Loading...
PROOF OF INSURANCE (2014) CLOSED ACO CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYW) L/1512014, 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 pollcy(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 NAME: Key Helmick Alliant Insurance Services, Inc. PHONE q JFAX 701 B Street,6th floor re/r�uo r en1,7Rn_"1n,d_7_&?1.... .. .- -�.w.. n.N«I� rO.. 4 ^. ..,., MAIL San Diego CA 92101 ADDRs11t(lTt18N1i8171. k11Y _... NAIC# w. ,S AFFORt�INC'�CG�VIE„m , A:VallPv Fnrr1P Inc,i,Jrnpce QQmnanv n5n� INSURE,R.... .� INSURED DOWNSER-01 .� , R INSURER B ('�nntmPntal Inc�iranrP(�mm�anv 59RA Downstream Services, Inc. INSURER C: 2855 Progress Place INSURER D: Escondido CA 92029 INSURER E INSURER F COVERAGES CERTIFICATE NUMBER:1064623616 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. INSR AOISL SUlki LIC POY EFF POLICY E%P LTR TYPE OF INSURANCE !N-SR WVn I POLICY NUMBER (MM!DDfYYYY1 (MM1DnnYYY1 LIMITS A GENERAL LIABILITY Y 'Y 2094163615 11115/2013 ...1/1512014 EACH OCCURRENCE $1.000.000' X COMMERCIAL GENERAL LIABILITY PRFMIRFS fFa nrrurranrPl $100 000 j N ...R .._-Fa ,. ,. q CLAIMS-MADE R X .I OCCUR MED EXP(Any one person) $5.000 PERSONAL BADVINJURY $1,000,000 j GENERAL AGGREGATE $2.000,000 _ ............................................................... _9f;'N1.AGGRE'.GATE.LIMIT APPLIES.PER: PRODUCTS-COMPIOPAGG $1,000,000 —1-POLICY X PR�7. LOC PD deductible $$5,000 B AUTOMOBILE LIABILITY Y Y 5091396971 /19/2014 1115/2014 1,000 OOn .... fFa arririanfl� A_., _......... X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED - SCHEDULED BODILY INJURY(Per accident) $ X HIRED AUTOS X NON-OWNED PROPER^'DAMAGE $ _...,,,.,., AUTOS $ . A X UMBRELLA LIAB X OCCUR 2094163629 11/15/2013 11/15/2014 EACH OCCURRENCE $1,000.000 EXCESS LIAR CLAIMS-MADE AGGREGATE $1 000 000 DED .X RETENTION$10.000 $ , WC U-WORKERS COMPENSATION y I OTH aT PR AND EMPLOYERS'LIABILITY Y 1 N , ANY PROPRICTORIPARTNER&-,XTC!U'rVVr l—j NIA A E L.EACH ACCIDENT $ r°dF''FICEMMEMBER EXCI..UDFO? ] .. ..... ......... (Mowlototy lei NH) E.L.DISEASE-EA EMPLOYE I" S"1 11 Ifyre.'r descrrkte tUl Idl'lr ,,.., .......... ,.�„h,... ���������,. I;dE..SCRIPT OWN OF OPERAT IONS.6elew E,L.DISEASE-POLICY LIMIT $ I I DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) I RE: MAINTENANCE AGREEMENT,CITY WIDE LOCATIONS INSTRUMENTATION MAINTENANCE.CITY OF EL SEGUNDO, ITS OFFICIALS AND EMPLOYEES ARE NAMED AS ADDITIONAL INSURED,WAIVER OF SUBROGATION APPLIES.30 DAY NOC APPLIES. i i CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CITY OF EL SEGUNDO ACCORDANCE WITH THE POLICY PROVISIONS. PUBLIC WORKS ` 350 MAIN STREET AUTHORIZED REPRESENTATIVE EL SEGUNDO CA 90245-3813 / ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD G-140331-A E INSURED: Downstream Services, Inc. (Ed. 01/01) POLICY NO. : 2494163615 IMPORTANT: THIS ENDORSEMENT CONTAINS DUTIES THAT APPLY TO THE ADDITIONAL INSURED IN THE EVENT OF OCCURRENCE, OFFENSE, CLAIM OR SUIT. SEE PARAGRAPH CA. OF THIS ENDORSEMENT FOR THESE DUTIES. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTRACTOR'S SCHEDULED AND BLANKET ADDITIONAL INSURED ENDORSEMENT WITH PRODUCTS-COMPLETED OPERATIONS COVERAGE This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: Designated Project: WHERE REQUIRED BY WRITTEN CONTRACT (Coverage under this endorsement is not affected by an entry or lack of entry in the Schedule above.) A. WHO IS AN INSURED (Section II) is amended to not in addition to,the Limits of Insurance shown Include as an insured any person or organization, in the Declarations. including any person or organization shown in the 3. The coverage provided to the additional insured schedule above, (called additional Insured) whom by this endorsement and paragraph f. of the you are required to add as an additional Insured on definition of "insured contraof under this policy under a written contract or written DEFINITIONS (Section V) do not apply to agreement; but the written contract or written "bodily injyry" cr_"prQp,@rt_y damage" ail log o rt, agreement must be: f r�� �� pl a erration hazard!$ " 1. Currently In effect or becoming effective during rnless required by the wten contract or the temp of this policy; and written agreement. 2. Executed prior to the "bodily injury," "property 4. The insurance provided to the additional damage,"or"personal and advertising Injury". insured does not apply to "bodily injury," "property damage,"or"personal and advertising B. The insurance provided to the additional insured is injury" arising out of an architect's, engineer's, limited as follows: or surveyor's rendering of or failure to render 1. That person or organization is an additional any professional services including: insured solely for liability due to your a. The preparing, approving, or failing to negligence specifically resulting from " WL prepare or approve maps, shop drawings, work" for the additional insured which is the opinions, reports, surveys, field orders, su6j ct of the written contract or written change orders or drawings and agreement. No coverage applies to liability specifications; and resulting from the sole negligence of the additional insured. b. Supervisory, or inspection activities performed as part of any related 2. The Limits of Insurance applicable to the architectural or engineering activities. additional insured are those specified in the written contract or written agreement or in the C. As respects the coverage provided under this Declarations of this policy, whichever is less. endorsement, SECTION IV — COMMERCIAL These Limits of Insurance are inclusive of, and GENERAL LIABILITY CONDITIONS are amended as follows: G-140331-A Page 1 of 2 (Ed. 01101) G-140331-A (Ed. 01101) 1. The following is added to the Duties In The f. We have no duty to defend or indemnify an Event of Occurrence, Offense, Claim or Suit additional Insured under this endorsement Condition: until we receive written notice of a claim or e. An additional insured under this "suit"from the additional insured. endorsement will as soon as practicable: 2. Paragraph 4.b. of the Other Insurance (1) Give written notice of an occurrence or Condition is deleted and replaced with the an offense to us which may result in a following: claim or'suit" under this insurance; 4. Other Insurance (2) Tender the defense and indemnity of b. Excess Insurance any claim or "suit" to any other insurer This Insurance is excess over any other which also has Insurance for a loss we nsu m n enaI- cover under this Coverage Part; and Insured-a"n-insuM wwhe er (3) Agree to make available any other excess, contingent or on any other insurance which the additional insured basis unless a written contract or has for a loss we cover under this written agreement specifically requires Coverage Part. that this insurance be either primary or primary and noncontributing. G-140331-A Page 2 of 2 (Ed.01/01) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AMENDMENT OF OTHER INSURANCE CONDITION INSURED: Downstream Services, Inc. POLICY NO. 2094163615 This endorsement modifies Insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. The following is added to provision a. Primary Insurance of paragraph 4.Other Insurance under SECTION IV— COMMERCIAL GENERAL LIABILITY CONDITIONS: However,when an additional insured has been added to this Coverage Part by attachment of an endorsement,we will not seek contribution from the "additional insured's own Insurance"provided that: (1) You and the additi al insured have agreed in a written contract that this insurance is primary and non- contributory; and (2) The"bodily injury"or"property damage"occurs, or the"personal and advertising injury"is committed, subsequent to the execution of such contract. B. For the purposes of this endorsement the following is added to SECTION V—DEFINITIONS: "Additional Insured's own insurance" means other insurance for which the additional insured is designated as a Named Insured. Iuclndes copyrighted material of Insurance Services Office,Inc.,with its permission. 22-111 (01107) Page 1 of 1 INSURED: Downstream Services, Inc. POLICY NUMBER: 2094163615 COMMERCIAL GENERAL LIABILITY CO 24 04 06 08 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: CITY OF EL SEGUNDO, ITS OFFICIALS AND EMPLOYEES Infom ation required',to complete this Schedule if not shown above will be shown in the Declarations.. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV—Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products- completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 06 09 0 Insurance Services Office, Inc.,2008 Page 1 of 1 O INSURED: Downstream Services, Inc. Policy No: 2094163615 111.42700907 THIS OMRSEMENT CHANGES THE POLICY.PLEASE READ ff CAREFULLY. CALIFORNIA CHANGES - CANCELLATION AND NONRENEWAL This vftraerwt mcdfies Insurance provided undet the following; CAPITAL.ASSETS PROGRAM(OUTPUT POLICY)COVERAGE PART COMMERf7IAL.AUTOMOBILE COVERAGE PART COMMERCIAL GENERAL LIABILITY COVERAGE PART COMMERCdAL INLAND MARINECOVMAGE PART COMMERCIAL.PROPERTY COVERAGE PART CRIME AND FIDELITY COV'ERAGTc PART EMPLOYMENT-RELATED PRAC nCES I.Mall-1TY COVERAGE PART EQUIPMENT BREAKDOWN COVERAGE PART FARM COVERAGE PART LIQUOR LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART PRODUCTSCOMPLETED OPERATIONS UABIL.ITY COVERAGE PART PROFESSIONAL-LIABILITY COVERAGE PART A Pamagra phs Z and 2.of tha Canreffedon Common (2) Dlscavery of fraud or materiel Poky Condban are replaced by the fallowing` misrepreaertitaticrt by. 2. AD PaHelAar In ii flat For 00 Days Or Laos (a) Any Insured or his or her It this pol!*has been In ~for 60 clays or represontoWe in obtainft this %so, and is not a renewal of a polls► we have insurance;or b pmvlot*issued,we may caramel this poll by (b) You or pour ritiprasan1a0ve in meting or delivering to ttm first Named Insured pursukV a daim under this policy. at#tie malling address shown in the policy and (3) A jW met by a court or an to the producer of retard,advance written notice edr irWrative tribunal that you have of cancellation, stating fttia reason for vi lead a California or Federsi law. cancellatiarti,at least havino as one of NN nwressary a. 110 days before the effective dale of sWro is an amt which' materially carmlfotion'lwocancelfor Increases arty of ft rim insured (1) NorrE ayff mt of prarniurn;or against. (2) Disc wery of freed by: (4) Diecovary of urllt A or grossly neogent (a) Any insured or his or ht+r Rots or omiesions, or of arty violations representative in obtaining this of std a laws or regtfttions aft Wishing safely sta ndwds, by you or your Insurance;or rapreaertifafivs, which materially (b) You or your mpnw4fdafiva in increase any of the risks insured _ pursuing a claim under this poky, against b. 30 days before ttm effeowe slate of (5) Fadlure by you or yaw naprasw tatnre to ca"ceilation if we cancel for any other ImpiwW1 reasonswe loss control reason. rowernm9k woo to by you as a pl. lUI IPalicia>o lkr l�ffaCt For flAorre Tlwrr 84 E3oara condition of policy Imuance, or which were conditions precedent to our use of a. If this poficy hale bw in effect for mm a park u* rate or raft plan, if that than 60 days,or Is a renewal of a poNay we failure ma hoidy inavasee any of the Issued,we may cancel this poft s>*upon risks["owed against. the occurrence, after the affactiva dais of (g) A deterrminoWn try ft C-m missionar e ft policy,of stria or More of Ute fotic�rrfnp: of lnsur Mm that the: (1) Nonpayment of premium, including payment due on a prior policy we (a) LOSS of, or ohanges In, our Issued Wd due alining tttie current rainswance coverft all or pad of paN4y term Covering to$am risks. NL 02 7'0 00131 Copyrtgfrt,ISO Properfies,Inc.,2006 Pads!Of 3 the risk would threaten our linanc W However, we shall cancel this policy t fits Integrity or solvency;or first Named Insured has accepted a now or (b) Continuation of the poilcy coverage renewal policy limned by the CEA that ,would, includes an earthquake policy prentiurn (l), Place violation of surcharge but falls to pay the earthquake California law or #fie laws of CEA.premium shtrohatrge authorized by ills the state where we are c, We ma not cancel such covers sole domiciled,or Y g° �` (l!} Threaten,or solvency. because carrosive sot conditions exist on #to prenvess. Tftls Reslnctton (o,) applies (7) A change by you or your reprowrieWe only if coverage Is strf W to one of the In the aoNvities or property Of tho iolow% which exclude loss or damage commercial or industrial enterprise, caused by or resWOM from corrosive soli which results in a materially added, aonditions: increased or o l ngsd risk, unless the (1) Ca 1 Assets am Coverage added, lrweased or changed risk is Fond((OuVut PoIW—. r included In the policy. Cornmerciel dY Coverage Part – b. We will mail or delhw advarics written � Pa Causes Of Lass-Special Form;or notice of cancellation,staling the reason for (3) Farm Coverage Bart– Causes Of toss cancalialion, to the ftrat Narned Insured, at the mailing address shown, In the policy, Form –Farm Property, Paragraph Q. wn, and to the producer of record.at least: Covered Causes Of lass dell, (1) 10 days before the effective cute of C• The fallowing is added mild ewpersod" any cancellation K we cancel for provisions b the contrary: nonpayment of pT&mlum or digoovery of NONRENEWAIL fraud;or 1. Subjed to the p harm of Paragraphs C.2. (2) 30 days before #A eihK*e date of and C.S. below, if we elect not to renew this cancellation If we cannel for any other policy, we will mail or deliver written notIce reason fisted in Paragraph 8.a6, stattng the reason for norverwmal to the first B. The following provision Is added to to Carmelliation Narned Inwzed shown in the Declarations and unman Pokey Condition: to lire producer of reowd, at least 60 days, but 7. 1 Ider01s1 not more than 120 days,before the expiration or � ► annivereary date. This pmtavWon applies to coverage on read We wig mail or deliver our notice to the first property which Is t4w predominantly for Named Ins ed. and to the producer of record. r r"purposes and consisting of not morn at the mailing address shown in the policy, than four dwelling units, and to coverage on 2. Residenl[W nts" household p l property in aY ntiai unit,If such coveme,Is wAtlen under This provision allies to covetous on real one of the following: properbr used pmdominantly for residential Cornmarcial Property Coverage Part Purposes and corgi of not more than four Farm Coven Part –farm dwelling units, and to c iwarage on tenant,,' Property –Farm household property contained in a residential Household Appurtenant Structures And unit~If such coverage is written under one of the i�auselhold Pers>snal Property Coverage Farm folkrwvirrg: b If such coverage has been in effect for 80 Capital Asset Program (Output Palley) days or lass, and is What a renewed of coverage we previously issued, we may Coverage Part cancel this coverage for any reason.except Comrrhercial Property Coverage Part as provided in b.and et.WOW. Farm Cmmage, Part –Farr, Property –Farm b. Ww may not cancel this policy solely Dwellings. Appurtenant Structures And because ft first Named Insured hw Wousohdd Personal Property Coverage Form (1) Ameptatl an offer of earthquake a. We may AW.'t not to renew such coverage coverage;or for any reason, except as provided in b.,a. and d.Wow: (2) Canceled or did not romwv a pokey b. We will not retwo to renew such coverage Issued by the Cattomia Earthquake riot because the first Named Insured has Authority (CEA) that Included an ac oopted an offer of earthquake policy prorrtium aurcfrarprt, aa►thquske cxweraQe- However, tfrs fakawirrg atpplies only, to insurers who are associate participating Pep 2 d 3 CoPydght,ISO Properties,Inc.,2006 IL 02 70 09 07 insurem as established by Cal. Ins. Coda included an earthquake policy premium Section 100136.16. We may elect not to surcharge, renew suob coverage after tho first Named d We will not'refuse to t~ouch coverage oft has accepted an o of solely. because owcslve soil conditions earthquake coverage, It one or mom of the exist on the premises. This Restriction (d.) fong reasons applies: applies only if coverage is subject to one of (1) The nonronewal is based on sound the following,which exclude loss or damage undwwriihtg prirrcgles that relate to the caused by or resulting tram corrosive soil coverages provided by this policy and conditions: that are consistent with tfta approved (1) Capital Assets Program Coverage raWg plan and related doodrrmo to filed Form(Output Policy); with the Departmem of Insurance as required by existing law; (�) Corrrrnrarciel Prcpergr Coverage Part - (2) The Commissioner of Insurance finds Causes Of Loss pedal Form;or OW the exposure to potential losses (3) Farm Coverage