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PROOF OF INSURANCE (2020) CLOSEDPolicy Number: VARIOUS Date Entered: 11/6/2019 'E � ( CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 11/6/2019 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 Diane DeSilva Mary Barnard Insurance PHONEww_........�.4.08) I FAX ) 8) 286-1334 (.4.08) 286...........25 ' 2190 Stokes Street i'.�..N� Ext): (,s�C ,Ne ; -6425 EMAIL ennie@barnardinsurance.com Suite 201 "ewpt5s.3 INSURERS) AFFORDING COVERAGE NAIC # San Jose CA 95128 ...... ............ a ....... ...................... I'll—. .............. INSUREDRan Maintenance .. ,... Range enance Services, L.L.C. Donna Foggiato 301 Mary Belle Way Angels Camp, CA 95222 CATLIN SPEC ................._. INSURERA: MALTY INSURANCE COMPANY INSURER B':ALLSTATE INSURERC:STATE COMPENSATION INSURANCE FUND I' INSURER D: 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 EFOJ' POLICY—fP I la _.,._N TYPE OF INSURANCE IN D POLICY NUMBER IMMIDD/YYYY! (,,MM/DOIYYYY! LIMITS CLAIMS -MADE OCCUR 0400702136 11/01/19 11/01/2020 PR$G9z a cErnr�ca�i..,'."'1 W 00100,000 00 / 00 A COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE ........... 00 ';w. .. ® ' ....�................ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) *TEN DAYS NOTICE OF CANCELLATION APPLIES FOR NON—PAYMENT OF PREMIUM 30 DAYS FOR ALL OTHER. RE: ALL CALIFORNIA OPERATIONS. CERTIFICATE HOLDER IS NAMED AS ADDITIONAL INSURED. CERTIFICATE HOLDER CANCELLATION CITY OF EL SEGUNDO, CITY CLERK ATTENTION: BRIAN EVANSKI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 350 MAIN STREET ACCORDANCE WITH THE POLICY PROVISIONS. EL SEGUNDO, CA 90245 AUTHORIZED REPRES TATIV'E &"Id ©1'988-2 15 ORD CORPORAT(bN. All rights reserved. ACORD 25 (2096/03) The ACORD name and logo are registered marks of ACO MED EXP (Any one person) ..........................._...................... $ 5,000 PERSONAL & gD ,INJUR .................Y..........._..g 1,000,000 GF'hrLAGGRE'GMELIMITAPPLIESPER: GENERAL AGGREGATE .............................................. $2,000,000 _.. POLICY JEI LOC PRODUCTS-COMP/OPAGG $ INCLUDED 0"1'HER $ AUTOMOBILE LIABILITY t�OMBINED SINGLE LIMVT Me aocidentl $1,000,000 B ANYAUTO 64882726411/1/2019 11/1/2020 BODILY INJURY (Per person) $ OWNED SCHEDULED ........ BODILY INJURY (Per accident) ....................................................... .........� $ AUTOS ONLY AUTOS ­­­­­ HIRED NON -OWNED XAUTOS ONLY AUTOS ONLY PR ' MAGE ` Per aorldaom�..................................................._.. _ en . UMBRELLA LIAB OCCUR FACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE mm $ .. DED RETENTION $ $ WORKERS COMPENSATION S7ARTI.ITF. ER AND EMPLOYERS' LIABILITY Y / N E.L EACH ACCIDENT 1, 000, 000 C ANY PROPRIETOR/PARTNER/EXECUTIVE NIA 1760432 11/01/19 '11/01/2020 $ IT -- OFFICERNEMBEREXCLUDED? 1,000,000 ( rY ) N E $ IfMes,describe der DESCRIPTION OF OPERATIONS below E.L DISEASE $ 1, 000 , 000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) *TEN DAYS NOTICE OF CANCELLATION APPLIES FOR NON—PAYMENT OF PREMIUM 30 DAYS FOR ALL OTHER. RE: ALL CALIFORNIA OPERATIONS. CERTIFICATE HOLDER IS NAMED AS ADDITIONAL INSURED. CERTIFICATE HOLDER CANCELLATION CITY OF EL SEGUNDO, CITY CLERK ATTENTION: BRIAN EVANSKI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 350 MAIN STREET ACCORDANCE WITH THE POLICY PROVISIONS. EL SEGUNDO, CA 90245 AUTHORIZED REPRES TATIV'E &"Id ©1'988-2 15 ORD CORPORAT(bN. All rights reserved. ACORD 25 (2096/03) The ACORD name and logo are registered marks of ACO POLICY NUMBER: 040070213G-01 COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 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 Name Of Additional Insured Person(s) Or Orcanization(s): "ALL PERSONS OR ORGANIZATIONS AS REQUIRED BY WRITTEN CONTRACT WITH THE INSURED." SCHEDULE Location(s) Of Covered Operations 301 MARY BELLE WAY ANGELS CAMP, CA 95222 Informati,r_q_Mpuired to comnletethis 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) designated above. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. 