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PROOF OF INSURANCE (2014) CLOSED----OqN EXCEELE -02 MSANDY F LIABILITY INSURANCE DATE DIY3 4/24/2013 ,a�� ° ...........CERTIFICAT.E OF e.. - ------ -- - ... .... ----------- _. 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 polic y(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). Preferred 0484 Armst on Insurance St e ................... / Services, Inc PHONE f Certificate 03 667 5940_ en FAX PRODUCER CON TACT T Street c Nil703 991 -4838 Fairfax, VA 22030 ADDRESS: certs @preferins.com INSUR,ER(S AFFORDING COVERAGE NA,IC p INSURER A: Hartford Underwriters Insurance Company 30104 - -- - _...._........... ...... — — derwr .............. — — INSURED INSURER B: National Union Fire Ins Co 19445 Excelsior Elevator Corporation INSURERC..,..Prefe„rred Employers Insurance Company 1961 Blair Avenue INSURER D; .�I,,,..._,_—................................ .............. �............-.................................................................................. ...........W�W�W�. ° °.......r, -- Santa Ana, CA 92705 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 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 00 PPEf6_y -FF PsSLC Y EXP TYPE OF INSURANCE - - -.......... POLICY NUMBER 9NI0DNYYY -(M,M-P -Pt,Y) - -. v LIMIT6 __ �������-� GENERAL LIABILITY URRENCE $ 1,000,000 EACH OCCURRENCE A X COMMERCIAL LIABILITY X X 13UENOJ6536 4/1 /2013 4/112014 DAMACC�FN rD' , .(E �IPneu�peI, $� 300,000 4 tEMISES CLA MS MADEGENERAL OCCUR MED EXP Any one person) $ 10,00 PERSONAL & ADV INJURY $ 1,000,00 ........ fw00 .... GENERALAGGREGAT.E. $ 3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS -W COMP /OP AGG $ 3,000,000 PRO POLICY X LOC $ JC AUTOMOBILE LIABILITY CONIMNED SINGLE Ea aCCidkt 11 $........ .... ....... ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ ....,..... AUTOS __............ AUTOS NON -OWNED PR PERTY DAMAGE $ .............. HIRED AUTOS ........ AUTOS PER AC' Qlppl Jj.)'.............................. WW.,., ..................._........... ........ ...........,_..._.. UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 5,000,000 EXCESS LIA DE X X EB U011502111 4/1/2013 4l 1/2014 B...- X CLAIMS MA AGGREGATE $ DER RETENTION$ _ -- --._ O Aggregate $ 5,000,000 - -_E_ .-.._, '. WORKERS COMPENSATION 0 �( EMPLOYERS' LIABILITY C RTNERI ECUTIVE N/A WKN 146402 4/1/2013 411/2014 a / _RXTTATU E,L.EACHACCIDENT $ 1,000,000. OFFICER/MEMBER IMBEREXCLUDED? " ° °� .L,DISEASE - EAEMPLOYEE $ 1,000,UUO'. ....... ..____- .-- -.,,.. If yes, descnbe under NS below .,... Ll ,DESCRIPTION OF.,„�PERATIQ w .................. ......_ - ....�,......�.. 1,000,000. E.L. DISEASE POLICY LIMIT $ .. �. .�.� ..... ..................... (Attach ACORD DESCRIPTION OF OPERATIONS (LOCATIONS /VEHICLES (A 1 Additional Remarks Schedule, if more space Is � required) Re: City, its officials, and employees are Additional Insured with respect to General Liability regarding all work performed by the named insured. Waiver of Subrogation in favor of Additional Insureds applies to General Liability. Excess Liability Follows form. Primary & non - contributory wording applies to General Liability as required by written contract. 30 Days Cancellation. ... - - - - - -- ...... ... CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of El Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ty 9 ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street El Segundo, CA 90245-3813 ID AUTHORIZED �_. ._._. w ................................ ....................... ........ .. AUTHORIZED ................D REPRESENTATIVE .... _........... ................. - - -- ,... .. ..r ..,..,.-_ ................. . ......_,�9,,,,,�,�...,.,...,.._ w...._,w. .. .... ©1988 -2010 ACORD CORPORATION. All rights reserved, ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: 13UENOJ653 6 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 Ora ation s : Locations Of Covered Operations Any person or organizatior6or whom you are performing Any location within the "coverage territory" operations when you have agreed that such person or organization be added as an additional insured on your policy under: 1. A written contract or agreement that is in effect dur- ing the term of this policy and such contract is en- tered into prior to the "occurrence" of any "bodily in- jury", "property damage ", "personal injury", or "ad- vertising injury"; or, 2. An oral contract or oral agreement with a person or organization when a certificate of insurance showing that person or organization as an Addi- tional Insured has been issued; and such oral con- tract or oral agreement is in effect during the term of this policy and is entered into prior to the "occur- rence" of any "bodily injury ", "property damage ", "personal injury ", or "advertising injury." Information re uired 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 CG 20 10 07 04 © ISO Properties, Inc., 2004 Page 1 of 2 ❑ 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 other than another contractor or subcontractor engaged in performing operations for a princi- pal as a part of the same project. Page 2 of 2 0 ISO Properties, Inc., 2004 CG 20 10 07 04 13 POLICY NUMBER: 13UENOJ653 6 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 Organization(s): Location And Description Of Completed Opera - tions Any person or organization for whom you are perform- Any location within the "coverage territory', and for all ing operations when you have agreed that such person completed operations or organization be added as an additional insured on your policy under: 1. A written contract or agreement that is in effect during the term of this policy and such contract is entered into prior