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PROOF OF INSURANCE (2014) CLOSEDTHE POLICIES OF INSURANCEUSTED 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 THS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECTTO ALLTHE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BYPAID CLAIMS TYPA OFINSUAANP POLICY NUMBER mmy m EX LIMITS GENERAL. LIABILITY EACH OCCURRENCE 155 000, C EdRCIAL GENERAV„LgAENWUiY FIRE DAMAGE W are 5m _ .S 50,000 _ NX culMS MARrc " OCCUR. MEDEXP oro rson).. $ 5.00 11 0 A CONT. POLLUTION FEI —ECC- 10862 -01 10/31/13 10/31 /14 PERSONALBADVINJURY X5,000,000 GENEPALAGGREGATE s54000,000 GEN"LAGGREGATEUMRAPP41'ESP R ..'.PRODUCTS- COAPIOPAGG... S5 000 000 POLIOY`. PR'- LOC, c 41 AUTOMOBILE LIABILITY ANYAUTO �EmacdE SINGLEL9dT ''..52,000,000 1' ALLOWNEDAUTOS - -ter• BOOLYINJURY NJURY S SCHEDULED AUTOS (Pc pawn) A HIREDAUTOS FEI— ECC - 10862 -01 10/31/13 10/31/14 , NONOWNEEDAUTOS INCLUDED IN GL ((Paracdd o _ 3 (PROPERTY DAMAGE S {PreaddmQ GARAGE .LJABLUTY AUTO ONLY- FAACOOENT '....$ ANYALITO EA ACC OTHER TFW N $ AUTO ONLY, AGG f EXCESS LIABILITY EACH OCCURRENCE S OCCUR CLAIMS MADE AGGREGATE 'S a DEDUCTIBLE i YYYY. S RETENTION $ S WORKERS COMPENSATION AND..._ A -. S' EMPLOYER LIABILITY 1� EL EACH ACCIDENT S E.L. DISEASE - EA EMPLOYEE $ EL. DISEASE - POLICY LIMITS , OTHER r B PROPERTY INS. 01 -CI- 148554 -6 01/07/14 01/07/15 SPECIAL 'FO DESCRIPTION OF OPERATION. SILOCATIONSNEMCLESEXCWSIONSADOED BYENDORSEMENTISPECWL PROVISIONS RE: CITY HALL WATER DAMAGE / CITY HALL — 350 MAIN STREET CITY OF EL SEGUNDO, ITS OFFICIALS AND EMPLOYEES HAS BEEN NAMED AS ADDITI' INSURED WITH RESPECT TO THE GENERAL LIABILITY. PRIMARY AND NON —CO RIBiiTOR COVERAGE APPLIES. WAIVER OF SUBROGATION APPLIES. 30 DAY CANCELLATION APPLIES. (BLANKET ENDORSEMETS ATTACHED) C RTTIFIC' TE HOLDER ADDTTAONAL INSURED, INSURER LETTER; CANCELLATION _ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCFILED BEFORETHE EXPIRATION CITY OF EL SEGUNDO DATE THEREOF, THE ISSUING INSURER WALL ENDEAVOR To MAIL 3,Q_ DAYS WRITTEN ATTN: FLORIZA RIVERA NOTTCETO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUTFAILURETO DO SO SHALL 350 MAIN STREET IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR EL SEGUNDO, CA 90245 R PRBSWiTATTVES. AUTNORTE'IRE E,.... ACORD 25-S (7197) 6ACORO CORPORATION 1988 A &V Contractors, Inc. Endorsement Number: 4 Automatic Additional Insured — Owners, Lessees or Contractors ECC- 319 -0712 This endorsement, effective 10/3112013 attaches to and forms a part of Policy Number FEI- ECC- 10862 -01. This endorsement changes the Policy. Please read it carefully. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART CONTRACTORS POLLUTION LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: Any person(s) or organization(s) whom the Named Insured agrees, in a written contract, to name as an additional insured. However, this status exists only for the project specified in that contract. The person or organization shown in this Schedule is included as an insured, but only with respect to that person's or organization's vicarious liability arising out of your ongoing operations performed for that insured„ IN A &V Contractors, Inc. Endorsement Number: 19 Additional Insured - Owners, Lessees or Contractors - Completed Operations This endorsement, effective 10 /31/2013 attaches to and forms a part of Policy Number FEI- ECC- 10862 -01. This endorsement changes the Policy. Please read it carefully. In consideration of an additional premium of JAMlie this endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or O anization s : Location And Description Of Completed Operations Any person(s) or organization(s) whom the Named Insured Those project locations where this agrees, in a written contract, to name as an additional insured. endorsement_ is required by contract However, this status exists only for the project specified in that contract. Information Mquimdto complete this Schedule, if not shown above will be shown in the Declarations. 