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. CG 2010 04 13 0 Insurance Services Office, Inc., 2012 Page 1 of 2 C. With respect to the insurance afforded to these 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 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. Page 2 of 2 © Insurance Services Office, Inc., 2012 CG 2010 0413 POLICY NUMBER: 0400702136-01 COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTSICOMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE I Name Of Person Or Ownization: "ALL PERSONS OR 0 1ANIZATIONS AS REQUIRED BY WRITTEN CONTRACT WITH THE INSURED." Infounation requiEed to rrrra r 4pfethi,; !;chwfifle, if not shQwn above, 'llbeshewns ns, The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV —Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or darnage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products - completed operations hazard"'. This waiver applies only to the person or organization shown in the Schedule above, CG 24 04 05 09 C Insurance Services Office, Inc., 2008 Page 1 of 1 0 Coverage provided under this policy is modified by the attachment of this endorsement, If there is any conflict In coverage provisions between this form and any state specific endorsement also attached to this policy„ the provision(s) of the state specific form shall apply. This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM In SECTION I - COVERED AUTOS, the following changes are made: The following is added: D. Physical Damage Coverage for Temporary Substitute and Leased Autos If Physical Damage Coverage is provided by this policy, the following kinds of "autos" are covered "autos'"' for the same coverages provided by the policy: 1. Any private passenger "auto", or other than private passenger vehicle with gross vehicle weight of 20,000 lbs. or less, you do not own while used with the permission of the owner as a temporary substitute for a covered "auto" you own that is out of service because of its: a. Breakdown; b. Repair; c. Servicing; d. "Loss"; or e. Destruction. 2. Private passenger "autos" and other than private passenger vehicles with gross vehicle weight of 10,000 lbs. or less, Leased, mired, rented, or borrowed for a period of 30 days or less. This does not include any vehicle you Lease, hire, rent, or borrow from any of your "employees" or partners or members of their households. d. Any organization, other than a partnership or joint venture, over which you maintain ownership or in which you hold a majority interest. This provision applies only if there is no similar insurance provided to that organization. e. Any organization you acquire or form after policy inception, other than a partnership or joint venture, over which you maintain ownership, or in which you hold a majority" interest Coverage under this provision does not apply; (1) If there is similar insurance provided to that organization; or (2) To "bodily injury" or "property damage" that occurred before you acquired or formed the organization. f. Any person or organization that you are required to name as an additional insured under the terms of a written job contract, or by written insurance requirements executed prior to any covered 'loss" or claim. This protection applies only if the person or organization is liable for the conduct of an 'Insured" and only to the extent of that liability. Under A Coverage, Coverage Extensions, Supplementary Payments, subparagraphs (2) and (4) are replaced with the following: (2) Up to $5,000 for cost of bail bonds (including In SECTION II — LIABILITY COVERAGE, the bonds for related traffic law violations) required following changes are made: because of an "accident" we cover. We do not have to furnish these bonds. Under A Coverage, Who Is An Insured,' the following is added: Includes copyrighted material of Insurance Services Office, Inc., with its permission AA CW 201011 Allstate Insurance Company Page 1 of 3 648827264 (4) All reasonable expenses Incurred by the "insured" at our request, including loss of earnings up to $500 a day because of time off from work, Under B. Exclusions, Fellow Employee, the following paragraph is added: But this exclusion does not apply to "bodily injury" to a fellow "employee!' caused by any person whose position within the insured organization is at or above the level of manager or Supervisor. Coverage afforded by this provision is excess over any other collectible insurance. In SECTION [if - PHYSICAL DAMAGE COVERAGE, the foll6wind changes are made: R - - 7147"17L, Or Animal - Fa9in'9 Objects Or Missile.% the following is added: If damage to glass is repaired' in lieu of being replaced, no deductible will apply for repair only. Under A Coverage, Coverage Extensions, the following is added: c. Personal Effects Coverage In the event of a total theft of your covered "auto", for which you carry either Comprehensive or Specified Causes of Loss coverage, we will pay up to $500 for the personal effects which are: 1. owned by you; and 2- in your covered "auto" at the time of the total theft of such "auto". No deductible applies to Personal Effects Coverage. Under A Coverage, the following is added: & Lease and Loan Gap Coverage In the event of a total 'loss" to a covered "auto" shown in the Schedule or Declarations for, which a specific premium charge indicates that physical