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PROOF OF INSURANCE (2015) CLOSEDHLMOE -1 OP ID: T2 CERTIFICATE OF LIABILITY INSURANCE DATEiMMIDD,Y,, 03109/15 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(iss) 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). United es, Inc, (T) Fax: PHONE 626 .535-8309 .. .., .. A _m Agencies, Phone: 818 - 643.2300 NgME. Susan Pa ne PRODUCER CA License X0252636 AtDDRSSS s a ns uni.. A, Nod 6260-577-1346 450 N. Brand Blvd., Ste. 820 E1IL fade encies corn Glendale, CA 91203 ... _ �f? . " .. ..n..... ... ......... Jim Stone INSURE:R(Si AFFORDING C'OVERAGE. NAIC p INSURER A: James River Insurance Co. 12203 INSURED H.L. Moe Company, Inc, wsuReR c Hartford Fire a Compan�/ DBA: John K. Keefe Company - -• DBA: Advance Mechanical INSURERB Hartfor Insurance a Insurance Co 119682 r Contractors, Inc. INSURER D Chartist' Seclal� Insurance m Co Mike Davie . „ �.....�� , . � _ �.....w�...� 526 Commercial Street �­!NS! R ER #:11­11 _ .. ,. _...a........... 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. TYPE OF INSURANCE _ �. _ _ .. P60'e 'E F o...,POLt4” M9 ­- . 11 ., ..� _ , . —.,m -_ .... . ...... ... NSR 1 ADDL, mg , POLICY NUMBER dOD/1"YYY' M P OrYYYY LIMITS GENERAL LJABILITY EACH OCCURRENCE S y y ;COMMERCIAL GENERAL LIAEILITY 0005436'2 -2 08/01/14 08/01/15 SES„ iFaEor�ry�rrence, .. 8 , T.....T1 x050 0 A IX CLAIMS -MADE : � OCCUR MED FP tAny one pmclon) 5 EXclud .-. r ._...... �._ ... - .,......- ,.�._.,.,.,,,,m.� ....._ . ,. PERSONAL & ADV INJURY S 1,000,0 GENUw AGGREGATE LIMIT APPLIES PER I POLICY � X "0. 1 LOC AUTOMOBILE LIABILITY L %ONE SINGLE LIMN ANY AUTO BODILY INJURY (Per person) '.. S l... .... BODILY INJ URY (Per accident) S ALL OWNED I SCHEDULED AUTOS I AUTOS HIRED AUTOS NON -OWNED d AUTOS 1 UMBRELLA LIAR X OCCUR B X EXCESS LLAS _ I CLAIMS -MADE ..r,... DIED 1 X f RETENTPON.S. WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? F--] N / A! (Mandatory in NH) If yes, describe under DESCRIPTION OF P RATIONS below D ;Pollution i GENERAL AGGREGATE S 2 _... PRODUCTS - COMP /OP AGG S 2 _... .. � .._ � . _._ ,Em Ben S 1 L %ONE SINGLE LIMN BODILY INJURY (Per person) '.. S l... .... BODILY INJ URY (Per accident) S 1 m. i�I �J ti i-15--A NAA E 5 ,,,,,,. ....., ,.,..... S EACH OCCURRENCE S 4 4462 -01 08101/14 08101115 AGGREGATE S 4 S E1. DISEASE EMPLOYEE E L. DISEASE POLICY LIMIT S S 7662688 04/03114 04/03/15 Each Loss i Aggregate I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) Subject to all policy terms, conditions and exclusions, 30 days NOC except 10 for non - payment of premium. City of El Segundo Dept of Building & Planning 350 Main Street gUTHORIZED REPRESENTATIVE El Segundo, CA 90245 k \ "' °'M 01988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD CITYELS q Mk 1 5,000, 5,000, SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ACORD 25 (2010/05) '$ DATE (MMODAf-I'M CERTIFICATE OF LIABILITY INSURANCE _[ 115/2015 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(les) 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 Bolton & Compan 3475 E F% - ivd., Suite 100 Pasadena, CA 91107 !www.boltonco.com 0008309 ------ -.n-n ..... . ........ H,D!. Oca Insurance Com anv 41343 i INSURED . ...... INSURER B Hl. Moe Cornpanr, Inc. .... ....... . ..... ......... (SBA, John K. Kee e Company INSURER C: .. . .. . ..... M DBA: Advance echanical Contractors, Inc. INSURER D: 526 Commercial Street ......... . . ..... INSURER E Glendale CA 91203 INSURER F: COVERAGES; CERTIFICATE NUMBER: _22213442 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. i0W ..'.-e—.....-"-. 11-1-1 ­_..�=­ ­­­­ 11 ­11111-1-1111-1111111111".. . &i6exP-7-1— - - 'TYPE OF INSURANCE POLICY NUMBER I �l ]AND r_qy_y1' ---------- LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 'D ...... .. . ...... -MADE OCCUR 6AMA CLAIMS 'OST"ERTL "A MED EXP (Any one person) S PERSONAL & ADV INJURY S GENERAL AGGREGATE S PRO. GEN'L AGGREGATE LIMIT APPLIES PER: r I POLICY JECT LOC OTHERS s A t AUTOMOBILE LABILITY 'EAGCC000121315 11112015 1/112016 C0M11IN101IN6L9LIMIT V ANY AUTO BODILY INJURY (Per person) S ALL OWNED i BODILY INJURY (Per accident) S . .......... AUTOS AUTOS SCHEDULED 1 NON-OWNED PROP. Y AMA3E HIRED AUTOS AUTOS s UMBRELLA LAB OCCUR EACH PCCULRENCE S EXCESS UAB CLAIMS MADE AGGREGATE is DIED RETENTIONS A WORKERS COMPENSATION l IEWGCC000121315 1 1/1/2015 111/2016 6TH. AND EMPLOYERS' LIABILITY Y N ✓ � 'STARTUTE ANY PIROPMETOWPARTNEWEXECUTIVE EL. EACH ACCIDENT OFFICFA/MEMBER EXCLUDED' N/A� (Mandatory in NH) E,L. DISEASE - EA EMPLOYEE; S 1,000.000 Hnsa S� d scribe under — - - - ------ . ..... DESCRIPTION OF OPERATIONS twkw E.L. DISEASE - POLICY LIMIT 1,00u001 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) WC Waiver of Subrogation appfles per WC040306484 attached. Job: Operations of the Named Insured. The Certificate of Insurance is subject to policy terms, conditions, limitations, and exclusions. CERTIFICATE HOLDER CANCELLATION Operations of the Named Insured SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cl of EL Se undo ndo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 3�!