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PROOF OF INSURANCE (2015) CLOSED (3)CERTIFICATE OF LIABILITY INSURANCE D oils /z� 4 1 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. WPORTANT: if the caftlficate holder is an ADDf r(5iAL INSURED, the poilcy(les) must be endorsed. If SUBR'OG'ATION IS WANED, subjint to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate doss not confer rights to the cartiftcate holder In lfeu of such endorseme s, PRODUCER 310 - 659 -4950 rt Michelle NI'.a PHONE „310 659950 �, NIA INSURANCE AGENCY, INC. LIC#OB88707 11041 SANTA MONICA BLVD #719 MA�nJ , michelleQrnalnsuranceagency.com LOS ANGELES, CA 90025 PyyenAO4 ND# ..........._._. ._ ...............� � �................ 4INSUREBtilAFF9RoLNO ,. .1N URER�A• ..,. tef."R�L� �,�,___�,�,_ .._ INSURED ��� a' r r ,a?!dA.!1. mQ. .W......' . .............. SPEC CONSTRUCTION CO, INC. INSURERC'..._ _ ...1870 S. CARLOS AVE . NsUn�R Q L., „mm„ -,mm � ....................... ONTARIO, CA 91761 REFt INSI1 ".._ N RERF• 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. TR TYPE OF INSURANCE POUCY NU 4. FF.... Y LIMITS I1f1t1 I1l1 COMME;RCIALCdE?FERAI,.LIASILITY ✓ ✓ EACH OCCURRENCE A CLAIMS-MADE © OCCUR 0 S ��x.±Y^�"a..........,,....,. MED EXP arts S S,.QOQ�Q�,Q....Q., GEN °L. AGGR�EOATC LIMIT APPLIES PER. CGD00001202 04/28/2014 04/2612015 POENERAL.AOOREOATE m v .. i.F2 001]00 .., POLICY _ ,rC F LOC PRODUCTS-COMPIOP AGG 32 QQUOi),,,, ,„„.„,,...... omTDER° s AUTOMOBILE LIABILITY B ANY AUTO ♦ ♦ BODILY INJURY(Perp —) S ... ALL OWNED SCHEDULED 057559366 05/07/2014 05/07/2015 BODILY INJURY(P —adeM) S AUTOS ,. _, AUTOS I , NON -OWNED V HIRED AUTOS ., AUTOS i.Y. Sim fh1A. ....................... f .. ............................... S USIBREl1J1 _ OCCUR EACH OCCURRENCE...... i EXCESS LIAR CLAIMS -MADE. AGGREGATE S N I I $ WORKERS COMPENSATION PER R STATU ANO EM'PLOYER'S” LA AWLITY ANY¢ �TI'�OPRdET�ARTNE RRL COOIVE Y® NIA E,L.EACH ACCIDENT S RJM OFFICEEMBER. F.XCLUDEO7 . ".".""""".• iE Merwasty in NHi . E L D S om,, EMPLOYEE S IP � EL DISEASE. POLICY LIMIT _ .� .. DESCRIPTION OF OPERATIONS/ LOCATIONS I VEHICLES (ACORD 101, AddWaul Remote 30miuls, maybe aeached N mon spa" Is rsqulred) Additional Insured Endorsement USIC - CMGIA- 0310 -0412, USIC -CMGIA - 7900 0414, Waiver of Subrogation USIC -CMGIA 7830, Primary and Non - Contributory wording USIC -CMGIA including Products /Completed Operations are included. Waivers of Subrogation are executed for Commercial General Liability and Commercial Auto. The City, its officers, officials, employees and agents will be covered as insured as resepects: Liability arising out of activities performed by or on behalf of the Contrators, Premises owned, occupied or used by Contractors. 30 Days Notice of Cancellation for Non - Payment of Premium will be Issued. Re: RSI Program 61 (14 -18). City of El Segundo. RSI 333 Main Street Unit A El Segundo, CA 90245 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 M,m� 01SI T014 AO OORPORATION. All rights reserved. ACORD 25 (2070/01) The ACORD name and logo are registered merits ACOR ACORO- CERTIFICATE OF LIABILITY INSURANCE °0/2812014 °"r'�"'' 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 Pa chex Insurance Agency cy Inc - NAME" . _ - PAYCHEX INSURANCE AGENCY, INC. PHONE TFA 150 SAWGRASS DRIVE xis877-266-6850 fG, lc); 585-389-7426 -- ROCHESTER ' NY 74620 E °MA Cert s@p y chex .com S. ........ ...... — INSURER(S) AFFORDING COVERAGE NAIC # ----- – ------ INSURER A: NorGUARD Insuran........... ------ - - - - -- - -- INSURED ce Company 31470 ........ -- .....__ SPEC CONSTRUCTION CO INC INSURER B: 1870 S. CARLOS AVENUE - - -- ONTARIO, CA 91761 INSURER C: ...... INSURER D: ..... 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, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE -- ADD 5... PT. UBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS D MMIDDIYYYY, MM /DDIYYYY GENERAL LIABILITY EACH OCCURRENCE $ _ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED lLMIk.iEasls��ncrr) — $..... ,' LAJMS -MADE' _ O'CUR MED EXP (Any one person) $ -._ ........ . PERSON ... -..... ........ AL & ADV INJUR Y . ..... .._RY ,,.. GENERALAGGREG ............. ........- --- - -- --- -..... . ... .......... ... - -- GATE $ EN'I �AGGREGA—IMIT APPLIES PER: II(( �� P /OP AGG $ POLICY P81..OA -CTI .J LOC PRODUCTS -COM - _.._..._.. -.. _.. $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO _ (Ea accident) ALL OWNED I SCHEDULED BODILY INJURY $ AUT AUTOS WNED BODILY INJURY OS (Per parson) HIRED AUTOS NON -O �.. '. AUTOS ,,.._(Per accident) $ .... .... PROPERTY DAMAGE (Per accident) .. ,.M., .... $ UMBRELLA LIAR ) OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION AND WC STATU .