damage coverage applies, we will pay any unpaid amount due on the lease or loan for a covered "auto") less: a. The amount paid under the Physical Damage Coverage section of the policy; and b. Any: (1) Overdue leaselloan payments at the time of the "loss", (2) Financial penalties imposed under a lease for excessive use,` abnormal wear and tear or high mileage; (3) Security deposits not returned by the lessor; (4) Costs for extended warranties, Credit Life Insurance, Health, Accident or Disability Insurance purchased with the loan or lease, and (5) Carry-over balances from previous loans or leases. Under D. Deductible, the following paragraph is added: When Collision Coverage is provided, by this policy, the deductible amount will not be subtracted from the loss payment in collisions involving your covered "auto" and another auto covered by Allstate Insurance Company or any of its affiliates. In SECTION IV - BUSINESS AUTO CONDITIONS, the following changes are made: Under A. Loss Conditions, Duties In The Event Of Accident,' Claim, Suit Or Loss Condition, the following is added under subpart a* Knowledge of an "accident" or "loss" by any of your agents, servants or "employees" shall not In Itself constitute knowledge by you, unless you or one of your corporate officers, or managers, or any assignee, shall have received such notice from the agent, servant or "employed". When you report an occurrence of any "accidenVor"loss" to a Worker's Compensation carrier or self insured plan providing the named insured's Worker's Compensation insurance which later develops into a claim 'submitted under this policy, failure to report such "accident' or 'loss" to us at the same time shall not be deemed a Violation of this condition. After you become aware of such liability claim arising from the "accident" or "loss", y6u must give us prompt notice. Under A. Loss Conditions, Transfer of Rights of Recovery Against Others To Us, the following is added: We waive any right of recovery we may have against any ,person or organization because of payments we make for injury or damage arising out of work you perform under a contract with such person or organization, In which you have agreed to waive your right of such recovery. Includes copyrighted material of Insurance Services Office, Inc., with its permission AA CW 20 101'1 Allstate Insurance Company Page 2 of 3 648827264 Under EK General Conditions, Concealment Misrepresentation Or Fraud, the following 'is added: This condition does not apply to any omission or failure to provide material facts if the omission or failure was unintentional. Includes copyrighted material of Insurance Services Office, Inc., With its permission AA CW 201017 Allstate Insurance Company Page 3 of 3 POLICY NUMBER: 648827264 COMMERCIAL AUTO AA CW 40 10 11 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OFT E TRANSFER OF REC OVERY ALAI N ST OT H ERS TO US This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM SCHEDULE Designated Person or Organization: Contract Number: Description of Project: Location of Project: The following is added to the Transfer of Rights of Recovery Against Others To Us Condition: We waive any right of recovery we may have against the person or organization designated in the above Schedule because of payments we make for injury or damage arising out of work you perform under a contract with the above designated person or organization. The waiver applies only to the above designated person or organization and the work you perform must be under the contract, and for the project and location designated in the above Schedule, AA CW40 10 11 Allstate Insurance Company Page I of 1 Insured Full Copy ENDORSEMENT AGREEMENT WAIVER OF SUBROGATION BLANKET BASIS HOME OFFICE SAN FRANCISCO EFFECTIVE NOVEMBER 1, 2019 AT 12.01 A.M. AND EXPIRING NOVEMBER 1, 2020 AT 12.01 A.M. ALL EFFECTIVE DATES ARE AT 12:01 AM PACIFIC STANDARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME RANGE MAINTENANCE SERVICES, LLC 301 MARY BELLE WAY ANGELS CAMP, CA 95222 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. THE ADDITIONAL PREMIUM FOR THIS ENDORSEMENT SHALL BE 2.00% OF THE TOTAL POLICY PREMIUM. SCHEDULE PERSON OR ORGANIZATION JOB DESCRIPTION ANY PERSON OR ORGANIZATION BLANKET WAIVER OF FOR WHOM THE NAMED INSURED SUBROGATION HAS AGREED BY WRITTEN CONTRACT TO FURNISH THIS WAIVER 1760432-19 RENEWAL NA 6-17-16-03 PAGE 1 OF NOTHING IN THIS ENDORSEMENT SHALL BE HELD TO VARY, ALTER, WAIVE OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS POLICY OTHER THAN AS ABOVE STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR LIMITATIONS IN THIS ENDORSEMENT. COUNTERSIGNED AND ISSUED AT SAN FRANCISCO: NOVEMBER 4, 2019 1 777