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PROOF OF INSURANCE (2020 - 2021) CLOSEDNOBESYS-02 _ ANLOPE ACORO" E (MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE I DAT4/3/2020 .__..........�...................... ...m_..... 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 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�. _ License # 0757776 AnLopezPRODUCER ..... Angle Lo ., .... ....... ......, CONTACT HUB International Insurance Services Inc. PHONE Ext 909) 379-1347 AIC, No 470 East Highland Avenue AI"''" -ternational Com ! Redlands„ CA 92373 �5 angle.NopehLabin ............. _....... _....... 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 CERTIFICATE HOLDER City of EI Segundo 350 Main Street EI Segundo, CA 90245 ACORD 25 (2016/03) 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 logo are registered marks of ACORD INSURER(S,j, AFFORDING „COVERAGE NAI,C,,,#,,,,,,,,,,,,,,,,,,,,... ........ -INSURER A: WestAmeriCan Irisura,llce.CO 443,93,... INSURED INSURER B:United Financial Casualty, COm,,,,,an",, 11770 Nobel Systems, Inc.om CHartford „INSURER¢ a Property and Casualty Insurance ..........pany "of"Hartf 34690 436 E. Vanderbilt Way INsuRpR-QJ.loyd's of London 15792 San Bernardino, CA 92408 INSURERE; .................................. INSURER F: COVERAGE'SCERTIFICATE NUMBER! ................................... REVISION ,NNJMB R'. 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 POLIC ES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY 'AID CLAIMS. A66EJSUBR POLICY NUMBER iNSR TYPE ......... ..... ... .. .. BAR OGENERALLIAB..... POLICY EFF POLICY EXP LIMITS (fAMIDD/YYYY1 lMMIDDlYYVYI X COMMERCIAL EACH_ OCCURRENCE $ 2'000'000 CLAIMS -MADE I X ] OCCUR „ BKW 56 44 46 36 DAMAGE TORENTED�n..... 4/4/2020 4/4/2021 $ I,..S-IFS 9�rrR.lCC2. C�P) 500,000 15,000 MED EXP (,Any ane,person),..........,_5............... 2,000,000 PERSONAL & ADV INJURY $ GENT AGIGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 -� POLICY LOC -P.RODUCTS- -COMP/OP„AGG-__$ 4,000,000 ¢ i°r9EP _..... ......................... .... r_....... _..........000,000 __._..._........................................ a "AU, OMOBILE LIABILITY _$ COMBINED SINGLE VMNT $ ..{i:,iA.rk!.4:!'Is:�I�.I1.................� �..... 1 �...���................... X ANY AUTO 00809321-0 6/15/2019 6/15/2020 K)URY,�Parpersa9)_ $ .. OWN ED _ S ALIT L, HEDULEb .. �B"RpPu.CItNJURY Per accident` H NN .O 'PS rtt p� P: '..,. n'11 A.MA.CaF.. $ ... A SONLY jAU'TOiaM ........................ UMBRELLA LIAB � _WW ............... OCCUR EACH OCCURRENCE ..... EXCESS LIABCLAIMS-MADE I, AGGREGATE $ DED RETENTION $ _._. �.._............................................. WORK COMPENSATION ER X TA ( �RH_ ( LIABILITY YERS' LIABILITY AND EMPLOYERS' PROPRIETOR/PARTNER/EXECUTIVE YIN ANY Pakrnr 172 WEC GE6312 -- EACHTUTF 4/26/2019 4/26/2020 N E.L 1,000,000 AND R NIA MandE Mr do NH) - 1,000,000 If yes, describe under J EEI E.L. DISEA$ECIDA EMPLOY,,. 1,000,000 DESCRIPTION OF OPERATIONS E.L DISEASE -POLICY LIMIT $ w, D !Cyber Liability* DCCT00074-19 12/14/2019 12/14/2020 Limit 1,000,000 D Technology E&O Liab* IDCCT00074-19 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 CERTIFICATE HOLDER City of EI Segundo 350 Main Street EI Segundo, CA 90245 ACORD 25 (2016/03) 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 logo are registered marks of ACORD AGENCY CUSTOMER ID: NOBESYS-02 LOC #: 1 ` ADDITIONAL REMARKS SCHEDULE AGENCY License # 0757776 NAMED INSURED HUB International Insurance Services Inc. Nobel Sr� n el rbins, Inc. .................................................................................................... d36 E. `�anderbrlt UW'a+� POLI11 CY NUMBER Sari Bernardino, CA &08 SEE PAGE 1 CARRIER NAIC CODE SEE PAGE 1 SEE P 1 EFFECTIVE DATE:SEE PAGE 1 ..................................................... ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ..AP,PEP..?.§! FORM TITLE: Certificate of Liability Insurance ... . ANLOPEZ Page 1 of 1 Description of Operations/LocationsNehicles: "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 4412 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EEMT M1 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. 0 2012 Liberty Mutual Agency Corporation. All rights reserved. CG 89 98 0412 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 1 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 each person/ each accident Property Damage Combined Liability 1,000,000 General Liability 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 Form 1198(01/04) Policy expiration date: 06/15/2020 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 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 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", "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 operatons 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 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. B. With respect to the insurance afforded to these additional insureds, the following addi- tional exclusions apply: This insurance does not apply to "bodily in- jury" or" property damage" occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than ser- vice, maintenance or repairs) to be per- formed 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 or- ganization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. CG 20 10 04 13 J 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 ap- plicable Limits of Insurance shown in the Dec- larations. Page 2 of 2 11 Insurance Services Office, Inc., 2012 CG 20 10 04 13 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. 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. CG 20 37 04 13 1 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 11 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 Form WC 04 03 06 (1) Printed in U.S.A. Process Date: 03/17/19 Authorized Representative Policy Expiration Date: 04/26/20