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PROOF OF INSURANCE (2014) CLOSEDAgreement No. 4534 Quality Refrigeration Company QUALREF OP ID: AG CERTIFICATE OF LIABILITY INSURANCE DATE(11511 YYB) 011, 51, 4 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: R 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 Phone: 949-553-9800 The Wooditch Company Insurance Services, Inc. Fax: 949-553-067 1 Park Plaza, Suite 400 Irvine, CA 92614 Christopher Hodson MON PHONE FAX , No E c No): E-MAIL ADDRESS: INSURER(SI AFFORDING COVERAGE NAIC INSURERA:Ironshore Specialty Ins. Co. 25445 INSURED Quality Refrigeration Company, Inc. PO Box 367 Wilmington, CA 90748 INSURER B =Into on National Insurance Co. INSURERC: Liberty Insurance Underwriters 19917 INSURER D : INSURER E : .$ 1,000,00 A X COQ ?ERCIALC LL EtLtTY COVERAGES CERTIFICATE NUMBER- REVISION NUMBER- [ HIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD DICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS ERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, XCLUSIONS AND CONDITIONS OF SUCH POLICIES_ LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OFINSURANCE INQRlwvn POLICYNUMBER IMPWDM Jazwx= LIMITS GENERAL LIABILITY EACH OCCURRENCE .$ 1,000,00 A X COQ ?ERCIALC LL EtLtTY X AGS0058000 11101113 11101114 DAMAGE PREMISES tcITED occurrence) a 50,00 CLAIMS- IcaaDE OrrC €JR MED EXP (Any one person) $ 5,00 PERSONAL & ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER. PRODUCTS - COMPtOP AGG $ 2,000,00 FCucn- X ,7,¢ ' oc $ AUTOMOBILE LIABILITY ,, t 7L (Ea aceidant� ) $ 1,000,00 BODILY ; NJURY (Par person) B X AN guru X 12001040 11101113 11101114 ALL OWNED SCHEDULE Auros AUTOS BODILY INJURY (Per accident) PROPERTY DA3 IAGE `Per accicicnt $ PION -O ZONED HIRED AUTOS AL703 $ UMBRELLALIAB j( 0,_, -UP EACH OCCURRENCE $ 10,000,00 X AGGREGATE $ 10,000,00 C EXCESS LIAR C LAIr s rNADE 1000070949 -01 11/01113 11101/14 err, ., $ WORKERS COMPENSATION AND EMPLOYERS` LIABILITY YIN ANYPROPRiETORtPARTNERIS ECUTIVE AYR STIA U OTR E.L. EACH.4CCIDENT -- OFFICERRvL @tEER EXCLUDED? NIA _- .•.-' - -- (innnu5`svey iA NH) If a, es, dasorihe under DE*SCRIP T IflN OF OPERATIONS GAVoi E. L. DioFASE - EA E"AFIL0 i Ec $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS f LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, K more space Is required) *Except 10 Days Notice of Cancellation for Non - Payment of Premium Booking Room Freezer Compressor Change Out. This insurance shall apply as Primary and Non - Contributory per attached endorsement. * *SEE NOTES ** glaip /auaip ELSEGU2 City of El Segundo J City Clerk 350 Main Street, Room 5 El Segundo, CA 90245 , 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 064;k_~ reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD 1 NOTEPAD QUALREF PAGE 2 �NSURED�S NAME Quality Refrigeration OR ID: AG DATE 01115114 *Should this polies be cancelled before the expiration date, The T+fooditch Company will mail 30 (thirty) days written notice to those Certificate Holders which require such action per contract or agreement.* I I I NOTEPAD. HOLDER CODE ELSEGU2 QUALREF PAGE 3 INSUREDS NAME Quality Refrigeration OP ID: AG DATE 01115/14 City of El Segundo, its officials and employees are included as Additional Insureds as respects General and Auto Liability per attached endorsements. POLICY NUMBER: AGS0058000 COMMERCIAL GENERAL LIABILITY CG 2010 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. _ _ This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organ ization s : Location(sl Of Covered Operations I f Ire <r fh such ._ -..,.1 f ate' 1 t, Jne, o he k_ then 17-�S�l appL O'S iisun-A_a4>e , s,'I par�aq-fe; n c., Pseihod of s,r t'`.'".n:.%`-i.or� of rl .c t' ma wee ..e3 .rats u L - _erm�:s of I .t-: - Id .,rse e__.... -J _not n f: re _ __ r 5_M..t E. .:ab 1 Information required to corn-fete this Schedule, if not shown above, will be shown in the Declarations. A. Section 11 - Who Is An Insured is amended to include as an additional insurers" 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: v y 1. Your acts or omissions, or 2. The acts or omissions of those acting on yo behalf; in the performance of your ongoing operationifor 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 uropeicyucemage 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 iinsured(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 U ISO Properties, inc- 2004 Page 1 of 1 13 Policy Number AGS0058000 COMMERCIAL