� Main Stree ACCORDANCE WITH THE POLICY PROVISIONS. EL Segundo, CA 90245 N, AUTHORIZED REPRESENTATIVE Chau Tran ©1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD CERT NC.: 22943442 Nancy Cadwa1lacierr 1151201,. 9:1-1:57 by (ES"') Page 1 cf 2 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 Ed. 4.84 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT — CALIFORNIA 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. ( "rhis agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You 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 _% of the Califomia workers' compensation premium otherwise due on such remuneration. Person or Organization ALL PERSONS OR ORGANIZATIONS City of EL Segundo, as required by written co Endorsement Effective 1/1 /2015 Insured H.L. Moe Company, Inc. WC 262 (4 -84) WC 04 03 06 (Ed. 4-84) Schedule Job Description Policy No. EWGCC000121315 Insurance Company HDI- Gerling America Insurance Company Countersigned By C.YCe. NOC. 2214,14, 2 Norcy C,,adwall 1 . Adet I / 5 /2,1 S a.:.`.,7 AM CVST> <,:r,qe 2 r 2 Endorsement No. M40 P* Page 1 of 1 A R CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD,YYYY, 11512015 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 l (t statement t f WAIVED, subject to the terms and conditions policyt P ci smay, require an endorsement. A nh s certificate does not confer rights to the ate of such �e � Pasadena, A 91107 /A/c A.. .. . yy{/ . PRODUCER 36475 E I*o MCiI BIVd., Suite 100 PHONN ....,............ �s2s) 799-7000 W (04)L P 11 14 AFFORDING COVERAGE www.boltonr,o.com 0008309 INSURED ... s. .... _ _... - H.L. Moe om ar1 „ Inc. 7BA., John K. Kee #e Company iBA: Advance Mechanical Contractors, Inc. 525 Commercial Street Glendale CA 91.203 1343 COVERAGES CERTIFICATE NUMBER: 22943441 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. ...a..� _..n.� .. POLICY NUMBER .,., .. , .a. Y-E „. -M/ _ - ... ... LIMITS. � w . N TYPE OF INSURANCE .� ...,���"D)C POLkY OFF P�T,�CY EA"P..e,, COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE IS ,.V494AArr11T'C' C iPD e ._.w...., 1 p CLAIMS•MADE OCCUR PR MO'a d A aceurrcr' S LIMIT APPLIES PER: .. 4 w M POLECY ' � JECT LOC DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, may A MED EXP (Any one person) S v_ _ . . .. PERSONAL & ADV INJURY S __. ------- .... GENERAL AGGREGATE GRE AT S . . ._.._..... PRODUCTS COMPIOP AGG ! S I OTHCW S AUTOMOBILE LIABILITY be attached If more space is required) Re: Proof of Insurance. The Cert ificate of Insurance is subject to policy terms, conditions, limitations, and exclusions TE HOLDER CANCELLA City of El �e Undo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Det of Bullt�ng &Planning uW � THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN p ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street El Segundo, CA 90245 AUTHORIZED REPRESENTATIVE Chau Tran ©1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD CEi+a^ SC.: 2295354_ :1encY Catlwa liader 1/51'2J15 9: =5:5" A. (_ „) Page - It GEN L AGGREGATE EAGCC000121315 1/1/2015 1/1/2016 M MSIN IN L U I s 1 1Ca q;v4mnz1 QAO ANY AUTO BODILY INJURY (Per person) S ALL OWNED SCHEDULED AUTOS j AUTOS BODILY INJURY Per accident S ( ) AUTOS / NON -OWNED PF IrPERTY <7AMAG S e�HIRED ... AUTOS iPera4cdSff ,.,., i S UMBRELLA LIAR ....� OCCUR I - EACH OCCURRENCE S CLAIMS- MADE,4SiEGA LIABRETENTIONS m.. ..._._...0 ..,,,�........E "iE 5 .m .. DED� S ,WORKERS COMPENSATION iEWGCCO00121315 1/1/2015 1/1/2016 - STATUTF FRH AND EMPLOYERS' LIABILITY YIN ,/ ANY PROM IETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? NIA (Mandatory In NH) E.L. SEASECIEA EMPLOYEE S_ 0 1,000 if yes describe under DESCRIPTION OF OPERATIONS bebw (E L. DISEASE POLICY LIMIT ' S 1.00_. 1,000 LIMIT APPLIES PER: .. 