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PROOF OF INSURANCE (2013) CLOSEDbua CERTIFICATE OF LIABILITY INSURANCE DATE(MM /DD/YYYY) 11/15/2013 9/23/2013 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 INSUREII 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 Lockton Insurance Brokers, LLC 725 S. Figueroa Street, 35th Fl. CA License #OF 15767 Los Angeles CA 90017 (213) 689 -0065 INSURER A : 1334736 New Tangram, LLC See Attached Named Insured Schedule 9200 Sorensen Ave. Santa Fe Springs CA 90670 NAIC # 25682 COVERAGES NEWTA04 CERTIFICATE NUMBER: 12566892 REVISION NUMBER: XXXXXXX 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. INR LS TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF MM /DDIYYYY POLICY EXP MMIDD/YYYY LIMITS A „GEN'URALLIABILITY Y Y Y630154D2813 11/15/2012 11/15/2013 PREMISES PREMlSE:z IEa cur'.",.) $ 300,000 „....� MMERCIAL GENER�WLITY CLAIMS -MADE OCCUR MED EXP An one person) $�� X I PERSONAL & ADV INJURY ........ $ 1,000,000 No Deductible GENERAL AGGREGATE $ 2.000.000 4. AGGREGATE. LIMIT APPLIES PER: '.. PRODUCTS - COMP /OP AGG QQO GEN POLICY r X J21CO, LOC $ B AUTOMOBILE ....W LIABILITY N N Y8109496B44A 111/15/2012 11/15/2013 CO aBINE5 $ BODILY INJURY (Per person) y $ �XX ANY AUTO .......... ALL OWNED ISCHEDULED AUTOS '... AUTOS BODILYINJURYPeraccident'.$Xy X Zk,�... PROPERTY DAMAGE $ XXXXXXX HIRED AUTOS NON -OWNED AUTOS Comp /Coll Ded. $ 1,000 B X UMBRELLA LIAB 11 j{ I OCCUR N N YSMCUP9496B44A 11/15/2012 11/15/2013 EACH OCCURRENCE $ 20,000,000 EXCESS LIAB CLAIMS -MADE. 1 AGGREGATE $ DED RETENTIONS $ XXXXXXX B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE ��—�7�p OFFICER /MEMBER EXCLUDED? '" N/A Y YJUB9496B44A 11/15/2012 11/15/2013 X TORY LIMIT., ER E.L. EACH ACCIDENT $ ,. 1 ,000_000 (Mandatory in NH) 9 .i If yes, describe under E.L.. DISEASE - EA EMPLOYEE $... 1,000,000 DESCRIPTION OF OP RATIONS below E.L. DISEASE - POLICY LIMIT $ LLDESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) THIS CERTIFICATE SUPERSEDES ALL PREVIOUSLY ISSUED CERTIFICATES FOR THIS HOLDER, APPLICABLE TO THE CARRIERS LISTED AND THE POLICY TERM(S) REFERENCED, Project Name and Address: City of Segundo; 350 Main Street, El Segundo, CA 90245 -3813. City of El Segundo, its officials, and employees are an Additional Insured to the extent provided by the policy language or endorsement issued or approved by the insurance carrier. Waiver of Subrogation applies per attached endorsement(s) or policy language. CERTIFICATE HOLDER CANCELLATION See Attachltta.tt'ts SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 12566892 AUTHORIZED REPRESENTATIVE City of El Segundo, its officials, a d -, inplo ee .s, 350 Main Street, Room 5 El Segundo CA 90245 -3813 ACORD 25 (2010/05) Fhe ACORD name and logo are registered marks of ACORD 1,01988-AK04401A D ORPO'RATION. All rights reserved New Tangram, LLC Named Insured Schedule Effective: 11/15/2012 Entity Name New Tangram, LLC Tangram Fabricators, Inc dba Tangram Interiors dba New Tangram Nevada, LLC fdba Pacific Business Interiors fdba California Business Interiors fdba Pacific Business Services dba Recycled Office Solutions dba On -Site Furniture Services dba On -Site Fabricators dba Integrated Workplace Attachment Code: D462136 Master ID: 1334736, Certificate 1D: 12566892 POLICY NUMBER: Y630154D2813TIL11 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE RE BLANKET ADDITIONAL INSU (CONTRACTORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 1. WHO IS AN INSURED - (Section II) is amended to include any person or organization that agree in a "written contract requiring insurance" to include as an additional insured on this Coverage Part, but: a) Only with respect to liability for "bodily injury", "property damage" or "personal injury"; and b) If, and only to the extent that, the injury or damage is caused by acts or omissions of you or your subcontractor in the performance of "your work" to which the "written contract requiring insurance" applies. The person or organization does not qualify as an additional insured with respect to the independent acts or omissions of such person or organization. 2. The insurance provided to the additional insured by this endorsement is limited as follows: a) In the event that the Limits of Insurance of this Coverage Part shown in the Declarations exceed the limits of liability required by the "written contract requiring insurance ", the insurance provided to the additional insured shall be limited to the limits of liability required by that "written contract requiring insurance ". This endorsement shall not increase the limits of insurance described in Section III - Limits Of Insurance. b) The insurance provided to the additional insured does not apply to "bodily injury", "property damage ", or "personal injury" arising out of the rendering of, or failure to render, any professional architectural, engineering or surveying services, including: I. The preparing, approving, or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders or change orders, or the preparing, approving, or failing to prepare or approve, drawings and specifications; and ii. Supervisory, inspection, architectural or engineering activities. CG D2 46 08 05 Attachment Code: D461583 Certificate ID: 12566692 LY c) This insurance provided to the additional insured does not apply to "bodily injury" or "property damage" caused by "your work" and included in the "products- completed operations hazard" unless the "written contract requiring insurance" specifically requires you to provide such coverage for that additional insured, and then the insurance provided to the additional insured applies only to such "bodily injury" or "property damage" that occurs before the end of the period of time for which the "written contract requiring insurance" requires you to provide such coverage or the end of the policy period, whichever is earlier. 