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PROOF OF INSURANCE (2019 - 2020) CLOSED CERTIFICATE OF INSURANCE I ISSUE DATE 7/16120161 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($),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:IF THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED,THE POLICY(IES)MUST BE ENDORSED.IF SUBROGATION IS WAIVED, SUBJECT TO THE TERMS AND CONDITIONS OF THE POLICY,CERTAIN POLICIES MAY REQUIRE AN ENDORSEMENT.A STATEMENT ON THIS CERTIFICATE DOES NOT CONFER RIGHTS TO THE CERTIFICATE HOLDER IN LIEU OF SUCH ENDORSEMENT($). PRODUCER INSURER(S)AFFORDING COVERAGE Northeast Agency Insurance Services INSURER A: Colony Insurance 6467 Main Street-Suite 104 Williamsville, NY 14221 INSURER B: NIA INSURED INSURER C: N/A Bayshore Water Conditioning,See Schedule of INSURER D: N/A Named Insureds 10611 Calle Lee Ste 113 Los Alamitos,CA 90720 INSURER E: Colony Insurance COVERAGES THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF POLICY POLICY POLICY LIMITS LTR INSURANCE NUMBER EFFECTIVE DATE EXPIRATION DATE ,GENERAL LIABILITY MP4221319 _ 7/1/2018 7/1!2019 GENERAL AGGREGATE 2,000,000 PRODUCTS-Comi6p AGG, 2,000,000 PERSONAL&ADV.INJURY 2,000,000 EACH OCCURRENCE 2,000,000 I i DAMAGE PREM RENTED TO YOU 100,000 MED EXPENSE(Any one person) 5,000 S PERSONAL LIABILITY COMBINED SINGLE LIMIT I MEDICAL PAYMENTS TO OTHERS E EXCESS LIABILITY I' EACH OCCURRENCE AGGREGATE D 999 I � Y E PROPERTY MP4221319 711/2018 7/112019 BUILDING I CONTENTS 100,000 II BUSINESS INCOME I DESCRIPTION OF OPERATIONS 1 SPECIALTY'ITEMS Plumbing commercial&industnal,Banks and Offices other than Governmental,Plumbing residential or domestic-City of EI Segundo Fire Department are named as additional Insureds with respect to general Lability. CERTIFICATE HOLDER (SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED City of EI Segundo Fire DepartmentIYpBEFORE THE EXPIRATION DATE THEREOF„NOTICE WILL BE DELIVERED IN 314 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. El Segundo,CA 90245 AUTHORIZED SIGNATURE Cl CW A021011 CERTIFICATE OF INSURANCE This certificate is issued for informational purposes only. It certifies that the policies listed in this document have been issued to the Named Insured. It does not grant any rights to any party nor can it be used, in any way, to modify coverage provided by such policies. Alteration of this certificate does not change the terms, exclusions or conditions of such policies. Coverage is subject to the provisions of the policies, including any exclusions or conditions, regard- less of the provisions of any other contract, such as between the certificate holder and the Named Insured.The limits shown below are the limits provided at the policy inception.Subsequent paid claims may reduce these limits. Certificate Holder Named Insured: CITY OF EL SEGUNDO, ITS OFFICIALS AND BAYSHORE WATER CONDITIONING INC EMPLOYEES 10611 CALLE LEE STE 113 CITY CLERK LOS ALAMITOS CA 90720 3.50 MAIN ST RM 5 EL SEGUNDOv CA 90245-3813 Automobile Liability Insurer Name: Allstate Insurance Company 'Po icvNumber. 098308879 _ 1-Any Auto 2-Owned Autos Only 3-Owned Priv.Pass.Autos Only 4-Owned Autos Other Than Priv. 5-Owned Autos Subject to No 6-Owned Autos Subject to a Compulsory UM Law Pass.Autos Only Fault X 7-Specifically Described Autos 8-Hired Autos Only X 9-Non-owned Autos Only Policy Effective Date: 08-13-2018 Policy Expiration Date: 08-13-2019 Limits Of $ 1,000,000 Combined Single Limit(each accident) Insurance: C BI Per Person BI Per Accident a PD Per Accident Description of Operations/Locations/Vehicles/Endorsements/Special Provisions Interested Party Type: ADDITIONAL INSURED - OTHER THIS CERTIFICATE DOES NOT GRANT ANY COVERAGE OR RIGHTS TO THE CERTIFICATE HOLDER. IF THIS CERTIFICATE INDICATES THAT THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED, THE POLICY(IES) MUST EITHER BE ENDORSED OR CONTAIN SPECIFIC LANGUAGE PROVIDING THE CERTIFICATE HOLDER WITH ADDITIONAL INSURED STATUS.THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED ONLY TO THE EXTENT INDICATED IN SUCH POLICY LANGUAGE OR ENDORSEMENT. Producer B T MCMAHON INS SV(" Authorized Representative: d.