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PROOF OF INSURANCE (2011) CLOSEDFm:The Liberty Company Insurance BrokTo:General Lighting & Electrical Revised Certifica12:58 0112811 OGMT -08 Pg 02 -02 DATE (MMIDDIYYYY) ACORD CERTIFICATE OF LIABILITY INSURANCE 129/2010 PRODUCER (PAR)91R -3960 FAX: (R66)265 -1577 The Liberty Company Insurance Brokers, Inc 21820 Burbank Blvd Suite #269 Woodland Hills CA 91367 INSURED General Lighting and Electric, DBA: Strom 8132 Firestone Blvd #814 Downey CA 90241 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMA710N ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURER Golden Eagle in, surance Corp. INSURER B. - -- INSURER C - - INSURER U. _.. COVERAGES NOTWITHSTANDING FOR THE POLICY PERIOD THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUGD TO THE INSURED NAMED ABOVE CERTIFICATE WTH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. - - --- - -- -- - - POLICY EFFECTIVE POLICY EXPIRATION INSR`ADO'L POLICY NUTADER DATE Y AM —vVV LIMITS TR EACH OCCURRENCE 5 1,000,000 - GENERAL LIABILITY DAMAGE TO RENTED S. 100, 00.0 X COMMERCIAL GENERAL LIABILITY F RFMISES.(Ea occunenw) '. A x CLAIMS MADE X OCCUR CHP9B1RB36 1/15/2010 1/15/2011 MED EXP(Any ono person) 5 . 5,000 - PERSONAL E ADV INJURY S 1,000,000 GENERnLnGGREGnTE $ 2,000,000 REPLACES CERTIFICE DATED PRODUCTS - COMPIOPAGG S 2,000,000 GENN1 AGGREGATE LIMIT APPLIES PER 1 -27 -10 TO REFLECT X'.POLICY 'PRO LOC RENEWAL INFORMATION AUTOMOBILE LIABILITY COMBINED SINGLE LIAR S (Ea accldenl) ANY AUTO ALL OWNED AUTOS BODILY INJURY S (Per person) SCHEDULED AUI OS . HIRED AU IDS BODILY INJURY y (Per acclderl) NON- OV'INEDAUTOS - - -', - PROPERTY DAMAGE S - (Per accideet) AUTO ONLY - EA ACCIDENT 5 GARAGE LIABILITY - - - ANY AUTO 01 HER THAN E'. ACC S AUTO ONLY AGGS EACH OCCURRENCE S 1, 000, 000 EXCESS I UMBRELLA LIABILITY _ AGGREGATE S__ X OCCUR CLAIMS MADE - S A X DEDUCTIBLE CU8748842 1/15/2010 1/15/2011 S S RETENTION S -- - -� --- -yWCSTATU -'. OTH- WORKERS COMPENSATION TORY LIMITS. . ER_: AND EMPLOYERS' LIABILITY YIN E.L. EACH ACCIDENT 5 - ANY PROPRIETORIPARTNERIEXtCUTIVE .. OFFICERIN15HER EXCLUDED? ❑ E . DISEASE - EA EMP;OYEE 5 ...... - (Mandatory in NH) _..... -. If yes, describe under E L DISEASE -POLICY LIMIT S SPECIAL PROVISIONS belDw OTHER DESCRIPTION OF OPERATIONS LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS 10 day notice of cancellation will be sent for nonpayment of premium CERTIFICATE HOLDER "" "" "` "" -- SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION City of E1 Segundo DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30* DAYS WRITTEN Department Of Public Wor S NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO 00 SO SHALL ATTN: Maryam Jonas IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR 350 Main Street PRE ENTATIVES. El Segundo, CA 90245 -3813 AU1 112 REPRESENTATIVE ACORD 25 (2009101) INS025 (200001) JAN -28 -2010 12:49 © 1988 -2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 96% P.02 1 a DATE (MMIDD /YYYY) , ,c CERTIFICATE OF LIABILITY INSURANCE 12/16/2009 PRODUCER (888) 918 -3960 FAX: (866)26S-1577 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION The Liberty Company Insurance Brokers, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 21820 Burbank Blvd ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Suite #269 Woodland Hills CA 91367 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER Golden Eagle Insurance Corp. 10836 General Lighting and Electric INSURER Redwood Fire & Casualty 11673 DBA: Strom Lighting Services INSURER c 8132 Firestone Blvd #814 INSURER D Downey CA 90241 INSURER E UU V tKAUtzb -• •-----""-" BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING THE POLICIES OF INSURANCE LISTED OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR ANY REQUIREMENT, TERM OR CONDITION BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OFSUCH MAY PERTAIN, THE INSURANCE AFFORDED POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR INSR ADD'L POLICY EFFECTIVE POLICY EXPIRATION �I POLICY NUMBER DATE MM /DD /YYYY DATE MM /DD /YYYY LIMITS LTR R EACH OCCURRENCE $ 1,000,000 GENERAL LIABILITY - -, DAMAGETO RENTED Vii. $ 100,000 X COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence) A X CLAIMS MADE X OCCUR CBP9818836 1/15/2009 1/15/2010 MED EXP (Any one person) $ 5,000 III PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'LAGGRE GATE LIMIT APPLIES PER PRODUCTS - COMPIOPAGGI $ 2,000,000 X j POLICY I PRO- I LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) I ANY AUTO B ALL OWNED AUTOS CAA000596 2/22/2009 2/22/2010 BODILY INJURY $ (Per person) X SCHEDULED AUTOS - X HIRED AUTOS BODILY INJURY $ (Per accident) X NON -OWNED AUTOS PROPERTY DAMAGE $ (Per accident) %RVI am V IF WWI GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ "�°`' !3 °` q�gi rt f , ( 2009) AUTO ONLY. AGG $ EXCESS /UMBRELLA LIABILITY EACH OCCURRENCE $ AGGREGATE $ i CLAIMS MADE iI DEDUCTIBLE $ RETENTION $ ll WC STATU- 0TH -'' WORKERS COMPENSATION TORY LIMITS ER AND EMPLOYER 1 ECUTIVE /EXCLUDED? ` $ C OFFICER MEIMBOER ❑ (Mandatory in NH) . E EMPLOYEE E DISEASE . -. _. - A _- E $ If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ OTHER i DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS City of EL Segundo is named as additional insured per blanket gold endorsement GECG 602 (09/04) with respects to General Liability. *10 day notice of cancellation in the event of non - payment of premium. ,-r-m I iri%,m I C n%j L.LIGR I -• •-----""-" (310) 640 -0489 SHOULD ANY OFTHEABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION City of El Segundo DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL *30 DAYS WRITTEN Attn : Maryam Jonas NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL Department of Public Works IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR 350 Main Street El Segundo, CA 90245 -3813 REPRESENTATIVES. AUTHORIZED REPRESENTATIVE / Yoana M. Cruz_. -� ACORD 25 (2009/01) INS025 (200901) The ACORD name and logo are registered marks of ACO Insured: General Lighting Electric Policy #CBP9818836 COMMERCIAL LIABILITY GOLD ENDORSEMENT THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SECTION I - COVERAGES COVERAGE A. BODILY INJURY AND PROPERTY DAMAGE LIABILITY 2. Exclusions Item 2.g. 2) is replaced with the following: 2.g. 2) A watercraft you do not own that is: a) less than 50 feet long; and b) Not being used to carry persons or property for a charge. Item 2.g. 6) is added: 6) An aircraft in which you have no ownership interest and that you have chartered with crew. The last paragraph of 2. Exclusions is replaced with the following Exclusions c. through n. do not apply to damage by fire, explosion, sprinkler leakage, or lightning to premises while rented to you, temporarily occupied by you with the permission of the owner, or managed by you under a written agreement with the owner. A separate limit of insurance applies to this coverage as described in Section III - Limits of Insurance. SECTION I - COVERAGES COVERAGE C. MEDICAL PAYMENTS If Medical Payments Coverage is provided under this policy, the following is changed: 3. Limits The medical expense limit provided by this policy shall be the greater of a. $10,000; or b. The amount shown in the declarations. Coverage C. Medical Payments is primary and not contributing with any other insurance, even if that other insurance is also primary. (jIA'(i 002 (09104) Includes copynghted matcrm1 of Insurance Services Ufl`ices Inc with its pennissiun Page 1 of 6 The following is added. COVERAGE D. PRODUCT RECALL NOTIFICATION EXPENSES Insuring Agreement We will pay "product recall notification expenses" incurred by you for the withdrawal of your products, provided that: a. Such withdrawal is required because of a determination by you during the policy period, that the use or consumption of your products could result in "bodily injury" or "property damage "; and b. The "product recall notification expenses" are incurred and reported to us during the policy period. The most we will pay for "product recall notification expenses" during the policy period is $100,000. SUPPLEMENTARY PAYMENTS -COVERAGES A AND B Item b. and d. are replaced with: b. The cost of bail bonds required because of accidents or traffic law violations arising out of the use of any vehicle to which the Bodily Injury Liability Coverage applies. We do not have to furnish these bonds. d. All reasonable expenses incurred by the insured at our request to assist us in the investigation or defense of the claim or "suit" including actual loss of earnings up to $500 a day because of time off from work. SECTION II -WHO IS AN INSURED Itern 4. is replaced with: 4. Any subsidiaries, companies, corporations, firms, or organizations you acquire or form during the policy period over which you maintain a controlling interest of greater than 50% of the stock or assets, will qualify as a Named Insured if: a) you have the responsibility of placing insurance for such entity; and b) coverage for the entity is not otherwise more specifically provided; and c) the entity is incorporated or organized under the iaws of the United States of America. However; coverage under this provision does not apply to "bodily injury" or "property damage" that occurred before you acquired or formed the entity, or "personal injury" or "advertising injury" arising out of an offense committed before you acquired or formed the entity. Coverage under this provision is afforded only until the end of the policy period, or the twelve (12) month anniversary of the policy inception date whichever is earlier. SECTION III - LIMITS OF INSURANCE Paragraph 2 is amended to include: The General Aggregate Limit of Insurance applies separately to each "location" owned by you, rented to you, or occupied by you with the permission of the owner. GF,C'(i 602 (09/04) Includes copyrighted material of Insmance Services Offices Inc with its permission Page 2 of 6 Paragraph 6. is replaced with the following: 6. Subject to 