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PROOF OF INSURANCE (2015) CLOSEDCERTIFICATE OF LIABILITY INSURANCE D IDD/YYYY) CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, 9// 17/17/ 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 NAM . Kelle Kelley PHONE (713) 521 -9251 FAX (713) 521-0125 T. E1 Dorado Insurance Agency, Inc. E1 Dorado Sec Srvs Ins Agy E-r+aAl .kkalley eldoradoinsurance.com PO BOX 66571 INSURERS AFFORDING COVERAGE NAIC # - ......_, Houston TX 77266 INSURERA:First Mercury nsurance Co. 10.6. 57 . . ._.�..._._._. INSURED ........... INSURERB:Tokio Marine -Sioecl alt _..... ......_._ ....................._ .............. ..... Professional Building Maintenance INSURERC Ar onaut InsuranceCOmpan ......................._ ,.,mmmmmmmmmmmmmm m m m mmmmmmmmmmmmm 1299 E. Artesia Blvd. INSURER D.New Ham shire Insurance Co.. #240 INSURERE:Llo ds of... London ............. .............................__ .................. _m ...... .... Carson CA 90746 INSURER F: COVERAGES CERTIFICATE NUIMBER.PBM ('8/22) 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. TYPE OF INSURANCE POLICY NUMBER p PMi1 iY°dYYY MMIDDY/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 rA X COMMERCIAL GENERAL LIABILITY ❑rciirragral ....... I $ 100,000 CLAIMS MADE .I n, a OCCUR E -CGL- 0000026450 -02 4/1/2014 /1/2015 _PREMI4F41Fa MED EXP (An o�nep�erson) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 3,000,000 PRO• X POLICY t.00 $ AUTOMOBILE LIABILITY 1 dI- IN L . LIMA Ea a�ccdcgena $ 110-0 O BODILY INJURY (Per person) _ -0100 -$ B X _,n ANY AUTO ITIT- ALL OWNED SCHEDULED PK1213403 7/28/2014 3/31/2015 BODILY INJURY (Per accident) $ AUTOS AUTOS - NON -OWNED FRUPERT' _YD AMTdt= _$ HIRED AUTOS AUTOS „(Peracc{, dent ]',,.._..- ....m......._. .... ......... _. .......... _............. X UMBRELLA LIAR OCCUR EACH OCCURRENCE $ 5, 000, 000 `. EXCESS LIAR CLAIMS -MADE AGGREGATE _ _ .............................. $ 5,000,000 DED RETENTION$ XS9377686 -00 4/2/2014 4/2/2015 $ D WORKERS COMPENSATION WC 038238329 ALL OTHER X I WC STATU- OTH- TORY I.IMIS FIR AND EMPLOYERS' LIABILITY YIN E L EACH ACCIDENT $ 1 ANY PROPRIETOR /PARTNER/EXECUTIVE C 038238330 CA ONLY OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N/A C 038238331 FL ONLY /1/2014 1/1/2015 E L DISEASE - EA EMPLOYE _000,000 $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below C 038238335 NJ, PA E,L DISEASE - POLICY LIMIT $ 1,000,000 E 1st & 3rd PARTY CRIME 1921SR00288ON 0/15/201310/15/2014 LIMIT $1,000,000 DEDUCTIBLE $10,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) The General Liability policy includes a blanket automatic additional insured endorsement that provides additional insured status to the certificate holder only when there is a written contract between the named insured and the certificate holder that requires such status. A Waiver of Subrogation is included on the Workers' Compensation policy in favor of the Certificate Holder. CERTIFICATE HOLDER CANCELLATION City of E1 Segundo 350 Main Street E1 Segundo, CA 90245 ACORD 25 (2010/05) I N Sn 25 r9m nnFt m 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 R.L. Ring, Jr. /ELIZ " ©1988 -2010 ACORD CORPORATION. All rights reserved. Thn A!'npn nmma and Innn mrn mnia4nrnrl —rirc of Arf)Pn POLICY NUMBER: SE -CGL- 0000026450 -02 COMMERCIAL GENERAL LIABILITY CG 2010 07 04 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 Additional Insured Person(s) Or Organization Location: s Of Covered Operations ny person or organization as required by wntten Various contract or agreement Information re uked to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to B. With respect to he Insurance afforded to these include as an additional insured the person(s) or additional insureds, the following additional organization(s) shown in the Schedule, but only exclusions apply: with respect to liability for "bodily injury', "property This insurance does not apply to "bodily injury" or damage" or "personal and advertising injury" "property damage" occurring after. caused, in whole or in part, by. 1. All work, including material, parts or 1. Your ads or omissions; or equipment furnished in connection with such 2. The acts or omissions of those acting on your work, on the project (other than service, behalf; maintenance or repairs) to be performed by or in the performance of your ongoing operations for on behalf of the additional insured(s) at the the additional insured(s) at the location(s) location of the covered operations has been designated above. completed; or CG 20 10 07 04 0 ISO Properties, Inc., 2004 Page 1 of 1 POLICYNUMBER: SE -CGL- 0000026450 -02 COMMERCIAL GENERAL LIABILITY CO 24 0410 93 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: Any Person or Organization for whom the Insured had, prior to a Claim, a written agreement or written contractual obligation, to waive such Rights (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) The TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Condition (Section IV — COMMERCIAL GENERAL LIABILITY CONDITIONS) is amended by the addition of the following: 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 ". Thiswaiver applies only to the person or organization shown in the Schedule above. CG 24 04 10 93 Copyright, Insurance Services Office, Inc., 1992 Page 1 of 1 BLANKET WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different date is indicated below. (The Following "attaching clause" need be completed only when this endorsement is issued subsequent to preparation of the policy). This endorsement, effective 12:01 AM 01 /01 /2014 forms a part of Policy No. WC 038 -23 -8330 Issued to WORLDWIDE SOURCING GROUP INC DBA: PBM Facility Services, LLC By NEW HAMPSHIRE INSURANCE COMPANY We have a right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against any person or organization with whom you have a written contract that requires you to obtain this agreement from us, as regards any work you perform for such person or organization. The additional premium for this endorsement shall be 2.00 % of the total estimated workers compensation premium for this policy. WC 04 03 61 Countersigned by (Ed. 11/90) Authorized Representative