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PROOF OF INSURANCE (2011) CLOSEDApr 1411 09:08a PIS Lighting 5629464471 p.2 CERTIFICATE OF LIABILITY INSURANCE /6%2011' THIS CERTIFICATE 1S 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 csrlIfIcata holder Is an AD'DITIOf+iI L INSURED, the policy(ies) must be endorsed. It SUB 13GATfON I WAIVED, Subject ro 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 endorsemen PRODUCER NAIVE: 1(949) 261 -53 � 1 PIHOtiE 3�j F��- (919 1 2 61 -1911 Tutton Insurance Services Arc N0 E 2 913 S. Pullman St. Ac - .-.,... �.- .000O2�.dti Santa Ana CL 92105 INSURED P. L. S. Ligbting, Inc. 10616 S. noxwalk Blvd. Santa re Spriggs CA 90670 -3822 �..,.:..�. .. ......�.�., r.wr"r�n A E!uluanco.10 /° 1 ntJ",'ALtiI LAFFONRri1NG (q'V' RAG'L dFiAN . INSJRCRA:PeerleSS_VIL U,; n4 INSURaae:3olden Emile Insurance 10836 I N'SUURER. C: _.. ............_., o cv I e N Y1AI 111 Ie'M =• COVERAGES THIS VS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TOY THE INSURED NAMED A5011f FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO MICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, LIMITS SHOWTt MAY HAVE BEEN REDUCED BY PAID CLAIMS, ADM mm MG�ENERAL a slLny �soRANCE OF SUCH POLICIES - _�POUCV NUMBER r�TF Rust -Y x _ � LIMITS OCCURRENCE 3 1,000,000 COMME'RCIA�LLGENEriALLMILITY D/B /2010 0/9 /2011 P I � 100, 000 CLAXMSMAIiE OCCUR BP8332241 MEDEX Or McPenson) s� 5,000 PERSONAL & ADV INJ --RY $ 1, 000,000 GENERAL ,A GREGATE s 1,.000,000 SETT 4GGREGATEPLI �� I 1T.4PPLIESPFR: PRODUCTS - COMPJOP'AGG 5 1,000,,000 ix POLICY LOC AUTOMOBILE LIABI'2 COMBNED SINGLE LRA7 S� (Ea ace dant) ANY AUTO 8 ODILYINJURY(PerPerson) $ ALL OWNED AUTOS BODILY NJURY (Per acoldenl) $ SCHEDULEC ALTOS PRO ?ERTY DAYV:GE HIRED AUTOS (Per acdderij NON -0N\NED AUTOS mm ____. E CCUR EACH OCCUPRENC— E S ODD UMBRELLA JAB O _ X EKCESSLIAR CLA,!I0S -MADE AGGREGATE $ 1,000,000 DEDUCTIB -E S 8 RETENTION $ 0/8/2010 0/B /2011 . 8428667 VAC STATU- OTH- 6 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY R I ANY PROPRIETOWPARTNERIE>ECUTiYE � .NIA E. L. EACH ACCIDENT 3 _.._ OFFICEMMEMBER E:RCLLIDED7 (Mandatory In NH) E.L. DLSEASE - EA EMPLOYEE S _ Fyes. describe under _......_ DESCRhTIONOF OPERATIONS below EL. DISEASE- POLICY LIMIT ; DESCRPTION OF OPERATIONS! LOCATIONS 1 VEMICLES (Attach ACORD101, Additional Ramarke Scheduldk If micro space Is required) RE: All Operations City of E1 Segundo, its afficers, officials, employees, agents 6 volunteers are named as additional insured par attached CG2010 07/04 F CG2037 07/04. CERTIFICATE HOLDER L ANR t LLJR I1LJru SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE ThIEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City OE Sl Segundo Attn,. city Clerk 350 Main Street AUTHORIZED REPRESENTATIVE El Segundo, CA 90245 -0989 Stanley Tutton /CLAIMI ACORD 25 (2009109) O 1988 -2009 ACORD CORPORATION. All r9rits reservea, IN S025 (20U909) The ACORD name and logo are registered marks of ACORD CERTIFICATE HOLDER L ANR t LLJR I1LJru SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE ThIEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City OE Sl Segundo Attn,. city Clerk 350 Main Street AUTHORIZED REPRESENTATIVE El Segundo, CA 90245 -0989 Stanley Tutton /CLAIMI ACORD 25 (2009109) O 1988 -2009 ACORD CORPORATION. All r9rits reservea, IN S025 (20U909) The ACORD name and logo are registered marks of ACORD Apr 1411 09:08a Pls Lighting POLICY NUMBER: CBP8332241 5629464471 p,3 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 Organization(s): Locations Of Covered Operations City of El Segundo, its officers, officials a pit ees, agents & volunteers Information re uired