Part-Causes Of Loss wilt threaten our solver or place us It Form -firm Property, Paragraph D. a hazardous condition. A hazardous covered Causes Of Lase-Saedal. owdition includes,but Is not limited to, S. We are not required to send notice of a condition In which we make claims nonrenewal in flue following eiWations: payments for losses resulting fro rr an d, If the transfer or renewal of a policy, earthquake flat occurred within the l s, without preceding two yam and that required a Is chorus is totals, conditiana, dx rotas, reduction In policyhoidor surplus of at Is between us and a rnatnbar of our least 26%for payment of Itme dalrns; Insurance prcup, or b. If the poWy has been extended for tae days (S) We bava: ar lass.provided that notice has been given in accordance with Paragraph C.I. (A) trawl or socperi The a sut1elantiar o. It you have ollMned topiacement coverage, redaction m tre coverage; or or d the 1W Named Insured has agreed, In scope of raimsurx�nas coverage:ar writing,within 60 days of the termination of X (b) Bdpetienoad a substantial increase] the policy,to obtain that coverage, In the premium charged for d if the reMrsurance coverage of our Ply��a ie"0d of no more than minsantial propera insurance 60 days and you are noMed at the time of policies;and Issuance that It will not be renewed, file QMvY isskwW has approved a plan e. c the I not Named insured requests s for the nanreme�wals that � lair and ctra<tge In fine terms-or conditions or rises equitable, and that is responsive to the end of �the pperi WiUtih ti0 hays d1i the changes in cur reinsduarrae position. aloft at life po11C�r period. If we have a. We wig not refuse to redrew Rh coverage made a written offer to the:flrs uc t solely becakm the first Named Irwumd has beet rd Insured. in Paragraph the cwxxilled or did cad renew a policy, issued tirmelratrtres shown ht Paragraph term or by the California Earthquake Autlto*that c npw lhre policy under d urngerd iu mr; e, donditior+s or at an increased premium rate, when 1hs increase axoseds 26%. am W MOM IL alit?0 W ttI GopyriQilt,ISQ Properties,ft.,2006 Pugs 3413 CNA63359XX 0412 DOWNSTREAM SERVICES, INC. MR THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTRACTORS EXTENDED COVERAGE ENDORSEMENT - BUSINESS AUTO PLUS - This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM I. LIABILITY COVERAGE A. Who Is An Insured The following is added to Section II, Paragraph A.1.,Who Is An Insured: I. a. Any incorporated entity of which the Named Insured owns a majority of the voting stock on the date of inception of this Coverage Form; provided that, b. The insurance afforded by this provision A.1. does not apply to any such entity that is an "insured"under any other liability"policy" providing"auto"coverage. 2. Any organization you newly acquire or form, other than a limited liability company, partnership or joint venture, and over which you maintain majority ownership interest. The insurance afforded by this provision A.2.: a. Is effective on the acquisition or formation date, and is afforded only until the end of the policy period of this Coverage Form,or the next anniversary of its inception date, whichever is earlier. b. Does not apply to: (1) "Bodily injury" or "property damage" caused by an "accident" that occurred before you acquired or formed the organization; or (2) Any such organization that is an "insured" under any other liability "policy" providing "auto" coverage. 3. Any person or organization that you are required by a written contract to name as an additional insured is an "insured" but only with respect to their legal liability for acts or omissions of a person, who qualifies as an"insured"under Section II—Who Is An Insured and for whom Liability Coverage is afforded under this policy. If required by written contract, this insurance will be primary and non- contributory to insurance on which the additional insured is a Named Insured. 4. An "employee" of yours is an "insured" while operating an "auto" hired or rented under a contract or agreement in that "employee's" name, with your permission, while performing duties related to the conduct of your business. "Policy,"as used in this provision A.Who Is An Insured, includes those policies that were in force on the inception date of this Coverage Form but: 1. Which are no longer in force; or 2. Whose limits have been exhausted. B. Bail Bonds and Loss of Earnings Section Il, Paragraphs A.2.(2)and A.2.(4)are revised as follows: 1. In a.(2), the limit for the cost of bail bonds is changed from $2,000 to$5,000; and 2. In a.(4), the limit for the loss of earnings Is changed from $250 to$500 a day. C. Fellow Employee Section II, Paragraph B.5 does not apply. Such coverage as is afforded by this provision C. is excess over any other collectible insurance. II. PHYSICAL DAMAGE COVERAGE A. Glass Breakage—Hitting A Bird Or Animal—Falling Objects Or Missiles CNA63359XX 0412 The following is added to Section III, Paragraph A.3.: With respect to any covered "auto," any deductible shown in the Declarations will not apply to glass breakage if such glass is repaired, in a manner acceptable to us, rather than replaced. B. Transportation Expenses Section III, Paragraph AA.a. is revised, with respect to transportation expense incurred by you, to provide: a. $60 per day, in lieu of$20; subject to b. $1,800 maximum, in lieu of$600. C. Loss of Use Expenses Section III, Paragraph A.4.16. is revised,with respect to loss of use expenses incurred by you,to provide: a. $1,000 maximum, in lieu of$600. D. Hired "Autos" The following is added to Section III. Paragraph A.: 5. Hired"Autos" If Physical Damage coverage is provided under this policy, and such coverage does not extend to Hired Autos,then Physical Damage coverage is extended to: a. Any covered "auto"you lease, hire, rent or borrow without a driver;and b. Any covered "auto" hired or rented by your "employee" without a driver, under a contract In that individual "employee's" name, with your permission, while performing duties related to the conduct of your business. c. The most we will pay for any one "accident" or "loss" is the actual cash value, cost of repair, cost of replacement or$75,000, whichever is less, minus a$500 deductible for each covered auto. No deductible applies to"loss"caused by fire or lightning. d. The physical damage coverage as is provided by this provision is equal to the physical damage coverage(s) provided on your owned "autos." e. Such physical damage coverage for hired "autos"will: (1) Include loss of use, provided it is the consequence of an "accident" for which the Named Insured is legally liable, and as a result of which a monetary loss is sustained by the leasing or rental concern. (2) Such coverage as is provided by this provision will be subject to a limit of$750 per"accident." E. Airbag Coverage The following is added to Section III, Paragraph B.3.: The accidental discharge of an airbag shall not be considered mechanical breakdown. F. Electronic Equipment Section III, Paragraphs B.4.c and B.4.d.are deleted and replaced by the following: c. Physical Damage Coverage on a covered "auto" also applies to 'loss" to any permanently installed electronic equipment including its antennas and other accessories. d. A$100 per occurrence deductible applies to the coverage provided by this provision. G. Diminution In Value The following is added to Section III, Paragraph B.6.: Subject to the following,the"diminution in value"exclusion does not apply to: a. Any covered "auto" of the private passenger type you lease, hire, rent or borrow,without a driver for a period of 30 days or less, while performing duties related to the conduct of your business; and b. Any covered "auto" of the private passenger type hired or rented by your "employee" without a driver for a period of 30 days or less, under a contract in that individual "employee's" name, with your permission,while performing duties related to the conduct of your business. c. Such coverage as is provided by this provision is limited to a "diminution in value" loss arising directly out of accidental damage and not as a result of the failure to make repairs; faulty or incomplete maintenance or repairs; or the installation of substandard parts. d. The most we will pay for"loss"to a covered"auto" in any one accident is the lesser of: CNA63359XX 0412 (1) $5,000; or (2) 20%of the"auto's"actual cash value (ACV). III. Drive Other Car Coverage—Executive Officers The following is added to Sections II and III: 1. Any "auto" you don't own, hire or borrow is a covered "auto" for Liability Coverage while being used by, and for Physical Damage Coverage while in the care, custody or control of, any of your "executive officers,"except: a. An"auto"owned by that"executive officer"or a member of that person's household; or b. An "auto"used by that"executive officer"while working in a business of selling, servicing, repairing or parking"autos." Such Liability and/or Physical Damage Coverage as is afforded by this provision. (1) Equal to the greatest of those coverages afforded any covered "auto"; and (2) Excess over any other collectible insurance. 2. For purposes of this provision, "executive officer" means a person holding any of the officer positions created by your charter, constitution, by-laws or any other similar governing document, and, while a resident of the same household, Includes that person's spouse. Such "executive officers"are"insureds"while using a covered "auto"described in this provision. IV. BUSINESS AUTO CONDITIONS A. Duties In The Event Of Accident,Claim,Suit Or Loss The following is added to Section IV, Paragraph A.2.a.: (4) Your "employees" may know of an "accident" or "loss." This will not mean that you have such knowledge, unless such "accident"or"loss" is known to you or If you are not an individual, to any of your executive officers or partners or your insurance manager. The following is added to Section IV, Paragraph A.2.b.: (6) Your "employees" may know of documents received concerning a claim or "suit." This will not mean that you have such knowledge, unless receipt of such documents is known to you or if you are not an individual, to any of your executive officers or partners or your insurance manager. B. Transfer Of Rights Of Recovery Against Others To Us The following is added to Section IV, Paragraph A.5.Transfer Of Rights Of Recovery Against Others To Us: We waive any right of recovery we may have, because of payments we make for injury or damage, against any person or organization for whom or which you are required by written contract or agreement to obtain this waiver from us. This injury or damage must arise out of your activities under a contract with that person or organization. You must agree to that requirement prior to an"accident"or"loss." C. Concealment, Misrepresentation or Fraud The following is added to Section IV,Paragraph B.2.: Your failure to disclose all hazards existing on the date of inception of this Coverage Form shall not prejudice you with respect to the coverage afforded provided such failure or omission is not intentional. D. Other Insurance The following is added to Section IV, Paragraph B.5.: Regardless of the provisions of Paragraphs 5.a. and 5.d. above, the coverage provided by this policy shall be on a primary non-contributory basis. This provision is applicable only when required by a written contract.That written contract must have been entered into prior to"Accident"or"Loss." E. Policy Period, Coverage Territory Section IV, Paragraph B. 7.(5).(a). is revised to provide: a. 45 days of coverage in lieu of 30 days. V. DEFINITIONS Section V. Paragraph C. is deleted and replaced by the following: "Bodily injury" means bodily injury, sickness or disease sustained by a person, including mental anguish, mental injury or death resulting from any of these. AC CERTIFICATE OF LIABILITY INSURANCE m"`' " � 1 0 DATE(MMIDD 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 Beecher Carlson Insurance Services CONTACT NAME: RApn:hpr ClnrlSnn InSIIrAnr:A Anrvlrac 21650 Oxnard Street, Suite 1600 wa `. x .Y A Woodland Hills, CA 91367 PHONE IAI[ N F e1 St1R SaR-49nn FAXlAICA No) A1A-s a0-5Ron F-MAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A ACP Amprinnn InSllranf`P Co. A+XV w Barrett Business S.:. _... ... - - o . INSURE NE Parkway, Re. - I Services, Inc. Vancouver WA 98662 te 200 INSURER c . INSURE _ . ..,. . INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: 19297195 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. �......, IpYSR.,,.... .. ,,.ADDL SU9R ...------- ----..... .........POLICY JEFF ' POLICY EXP .... LIMITS LT•,R TYPE OF INSURANCE use unm POLICY NUMBER fMMInn.hrr Y1 !MM/ODIYYYYI GENERAL LIABILITY EACH OCCURRENCE $ DARMEMA ISE ES T O!E RY a EooNnce cT uEpl7D COMMERCIAL GENERAL LIABILITY �CLAIMS-MADE [ ]OCCUR eer P ERSONA &ADV INJURY $ GENERAL AGGREGATE $......... ...... ....... GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ ....,I POLICY PROs LOG $JErIT AUTOMOBILE LIABILITY G:�MStlNPO SING LE LIMIT a acedplemwt) $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED ' SCHEDULED BODILY INJURY(Per accident) 'AUTOS AUTOS $ NON-OWNED PROPERTY DAMAG E - -- HIRED AUTOS AUTOS (Per accident) $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ ........ .. .... f EXCESS LIAB AGGREGATE $ CLAIMS MADE _....... - _ DED --- RETENTION$ $ WORKERS COMPENSATION WCSTATU- OTry- �1•�_nnn_ -- --•L' A WCLC47118219 12/1/2012 1/1/2015 Tn1RYl_IMIT.R ✓ ER AND EMPLOYERS'LIABILITY Y/N `--`—' --------. ANY PROPRIETOR/PARTNER/EXECUTIVE """"" E.L.EACH ACCIDENT OFFICERIMEMBER EXCLUDED? NIA AC C $ .2.000,000--- -- (Mandatory in NH) E L DISEASE-EA EMPLOYEE'. $ n0f1 M0. If yes,describe under Covered states: -- 2,_-9 DESCRIPTION OF OPERATIONS below CA,;DE,,OR,;WA E.L.DISEASE-POLICY LIMIT $ 2,000.000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Sebodute,if more space is required) In the event of any payment under this policy for a Loss for which the named insured has waived the right of recovery in a written contract entered into prior to the Loss,insurer hereby agrees to also waive our right of recovery but only with respect to such Loss. sall-ins r : r r)i n CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE This Section Intentionally Left Blank THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE (WDHLS)Pam Brooskin ©1988-2010 ACORD CORPORATION. All rights reserved,. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD CE':RT NO 1%1,97195 (VIDTH's) Raheri. ;c:k:.wa xtx 2/20/201A 4:I39:::03 PkI Pe.q. 1 u$ :I- 902838 A Hmm R ce April 14, 2014 DOWNSTREAM SERVICES, INC 2855 PROGRESS PL ESCONDIDO, CA 92029-1516 Re: Barrett Business Services, Inc. ("BBSI") Letter of Self-Insurance for Workers' Compensation Coverage For DOWNSTREAM SERVICES, INC, CSLB license number 807953 As the named addressee of this Letter, your company's required workers'compensation coverage is provided through BBSI's state approved Self-Insured Workers' Compensation Plan. As a party to a co-employment contract with BBSI, which is effective from 1/1/2014 until 12/3112014, California Labor Code §3602 allows DOWNSTREAM SERVICES, INC to obtain its workers'compensation coverage from BBSI. BBSI's California customers can also verify BBSI's state certification at http://www.dir.ca.gov/osip/PrivateRoster.pdf;then scroll down to Barrett(the list is alphabetical by company name). Additional in(ormati n is as follows: State: California Workers'Compensation Limits: Em�yer L bility Limits:. Self Insurance Certification #: 2246 Statutory $5,000,000.0 Each Accident $5,000,000.0 Disease Coverage Limit by Client $5,000,000.0 Disease; Each Employee Notice of Termination: In the event the contract between BBSI and DOWNSTREAM SERVICES, INC is terminated, BBSI must provide notice of the termination within seven (7)days to the California Contractors State License Board ("CSLB"). Other Comments (place an "X" if applicable): o SERVICES, INC agree to waive their right of subrogation benefit f: Waiver of Subrogation: BB I and D DOWNSTREAM M for the City of El So undo- Public Works it's officers and em to ees at"All O erasions" X Named"Letter Holder": City of El Segundo- Public Works, it's officers and employees 350 Main Street El Segundo, CA 90245 ® Other: "All Operations" Additionally, BBSI's self-insured program is further supported by an excess workers'compensation insurance policy with ACE American Insurance Co. Copy of certificate is available upon request. For additional information, please contact your local BBSI office at: TEMECULA (951)296-3770 _.. One Ridge Gate Drive Suite 100 Temecula, CA 92590 Very truly yours, doe:Lasl-3 Michael L. Elich President and Chief Executive Officer