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PROOF OF INSURANCE (2020) CLOSED Page 1 of 1 DATE(MMIDD/YYYY) A � CERTIFICATE OF LIABILITY INSURANCE I 03/15/2019 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). PRODUC R NAME: c/oWil1is of New 26ECenturyYBlvd Inc. PHONE VAX N�N� Mt) 1-877-945-7378 1-888-967-2378 IL P.O. Box 305191 ADDRESS ificaes@willis.com cert.... t — Nashville, TN 372305191 USA INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: QBE, Insurance Corporation 39217 INSURED INSURERS General sualty Company of Wisconsin V 24414 Galls, LLC 1340 Russell Cave Rd. INSURER C: Praetorian Insurance Company 37257 Lexington, KY 405053114 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:W10471236 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 SAID CLAIMS. INTR ".. AL 'Wak POLICY IN.4 0 WVD .X'NUMBER... .......MM Dttf,E'YMY PWDDfYYYYI TYPE OF INSURANCE pOLIC LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE ($ 1,000,000 (AMAGe WRINIkC: 1,000,000 X p ED EXP(Any one person) $ .. -----..w..) A � MS-MADE _ OCCUR Y Y pERSI (Any $ 10,000 CLAIMS-MADE CGA1331044 03/01/2019 03/01/2020 1,000,000 ff ONAL&ADV INJURY $ gEN'L.AGGREGATE LIMIT APPLIES PER: — - GENERAL AGGREGATE $ I 2,000,000 OTtliER:❑ pR0• ❑ ..a.,$ X POLICY l O LOC PRODUCTS-COMPIOP AG 2,000,000 X AUTOMOBILE ANY AUTO ABILITY [BODILY 00 INED$lNGLE LIMIT s 1,000, Y INJURY(Per person) $ 0 CFa acclddnl) OWNED 1 SCHEDULE A AUTOS ONLY UTOS AUTOS ONLY HIRED AUTOSONLDY CBA1331044 03/01/2019 03/01/2020 �B—OON-OWNEDOpI Eycldry�UORA (Per accident)i$ i$ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE Is 5,000,000 B .-------- AGGREGATE 5, .E .. -$--- CLAIMSMADE EXCESS LIAB CCU1331044 03/01/2019 03/01/2020 000000' X DED I I RETENTION$10,000 $ WORKERS COMPENSATION PER 1 OTH- AND EMPLOYERS'LIABILITY OFYPROPRIETO REXCLUDED? NIA Y � 'L EACH ACCIDENT ER 1,000,00 ,00 CWC1331044 03/01/2019 03/01/20201 E $ 00,000 C (Mandatory m NH)PARTNER/EXECUTIVE Y❑ EL„�„DISEASE- A EMPLOYEE; $ ,0 0,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E .DISEASE-POLICY LIMIT $ V ®DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) City of E1 Segundo- Contract 3957 Certificate holder is included as an Additional Insured as respects to General Liability as required by written contract. Waiver of Subrogation applies in favor of Certificate holder with respects to General Liability and Workers Compensation as permitted by law. 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. The City of E1 Segundo AUTHORIZED REPRESENTATIVE 348 Main St /d r° E1 Segundo, CA 90245 United States of America r' / 7 ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD SR ID: 17665598 —CH: 1112683 CGA1331044 COMMERCIAL GENERAL LIABILITY CG 2010 0413 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) Location(s)Of Covered Operations WHERE REQUIRED BY WRITTEN CONTRACT OR AGREEMENT u 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 2. If coverage provided to the additional insured is include as an additional insured the person(s) or required by a contract or agreement, the organization(s) shown in the Schedule, but only insurance afforded to such additional insured with respect to liability for "bodily injury", "property will not be broader than that which you are damage" or "personal and advertising injury" required by the contract or agreement to caused, in whole or in part, by: provide for such additional insured. 1. Your acts or omissions; or B. With respect to the insurance afforded to these 2. The acts or omissions of those acting on your additional insureds, the following additional behalf; exclusions apply: in the performance of your ongoing operations for This insurance does not apply to "bodily injury" or the additional insured(s) at the location(s) "property damage"occurring after: designated above. 1. All work, including materials, parts or However: equipment furnished in connection with such work, on the project (other than service, 1. The insurance afforded to such additional maintenance or repairs) to be performed by or insured only applies to the extent permitted by on behalf of the additional insured(s) at the law; and location of the covered operations has been completed;or CG 20 10 0413 0 Insurance Services Office, Inc.,2012 Page 1 of 2 2. That portion of "your work" out of which the 2. Available under the applicable Limits of injury or damage arises has been put to its Insurance shown in the Declarations; intended use by any person or organization other than another contractor or subcontractor whichever is less. engaged in performing operations for a This endorsement shall not increase the principal as a part of the same project. applicable Limits of Insurance shown in the C. With respect to the insurance afforded to these Declarations. 