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PROOF OF INSURANCE (2015) CLOSEDMarx Bros Fire Extinguisher Co., Inc. Agreement No. 4631 AC"REP'S #/' OATE(MM/DDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 3/21/2014 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 policy(ies)must be endorsed. If SUBROGATION IS WANED,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 endomement(s). TRI WORLD INSURANCE AGENCY INC � _ ,_ N SHERLOCK ) PRODUCER HELEN p AD RESS I°she 4500 Campus Drive # 670 756-1356 I�locitlMT�,wor�,cjln,s co 9) Newport Beach, CA 92660-1830 INSURER(S) AFFORDING COVERAGE NAICN JAMES RIVER INSURANCE CO.INSURER A: A—IX 12203 INSURED MARX BROS. FIRE EXTINGUISHER CO. R���DEMN " 1 XI • INSURER B• & COOK FIRE EXTINGUISHER, A DIV. OF MARX INSURER C 0u 'ION'-PROF_"-&--CA-S=r _ A . _ 1159 S. SOTO INSURER D �. LOS ANGELES, CA 90023 INSURER E. 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, HAVE BEEN REDUCED BY PAID CLAIMS. EXCLUSIONSAN�OF NSIURANCEOF SUCH mmmIT m It1aR �v,A NUMBER N OO LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000/ R� 50,000 X COMMERCIAL GENERAL LIABILITY PREd!Ag9F3 tFa rxcsxrnrerlce $... CLAIMS-MADE OCCUR -5,000 OOO A X OCP X 00052508-2 03/26/14 03/26/15 ERSONAL&ADVINJURY 3 r one person) S 1 000, x $5000 Ded/Occ -,.., � � � y 2,000,000 OCC PRODUCTS GENERAL AGGREGA GEN'L AGGREGATE LIMIT APPLIES PER: COMP/2P S 2,OOO, OOO POLICY $ AUTOMOBILE LIABILITY Ea accdeni) S ANYAUTO $ BODILY INJURY(Per person),. .^ ......... . ALL AUTOS AUTOS D �arOaL URY(Per accdent) $ mm AUTOS ]AUTOS. S UMBREL OCCUR 4,000,000 B Exc�SL A LIAR X., NRA235131 03/26/14 03/26/15 EACH OCCURRENCE $ 4,000,000 IMS MADE AGGREGATE $ DED ETENTIO NS PRODUCTS/OPS $ 4,000,000 WORKERS COMPENSATION X W ' AND EMPLOYERS'LIABILITY E.L.DISEASE-FJ1 EMPLOYE $ 11000,000 ANY PMPLO TORS'LIABILITY ERIEXECUTIVE YIN CPCA16804-04 02/18/14 02/18/15 E..L.EACH ACCIDENT S 1,000,000 OFFICERIMEM13ER EXCLUDED? NIA (Mandatory in NH) M E. describe tnlder E.L DISEASE-POLICY LIMIT S 1,000, 000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Atladh ACORD 101,Additional Remarks Sdwdule,if more spece Is required) ALL OPERATIONS - SERVICE AGREEMENT CITY OF EL SEGUNDO, ITS EMPLOYEES, REPS, OFFICERS AND AGENTS ARE ADDITIONAL INSURED PER ATTACHED ENDORSEMENTS. WORK COMP WAIVER OF SUBROGATION ENDORSEMENT ATTACHED. THIRTY (30) DAYS NOC APPLIES TO ALL LISTED POLICIES. CERTIFICATE HOLDER CANCELLATION CITY OF EL SEGUNDO SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ATTN CITY CLERK THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 350 MAIN STREET ROOM 5 N` ACCORDANE WITH THE POLICY PROVISIO . EL SEGUNDO, CA 90245-3 3 Au71dORrZI PRESENT E. 01988-2010 ACORD CORPORATION. All rights reserved. ACORD25(2010105) The ACORD name and logo are registered marks of ACORD JAMES RIVER INSURANCE CO. • COMMERCIAL GENERAL LIABILITY CG 20 37 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY„ ADDITIONAL INSURED - OWNERS, LEASEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: CITY OF EL SEGUNDO, ITS EMPLOYEES, REPS, OFFICERS AND AGENTS RE: ALL OPERATIONS (If no entry appears above,information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) Section II - Who is An Insured Is amended to include as an insured the person 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"at the location designated and described in the schedule of this endorsement performed for that additional insured and included in the"products-completed operations hazard". PRIMARY INSURANCE CLAUSE: To the extent that this insurance is afforded to any additional insured under this policy, such insurance shall apply as primary and not contributing with any insurance carried by such additional insured, as required by written contract. . CG 20 37 07 04 C ISO Properties, Inc., 2000 Page 1 of 1 JAMES RIVER INSURANCE CO. • COMMERCIAL GENERAL LIABILITY CG 20 10 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE NAME OF PERSON OR ORGANIZATION: CITY OF EL SEGUNDO ITS EMPLOYEES, REPS, OFFICERS AND AGENTS RE: ALL OPERATIONS A. Section 11—Who Is An Insured is amended to include as an insured any 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: 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)at the location(s)designated above. S. With respect to the insurance afforded to these additional insureds, the following additional exclusions applies: This insurance does not apply to"bodily injury"or"property damage"occurring after: I. 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. PRIMARY INSURANCE CLAUSE: To the extent that this insurance is afforded to any additional insured under this policy, such insurance shall apply as primary and non contributory with any insurance carried by such additional insured, as required by written contract. • CG 20 10 07 04 ©ISO Properties, Inc., 2004 Page 1 of 1 r COMPANION PROPERTY & CASUALTY INS. CO. Policy Number: CPCA16804 Policy Period: 02/18/2014 TO 02/18/2015 Named Insured: MARX BROS FIRE EXTINGUISHER CO., INC. The information above is required only when this endorsement is issued subsequently to preparation of the policy. 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 3%of the California workers'compensation premium otherwise due on such remuneration. SCHEDULE P d l?D m�A@dI A TLQfq CITY OF EL SEGUNDO " ATfN: CITY CLERK 350 MAIN STREET, ROOM 5 EL SEGUNDO, CA 90245-38 "3` This endorsement changes the polity to which it is attached and is effective on the date issued unless otherwise stated. PRODUCER: TRI-WORLD INSURANCE AGENCY, INC. WC 04 03 06 �"' DATE(MMIDD/YYYY) W CERTIFICATE OF LIABILITY INSURANCE 06/11/2014 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 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 Bryce MCkell, Agent Jj7A ME Janlece Williams PerrONu awl,QI1Q 5q9 4�i'� FAIL r 1141 Foothill Blvd - - (Alet _ — fate a La Verne, CA 91750-3328 D' =home brrickell,com — INSURER(Sl AFFORDING COVERAGE NAIC 0 INSURERA State Farm MiAiml Autom.0 b P In SuranrP(`nm nanv 19171 ...INSURED.." ... ..........._. .....-. .�,�, m,.......—._ m,. ___-,..—_. �,,,.. ._.:.�..�.m. .._-.�..,,� Marx Brothers Fire Extinguisher Co Inc INSURERS: 1159 S Soto St INSURER C Los Angeles, CA 90023-2198 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 2013-2014 RENEWAL 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. INS..............�.� .�.�.�.�.�.� ...........�..........��.. ....._................—.. .. .._ ..........,.,..� ..�..._._. R TYPE OF INSURANCE iuco wun POLICY NUMBER IMM ooYIYYYVI (MlM1nnm VpY) LIMITS -... GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY PRPMIRPR(Pa omvre I $ CLAIMS-MADE 0 OCCUR MED'EXPm(„Anv one oersonl........ ............................................................ PERSONAL&ADV INJURY $ .........,. .�.......................................................................................... .GENERAL AGGREGATE.�.� ...,$.....................--..................................... GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP A G G $ 7 POLICY FI PRO- LOC $ A AUTOMOBILE LIABILITY N Y $ X ANY AUTO 404 5720-D19-75S 04/19/2014 10119/2014 BODILY INJURY(Per person) $ 1 000 000 ALL OWNED SCHEDULED BODILY INJURY(Per accident) 1,000,000 AUTOS AUTOS $ _ HIRED AUTOS NON-OWNED PROPERTY A E' 1,000,000 --- AUTOS (Per accident) $ UMBRELLA LIAB OCCUR _EACH OCCURRENCE $ EXCESS LIAB CLAIMS MADE AGGREGATE a-..._................-......--............ DED RETENTION$............�-�................ � �-----..........-�..- -- � .....--...�---_...............�.�_.�_-. WORKERS COMPENSATION wC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N - ,TORY i.J !T� .............._...-- ._--........ FFICCEIMEMrBER EXCLUDED?PROPRIETOR/PARTNER/EXECUTIVE NIA n�E�,L.�DISEASE�C�EAE EMPLOYEE $ nFer.Qescnb�under EmL,DISEASE.-..POLICY.LIMIT $ A EMPLOYERS NON-OWNED/HIRED AUTO BODILY INJURY(Per person) $1,000,000 LIABILITY W23 4999-E25-75Y 05/25/2014 71/25/2014 BODILY INJURY(Peraccident) $1,000,000 PROPERTY DAMAGE(Per accident) $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more apace Is required) Additional Insured to be named as:'the City,its officials,and employees'. Endorsement 6028AU attached. NOTE:This policy provides$2,000,000 combined limit for bodily injury and property damage liability,which is greater coverage than the requested $1,000,000 combined single limit. Cancellation Clause revised to say:'Should any of the above described policies be cancelled before the expiration date thereof,the issuing insurer will mail 30 days written notice to the certificate holder listed below.' Certificate Holder contact:Julie Hegvold/jhegvold @elsegundo.org CERTIFICATE HOLDER CANCELLATION City of El Segundo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE y g Un THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Attn: City Clerk „ �. ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main .Street � l,` AUTHORIZED REPRESENTATIVE El Segundo, CA 90245-0989 Digitally signed by Janiece Williams - LSA5 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 1001486 132849.8 01-23-2013 SlateMrni m 6028AU ADDITIONAL INSURED (Prior Notice of Termination) This endorsement is a part of your policy. Except for the changes it makes,all other terms of the policy remain the same and apply to this endorsement. It is effective at the same time as your policy unless a different effective date is specified by us in writing. It is agreed that LIABILITY — COVERAGE A of your policy is extended to the party named on the declarations page as an Additional Insured. The Additional Insured is subject to the provisions of the policy granting coverage to an insured other than you. The Additional Insured: 1. has the same right of recovery under this policy as before; 2. is not liable for any premium or other expenses under this policy; 3. is not a member of the State farm Mutual Automobile Insurance Company of Bloomington, Illinois. This policy will not be changed or terminated as to the interest of the Additional Insured unless we give such insured notice. The number of days' notice we will give is ten unless another number is shown on the declaration page. Additional Insured: 'the City,its officials,and employees The insurance is primary, and not contributory, with respect to any insurance or self-insurance program maintained by the City of El Segundo. Page 1 of 1 6028AU HOME OFFICE: BLOOMINGTON, ILLINOIS 61710-0001