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PROOF OF INSURANCE (2020 - 2020) CLOSED0 DATE (MM/DD/YYYY) � - CERTIFICATE OF LIABILITY INSURANCE I 11/5/2019 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(les) must 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 Trinity Insurance Services, Inc 23287 Ventura Blvd Woodland Hills, California 91364 INSURED Mobile Illumination, Inc 9255 Corbin Ave Northridge, CA. 91324 INSURER(SI AFFORDING COVERAGE NAIC„# INSURERA:COlony Ins Co INSURER B;_Progressive Ins Co INSURER C INSURER D: AIG -Nati onal Union Fire INSURER E : DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) The City of EI Segundo, its officers, officials, employees, agents, and volunteers 350 Main St. EI Segundo, CA 90245 are hereby named additional insured CERTIFICATE HOLDER CANCELLATION The City of EI Segundo, Its officers, Officials, employees, SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE agents, and volunteers 350 Main St. EI Segundo, CA 90245 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ACORD 25 (2009/09) AUTHORIZED REPRESENTATIVE 61-k cawo © 1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD INSURER F: COVERAGE'S 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. ...,,..A�I[iL.. ... NSR TYPE OF INSURANCE TRGENERAL ....., .... .... POLICY EFF POLICY EXPI MT�SL� bL..$ ,h H OCCURRENCE 3'0 t7MMERC3AIGEHERA. LABLk11 $, �I DAMAGE ..........�r...... ............. , 100,00 0 ..... I A CLAIMS -MADE 0,sUR X X 101GL0054665-03 06/10/19 06/10/20 MED EXP (Any one person) 5,000 PERSONAL B INJURY $ 3,000,000 GENERAL 000,000 GEN'L AGGREGATE LIMIT APPLIES PER ( PRODUCTS GCOMP OP AGG $ 4,0,0,0,000„ ............I POLICY ^„.. E LOG ( $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 dI,Nj�RY ANY AUTO (,,,...Per,,,,,,,,,,,,,,,,,,,,,,,,,,;, person) $ BODILY ALL OWNED AUTOS BODILY INJURY (Per accident) $ B SCHEDULED AUTOS X X 00777924-0 05/31/19 05/31/20 PROPERTY DAMAGE HIREDAUTOS (Per accident) $ '/. NON-OWNEDAUTOS $ ....................... ............. UMBRELLA LIAR5,000,000' ✓ 1, OCCUR EACH OCCURRENCE $ D EXCESS LIAB C CLAIMS MAD E. EBU038414371 06/10/19 106/10/20 AGGREGATE f $ 5 000 00 X DEDUCTIBLE 1 $,,,, RETENTION $ $ WORKERS WC I IMIT l7 R U- T TORY AND EMPLOYERS' L ABIILOITY Y / N _JAT ANY PROPRIETOR/PARTNER/EXECUTIVE E .L EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N / A (Mandatory 1 E1, DISEASE - EAEMPLOYEE, $ describe under " DESCRIPTION OF OPERATIONS below E.L. DISEASE - PpLICY LIMIT I $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) The City of EI Segundo, its officers, officials, employees, agents, and volunteers 350 Main St. EI Segundo, CA 90245 are hereby named additional insured CERTIFICATE HOLDER CANCELLATION The City of EI Segundo, Its officers, Officials, employees, SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE agents, and volunteers 350 Main St. EI Segundo, CA 90245 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ACORD 25 (2009/09) AUTHORIZED REPRESENTATIVE 61-k cawo © 1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 101 GL 0054665.02 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) (Additional Insured): Location(s) of Covered Operations: AS DESIGNATED IN WRITTEN CONTRACT AS DESIGNATED IN WRITTEN CONTRACT WITH THE NAMED INSURED WITH THE NAMED INSURED The insurance afforded by this Coverage Part for the additional insured shown in the Schedule is primary insurance and we will not seek contribution from any other insurance available to that additional insured. 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 forwhom you are performing operations when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy. Such person or organization is an additional insured 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. A person's or organization's status as an additional insured under this endorsement ends when your operations for that additional insured are completed. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to: Additional Insured Contractual Liability "Bodily injury" or "property damage' for which the additional insured(s) are obligated to pay damages by reason of the assumption of liability in a contract or agreement. Finished Operations at Work "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 worm' out of which the injury or damage arises has been put to its intended use by any person or organization. Negligence of Additional Insured U166-0310 Includes copyrighted material of ISO Properties, Inc., Page 1 of 2 with its permission. 101 GL 0054665-02 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. TRANSFER OF RIGHTS. OF RECOVERY AGAINST OTHERS TO US This endorsement modes insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTSICOMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to Paragraph 8. Transfer Of Rights Of RecoveryAgainst Others To Us of Section IV — Conditions: We waive any rights of recovery we may have against any person or organization because of payments we make for injury or damage resulting from your ongoing operations or "your work" done under a contract with that person or organization and included in the "products -completed operations hazard" if: a. you agreed to such waiver; b. the waiver is included as part of a written contract or lease; and c. such written contract or lease was executed prior to any loss to which this insurance applies. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. U047-0310 Includes copyrighted material of ISO Properties, inc., Page 1 of 1 with its permission. 101 GL 0054665.02 "Bodily injury" or "properly damage" arising directly or indirectly out of the negligence of the additional insured(s). ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. U16S-0310 Includes copyrighted material of ISO Properties, Inc., Page 2 of 2 with its permission. Ill I I DATE (MM/DD/YYYY) ACCOREF CERTIFICATE OF LIABILITY INSURANCE 11/05/2019 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 oug Jones cD/o Artex Risk Solutions, Inc. PHONE G l SDL)BSD,Certiflcates@artexrisk.com `1° X480 1-4266 FAX 95 ...................6 8840 E. Chaparral Rd., Suite 275 A - ^ _ 4_80 951-4177 N A1� Ne Scottsdale, AZ 85250 ... INSURERISIAFFORDING COVERAGE NAIL # wsuRER.P :. Amerioa.. n Zurich Insurance Company _ 40142 INSURED INSURER B: Avitus, Inc. dba: Avitus Group Labor Contractor, for co -employees of: Mobile Illumination, Inc. INSURERC: 175 N. 27th Street, Suite 800 PO Box 2506 I URER D : Billings, MT 59103 NS ^ INS,UE.RER... ,,.;.............. INSURER F : COVERAGE'S CERTIFICATE NUMBER:19MT901972376 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 ................. DDLSSV.B.R................................POUCVNUMBER dM..,_�........,_._..........,................._................ ........... OF INSURANCE P4.OdY EFF � POUCY' EXP LIMITS iA U LTR N rtJYYYVM !M'MBDDFVVVYY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ _..._—.j CLAIMS-MADE cc.„ .......°'! OCCUR N).349MW�GK� S.(kfiPFE. u�rOronce9 $ .. ........................— ED ( RETENTION $ $ WORKERS COMPENSATION X I'. STATUTE— J SRH A OFFDICER/MEMBOER EXCLUDED? D D?ECUTIVE ILITY YI❑N NIA WC 96-20-045-01 04/01/2019 04/01/2021) EL EACH ACCIDENT$,,1000'000 E L DISEASE - EA EMPLOYEE .$......................... 1 .. 0O (Mandatory in NH) 000 If yes, describe under DESCRIPTION OF OPERATIONS below E L DISEASE - POLICY LIMIT $ 1,000,000 Location Coverage Period: 04/01/2019 04/01/2020 Client# HH4-CA DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Coverage m provtded for Mobdte Illumination, Inc. only those co -employees 9255 Corbin Ave. of, but not subcontractors NodhFddge, CA 91324 to: CERTIFICATE HOLDER The City of EI Segundo and volunteers 350 Main St EI Segundo, CA 90245 ACORD 2512016/031 CANCELLATION its officers, officials, employees, agents, SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and loco are registered marks of ACORD ne person) $ PERSONAL & ADV INJURY $ ...........................^............ � GEN"L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ L I PRODUCTS - COMP/OP AGG $ — POLICY JERCOT ,.....,,,, '. I $ OTHER COMBINEDSINGLE LIMIT $ AUTOMOBILE LIABILITY ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY (Per ac..cm..,mad..e. nt) $ AUTOS ONLY HIRED AUOS NON -OWNED OPERAM: $ AUTOS ONLY AUTOSON rINJURYYi (PR UMBRELLA O EACH OCCTE $ ....................... EXCESSLIABIAB CL.. CLAIMS -MADE AGGREGA ....................... $.R.E.N.C.E ED ( RETENTION $ $ WORKERS COMPENSATION X I'. STATUTE— J SRH A OFFDICER/MEMBOER EXCLUDED? D D?ECUTIVE ILITY YI❑N NIA WC 96-20-045-01 04/01/2019 04/01/2021) EL EACH ACCIDENT$,,1000'000 E L DISEASE - EA EMPLOYEE .$......................... 1 .. 0O (Mandatory in NH) 000 If yes, describe under DESCRIPTION OF OPERATIONS below E L DISEASE - POLICY LIMIT $ 1,000,000 Location Coverage Period: 04/01/2019 04/01/2020 Client# HH4-CA DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Coverage m provtded for Mobdte Illumination, Inc. only those co -employees 9255 Corbin Ave. of, but not subcontractors NodhFddge, CA 91324 to: CERTIFICATE HOLDER The City of EI Segundo and volunteers 350 Main St EI Segundo, CA 90245 ACORD 2512016/031 CANCELLATION its officers, officials, employees, agents, SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and loco are registered marks of ACORD WORKERS' COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 4-84) 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 per- form 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 otherwise due on such remuneration. Person or Organization IN FAVOR OF: The City of EI Segundo, its officers, officials, employees, agents, and volunteers 350 Main St EI Segundo, CA 90245 $0 of the California workers' compensation premium SCHEDULE Job Description Waiver of subrogation issued in favor of the certificate holder for the following project: All Operations 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: 11/12/2019 Policy No: WC 96-20-045-01 Insured: Avitus, Inc. dba: Avitus Group Labor Contractor, for co -employees of: Mobile Illumination, Inc. Insurance Company: American Zurich Insurance Company WC 04 03 06 Copyright 1983 National Council on Compensation Insurance Endorsement No: Countersigned by