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PROOF OF INSURANCE (2013) CLOSEDACOR" CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DD/YYYY) 8/21/2013 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 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 Alliant Insurance Services, Inc. B Street, 6th floor San Sa n Diego CA 92101 CONTACT NAME: Barbara a/CONN Ext :619- 849 -3752 I a/c No :619- 699 -2144 E-MAIL D R DSS:bmeneese alliant. om 2094163615 11/15/2012 1/15/2013. INSURER(S) AFFORDING COVERAGE NAIC # INSURER A:Valley Forge Insurance Company. 0 MED EXP (Any one person) INSURED DOWNSER -01 INSURER B:C n inental Insurance Company 5289 INSURER C: Downstream Services, Inc. 2855 Progress Place Escondido CA 92029 INSURER 0: PRODUCTS - COMP /OPAGG $1,000,000 P deductible $$5,000 INSURER E: AUTOMOBILE INSURER F: Y COVERAGES CERTIFICATE NUMBER: 1025855360 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILLTR TYPE OF INSURANCE NSR S WVD POLICY NUMBER MY M/DD/Y)D POLICY EXP MMIDD/YYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 1XI OCCUR Y 2094163615 11/15/2012 1/15/2013. EACH OCCURRENCE $1,000,000 PREMISE S S DAMAGE ( RENTED Ea occurrence ) $100,000 MED EXP (Any one person) $5,000 PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X PRO- LOC PRODUCTS - COMP /OPAGG $1,000,000 P deductible $$5,000 B AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS X AUTOS ED Y 5091396971 /19/2013 /19/2014 • BI E IN LE I Ea accidenn t �• $1,000,000 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ X PROPERTY DAMAGE $ 0111 $ A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE 2094163629 11/15/2012 1/15/2013 EACH OCCURRENCE $1,000,000 AGGREGATE $1,000,000 DED X I RETENTION $10,000 $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR /PARTNER /EXECUTIVE OFFICER /MEMBER EXCLUDED? ❑ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA WC STATU- OTH- TORY LIMITS ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) See attached letter for Proof of Workers' Compensation coverage 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+CK I Irll.A I C t1VLUCK _ T' UANLaLLA I IUN V4 i� CITY OF EL SEGUNDO ��, XV u; PUBLIC WORKS `r` ' 350 MAIN STREET v' ;J 1 EL SEGUNDO CA 90245 -3813 i 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 ©1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD INSURED: Downstream. Services, Inc. POLICY NUMBER: 2094163615 COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OFF 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: Information 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 1V — 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 05 09 C Insurance Services Office, Inc., 2008 Page 1 of 1 13 INSURED: Downstream Services, Inc. Policy No: 2094163615 IL 09 70 0 07 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT C AREFULLY. CALIFORNIA CHANGES - CANCELLATION 9�' AND NONRENEWAL n`v This endorsement modifies insurance provided under MefollovAng: CAPITAL. ASSETS PROGRAM (OUTPUT POLICY) COVERAGE PART COMMERCIAL AUTOMOBILE COVERAGE PART COMMERCIAL GENERAL LIABILITY COVERAGE PART COMMERCIAL INLAND MARINE COVERAGE PART CCIM RCIAL PROPERTY COVERAGE PART CRIME AND FIDELITY COVERAGE PART EMPLOYMENT-RELATED PRACTICES LIABILITY COVERAGE PART EQUIPMENT BREAKDOWN COVERAGE PART FARM COVERAGE PART LIQUOR LIABILITY COVERAGE PART POLLUTItON LIABILITY COVERAGE PART €'RtiDUGTSICOMPLETED OPERATION$ UASILITV COVERAGE PART PROFESSIONAL LIABILITY COVERAGE PAIN A. Parap*hs 2 and 3. of tha Cancaffaflan Common (2) Discovery of fraud or material Policy Condition are replaced by the F;oflmvinV by. 2. AN Polkios In Effed For 60 Days Or less (a) Any Insured or his or her If this policy has been in effect for 60 days or representative in obtaining this loss, artd is not a renewal of a policy we have Insurance; or previously issued, we may cancel this policy by (b) You or your representative in miming or delivering to the fiW Named InsufW pu ;suing a Bairn under this policy. at the mailing address shown in the policy and { } A judgment . a court or an to the producer of record, advance written notice administrative tribunal that have have of canGellatlon, stating ft reason for er V€olatod a �Ilfomfa cx Federal law, Cancellation, at least: having as ort9 of ils mcessary a, 10 cats before the effective date of elemards an act which materially canceffatioan if wG camel for- increases any of the risks insured (t ) Nonpayment of promiuml or against. ( } Discovery of fraud by. (4) i?iscovary of willful or grossly negligent acts or omissions, or of any violations (a) Any insured or his or her of stets €arvs or ragulations establishing representative in obtaining this safety standards, by you or your insurrancs; or reprew1utive. Which materially (b) You or your represertative in incraose, any of the risW insured pursuing a claim under this policy, against. b. ail days before the effective date of (S) Failure by you m your representative to ; cancellation if we camel for any ortlw IIm�p�l�eme\nt{{ rea abie�y loss control reason. you .3�Kfire7 ants,, agreed to by you as a 1�Ik Ixolfcf Ilri IEfie t For Ilse 7�taei 84 Days Condition of policy issuance, or which ware conditions precedent to our tale of a. 0 this policy has bean in sfheot for more a. particular rate or rating plan, If that than 60 days, or is a rwowal of a policy we failure materially increases any of the Issued, vre may cancel this pahicy Only upon Asks InsurW against. the occurrence, after the effectiva date of (B} the Commissioner tlta € icy, of one or more of the €atlo*Ang: of it a oe Vim ft: (i) Nonpayment of premium, includng {a) Lass of, or �anr�es in, our �— payment slue on a P� policy we reinsurance covering all or part of Issued anti due during ft current policy term covering the sane risks. II., 02 70 09 07 COpyrkjd, ISO ProWies, Inc., 2006 F"e # fit« 3 the risk would thmaten out limnei € However, ate shall canal this policy if the Integrity or solvency; or firsi lamed Insured has accepted a new or (b) Continuation of to poflcy coverage resmal policy issued by the CEA that would: includes an earthquake policy prcatrilurm (i} Place us in violation of surcharge but fails to pay the earthquake California lave at His laws of policy premium surcharge authorized by the +CEA. the StEtl, Where YtB are darnle €teal; or C. Wa may not cancel such covore sole Y � • h' (II) Threaten our solvency. because corrosive sorb conditions axis; on #h;a promises. This € ewnction (c,) applies (n A change by you or your representative only if coversigs is subject to one of the In the activities or property of tho iollowing, which exclude loss or damage commercial or industrial enterprise, caused by or resulting from corrasfve sofl which results In a materially added, tonditions: increased or changed lido, unless tho (1) Capital Assets Program !Coverage added, increased or changed risk is Form (Output Fa14); included in the ptAicy. #t. Mile will mail or deliver advance written (2� Gcntmerc�iai i�r�aperty Coverage Part — Causes Of Loess - Special Forth; or notice of canoe €lation, stating the reason for cancellation, to the first Named Insured, at ss (g) Farm Coverage Part Causes Of Lass the mailing address shomi In the policy, Form —Farm Property, ope�r, D. ancf to the producer of record, at least: Covered Causes Of hues -Sp ial, (1) 10 days before the effective date of C• The following is added and supetWas any cancellafon R we cancel for provisions to the contrary: nonpayment of premium or discovery of NONRENEWAL fraud; or 1. Sub ec# Ito the provisory of Paragraphs C2, (2) 30 days before the effective date of and CA. below, if we elect not to renew this cancellation If we cancel for any oftr policy, we wilt mail or deliver written notice reason fisted in Paragraph 9.& stating ttte reason for momenewal to the first B. The IbMwing provision is added to the Cancelathm Named Insured shawn in the Declarations and Coalition Policy Condition: to llte producer of record, at toast 80 days, but T. R Mdsrtl€la# Property not rnoro than 12D days, botom the oxpirafion or anniversary date. This provision applies to coverage on teat property which is rased predominantly for We will mail or deliver our notice to the first res##tiarttial purposes and consisting of n X morn Namod Insurod. and to the producer of record, at the m3ailfiV address shawl in the policy. . than four dwelling units, and to coverage on grits' household Personal property in a 2. Ff ermal FE oP�Y reWenfial unit, 9 such coverage 14 wtitten under This provision applies to coverage on real one of the following: prop" used prodominarrily for residential Comrrnarcial Property Coverage Part purposes and cDnsistinp of not more than four Farm Coverage Part —Fam Property —Farm dwelling units, acrd to cxworags on tenants" household property contained in a residential Dwellings, Appurtenant Structures And Household PersDnal Prop" Coverage Farm unit, It such coverage is written under one of rho following: fatl4svirig: a. If such coverage has been in effect for go days or less, and is not a renewal of Assets F'ragratrr (output Policy) coverage we previously issued, wo may Goverage Part cancel this coverage for any reason, except Commercial Property Coverage Part as proviled in fs and c, Wow. Farm Coverage Par# -Farm Property —Farm lie. We may not carrel this policy solely dwellings, Appurlentant Structures And Houaohold Personal Property Coverage Farm Because the first Named Insured has: (1) Arcapted an offer of oarthquako e. We may elect not to renew such coverage coverage, or for any reasam, except as provided in b., c. and & below: (2) Cancelled or dd not renew a policy Issued by the California Earthquake b. We will not refuse to renew such coverage Auilhor#ty (GFA) that Included an soeey bemuse the First Named Insured has earthquake policy preri�um surc�iarge, a� � offer of earttiqui�Cie coverage. However, the following applies only to insurers who are associate pt W-1 ting Page 2_ of 3 Copyright, ISO Properties, Inc,, 2006 IL 02 70 09 07 insurem as established by Cal. Ins. Code inr;ltxW an earthquake policy premium motion t 0089,16. We may elect not to surcharge. renetrr such overage after the first Named d. We vAll not refuse to rortew suoh ooverage Insured has accoptod an offer of solwy, because r orroshm Soil conditions eat"cake coverage, if one or mom of the exist on trra premises. This Restriction (d.) following reasons applies: applies Only If coverage is subject to one of (1) The nunrenewal is basod on sound the following, which exclude toss or damage underwriting prirtciples that relate to the caused by or resulting from corrosive sail coverages provided by this policy and conditions: that are consistent with the approved (1) Capital Assets Program coverage rating plan and ralated docursatft tllod Form (Output Policy); with the Deparknent of Insurance as required by existing law- (2) Commercial Property Coverage Part -- Causes Of Loss pedal I*arm; or a 42) The Commissioner of Insur nm finds that the exposure to potential tosses {s} Farris Coverage Pad - Causes Of Loss W11 threaten our solverscy or place tits In Form --Farm Property, Paragraph D. a hazardous condition. A hazardous Covered Cactses Of Loss - Spacial. condition inc ludes, but is not limited to. We are not required to send notice of a condition in which we make - claims nonrenewal in ft fallowing situations: payments for losses resulting #runt an a. if the transfer or rarlMal of a policy, without eanhquaka f#taf occurred Within the any changes In terms. conditions, or rates, preceding two years and that required a Is between us and a member of our reduction in policyholder surplus of at Insurance soup. least 25% for payment of those ctalms; or b, If the policy has been extended for 90 days or less, provided that nadce has been given (3} We #gave: in accordance with Paragraph CA. (a) frost or oxparionod a substantial c, If you have obtained tepkmement coverage, reductions in rte availabilily or or t tho first Named Insured has agreed, In scope of rainssrrmsaae coverage; or writing, within 60 days of the termination of (b) Exporienmd a subsUntial increase the policy, to obtain that coverage, it the premium charged for +d. if the policy is far a period of no more than reinsurance coverage of out residential property itNurance 60 days and you are noUlod at the time of policies; and issuance that it wig not t* renewed. the Comrrt ssioner hies approved a plan a. If the first Named insured requosts a aharW in the tserrus -tar cordtlons or risks for the nvnrenewals that is fair and covered by the policy vtithih 00 days of the equitable, and that is responsive to the end of the policy parlor. changes in our minsura ace position. f. It we have made a written offer to the .-first a. We will not refuse to renew such coverage has Nerved Insured, in accordanoe with the sorely betmuse the first Named Insured timetrames shown in Paragraph; C.1., to cancelled or did not rersew a policy, i d ranow the policy under changed terms or by ti'te California Earthquake Authority that conciifions or at an increased premium rate, when the increase exoseds 26%. IL 92 70 09 07 Copyright, 180 Properties, lrc., 20El6 PW 3 01 3 CNA63359XX 0412 DOWNSTREAM SERVICES, INC. CA!fA 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 COV RR E ORM 1. LIABILITY COVERAG' A. Who Is An Insured -- The following is added to Section 11, Paragraph A.1., Who Is An Insured: 1. 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.I. 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 11— 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 II, 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 11, Paragraph B.5 does not apply. Such coverage as is afforded by this provision C. is excess over any other collectible insurance. 11. 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 AA.b. 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 111, 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). 111. 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.: (B) 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.S.: 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. INSURED: Downstream Services, Inc. POLICY NO.: 2094163615 G- 140331 -A (Ed. 01/01) IMPORTANT: THIS ENDORSEMENT CONTAINS DUTIES THAT APPLY TO THE ADDITIONAL INSURED IN THE EVENT OF OCCURRENCE, OFFENSE, CLAIM OR SUIT. SEE PARAGRAPH C.'I.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 CANT CT (Coverage under this endorsement is not affected by an entry or lack of entry in the Schedule above.) A. WHO IS AN INSURED (Section 11) 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 contract" under this policy under a written contract or written DEFINITIONS (Section V) do not apply to agreement; but the written contract or written "bodily injury" or "property damage" arising out agreement must be: of the "products- completed operations hazard" 1. Currently in effect or becoming effective during unless required by the written contract or the term 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 "your prepare or approve maps, shop drawings, work" for the additional insured which is the opinions, reports, surveys, field orders, subject 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. 01/01) 1. The following is added to the Duties In The Event of Occurrence, Offense, Claim or Suit Condition: e. An additional insured under this endorsement will as soon as practicable: (1) Give written notice of an occurrence or an offense to us which may result in a claim or "suit" under this insurance; (2) Tender the defense and indemnity of any claim or "suit" to any other insurer which also has insurance for a loss we cover under this Coverage Part; and (3) Agree to make available any other insurance which the additional insured has for a loss we cover under this Coverage Part. G- 140331 -A (Ed. 01101) G- 140331 -A (Ed. 01/01) f. We have no duty to defend or indemnify an additional insured under this endorsement until we receive written notice of a claim or "suit" from the additional insured. 2. Paragraph 4.b. of the Other Insurance Condition is deleted and replaced with the following: 4. Other Insurance b. Excess Insurance This insurance is excess over any other insurance naming the additional insured as an insured whether primary, excess, contingent or on any other basis unless a written contract or written agreement specifically requires that this insurance be either primary or primary and noncontributing. Page 2 of 2 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ,y` .;, P AMENDMENT OF OTHER INSURANCE CONDITION r `'{` {�' ; ;` -J INSURED: Downstream Services, Inc. POLICY NO. 2094163615E §' Au� ry This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART e'+ 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 additional 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. includes copyrighted material of Insurance Services Office, Inc., with its pennission. 22 -111 (01 /07) Page 1 of 1 %e ` CERTIFICATE OF LIABILITY INSURANCE +� � -" ttft 717i'147 THIS CERTIFWATE IS ISSUED AS A. MATTER OF INFORMATION ONLY AND CONFERS NO R1GfM UPON THE CER71F1CATE HOLDER. TM CERTIFICATE DOES NOT AFR011A.TIVELY OR NEGATIVELY AMEND, MEMO OR ALTER THE COVERAGE AFFORDED BY THE POt.IC1ES BELOW THIS .CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORUED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLIER_ OVORTANT_ tI he iitiEiWbDkWr % an ADDITIONAL INSURED, 11fm poft%faa) meet 1* ondo ed. B SU13ROBATION 15 WAIVED. subject bre.tetme enA Cwtsl11C1►a W th8 {wSCX. Cwialn poliaias Slay rasplln �I 8ndsxearllar►t A at8�8rilaTlt oo thle cBTtRleete tloa�.11ot CoTtiar 1 tQ ills G81f1#1s�81wlder � Tea oT sTx�# 81#dllaeelamtlsj. FiYDfi-b -1m Beecher Carlson Insurance Services 21700 Oxnard Street Suite 1800 Woodland Hills, CA 01387 wwwr.GeedwcaMorr.oarn to"&= rAr� RI�iNE Na 818 S4E -d2uu . r r 818;598 680 e4"m I�IrwEr�atARTnReawaaaiersAOa rArer p{llireFaAe ACEAmeAc3l CO. Barrett Business SerV.. 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UM23n rW= P 4LffiJ PLQ3 -hy Uf32f=32. 2.CG.22 RI 2.9. 3 ¢t 1 doc: C0I -3 EBEI A Human Resource Management Company August 21, 2013 DOWNSTREAM SERVICES 2855 PROGRESS PL ESCONDIDO, CA 92029 -1516 Re: Barrett Business Services, Inc. ( "BBSI ") Letter of Self- Insurance for Workers' Compensation Coverage For DOWNSTREAM SERVICES, CSLB license number 807953 812400 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 1/1/2013 until 12/31/2013, California Labor Code §3602 allows DOWNSTREAM SERVICES 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 informatiop is as follows: State: California Employer Liability Limits: Self Insurance Certification #: 2246 $5,000,000.00 Each Accident $5,000,000.00 Disease Coverage Limit by Client $5,000,000.00 Disease; Each Employee Notice of Termination: In the event the contract between BBSI and DOWNSTREAM SERVICES 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): Waiver of Subrogation: BBSI and DOWNSTREAM SERVICES agree to waive their right of subrogation for the benefit of: City of El Segundo, its officials and employees at "City Wide Locations — Maintenance Agreement — All Operations" Named "Letter Holder ": City of El Segundo, its officials and employees — Public Works 350 Main Street El Segundo, CA 90245 ® Other: "All Operations — Note: 30 day Notice of Cancellation" 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, .�"doc: LOSI -3 Michael L. Elich President and Chief Executive Officer