agreement that this insurance would be primary and would not seek contribution from 2. You have agreed in writing in a contract or any other insurance available to such"insured". agreement that this insurance would be primary and would not seek contribution from any other insurance available to such "insured". © Insurance Services Office, Inc., 2016 Page 1 of 1 CA 04 49 11 16 Policy Number: 1845023 Transaction Effective Date: 11/12/2025 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED BY CONTRACT ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE PART With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. A. WHO IS AN INSURED for "bodily injury" and "property damage" liability is amended to include: Any person or organization other than a joint venture, for which you have agreed by written contract to procure bodily injury or property damage "auto" liability insurance arising out of operation of a covered "auto" with your permission. However, this additional insurance does not apply to: (1) The owner or anyone else from whom you hire or borrow a covered "auto". This exception does not apply if the covered "auto" is a "trailer" connected to a covered "auto" you own. (2) Your "employee" if the covered "auto" is owned by that "employee" or a member of his or her household. (3) Someone using a covered "auto" while he or she is working in a business of selling, servicing, repairing, parking or storing "autos" unless that business is yours. (4) Anyone other than your "employees", partners (if you are a partnership), members (if you are a limited liability company), or a lessee or borrower or any of their "employees", while moving property to or from a covered "auto". (5) A partner (if you are a partnership), or a member (if you are a limited liability company) for a covered "auto" owned by him or her or a member of his or her household. B. The coverage extended to any additional insured by this endorsement is limited to, and subject to all terms, conditions, and exclusions of the Coverage Part to which this endorsement is attached. In addition, coverage shall not exceed the terms and conditions that are required by the terms of the written agreement to add any insured, or to procure insurance. C. The limits of insurance applicable to such insurance shall be the lesser of the limits required by the agreement between the parties, or the limits provided by this policy. D. Additional exclusions. The insurance afforded to any person or organization as an insured under this endorsement does not apply: 1. To "loss" which occurs prior to the date of your contract with such person or organization; 2. To "loss" arising out of the sole negligence of any person or organization that would not be an insured except for this endorsement. 3. To "loss" for any leased or rented "auto" when the lessor or his or her agent takes possession of the leased or rented "auto" or the policy period ends, whichever occurs first. Includes copyrighted material of Insurance Services Office, Inc. with its permission. CA-F-127 (03-03) Policy Number: 1845023 Transaction Effective Date: 11/12/2025 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET WAIVER OF TRANSFER OF RIGHTS OF RECOVERY This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE PART With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. In the event of any payment for a loss under this Business Auto Coverage Part arising out of your ongoing operations, we agree to waive our rights under the TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US condition against any person or organization, its subsidiaries, directors, agents or employees, for which you have agreed by written contract, prior to the occurrence of any loss, to waive such rights, except when the payment results from the sole negligence of that person or organization, its subsidiaries, directors, agents or employees. Includes copyrighted material of Insurance Services Office, Inc. with its permission. CA-F-128 (03-03) Policy Number: 1845023 Transaction Effective Date: 11/12/2025 N, DATE (MMIDDIYYYY) AC" CERTIFICATE OF LIABILITY INSURANCE 11/6/2025 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 pollc'y(es) must have ADDkTIONAL NNSURED 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 tights to the certificate holder in lieu of such endorsement )., PRODUCER NAME• Behr insurance Services Inc. „Eat ; 888-988-2347 