• . ,_ .. _. Date: 01-08-19 Includes copyrighted material of Insurance Services Office, Inc.,with its permission Cl CW A021011 Allstate Insurance Company Page 1 of 1 Corlikate Copy A0948-82-84 CERTIFICATE OF LIABILITY INSURANCE I D1/10/2ATE IDD"YYY' A��R C 1/10/2019 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 cNAMoNTAE,cr Rebecca Huddle Becky Huddle Insurance Agency PHONE 916-789-7500 FAX 916-789-2545 IAIC,No,, Ext)' „(AIC,No); 729 Sunrise Ave Ste 504 E-MAILsaff.ruefarlTle'rsa erlc ADDRESS: thddl@ y•com Roseville CA 95661 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:MID CENTURY INSURANCE 21687 INSURED ..... INSURER B! Bayshore Water Conditioning DBA Elite Water Systems INSURER c 10611 CALLE LEE SUITE 113 INSURER D LOS ALAMITOS,CA 90720 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ( POLICY EXP LTR COMMETYPE RCIAL GENERAL INSURANCE N URAN(ABILITY N IR L SUBR POLICY NUMBER (MM/IDDY/YYYYt dMhNVDDPY Y S YYYI LIMIT EACH OCCURRENCE S t"JAMA6 1O 14�NT Eb CLAIMS-MADE 0 OCCUR PREMISES(Ea occurrence) MED EXP(Any one person) $ PERSONAL&ADV INJURY S GEN'L AGGREGiAllf,`LIMIT APPLIES PER: GENERAL AGGREGATE $ PC11LICI'El PRO, LOC PRODUCTS-COMP/OP AGO S dEC"Y t,�T ricl'6' , $ AUTOMOBILE LIABILITY � 001 10"Ef.P�SINGL.'ELVOTLi $ _ gEnr ar:, daPb ANY AUTO BODILY INJURY(Per person) $ — OWNED SCHEDULED BODILY INJURY(Per accident)' $ AUTOS ONLYAUTOS — HIRED NON-OWNED Y IDAMA(n',F $ AUTOS ONLY AUTOS ONLY (Per acci1enll $ .. .. EXCESSLIAB ,�,CLAIMS-MADE AGGREGATEPENCE $ UOCCUEACH MBRELLA AB DED F7RETENTION S S WORKERS COMPENSATION �''',f STATUTE, ETH YIN AND EMPLOYERS'LIABILITY 4� A ANYPRBER PR TORIPA TNERIE?ECUTIVE NIA A0948-82-84 1/1/2019 1/1/2020 EL;EACH ACCIDENT $ 1,000,000 OFFin NH) ❑ DISEASE-EA EMPLOYEE S 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) RE:Install three reverse osmosis systems at 314 Main St.EI Segundo and 2261 E.Mariposa Ave.,EI Segundo WAIVER OF SUBROGATION:workers'compensation CERTIFICATE HOLDER CANCELLATION City of EI Segundo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Fire Dept. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 314 Main St. El m .. .. l . .... ,.., .,mom Segundo, AUTHORIZED REPRE'SENTATP Rebecca Huddle ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Produced using Forms Boss Web Software.www.FormsBoss.com(c)Impressive Publishing 800-208.1977 rvl� FARMERS INSURANCEWC 99 06 19 WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY INSURANCE POLICY Named Insured 0 Bayshore Water Conditioning DBA Elite Water Systems 0 10611 CALLE LEE SUITE 113 0 LOS ALAMITOS, CA 90720 Effective Agent A0948-82-84 2019 Date 01/01/2019 95-39-36A Policy Number Policy of the Company Year WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - BLANKET We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization for which you perform work under a written contract that requires you to obtain this agreement from us. The additional premium for this endorsement shall be 3.0 % of the Workers' Compensation premium otherwise due for the state(s) listed below on such remuneration, subject to a minimum charge of 250 . All written contracts in the state(s) of: This endorsement is part of your policy. It supersedes and controls anything to the contrary. It is otherwise subject to all the terms of the policy. Countersigned Authorized Representative 93-6369 1ST EDITION 9-07 WC990619A J6369111 PAGE 1 OF 1