5. above, the Fire Damage Limit is the most we will pay under Coverage A for damages because of "property damage" to premises while rented to you, temporarily occupied by you with permission of the owner, or managed by you under a written agreement with the owner, arising out of any one fire, explosion or sprinkler leakage incident. The Fire Damage Limit provided by this policy shall be the greater of: a. $500,000. or b. The amount shown in the Declarations SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS Item 2. a.is replaced with: 2. Duties In The Event of Occurrence, Offense, Claim or Suit a. You must promptly notify us. Your duty to promptly notify us is effective when any of your executive officers, partners, members, or legal representatives is aware of the "occurrence ", offense, claim, or "suit ". Knowledge of an "occurrence ", offense, claim or "suit' by other employee(s) does not imply you also have such knowledge. To the extent possible, notice to us should include: 1) How, when and where the "occurrence" or offense took place; 2) The names and addresses of any injured persons and witnesses; and 3) The nature and location of any injury or damage arising out of the "occurrence ", offense, claim or "suit ". Item 4. b. 1) b) is replaced with: b. Excess Insurance 1) b) That is Fire, Explosion or Sprinkler Leakage insurance for premises while rented to you, temporarily occupied by you with permission of the owner, or managed by you under a written agreement with the owner; or Item 6. is amended to include: 6. Representations d. If you unintentionally fail to disclose any hazards existing at the inception date of your policy, we will not deny coverage under this Coverage Part because of such failure. However, this provision does not affect our right to collect additional premium or exercise our right of cancellation or non - renewal. Item 8. is replaced with: 8. Transfer of Rights Of Recovery Against Others To Us a. If the insured has rights to recover all or part of any payment we have made under this Coverage Part, those rights are transferred to us. The insured must do nothing after loss to impair them. At our request, the insured will bring suit or transfer those rights to us and help us enforce them. GLUE 002 (09/04) Includes copynghtcd material of Insurance SCT%1CCs Offices Inc- with its permission Page 3 01 6 b. If required by a written "insured contract ", 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 your ongoing operations or "your work" done under that written "insured contract' for that person or organization and included in the "products- completed operations hazard ". Item 10. and Item 11, are added: 10. Cancellation Condition If we cancel this policy for any reason other than nonpayment of premium we will mail or deliver written notice of cancellation to the first Named;lnsured at least 60 days prior to the effective date of cancellation. 11. Liberalization If we adopt a change in our forms or rules which would broaden your coverage without an extra charge, the broader coverage will apply to this policy. This extension is effective upon the approval of such broader coverage in your state. SECTION V- DEFINITIONS The following definitions are added or changed: 9. "Insured contract' a. Is changed to: a. A contract for a lease of premises. However, that portion of the contract for a lease of premises that indemnifies any person or organization for damage by fire, explosion or sprinkler leakage to premises while rented to you, or temporarily occupied by you with permission of the owner, or managed by you under a written agreement with the owner is not an "insured contract'. 23 and 24 are added: 23. "Location" means premises involving the same or connecting lots, or premises whose connection is interrupted only by a street, roadway, waterway or right -of -way of a railroad. 24. 'Product recall notification expenses" means the reasonable additional expenses (including, but not limited to, cost of correspondence, newspaper and magazine advertising, radio or television announcements and transportation cost), necessarily incurred in arranging for the return of products, but excluding costs of the replacement products and the cash value of the damaged products. The following Provisions are also added to this Coverage Part: A. ADDITIONAL INSUREDS - BY CONTRACT, AGREEMENT OR PERMIT Paragraph 2. under SECTION II - WHO IS AN INSURED is amended to include as an insured any person or organization when you and such person or organization have agreed in writing in a contract, agreement or permit that such person or organization be added as an additional insured on your policy to provide insurance such as is afforded under this Coverage Part. Such person or organization is not entitled to any notices that we are required to send to the Named Insured and is an additional insured only with respect to liability arising out of: a. Your ongoing operations performed for that person or organization; or b. Premises or facilities owned or used by you. (&CG 602 (09/04) Includes copyrighted imateiial of] lism allcc 5ely ices Offices Inc with its permission Page 4 of 6 With respect to provision 1.a. above, a person's or organization's status as an insured under this endorsement ends when your operations for that person or organization are completed. With respect to provision 1.b. above, a person's or organization's status as an insured under this endorsement ends when their contract or agreement with you for such premises or facilities ends. 2. This endorsement provision A. does not apply: a. Unless the written contract or agreement has been executed, or permit has been issued, prior to the "bodily injury ", "property damage" or "personal and advertising injury"; b. To "bodily injury" or "property damage" occurring after: (1) All work, including materials, parts or equipment furnished in connection with such work, in the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the site 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; c. To the rendering of or failure to render any professional services including, but not limited to, any professional architectural, engineering or surveying services such as: (1) The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; and (2) Supervisory, inspection, architectural or engineering activities; d. To "bodily injury ", "property damage" or "personal and advertising injury" arising out of any act, error or omission that results from the additional insured(s sole negligence or wrongdoing; e. To any person or organization included as an insured under provision B. of this endorsement; f. To any person or organization included as an insured by a separate additional insured endorsement issued by us and made a part of this policy. B. ADDITIONAL INSURED — VENDORS Paragraph 2. under SECTION II - WHO IS AN INSURED is amended to include as an insured any person or organization (referred to below as "vendor ") with whom you agreed, in a written contract or agreement to provide insurance such as is afforded under this policy, but only with respect to "bodily injury" or "property damage" arising out of "your products" which are distributed or sold in the regular course of the vendor's business, subject to the following additional exclusions: 1. The insurance afforded the vendor does not apply to: a. "Bodily injury" or "property damage" for which the vendor is obligated to pay damages by reason of the assumption of liability in a contract or agreement. This exclusion does not apply to liability for damages that the vendor would have in the absence of the contract or agreement; b. Any express warranty unauthorized by you; c. Any physical or chemical change in the product made intentionally by the vendor; G1 -;CG 602 (09/04) Includes copyrighted material of Insurance Services Offices Inc with its permission Page 5 of 6 d. Repackaging, unless unpacked solely for the purpose of inspection, demonstration, testing, or substitution of parts under instructions from the manufacturer, and then repackaged in the original container; e. Any failure to make such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the course of business, in connection with the distribution or sale of the products; f. Demonstration, installation, servicing or repair operations, except such operations performed at the vendor's premises in connection with the sale of the product; g. Products which, after distribution or sale by you, have been labeled or relabeled or used as a container, part or ingredient of any other thing or substance by or for the vendor; or h. To "bodily injury" or "property damage" arising out of any act, error or omission that results from the additional insured's sole negligence or wrongdoing. 2. This insurance does not apply to any insured person or organization, from whom you have acquired such products, or any ingredient, part or container, entering into, accompanying or containing such products. (&C(i 002 (09/04) Includes copyrighted material of Insurance Services Offices Inc with its permission Page 0 offs CERTHOLDER COPY STATE P.O. BOX 420807, SAN FRANCISCO,CA 94142 -0807 COMPENSATION INSURANCE FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 04 -01 -2008 GROUP: 000624 POLICY NUMBER: 0000685 -2008 CERTIFICATE ID: 126 GERTIFIC 04- 01- 2008/04- 01-2010 CITY OF EL SEG NVDO SC 350 MAIN ST EL SEGUNDO CA 80245 -3813 This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated, This policy is not subject to cancellation by the Fund except upon S0 days advance written notice to the employer. We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy. tTH:ORIZE60 REPRESENTATI PRESIDENT EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT #160D - THARATHORN SUNNANON, PRESIDENT - EXCLUDED. ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 04-01 -2006 IS ATTACHED TD AND FORMS A PART OF THIS POLICY. EMPLOYER GENERAL LIGHTING AND ELECTRIC, INC SC 8132 FIRESTONE BLVD # 814 DOWNEY CA 90241 M0408 PRINTED : 03- 17-2008 (REV.2 -05)