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PROOF OF INSURANCE (2020 - 2020) CLOSEDNOBESYS-02 ANLOPE,Z ACORO� DATE (MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 12/16/2019 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 endorsements). g ................................... CONTACT License # 0757776 PRODUCER NF MS Angie Lopez HUB International Insurance Services Inc. PHONE iAAr 470 East Highland Avenue an ie,lcr e2 347 Nr> n oa Ext): (90'9 379-1347 ,N'. Redlands, CA 92373 . " $r... �a �a I1ttbRnternatlonaN.com ........LN.S.D.R.E.RLS.L.AFFORDING „OQy,ER,AGE N.A.l.G..?Y........ „ INSURER A:WestAmerican Insurance CO 44393 INSURED INSU,RERB:United financial Casualty Company 11770 Nobel Systems, Inc. ; Property and Casualty Insurance Company of Hartford $4690 ..,I,NSU,R E... R_....c.. 436 E. Vanderbilt RER. D : L 9y4'sof London 1-5792_.--- _____ San Bernardino, CA 92408 INSD............. �.... 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, H POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED B P CLAIMS. INSR ADDL SUBR .... .,.,. POLICY NUMBER IMM IC YEFF POLICY,... .. ... .... ....... .... EXCLUSIONS AND CONDITION iTRTYPE OF INSURANCE Xy LIMITS A X COMMERCIAL GENERAL LIABILITY E..90 2,000,000 FVJ§E:c RENTED 500,000 PR CLAIMS -MADE X OCCUR BKW 56 44 46 36 4/4/2019 4/4/2020 M r,,qe) 1 MED EXP (Any gQaperson) $ 15,000 _PERSONAL & ADV INJURY....$2,000,000 ti;,slk P•L7C1fEA'fi LIMIT P OOO LOC PRpC}UCTSGCOMP pP AGG $ 0 000 4,000 1LC., ❑ 4'00 ' II OTHER ........ $ B AU"OMOBILE LIABILITY ...._., .. COMBINED SINGLE LIMIT ,glliggil 1,000000 $ X ANY AUTO 6/15/2019 6/15/2020 BODILY OD (Peraccdenll� ............���.� AUTOS ONLY � SCHEDULED00809321-0 AUTOS R���.�.��.L...INJ ,, D OI,LY,IN„JURY„. $.......................... ONLY F--� N�pppp��• '4+�t+N�R'DAUTOS 0 ALNlCSa ¢SNLt ,, T /DAMAGE $HIRED �.......................$ UMBRELLA �, ... _. ..w...„.a...................� A.._..... ..............H OCCU........... C,U, ...... $ ...... .........._ EXCESSCCUR A ,BIAB �....., -, CLAIMS -MADE .ERC.GG.REG.,A,TE ARRENCE ........................................���„ $ �.... RETENTION $ C WORKERS COMPENSATION X ] PT17E ER ASND EMPLOYERS' LIABILITY y 1 N -11 _ ,PT .�... ..L -11 72 WEC GE6312 4/26/2019 4/26/2020 1'000'000 PROPRIETOR/PARTNER/EXECUTIVE ANY / N IA E.L EACH ACG,ID,ENT,$ FdIC'ER/MEMBER EXCLUDED? lee° EMPLOYEE....q 1,000,000 f yes, describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.l.., DISEASE • PO ICY L MIT $ _..__....._.�. D Cyber Liability* DCCT00074-19 12114/2019 12/1412020 Limit 1,000,000 D Technology E&O Liab* DCCT00074-19 12/14/2019 12/14/2020 Limit 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) "Retention: $2,500 RE: Verification of Insurance Certificate Holder is Additional Insured on the General Liability as required by written contract or agreement including Waiver of Subrogation and Primary/Non -Contributory, as per attached. Auto Additional Insured including Primary and Waiver of Subrogation per forms on file with company. Workers Compensation Waiver of Subrogation applies as per written contract or agreement, as per attached. SEE ATTACHED ACORD 101 .-_._._._m CERTIFICATE HOLDER _m.m._......... CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Ci of EI Segundo City 9 ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street EI Segundo, CA 90245 -- �- - AUTHORIZED REPRESENTATIVE IIXelz—�- ACORD 25 (2016/03) .... c ............... ....._...... ...„._..... . O 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: NOBESYS-02 ✓ "".+. LOC #:ACC>R1 Om ADDITIONAL REMARKS SCHEDULE ................................ AGENCY License # 0767776 NAMED INSURED International Insurance Services Inca Nobel Sy Stems t HUUBB 436 E. Vanderbilt V11a YNU.. MEER San Bernardino, CA 2408 SEE PAGE 1 SERAIC CODE PAGE 1 ISEE P 1 EFFECTIVE DATE: SEE PAGE 1 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACPf RI FORM TITLE: Certifcate of Liability lns,urance ANLOPEZ Page 1 of .....1..... Description of Operations/Locations[Vehicles: "Should the policies be cancelled before the expiration date, Hub International Insurance Services Inc. (Hub), independent of any rights which may be afforded within the policies to the certificate holder named below, will provide to such certificate holder notice of such cancellation within thirty (30) days of the cancellation date, except in the event the cancellation is due to non-payment of premium, in which case Hub will provide to such certificate holder notice of such cancellation within ten (10) days of the cancellation date." ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY: BKW56444636 COMMERCIAL GENERAL LIABILITY CG 89 98 0412 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AMENDMENT OF OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. The following is added to provision a. Primary Insurance of Paragraph 4. Other Insurance under Section IV - Commercial General Liability Conditions: However, when an additional insured has been added to this Coverage Part by attachment of an endorsement, we will not seek contribution from the "additional insured's own insurance" provided that: (1) You have agreed in a written contract that this insurance is primary and non-contributory; and (2) The "bodily injury" or "property damage" occurs, or the "personal and advertising injury" is committed, subsequent to the execution of such contract. B. For the purposes of this endorsement the following is added to Section V -Definitions: "Additional insured's own insurance" means other insurance for which the additional insured is designated as a Named Insured. ® 2012 Liberty Mutual Agency Corporation. All rights reserved. CG 89 98 04 12 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 1 . � 7'11 �, .