to complete this Schedule- if not shown above, will be shown in the Declarations. A. Section 11 — Who Is An insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the fallowing additional exclu- organization(s) shown in the Schedule, but only sions apply: with respect to liability for "bodily injury", "property This insurance does not apply to "bodily injury" or damage" or "personal and advertising injury" "property damage" occurring after: caused, in whole or in part, by: 1. All work, including materials, parts or equip - 1. Your acts or omissions; or meni furnished in connection with such work, 2. The acts or omissions of those acting on your on the project (other than service, maintenance behalf; or repairs) to be performed by or on behalf of in the performance of your ongoing operations for the additional insured(s) at the location of the the additional insured(s) at the location(s) desig- covered operations has been completed; or nested above. 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 en- gaged in performing operations for a principal as a part of the same project. CG 2010 07 04 0 190 Properties, Inc„ 2004 Page 1 of 1 13 Apr 14 11 09 :09a Pls Lighting POLICY NUMBER: CBP8332241 5629464471 p.4 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: City of El Segundo, its officers, officials, employees agents & volunteers Information rrs uired to comp late this Schedule, if n Section II — Who Is An Insured is amended to include as an additional insured the person(s) or orgenizaticn(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property dam- age" caused, in whole or in part, by "your work" at the location designated and described in the sched- ule of this endorsement performed for that additional insured and included in the "products- completed operations hazard ". CG 20 37 07 04 0 ISO Properties, Inc., 2004 Page 1 of 1 EI Apr 12 11 11:56a PIs Lighting 5629464471 p.8 Tutton Insurance 418/2011 iJP3 i.?AUr. UUD/ vuu rays OVA voi 5c P.O. BOX 424807, SAN FRANCISCO,CA 94142 -0807 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 04- 06-2011 GROUP: POLICY NUMBER: 0724848 -2011 CERTIFICATE ID: 91 CERTIFICATE EXPIRES: 02-01 -2012 02-01 - 2011102 -01 -2012 CITY OF EL SEGUN130 Sc 359 MAIN ST EL SEGUNDO CA 90245 -3813 This is 10 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 30 days advance written notice to the employer.. We will also give you 30 days advance notlee should this policy be cancelled p-ior to its normal expiration. This certilicate of insurance is not an ins►rance policy and does not amend, extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirernenT, term or condition of any contract or other document with respect to which this certificate of insurance may be Issued or io which it may pertain, the insurance aliorded 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 LIMI1 INCLUDING DEFENSE CUM: $1,000,000 PER OCCURRENCE. ENOORSEMEN'r 01600 - VIRGINIA AGUILAR PRES - EXCLUDED. ENDORSEMENT 02005 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 02 -01 -1997 IS ATTACHED TO AND FORWS A PART OF THIS POLICY. EAAP LOVER PLS LIGNTSNG, INC. SC 10616 NORWALK BLVD SANTA FE SPRINGS CA 90670 I61 Y, S PI PRINTED ; 04- 06-2011 m v. B • 2010) Apr 1211 11;55a Pls Lighting state Farm Mutual AubonwWle Insurance Company 6400 Wale Farm D&O Aohnart Park CA 94928 AT2 1 H -3086 A 000010 ASUILAIt, OrRGINIA Ply 0 01 SANTA FE 5P05 CA 90670 -3822 5629464471 p.6 °r'OUC,Y" NUetSER 402 8901- A04 -75N� .LAN "2011 to JAN 04 2012 DATE DUE PLEASE PAY THIS AMOUNT JAN 04 2011 $1933.48 1 Coverages and Limits Premiums cur premium is based on thip following . _ -9 not correct, contact your agent. J t402 INTERNATL CRANE VIN 1 HTMMAAL02H522526 We 50600000 irtmerdarveli1CI4 �- -- iditional Information... to amount you pay is for 12 months.. A 0 �� Ea' -, 5 6 2 C %lealI' �r tii�hls � 0 1„ .44A D 500 Deduclibls Ciamprehenaive 155.64 G 500 Deductibe Collision 326.00 U Uninsured Motor Vehicle Bodilylnjury50,000 /100,000 Motor Vehicle 45.00 U1 Uninsured Property Damage 4.80 Premium Amount 1,908.50 Plus Previous Charge 24-98 .