GENERAL LIABILM CG 20370704 THIS ENDORSEINIENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - t3N NERS3 LESSEES OR CONTRACTORS - COMPLETED OPERATIONS T lels eado"enient mtwjities ki.stiGioce provided under the following: COMME;ItCUL GENERAL RA[ I UX-B Ei "t`1 GOWAACsE PART SCRFDULE Name Of Additional Insured Person(s) Or (} anizafion s Location And Description Of Completed Operations Blanket as required by contract. Blanket as required by written contract and effective Primary Insurance Applies: It is agreed that during the policy period as stated on the policy such insurance as is afforded by this policy for declarations, the benefit of the additional insured shown shall be primary insurance, and any other insurance maintained by the additional insured(s) shall be excess and non contributory as respects any claim, loss or liability allegedly arising out of the operations of the named insured, provided however that this insurance will not apply to any claint bass or liability which is determined to be solely the result of the additional insumd's responsibility. lrrforreraticnr required to etttcplvty this Schedule, i€ not shown above, will be Shown in the Declarations, 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 "proper am- age>' caused, in whole or in part, by "your wor 1t the location designated and described in the sched- ule of this endorsement performed for that addition insured and included in the "products - completes operations hazard ". CG 20 37 07 04 @ ISO Properties, Inc., 2004 Page 1 of I "• WA 17, 1111TIT, ; i 14 s y COMMERCIAL AUTO CA 20 48 02 99 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" under the Who Is An Insured Provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. 11/01/2013 Inc. SCHEDULE Name of Person {s} or Organizations): Any person or organization where required by written contract (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to the endorsement.) Farh person or ornani7nfinn ,zhnwn in tha 54rhpdida is nn " insured" for 1 inhility f`nvarnna hwit nnhi to the avtnnt tha± to r_. __.. _."a..._._...�.., y ,,,, person or organization qualifies as an "insured" under the Who Is An Insured Provision contained in Section II of the Au �� vuvcragc CA 20 48 02 99 Copyright, Insurance Services Office, Inc., 1998 Page 1 of 1 Business Auto Policy #12001040 B. General Conditions 1. Bankruptcy Bankruptcy or insolvency of the "insured" or the "insured's" estate will not relieve us of any obli- gations under this coverage form. 2. Concealment, Misrepresentation Or Fraud This coverage form is void in any case of fraud by you at any time as it relates to this coverage form- It is also void if you or any other "in- sured". at any time. intentionally conceal or misrepresent a material fact concerning: a. This coverage form-, b. The covered "auto": c. Your interest in the covered "auto",- or d. A claim under this coverage form 3. Liberalization If we revise this coverage form to provide more coverage without additional premium charge, your policy will automatically provide the addi- tional coverage as of the day the revision is ef- fective in your state, 4. No Benefit To Bailee — Physical Damage Coverages We will not recognize any assignment or grant any coverage for the benefit of any person or organization holding, storing or transporting property for a fee regardless of any other pro- vision of this coverage form. 5, Other ins uranne, Primary a. F51-Ir any ',-om cov- Pflv a's amce For any covered "auto" you don't own, the in- surance provided by this coverage form is excess over any other collectible insurance. However, while a covered "auto" which is a "trailer" is connected to another vehicle. the L-fou'llLy ti,Vvvlovtz; U11;> %,VVV1C2V= ivilil Viv- vides for the "trailer" is: (1) Excess while it is connected to a motor vehicle you do not own eired "auta" pou crxn b. For Hired Auto Physical Damage Coverage, any covered "auto" you lease, hire, rent or borrow is deemed to be a covered "auto" you own. However, any "auto" that is leased, hired, rented or borrowed with a driver is not a covered "auto". c. Regardless of the provisions of Paragraph a. above, this coverage form's Liability Coverage is primary for any liability as- sumed under an "insured contract". d. When this coverage form and any other coverage form or policy covers on the same basis. either excess or primary, we will pay only our share- Our share is the proportion that the Limit of Insurance of our coverage form bears to the total of the limits of all the coverage forms and policies covering on the same basis. 