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PROOF OF INSURANCE (2013) CLOSEDCERTIFICATE OF LIABILITY .- � INSURANCE I3i9i2o12YYY, 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 NANTA Tina Cowie Cornerstone Specialty Insurance Services, Inc. PHONE . (714) 731 -7700 FAX . (714) 731 -7750 LA& Na 14252 Culver Drive A.299 EMAIL tina @cornerstones ecialty,com E-MAIL p UP- 3429T370 /8/2012 8/8/2013 W- DFD RETENTION $ $ A COMPENSATION AND EMPLOYERS' LIABILITY Y / N . ............. (Mandatory in NH) EXCLUDED? N/A EL DISEASE - EA EMPLOYEE $ m mmm 't "000 000 ANY PROPRIETOR /PARTNER /EXECUTIVE JUB- 3642T261 8/8/2012 /8/2013 E L EACH ACCIDENT $ ..,_mmmmmmmmm1m,, 000 -000 If yes, describe under mmDESCRIPTION OF OPERATIONS below m mmmmmmm wwwwwwww mm ww T E L DISEASE - POLICY LIMIT $ 10ITQmQ QOITQ' C Professional Liability x114007309 8/8/2012 8 /8/2013 'Each Claim $2,000,000 Claims Made Annual Aggregate $2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Certificate Holder is Additional Insured for General Liability but only if required by written contract with the Named Insured prior to an occurrence and as per attached endorsement. Coverage is subject to all policy terms and conditions. *30 days notice of cancellation, except for 10 days notice for non - payment of premium. For Professional Liability coverage, the aggregate limit is the total insurance available for all covered claims reported within the policy period. CERTIFICATE HOLDER CANCELLATION (310) 322 -4167 rsumi@elseg-undo.org SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of E1 Segundo " ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street El Segundo, CA 90245 Mw �I AUTHORIZED REPRESENTATIVE Tina Cowie /TCOWIE� ACORD 25 (2010/05) ©1988 -2010 ACORD CORPORATION. All rights reserved. INS025 (201005),01 The ACORD name and logo are registered marks of ACORD INSURERS) „ NAIC # Irvine CA 92604 I „AFFORDING C 25674 INSURED I INSURERB:Trvelers Indemnit Co of Conn 2 25682 JAS PACIFIC, INC. I INSURERC:Continental Casualt y Co;� 0 0443 201 N. Euclid Avenue I INSURERD: ''.... INSURER E .Upland CA 91786 I INSURER F: COVERAGES CERTIFICATE NUMBER:12 /13 ALL COVERAGES REVISION NUMBER:. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE L 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. AffbILSUffR LTR TYPE OF INSURANCE .... ................. ._. . A GENERAL LIABILITY E EACH OCCURRENCE $ 1 1,000,000 X COMMERCIAL GENERAL LIABILITY A A � uuuu 3 300 000 A _ CLAIMS -MADE � m OCCUR X 8 80- 7384P218 /8/2012 /8/2013 ITIT 5,000 X ADDITIONAL INSURED P PERSONAL &ADVINJURY - 1,000,000 X BLNKT WVR OF SUBROX G GENERAL AGGREGATE $ 2 2,000,000 GENT AGGREGATE LIMIT APPLIES PER: P PRODUCTS - COMP /OP AGG $ 2 2,000,000 P POLICY X PRO” LOO $ $ ................ _ _.... AUTOMOBILE LIABILITY C COMBINED SINGLE LIMIT _��_......_1 � 000 000 B X ANY AUTO B BODILY INJURY (Per person) $ - -uu ALL OWNED SCHEDULED - - OC906515 /8/2012 83/8/2013 BODILY INJURY (Per accident) $ HIRED AUTOS NON -OWNED P PROPERTY DANIAGE - m$mmmmm- W WUu Medical payments $ X UMBRELLA LIAB X OCCUR E EACH OCCURRENCE $ 5 5,000,000' A E EXCESS LIAB CLAIMS MADE A AGGREGATE $ 5 5,000,000 (310) 322 -4167 rsumi@elseg-undo.org SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of E1 Segundo " ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street El Segundo, CA 90245 Mw �I AUTHORIZED REPRESENTATIVE Tina Cowie /TCOWIE� ACORD 25 (2010/05) ©1988 -2010 ACORD CORPORATION. All rights reserved. INS025 (201005),01 The ACORD name and logo are registered marks of ACORD _ Y POLICY NUMBER: 680- 7384P218 ��, A COMMERCIAL GENERAL LIABILITY NAMED INSURED: JAS Pacific, Inc. ly POLICY PERIOD: 8/8/2012 to 13 ,, 8/8/2013 , THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED (ARCHITECTS, ENGINEERS AND SURVEYORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. The following is added to WHO IS AN INSURED (Section II): Any person or organization that you agree in a "contract or agreement requiring insurance" to in- clude as an additional insured on this Coverage Part, but only with respect to liability for "bodily in- jury", "property damage" or "personal injury" caused, in whole or in part, by your acts or omis- sions or the acts or omissions of those acting on your behalf: a. in the performance of your ongoing opera- tions; b. In connection with premises owned by or rented to you; or c. In connection with "your work" and included within the "products- completed operations hazard ". Such person or organization does not qualify