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 Page 2 of 2 0 Insurance Services Office, Inc.,2012 CG 2010 0413 (iv) If the loss arises out of the 0. LIMITED WORLDWIDE LIABILITY COVERAGE maintenance or use of aircraft, The following is added to SECTION IV — extent", or watercraft to the CONDITIONS within the COMMERCIAL GEN- graph 2. g. Aircraft, Auto Or extent not subject to Para- ERAL LIABILITY COVERAGE FORM: Watercraft under COVER- Expanded Coverage Territory AGE A.BODILY INJURY 1. If a"suit" is brought in a part of the "coverage AND PROPERTY DAMAGE territory" that is outside the United States of LIABILITY of SECTION I – COVERAGES within the America (including its territories and posses- sions), Puerto Rico or Canada, and we are COMMERCIAL GENERAL COMMERCIAL prevented by law, or otherwise, from defend- LIABILITYFORM. ing the insured, the insured will initiate a de- fense of the "suit". We will reimburse the in- 0. UNINTENTIONAL FAILURE TO DISCLOSE sured, under Supplementary Payments, for HAZARDS any reasonable and necessary expenses in- The following is added to Paragraph curred for the defense of a "suit" seeking 6. Representations of SECTION IV — COM- damages to which this insurance applies, that MERCIAL GENERAL LIABILITY CONDITIONS we would have paid had we been able to ex- within the COMMERCIAL GENERAL LIABILITY ercise our right and duty to defend. COVERAGE FORM: If the insured becomes legally obligated to Any unintentional failure to disclose all exposures pay sums because of damages to which this or hazards existing as of the effective date of the insurance applies in a part of the coverage Commercial General Liability Coverage Form or territory" that is outside the United States of at any time during the policy period will not invali- America (including its territories and posses- date or adversely affect the coverage for such sions), Puerto Rico or Canada, and we are exposure or hazard. However, you must report prevented by law, or otherwise, from paying the undisclosed exposure or hazard to us as soon such sums on the insured's behalf, we will ye- as reasonably possible after the exposure or imburse the insured for such sums. hazard is discovered. 2. All payments or reimbursements we make for P. WAIVER OF SUBROGATION damages because of judgments or settle- ments will be made in U.S. currency at the The following is added to Paragraph 8.Transfer Of prevailing exchange rate at the time the in- Rights Of Recovery Against Others To Us of sured became legally obligated to pay such SECTION IV — COMMERCIAL GENERAL sums. All payments or reimbursements we LIABILITY CONDITIONS within the COMMER- make for expenses under Supplementary CIAL GENERAL LIABILITY COVERAGE FORM: Payments will be made in U.S. currency at This condition does not apply to any person or the prevailing exchange rate at the time the organization to which you waived this condition by expenses were incurred. written contract or agreement, but only to the 3. Any disputes between you and us as to extent that subrogation is waived prior to the whether there is coverage under this policy "bodily injury" or "property damage" under a must be filed in the courts of the United contract with that person or organization. States of America (including its territories and possessions), Puerto Rico or Canada. 4. The insured must fully maintain any coverage required by law, regulation or other governmen- tal authority during the policy period, except for reduction of the aggregate limits due to pay- ments of claims,judgments or settlements. Failure to maintain such coverage required by law, regulation or other governmental authori- ty will not invalidate this insurance. However, this insurance will apply as if the required coverage by law, regulation or other govern- mental authority was in full effect. Includes copyrighted material of Insurance Services Office, Inc., CG 8179 01 11 with its permission. Page 5 of 6 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13 (Ed. 4-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT 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 named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule Any person or organization for which you have agreed to waive your rights of recovery in a written contract, provided such contract was executed prior to date of loss. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 03/01/2019 Policy No. CWC1331044 Endorsement No. 000 Insured CB GENERAL HOLDINGS LLC Premium $750,000.58 Insurance Company PRAETORIAN INSURANCE COMPANY Countersigned by WC 00 03 13 (Ed. 4-84) C 1983 National council on Compensation Insurance. CWC13 3104 4 20180301 000