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PROOF OF INSURANCE (2013) CLOSEDDATE (MM /DD/YYYY) '?! CERTIFICATE OF LIABILITY INSURANCE 05/08/2012 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 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 SUBROGATIONI 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 endorsoment(s). PRODUCER NAME MARSH USA INC. PHONE"" " " "" -- - - - - -- ' FAx, 20 CHURCH STREET t!uC,Na i; m tAJC,NoI:. HARTFORD, CT 06103 E ^MpIC- INSURER A :Hartford Fire Insurance Comte COVERAGE w .�_ N9682 INSURED AMTECH ELEVATOR SERVICES INSURER B :The Insurance Company of the State of Pennsylvania 19429 9808 FIRESTONE BLVD. INSURER C :Illinois National Insurance Co. 23817 DOWNEY, CA 90241 INSURER D :National Union Fire Insurance .. ...... ...... nce Company of PittsburhmmmPAm m mmmmm mmmmmm19445 INSURER E: New Hampshire Insurance Company 1 23841 COVERAGES CERTIFICATE NUMBER:4LSRZRL9 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. ...,- ._.,.- ,,.,e.,........ -- ...... .. IN5R ........................... TYPE OF INSURANCE POLICY N LTR UMBER (MM/DD/YYYY MM10D/'YYYY LIMITS A GENERALLIAWLiTY Facility Maintenance 150 Illinois St. 02CSET10004 04/01/2012 04101/2013 EACH OCCURRENCE $ 1,000,000 Ar11Rn 2r ign,i irl X COMMERCIAL GENERAL LIABILITY r____1 OCCUR CLAIMS -MADE $2 „000,000 general aggregate per location /pro act 510,000,00 policy general aggregate OAKiCG'ET'Ni E .PREMISES Ea occurrence -- — $ 300,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP /OP AGG ... -. $ 2,000,000 GENT AGGREGATE LIMI........._. AGG TE LIMIT APPLIES PER: $ X POLICY PRO- LOC El A AUTOMOBILE LIABILITY 02CSET10000 A/O) 02CSET10019 �HI) 04/01/2012 04/01/2013 I” N L Ea accident $ 1,000,000 BODILY INJURY (Per person) $ X ANY AUTO Hartford Underwriters Ins ALL OWNED SCHEDULED AUTOS AUTOS NON-OWNED HIRED AUTOS AUTOS BODILY INJURY (Per accident) $ PROPEIt7Y C7l1NiAGE Per accident $ A X UMBRELLA LIAB X OCCUR 02HUT10021 04/01/2012 04/0112013 EACH OCCURRENCE $ 10,000,000 R.-DED' AGGREGATE $ 10,000,000 EXCESS LIAB_ CLAIMS -MADE RETENTION $ $ B CD E WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N ANY PROPRIETORMARTNER /EXECUTIVE OFFICE /MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A FL-019736910 16909 CA -01 2 SMM NJ•019 36911 M EX COV- 11924931 LTp.01g736912 MULTI- 019736913 MN- 019736914, MA- 01973619 04I01I2012 04/01/2013 WC STArU- OTH E L, EACH ACCIDENT E L DISEASE - EA EMPLOYEE E L DISEASE - POLICY LIMIT $ 1,000,000 $ 1,000,000 $ 1,000,000 S DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) This certificate only applies to DVL -06794 City of El Segundo, 348 & 350 Main Street, El Segundo, CA City of El Segundo and their officers, officials, employees, agents, representatives and certified volunteers are additional insured to the extent required by contract with Otis Elevator Company. The policies are primary and non - contributory and include a waiver of subrogation, both to the extent required by contract with Otis Elevator Company. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of El Segundo Facility Maintenance 150 Illinois St. AUTHORIZED REPRESENTATIVE /S(y� &.Y El Segundo, CA 90245 ar7 1 °/ Page 1 of 1 ©1988 -2010 ACORD CORPORATION. All rights reserved. Ar11Rn 2r ign,i irl Tha Ar_r1Rn noma nn.l Inn^ ora raniafororl morlrc ^f Af•r%Pn Policy Number. 02 CSE T10004 EffecthreDate: 04/01/2012 y Named Insured and Address: UNITED TECHNOLOGIES CORPORATION EndL No. ONE FINANCIAL PLAZA HARTFORD, CT 06101 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS Name of Person or Organization: ANY PERSON OR ORGANIZATION WITIE WHOM OTIS ILRVATOR CO?WANY D /E /A AWEC31 ELEVATOR SERVICES, HAS, THROUGH WRITTEN CONTRACT, AGREED To PROVIDE INSURANCE PROTECTION UNDER INSURANCE SERVICES OPHICE (ISO) PORK CG 20 10 11 85. (a list of such persona /organizations on file with the compaay) WHO IS AN INSURED (Section II) Is amended to include as an insured the person or organizatlon shown in the Schedule, but only with respect to liability arising out of 'your work" for that Insured by or for you. For the purposes of this endorsement, "you- shall refer to Otis Elevator Company d/ b/a Amtech elevator Service., and your work" shall mean work performed by or for Otis Elevator Company d/b /a Antsch Elevator Services. Form GT 63 44 13 (Ed &03) (c) 2003, The Hartford (Includes Copyrighted material of insurance Services Office with its permission. Copyright, Insurance Services Office, Inc., 2003) Pages 1 of 1 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT — CALIFORNIA This endorsement changes the policy to which it is attached effective on 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 12:01 AM 04/01/2012 forms a part of Policy No. WC 019 -73 -6909 Issued to UNITED TECHNOLOGIES CORPORATION By THE INSURANCE COMPANY OF THE STATE OF PENNSYLVANIA Premium: INCLUDED 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.) Your 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 2% of the California workers' compensation premium otherwise due on such remuneration. Schedule Person or Organization Job Description ANY PERSON OR ORGANIZATION TO WHOM YOU BECOME OBLIGATED TO WAIVE YOUR RIGHTS OF RECOVERY AGAINST, UNDER CONTRACT OR AGREEMENT YOU ENTER INTO PRIOR TO THE OCCURRENCE OF LOSS. Poticy Number 02 CSE T10004 Effective Date: 04 /01 /2012 Named Insured and Address: ONITED T6C11NOLOGIE3 CORPORATION Endt.No, ONE FINANCIAL PLA7 " HARTFORD, C, , 06101 THIS ENDORSEMENT CHANGES THE POLICY PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF AGAINST OTHERS TO US SCHEDULE Name of Persons Or Organization: 9LANICET DIME REQUIRED By WRITTEN CONTRACT RECOVERY (If no entry appears above, information required to Complete this endorsement will be shown in the Declarations as applicable to this endorzemerd,) The Transfer of Rights of Recovery Against Others To Us Condillon (Section Iv) is amended by the addition of the following; We waive any right of recovery we may have against the person or organization shown in the Schedule above because of Payments we matte for injury or damage arlsing out of: 1. Your ongoing operations; or 2. "Your work" Included in the "products - completed operations hazard" and which are done under a written contract with that person(s) or organization(s). The waiver applies only to the person(s) or organization(s) shown in the Schedule above. Form GN 2404 15 (ED. 02196) Printed In U.SA„ (NS) (C) 19%. The Hartford (Includes copyrighted material of Insurance Services Office with its permission, Copyright, Insurance Services Office, 19,92)