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PROOF OF INSURANCE (2012) CLOSEDNFTWINTI =1 vncn ur. avw..a ACORD,. CERTIFICATE OF LIABILITY INSURANCE 06!DATE(MM03!22011 011YY} 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: 1f the cert)flcate holder is an ADDITIONAL INSURED, the poiicy(les) must be endorsed. If SUBROGATfON lS 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 Hub International NAME: T Adrianna Siqueiros _ A/CONNo 877 825 -2681 LAIC, No): 951 231 -2572 HUB Int'i Insurance Serv. Inc. 4371 Latham St, Ste #101 E-DDRESS: MAIL hubinternational.co CAOOI.ProcessingUnit@hubinternational.co A.._.__. INSURERS) AFFORDING COVERAGE NAIL 0 Riverside, CA 92501 INSURERA; Hartford Casualty Insurance Com 29424 INSURED Network Integration Co. Partners, Inc. 11981 Jack Benny Drive, #103 Rancho Cucamonga, CA 91739 INSURER B; Hartford Fire Insurance Company 19682 INSURER C: $300,000 INSURER D: $10,000 INSURER E: CLAIMS -MADE � OCCUR INSURER F: V V V CRfiV CJ 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 CONTRACTOR 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 LTR TYPE OF INSURANCE IINSR ADDLSUBR IWVD POLICY NUMBER POLICY EFF MWDD/YYYY POLICY EXP MM/DD LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL UABILITY 72UUNKT6838 06(04/2011 06!04!201 "CH OCCURRENCE $1,000,000 pAMAGE TO RENTED PREMISES (Ea occunenca $300,000 MED EXP (An one parson $10,000 CLAIMS -MADE � OCCUR PERSONAL & ADV INJURY $1,000000 $2,000,000 GENERAL AGGREGATE GENL AGGREGATE LIMIT APPLIES PER: PRODUC .GOMPIOP AGG $2,000,000 OMBINED SINGLE LIMIT Ee accident $ 81,000,000 A X POLICY JECT LOC AUTOMOBILE LIABILITY 72UUNKT6838 6/04/2011 06104/201 BODILY INJURY (Per person) $ - X ANY AUTO BODILY INJURY (Per accided) $ ALL OWNED SCHEDULED AUTOS NON -OWNED X S X AUTOS PROPERTY DAMAGE $ a B X LIAB B ERETENTION X OCCUR CLAIMS -MADE 72RHUVZ7428 6/0412011 06104/201 $5,000,000 eTW.CRG1 $5,000,000 $10,000 WORKERS COMPENSATION OTH- $ E.L. EACH ACCIDENT $ AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNERIEXECUTNE Y I N OFFICERIMEMBER EXCLUDED? � (Mandatory In NH) NIA E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ If yes, describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is requlrad) City of El Segundo, its officers, officials, agents, employees and volunteers are Additional Insured in regards to General Liability policy per attached forms CG2010 07104 and CG2037 07104. Insurance is Primary/Non- Contributory per attached form HG0001 06/05. Additional Insured in regards to Auto Liability policy per attached form CA0001 10/01. "Should the policies be cancelled before the expiration date, Hub (See Attached Descriptions) CC of El Segundo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City g THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Public Works Department ACCORDANCE WITH THE POLICY PROVISIONS. El Segundo City Hall 350 Main Street AUTHORIZED REPRESENTATIVE El Segundo, CA 90245 -3813 "2e.. 17AO- _ — ACORD 25 (2010/05) 1 of 2 #S1198010/M1197995 U Tats 6 -ZUTU A4VKU a,u rcrvnrar rvr�. nn r,y�iw ,aac�.o... The ACORD name and logo are registered marks of ACORD VG41 DESCRIPTIONS (Continued from Page 1) J 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." SAGITTA 25.3 (2010/05) 2 of 2 #S1198010/M1197995 POLICY NUMBER: 72 UUN KT68381""� COMMERCIAL GENERAL LIABILITY CG 20 10 07 0 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): City of E1 Segundo, its officers, officials, agents, employees n volunteers Public Works Department El Segundo City Hall 350 Main Street El Segundo, CA 90245 -3813 SCHEDULE Location(s) Of Covered Operations As Required by Written Contract 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 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, 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 20 10 07 04 0 ISO Properties, Inc., 2004 Page 1 of 1 POLICYNUMBER: -72 UUN KT6838 COMMERCIAL GENERAL LIABILITY CG 20 37 07 04 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 SCHEDULE Name Of Additional Insured Person(s) Location And Description Of Completed Or Organization(s): Operations City of E1 Segundo, its of-fi officials, agents, employe and volunteers Public Works Department E1 Segundo City Hall 350 Main Street E1 Segundo, CA 90245 -3813 As Required by Written Contract Information required to complete this Schedule, if not shown above, will be shown in the Declarations. 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" or "property damage" caused, in whole or in part, by "your work" at the location designated and described In the schedule of this endorsement performed for that additional Insured and Included in the "products - completed operations hazard ". CG 20 37 07 04 © ISO Properties, Inc,, 2004 Page 1 of 1 DATE (MM /DD/YY) Afti Rd CERTIFICATE OF LIABILITY INSURANCE 05112/11 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 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 Aon Risk Services, Inc of Florida NAME: Aon Risk Services, Inc of Florida PHONE 800 - 743 -8130 FAX 800 - 522 -7514 1001 Brickell Bay Drive, Suite #1100 AIC No. Ext : A/C, No : Miami, FL 33131 -4937 E-MAIL__ ADP_COI_Center @Aon.com ID #: 10762287 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: National Union Fire Ins Co of Pittsburgh 19445 INSURED g4 ADP TotalSource CO XXII, Inc INSURER B: 10200 Sunset Drive INSURER C: Miami, FL 33173 L /C /F INSURER D: Network Integration Company Partners INSURER E: 11981 Jack Benny Dr., Suite 103 Rancho Cucamonga, CA 91739 INSURER F: COVERAGES CERTIFICATE NUMBER: 292090 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. LINII ES SHOWN ARE AS REQUESTED. INSR ADDL SUER POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR TYPE OF INSURANCE INSR WVD DATE I MIDOIYYYY) DATE (MMIDD/YYYY) EACH OCCURRENCE $ GENERAL LIABILITY ❑ COMMERCIAL GENERAL LIABILITY ❑ CLAIMS MADE ❑ OCCUR GEN'L AGGREGATE LIMIT APPLIES PER ❑ POLICY ❑ PROJECT ❑ LOC AUTOMOBILE LIABILITY ❑ ANY AUTO ❑ ALL OWNED AUTOS ❑ SCHEDULED AUTOS ❑ HIRED AUTOS ❑ NON OWNED AUTOS ❑ UMBRELLA LIAR OCCUR ❑ EXCESS LIAR CLAIMS -MADE ❑ DEDUCTIBLE ❑ RETENTION $ A IWOKKtKS' %. IMrCn1Qnn ­ EMPLOYERS' LIABILITY ANY PROPRIETOR /PARTNER /EXECUTIVE OFFICER/MEMBER EXCLUDED? N/A ❑ (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below DAMAGE TO RENTED $ PREMISES (Ea occurrence) MED EXP (Any one person) $ PERSONAL 8 ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS — COMP /OP AGG I $ COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ EACH OCCURRENCE $ AGGREGATE $ $ WC 058340908 CA 07/01 /10 07101111 I ® TO Y LIMIT ❑ OTHER TORY LIMITS E.L. EACH ACCIDENT $ $2,000,000 E.L. DISEASE — EA EMPLOYEE $ $2,000,000 E.L. DISEASE — POLICY LIMIT $ $2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) All worksite employees working for the above named client company, paid under ADP TOTAL SOURCE, INC'S payroll, are covered under the above stated policy. CERTIFICATE HOLDER CANCELLATION City of El Segundo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE 350 Main Street THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. El Segundo, CA 90245 -3813 AUTHORIZED REPRESENTATIVE t n _ �_ `,� �p/t v�� �ltVIClS, YrsC O f (fL0'Ciaa ACORD 25 (2009109) J @1988.2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD