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PROOF OF INSURANCE (2013) CLOSEDCERTIFICATE OF LIABILITY INSURANCE D /4 /2UDDIYYTI� 3/4/2013 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 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 i"M TM1idy tJemprNey CA License #OD44424 / o , jclecuapaey0insur Walter Mortensen Insurance INSURICA ' 1 (760)379 -0722 " Y Ica . com 5520 G4 Isabella Bl, POBx 2663 L iIWSURERS AF'F'OR#7YNCw'COVERAGE.. _ NAYC1e0N Lake Isabella CA 93240 [NSURERa Endurance American S ecialt INSURED INSURER B : Rite Inc., DBA: The Perfect Field INSURER C: 2075 Corte del No a1 INSURE RD: _ ....... - -_ .._,. -..�. Suite X ....�_..._..._...�. INSURER E " Carlsbad CA 92011 INSURER F: COVERAGES CERTIFICATE NUMBE'R:12 /13 GL 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, N� EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. N.R TYPE OF INSURANCE _..._ E P 41CY NUMBER P f tCOY EFP O� CY EXP _LIMITS GENERAL LIABILITY OCCURRENCE S 1, 000, 000 ,� � EACH A CLAIM6S•MADLmIAUILIT'Y MED E ___..... .... GENERAL X COMMERCIAL OCCUR PO00000021900 /23/2012 /23/2013 MI AE I �JpolsonL $ 100, 000 )dEItCIAh XP (� one�aad6t $ 2,500 PERSONAL �±R6I INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 0 L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGO $ 2,000,000 IJOLICY PR LOC $ AUTOMOBILE LIABILITY fIYN ANY AUTO BODILY INJURY(Perperson) $ ALL OWNED $ SCHEDULED BODILY INJURY Peraccident $ AUTOS AUTOS I ) HIRED AUTOS NOR—OWNED iTO OWNED , .. NJ $ YN PYYYArYAG $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS mMADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION NCC STATU- 0TH AND EMPLOYERS' LIABILITY YIN-......--.. - ANY PROPRIETOWPARTNERIEXECUT(VE OFFICERJMEMBER EXCLUDED? NIA E_L EACH ACCIDENT S (Mandalory to NH) E.L. DISEASE - POLICY LIMIT $ 1. yes c+es ^�he:r�r E.L.. DISEASE EAEMPLOYEr DESGIRIPT(ON OF OPERATI NS below $ ._.�..m.,...... DESCRIPTION OF OPERATIONS / LOCATIONSI VEHICLES (Attach ACORD 101, Additional Remarks Schedule, Yf more space Is required) The City of El Segundo, its officers, officials, employees, agents & volunteers are added to the General Liability policy as Additional Insureds, per form CG 20 37 7/04 attached, subjeot to the terms, conditions and exclusions of the policy. Insurance is primary and non contributory per form EGL905 (06/06). A written contract is required for the additional insured and primary & non contributory to be valid. Cancellation provisions per attached form IL 00 17 (11/98). This certificate replaces the one issued 4/25/12 CERTIFICATE HOLDER e":Lirw Pr—I I ATfnid 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. its off icialsityemlloyee err AUTHORIZED REPRESENTATIVE 350 Main Street El Segundo, CA 90245 y Ron Burcham /NERICYC � —1 � �✓ ACORD 25 (2010106) ©19B8 -2010 ACORD CORPORATION. All rights reserved. INS026 potoos).o1 The ACORD name and logo are registered marks of ACORD POLICY NUMBER; AP000000021900 COMMERCIAL GENERAL LIABILITY CG 20 37 07 04 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 Name Of Additional Insured Person(s) Or Or anization s : Location And Descrl flan Of Com feted O stations City of El Segundo, its officials & employees Various Attention: City Clerk 350 Main Street El Segundo, CA 90245 Information required to complete this SchedUl! if not shown above will be shown bn tine 13eclarat8ons. 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 liablllty for "bodll,y Injury" or "property damage " caused, in whole or In part, by "your work " at the location designated and described In the schedule of this endorsement performed for that additional insured and Included n the "products - completed operations hazard ,, CG 20 37 07 04 © ISO Properties, Inc., 2004 Pago 1 of 1 13 POLICY NUMBER: AP000000021900 COMMERCIAL GENERAL LIABILITY CG 20 26 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -- DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL. GENERAL LIABILITY COVERAGE PART SCHEDULE Secti011 1I - Who Is An Insured Is amended to In- clude as an additional Insured tlae person(s) or organ- Iation(s) shown In the Scheduler, but only with re- spect to liability for "bodily Injury ", "property damage " or "personal and advertising Injury" caused, In whole or In part, by your acts or onrisslons or the acts or o nIsslons of those acling on your behalf A. In the performance of your ongoing operations; or B. In conned with your premises owned by or rented yora. CGG20 26 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 13 PRIMARY NON-CONTRIBUTORY ENDORSEMENT This endorsement changes the policy, please read it carefully. T19s endorsement modifies insurance provided under the fallowing: CONINERCIAL GENERAL LIABILITY COVERAGE PART Men required by writuni contract Or agreement, the insurance provided by endorsement CG 20 26 (07/04) is primary instil•alice and we will not seek contribl,111oz, fro,n ally other insurance available t6 file person or organization cohered as nddNional insured hereunder, This endorsement does not change any other provision of the policy. Endurance American Specialty Insurance Company EGL 0905 0606 POLICY NUMBER: APO00000021 goo COMMON POLICY CONDITIONS All Coverage Parts included in this policy are subject to the following conditions. A. Cancellation 1. The first Named Insured shown in the Declara- tions may cancel this policy by mailing or deli- vering to us advance written notice of cancella- tion. 2. We may cancel this policy by mailing or deli- vering to the first Named Insured written notice of cancellation at least: a. 10 days before the effective date of cancel- - latlon if we cancel for nonpayment of pre- mium; or b. 30 days before the effective date of cancel- lation if we cancel for any other reason. 3. We will mail or deliver our notice to the first Named insured's last mailing address known to us. 4 Notice of cancellation will state the effective date of cancellation. The policy period will end on that date. 5. If this policy is cancelled, we will send the first Named insured any premium refund due, If we cancel, the refund will be pro rata. If the first Named insured cancels, the refund may be less than pro rata. The cancellation will be ef- fective even if we have not made or offered a refund. 6. If notice is mailed, proof of mailing will be suffi- cient proof of notice. B. Changes This policy contains all the agreements between you and us concerning the insurance afforded. The first Named Insured shown in the Declara- tions Is authorized to snake changes in the terms of this policy with our consent. This policy's terms can be amended or waived only by endorsement issued by us and made a part of this policy. C. Examination Of Your Books And Records We may examine and audit your books and records as they relate to this policy at any time during the policy period and up to three years af- terward. D. Inspections And Surveys 1. We have the right to: a. Make Inspections and surveys at any time; IL 00 17 11 98 b. Give you reports on the conditions we find; and c. Recommend changes. 2. We are not obligated to make ally Inspections, surveys, reports or recommendations and any such actions we (lo undertake relate only to In- surability and tide premiums to be charged. We do not make safety inspections, We do not urt- dertake to perform tide duty of any person or organization to provide for the health or safety of workers or the public. And we do not warrant that conditions. a. Are safe or healthful; or b. Comply with laws, regulations, codes or standards. 3. Paragraphs 1. and 2. of (Ills condition apply not only to (is, but also to any rating, advisory, rate service or sirniiar organization which makes In- surance inspections, surveys, reports or.rec- ommendations. . Paragraph 2. of this condition does not apply to any Inspections, surveys, reports or recom- mendations we may make relative to certifica- tion, tinder state or municipal statutes, ordin- ances or regulations, of boilers, pressure ves- sels or elevators. E. Premiums The first Named Insured shown in the Declara- tions: 1. is responsible for the payment of all premiums; and 2. VUj! be the paye e for any return premiums we pay. B. Transfer Of Your Rights And Duties Under This Policy Your rights and dtitles under this policy may not be transferred without our written consent except In the case of death of an individual named in- sured, if you die, your rights and duties will be transferred to your legal representative but only while acting within the scope of dudes as your legal represent- ative, Until your legal representative is appointed, anyone having proper temporary custody of your property will have your rights and duties but only will) respect to that property. IL 0017 1198 Copyright, Insurance Services Office, Inc., 1998 Page 1 of 1 Ll ACC>O CERTIFICATE OF LIABILITY INSURANCE 3A�E6(MM/DDlYYYI) / /2fl12 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(les) 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 endorsements , PRODUCER CO . OuOtY Dempsey Walter Mortensen Insurance (760,)379 -4651 PHONE __. FA 40, „.(760)379 -9722 CA License #OB44424 E' ADORES& 01 I de mpsey0guarantyins . com 5520 G4 Isabella Bl, POBx 2663 INSURER NAIC4 Lake Isabella CA 93240 INSURER A:Paerless Insurance Company INSURED INSURERS: Rite, Inc., dba The Perfect Field INSURER C: 2075 Corte del Nogal INSURER D: Suite X �._ INSURER E . ..... Carlsbad CA 92011 INSURER F: COVERAGES CERTIFICATE NUMBER:12 /13 BA REVISION NUMBERf 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 w4 L�9i5�6M LICY'EF F'OLICYEXP LTR TYPE OF INSURANCE POLICY NUMBER PO LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY i1TAN r0 $ MED EXP (An rL�op� a floor) $ CLAIMS•MADE n OCCUR PERSONAL & ADV INJURY S GENERAL AGGREGATE $ GEN'I,AGGR£GATELIMfr APPLIES PER: PRODUCTS - COMP /OPAGG $ POLICY El PR() LOC $ AUTOMOBILE LIABILITY ED I LE LIMIT (Ea acc den _,• „m„ 1 ii 0 0 0 0 A ANY AUTO BODILY INJURY (Per person) $ ALL OWNED X SCHEDULED AUTOS AUTOS BA1039385 /16/2012 /16/2013 BODILY INJURY (Peraccident) $ X NOWOWNED HIRED AUTOS X AUTOS PROPERTY DAMA E (Per accident $ Uninsured motorist Bl -si le $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ ]DED XCESS LIAB CLAIMS -MADE AGGREGATE $ _ -� RETENTION $ $ WORKERS COMPENSATION WC STATU OTH- YIN m . ANY EEEXCL ECUTiVE E.L EAC HACCIDENT $ n OFFICERIMMBR D? NIA .w (Mandatory in NN) E.L. DISEASE - EA EMPLOYEE YE$ IF yes, describe under DESCRIPTION OF OPERATIONS below E.L DISEASE - POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) TION 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, its officials & employees AUTHORIZED REPRESENTATIVE c/o City Clerk 350 Main Street, Room #5 El Segundo, CA 90245 -3813 Q / Ronald Burcham /NERICK ACORD 26 (2010/06) ©1988 -2010 ACORD CORPORATION. All rights reserved. INS026 (201005) 01 The ACORD name and logo are registered marks of ACORD ACC aA CERTIFICATE OF LIABILITY INSURANCE OATE(MM/DD/YYYY) 02/27/2013 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 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 endorsements . 90DUCER CONTACT Paychex Insurance Agency Inc NA PAYCHEX INSURANCE AGENCY, INC. PHONE FAX 150 SAWGRASS DRIVE , 877 -266 -6850 �585�389 7426 ROCHESTER, NY 14620 E -MAIL Certs @paychex.com INSURER(S) AFFORDING COVERAGE NAIC # ISUUED INSURER A: NorGUARD Insurance Company 31470 RITE INC INSURER B: 2075 CORTE DEL NOGAL .... SUITE X INSURER C: CARLSBAD, CA 92011 _ '- " "— " —" INSURER D: INSURER E: INSURER F: OVERAGES 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. _,ww I TYPE OF INSURANCE DDL UBR POLICY NUMBER PouCY EFF POLICY EXP LIMITS R INSR VD (MM/DD/YYYY MM /DD/YY GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED SdGG $ �LAIMS "MADk �UR MED EXP (Any (Any one person) $ PERSONAL _... & ADV INJURY $ GENERAL �I .... AGGREGATE $ EN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPlOP AGG $ POLICY = PROJECT LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ BODILY INJURY (Per person) $ ALLOWNED SCHEDULED AUTOS 'AUTOS I AOTOSWNED BODILY INJURY HIRED AUTOS (Per accident) $ PROPERTY DAMAGE $ (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE $ .. $ ...mE- ....... '.. R __.. DD ETENTION $ WORKFRC COMPENSATION AND RIWC469772 03/08/2013 03/08/2014 OTH- 7]FtY"— "NITS EMPLOYERS'LIABILITY -- E.L. EACH ACCIDENT $ 1,000,000.00 ANY PROPRIETOR/ PARTNER / EXECUTIVE '"""" "' "' "' OFFICER/MEMBER EXCLUDED? DISEASE- EA EMPLOYEE $ 1,000,000.00 (Mandatory in NH) Y N/A X E.L. DISEASE - POLICY LIMIT $ 1,000,000.00 If yes, describe under SCRIPTION OF OPERATIONS / LOCATIONS/ VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Waiver of Subrogation granted in favor of the certificate holder :ERTIFICATE HOLDER CANCELLATION CITY OF EL SEGUNDO ITS OFFICIALS AND SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION EMPLOYEES DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY ATTN CITY CLERK PROVISIONS, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR 350 MAIN STREET LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. EL SEGUNDO CA 90245 -0989 , AUTHORIZED REPRESENTATIVE y�l .CORD 25 (2010/05) ©1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Important Information Rite Inc 2075 Corte Del Nogal Suite X Carlsbad, CA 92011 GUARD INSURANCE GROUP Your Business Is Our Business Agency PAYCHEX INSURANCE AGENCY 150 Sawgrass Drive Rochester, NY 14620 Changes to Your Workers' Compensation Policy with NorGUARD Insurance Company Policy Number RIWC469772 Policy Period From March 08, 2013 to March 08, 2014, 12:01 AM, standard time at the insured's mailing address. 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 See Above Insured Rite Inc Policy No. RIWC469772 Endorsement No. 1 Premium $ 355.00 Insurance Company NorGUARD Insurance Company Countersigned by Thank You Again for Choosing GUARD! Call our Customer Service Hotline at 1 -800- 673 -2465, Ext. 1300 with any questions. Endorsement WC 99 00 13 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 1_1? _% of the California workers' compensation premium otherwise due on such remuneration. Schedule Person or Organization Job Description Blanket Waiver - Any person or organization for whom the All CA Operations Named Insured has agreed by written contract to furnish 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.) Endorsement Effective Policy No. RIWC469772 Endorsement No. Insured Insurance Company Countersigned By