as an additional insured for "bodily injury", "property damage" or "personal injury" for which that per- son or organization has assumed liability in a con- tract or agreement. The insurance provided to such additional insured is limited as follows: d. This insurance does not apply on any basis to any person or organization for which cover- age as an additional insured specifically is added by another endorsement to this Cover- age Part. e. This insurance does not apply to the render- ing of or failure to render any "professional services ". f. The limits of insurance afforded to the addi- tional insured shall be the limits which you agreed in that "contract or agreement requir- ing insurance" to provide for that additional insured, or the limits shown in the Declara- tions for this Coverage Part, whichever are less. This endorsement does not increase the limits of insurance stated in the LIMITS OF INSURANCE (Section III) for this Coverage Part. B. The following is added to Paragraph a. of 4. Other Insurance in COMMERCIAL GENERAL LIABILITY CONDITIONS (Section IV): However, if you specifically agree in a "contract or agreement requiring insurance" that the insurance provided to an additional insured under this Cov- erage Part must apply on a primary basis, or a primary and non - contributory basis, this insurance is primary to other insurance that is available to such additional insured which covers such addi- tional insured as a named insured, and we will not share with the other insurance, provided that: (1) The "bodily injury" or "property damage" for which coverage is sought occurs; and (2) The "personal injury" for which coverage is sought arises out of an offense committed; after you have entered into that "contract or agreement requiring insurance ". But this insur- ance still is excess over valid and collectible other insurance, whether primary, excess, contingent or on any other basis, that is available to the insured when the insured is an additional insured under any other insurance. C. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us in COMMERCIAL GENERAL LIABILITY CON- DITIONS (Section IV): We waive any rights of recovery we may have against any person or organization because of payments we make for "bodily injury", "property damage" or "personal injury" arising out of "your work" performed by you, or on your behalf, under a "contract or agreement requiring insurance" with that person or organization. We waive these rights only where you have agreed to do so as part of the "contract or agreement requiring insur- ance" with such person or organization entered into by you before, and in effect when, the "bodily Page 1 of 2 0 The Travelers Companies, Inc. CG D3 891 09 07 Includes the copyrighted material of Insurance Services Office, Inc. with its permission. COMMERCIAL GENERAL LIABILITY injury" or "property damage" occurs, or the "per- sonal injury" offense is committed. D. The following definition is added to DEFINITIONS (Section V): "Contract or agreement requiring insurance" means that part of any contract or agreement un- der which you are required to include a person or organization as an additional insured on this Cov- erage Part, provided that the "bodily injury" and ..property damage" occurs, and the "personal in- jury" is caused by an offense committed: a. After you have entered into that contract or agreement; b. While that part of the contract or agreement is in effect; and c. Before the end of the policy period. Page 2 of 2 © The Travelers Companies, Inc. CG D3 891 09 07 Includes the copyrighted material of Insurance Services Office, Inc. with its permission. POLICY NUMBER: BA- OC906515 INSURED: JAS Pacific EFFECTIVE DATE: 8/8/2012 to 8/8/2013 COMMERCIAL AUTO COA T4 37 08 08 0 2D0B The TraveWrs Companier, Int. Page of INSURED: JAS Pacific, Inc. TRAVELERS) POLICY DATES: 8/8/2012 to 8/8/2013 WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 99 03 76 (00) - 001 POLICY NUMBER: UB- 3642T261 WAIVER OF OUR RIGHT TO RECOVER FROM OTH S ENDORSEMENT — CALIFORNIA ra, (BLANKET WAIVER) c wti'� 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, 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 3 % of the California workers' compensation premium otherwise due on such remuneration. Schedule Person or Organization Job Description ALL PERSONS OR ORGANIZATIONS THAT ARE PARTIES TO A CONTRACT THAT REQUIRES YOU TO OBTAIN THIS AGREEMENT, PROVIDED YOU EXECUTED THE CONTRACT BEFORE THE LOSS. 16t, S�v( 23 bF CSR- tkc,'� �t31