� s Additional Insured Endorsement Name of Person or Organization City of El Segundo 350 Main Street El Segundo CA 90245 The person or organization named above is an insured with respect to such liability coverage as is afforded by the policy but this insurance applies to said insured only as a person liable for the conduct of another insured and then only to the extent of that liability. We also agree with you that insurance provided by this endorsement will be primary for any power unit specifically described on the Declarations Page. Limit of Liability Bodily Injury Property Damage Combined Liability 1,000,000 General Liability each person/ each accident each accident each Occurrence General Aggregate Products/Completed Operations Aggregate Personal and Advertising Injury Damage to Premises Rented to You Medical Expense (any one person) All other terms, limits and provisions of this policy remain unchanged. This endorsement applies to Policy Number: 008093210 Issued to (Name of Insured): Nobel Systems Inc. Effective date of endorsement: 06/15/2019 Policy expiration date: 06/15/2020 Form 1198(01/04) each accident POLICY NUMBER: BKW56444636 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 SCHEDULE Name Of Additional Insured Person(s) Or Organization (s): Blanket Additional Insured agreed Location(s) Of Covered Operations Location(s) at which You performed work described in written contract, agreement or permit 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 B. With respect to the insurance afforded to include as an additional insured the person(s) these additional insureds, the following addi- or organization(s) shown in the Schedule, but tional exclusions apply: only with respect to liability for "bodily in- This insurance does not apply to "bodily in- jury", "property damage" or "personal and jury" or" property damage" occurring after: advertising injury" caused, in whole or in 1. All work, including materials, parts or part, by: equipment furnished in connection with 1. Your acts or omissions; or such work, on the project (other than ser - 2. The acts or omissions of those acting on vice, maintenance or repairs) to be per - your behalf; formed by or on behalf of the additional ° in the performance of your ongoing insured(s) at the location of the covered operatons for the additional insured(s) at the operations has been completed; or location(s) designated above. 2. That portion of "your work" out of which However: the injury or damage arises has been put 1. The insurance afforded to such additional to its intended use by any person or or - insured only applies to the extent permit- ganization other than another contractor ted by law; and or subcontractor engaged in performing operations for a principal as a part of the 2. If coverage provided to the additional in- same project. sured is required by a contract or agree- ment, 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. CG 20 10 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 2 i 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 ap- plicable Limits of Insurance shown in the Dec- larations. Page 2 of 2 © Insurance Services Office, Inc., 2012 CG 20 10 04 13 E r POLICY NUMBER: BKW56444636 COMMERCIAL GENERAL LIABILITY CG 20 37 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS -COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Blanket Additional Insured agreed Location And Description Of Completed Operations Work described in writing in the contract, agreement or permit." Location(s) at which You performed work described in written contract, agreement or permit. 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 in- jury" or "property damage" caused, in whole or in part, by "your work" at the location des- ignated and described in the Schedule of this endorsement performed for that additional insured and included in the "products -com- pleted operations hazard". However: 1. The insurance afforded to such additional insured only applies to the extent permit- ted by law; and 2. If coverage provided to the additional in- sured is required by a contract or agree- ment, 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. CG 20 37 04 13 B. 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 ap- plicable Limits of Insurance shown in the Dec- larations. © Insurance Services Office, Inc., 2012 Page 1 of 1 POLICY NUMBER: BKW 56 44 46 36 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 PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: "As required by written contract or agreement entered into before loss." 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 damage 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 organi- zation shown in the Schedule above. CG 24 04 05 09 ® Insurance Services Office, Inc., 2008 Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA Policy Number: 72 WEC GE6312 Endorsement Number: Effective Date: 04/26/19 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address: NOBEL SYSTEMS INC 436 E VANDERBILT WAY SAN BERNARDINO CA 92408 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 % of the California workers' compensation premium otherwise due on such remuneration. SCHEDULE Person or Organization Job Description Any person or organization from whom you are required by written contract or agreement to obtain this waiver of rights from us Countersigned by Authorized Representative Form WC 04 03 06 (1) Printed in U.S.A. Process Date: 03/17/19 Policy Expiration Date: 04/26/20