PROOF OF INSURANCE (2026 - 2027)DATE (MM/DD/YYYY)
� �°" CERTIFICATE OF LIABILITY INSURANCE
6/1 /2026
THIS CERTIFICATE I8 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).
CONTCT
PRODUCER NAMK� Certificates_1111111, _
Orr &Associates Insurance Services
es cents,., gasoclat/ 800 474003
28780 Single Oak Dr "Ro F>4) 800 311 30 (t,
Ste 255 orrand es com
Temecula CA 92590 INSURER(S) AFFORDING COVERAGE I NAIC #
INSURED
SS+K Construction Inc
22142 Sabroso
Mission Viejo CA 92691
SSK0000-01
t10M-r 1t-ATC N111RADCD• 10n19Z114n1
INSURER A: AmGuard Insurance GO
INS"" .....___. ........... ... --...
INSURER B: Lexinaton Insurance Co
INSURERC: Endurance
D; ,Navigators Insurance
E: Palms Insurance Con
Ltd,
RFVISIAN NIIMRFR!
42390
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. ..................... ......_..
. EOFINSU....... � _ _ I. ......... _,.
R - -- INS'TMP..., .. ... . cati'fal:�G1"tR�.,. ----- POLICY .... ........... .... MMIDDYEFF....� ...POLICY EX'i' .. .........„„, _.
RANCE j NUMBER MMIDD LIMITS
B
X
COMMERCIAL GENERAL LIABILITY
Y
Y
019810507-00
6/16/2025
6/16/2026 EACH OCCURRENCE
I $ 1,000.000
....,.
CLAIMS -MADE X OCCUR
1..,.,.__I „
AIVIAI�I=Y(71t1="N-Y(='iy
a u .. ....
$ 100 000 .
ME EXPSAnaone pTence)
�.. i a erson)
$ 5 000
PERSONAL & ADV INJURY
......
.......
$ 1 000 000
GEN'L
AGGREGATE LIMIT APPLIES P ER.
GENERAL AGGREGATE
$ 2,000,000
POLICY X J PE O J LOC
PRODUCTS COMP/OP AGG
$ 2 000 000
OTHER:
A
AUTOMOBILE
LIABILITY
Y
Y
SSAU762906
3/20/2026
3/20/2027
I OPURNIPPI) INGLE Lima$
li
$ 1000000
ANY AUTO
BODILY INJURY (Per person)
1
$
OWNED X I SCHEDULED
BODILY INJURY (Per accident)
I $
X,,,
AUTOS ONLY AUTOS
X
PROPERTI'
(Pgrccbd Y))AMA(sE
ant
$
�...
AUTOS ONLY
1 AUTOS ONLY
eeee.
f
.. �.
1$
B
UMBRELLA LIAB X occuR
1
071732733-00
6/16/2025
6/16/2026
1 EACH OCCURRENCE
$ 5 000 000
EXCESS LIAB CLAIMS MADE
1 AGGREGATE
$ 5,000, 000 ....._
.............. ..,
DED RETENTION $
I
1/25/2026
1/25/2027
OTH
C
WORKERSCOMPENSATION�
E
AND EMPLOYERS' LIABILITY Y / N
ANYPROPRIETOR/PARTNER/E' ECUTIVE
OFFICEEREXCLUDED.
NIA A
EAW00004901-00
I
1�X STATUTE ER
E.L. EACH ACCIDENT
�,
$ 1 000 000 _
in
(Mandatory in NH)
(Mandatory
E L DISEASE EA EMPLOYEE!
$ 1 000 0 00
If yes, descrdbe under
� E L DISEASE POLICY LIMIT
$ 1,000,000
DESCRIPTION OF OPERATIONS below
-
E i
D
Pollution Liability
Equipment Floater
CSIPCPPLOO100-02
04-IM062376
5/28/2026
2/10/2026
5/28/2027
2/10/2027
Aggregate
Rented/Leased Equip
2,000,000
50,000
DESCRIPTION OF OPERATIONS / LOCATIONS 1 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 are named as Additional Insured as per attached endorsement form(s).
Re: RECREATION PARK, TEEN CENTER, PLAZA, AND SKATEPARK RENOVATION PROJECT, PROJECT NO.: PW 25-13
405 E GRAND AVE, EL SEGUNDO, CA 90245
CERTIFICATE HOLDER
The City of El Segundo, its elected and appointed officials,
employees„ and volunteers
PUBLIC WORKS DEPARTMENT, ENGINEERING
DIVISION
350 MAIN 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.
AUTHORIZED REPRESENTATIVE
NM&
fJ 1938-ZUI5 AGUKU GUKI'UKA I IUN. An rlgnis reserves.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
POLICY NUMBER: 019810507-00
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) Location(s) Of Covered Operations
Or Organ ization(s):
Those persons or organizations where required Those locations where required by written
by written contract or agreement with the contract or agreement with the Insured,
Insured, executed prior to the occurrence executed prior to the occurrence or loss.
or loss.
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
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.
CG 20 10 04 13 Copyright, Insurance Services Office, Inc., 2012 Page 1 of 2
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.