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 wor ;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 ". CG 20 37 07 04 © ISO Properties, Inc., 2004 A &V Contractors, Inc. Endorsement Number: 14 *==- Automatic Primary and Non - Contributory Insurance Endorsement Designated Work Or Project(s) This endorsement, effective 10/31/2013 attaches to and forms a part of Policy Number FEI -ECC- 10862 -01. This endorsement changes the Policy. Please read it carefully. SCHEDULE Name of Person or Organization: Any person(s) or organization(s) whom the Named Insured agrees, in a written contract, to provide Primary and/or Non - contributory status of this insurance. However, this status exists only for the project specified in that contract. In consideration of an additional premium of $Appli ed and notwithstanding anything contained in this policy to the contrary, it is hereby agreed that this policy shall be considered primary to any similar insurance held by third parties in respect to work performed by you under any written contractual agreement with such third party. It is further agreed that any other insurance which the person(s) or organization(s) named in the contributory to this insurance. ECC -548 -0712 excess and non- A &V Contractors, Inc. Endorsement Number: 5 aad�u Automatic Waiver of Subrogation Endorsement This endorsement, effective 10/31/2013 attaches to and forms a part of Policy Number FEI -ECC- 10862 -01. This endorsement changes the Policy. Please read it carefully. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART CONTRACTORS POLLUTION LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: Any person(s) or organization(s) to whom the Named Insured agrees, in a written contract, to provide a waiver of subrogation. However, this status exists only for the project specified in that contract. The Company waives any right of recovery it may have against the person or organization shown in the above Schedule because ofpayments the Company makes for injury or damage arising out of the insured's work done under a contract with that person or organization. The waiver applies only to the person or organization in the above Schedule. Under no circumstances shall this endorsement act to extend the policy period, change the scope of coverage or increase the Aggregate Limits of Insurance shown in the Declarations. ECC- 320 -0712 POLICYHOLDER COPY 350 MAIN ST EL SEGUNDO CA 90245 -3813 This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 30 days advance written notice to the employer.. i We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policy listed herein. C+,kotwr;hslandin any ri.-cioirerrent, term or condition of any contract or other document with respect to which this certificate of insurance may be issued or to which i, may pertain, the insurance afforded by the pc «icy described herein is subject to all the terms, exclusions, and conditions. of such policy. Z141, Authorized Representative President and CEO EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT #1600 - TRINIDAD ALMENDAREZ PRES - EXCLUDED;. ENDORSEMENT #1800 - TIMOTHY J VELARDE VP - EXCLUDED. ENDORSEMENT #1800 - DAVID ALMENDAREZ SEC TRES - EXCLUDED. ENDORSEMENT #2086 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 04 -01 -2006 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. ENDORSEMENT #2670 ENTITLED WAIVER'OF SUBROGATION EFFECTIVE 2014 -09 -03 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. THIRD PARTY NAME: CITY OF EL SEGUNDO ENDORSEMENT #2001 ASBESTOS CERTIFICATION EFFECTIVE 04 -01 -2004 IS ATTACHED TO AN ffatS A PART OF THIS POLICY. EMPLOYER A 8 V CONTRACTORS, INC 1531 W COMMONWEALTH AVE FULLERTON CA 92833 (REV. 7.2014) SP (P1 K,SPI PRINTED : 09 -03 -2014 SP a. WAIVER OF SUBROGATION 1800036-14 RENEWAL sp 2-28-16-80 PAGE I A & V COOTRACTORS ZNC 15.31 W COMMONWFJ�.LTH AVE PUlIMTOM, CA 92813 ANYMING T-N ITIM MY - TIMISM01140. SKI, I ON - U! SU A, C, E FUND lolhl'v 'S, AbTf ITIME (If EAMPOMATtON ADAINST. (-�f Ft. SE=1001 toV,.[,IlCfl MI(IFff ; tea ' ( i0W We PAYN"E'wr 11M.-E , TIMS f1c)LIVY IN (20NNEFT-1-l"aw wm" w(IRY, PFRE(CIRMED Ulx` A & v t,7UtTrTlhf�7'rQR-S tbK! rl- IS MRIVER AOREED 'ITIAT -MLI JfISMIED ',MHALL MAINT-UN PMMI P.F(10PMI�4 AC!'CUBATEI.Y SFUREtwrivia, -mf, T,*,,'MUM.NATlQN (-,IF V4PUJY-EES .I t. NUAGED 114 WoRK Fok 7"Itm' xac-wE EMPLOYEML ilr I's FURTHER AGRFL-11 TUAT PREMIUM ('KN IMI UANTNUS OF 5,01IM-i r Nl' Em"im Fri WIMP it! ZOOS CCOMAMED SHALL HE HM10 11) %641Y, ALTVA WAM ag F-XTEVO ANY CW'rffE TEPM ENT$, 09 UMITAInQNS OF YMS 5, COMMON.& A&MMMOO MICY OTs" rRM AS SIAT01 NMHM#K� ELSEWMPE ON TMS POLICY PAU 49 HELD Y* VARV, ALTER, 14AM OR LIM M IRAQ cuormfoom" mummms M4 L."AMMONS Of TWS MXM99"MMW ,ofjfrcMAWGMED AM �SVUED A-1 SAN MAWISCO, SEPTEMBER C 2014 PRI'Vi T-Iff 04,1 �-,EQ 2570