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PROOF OF INSURANCE (2020) CLOSEDSEACLEA-01 TIMH CERTIFICATE OF LIABILITY INSURANCE DATE(MMMD/YYYY) 6.12712019 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 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 statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCERCT H&S Insurance Services, Inc. PHO.NW ,Eat): (805) 212-4890 Ac, Nol:(805) 212-4891 887 Patriot Drive, Ste. D Moorpark, CA 93021 Ram CERTIFICATE HOLDER CANCELLATION' SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CE of EI Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City g ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main St. EI Segundo, CA 90245 AUTHORIZED REPRESENTATIVE ACORD 25 (2016103) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD INSURER(SI AFFORDING COVERAGE NAIC 0 INSURER A: United National Insurance Company 13064 INSURED INSURER B : Metropolitan Olrect Property and Casualty Insurance Company 25321 Sea Clear Pools, Inc. INSURER C. National Union Fire Insurance Company of Pittsburgh, Pa. 18445 23316 S Normandle Ave #B INSURER, 0; Pacific Compensation Insurance Company j11555 Torrance, CA 90502 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. INSR TYPE OF INSURANCE ADSL STIR POLICY NUMBER POLICY EPP P MID, EXP LIMITS Ap( COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 CLAIMS -MADE X OCCUR L7219632 -F X 71112019 7/112020 DAM E TG RENTED I _M S t MC. 50,000 MED EXP (Anv one person) $ 0 PERSONAL & ADV INJURY S 1,000,000 N'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000 X POLICY r7 JECT LOC PRODUCTS - COMPIOP AGG S 2,000,000 pp, AUTOMOBILE OTHER LIABILITY IiS COMBINEtSINT,,LE LIMIT S 1,000,000 AUTO CA044844P2019 71112019 7/112020 BODILY INJURY IPer oerson) S �AApNY ZVOESDONLY X SCHEDULED Q V BQpILY I WURY )Par accident) $ X AUS ONLY X pp�,yyyy pp AUTO�!itPER d®TYhtAMAGE' S S C UMBRELLA LIAB EACH OCCURRENCE I S 1,000,001I', X EXCESS UAB MOCCUR CLAIMS -MADE EBU014796938 7/112019 7/1/2020 AGGREGATE S 1,000,000 I DED I II RETENTIONS 1 S D MIORKERS COMPS DEMPLOERNI� I AOH TT- ANY PR OPRIETORIPARTNERIEXECUTIVE YIN X WA-004676-01 7/1!2019 711/2020 EL EACH'ACCtlOENT $ 1,000,000 FIC ERrMEMgEp EXCLUDED' N!A ndatorylnNHI i 1,000,000 It yes, describe under 0ESCRCPTION OF OPERATIONS below EL.DISEASE- EAEMPLOYEE S E L OISF.ASE - POLICY LIMIT S 1,000,000' U I DESCRIPTION OF OPERATION'S ( LOCATIONS I VEHICLE'SACORD 101, Additional Romarlis Schedule, may be attached U more space Is required) '30 days notice of cancellation except 10 days for non-payment of premium. The City of EI Segundo Is named as additional insured as required'by written contract. A waiver of subrogation applies to the Workers' Compensation policy. CERTIFICATE HOLDER CANCELLATION' SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CE of EI Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City g ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main St. EI Segundo, CA 90245 AUTHORIZED REPRESENTATIVE ACORD 25 (2016103) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: L7219632 -F COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. • • "' s-"" This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART. SCHEDULE Name of Person or Organization: AS REQUIRED BY WRITTEN CONTRACT (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of "your work" for that insured by or for you. CG 20 10 11 85 Copyright, Insurance Services Office, Inc., 1984 Page 1 of 1 0 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 4-841 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT -CALIFORNIA 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.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 2_5% of the Califomia workers' compensation premium otherwise due on such remuneration. Schedule Person or Organization Job Description Blanket Waiver of Subrogation As respects to all CA jobs performed by the named insured during the policy period where by written contract a waiver of subrogation is required prior to the commencement of work. This endorsement changes the policy to w hich 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 07-01-2019 Policy No. WA004676-01 Endorsement No. 1 Insured Insurance Company: Sea Clear Pools, Inc. (A Corp) Pacific Compensation Insurance Co. Countersigned By Sr" " & H&rtvfv 01998 by the Workers' Com pensation Insurance Rating Bureau of California. All rights reserved.