Page 2 of 2 Copyright, Insurance Services Office, Inc., 2012 CG 20 10 04 13
POLICY NUMBER:019810507-00
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
Those persons or organizations where required
Those locations where required by written
by written contract or agreement with the
contract or agreement with the Insured,
Insured, executed prior to the occurrence or
executed prior to the occurrence or loss,
loss.
for commercial construction work contemplated
under the listed ISO class code(s).
............... _........... _ ................ ..........
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 is added to
organizatin(s) shown in the Schedule, but only
Section III - Limits Of Insurance:
with respect to liability for "bodily injury" or
If coverage provided to the additional insured is
"property damage" caused, in whole or in part, by
required by a contract or agreement, the most we
"your work" at the location designated and
will pay on behalf of the additional insured is the
described in the Schedule of this endorsement
amount of insurance:
performed for that additional insured and included
in the "products -completed operations hazard".
1. Required by the contract or agreement; or
However:
2. Available under the applicable Limits of
Insurance shown in the Declarations;
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.
whichever is less.
This endorsement shall not increase the
applicable Limits of Insurance shown in the
Declarations.
CG 20 37 04 13 Copyright, Insurance Services Office, Inc., 2012 Page 1 of 1
COMMERCIAL GENERAL LIABILITY
CG 20 01 04 13
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
PRIMARY AND NONCONTRIBUTORY -
OTH'ER INSURANCE CONDITION
This endorsement modifies insurance provided under the following,
COMMERCIAL GENERAL LIABILITY COVERAGE PART
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
The following is added to the Other Insurance
Condition and supersedes any provision to the
contrary:
Primary And Noncontributory Insurance
This insurance is primary to and will not seek
contribution from any other insurance available
to an additional insured under your policy
provided that:
(1) The additional insured is a Named Insured
under such other insurance; and
(2) You have agreed in writing in a contract or
agreement that this insurance would be
primary and would not seek contribution
from any other insurance available to the
additional insured.
CG 20 01 04 13 Copyright, Insurance Services Office, Inc., 2012 Page 1 of 1
POLICY NUMBER:019810507-00
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
PersonName Of r Organization:
Any and all persons or organizations where required by written
contract with the insured, and executed prior to the occurrence or
loss to provide such persons or organizations with coverage afforded
by this endorsement.
Information required to complete this Schedule, if not shown above, will be shown in the Declarations,.
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 person or organization shown in the Schedule
above because of payments we make for injury or
damage arising out of your ongoing operations or
"your work" done under a contract with 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 Copyright, Insurance Services Office, Inc., 2008 Page 1 of 1
SSAU762906
COMMERCIAL AUTO
BA 99 02 09 08
BLANKET WAIVER OF SUBROGATION
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 - BUSINESS AUTO CONDITIONS, A. Loss Conditions, 5. Transfer Of Rights Of
Recovery Against Others To Us is amended by adding the following:
We waive any right of recovery we may have against any person or organization with whom you have a
written contract that requires such waiver because of payments we make for damages under this
Coverage Form.
BA 99 02 09 08 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 1
SSAU762906
COMMERCIAL AUTO
BA 99 04 06 18
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.
This provision does not apply in regard to any ownership, maintenance or use of the additional insured's "autos."
Additional Insured When Required by Contract
(1) Paragraph A.1. — WHO IS AN INSURED —
of Section II — Liability Coverage is
amended to add:
d. When you have agreed, in a written
contract or written agreement, that a
person or organization be added as an
additional insured on your business auto
policy, such person or organization is an
"insured", but only to the extent such
person or organization is liable for
"bodily injury" or "property damage"
caused by the conduct of an "insured"
under paragraphs a. or b. of Who Is An
Insured with regard to the ownership,
maintenance or use of a covered "auto."
The insurance afforded to any such
additional insured applies only if the
"bodily injury" or "property damage"
occurs:
(1) During the policy period, and
(2) Subsequent to the execution of such
written contract, and
(3) Prior to the expiration of the period
of time that the written contract
requires such insurance be provided
to the additional insured.
(2) How Limits Apply
If you have agreed in a written contract
or written agreement that another
person or organization be added as an
additional insured on your policy, the
most we will pay on behalf of such
additional insured is the lesser of:
(a) The limits of insurance specified in
the written contract or written
agreement; or
(b) The Limits of Insurance shown in
the Declarations.
Such amount shall be a part of and not
in addition to Limits of Insurance shown
in the Declarations and described in this
Section.
(3) Additional Insureds Other Insurance
If we cover a claim or "suit" under this
Coverage Part that may also be covered
by other insurance available to an
additional insured, such additional
insured must submit such claim or "suit"
to the other insurer for defense and
indemnity.
However, this provision does not apply
to the extent that you have agreed in a
written contract or written agreement
that the insurance is primary and non-
contributory with the additional insured's
own insurance.
(4) Duties in The Event Of Accident, Claim,
Suit or Loss
If another person or organization is
added as an additional insured on your
policy, the additional insured shall be
required to comply with the provisions in
A. Loss Conditions 2. — Duties In The
Event Of Accident, Claim, Suit Or
Loss — of SECTION IV — BUSINESS
AUTO CONDITIONS, in the same
manner as the Named Insured.
BA 99 04 06 18 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 1