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PROOF OF INSURANCE (2014) CLOSEDClient #: 1255108 305A1 ENT ACORDTM CERTIFICATE OF LIABILITY INSURANCE 3/27/2013 DATE (MM /DD/YYYY) M/DDN 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 pOINCy(ie s) " 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 NAME' Vanessa Maldonado BB &T Insurance Services PWrNE — .. VIA ................. ....... 9 Y vmaidonado@bbandt.com No,, Ext). 714 578 72.56 dt.com (° �C-N° 877- 297 -1116 of Orange County — _Ap1SRES'6. 680 Langsdorf Drive Suite 100 INSURERS) AFFORDING COVERAGE Fullerton, CA 92831 INSURE NAIL n R A :James River Insurance Company 12203 ' INS... .............. ........__.. _._.__... ,.... INSURER ............ _ .. - ........ _ ............ ............... .. URED B: Zurich American Insurance Co 16535 A -1 Enterprises Inc. dba A -1 Fence Company 2831 E. La Cresta Ave. Anaheim, CA 92806 INSURER C: INSURER E: COVERAGES 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 CONTRACTOR 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, LTRR I AbDL N R SV�V(i„ . - .._... POLICY EFF POLNCy EXP TYPE OF INSURANCE POLICY NUMBER (MMiDDlYYYY) (MM /DD/YYmYY LIMITS A GENERAL LIABILITY 000202726 12/01/2012 12101/201 EACH OCCoQ(URRENCE $1,000,000 CLAIMS -MADE X OCCUR MED EXP {AnRy ne person) _ $ EXclu X COMMERCIAL GENERAL LIABILITY PREMISES Ea cocurrenoe $5U 000 X BI /PD Ded: $5,000 PERSONAL &ADV INJURY $1,0001000 ......... GENERAL AGGREGATE $2,000000_ GEN L AGGREGATE LIMIT APPLIES PER: PRODUCTS COMP /OP AGG $2,000,000 - - - - -- POLICY X� 0. �„ LOC $ -- _ AUTOMOBILE LIABILITY .EaLaq NED SINGL & IMIT AU ( (Ea �rcc gg) - ----- - -- -- - - - --- .1 ...... ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS NON -OWNED PROPERTY DAMACa�'E. $ HIRED AUTOS AUTOS (PeraPPl00 ......__ ........ ..... - .. ......... , .. EXCESS LIABAB 1 _____ .. UMBRELLA LAB A�C°yC"RE�"APL= RENCE B WORKERLCOMR COMPENSATION Y /N... WC966159200 1/01/2013 01/01/201 WCSTATU �OTH- DED ETENTI _ _ ANY PROP RIETOR/PARTNER/EXECUTIV E. EACH ACC D ..... ER, LIABILITY E E L EACH ACCIDENT $1000000 OFFICER/MEMBER EXCLUDED? ❑ NIA (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $1,0 00x000 If yes, describe under DESCRIPTION OF OPERATIONS below E L DISEASE - POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) RE: Covered CA Operations Performed By Or On Behalf of the Named Insured. The City of El Segundo, its officers, officials, employees, agents, and volunteers are named additional insured as respects general liability and this insurance is primary and noncontributory with any other insurance of the additional insured; and waiver of subrogation applies as respects workers compensation as required by written contract, per endorsements attached. (See Attached Descriptions) City of El Segundo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Y g un THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 150 Illinois Street ACCORDANCE WITH THE POLICY PROVISIONS. El Segundo, CA 90245 AUTHORIZED REPRESENTATIVE a ©1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) 1 of 2 The ACORD name and logo are registered marks of ACORD #S1 0213218/M988701 0 VLMAL SAGITTA 25.3 (2010/05) 2 of 2 #S10213218/M9887010 POLICY NUMBER: 000202726 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 Additional Insured Person(s) Or Organ ization s : Locations Of Covered Operations Where required by written contract or agreement All operations of the Named Insured's.. 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 insured(s) at the location(s) desig- nated above. 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 oth- er than another contractor or subcontractor engaged in performing operations for a prin- cipal as a part of the same project. CG 20 10 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 0 POLICY NUMBER: 000202726 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) Location And Description Of Completed Opera - Or Organ ization s : tions Where required by written contract or agreement All operations of the Named Insured's. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organiza- tions) 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 desig- nated and described in the schedule of this endorse- ment performed for that additional insured and included in the "products- completed operations hazard ". CG 20 37 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 4 -84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT- - CALIFORNIA This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different date is indicated below. (The following "attaching clause" need be completed only when this endorsement is issued subsequent to preparation of the policy.) This endorsement, effective on 1/1 /13 at 12:01 A.M. standard time, forms a part of (DATE) Policy No. WC966159200 Endorsement No. of the Zurich American Insurance Company (NAME OF INSURANCE COMPANY) issued to A -1 Enterprises Inc Premium (if any) $ 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 % of the California workers' compensation pre- mium otherwise due on such remuneration. Schedule Person or Organization ANY PERSON OR ORGANIZATION FOR WHOM YOU ARE REQUIRED BY WRITTEN CONTRACT OR AGREEMENT TO OBTAIN WC 252 (4 -84) WC 04 03 06 (Ed. 4-84) Job Description Page 1 of 1 A4CC)BR" AIFEN-1 OP ID., 81 °"'1/30/ f WDDfyyyy) CERTIFICATE OF LIABILITY INSURANCE 2012 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 ISSUIN43 INSURERJS), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER, IMPORTANT: If 'the Flolder Ie an ADDITIONAL the terms and C �150 enclorsetL If SILI 14—VEO. �Sub)ftt to 4 statement on this certificate does not confer rights to the PRODUCER eusInp3s, & Health 1206 E. Yorba Lind Placentia, CA 9207 Paul Kinan iw�� - — ----- — "'ungo 4-1 ;NsumE!�6,..Nsfipnw�d& s o fAjjjerIr , " _ _ a 2831 E. La Cresta Ave. aISU R Anaheim, CA 92806-1817 . . . ..... INS I AiNunll —a 0 INSURER 0. . ­- . . . . .. ........ . .... ­ REVISION NUMBER: THIS IS TO CERTIFY THAT THE 1: 11 KIES 11: :11: lilE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PER—too INDICATED NOTWITHSTANDING ANY REQUIREMENT TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAp BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HER IS SUBJECT TO ALL THE TERMS, Pd ICY EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BYPAID CLAIMS HUMBER bat Usk'—­­"' otm TYPE F I NSURANCE Rffyp L GENERAL LIABILITY-- 17 LIMITS 3r, rACH OCCURRENCE COW4RCtAL GENERAL LIABILITY CLAJMS•MADE OCCUR (go i��Zplrmj MED EXP (AT"�n!pPr4c�,1 PERSONAL 6 AOV INJURY II GENERA GEN'L AGGREGATE LIMIT APPLIES PER _��L AGGREGATE $ POLICY IRO PROOUCTS COMPIOP AGG 9 to AUTOMOBILE LIABILITY $ A ANY AUTO X ACP BAZ 2642860196 0012912012 08129/2013 -;-- 1.,.000 .000 I—" ALL OW14ED SCHEDULED BODILY INJURY (Par oerson) 3 AUTOS AUTOS HIRED AUTOS x NON.OWNFD AUTOS PA`—pCkWbiAM--Adt__ UMBRELLA LIAR OCCUR $ EXCESS LIAR EACH OCCURRCNqC PC"C *' '" Lryy '4� X X BODILY INJURY (Peraccideni) S _r — — -MADE JA' G _E D CT gyn2tu AGGREGATE 0 KRIIISCOMPENSATION AND EMPLOYERS' LIABILITY Y/N 0 SIAT OTH- .–JARYI ANY PROPRIETORMARTNERMXECLI TKE7214 . ..... OFFICERNEMSER FXCttI NIA (M andalosy fn NH) It 105, dam,be 00doe DISEASE - E APLOYE� ID t PTI OF ERATI HIS boi" LM,_ - $ 4-4­4�-_ E L OttPAS'll , PnT 1PY I lun' 4 CITYEL SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CITY OF EL SEGUNDO ACCORDANCE WITH THE POLICY PROVISIONS. RECREATION & PARKS FAX: 310-647-4223 AUTHORIZED REPRESENTATIVE 401 SHELDON STREET Paul Kinan ACORD 25 2010105 ©1988 -2010 ACORD CORPORATION. All rights reserved. J) The ACORD name and logo are registered marks of ACORD CA 20 48 (02 -99) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM Wlth respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" under the Who Is An Insured Provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. SCHEDULE Name of Person(s) or Organization(s): CITY OF EL SEGUNDO RECREATION AND PARKS 401 SHELDON ST EL SEGUNDO CA 90245-4013 (if no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to the endorsement.) Each person or organization shown in the Schedule is an "insured" for Liability Coverage, but only to the extent that person or organization qualifies as an "Insured" under the Who Is An Insured Provision contained In Section II of the Coverage Form. Copyright, Insurance Services Office, Inc., 1998 CA 20 48 (02.99) ACP 8AZ 26.4- 2660196 LNHY 12216 AGENT COPY CA2048029900 0240 25 0000152