4 w M POLECY ' � JECT LOC DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, may A MED EXP (Any one person) S v_ _ . . .. PERSONAL & ADV INJURY S __. ------- .... GENERAL AGGREGATE GRE AT S . . ._.._..... PRODUCTS COMPIOP AGG ! S I OTHCW S AUTOMOBILE LIABILITY be attached If more space is required) Re: Proof of Insurance. The Cert ificate of Insurance is subject to policy terms, conditions, limitations, and exclusions TE HOLDER CANCELLA City of El �e Undo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Det of Bullt�ng &Planning uW � THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN p ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street El Segundo, CA 90245 AUTHORIZED REPRESENTATIVE Chau Tran ©1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD CEi+a^ SC.: 2295354_ :1encY Catlwa liader 1/51'2J15 9: =5:5" A. (_ „) Page - It THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following; COMMERCIAL GENERAL LIABILITY SCHEDULE Name Of Additional Insured Person(s) Covered Operations Or Organization(s): Where required by written contract or agreement All non - residential construction projects of the Named Insured 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 any person or organization shown in the Schedule for which you are required to include as an additional insured on this policy by written contract or written agreement in effect during this policy period and executed prior to the `occurrence" of the "bodily injury" or "property damage." Coverage provided such additional insured is 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), providing that: "your work" or "your product' related to Covered Operations shown in the Schedule above, is other than "residential development' of any description. 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. MC2010US 09 -12 Page 1 of 2 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. C. For the purposes of this endorsement, the following is added to the Other Insurance Condition and supersedes any provision to the contrary: Primary and Noncontributory Insurance This insurance is primary to and will not seek contribution from any other insurance available to the additional insured designated in the Schedule, provided that: (1) The additional insured Is a Named Insured under such other insurance; and (2) You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. The following definitions are added to SECTION V — DEFINITIONS of this policy: "Residential development" means a structure or structures, including the land upon which it is situated, designed or intended for occupancy in whole or in part as a residence by any person or persons. "Residential development" does not include "apartments" or "apartment buildings." "Apartments" means one or more rooms of a building used as a dwelling unit separate from others in the building and which are rented from others by those dwelling in them. "Apartments building" means a structure containing two or more separate "apartments." ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. Includes copyrighted material of Insurance Services Office, Inc., with its permission. MC2010US 09 -12 Page 2 of 2 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PERSON A I ATI N This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY SCHEDULE Name Of Additional Insured nsured Persons) ._. Covered Completed operations Or Organization(s): ...� __ _ __...o.wnti. . �. Where required by written contract or All non - residential construction projects of the agreement Named Insured 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" or "property damage" caused, in whole or in part, by "your work ", as described in the schedule of this endorsement performed for that additional insured and included in the "products- completed operations hazard" as described in the Covered Completed Operations, schedule above. B. The insurance provided to the additional insured under this endorsement is limited as follows: Covered Completed Operations shown in the schedule above shall not include "residential development" of any description. C. For the purposes of this endorsement, the following is added to the Other Insurance Condition and supersedes any provision to the contrary: Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution from any other insurance available to the additional insured designated in the Schedule, provided that: (1) The additional insured is a Named Insured under such other insurance; and (2) You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. D. The following definitions are added to SECTION V — DEFINITIONS of this Policy: "Residential development" means a structure or structures, including the land upon which it is situated, designed or intended for occupancy in whole or in part as a residence by any person or persons. "Residential development" does not include "apartments" or "apartment buildings." MC2037US 09 -12 Page 1 of 2 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. "Apartments" means one or more rooms of a building used as a dwelling unit separate from others in the building and which are rented from others by those dwelling in them. "Apartments building" means a structure containing two or more separate "apartments." ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. Includes copyrighted material of Insurance Services Office, Inc., with Its permission. MC2037US 09 -12 Page 2 of 2