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PROOF OF INSURANCE (2014) CLOSEDAgreement No. 4590 Advance Mechanical Contractors HLMOE-1 OP ID:T2 CERTIFICATE OF LIABILITY INSURANCE r DATE 03105/14(MM/DDtYYYY) 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 Phone: 626-535-8300 CONTACT Susan Pane _ United Agencies, Inc. T PHONE . mM®... ...... ...a PAX ICA License#0252636 Fax: 626-577-1346 [AJC,N oFttt3:626-535-8309 ���.?�Iw.6..26.5..77.. 1..3..46 301 E.Colorado Blvd.Ste.200 E-MAIL .. AoolESS s a r � T ,� a Cue"s Com Pasadena,CA 91101 Jim Stone INSURER(S)AFFORDING COVERAGE_ NAIC# INSURER A:James River Insurance Co. 12203 INSURED H.L.Moe Company,Inc. INSURER B:Navigators Insurance Co. 42307 DBA:John K. Keefe Company INSURER c:Liberty Mutual Insurance DBA:Advance Mechanical ...rance Co� _. ... Contractors,Inc. INSURER D:Chartis Specialty Insurance Co Mike Davis �. 614 W.Colorado Street INSURER E Glendale,CA 91204 INSURER F! COVERAGES CERTIFICATE NUMBER: 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 .. ....,_....... ..., _.....--- AN�DR wvn..... POLICY N.. ..POLICY EFF-- POLI�;Y EXia� I TR TYPE OF INSURANCE UMBER MMPDOFYYYY y M'WVNIDDFY'YYY. LIMITS _... GENERAL LIABILITY EACH OCCURRENCE $ 1,000,0 DAMAGE TYI N1Lla A X COMMERCIAL GENERAL LIABILITY X 000543621 08/01/13 08101/14 PREMISES!Ea SccXararelrtp—_ $ 50,00 � CLAIMS-MADE I,X OCCUR MED EXP(,Any one Person) $ ------ -- -- PERSONAL&ADV INJURY $ 1,000,000' GENERAL AGGREGATE $ 2,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP A G G $ 2,000,000 0 I=mp B POLICY X... LOO en. $ 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000, !Ea accident) $ .n e,-,..m....,... ,.. C X ANY AUTO BAA55812697 01/01/14 01/01115 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ --_ AUTOS AUTOS X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE. $ AUTOS ,IPeraccidentl UMBRELLA LIAB [,X]OCCUR EACH OCCURRENCE $ 10,000, B X EXCESS LIAB CLAIMS-MADE LA13EXC7550581V 08/01/13 08/01/14 AGGREGATE ." - ..._...,. $ 10,000,00.m._......0 D E D X RETENTION$ $ WORKERS COMPENSATION WC ST'AT'U- OTH- AND EMPLOYERS'LIABILITY Y/N JI TORY UMM U .. .... - ..." ..., ANY PROPRIETOR/PARTNER/EXECUTIVE [--] N/A E L,EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? "' (Mandatory in NH) E L DISEASE,,-_EA EMPLOYEE $describe under If DESCRIPTION OF OPERATIONS below E.L DISEASE POLICY LIMIT $ 7 D Pollution CP017662688 04/03/13 04/03115 Each Loss 5,0001, 0 Aggregate 5,000„00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) The City of E1 Segundo, its employees, officers, officials, agents & volunteers are included as Additional Insureds if required by contract as per form MC201OUS (09/12) and MC2037US (09/12) attached. Subject to policy terms, conditions & exclusions. 30 days NOC except 10 for non-payment of premium. CERTIFICATE(HOLDER 4. CANCELLA'TION' SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 14ry THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of El Segundo ACCORDANCE WITH THE POLICY PROVISIONS. Segundo, CA 90245 ”a ( � 350 Main Street EI Se � I + ' g AUTHORIZED REPR ESENTATIVE E ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD HOLDER CODE HLMOE-1 PAi3E 2 NOTEPAD: INSURED'S N�Amt H.L. Moe Company, Inc. OP ID:T2 DATE 03105/14 ....................... -— - -——----------I.I.- I-------------------- ................. terms,conditions&exclusions.30 days NOC except 10,for non-payment of premium. ...........--................ ............... THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS (SCHEDULED) - WHEN REQUIRED IN WRITTEN CONTRACT OR AGREEMENT; APARTMENTS AND ALL CONSTRUCTION OTHER THAN RESIDENTIAL DEVELOPMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY SCHEDULE Name Of Additional Insured Person(s) Covered Operations Or Organization(s): Where require _......_ .......... .._.................. _.. ......._..............."......................_........_..r'u'.................r`6j..c.._... ........... d by written contract or agree root All non-residential construction projects of the Named Insured �.w Information required to complete,this Schedule, if not shown above, will be shown in the Declarations. A. SECTION II—Who Is An Insured is amended to include any person or organization shown in the Schedule for which you are required to include as an additional insured on this policy by written contract or written agreement in effect during this policy period and executed prior to the'occurrence" of the"bodily injury" or"property damage." Coverage provided such additional insured is only with respect to liability for"bodily injury", "property damage"or"personal and advertising injury"caused, in whole or in part, by: 1.Your acts or omissions; or 2.The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s), providing that: "your work"or"your product' related to Covered Operations shown in the Schedule above, is other atfi ruslVential development' of any description. 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"property damage"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 insured(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. MC2010US 09-12 Page 1 of 2 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. C. For the purposes of this endorsement, the following is added to the Other Insurance Condition and supersedes any provision to the contrary: Primary and Noncontributory Insurance This insurance is primary to and will not seek contribution from any other insurance available to the additional insured designated in the Schedule, provided that: (1) The additional insured is a Named Insured under such other insurance; and (2) You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. The following definitions are added to SECTION V—DEFINITIONS of this policy: "Residential development" means a structure or structures, including the land upon which it is situated, designed or intended for occupancy in whole or in part as a residence by any person or persons. "Residential development"does not include"apartments"or"apartment buildings." "Apartments" means one or more rooms of a building used as a dwelling unit separate from others in the building and which are rented from others by those dwelling in them. "Apartments building" means a structure containing two or more separate"apartments." ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. Includes copyrighted material of Insurance Services Office, Inc., with its permission. MC2010US 09-12 Page 2 of 2 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS - APARTMENTS AND ALL CONSTRUCTION OTHER THAN RESIDENTIAL DEVELOPMENT- SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY SCHEDULE �. O Completed Operations �....._. Name Of Additional Insured Persons Covered Com lete Or Organization(s): Where required Ali q d by written contra i"r All non-residential construction projects of the agreement Named Insured Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. SECTION II—Who Is An Insured is amended to 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"property damage"caused, in whole or in part, by"your work", as described in the schedule of this endorsement performed for that additional insured and included in the"products-completed operations hazard"as described in the Covered Completed Operations, schedule above. B.The insurance provided to the additional insured under this endorsement is limited as follows: Covered Completed Operations shown in the schedule above shall not include"residential development"of any description. C. For the purposes of this endorsement,the following is added to the Other Insurance Condition and supersedes any provision to the contrary: Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution from any other insurance available to the additional insured designated in the Schedule, provided that: (1) The additional insured is a Named Insured under such other insurance; and (2) You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. D. The following definitions are added to SECTION V—DEFINITIONS of this Policy: "Residential development" means a structure or structures, including the land upon which it is situated, designed or intended for occupancy in whole or in part as a residence by any person or persons. "Residential development"does not include"apartments"or"apartment buildings." MC2037US 09-12 Page 1 of 2 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. "Apartments" means one or more rooms of a building used as a dwelling unit separate from others in the building and which are rented from others by those dwelling in them, "Apartments building" means a structure containing two or more separate"apartments," ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. Includes copyrig hted material of Instuence Services Office, Inc., with its pernlissjon MC2037US 09-12 Page 2 of 2 � DATE(MM/DDIY1'YY) AC� �. CERTIFICATE OF LIABILITY INSURANCE 3/6/2014 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(les)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 endorsements. CONTACT PRODUCER Bolton &Company NAME 3475 E. Foothill Blvd., Suite 100 Pasadena, CA 91107 (A/C_No,Exti- (626)799 7000 . (a�r,Na1 .. 626-583-2125 E-MANE nnDNES ' .................. (S)AFFORDING COVERAGE NAIC# ..... .............. INSURER,w,..,....� ......... .----.... .---......-- www.boltonco.com 0008309 INSURER A: HDI-Gerling America Insurance Comoanv 41343 ...... ......... ......... INSURED INSURER B: _ H.L. Moe Company, Inc. -- ...... --------------- DBA: John K. Keefe Company -INSURER C-: DBA:Advance Mechanical Contractors, Inc. INSURERD: 614 W. Colorado Street _ Glendale CA 91204 INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: 19434020 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 ....,.. pN cn SUB R POLIC.. .... .... PO LICY............ .......... ..------- -------- LTq TYPE OF INSURANCE EFF POLICY EXP "" Y NUMBER (MMIDDIYYYY) (MMIDDIYYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ ....— DAMAGE T15 RENTED . ._... . , .,.., CLAIMS-MADE OCCUR PrjFrullgr- (F rre ,) .... $ MED EXP(Anv one Derson) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ [:]POLICY 1:1 PRO- JECT LOG .PRODUCTS COMP/OPAGG OTHER: $ AUTOMOBILE LIABILITY COMOWED INGLE LEMtT $ ._ .. (Ea 0-;g den1) ANY AUTO BODILYINJURY(Perperson) $ --- ---- .._.................... ...................................... ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPEkTY DAMAGE r ap( nR).- $ HIREDAUTOS AUTOS „„$ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ ...... .$...... ........ A WORKERS COMPENSATION EWGCCO00121314 1/1/2014 1/1/2015 PER oTH- AND EMPLOYERS'LIABILITY _ crnrl irF ER ANY PROP RIETOMP6A;RITNCRIEXEC I'VC Y' NIA E L EACH ACCIDENT $ 1,000,000 OFRCEWMEM$ER EXCLUDED in I If as,describe under 1 000,000 UhSCRIPTiON nF)nPFRn,TNONS balowr E.L.DISEASE POLICY LIMIT IT $. ........ .....0 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) WC Waiver of Subrogation applies per WC040306484 attached. Job:Operations of the Named Insured. The Certificate of Insurance is subject to policy terms,conditions,limitations,and exclusions. CERTIFICATE HOLDER CANCELLATION Operations of the Named Insured Cit of EL Segundo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE g THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 35 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. EL Segundo, CA 90245 AUTHORIZED REPRESENTATIVE Matt Chase ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD CERT NO.: 1.9434020 Bo:l-ton Certificate Processing 3/6/2614 4:42:21 AM Page 1 of 2 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed.4-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT—CALIFORNIA We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be % of the California workers' compensation premium otherwise due on such remuneration. Schedule Person or Or anizaltion,, Job Description This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 1/1/2014 Policy No. EWGCC000121314 Endorsement No. Insured Insurance Company HDI-Gerling America Insurance Company H.L. Moe Company, Inc. Countersigned By 01998 by the Workers'Compensation Insurance Rating Bureau of California.All rights reserved. CFRT NO.: :1.9434020 HoLton Certificate Processing 3/6/2014 4:42:27. AN Page 2 of 2