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PROOF OF INSURANCE (2016) CLOSED (2)ti CERTIFICATE OF LIABILITY INSURANCE DATE (WAIDWYYYY) 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 T14C ISSUING INSURERS), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an A 1-11111*1 k be INSURED, t9; :110Y(109) must endorsed. It SUBROGATION IS WAI1lED, aub ;set to statement on thi certificate does not Confer rights to the the terms and conditions of the policy, certain policies may require an endorsement A state s PRODUCER RT1 Insurance Services, Inc. 1383 Redondo Avenue Suite 101 Long Beach, CA 90804 License #: 0016014 INSURED J & L BUILDING MAINTENANCE LLC 6636 FLORENCE AVE STE 337 BELL GARDENS, CA 90201-4990 QNIA�i , - 0 n Kori DaLe AR---- � HONE OW408.1301 3* A _kori rtl�lns.Lc --LNs U ±gRj8j A Mercury -. 41 N$AJRCRF: ;R9VlqInN NIJIVIRERt 15 COVERAGES_ CERTIFIUA111INIUMMM VUVwAJUVw"2w'Juc THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REOUIREMENT, 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: SEEN REDUCED By PAID CLAIMS, P Y EXP LIMITS 0 _KV-17— TYPE OF INSURANCE POLICY NUMBER, (M-11M (Mm"1001YYYY) -L RRENCE 1'0 E* RF� MERCIAL GENERAL LIABILITY Y Y CCP0042411 03129/2015 03/2912916 CH'y —00,009— A �-X�—Tm — 1 -.6 VA M k N1 "IS 26,000 CLAIMS-MAOE OCCUR 6 19Q__ PERSONAL & ACV 1NJ URY --110-001(—)00 --- 2,000000 GENL AGGREGATE LIMIT APPF.JES PER: s 2 POLICY PRO- PRODUCTS - CC-MP,,'0P AGG 3—=1000104-00 ACT OTHER- 5 Mr LE LIMIT AUTOMOBILE LIASILITY BODILY INJURY (Per WSOM ky iFar accd;M—) ANY AUTO BODILY INJ $ ALL CM7 ED SCHEDULED i AUTOS AUTOS NAAGE $ NON-OANED -IP-AL3-��;L F-11 HiREDAUTOS AUTOS S EACH OCCURRENCE UMERELLA LIAS l OCCUR AGGREGATE EXCESS LIAS MADE !7j-O-ED-- E _7 WORKERS COMPENSATION s --S AND EMPLOYERS' LIABILITY Y/W E,L, EACH ACCIDENT ANY PROPRIE TOR +PARTNERIEXECUTIVE 1NIAT OMCMUmMSER EXCLUDED? _�LDISEASE - EA eAPLOYEE S (Mandatory in NH) It yes. de=Da Under 1 E.L. DISEASE - PaJCY LIMIT 1 S ERATIONS betow RiPTION OF .OP 10,000 ' B Y 71628867 Surety Bond Y 103128120 10312812016 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 10t AddMonal Remarks Sctwduj#, may be attached if more space is required) and maintenance. The City See policy for actual limits, terms, conditions and limitations as they may apply. Office cleaning a of El Segundo, it's officials and employees and named as addlitonal insured under this policy in a primary and non-contributory placement City of El Segundo 350 Main 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. NSo:2014 ACORD CORPORATION. All rights ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD Printed Dy KD1 on April 29, 2015 at 10:35AM POLICY NUMBER: CCP0042411 COMMERCIAL GENERAL LIABILITY CG 20 26 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organ ization(s): City of El Segundo, It's Officials and Employees 350 Main Street Room 5 El Segundo, CA 90245 I Information required to complete this Schedule, if not shown above, will be shown in the Declarations. I A. Section If — 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 your acts or omissions or the acts or omissions of those acting on your behalf: 1. In the performance of your ongoing operations; or 2. In connection with your premises owned by or rented to you. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and B. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. (�k CG 20 26 0413 @insurance Services Office, Inc., 2012 Page 1 of 1 AC®R ® CERTIFICATE LIABILITY DATE (MM /DDIYYYY) F5/7/2015 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(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 C &S Insurance Services 3220 Sepulveda Blvd, #202 Torrance CA 90505 CONTACT Linda Goodyear ear y PHONE (310) 517-8255 FAX (310)517 -0434 AIC No): E-MAIL .Linda @inscenter.com IINSURERA:State INSURERS AFFORDING COVERAGE NAIC # Compensation Fund 12345 INSURED J &L Building Maintenance LLC 6635 Florence Ave Suite 337 Bell Gardens CA 90210 INSURER B INSURER C: INSURER D: INSURERE: $ INSURER F: COMMERCIAL GENERAL LIABILITY COVERAGES CERTIFICATE NUMBER:CL1542802700 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. ILTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF MM/ D POLICY EXP MM/ D LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE N PREMISES Ea occurrence $_ _ CLAIMS -MADE D OCCUR MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ POLICY PRoi El LOC $ AUTOMOBILE LIABILITY C M81NED SINGLE LIMIT Ea accident BODILY INJURY (Per person) _ $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY {Per accident} $ HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE Per accident) $ $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ AGGREGATE __ S EXCESS LIAB CLAIMS -MADE DED I I RETENTION S S A WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS' LIABILITY Y / N E.L. EACH ACCIDENT $ 11000,000 ANY PROPRIETOR /PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N/A 096795 -15 /22/2015 /22/2016 E.L. DISEASE - EA EMPLOYEE S 1 1000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) Coverage applies to the above term only. See policy for actual coverage, terms, conditions, and limitatations that may apply. Re: Engineering Plan Check Services, City of El Segundo. City of E1 Segundo, its officials, officers, agents & employees. WOS to follow. City of El Segundo Attn: PW Dept 350 Main St E1 Segundo, CA 90245 ACORD 25 (2010/05) INS025 (201005).01 L:ANL;tLLA I IUN 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 INSURANCE/LINDA ©1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD J & L BUILDING MAINTENANCE SER 6635 FLORENCE AVE STE 337 BELL GARDENS, CA 90201 ANYTHING IN THIS POLICY TO THE CONTRARY NOTWITHSTANDING, IT IS AGREED THAT THE STATE COMPENSATION INSURANCE FUND WAIVES ANY RIGHT OF SUBROGATION AGAINST, CITY OF EL SEGUNDO WHICH MIGHT ARISE BY REASON OF ANY PAYMENT UNDER THIS POLICY IN CONNECTION WITH WORK PERFORMED BY, J & L BUILDING MAINTENANCE SER IT IS FURTHER AGREED THAT THE INSURED SHALL MAINTAIN PAYROLL RECORDS ACCURATELY SEGREGATING THE REMUNERATION OF EMPLOYEES WHILE ENGAGED IN WORK FOR THE ABOVE EMPLOYER. IT IS FURTHER AGREED THAT PREMIUM ON THE EARNINGS OF SUCH EMPLOYEES SHALL BE INCREASED BY 03 %. NOTHING IN THIS ENDORSEMENT CONTAINED SHALL BE HELD TO VARY, ALTER, WAIVE OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS POLICY OTHER THAN AS STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR LIMITATIONS OF THIS ENDORSEMENT. COUNTERSIGNED AND ISSUED AT SAN FRANCISCO: MAY 8, 2015 2570 AUTHORIZED REPRESENT IVE PRESIDENT AND CEO SCIF FORM 10217 IREV.7-2014) OLD DP 217 E L'vl DATE WM1 DD,,-YYYY) 5/5/2015 CERTIFICATE OF LIABI R054 LITY INSURANCE I AUTO INS SPECIALISTS LLC/PHS (8 6 6) 4 67 -8730 if C, NOY, 888 443--6 2 255261 P: (866) 467-8730 F: (888) 443-6112 A'Mr,'16S: PO BOX 33015 WSURS(SIAFFORDING COVERAGE NA[r-- SAN ANTONIO TX 78265 NtURARA; l4artfC3d Accidenz. & Inc I ie;nnit-i co INSURED J&T BUILDING IvAiINTENANCE INSURER 0 6635 FLORENCE AVE INSURERS: BELL GARDENS CA 90201 INSURER F; f%C0*rICII'A'rC ICI iaxcaca. REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES I OF . I - NSURANCE 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. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED ADDL SUNI? POLICYNCAIRER A UTHORIZW R-EPRESEAfTA TWE CITY OF EL SEGUNDO 3 50 MAIN ST EL SEGUNDO, CA 90245 EACH OCCURRENCE COMMERCIAL GENERAL LIABILITY CLAIMS-MADE DOCCUR DAMAGE FIRE TO RENTED SES (E. BRED EXP (Any one Peron) PERSONAL& ADVIMIURY S GENERAL AGGREGATE GEWL AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPiop AGG �OTHER] POLICY 7 LOC 71 PRO- I AUTOMOBILE LIABILITY CM49INED SINGLE LOW T (Ea actident) BODILY INJURY (Per person) $ X ANY AUTO x BODILY INJURY' Mal' amidert) I SCHEDULED A OWNED ZLTO' AUTOS HIRED AUTOS ON-OWNED Os X AUTOS 12 UEC GZ0073 /28/2015 03,2,8/20-.6 PROPERTYOANIAGE 'Per accident) UMBRELLA LIAR OCCUR EACH OCCURRENCE AGGREGATE EXCESS LIAR CLAIMS-41ADE MCI IeT..T.. ;fVRKE9SC0'4Pr-V.VAI7UV ANY PROPRIC-TOPJPAFZTNMEXECUTIV£ YIN f L P TR 'TE I joR i-ff- " I I E E.L, EACH ACCIDENT OFFICEWMENISSR EXCLUDED? in Nf� (Mandatory NIA E— E,L. DISEASE- EA E!VPLOYEE E.L. DISEASE - If y", describe under DESCRIPTION OF OPERATIONS telaw DESCRIPTION OF OPERATIONS ILOCATIONS (VEHICLES (ACORD iOl, Additional Rornaft Sohedule, may be attaotled It more space IS required} Those usual to the Insured's Operations. Certificate Holder is an Additional insured per Designated insured CA2048 attached to this policy. lW I VOO-AV 114 /k%,Vr%LJ %oWF%rWF%^ ItvIN. M I I =Pvt VIZU, ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. A UTHORIZW R-EPRESEAfTA TWE CITY OF EL SEGUNDO 3 50 MAIN ST EL SEGUNDO, CA 90245 lW I VOO-AV 114 /k%,Vr%LJ %oWF%rWF%^ ItvIN. M I I =Pvt VIZU, ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD Select Customer insurance Center 3600 WISEMAN BLVD. SAN ANTONIO TX 78251 Policyholder, please callus at: (866) 467-8730 Agent, please callus at: (800) 447-7649 SERVICE.TX(a-THEHARTFORD-Coal ATTACHED Enclosed is an endorsement for your business insurance policy. Please review it at your convenience. If you have questions or need to make further changes: Policyholder, please callus at: (866) 467 -6730 Agent, please callus at: (800) 447-7649 between 7 A. m. and 7 P.M- CENTRAL TIME. The premium billing will be mailed to you separately. You can expect to receive it soon. Thank you for allowing us to service your business needs. AUTO INS SPECIALISTS LLC/PHS THE HARTFORD SELECT CUSTOMER INSURANCE CENTER W The Hartford Hartford Fire Insurance Company and its Affiliates One Hartford Plaza, Hartford, Connecticut 06155 POLICY NUMBER: 72 OEC GZ0073 CHANGE 0l3MBEG; 001A This endorsement modifies insurance provided under the following: "If =0 4821911-1 With respect tocoverage provided by this endorsement, the provisions cf the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) urorganizedon(s) who are "hneuredm" for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form, This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective On the inception date of the policy unless another date is indicated below. Named Insured: Endorsement Effective Date: Name Of Or : CITY OF EL GEGlNDO sso MAIN STREET |EL SEGUN0O, CA' 90245 1­1�formation_ required to compt - ate this Schedule, if not shown above, will be shown in the Declarations. Each person m' organization shown in the Schedule is on "inaured" for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Paragraph A.I. of Section U — Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Fmnnm and Paragraph D`2. of Section I — Covered Autos Coverages of the Auto Dealers Coverage Form. 0 CA 20 4810 13 @ Insurance Services Office, Inc., 2011 Page isfi