— _OH- EMPLOYERS•LIABILITY SPWC583326 03/12/2014 03/12/2015 " ...._ ........... E.L. EACH ACCIDENT $ 1,000,000.00 ANY PROPRIETOR /PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? IIY /IN.,� E.L. DISEASE EASE -EA EMPLOYEE $ 1,000 „000.00 (Mandatory ) E.L. DISEASE ......... , - - -- ............. Mandato In NH Y N/A X POLICY $ 1,000,000.00 If yes, describe under DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Waiver of Subrogation granted in favor of the certificate holder CERTIFICATE HOLDER CANCELLATION City Of El Segundo ..,. `' ", SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION RSIP 14 -18 - Group 61 DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY 333 Main St Unit A PROVISIONS, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR El Segundo, CA 90245 LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. r AUTHORIZED REPRESENTATIVE µ. roams f ACORD 25 (2010/05) @1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY COMMERCIAL GENERAL LIABILITY POLICY NUMBER: CGD00001202 US1C -CMGIA INSURED : Spec Construction Co Inc. ADDITIONAL INSURED - PRIMARY AND NON - CONTRIBUTORY - OWNERS, LESSORS OR CONTRACTORS COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: City of El Segundo, The City, its officials, Officers, employees & agents 333 Main Street Unit A El Segundo, CA 90245 Re: RSI Program 61(14 -18) Section II -In accordance with the terms, conditions, limitations and provisions of the policy to which this endorsement is attached, Section II -Who is an Insured is amended to include an Additional Insured The Person, organization or entity designated In this endorsement but only with respect to liability for bodily injury or property damage caused, In whole or in part, by your work at the designated construction project performed) for the designated person, organization or entity and Included In the ongoing operations hazard. This endorsement does not create or our part a dray to defend the designated person, organization or entity or contribute to or reimburse the designated person, organization or entity, This endorsement Is only applicable It the designated person, organization or entity and the designated i project sections are completed. With respect to the Insurance afforded to these Additional Insured , the following additional inclusions apply: This insurance applies to "Bodily Injury" or "Property Damage" occurring after: All work, including materials, parts or equipment furnished in connection with such work, on the project other than service, maintenance or repairs to by performed by or on behalf of the Additional Insured. At the location of the covered operations has been completed ; or That portion of "Your Work" out of which the injury or damage has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for the principal as part of the same project. PRIMARY /NON- CONTRIBUTORY WORDING: It Is agreed that this insurance Is primary and non - contributory and that no insurance held or owned by the designated Additional Insured shall be called upon to cover a loss under said policy up to the limits of this policy if loss under this policy arises directly from work performed by Named Insured. All other terms, conditions and exclusions remain unchanged (OM1N1 7 EFQA12 -11 -5- 1/12/1203051353) Form Edition 05110/12 INSURED: SPEC CONSTRUCTION CO, INC. CARRIER: UNITED SEPCIALTY INSURANCE COMPANY ATTACHED TO AND ENDORSEMENT EFFECTIVE DATE FORMING A PART OF (OR AM. STANDARD TIME) POLICY NUMBER ADDITIONAL INSURED ENODRSEMENT NO. City of El Segundo, The City, its officials, officers, employees and agents. 333 Main Street Unit A CGD00001202 04/26/2014 El Segundo, CA 90245. Re: RSI Program 61(14 -18) USIC- CMGIA -' 0310 -0412 (The above Information is required only when this endorsement Is Issued subsequent to preparation of the policy.) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, ADDITIONAL INSURED — OWNERS, LESSEES OR CONTRACTORS — AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section I1--Who Is An Insured is amended to in- of, or the failure to render, any professional clude as an additional insured any person or organk architectural, engineering or surveying services, zation for whom you are performing operations when including: you and such person or organization have agreed in a. The preparing, approving, or failing to prepare writing, and executed such a contract or agreement prior to the time of an occurrence giving rise to a or approve, maps, shop drawings, opinions, claim, that such person or organization be added as reports, surveys, field orders, change orders an additional insured on your policy. Such person or or drawings and specifications; and organization is an additional insured only with respect b. Supervisory, inspection, architectural or engi- to liability for "bodily injury," "property damage" or neering activities. "personal and advertising injury" caused, In whole or in part, by: 2. "Bodily injury" or "property damage" occurring after: 1. Your acts or omissions; or a. All work, including materials, parts or equip - 2. The acts or omissions of those acting on your ment furnished in connection with such work, behalf; on the project (other than service, mainte- in the performance of your ongoing operations for the nance or repairs) to be performed by or on additional insured. behalf of the additional insured(s) at the site of the covered operations has been complet- B. With respect to the insurance afforded to these addi- ed; or tonal insureds, the following additional exclusions b. That portion of "your work" out of which the in- apply: jury or damage arises has been put to its in- This insurance does not apply to: tended use by any person or organization 1. "Bodily injury," "property damage" or "personal other than another contractor or subcontrac- and advertising injury" arising out of the rendering for engaged in performing operations for a principal as a part of the same project. NIA INSURANCE AGENCY, INC. 10/2412014 AUTHORIZED REPRESENTATIVE DATE` Includes copyrighted material of ISO Properties, Inc, with Rs permission. Copyright, ISO Properties, Inc., 2004 USIC- CMGIA -0310-0412 Policy Number Named Insured Effective Date CGD00001202 Spec Construction Co, Inc. 04/26/2014 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS (FORM B) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART City of El Segundo, The City, its officers, officials and agents. Re: RSI Program: 61(14 -18) 333 Main Street Unit A El Segundo, CA 90245 Section II -Who Is An insured is amended to Include as an additional insured only the person (p) or organization (s) who have entered Into a written contract with "you" prior to "your"' commencement of work for the person(s) or organization (s) with whom "you" have entered Into a written contract and such written contract specifically requires that "you " provide this coverage, but only with respect to liability for "bodily injury" or ",property damage" caused in whole and exclusively by ",you" performing "your work" on completed operations hazard" under the policy. This amendment does not apply to "your work" on any residential construction project. Terms in quotation marks are defined in the policy to which the endorsement is attached. USIC -CMGIA -7810 Rev.925/2013 INSURED: SPEC CONSTRUCTION CO, INC. CARRIER: UNITED SPECIALTY INSURANCE COMPANY ATTACHED TO AND FORMING A PART OF (1 EXPORSEMENT A.M. STANDARD TIME) EFFECTIVE BATE' CERTIFICATE HOLDER ENDORSEMENT NO. POLICY NUMBER City of El Segundo, RSI Program. The City, its officials, offic- ers, employees, agents. CGD00001202 04/26/2014 333 Main Street Unit A USIC -CMGIA El Segundo, CA 90245 Re: RSI Program 61(14 -18) 7830 (The above Information Is required only when this endorsement Is Issued subsequent to preparation of the policy.) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. LIMITED WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 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 an additional insured shown on form USIC- CMGIA- 0310 -0412 but only with respect to liability for "bodily injury," "property damage" or "personal and advertis- ing injury" caused by: 1. The named insured's acts or omissions; or 2. The acts or omissions of those acting on the named insured's behalf; in the performance of the named insured's ongoing operations for the additional insured shown on form USIC- CMGIA- 0310 -0412. All other Terms and Conditions of this Policy remain unchanged. NIA INSURANCE AGENCY, INC. 1024/2014 AUTHORIZED REPRESENTATIVE DATE Includes Copyrighted material of ISO Propertles, Inc., with its permission. Copyright, ISO Properties, Inc., 1992, 2003 USIC -CMGIA 7830 INSURED: SPEC CONSTRUCTION CO, INC. CARRIER: PROGRESSIVE CASUALTY INSURANCE COMPANY ATTACHED TO AND FORMING A PART OF ENDORSEMENT EFFECTIVE DATE 112.V 0.M. STANDARD TIME) ADDITIONAL INSURED ENDORSEMENT NO. POLICY NUMBER City of El Segundo, The City, its officials, officers, employees and agents. 