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PROOF OF INSURANCE (2014) CLOSEDBELLB -1 OP ID: SO CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DDNYYY) 12/26/12 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 Phone: 951 - 676 -3365 TA �tAcoNME: cT Stacy Ortiz United Agencies, Inc. (M) Fax: 951 - 676- 3020H/xt);951- 676 -3365 Jc,N) 951- 676 -3020 CA License #0252636 E MAIL 27403 Ynez Rd., Ste. 110 ADE1REss< sortiz @unitedaencies.com Temecula, CA 92591 Ryan E. Hollander _ INSURE (S)AFFORDINGCOVERAGE .. , _NAIC# INSURERA CentUr�r SU "ret�l Company 36951 INSURED Bell Building Maintenance Co. INSURERB:Topa Insurance Services Mrs. Yang hanhees � � r INSURER C: urance Company 15586 c reserver n 5170 Sepulveda Blvd., #180 Sherman Oaks, CA 91403 INSURER INSURER E INSURER F: 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. TR ,._ ... — A"( OLi9U8114 TYPE OF INSURANCE _ POLICY EFF POLICY NUMBER MM /OD/YYYY POLICY EXP� ..... MM /DD/YYYY 1 LIMITS GENERAL LIABILITY I y r EACH OCCURRENCE $ 1,000,00 COMMERCIAL GENE RALLIABILITY X X CCP780594 01/10113 DAMAGE 01/10/14 PREMISE gEar�cca�ir�rrerl $ 100,00 CLAIMS -MADE j X OCCUR MED EXP A& 5 0 0,00 L ADV INJURY $ 1,000 , PERSONA ', GENERAL AGGREGATE $ 2,000,00 GATE LIMIT APPLIES PER: GEN'L AGGREGATE PRODUCTS - COMP /OP AGG ($ 1,000,00 _ _ , _ PRO - I7 � $ POLICY LOC POLICY ....... AUTOMOBILE LIABILITY � COMBINED SINGLE LIMIT (Ea acculmr)t) �..$ ...... _ _ ....._ ANY AUTO i _ BODILY INJURY (Per person) $ ALL OWNED I SCHEDULED BODILY INJURY (Per accidenq $ AUTOS AUTOS NON- OWNED PROP6R7Y DOE' $ HIRED AUTOS AUTOS ,(GtrPccGd� k) _ E Is X OCCURRENCE RENCE 5,000,00 B X EX ESS LABIAB CLAIMS MADE XL6604552 01/10/13 01/10/14 i $ 5,000,00 DED � X 1 RETENTION $ WORKERS COMPENSATION WC STATU- (OTH- X TORY LJMIITS R AND EMPLOYERS' LIABILITY , .. C ANY PROPRIETOR /PARTNER /EXECUTIVE Y "LN WCC 0004991 05/02/12 05/02113 E L. EACH ACCIDENT $ 1,000,00 ,,. OFFICER /MEMBER EXCLUDED? �',. NIA " (Mandatory in NH) E L DISEASE EA EMPLOYEE_] $ 1,000,00 If yes describe under ` DESCRIPTION OF OPERATIONS below E L DISEASE POLICY LIMIT $ 1,000,000 ( I DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) The City of E1 Segundo and Its Officals and Employees are additional insured thereunder in relation to those operations, uses, occupations, acts, and described generally above with regard to operations performed by ,activities or on behalf of the named insured where required by contract. NEXT PAGE CERTIFICATE HOLDER trAN(;tL.LA a IUN ELSEGUN CITY OF EL SEGUNDO PUBLIC WORKS 150 ILLINOIS ST EL SEGUNDO, CA 90245 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 2I& © 1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD NOTEPAD. HOLDER CODE ELSEGUN BELLB -1 PAGE INSURED'S NAME Bell Building Maintenance Co. OP ID: SO DATE 12/26/12 Coverage is primary & non - contributory; waiver of subrogation applies. CGL 1816 0106 H. -- THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION - PRIMARY AND NON-CONTRIBUTORY COVERAGE This endorsement modifies insurance provided under the following: CONTRACTORS LIMITED CLAIMS MADE GENERAL LIABILITY COVERAGE FORM CONTRACTORS LIMITED CLAIMS MADE AND REPORTED GENERAL LIABILITY COVERAGE FORM COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or organization (s): kNY PERSONS OR ORGANIZATION AS REQUIRED BY WITTEN CONTRACT TO BE NAMED AS ADDITIONAL NSURED. 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 Location(s) Of Covered Operations VARIOUS LOCATIONS PER CONTRACT WITH THE NAME INSURED. 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. C. It is agreed that the insurance provided for the benefit of the above additional insured(s) shall be primary and non - contributory, 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. CGL 1816 0106 Includes copyrighted material of Insurance Services office, Inc. with its Page 1 of 1 permission. t0 ISO Properties, Inc., 2004 COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER OF TRANSFER RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS /COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE of Person or Organization: ( PERSONS OR ORGANIZATION AS REQUIRED BY WRITTEN CONTRACT TO BE PROVIDED WAIVER SUBROGATION. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV - Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or '`your work" done under a contract with that person or organization and included in the "products - completed operations hazard ". This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 1