3. This insurance provided to the additional insured by this endorsement is excess over any valid and collectible other insurance ", whether primary, excess, contingent or on any other basis, that is available to the additional insured for a loss we cover under this endorsement. However, if the "written contract requiring insurance specifically requires that this insurance apply on a primary basis or a primary and non - contributory basis, this insurance is primary to 'other insurance" available to the additional insured which covers that person or organization as a named insured for such loss, and we will not share with that "other insurance ". But the insurance provided to the additional insured by this endorsement still is excess over any valid and collectible 'other insurance ", whether on primary, excess, contingent or on any other basis, that is available to the additional insured when that person or organization is an additional insured under such "other insurance ". 4. As a condition of coverage provided to the additional insured by this endorsement: a) The additional insured must give us written notice as soon as practicable of an 'occurrence" or an offence which may result in a claim. To the extent possible, such notice should include: (C) 2005 The St, Paul Travelers Companies, Inc. Page 1 of 2 COMMERCIAL GENERAL LIABILITY i. How, when and where the 'occurrence" or offense took place; U. The names and addresses of any injured persons and witnesses; and iii. The nature and location of any injury or damage arising out of the 'occurrence" or offense. b) If a claim is made or "suit' is brought against the additional insured, the additional insured must: i. Immediately record the specifics of the claim or "suit' and the date received; and ii. Notify us as soon as practicable. c) The additional insured must immediately send us copies of all legal papers received in connection with the claim or "suit', cooperate with us in the investigation or settlement of the claim or defense against the "suit', and otherwise comply with all policy conditions. any provider of "other insurance" which would cover the additional insured for a loss we cover under this endorsement. However, this condition does not affect whether the insurance provided to the additional insured by this endorsement is primary to 'other insurance" available to the additional insured which covers that person or organization as a named insured as described in paragraph 3. above. 5. The following definition is added to SECTION V. - DEFINITIONS: "Written contract requiring insurance" means that part of any written contract or agreement under which you are required to include a person or organization as an additional insured on this Coverage Part, provided that the "bodily injury" and "property damage" occurs and the "personal injury" is caused by an offense committed: a. After the signing and execution of the contract or agreement by you; b. while that part of the contract or agreement is in effect; and d) The additional insured must tender the defense and c. before the end of the policy period. indemnity of any claim or "suit' to Page 2 of 2 (C) 2005 The St. Paul Travelers Companies, Inc. Attachment Code: D461583 Certificate ID: 12566892 CG D2 46 08 05 Policy Number: Y630154D2813 COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS /COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: WHERE REQUIRED BY WRITTEN CONTRACT Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV - Conditions: 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 ". This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 05 09 ©Insurance Services Office, Inc., 2008 Pagel of 1 Attachment Code: 0461586 Certificate ID: 12566892 TRAVELERS WORKERS COMPENSATION ONE TOWER SQUARE AND HARTFORD, CT 06183 EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 99 03 76 (A) - 001 POLICY NUMBER: YJUB9496B44A WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA (BLANKET WAIVER) 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. The additional premium for this endorsement shall be 3 .0 % of the California workers' compensation premium. Schedule Person or Organization Job Description WHERE REQUIRED BY WRITTEN CONTR 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 11/15/2012 Policy No. YJUB9496B44A Insured New Tangram, LLC Insurance Company Travelers Property Casualty Company of America Attachment Code: D461587 Certificate ID: 12566892 Endorsement No. Premium Page 1 of 1