to the 'occurrence" of any "bodily injury ", "property damage ", "personal in- jury', or "advertising injury'; Or, 2. An oral contract or an oral agreement with a person or organization where a certificate of insurance showing that person or organization as an Additional Insured has been issued; and such oral contract or oral agreement is in effect during the term of this policy and such contract is entered into prior to the 'occurrence" of any "bodily injury", "property damage ", "personal in- jury", or "advertising injury'; 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 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 wor 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 ". CG 20 37 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 13 THIS EXTRACT OF COVERAGE IS ISSUED AS AN ATTACHEMENT TO THE CERTIFICATE OF INSURANCE ATTACHED HERETO, THIS EXTRACT IS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS EXTRACT DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, ALTER, EXTEND THE COVERAGE AFFORDED BY THE POLICIES. THIS EXTRACT OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, OR THE CERTIFICATE HOLDER. (7)When You Add Others As An Additional Insured To This Insurance Any other insurance available to an additional insured. However, the following provisions apply to other insurance available to any person or (arganization who is an additional insured-under this coverage part. ) Primary Insurance When Required By Contract This insurance is primary if you have agreed in a written contract or written agreement that this insurance be primary. If other insurance is also primary, we will share with all that other insurance by the method described in c. below, (b) Primary And Non - Contributory To Other Insurance When Required By Contract If you have agreed in a written contract, written agreement, or permit that this insurance is primary and non - contributory with the additional insured's own insurance, this insurance is primary and we will not seek contribution from that other insurance. Paragraphs (a) and (b) do not apply to other insurance to which the additional insured has been added as an additional insured. When this insurance is excess, we will have no duty under Coverages A or B to defend the insured against any "suit" if any other insurer has a duty to defend the insured against that "suit ". If no other insurer defends, we will undertake to do so, but we will be entitled to the insured's rights against all those other insurers. When this insurance is excess over other insurance, we will pay only our share of the amount of the loss, if any, that exceeds the sum of: (1) The total amount that all such other insurance would pay for the loss in the absence of this insurance; and (2) The total of all deductible and self- insured amounts under all that other insurance. We will share the remaining loss, if any, with any other insurance that is not described in this Excess Insurance provision and was not bought specifically to apply in excess of the Limits of Insurance shown in the Declarations of this Coverage Part. WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 0313 (Ed. 4 -84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT 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.) This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule "ALL ENTITIES THAT ARE NOTED AS ADDITIONAL INSURED ON THE CERTIFICATE" 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. Endorsement No. Insured EXCELSIOR ELEVATOR CORPORATION �,- Insurance Company WKN Countersigned by:. ............................ ........................_..__._ � ......_�..°,,,. - -. Preferred Employers Insurance Company WC 00 03 13 (Ed. 4 -84) @ 1983 National Council on Compensation Insurance. r EXCEL -2 OP ID: LP �DATE (MM /DDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 04/2412013 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 endorsementtsi. PRODUCER RBN & Associates, Inc. 303 East Wacker Dr Suite 1130 Chicago, IL 60601 Richard Scodro INSURED 2219 S. Grand Avenue Santa Ana, CA 92705 Phone: 312-856-9400 Fax: 312 - 856 -9425 :Sentinel Insurance R° INSURER D: F:. COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 11000 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. .__ .,....... ,.... _.n ........ .... ......PGLICY EFF ' _'Pi L6 EXP ""......... 1LTRR TYPE OF INSURANCE DOL POLICY NUMBER iMM/DDIYYYYI ,. ... ........... __.....� ..._.. LIMITS GENERAL LIABILITY ......... EACH OCCURRENCE $ m C O .. MMERCIAL GENERAL LIABILITY -DAMAGE NTD M�� CLAIMS -MADE � OCCUR . , MEAonpn) $ .,... PERSONAL & ADV INJURY GENERAL AGGREGATE n.mm - ... - �- � - - - - -- N'L AGGREGATE LIMIT APPLIES . GE LI .... ES PER: OP AGG $ POLICY Pr m- LOC $.. ,........ AUTOMOBILE LIABILITY COMaB4cNED S INGL E LIMIT d ...._ 11000,000 ........ A X ANY AUTO X 83UECAJ5318 11/15/2012 11/15/2013 BO BODILY INJURY (Per person) J ,.. . . $ ALL OWNED SCHEDULED ., ., AUTOS AUTOS BODILY INJURY Per accident) $ ,...,, NON -OWNED Prac eent''r X COMP 1 000 X COLL 1,000 n $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS L A BL CLAIMS -MADE AGGREGATE ' - -- '... $ DFD RETBNTION� WORKERS COMPENSATION WC STA7U- OTH- AND EMPLOYERS' LIABILITY / TRY 5 ANY PROPRIETOR/PARTNER/EXECUTIVE E L EACH A ACCCIDENT $ OFFICE RIM OFyFICER/MEMBER EXCLUDED N / A (Mandatory m NH -� L DISEASE - E E desibe under „E DESCRIPTION OF OPERATIONS below I EL. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) A WAIVER OF SUBROGATION APPLIES WITH RESPECTS TO THE AUTO LIABILITY ONLY. CITYOFE CITY OF EL SEGUNDO 350 MAIN STREET EL SEGUNDO, CA 90245 -3813 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE U IW S -201 O AGORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD