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PROOF OF INSURANCE (2014) CLOSEDAgreement No. 4532 The Glass Mirror and Storefront Co. DBA The Glass Professionals 272545 ----1 ® ,4COR© CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDNYYY) F 6/7/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS I� 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((es) must be endorsed. if SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require ar>endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Commercial Lines - (818) 464 -9300 O AC NA E: PHONE FAX No): ADD LESS: Wells Fargo Insurance Services, Inc. - CA Lic#: OD08408 INSURE S AFFORDING COVERAGE NAIC # 15303 Ventura Boulevard, 7th Floor - Sherman Oaks, CA 91403 -3197 INSURED INSURERA: Nationwide Mutual Insurance Company INSURER e : State Compensation Insurance Fund 23787 35076 INSURER C. 1,000,000 — The Glass Professionals INSURER D: 239 S. La Brea Avenue INSURER E: BODILY INJURY (Per accidenrt) $ INSURER F v,�l/1�1 LlrrMr7 Ct!• C.... i..inur $ Inglewood, CA 90301 ___ :OVERAGES CERTII=(GA I t Nu1111OC c: THIS IS TO ERTIFY THAT THE IND CATED.CNOTWITHSTANDING ANY IREOUIREMENATN, TERM OR CONDITION OF F ANY CONTRACT O R THE OTHER DOCUMENT POLICY DOCUMENT WIITH RE PECT TOWHICHTHIS 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. SR L POLICY EFF POLICY EXP LIMITS TYPE OF INSURANCE POLICY NUMBER MMIDONM MM/D GENERAL LIABILITY EACH OCCURRENCE $ 1.000,000 A ACP7852143045 03/0112013 0310112014 100,000 LU%MAUft %( COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ F OCCUR MED EXP (Any one person) $ 5,000 CLAIMS -MADE 1,000,000 ocacru,IAl R AnV INJURY $ DESCRIPTION OF OPERATIONS i LOCATIONS I VEHICLES (A$ach ACORD 101, Additional Remarks Schedule, if Mom space is required) The City of El Segundo, its officials and employees are included as Additional Insureds with regards to the referenced General Liability insurance, where required by written contractlagreement, as respects to all operations of the Insured. This insurance is primary and any other insurance carried by the Additional Insureds is excess of this insurance. Endorsement 2570 titled "Waiver of Subrogation" effective April 2, 2013 is applicable to the above referenced Workers Compensation insurance policy and is attached to this certificate. City of El Segundo Office of the City Clerk 350 Main Street El Segundo, CA 90245 -3895 ACORD 25 (2010105) 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 / 911— % 14— The ACORD name and logo are registered marks of ACORD O 1988 -2010 ACORD CORPORATION. All rights reserved. GEN'LAGGREGATE LIMIT APPLIES PER: POLICY PRO LOC PRODUCTS - COMP /OP AGG $ 2,000,000 $ ACP7852143045 03/01/2013 03/01/2014 C NED SIN LIMIT Ea acrddent 1,000,000 — AUTOMOBILE LIABILITY X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS X NON-OWNED HIRED AUTOS X AUTOS BODILY INJURY (Per Pereon) $ BODILY INJURY (Per accidenrt) $ PROPERTY DAMAGE Per accident $ $ EACH OCCURRENCE $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE AGGREGATE $ DED RETENTIONS I 708.505048 1 06/08/2013 1 06/08/2014 1 X WC STATU- OTH B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? Wandatory in NH) -- N / A I E.L. EACH ACCIDENT 1,000,000 $ E.L. DISEASE - EA EMPLOYE 1,000,000 S �• _ _.. _...._.._ I F T ni.SFARF - PULn:Y LIMIT .. 1.000.000 1 5 DESCRIPTION OF OPERATIONS i LOCATIONS I VEHICLES (A$ach ACORD 101, Additional Remarks Schedule, if Mom space is required) The City of El Segundo, its officials and employees are included as Additional Insureds with regards to the referenced General Liability insurance, where required by written contractlagreement, as respects to all operations of the Insured. This insurance is primary and any other insurance carried by the Additional Insureds is excess of this insurance. Endorsement 2570 titled "Waiver of Subrogation" effective April 2, 2013 is applicable to the above referenced Workers Compensation insurance policy and is attached to this certificate. City of El Segundo Office of the City Clerk 350 Main Street El Segundo, CA 90245 -3895 ACORD 25 (2010105) 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 / 911— % 14— The ACORD name and logo are registered marks of ACORD O 1988 -2010 ACORD CORPORATION. All rights reserved. ENDORSEMENT AGREEMENT WAIVER OF SUBROGATION 708 -12 505048 RENEWAL SC 3- 28 -94 -93 PAGE 1 HOME OFFICE SAN FRANCISCO EFFECTIVE DECEMBER 19, 2013 AT 12.01 A.M. ALL EFFECTIVE DATES ARE AND EXPIRING JUNE 8, 2014 AT 12.01 A.M. AT 12:01 AM PACIFIC STANDARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME THE GLASS PROFESSIONALS 239 S LA BREA AVE INGLEWOOD, CA 90301 ANYTHING IN THIS POLICY TO THE CONTRARY NOTWITHSTANDING, IT IS AGREED THAT THE STATE COMPENSATION INSURANCE FUND WAIVES ANY RIGHT OF SUBROGATION AGAINST: CITY OF EL SEGUNDO WHICH MIGHT ARISE BY REASON OF ANY PAYMENT UNDER THIS POLICY IN CONNECTION WITH WORK PERFORMED BY: THE GLASS PROFESSIONALS IT IS FURTHER AGREED THAT THE INSURED SHALL MAINTAIN PAYROLL RECORDS ACCURATELY SEGREGATING THE REMUNERATION OF EMPLOYEES WHILE ENGAGED IN WORK FOR THE ABOVE EMPLOYER. IT IS FURTHER AGREED THAT PREMIUM ON THE EARNINGS OF SUCH EMPLOYEES SHALL BE INCREASED BY 03%. NOTHING IN THIS ENDORSEMENT CONTAINED SHALL BE HELD TO VARY, ALTER, WAIVE OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS POLICY OTHER THAN AS STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR LIMITATIONS OF THIS ENDORSEMENT. COUNTERSIGNED AND ISSUED AT SAN FRANCISCO: DECEMBER 23, 2013 2570 AUTHORIZED REPRESENTA IVE PRESIDENT AND CEO SCIF FORM 10217 (REV.1-2012) OLD DP 217