333 Main Street Unit A 057559366 05/07/2014 El Segundo, CA 90245. Re: RSI Program 6](14-18) ) USIC- CMGIA- (The above information is required only when this endorsement is issued subsequent to preparation of the policy.) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU This endorsement modifies insurance provided under the following: COMMERCIAL AUTO LIABILITY COVERAGE PART A. Section I1--Who Is An Insured is amended to in- clude as an additional insured any person or organi- zation for whom you are performing operations when you and such person or organization have agreed in writing, and executed such a contract or agreement prior to the time of an occurrence giving rise to a claim, that such person or organization be added as an additional insured on your policy. Such person or organization is an additional insured 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. B. With respect to the insurance afforded to these addi- tional insureds, the following additional exclusions apply: This insurance does not apply to: 1. "Bodily injury," "property damage" or "personal and advertising injury" arising out of the rendering USIC -CMGIA -0310 -0412 of, or the failure to render, any professional architectural, engineering or surveying services, including: a. The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; and b. Supervisory, inspection, architectural or engi- neering activities. 2. "Bodily injury" or "property damage" occurring after: NIA INSURANCE AGENCY, INC. a. All work, including materials, parts or equip- ment fumished in connection with such work, on the project (other than service, mainte- nance or repairs) to be performed by or on behalf of the additional insured(s) at the site of the covered operations has been complet- ed; or b. That portion of "your work" out of which the in- jury or damage arises has been put to its in- tended use by any person or organization other than another contractor or subcontrac- tor engaged in performing operations for a principal as a part of the same project. AUTHORIZED REPRESENTATIVE Includes copyrighted material of ISO Properties, Inc., with Us permission. Copyright, ISO Properties, Inc., 2004 10/24/2014 DATE INSURED: SPEC CONSTRUCTION CO, INC. CARRIER: PROGRESSIVE CASUALTY INSURANCE COMPANY ATTACHED TO AND FORMING A PART OF ENDORSEMENT EFFECTIVE DATE (12.01 A.M. STANDARD TIME) CERTIFICATE HOLDER ENDORSEMENT NO. POLICY NUMBER City of El Segundo, RSI Program. The City, its officials, offic- ers, employees, agents. 057559366 05/07/2014 333 Main Street Unit A USIC -CMGIA El Segundo, CA 90245 Re: RSI Program 61(14 -18) 7830 (The above Information Is required only when this endorsement Is Issued subsequent to preparation of the policy.) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. LIMITED WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL AUTO LIABILITY COVERAGE PART The TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Condition (Section IV— COMMERCIAL AUTO LIABILITY CONDITIONS) is amended by the addition of the following: We waive any right of recovery we may have against an additional insured shown on form USIC- CMGIA- 0310 -0412 but only with respect to liability for "bodily injury," "property damage" or "personal and advertis- ing injury" caused by: 1. The named insured's acts or omissions; or 2. The acts or omissions of those acting on the named insured's behalf; in the performance of the named insured's ongoing operations for the additional insured shown on form USIC -CMGIA -0310 -0412. All other Terms and Conditions of this Policy remain unchanged. NIA INSURANCE AGENCY, INC. 1 0/2412 0 1 4 AUTHORIZED REPRESENTATIVE DATE Includes copyrighted material of ISO Properties, Inc., with its permisslon. Copyright, ISO Properties, Inc., 1992, 2003 USIC -CMGIA 7930 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 .µ1_02__ % of the California workers' compensation premium otherwise due on such remuneration. Schedule Person or Organization Job Description Blanket Waiver -Any person ororganization forwhomth All CA Operations Named Insured has agreed by written contract to fumis this waiver. 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.) Policy No_ SPWC583326 Insurance Company Countersigned By City of El Segundo RSIP 14 -18 - Group 61 333 Main St Unit A El Segundo, CA 90245 ACORD 4190709 0079/A7903017