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PROOF OF INSURANCE (2020 - 2020) CLOSEDDATE (M AR....JRV M/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 06/13/2019 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 CONTACT CAnnister LicenaeE#0691071tes Insurance Agency Ecl: (714) 5366086 IAJC No): (714) 6-4054 Y�A� M 305 17th Street Huntington Beach CA 92648 AmR...:.................. ichbai-ins.com_................................................. NSURER(S)AFFORDING COVERAGE ( NAIC# URERA: Houston Specialt� Insurance CO ...... ....... ..... ....��. ....... .. ..... .. INS.. ... ... _.... .. ..., INSURED (310) 618-2600 INSURER B: Nationwide Mutual Insurance CO Carter Services, Inc. ._...... ... „yt ............. INSURERC: Travelers CasualtY Co... ............. ......................... m 2807 Oregon Court, F3 INSURERD:Securit National Insurance Cc ........ _... Torrance CA 90503�..INSURER.9........... COVERAGES CERTIFICATE NUMBER: Cert ID 3280 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 'OLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. FW R TYPE OF INSURANCE .... ......................— Ste.- ........ _POUCY'MIDDf EFF (MMID fYYY .. LIMITS NUMBER IMMIDDIYYYYI (MMIDDIYYYYI A X V COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 11 CLAIMS MADE X OCCUR Y T8N-23435 06/15/2019 06/15/2020 _ER FMtvSES„(Eaoccurrence) $ 100,09 0 MED EXP (Any one person) $ 5 000 (PERSONAL&ADV INJURY $ 11000,000 GEN'LAGGREGATE LIMIT APPLIES PER:GENERAL,AGGREGATE $ 2 000,000 POLICY X PRO- LOC PRODUCTS AGG OM ,iab $ 2,000 000 ..... � OTHER: Bm 1 Benefits p it $ 1,000,000 AUTOMOBILE LIABILITY GLE 29.ar.,cdent) is ^^ $ 1,000,000 H X ANY AUTO ACP 3067747466 Per BODILY INJURY ( parson) 06/15/2019 06/15/2020 on $ OWNED SCHEDULED BODILY INJURY (Per accident) $ ONLY AUTOS..$....-.�_ ............................. .. HIRED NON -OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY ....... .... (Ia..1)................... �� ���.. _..............._. ....m CX UMBRELLALIAB gOCCUR ZUP-21P12586-19-NF 06/15/2019 06/15/2020 11 EACH OCCURRENCE $ 5,000,000 X EXCESS LIAB V CLAIMS -MADE AGGREGATE ,000,000 $5,,, DED II XII RETENTION $...... ..... .....1.............0,0......000 $ KERS COMPENSATION Y x PER E 04/01/2019 04/01/2020_ !!I OTH- D AND EMPLOYERS' LIABILITY Y❑ SWC1238198 _ ANYPROPRIETOR/PARTNER/EXECUTIVE HACCIDENTITER E L EACH $ 1,000,000 OWORCER/MEMBEREXCLUDED� OFFICER/MEMBER / in N/A (Mandatory ) EL DISEASE-AEMPLOYEE ............. $ 1.000, 000.......... If yes, describe under DESCRIPTION OF OPERATIONS below E DISEASE -POLICY LIMIT $ 11000,000 $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) The City of El Segundo, its officials and employees are named as additional insureds with respects general liability policy limits. Primary and non-contributory wording applies with respects general liability policy limits. Waiver of subrogation applies with respects workers compensation policy limits. 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. City of El Segundo City Clerk 350 Main Street, AUTHORIZED REPRESENTATIVE Room 5 /i 1 J ]31 Segundo CA 90245 _IV` L I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Page 1 of 1 POLICY NUMBER: TEN -23435 COMMERCIAL GENERAL LIABILITY CG 20 10 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, S, 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): Only those parties required to be named as an Addi- ALL tional Insured in a written contract with the Named Insured under this policy, entered into prior to loss or "occurrence". Location(s) Of Covered Operations 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) desig- nated above. B. With respect to the insurance afforded to these additional insureds, the following additional exclu- sions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equip- ment 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 in- tended use by any person or organization other than another contractor or subcontractor en- gaged in performing operations for a principal as a part of the same project. CG 20 10 07 04 0 ISO Properties, Inc., 2004 Page 1 of 1 0 POLICY NUMBER: TEN -23435 COMMERCIAL GENERAL LIABILITY CG 20 37 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - O'#l'IN"NERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Location And Description Of Completed Operations Only those parties required to be named as an ALL Additional Insured in a written contract with the Named Insured under this policy, entered into prior to loss or "occurrence". Information required to complete this Schedule, if not shown above, will be shown in the Declarations. 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 dam- age" caused, in whole or in part, by "your work" at the location designated and described in the sched- ule of this endorsement performed for that additional insured and included in the "products -completed operations hazard". CG 20 37 07 04 0 ISO Properties, Inc., 2004 Page 1 of 1 0 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 04-84) 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 5% Of the California workers' compensation premium otherwise due on such remuneration. Schedule Person or Organization Job Description Any person or organization as required by written contract. 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 4/1/2019 Policy No. SWC1238198 Endorsement No. 0 Insured Carter Services, Inc. (A Corp) Premium $ 97,800 Insurance Company Security National Insurance Company Countersigned by WC 04 03 06 (Ed. 04-84)