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PROOF OF INSURANCE (2014) CLOSED,crer CERTIFICATE OF LIABILITY INSURANCE UATE,MMIDDIYYYY) 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 Ed ewood Partners Insurance Center (EPIC) CONTACT NAME. 19000 MacArthur Blvd, PH Floor PHONE (A Irvine, CA 92612 lG.ld. EXP) (949),2,63-0606 FAX LAIC N (4).23r090 INSURED Ortco Inc. 2163 N. Glassell Avenue Orange CA 92186 F: COVERAGES CERTIFICATE NUMBER: 17r177'%77 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, 'iNSR ,AbOL SU8 LTR TYPE OF INSURANCE POLICY NUMBER .. .......POLICY &F F I POLICY EXP ..,... ........................ .... .... ...... .. .e,,,...,.,�,w,,........ MMIDDIYYYY MM /DD/YYYY. LIMITS A GENERAL LIABILITY CA00000517310 6121/2013 6/21/2014 EACH OCCURRENCE $ 1,000,000 ,f COMMERCIAL GENERAL LIABILITY D ^7{ DAMA E 0REg't'a R1MI ES (reorcantnre) ...... ......... .. , $ 50,000 CLAIMS -MADE yj OCCUR MED EXP (Any one person) $ Excluded 0 5 00 s Ded per PgCUfre�l�� ...... RY RRAL GENE AGGREGATE $ 2,000,000''. _...... GE'1• t AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 2,000,000.. p FERCO' 1—i � .V POLICY u I LOC $ B AUTOMOBILE ....... LIABILITY BA9830185 6/21/2013 6/21/2014 ;COMI,R,TFYtrGmR aYY D SINGLE Lima Eta I . $ ................... 000 0 .w 3" ANY AUTO BODILY INJURY (Per person) $ ALL OWNED AUTOS . BODILY INJURY (Per accident) ,______ $ NON OWNED ! RQ9 Li1PYURY a a . DAMACa "E HRTEODAUTOS ✓..,.. AUTOS (PeraoJ11'Y )) .,. $ V $1000 ded comp & Coll �. ....... g..... D UMBRELLA OCCUR NHA233218 6/21/2013 6/21/2014 OCCU RRENCE $ 1,000,OO6 EXCESS LIAB CLAIMS MAD E AGGREGATE .$ $ 1,000,000 „ .. O DED RETENTION $ , ... � .....,........ .......... .. ...... ................ ..,. C WORKERS COMPENSATION 3300008099 -121 10/1/2012 10/1/2013 WC STATU- OTH- LIMITS ERR AND EMPLOYERS' LIABILITY Y 1 N ,,,, „TORY __ ANY PROPRIETOR /PARTNER /EXECUTIVE " " " " " " "" EL EACH ACCIDENT $ 0' OF EXCLUDED? N/A .1iOOO.Q (Mandatory in NH) " " " " " "" E DISEASE - EA EMPLOYEE $ 1 000000 If yes, describe under DESCRIPTION OF OPERATIONS below EL DISEASE -POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Certificate Holder is additional insured as respects General Liability per forms CG20100704 and CG20370704 and Auto Liability per form GECA7010107, but only if required by signed written contract with Named Insured prior to an occurrence. Blanket Primary Wording form AD06571203, and Blanket Waiver of Subrogation form CG24040509 apply to General Liability. W i J nk iv Form 41 A_ 7- u " Il ggligy terms and pgndilion . CERTIFICATE HOLDER CANCELLATION \ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of El Segundo'" THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Recreation & Parks Department "� eats ��� ACCORDANCE WITH THE POLICY PROVISIONS. 350 Street Q w Jy °� 1.,' El Segundo CA 9024rJ "n4 AUTHORIZED REPRESENTATIVE Kent Briggs © 1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD CERT NO.: 17027377 Tina Coleman 7/17/2013 3:27:55 PM Page 1 of 10 J I Ortco, Inc. Policy Number: CA00000517310 7/17/2013 CG 20 37 07 04 Effective Date: THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Section H —Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, brjt only with respect to liability for "bodily injti "" car' "prep ty daniage" caused,, na whole or in part by "`your wog °lc "" t the location designated and described in the schedule of this endorsement performed for that additio al insured and included in the "products - completed o cra : ns hazard ". CG 20 37 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 ❑ CERT NO.: 17027377 Tina Coleman 7/17/2013 3:27:55 PM Page 2 of 10 Ortco, Inc. 7/17/2013 POLICY NUMBER: CA00000517310 COMMERCIAL GENERAL LIABILITY CG 2010 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 Additional Insured Person(s) Or Or anizationL : Locations Of Covered Operations Blanket where required by written contract Information required to complete this Schedule if not shown above, will be shown in the Declarations. A. 