PROOF OF INSURANCE (2014) CLOSED.4CC)Mbf
CERTIFICATE OF LIABILITY INSURANCE
NAM
THIS CERTIFICATE If ISSUED A$ 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(% AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IINPORTANT: If the avilksto hoadsr Is on ADDITIONAL INSURED, " polNey(Iss) must be *ndomod, N SUSROGAT'IOf+N IS WAIVED, sub)sat to
the tonne and conditions of the Policy, caMn pollcMs may noire an sndsnsn ant, A statsmsnt on this osrtlAeab doss not confer tights to the
In Ilsu of such sndom montitL
PRODUCER
TRI WORLD INSURANCE AGENCY INC
4500 Campus Drive # 670
Newport Beach, CA 92660 -1830
INSURED MARX BROS. FIRE EXTINGUISHER CO.
& COOK FIRE EXTINGUISHER, A DIV. OF MARX
1159 SOUTH SOTO
LOS ANGELES, CA 90023
o M . REVISION w
wucr
10833
22314
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,
EXCLUSIONSAND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN
REDUCED BY PAID CLAIMS,
MR LTR
TYPE OF INSURANCE
POLICY NUMBER
iFF
/
LIMITS
GENERAL
LIABILITY
EACH OCCURRENCE
$ n
PRMI
S p 0
X
cowmcm GENERAL LIABILITY
CLAIMS -MADE � OCCUR
MEO EXPAn o n)
S
PERSONAL& ADV INJURY
S 110001000
A
CCP
000525080 -01
03/26/13
03/26/14
$5900_Ded /Occ
GENERAL AGGREGATE .
s 2 000 000
CEN'L AGGREGATE LIMIT APPLIES PER
PRODUCTS • COMP/OP AGG
s 21000,000
POLICY X. LOC
S
AUTOMOBILE LIABILITY
Ee spC9
ANYAVTO
BODILY INJURY (Pa Pawn)
S
ALL OWNED AUTOS LED
BODILY .._Y (
INJURY (Pa eocid—
$
HIRED AUTOS NON -OWNED
AUTOS
Pa 1
S
s
-
UMBRELLA LIAS X OCCUR
NHA230714
03/26/13
03/26/14
EACH OCCURRENCE
s 4,000j000
AGGREGATE
a 4,000,000
B
EXCESS LIAR CLAIMS -MADE
PRODUCTS OPS
s 4 000 000
DIED I i RETENTION (c
WOR)MRS COMPENSATION
OTH X
�.
AND EMPLOYER& LIABILITY
AW PROPRETORPARTNEREXEOUrIVE �""
�. CPCA16804
02/18/13
02/18/14
E.L. EACHACCIDENr
' x_1.000,000
C
OWN)ERURIBER EXCLUCEOO Y
Piwarory In Pit"
NSA
E,L, DISEASE - EA EMPLOYE
S 1 000 000
DES RIPTIOM O OPERATIONS below
El DISEASE • POLICY' LIMIT
i 1,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS! VEHICLES (Agech ACORD 101, AWW" Remarks SdwduAs, N more spas Is required)
ALL OPERATIONS - SERVICE AGREEMENT
CITY OF EL SEGUNDO, ITS EMPLOYEES, REPS, OFFICERS AND
AGENTS ARE ADDITIONAL INSURED
PER ATTACHED ENDORSEMENTS. WORK COMP WAIVER OF SUBROGATION ENDORSEMENT ATTACHED,
THIRTY (30) DAYS NOC APPLIES TO ALL LISTED POLICIES.
CERTIFICATE HOLDER
CANCELLATION
CITY OF EL SEGUNDO
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
ATTN CITY CLERK
THE EXPIRA ON DATE THEREOF, NOTICE WILL BE DELIVERED IN
350 MAIN STREET, ROOM 5
ACCORDANCjr THE POLICY PROMS S.
EL SEGUNDO, CA 90245 -3813
AUTHORIZED SENTA
r
0 1988 -2010 ACORD CORPORATION. All rights reserved.
ar,rwn,me7ninimN Tho at^nan name and I^nn arm
rAw4W*rarM rnartre rvf artrlpn
JAMES RIVER INSURANCE CO,
COMMERCIAL GENERAL LIABILITY
CG 20 37 07 04
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LEASEES OR
CONTRACTORS - COMPLETED OPERATIONS
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name of Person or Organization:
CITY OF EL SEGUNDO, ITS EMPLOYEES, REPS, OFFICERS AND AGENTS
RE: ALL OPERATIONS
(If no entry appears above, Information required to complete this endorsement will be shown in the Declarations as
applicable to this endorsement.)
Section II - Who Is An Insured Is amended to Include as an Insured the person or organization(s) shown in the
Schedule, but only with respect to liability for "bodily 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 in the "products - completed operations hazard ".
PRIMARY INSURANCE CLAUSE: To the extent that this insurance Is afforded to any additional insured
under this policy, such insurance shall apply as primary and not contributing with any insurance carried
by such additional insured, as required by written contract.
a
CG 20 37 07 04
C) ISO Properties, Inc., 2000
Page 1 of 1
JAMES RIVER INSURANCE CO.
COMMERCIAL GENERAL LIABILITY
CG 20 10 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 PERSON OR ORGANIZATION:
CITY OF EL SEGUNDO ITS EMPLOYEES, REPS, OFFICERS AND AGENTS
RE: ALL OPERATIONS
A. Section 11— Who Is An Insured is amended to include as an insured any 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 Insured(s) at the
location(s) designated above.
S. With respect to the insurance afforded to these additional insureds, the following additional exclusions
applies:
This insurance does not apply to "bodily injury" or "property damage" occurring after:
1. All work, including materials, parts or equipment 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 intended use by any
person or organization other than another contractor or subcontractor engaged in performing operations
for a principal as a part of the same project.
PRIMARY INSURANCE CLAUSE: To the extent that this insurance is afforded to any additional insured under this policy,
such insurance shall apply as primary and non contributory with any insurance carried by such additional insured, ad
required by written contract.
�j ya�r
CG 20 10 07 04
®ISO Properties, Inc., 2004 Page 1 of 1
COMPANION PROPERTY & CASUALTY
Policy Number: CPCA16804
Policy Period: 02/18/2013 TO 02/18/2014
Named Insured: MARX BROS FIRE EXTINGUISHER CO., INC.
The Information above is required only when this endorsement is issued subsequently to preparation of the policy.
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 3% of the California workers' compensation premium otherwise
due on such remuneration.
SCHEDULE
PERSON OR ORGANIZATION
CITY OF EL SEGUNDO
ATTN: CITY CLEARK
350 MAIN STREET, ROOM
EL SEGUNDO, CA 90245 -3813
This endorsement changes the policy to which It is attached and Is effective on the date issued unless otherwise stated.
PRODUCER: TRI -WORLD INSURANCE AGENCY, INC.
WC 04 03 06� � .