$1,933.48 :)NVENIENT PAYMENT OPTION: You may use one of State Farm's alternate payment plans which divides your present :mium into two separate payments. e half of the amount due, $966.74, plus a handling charge of $2.00. The amount due on'JAN 04 2011 be i e remaining half will be due on MAR 05 2011. Well send you a reminder notice. iF �^ f /F *-i 79 7054 3807 I� Seerevemeside for importantinlbm7alion. I i'�r11 ADAM C LIBERTOSKI INS AGCY INC Please keep Eris part loryourrecord. e!ePhcne (562)693 -8288 or (866)523 -5300 Prepared OCT 25 2010 Apr 12 11 11:56a Pls Lighting State Farm MuUW Automobile rncerans a Amy 900Old i$ver Road 8akevsFrald CA 93311 -0001 AT"2 1 H -3086 A AGUTt.AR, VIRGINIA �A �L8 �16TINw0 0 SANTA FE SPOS CA 90670 -3822 5629464471 POLICY NUMBER V54 8413- D20 -75H APR 20 2011 to (DOT 20 2011 DATE DUE APR 20 2011 your premium is used on the foUowfng - - f rp t correct, 1 onf act 9805�t 2002 FORD RANGER crass _0,1331,iCX1 H._ _. __— Superior Driver Rate Level (See description on back). Driven over 7,500 miles annually. (National average is 12,000 miles annually.) Pleasure use or commuting to and from work or school. p.7 PLEASE PAY THIS AMOUNT $374.31 C,,overages and Lknits rremwrn: A wile , -$0`06"90,000 , ,��, % %,��,� la! jlt" , ,,,, , ; 76. 1! Pro- pe"Ift Damage 100,000 189.4 C Medical Payments 5,000 5.7' D Comprehensive G 250 Deductible Collision 3 7.21 107.44 H Emergency Road Service 2.61 U Uninsured Motor Vehicle 81.5 Bodily Injury 100,000 00,000 22. 9 ! U1 Uninsured Motor Vehicle Property Damage 1 Amount Due s374.3: Your premium has already been adjusted by the following: Premium Reductions Multiple Line 76. 1! Multicar 8 8 .5 , Vehicle Safety 5.7' Driving Safety Record 372.5 California Good Driver 93.5; Loyalty 81.5 Zsp Dade Used tc Determine Rate Charged - 90604 Part of your premium depends on the miles you expect to drive this car. Please contact your agent at the number below to Provide an updated estimate of the expected annual mileage of this oar for the coming 12 months. Refer to the Drive Safe & Save (1-M) Insert for information about an important program for which you may be eligible. CONVENIENT PAYMENT OPTION:-You may use one of premium into two separate payments. G o . ne loa if of the amourd due; $187.15, plus ill be ti aa WI A7 5� The remaining half will be due on JUN 19 2011- We'll sen " Location used to determine rate charged -14227 L.ANN Your prerniurn may be influenced by the drivers listed bel does not extend Or expand coverage beyond that contair reported to us that own or regulatiy operate any vehicle it VIRGINIA AGUILAR, LAURA AGUILAR, CARLYN AGUI DANIEL LARA, DREW MORENO. I plans Khios divides your present -amount- due -o?i APR 23 2011 ad to operate your vehicle. This list ie drivers listed below are -the drivers 1NIRTA,JESSICA AGUILAR, RICHARD MORENO, It the above information is incomplete or inaccurate, or if you want to confirm the information we have in our records please contact your agent. "`' Your polloy has the Guaranteed Renewal Endorsement. "' 79 7133 2577 as r- "" See reverse side for important inlarmafioi Agent ADAM C LIBERTOSKI INS AGCY INC please keep this pad foryourrecord. Telephone (562)693$288 or (866)523- 5300Prepare -d - FE6 07 201 1 --