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", "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 " s (s) at the location(s) desig- nated above. CG 2010 07 04 B. With respect to the insurance afforded to these additional insureds, the following additional exclu- sions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equip- ment 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 in- tended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a princi- pal as a part of the same project. © ISO Properties, Inc., 2004 CERT N6.: 17027377 Tina Coleman 7/17/2013 3:27:55 PM Page 3 of 10 Page 1 of 1 ❑ Ortco, Inc. BA9830185 7/17/2013 COMMERCIAL AUTO GOLD ENDORSEMENT THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM SECTION II - LIABILITY COVERAGE A. COVERAGE 1. WHO IS AN INSURED The following is added: d. Any organization, other than a partnership or joint venture, over which you maintain ownership or a majority interest on the effective date of this Coverage Form, if there is no similar insurance available to that organization. e. Any organization you newly acquire or form other than a partnership or joint venture, and over which you maintain ownership of a majority interest. However, coverage under this provision does not apply: (1) If there is similar insurance or a self- insured retention plan available to that organization; or (2) To "bodily injury" or "property damage" that occurred before you acquired or formed the organization. f. Any volunteer or employee of yours while using a covered "auto" you do not own, hire or borrow in your business or your personal affairs. Insurance provided by this endorsement is excess over any other insurance available to any volunteer or employee. g. Any person, organization, trustee, estate or governmental entity with respect to the operation, maintenance or use of a covered "auto" by an insured, if: (1) You are obligated to add that person, organization, trustee, estate or governmental entity as an additional insured to this policy by: (a) an expressed provision of an "insured contract', or written agreement; or (b) an expressed condition of a written permit issued to you by a governmental or public authority. (2) The "bodily injury" or "property damage" is caused by an "accident' which takes place after: (a) You executed the "insured contract' or written agreement; or (b) the permit has been issued to you. GECA 701 (01/07) Includes myrighted material of Insurance Services Offices, Inc. with its permission Page 1 of 4 CERT NO.: 17027377 Tina Coleman 7/17/2013 3:27:55 PFf Page 4 of 10 2. COVERAGE EXTENSIONS a. Supplementary Payments. Subparagraphs (2) and (4) are amended as follows: (2) Up to $2500 for cost of bail bonds (including bonds for related traffic law violations) required because of an "accident" we cover. We do not have to furnish these bonds. (4) All reasonable expenses incurred by the "Insured" at our request, including actual loss of earning up to $500 a day because of time off from work. SECTION III - PHYSICAL DAMAGE COVERAGE A. COVERAGE The following is added: 6. Hired Auto Physical Damage a. Any "auto" you lease, hire, rent or borrow from someone other than your employees or partners or members of their household is a covered "auto" for each of your physical damage coverages. b. The most we will pay for "loss" in any one "accident" is the smallest of: (1) $50,000 (2) The actual cash value of the damaged or stolen property as of the time of the "loss'; or (3) The cost of repairing or replacing the damaged or stolen property with other property of like kind and quality. If you are liable for the "accident ", we will also pay up to $500 per "accident" for the actual loss of use to the owner of the covered "auto ". c. Our obligation to pay for, repair, return or replace damaged or stolen property will be reduced by an amount that is equal to the amount of the largest deductible shown for any owned "auto" for that coverage. However, any Comprehensive Coverage deductible shown in the Declarations does not apply to "loss" caused by fire or lightning. d. For this coverage, the insurance provided is primary for any covered "auto" you hire without a driver and excess over any other collectible insurance for any covered "auto" that you hire with a driver. 6. Rental Reimbursement Coverage We will pay up to $75 per day for up to 30 days, for rental reimbursement expenses incurred by you for the rental of an "auto" because of "loss" to a covered "auto ". Rental Reimbursement will be based on the rental of a comparable vehicle, which in many cases may be substantially less than $75 per day, and will only be allowed for a period of time it should take to repair or replace the vehicle with reasonable speed and similar quality, up to a maximum of 30 days. We will also pay up to $500 for reasonable and necessary expenses incurred by you to remove and replace your materials and equipment from the covered "auto ". GECA 701 (01/07) Includes coUyrighted material of Insurance Services Offices, Inc. with its permission Page 2 of 4 CERT NO.: 17027377 Tina Coleman 7/17/2013 3:27:55 PAl Page 5 of 10 If "loss" results from the total theft of a covered "auto" of the private passenger type, we will pay under this coverage only that amount of your rental reimbursement expenses which is not already provided under paragraph 4. Coverage Extension. 7. Lease Gap Coverage If a long -term leased "auto" is a covered "auto" and the lessor is named as an Additional Insured - Lessor, In the event of a total loss, we will pay your additional legal obligation to the lessor for any difference between the actual cash value of the "auto" at the time of the loss and the "outstanding balance" of the lease. "Outstanding balance" means the amount you owe on the lease at the time of loss less any amounts representing taxes; overdue payments; penalties, interest or charges resulting from overdue payments; additional mileage charges; excess wear and tear charges; and lease termination fees. B. EXCLUSIONS The following is added to Paragraph 3 The exclusion for "loss" caused by or resulting from mechanical or electrical breakdown does not apply to the accidental discharge of an airbag. Paragraph 4 is replaced with the following: 4. We will not pay for "loss" to any of the following: a. Tapes, records, disks or other similar audio, visual or data electronic devices designed for use with audio, visual or data electronic equipment. b. Equipment designed or used for the detection or location of radar. c. Any electronic equipment that receives or transmits audio, visual or data signals. Exclusion 4.c does not apply to: (1) Electronic equipment that receives or transmits audio, visual or data signals, whether or not designed solely for the reproduction of sound, if the equipment is permanently installed in the covered "auto" at the time of the "loss" and such equipment is designed to be solely operated by use of the power from the "auto's" electrical system, in or upon the covered "auto'; or (2) Any other electronic equipment that is: (a) Necessary for the normal operation of the covered "auto" or the monitoring of the covered "auto's "operating system; or (b) An integral part of the same unit housing any sound reproducing equipment described in (1) above and permanently installed in the opening of the dash or console of the covered "auto" normally used by the manufacturer for installation of a radio. D. DEDUCTIBLE The following is added: No deductible applies to glass damage if the glass is repaired rather than replaced. GECA 701 (01/07) Includes coRyrighted material of Insurance Services Offices, Inc. with its permission Page 3 of 4 CHRT NO.: 17027377 Tina Coleman 7/17/2013 3:27:55 P Page 6 of 10 SECTION IV. BUSINESS AUTO CONDITIONS A. LOSS CONDITIONS Item 2.a. and b. are replaced with: 2. Duties In The Event of Accident, Claim, Suit, or Loss a. You must promptly notify us. Your duty to promptly notify us is effective when any of your executive officers, partners, members, or legal representatives is aware of the accident, claim, "suit', or loss. Knowledge of an accident, claim, "suit ", or loss, by other employee(s) does not imply you also have such knowledge. b. To the extent possible, notice to us should include: (1) How, when and where the accident or loss took place; (2) The names and addresses of any injured persons and witnesses; and (3) The nature and location of any injury or damage arising out of the accident or loss. The following is added to 5. We waive any right of recovery we may have against any additional insured under Coverage A. 1. Who Is An Insured g., but only as respects loss arising out of the operation, maintenance or use of a covered "auto" pursuant to the provisions of the "insured contract', written agreement, or permit. B. GENERAL CONDITIONS 9. is added 9. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS Your unintentional failure to disclose any hazards existing at the effective date of your policy will not prejudice the coverage afforded. However, we have the right to collect additional premium for any such hazard. COMMON POLICY CONDITIONS 2.b. is replaced by the following: b. 60 days before the effective date of cancellation if we cancel for any other reason. caaT NO.: 1702 GECAT Oa (01 007) /i� /zoi Includessscoogyprighted matoerial of Insurance Services Offices, Inc. with its permission Page 4 of 4 7/17/2013 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 0410A (Ed 07 -07) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA BLANKET BASIS 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.) The additional premium for this endorsement shall be 2.00 % of the total policy premium otherwise due on such remuneration. The minimum premium for this endorsement is $ 350 nn Schedule Person or Organization Job Description ALL ORGANIZATIONS FOR WHOM THE WAIVER OF SUBROGATION IS ALL CALIFORNIA OPERATIONS ISSUED 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 10/01/2012 Policy No. 3300008099 -121 Endorsement No. 1 Insured ORTCO, INC. Premium $ Insurance Company Countersigned by Cypress Insurance Company WC 99 0410A (Ed 07 -07) CERT NO.: 17027377 Tina Coleman 7/17/2013 3:27:55 PM Page 8 of 10 7/17/2013 Ortco, Inc. POLICY NUMBER: CA00000517310// 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: Any person or organization when you and such person or organization have agreed in a contract or agreement that such person or organization be added with waiver of transfer of rights on your policy to performance of the agreement. this Schedule, if not shown above, wi8 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 o organization shown in the Schedule above. CG 24 04 05 09 ©Insurance Services Office, Inc., 2008 Page 1 of 1 ❑ CERT NO.: 17027377 Tina Coleman 7/17/2013 3:27:55 PM Page 10 of 10 Ortco, Inc. Policy Number: CA00000517310 7/17/2013 AD 06 5712 03 Effective Date: THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY /NON - CONTRIBUTING INSURANCE ENDORSEMENT This endorsement modifies insurance provided under the following: COMA4ERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE ANY PERSON OR ORGANIZATION QUALIFYING AS AN INSURED UNDER THE ADDI- TIONAL INSURED — OWNERS, LESSEES OR CONTRACTORS ENDORSEMENT FORM AT- TACHED TO THIS POLICY. It is agreed that Commercial General Liability Coverage Form CG 00 01 Section IV paragraphs 4.b. and 4.c. do not apply with respect to other valid and collectible Commercial General Liabil- ity insurance, whether primary or excess, avail- able to the person or organization shown in the Schedule and: 1) who is an insured under an Additional Insured - Owners, Lessees or Contractors endorsement at- tached to this policy; and AD 06 5712 03 CERT NO.: 17027377 Tina. Coleman 7/17/2013 3:27:55 PM Page 9 of 10 2) Who requires by specific written contract that this insurance is to be primary and/or non - contributory to other valid and col- lectible insurance available to that person or organization. This endorsement does not change the scope of coverage provided to the person or organization by any Additional Insurcd endorsement. All other terms and conditions remain un- changed. Page 1 of 1 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 04 02B (Ed 7 -07) 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 bP 5.00 % of the total policy premium otherwise due on such remuneration subject to a policy maximum charge for all such waivers of 5.00 % of total policy premium. The minimum premium for this endorsement is $ nsn_nn Person or Organization Schedule .fob Description City of El Segundo, its officers, officials, employees, agents & volunteers 350 Main Street, El Segundo, CA 90245 EI Segundo Teen Center 425 E. Grand Ave., El Segundo, CA 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 10/01/2012 Insured ORTCO, INC. Insurance Company Cypress Insurance Company WC 99 04 02B (Ed 7 -07) Policy No. 3300008099 -121 Countersigned by Endorsement No. 2 Premium $