6. Premium Audit a. The estimated premium for this coverage form is based on the exposures you told us you would have when this policy began. We will compute the final premium due when we determine your actual exposures. The estimated total premium will be credited against the final premium due and the first Named Insured will be billed for the bal- ance, if any. The due date for the final pre- mium or retrospective premium is the date shown as the due date on the bill. If the es- timated total premium exceeds the final premium due, the first Named Insured will get a refund. b, If this policy is issued for more than one year, the premium for this coverage form will be computed annually based on our rates or premiums in effect at the beginning of each year of the policy, 7. Policy Period, Coverage Territory Under this coverage form, we cover "accidents" and "losses" occurring: a. During the policy period shown in the Dec- larations: and b. Within the coverage territory. The coverage territory is: (1) The United States of America-, (2) The territories and possessions of the Unit- ed States of America� (3) Puerto Rico-, (4) Canada;and (6) Anywhere in the world if: (a) A covered "auto" of the private passen- ger type is leased, hired, rented or bor- rowed without a driver for a period of 30 days or less-, and (b) The "insured's" responsibility to pay damages is determined in a "suit" on the merits, in the United States of America. the territories and possessions of the United States of America, Puerto Rico or Canada or in a settlement we agree to. CA 00 01 03 10 (D Insurance Services Office, Inc„ 2009 Page 9 of 12 ACORDM CERTIFICATE OF LIABILITY INSURANCE 01 /15 /20 ) PRODUCER 310.328.3622 FAX 310.328.6054 Post Insurance Services, Inc. License #0551220 2356 Torrance Blvd. Torrance, CA 90501 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 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 # INSURED Quality Refrigeration Company Inc 45 Dappl egray Lane Rolling Hills Est, CA 90274 INSURERA: Hartford Fire Insurance Co 19682 INSURERS: American Longshore Mutual Assoc LIMITS INSURER C: INSURER D: INSURER E: rOVFRAC;FR 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDT TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MMIDDMI POLICY EXPIRATION LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ CLAIMS MADE F—] OCCUR MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ POLICY PRO ECT LOC J AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident) $ HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO $ AUTO ONLY: AGG EXCESS /UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR F-1 CLAIMS MADE AGGREGATE $ $ $ ]DEDUCTIBLE $ RETENTION $ WORKERS COMPENSATION AND 21WEOB45 71 04/01/2013 04/01/2014 X WC STATU- OTH- E.L. EACH ACCIDENT $ 1, 000, 90 A ANY `PROPRIETOR /PARTNER /EXECUTIVE LA STATE AL I E.L. DISEASE - EA EMPLOYEE $ 1,000,000 OFFICER /MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 OTHER SL &H ALMA00695 -03 04/01/2013 04/01/2014 Statutory B DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS hose usual to the Insureds operations. 0 day cancellation notice except nonpay /nonreporting which is 10 days. C Waiver of Subrogation attached as required by written contract. City of E1 Segundo City Clerk 350 Main Street Room 5 E1 Segundo, CA 90245 -3813 MV VRV LV %LVV 1 1VVl SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Dan Post. CIC /STACEY��TT IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25 (2001/08) 14 N 14 r4 0 0 O ri 0 0 L, sw THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF OUR RIGHT TO RECOVER FROM- - OTHERS ENDORSEMENT - CALIFORNIAN 13 'ii Policy Number: 21 WE OB4571 Endorsement Number: Effective Date: 04/01/13 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address: QUALITY REFRIGERATION COMPANY, INC. 45 DAPPLEGRAY LANE, ROLLING HILLS ESTATES, CA 90274 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 premium otherwise due on such remuneration SCHEDULE Person or Organization ANY PERSON OR ORGANIZATION WITH WHOM THE NAMED INSURED HAS AGREED BY WRITTEN CONTRACT TO FURNISH THIS WAIVER Countersigned by Form WC 04 03 06 (1) Printed in U S A Process Date: 04/08/13 2 % of the California workers' compensation Job Description Authorized Representative Policy Expiration Date: 04/01/14