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PROOF OF INSURANCE (2015) CLOSEDGOVESTA -02 PPISANO CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DD/YYYY) 1/28/2015 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 CONTACT NAME: CTK North American Insurance Services, LLC PHONE FAx ." .......... 1240 North Lakeview Avenue, #240 (vc, rvo, Ext): (714) 779 -2000 IA /c N..(1 779129 Anaheim, CA 92807 ADDARISS. INSURED Government Staffing Services P.O. Box 718 Imperial Beach, CA 91933 IN's`URER A: Zurich .. American ) AFFt7 ...7855 c..# INSURER B:Amer can Guarantee and L ability Ins. Co. 2 Insurance Co. of IL 2 6247 INSURER C : INSURER D INSURER E'z t" nV'FR AFR CFRTIFICATF NI IMRFR• RFVI_QlnKl MI IMRFR- 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. _ i(iiiJC � ILTR TYPE OF INSURANCE POLICY NUMBER MM OID'�YY. MddYJiYD YYYY LIMITS IN! WVD A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 CLAIMS -MADE occuR X PRA969906302 05!10/2014 05/10/2015 �q r.urr r r).$ RM; t u I 100,00 — . ... .......... MED EXP (Any one person) $ 10_,000 ._..00 .. ................. PERSONAL &ADVINJURY .............................._ $ 1,000, GEN'L AGGREGATE LIMIT APPLIES PER: GE.................. AGGREGATE 2,000,000 X POLICY PR LOC PRODUCTS TSCOMPOPAGG $ T^^^2,000,00. OTHER: $ AUTOMOBILE LIABILITY COMBINED eDISINGLELIMIT $ 1,000 0 A ANY AUTO PRA969906302 05/10/2014 05/10/2015 Bo «.° "'...__...�J BODILY INJURY (Per person) ___..... _.....m .................�_.__. $ - -- --� SCHEDULED ALL OWNED AUTOS AUTOS ODI .�LY......_.U. INJ .. . ., R UR . Y -_ (Per accident) $ X NON -OWNED PPePEFtTY I)A63hAa, $ HIRED AUTOS .. AUTOS ,(Rrr,acgdr�nl) X UMBRELLA LIAB X OCCUR OCCURRENCE $ 1,000, 0 B H EXCESS LIAB CLAIMS -MADE - UMB946734702 05/10/2014 05110/2015 AGGREGATE $EACH 1,000,00 DED.�...x......RETENTION $ U..$ .......................................... ..............................: WORKERS COMPENSATION �. "" PER OTH- ATATUTE 1. R.— AND EMPLOYERS' LIABILITY YIN .., ..ma _,____,� ................ .w „w ANY PROPRIETORIPARTNER /EXECUTIVE OFFICER /MEMBER EXCLUDED? N / A X M „M„ E.L. EACH ACCIDENT $ (Mandatory in NH) E LDISEASE EA EMPLOYEE $ E If yes, describe under „t ..................... DESCRIPTION of OPERATIONS below E L. DISEASE - POLICY LIMIT $ A Crime PRA969906302 05/10/2014 05/10/2015 2,500 Deductible 100,000' A Prof. Liability PRA969906302 05/10/2014 05/10/2015 $1M /$2M DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) Schedule of Named Insured(s) Government Staffing Service dba: Herrera & Associates Staffing Services Government Staffing Service dba: Munigroup Government Staffing Service dba: Munitemps Government Staffing Service dba: Munistaff SEE ATTACHED ACORD 101 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of El Segundo Attn: David King ACCORDANCE WITH THE POLICY PROVISIONS. � , 350 Main Street El Segundo, CA 9024 AUTHORIZED REPRESENTATIVE ©1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD POLICYNUMBER: PRA969906302 COMMERCIAL GENERAL LIABILITY 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. SCHEDULE Name of Person or Organization: City of El Segundo, its officials, officers, employees, agents and volunteers (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of "your work" for that insured by or for you. s° CG 20 10 1185 Copyright, Insurance Services Office, Inc., 1984 Page 1 of 1 CERTHOLDER COPY SP P.O. BOX 8192, PLEASANTON, CA 94588 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 02 -02 -2015 CITY OF EL SEGUNDO SP DEPT OF BUILDING & SAFETY 350 MAIN ST EL SEGUNDO CA 90245 -3813 GROUP: POLICY NUMBER: 9008463 -2014 CERTIFICATE ID: 11 CERTIFICATE EXPIRES: 11 -01 -2015 11 -01- 2014/11 -01- 2015,' This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 10 days advance written notice to the employer. We will also give you 10 days advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy. Authorized Representative President and CEO EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE, ENDORSEMENT #1600 - HERRERA, JOHN PRESIDENT - EXCLUDED. ENDORSEMENT #1600 - HERRERA, MARRISAL VICEPRES - EXCLUDED. ENDORSEMENT #2570 ENTITLED WAIVER OF SUBROGATION EFFECTIVE 2015 -02 -02 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. THIRD PARTY NAME: CITY OF EL SEGUNDO EMPLOYER GOVERNMENT STAFFING SERVICES INC DBA: SP MUNITEMPS PO BOX 718 IMPERIAL BEACH CA 91933 [VM5,CS] (REV.7 -2014) PRINTED : 02 -02 -2015 ENDORSEMENT AGREEMENT WAIVER OF SUBROGATION 9008463 -14 RENEWAL SP 7- 83 -77 -00 PAGE 1 HOME OFFICE SAN FRANCISCO EFFECTIVE FEBRUARY 2, 2015 AT 12.01 A.M. ALL EFFECTIVE DATES ARE AND EXPIRING NOVEMBER 1, 2015 AT 12.01 A.M. AT 12:01 AM PACIFIC STANDARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME MUNITEMPS PO BOX 718 IMPERIAL BEACH, CA 91933 ANYTHING IN THIS`°0tlCY TOEITIE CONTRARY NOTWITHSTANDING, IT IS AGREED THAT THE STAT COMPENSATION INSURANCE FUND WAIVES ANY RIGHT OF SUBROGATION AGAINST, CITY OF EL SEGUNDO WHICH MIGHT ARISE BY REASON OF ANY PAYMENT UNDER THIS POLICY IN CONNECTION WITH WORK PERFORMED BY, ulJ�, IT IS FURTHER AGREED THAT THE INSURED SHALL MAINTAIN PAYROLL RECORDS ACCURATELY SEGREGATING THE REMUNERATION OF EMPLOYEES WHILE ENGAGED IN WORK FOR THE ABOVE EMPLOYER. IT IS FURTHER AGREED THAT PREMIUM ON THE EARNINGS OF SUCH EMPLOYEES SHALL BE INCREASED BY 03%. NOTHING IN THIS ENDORSEMENT CONTAINED SHALL BE HELD TO VARY, ALTER, WAIVE OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS POLICY OTHER THAN AS STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR LIMITATIONS OF THIS ENDORSEMENT. COUNTERSIGNED AND ISSUED AT SAN FRANCISCO: FEBRUARY 4, 2015 AUTHORIZED REPRESENT IVE PRESIDENT AND CEO 2570