ANY PROPRIETOR/ PARTNER/ EXECUTIVE
OFFICER/ MEMBER EXCLUDED?
INSR ADDL SUBR
LTR INSD WVD
DATE ( MM/DD/YYYY)
PRODUCER CONTACT
NAME:
FAXPHONE
A/C, No, Ext): A/C, No):(
E-MAIL
ADDRESS:
INSURER A :
INSURED INSURER B :
INSURER C :
INSURER D :
INSURER E :
INSURER F :
POLICY NUMBER EXPTYPEPOLICY EFF POLICY
OF INSURANCE MM/DD/YYYY)( MM/DD/YYYY) LIMITS(
AUTOMOBILE LIABILITY
UMBRELLA LIAB
EXCESS LIAB
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES ( ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
AUTHORIZED REPRESENTATIVE
EACH OCCURRENCE $
DAMAGE TO RENTED
CLAIMS- MADE OCCUR $ PREMISES ( Ea occurrence)
MED EXP ( Any one person)$
PERSONAL & ADV INJURY $
GEN' L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ PROPOLICY LOC PRODUCTS - COMP/ OP AGG $ JECT
OTHER:$
COMBINED SINGLE LIMIT $(
Ea accident)
ANY AUTO BODILY INJURY ( Per person)$
OWNED SCHEDULED BODILY INJURY ( Per accident)$
AUTOS ONLY AUTOS
HIRED NON- OWNED PROPERTY DAMAGE $
AUTOS ONLY AUTOS ONLY ( Per accident)
OCCUR EACH OCCURRENCE $
CLAIMS- MADE AGGREGATE $
DED RETENTION $$
PER OTHSTATUTE ER
E.L. EACH ACCIDENT $
E.L. DISEASE - EA EMPLOYEE $
If yes, describe under
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ INSURER( S) AFFORDING COVERAGE NAIC #
COMMERCIAL GENERAL LIABILITY
Y / N
N / A
Mandatory in NH)
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.
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.
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).
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
CERTIFICATE HOLDER CANCELLATION
1988-2015 ACORD CORPORATION. All rights reserved.
ACORDACORD 25 (2016/03) The ACORD name and logo are registered marks of
CERTIFICATE OF LIABILITY INSURANCE
Lockton Companies, LLC
DBA Lockton Insurance Brokers, LLC in CA
CA license # 0F15767
444 W. 47th St., Ste. 900
Kansas City MO 64112-1906
816) 960- 9000 kcasu@lockton. com
DUDEK
687 SOUTH COAST HIGHWAY 101
SUITE 110
ENCINITAS CA 92024
Zurich American Insurance Company 16535
X
X
2,000, 000
100, 000
10, 000
2,000, 000
4,000, 000
4,000, 000
X
1,000, 000
XXXXXXX
XXXXXXX
XXXXXXX
XXXXXXX
XXXXXXX
XXXXXXX
XXXXXXX
N
X
1,000, 000
1,000, 000
1,000, 000
A BAP0146329 8/28/2025 8/28/ 2026
A GLO0146311 8/28/ 2025 8/28/ 2026
A WC0146330 8/28/ 2025 8/28/ 2026
NOT APPLICABLE
8/28/2026
1550545
Y Y
Y Y
Y
4/8/2026
23287347
23287347 XXXXXXX
CITY OF REDONDO BEACH
415 DIAMOND ST
REDONDO BEACH CA 90277
RE: CITY OF REDONDO BEACH, ITS OFFICERS, ELECTED AND APPOINTED OFFICIALS, EMPLOYEES, AND VOLUNTEERS ARE ADDITIONAL INSURED ON GENERAL AND AUTO LIABILITY, ON A PRIMARY, NON- CONTRIBUTORY BASIS, IF REQUIRED BY WRITTEN CONTRACT. WAIVER OF SUBROGATION IN FAVOR OF THE ADDITIONAL INSURED APPLIES ON GENERAL LIABILITY, AUTO LIABILITY AND WORKERS COMPENSATION/ EMPLOYER’ S LIABILITY, IF REQUIRED BY WRITTEN CONTRACT AND WHERE ALLOWED BY LAW. COVERAGE IS SUBJECT TO THE TERMS AND CONDITIONS OF THE POLICY.
X X
See Attachments
Additional Insured – Owners, Lessees Or
Contractors – Scheduled Person Or Organization
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
Policy No. GLO0146311 Effective Date: 8/28/2025
This endorsement modifies insurance provided under the:
Commercial General Liability Coverage Part
SCHEDULE
Name Of Additional Insured Person(s)
Or Organization(s):
Location(s) Of Covered Operations
ANY PERSON OR ORGANIZATION ARE REQUIRED
TO PROVIDE ADDITIONAL INSURED STATUS IN
A WRITTEN CONTRACT, AGREEMENT OR PERMIT.
ALL
LOCATIONS
U-GL-2169-A CW (02/19)
Includes copyrighted material of Insurance Services Office, Inc., with its permission.
Attachment Code: D574649 Certificate ID: 23287347
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 of this endorsement, 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 in such Schedule.
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.
All other terms, conditions, provisions and exclusions of this policy remain the same.
U-GL-2169-A CW
02/19)
Includes copyrighted material of Insurance Services Office, Inc., with its permission.
Attachment Code: D574649 Certificate ID: 23287347
Additional Insured – Owners, Lessees Or Contractors
Completed Operations
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
Policy No. GLO0146311 Effective Date: 8/28/2025
This endorsement modifies insurance provided under the:
Commercial General Liability Coverage Part
SCHEDULE
Name Of Additional Insured Person(s)
Or Organization( s):
Location And Description Of Completed Operations
ANY PERSON OR ORGANIZATION ARE REQUIRED
TO PROVIDE ADDITIONAL INSURED STATUS IN
A WRITTEN CONTRACT, AGREEMENT OR PERMIT.
ALL
LOCATIONS
U-GL-2168-A CW (02/19)
Includes copyrighted material of Insurance Services Office, Inc., with its permission.
Attachment Code: D580830 Certificate ID: 23287347
Section II – Who Is An Insured is amended to include as an additional insured the person( s) or organization( s) shown in the Schedule of this endorsement, but only with respect to liability for " bodily injury" or " property damage" caused, in whole or in part, by " your work" at the location designated and described in such Schedule, performed for that additional insured and included in the " products- completed operations hazard".
All other terms, conditions, provisions and exclusions of this policy remain the same.
U-GL-2168-A CW
02/19)
Includes copyrighted material of Insurance Services Office, Inc., with its permission.
Attachment Code: D580830 Certificate ID: 23287347
Waiver Of Subrogation (Blanket) Endorsement
Policy No. Eff. Date of Pol. Exp. Date of Pol. Eff. Date of End. Producer Add’ l Prem. Return Prem.
GLO0146311 8/ 28/ 2025 8/ 28/ 2026 37385000 $ INCL $
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
This endorsement modifies insurance provided under the:
Commercial General Liability Coverage Part
The following is added to the Transfer Of Rights Of Recovery Against Others To Us Condition:
If you are required by a written contract or agreement, which is executed before a loss, to waive your rights of recovery from others, we agree to waive our rights of recovery. This waiver of rights shall not be construed to be a waiver with respect to any other operations in which the insured has no contractual interest.
U-GL-925-B CW (12/01)
Attachment Code: D574648 Certificate ID: 23287347
Other Insurance Amendment – Primary And
Non-Contributory
Policy No. Eff. Date of Pol. Exp. Date of Pol. Eff. Date of End. Producer No. Add’ l. Prem Return Prem.
GLO0146311 8/28/2025 8/28/2026 37385000 INCL
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
Named Insured:
Address (including ZIP Code):
This endorsement modifies insurance provided under the:
Commercial General Liability Coverage Part
1. The following paragraph is added to the Other Insurance Condition of Section IV – Commercial General Liability Conditions:
This insurance is primary insurance to and will not seek contribution from any other insurance available to an additional insured under this policy provided that:
a. The additional insured is a Named Insured under such other insurance; and b. You are required by a written contract or written agreement that this insurance would be primary and would not seek contribution from any any other insurance available to the additional insured.
2. The following paragraph is added to Paragraph 4.b. of the Other Insurance Condition of Section IV Commercial General Liability Conditions:
This insurance is excess over:
Any of the other insurance, whether primary, excess, contingent or on any other basis, available to an additional insured, in which the additional insured on our policy is also covered as an additional insured on another policy providing coverage for the same occurrence , offense, claim or suit . This provision does not apply to any policy in which the additional insured is a Named Insured on such other policy and where our policy is required by written contract or written agreement to provide coverage to the additional insured on a primary and non-contributory basis.
All other terms and conditions of this policy remain unchanged.
U-GL-1327-B CW (04/13)
Includes copyrighted material of Insurance Services Office, Inc., with its permission.
Attachment Code: D632272 Certificate ID: 23287347
Coverage Extension Endorsement
Policy No. Eff. Date of Pol. Exp. Date of Pol. Eff. Date of End. Producer No. Add’l. Prem Return Prem.
BAP0146329 8/28/2025 8/28/2026 8/28/2025 37385000 INCL
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
P. Waiver of Transfer Of Rights Of Recovery Against Others To Us The following is added to the Transfer Of Rights Of Recovery Against Others To Us Condition:
This Condition does not apply to the extent required of you by a written contract, executed prior to any "accident" or "loss", provided that the "accident" or "loss" arises out of operations contemplated by such contract. This waiver only applies to the person or organization designated in the contract.
Attachment Code: D574651 Certificate ID: 23287347
POLICY NUMBER: BAP0146329 COMMERCIAL AUTO
CA 20 48 10 13
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
DESIGNATED INSURED FOR
COVERED AUTOS LIABILITY COVERAGE
This endorsement modifies insurance provided under the following:
AUTO DEALERS COVERAGE FORM
BUSINESS AUTO COVERAGE FORM
MOTOR CARRIER COVERAGE FORM
With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement.
This endorsement identifies person(s) or organization( s) who are “insureds” for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form.
This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below.
Named Insured: DUDEK
Endorsement Effective Date: 8/28/2025
SCHEDULE
Name Of Person(s) Or Organization( s):
ANY PERSON OR ORGANIZATION TO WHO OR WHICH YOU ARE REQUIRED TO
PROVIDE ADDITIONAL INSURED STATUS IN A WRITTEN CONTRACT, AGREEMENT OR PERMIT.
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
Each person or organization shown in the schedule is an Attachment Code: D574651 Certificate ID: 23287347
insured" for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an insured" under the Who Is An Insured provision contained in Paragraph A.1. of Section II- Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms and Paragraph D.2. of Section I- Covered Autos
Coverages of the Auto Dealers Coverage Form.
Attachment Code: D574651 Certificate ID: 23287347
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13 WC0146330 Dudek 8/28/20258/28/2026 ( 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 YOU ARE REQUIRED TO WAIVE YOUR RIGHTS OF
RECOVERY IN A WRITTEN CONTRACT, AGREEMENT OR PERMIT WITH THE NAMED INSURED.
WC 00 03 13
Ed. 4-84)
1983 National Council on Compensation Insurance.
Attachment Code: D574650 Certificate ID: 23287347
Coverage Extension Endorsment
Policy No. Eff. Date of Pol. Exp. Date of Pol. Eff. Date of End. Producer No. Add’ l. Prem Return Prem.
BAP0146329 8/28/2025 8/28/2026 37385000 INCL
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the:
Business Auto Coverage Form
Motor Carrier Coverage Form
A. Amended Who Is An Insured
1. The following is added to the Who Is An Insured Provision in Section II – Covered Autos Liability Coverage: The following are also "insureds":
a. Any "employee" of yours is an "insured" while using a covered "auto" you don't own, hire or borrow for acts performed within the scope of employment by you. Any “employee” of yours is also an “insured” while operating an “auto” hired or rented under a contract or agreement in an “employee’s” name, with your permission, while performing duties related to the conduct of your business. b. Anyone volunteering services to you is an "insured" while using a covered "auto" you don’t own, hire or borrow to transport your clients or other persons in activities necessary to your business. c. Anyone else who furnishes an "auto" referenced in Paragraphs A.1.a. and A.1.b. in this endorsement. d. Where and to the extent permitted by law, any person(s) or organization(s) where required by written contract or written agreement with you executed prior to any "accident", including those person(s) or organization(s) directing your work pursuant to such written contract or written agreement with you, provided the "accident" arises out of operations governed by such contract or agreement and only u p to the limits required in the written contract or written agreement, or the Limits of Insurance shown in the Declarations, whichever is less.
2. The following is added to the Other Insurance Condition in the Business Auto Coverage Form and the Other
Insurance – Primary and Excess Insurance Provisions Condition in the Motor Carrier Coverage Form:
Coverage for any person(s) or organization( s), where required by written contract or written agreement with you executed prior to any " accident", will apply on a primary and non-contributory basis and any insurance maintained by the additional " insured" will apply on an excess basis. However, in no event will this coverage extend beyond the terms and conditions of the Coverage Form.
Includes copyrighted material of Insurance Services Office, Inc., with its permission. U-CA-424-F CW(04-14) Attachment Code: D633798 Certificate ID: 23287347