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PROOF OF INSURANCE (2012) CLOSEDOP ID: LL CERTIFICATE OF LIABILITY INSURANCE r 6ATE(MM,DD /YYYY) 02106F12 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 760 -804 -0402 CONTACT NAME Marrs Maddocks & Associates 760- 804 PHONE PAX -0942 Insurance Svcs, Inc. #0818269 _(At-G- Eli �. .... Zsu.p ... 1903 Wright Place, Suite #280 E -MAIL Carlsbad, CA 92008 -ADDRESS: -1 E. Glenn Ables, CIC fig) #;CCSPR INSURERS AFFORDING COVERAGE NAIC # INSURED LlghtwerksCommunlcation INSURER A: Hanover American Ins. Co. 36064 _ Systems, Inc., dba: CCS y INSURER B:Allmerica Financial Benefits 41840 Presentation Systems INSURERc:The Hanover Insurance Group 22292 David Riberi mmm 3331 Jack Northrop Ave. Bldg 6 INSURER D:Sequoia Insurance Company 22985 Hawthorne, CA 90250 INSURER E: Lloyd s of London ......... ... .. .. ........... 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. _-----.,. IN5R TYPE OFINSURANCE ---- ---- -- -AOIi St�Bifi ........... PO VCYN:U ...... POLICY EFF POLICY EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00. A X "COMMERCIAL GENERAL LIABILITY X ZZF 9100960 -00 04/15/11 04/15/12 ocGarn ctl $ 100,00 '.� CLAIMS -MADE F OCCUR MEDMEXP (Any one person) $ 10,00 � , X Contractual Llab. PERSONAL & ADV INJURY $ 1,000,00 No Deductible GENERAL AGGREGATE $ 2,000,00 ''.. GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 2,000,00 POLICY X PFii�• , L. $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 B X ''4NYAUTO AWF9101066 00 04/15111 04/16/12 ! (Eaaccident) ___ .................a..__..._ BODILY INJURY (Per person) $ ALL OWNED AUTOS BODILY INJURY (Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE $ X HIRED AUTOS (Per accident) X NON -OWNED AUTOS .......... _$ ......................... No Deductible $ UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 10,000,00 C X.. EXCESSLIAB CLAIMS -MADE UHF9100961 -00 04/15/11 04/15/12 AGGREGATE $ 10,000,00: _ DEDUCTIBLE Excludes $ ..........................$........... ..........................__ X RETENTION I None Prof Liab WORKERS COMPENSATION X Y.4�Ai t_ OTHH TW AND EMPLOYERS' LIABILITY 1, Y� D ANY PROPRIETOR /PARTNER /EXECUTIVE SWP209240 -2 11/01/11 11101/12 E.L. EACH ACCIDENT $ 1,000,00 OFFICER /MEMBER EXCLUDED? N/A E. L. DISEASE - EAEMPm ... ......1,0 (Mandatory in NH) EMPLOYEE $ 1,000,00 If yes, DESCRIPTION F PERATIQNS below E L DISEASE POLICY LIMIT $ 1,000,00 Wt P LiabrlClaims 453199 07/01/11 07/01/12 OcclA Made Policy Form IRETRO DATE: 7/1106 Retention 5,00 DESCRIPTION OF OPERATIONS t LOCATIONS l VEHICLES (Attach ACORD 101, Addiflohal Retnarks Schedule, if more space is required) The City of El Segundo, Its officers, Officials, employees„ agents and volunteers are named as additional Insured as respects general liability er forms CG2010 & C+G2037 07104 as required by writhe contract. 0 Day NOC -10 Days for Non -Pay 130 ELSEGUN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES _P2 CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of El Segundo ACCORDANCE WITH THE POLICY PROVISIONS. Attn: City Clerk 360 Main Street AUTHORIZED REPRESENTATIVE El Segundo, CA 90246 e ©1988 -2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: ZZF 9100960 -00 COMMERCIAL GENERAL LIABILITY NAMED INSURED: Lightwerks Communication Systems, Inc. CG 20 10 0704 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): LocationfsLOf Covered Operations "Any person or organization when required by a written "All projects of the named insure" contract, written agreement or permit' 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) designated above. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: 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, CG 20 10 07 04 / © ISO Properties, Inc., 2004 Page 1 of 1 POLICY NUMBER: ZZF 9100960 -00 COMMERCIAL GENERAL LIABILITY NAMED INSURED: Lightwerks Communication Systems, Inc. CG 20 37 0704 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) Loca i i tion And Description of Completed Or Organization(s): Operations "Any person or organization when required by "All projects of the named insured" a written contract, written agreement or permit" Informati 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 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. CG 20 37 07 04 © ISO Properties, Inc., 2004