INC, No): 1420 E Los Angeles Ave #203 ARRmESS aeryicc(rtlhchrtns"ctr'A'r MSURER(Si AFFORDING COVERAGE NAIC # Simi Valley NS CO 10499 CA 93065 INSURER A : COREPOINTE I INSURED INSURER B CJ Concrete Construction Inc '..INSURER C : 10142 SHOEMAKER AVE INSURER O INSURER. E SANTA FE SPRINGS CA 90670-3404 INSURER. F ; COVERAGES CERTIFICATE NUMBER: REVISION NUMBER. THIS IS TO CERTIFY THAT THE POL(CIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD NOTWITHSTANDING ANY REQUIREMENT„ TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS INDICATED. PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, CERTIFICATE MAY BE ISSUED OR MAY EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ..•POLICY AM SVOR TYPE OF INSURANCE _EFF NUMBER tINLIC "YYYIfI Porm P'YY'fp t;"tR INSD '41N0'. � LIMITS „. CRgI✓tMERCIp.. ENkERALLI'ABTLITY EACH OCCURRENCE -- $ CLAIMS -MADE OCCUR 'PRENIISE'St[a occo¢trrpec�A $ MED EXP [Any one person) $ PERSONAL 8 ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ F+RODUCTS-COMPIOP AGG .__. �--- $ PRO- POLICY �JECT �LOC $ " $ AUTOMOBILE LIABILITY itEri oCe^donor) ��.. ..._. �Y INJURY (Per person) BOUIL 'S ANY AUTO IB'ODII..Y INJURY (Per accident) S OWNED SCHEDULED AUTOS ONLY AUTOS '� �B' $ HIRED NON-OWNEDs A010S, ONLY AUTOS ONLY UMBRELLA LIAR OCCUR-- �F;ACH OCCURRENCE $ - m.EXCESS LIAB CLAIMS -MADE AGGREGATE $ DED RETENTION S..... �.... DRKERSCOMPENSATION . - X.STATU'T'E ER ACCIDENT E.L. EACH 1,000,000 NO EMPLOYERS' LIABILITY YIN A Y P'RoprilE TOPJPAR TN�EMFXECUT IIVE )FFICERT'M EMBER EXCLUDED? N T A Y CTP1003801 05/08/2025 OS/08/2026 E.L. DISEASE.. EA EMPLOYEE $ 1,000,000 Mandatory in NH) E.L DISEASE- POLICY LIMIT $ 1,000,000 yy , describo under IES CR1PTtON OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additlonal Remarks Schedule, may be attached it more space is required) Project Full Name: FY25-26 CONCRETE IMRPOVEMENTS PROJECT Waiver of subrogation (WC 04 03 06) applies to workers compensation only if an executed written contract explicitly requires these specific endorsements. Coverage subject to policy terms and exclusions. CERTIFICATE HOLDER CANC'ELLAA"UNe SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City ofEl Segundo ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street AU1HORI2E0 REPRESENTATIVE Jaw Oekr El Segundo, CA 90245 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD 1 tl$ CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 1 11/5/2025 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(les) 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 Behr Insurance Services Inc. 1420 E Los Angeles Ave #203 Simi Valley CA 93065 QONTXCT NAME: APC Ne) xs : 888-988-2347 ADORES& service@behrins.com INSURER(S)AFFORDING COVERAGE NAIL # INSURERA: COREPOINTE INS CO 10499 INSURED CJ Concrete Construction Inc 10142 SHOEMAKER AVE SANTA FE SPRINGS CA 90670-3404 INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : r.r'rtrsrrarzP 11 r..90TIP=1r`AT NI IIUIRizR- 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. LTR"' TYPE OF INSURANCE )NSD WVD POLICY NUMBER IMMIDDrrMI (MRDO1YYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS -MADE DOCCUR PREMLSES(Fa accupramo) $ MED EXP (Any one person) $ PERSONAL &ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY JERCT 7 LOC HOTHER: PRODUCTS - COMP/OP AGG S $ AUTOMOBILE LIABILITY Eaatir. de,.nt) ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED ONLY AUTOS BODILY INJURY (Per accident)AUTOS $ HIRED NON -OWNED AUTOS ONLY 'AUTOS ONLY (Per'�accfd001) $ .UMBRELLA LIAB OCCUR EACH OCCURRENCE $ HCLAIMS-MADE AGGREGATE '$ EXCESSLIAB DED I I RETENTION$ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY M nCERtM ^EHHRIPXCLUorJEXECIJTiVE Y , FFICER/MEMBER EXCLUOlJ71 Y ry NIA Y CTP1003801 05/08/2025 05/08/2026 X STATUTE ER E.L. EACH ACCIDENT E.L. DISEASE- EA EMPLOYEE $ 1,000,000 $ 1,000,000 f yyos, describe under ESCRIPTION OF OPERATIONS below E. L. DISEASE- POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) Waiver of subrogation (WC 04 03 06) applies to workers compensation only if an executed written contract explicitly requires these specific endorsements. Coverage subject to policy terms and exclusions. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of El Segundo ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street AUTHORIZED REPRESENTATIVE Jowo tka�. SrAr El Segundo, CA 90245 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD