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PROOF OF INSURANCE (2013) CLOSED A-Throne Agr. No. 4520 69128 DATE(MM/DD/YYYY) ACC-MV CERTIFICATE OF LIABILITY INSURANCE 9/17/2013 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 pol(cy(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 N_ME,' g Heather Berglund Commercial Lines- 952 830-3000 PHONE FAX ( ) 952-563-0507 952-563-9507 M (A/ ,No)c Wells Fargo Insurance Services USA, Inc. L r NlLE ss, Heather.berglund @wellsfargo.com k 300 MarketPointe Drive,Suite 600 INSURER(S)AFFORDING COVERAGE NAIC# oomington,MN 55435-5455 INSURERA; Nationwide Mutual Insurance Company P26247 3787 URED INSURER a American Guarantee and Liability Insurance Com A-Throne Co., Inc. INSURER C: . ...._... .,_.._...�.. ._.... .....—.. Attn: Nikki Hussein INSURER.....:............................_............................................................................................. ......... 1850 E.33rd Street INSURER . °�...___........................................... ............. Long Beach,CA 90807-5208 INSURER F: COVERAGES CERTIFICATE NUMBER: 6587464 REVISION NUMBER: See below 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. 1NSR w.......,gD'FSL,S gR ........_. ..................... ..POLICI'1"=FF.._POLICY EXP,... ., .,...�....... .._.,.... LTR TYPE OF INSURANCE INCw wVn POLICY NUMBER (MMIDD/WYYI (MM/DDIYYYYI LIMITS X GENERAL ,�A ACP7133675981 11/22/2012 11/22/2013 "-Y A' 9 COMMERCIAL GENERAL LIABILITY M ne, oo 00o .._.................................. CLAIMS-MADE q X OCCUR MEDwEXP(Anv one Derson) $ 10000 ....... ..... .. ... .._ ....... .......... PERSONAL&ADV INJURY $ 1,000,000 - ._--_..m..-..r_... ..........._................................................................, GENERAL AGGREGATE $ 2,000,000 _.�_..._. �............ :................................_2 00.000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 P(LCCY X PRO- C $ A AUTOMOBILELIABILITY ACP7133675981 11/22/2012 11/22/2013 (°lar.r. PnsrNGLeLIMrr 1,000,000 . X ANY AUTO BODILY�INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY __ .__ AUTOS AUTOS (Per accident) $ NON-OWNED PROPERTY DAMAGE X HIRED AUTOS X AUTOS (Peracctdentl $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ RF DED TFNTinwt $ B AND EMPLOYERS'LIABILITY WC655829803 11/22/2012 11/22/2013 _.....-. WORKERS COMPENSATION F—] X nRV i inTC OFa ANY OFFICE /M BE PROPRIETOR/PARTNER/EXECUTIVE E.L.DISEASE $ 0 YIN OFFICERIMEMBER EXCLUDED? N/A 1,000 000 ������ 1,000,00.... ( ry ) EMPLOYEE $under If D E yes,d scribe pF OPERATIONS hPlnw E,L,DISEASE-POLICY LIMIT� . Y $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,Additlonal Remarks Schedule,If more space is required) Re:Covered CA Operations Performed By Or On Behalf of the Named Insured. The City of El Segundo,its officers,officials,employees,agents and volunteers are included as Additional Insured on a Primary and Non-Contributory basis for General Liability. A Waiver of Subrogation applies as respects Workers'Compensation as required by written contract.30 day notice of cancellation on General Liability policy. CERTIFICATE HOLDER CANCELLATION' City of El Segundo �' ,,, t „ Fy SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Attn:City Clerk I a THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main St. � El Segundo,CA 90245 )d i°°� AUTHORIZED REPRESENTATIVE The ACORD name and logo are registered marks of ACORD ©1988-2010 ACORD CORPORATION. All rights reserved, ACORD 25(2010/05) (This certificate replacas certificate#65@7456 issued an 0/97l2Q13} ACP7133675981 � ' �� p COMMERCIAL GENERAL LIABILITY CG 71 57 08 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL. INSURED -- OWNERS, LESSEES OR CONTRACTORS AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION CONTRACT PRIMARY AND NON-CONTRIBUTORY This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section It — Who Is An Insured is amended to 1. "Bodily injury", "property damage" or"personal include as an additional insured any person or or- and advertising injury" arising out of the ren ganization for whom you are performing opera- dering of, or the failure to render, any profes- tions when you and such person or organization sional architectural, engineering or surveying have agreed in a written contract that such person services, including: or organization be added as an additional insured a. The preparing, approving, or failing to pre- on your policy. Such person or organization is an pare or approve, maps, shop drawings, additional insured only with respect to liability for opinions, reports, surveys, field orders, "bodily injury","property damage"or"personal and change orders or drawings and specifica- advertising injury"caused, in whole or in part,by: tions; or 1. Your acts or omissions; or b. Supervisory, inspection, architectural or 2. The acts or omissions of those acting on your engineering activities. behalf; 2. 'Bodily injury" or "property damage" occurring in the performance of your ongoing operations after: for the additional insured. a. All work, including materials, parts or A person's or organization's status as an addi- equipment furnished in connection with tional insured under this endorsement ends such work, on the project (other than ser- when your operations for that additional in- vice, maintenance or repairs) to be per- sured are completed. formed by or on behalf of the additional in- No such person or organization is an add- sured(s) at the location of the covered tional insured for liability arising out of the operations has been completed;or "products-completed operations hazard". b. That portion of"your work" out of which the injury or damage arises has beers put to its B.The following is added to SECTION III —LIMITS intended use by any person or organization OF INSURANCE: tractor than another contractor or subcon- tractor engaged in performing operations The limits of insurance applicable to the additional for a principal as a part of the same project. insured are those specified in the written contract D. With respect to the insurance afforded to these between you and the additional insured, or the lim- additional insureds, Condition 4. Other Insur- its available under this policy, whichever are less. ante is replaced by the following: These limits are part of and not in addition to the limits of insurance under this policy. 4. Other Insurance If other valid and collectible insurance is avail- C. With respect to the insurance afforded to these able to the insured for a loss we cover under additional insureds, the following additional exclu- Coverages A or B of this Coverage Part, our sions apply: obligations are limited as follows: This insurance does not apply to: CG 71 57 08 04 Page 1 of 2 CG 71 57 08 04 a. Primary Insurance When this insurance is excess over other This insurance is primary except when it is insurance,we will pay only our share of the excess as provided under part b., below. amount of the loss, if any, that exceeds the When this insurance is primary, we will not sum of: seek contribution from other insurance (1) The total amount that all such other in available to the person or organization surance would pay for the loss in the shown in the Schedule of this endorsement. absence of this insurance;and b. Excess Insurance (2) The total of all deductible and self- This insurance is excess over: insured amounts under all that other in- (1) Any of the other insurance, whether surance. primary, excess, contingent or on any We will share the remaining loss,if any,with other basis: any other insurance that is not described in That is Fire, Extended Coverage, this Excess Insurance provision and was not (a) That Risk, Installation Risk or bought specifically to apply in excess of the Limits of Insurance shown in the Declara- similar coverage for"your work"; tions of this Coverage Part. (b) That is l=ire insurance for premises rented to you or temporarily occu- c. Method Of Sharing pied by you with permission of the owner; If all of the other insurance available to (c) That is insurance purchased by you the additional insured permits contribu- te cover your liability as a tenant for t'ton by equal shares, we will follow this "property damage" s premises method also. Under this approach each rented to you or temporarily occu- insurer contributes equal amounts until it pied by you with permission of the has paid its applicable limit of insurance or none of the loss remains, whichever owner;or comes first. (d) If the loss arises out of the mainte- If any of the other insurance available to nance or use of aircraft, "autos" or the additional insured does not permit watercraft to the extent not subject contribution by equal shares, we will to Exclusion g. of Section I — Cov- contribute by limits. Under this method, erage A — Bodily Injury And Prop- each insurer's share is based on the ra- erty Damage Liability do of its applicable limit of insurance to When this insurance is excess,we will have the total applicable limits of insurance of no duty under Coverages A or B to defend all insurers. the additional insured against any "suit" if any other insurer has a duty to defend the additional insured against that "suit". If no other insurer defends, we will undertake to do so, but we will be entitled to the addi- tional insured's rights against all those other insurers. All terms and conditions of this policy apply unless modified by this endorsement. Page 2 of 2 Includes copyrighted material of Insurance Services Office, Inc,with permission. CG 71 57 08 04 0 ISO Properties, Inc.,2004 XU e WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 4-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT- 1 ' CALIFORNIAw This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different date is indicated below. (The following"attaching clause"need be completed only when this endorsement is issued subsequent to preparation of the policy.) h. 1 1/22/2012 at 12:01 A.M. standard time, forms a part of This endorsement, effective on (DATE) Policy No. WC655829803 Endorsement No. of the ZURICH AMERICAN INSURANCE COMPANY (NAME OF INSURANCE COMPANY) issued to A-Throne Co.,Inc. 9� Premium (if any) $ Authorized Representative 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 % of the California workers' compensation pre- mium otherwise due on such remuneration. Schedule Person or Organization Job Description ALL PERSONS ANDIOR ORGANIZATIONS THAT ARE REQUIRED ALL CALIFORNIA OPERATIONS BY WRITTEN CONTRACT OR AGREEMENT WITH THE INSURED, EXECUTED PRIOR TO THE ACCIDENT OR LOSS, THAT WAIVER OF SUBROGATION BE PROVIDED UNDER THIS POLICY FOR WORK PERFORMED BY YOU FOR THAT PERSON AND/OR ORGANIZATION WC 252(4-84) Page 1 of 1 WC 04 03 06(Ed.4-84) Shilling, Mona From: Garcia, Angelina Sent: Tuesday, September 17, 2013 11:59 AM To: Ramos, Vina Cc: Shilling, Mona Subject: RE: Halloween Frolic Portable Restrooms Insurance approved. Angelina Garcia From: Ramos, Vina Sent: Tuesday, September 17, 2013 9:41 AM To: Garcia, Angelina; Shilling, Mona Cc: Petit, Meredith; Bobbett, Jesse Subject: FW: Halloween Frolic Portable Restrooms Good morning Angie, Attached are insurance documents for your review and approval for A-Throne. We used A-Throne for portable restrooms on an as needed basis. Please review insurance and let me know if you need anything else. I am still waiting for vendor's signature. Thank you, Vina From: Ramos, Vina Sent: Monday, September 16, 2013 9:32 AM To: 'Michele Chavez' Cc: Bobbett, Jesse; Petit, Meredith Subject: FW: Halloween Frolic Portable Restrooms Good morning Michelle, Just following up if you had a chance to sign the agreement and obtain new insurance documents. Let me know if you have any questions. Thank you, Vina Ramos Administrative Analyst Recreation and Parks Department Phone: 310-524-2882 Fax: 310-647-4223 From: Ramos, Vina Sent: Wednesday, September 04, 2013 5:42 PM To: 'Michele Chavez' Cc: Bobbett, Jesse Subject: RE: Halloween Frolic Portable Restrooms