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PROOF OF INSURANCE (2016) CLOSEDDATE (MM /DD /YYYY) CERTIFICATE OF LIABILITY INSURANCE 4/1/2015 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 NAME: ON ACT Amanda Nero Cailor Fleming Insurance ; °NN F „ (330) 782 -8068 rFpp Nol (330 >782 -0458 4610 Market St. E-MAIL anero @cailorfleming.com -ADDRESS:. P.O. BOX 3989 INSURER(S) AFFORDING COVERAGE NAIC # g .INSURERA:Penn America Insurance..... ComvanV ............................................. ...............�............._. Youngstown OH 44513 �. INSURED,....... �. �. �. �. �. �. �. �..... �. �. �. �. �. �. �. �. �. �. �.�.�.�.� ...................�.� .................................................................................................. �„ �......,,,,.......,,,,,._._. a..__......,_,..,__.......,,,,,,.. �.. �..., �.. M,- �................................, ..............___......._____.. INSURER B American EConomv Insurance Co . .. INSURER.. C ....... ............................... �._.-.-_ ------------------- _.....,....,.,.,._.. � ........ .,. ............____..,.__..__.__ —. ERE, Inc. INSURER --------- _.__-- _.__-__..,................ ... .. 270 Davids Drive RERD: INSURER E Wilminqton OR 45177 INSI IRFR F: r.nVFRAC°ES f`.rPTIFti".ATE NflAARr -Rs4 /1/15 -16 GL /Auto /Excess 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. �INSR ........... .... .... .... u�w - „ --------- _ POLCEFF POLICY vvvivl LIMITS TR TYPE OF INSURANCE n' n POLICY NUMBER rm X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 300,000 A CLAIMS -MADE OCCUR PRrYu11 F �Ljr oac�gftQgW)$. ^MEDEXP_ m,,,,,,,., X PAC7088935 4/1/2015 4/1/2016 (Any one person) ,PERSONAL $ 5,000 ..$ .............. ...__..n._....m___— _____..... & ADV I NJU RY....... 1,000,000 GEN L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 3,000,000 $ 0 X..., POLICY PRO- LOC JECT .PRODUCTS, COMP /OPAGG, $ 3,000,000 0T6t,FRu Professional Liability $ 1,000,000 AUTOMOBILE LIABILITY V I `Ell $ 1,000,000 ANY AUTO BODILY INJURY (Per person) $ B .. ALL OWNED "� SCHEDULED AUTOS X AUTOS ''. 01 —CI- 440309 -50 4/1/2015 4/1/2016 BODILY INJURY (Per accident) ___...�..... �_. -' ____ $ - - -- X... NON-OWNED PROPER'T'Y DAMAGE "' $ HIRED AUTOS!.: AUTOS !Pw arraden)1 UMBRELLA LIAB I X OCCUR EACH OCCURRENCE $ 51 000, 000 A X, EXCESS LIAB CLAIMS -MADE AGGREGATE $ 5,000,000 ._.,__. —, DED RETENTION $ XPA0001477 4/1/2015 4/1/2016 $..------ WORKERS COMPENSATION A AND EMPLOYERS' LIABILITY Y d N ....................: mm, ATI_ I,T,F...............TI,...... '..... ANY N/A a IEn T� /TXCLUI EXCLUDED? ECUTIVI ,L. EACH ACCIDENT ... ..... $ ... NI (Mandatory E.L. DISEAS.... E - EA EMPLOYE $ li' crs, da+xcrlbe urldI D aCRIPTION OF OPERATIONS b0omn E.L. DISEASE POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The Certificate Holder listed below is named as an Additional Insured on the General Liability coverage, when required by written contract, with respect to work performed for them by the Named Insured, as their interest may appear. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of E1 Segundo, its officers, official THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN employees, agents & volunteers ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street El Segundo, CA 90245 -3813 AUTHORIZED REPRESENTATIVE J Michalenok /NERO"" - ©1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS025 (201401) Additional Named Insureds Other Named Insureds ERIE Do.ing Business As EMSAR Cal.J.-fornia Corporation, Additional Named Insured EMSAR Chicago Corporation, Additional Named Insured EMSAR Flor.J..da. Corporation, Additional Named Insured EMSAR Great. Lakes CorporaL..1-on, Addi t i o n al Named Insured EMSAR flawai.J.. CorporaLi.on, Addit.ional. Named Insured EMSAR International Sol..W.J..ons, Inc, Corporation, Add..!.. ti-onal- Named Insured EMSAR 1,as Vegas Corporation, Additional Named Insured EMSAR Monida Corporat.ii-on, Additional. Named Insured EMSAR Real Estate F.J.,C Limited Liabi].J.Ly Company, Addit.J.-onal Named Insured EMSAR Tochno.1ogy So-lut ions, Inc, Corpora{..J.on, Additional Named Insured EMSAR Washington Corporation, Addil.-i-onal Named Insured EMSAR Wisconsin Corpora t..i on, Additional Named Insured EMSAR, Enc, Corpora LJ..on, Additional Named Insured Equipment Manage.ment Scrvi.ce and Repa-l-r Inc. Corporation, Additional Named In.,.,,ut-ed ERLA, Inc. Corporat.J..on, Additional. Named Insured I I I OFAPPINF (02/2007) COPYRIGHT 2007, AMS SERVICES INC I .. CE RTIFICAT ' OF'"' LIIAIN ILITY INSURANCE $�6 %ZOiSYY "' 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 NAME: Amanda Nero Cailor Fleming Insurance PHONE (330)782 -8068 Fed No); (330) 782 -0458 4610 Market St. E" " ,Herocailorfleming „com P.O. BOX 3989 INSURER(§) AFFORDING COVERAGE NAIC # Youngstown OH 44513 INSURERA:The Travelers Property Casualty 5674 INSURED _ FINSURER B EHE, Inc . SURER C: 270 Davids Drive iNCUaFR n Wilminuton OH 45177 (INSURER F: COVERAGES CERTIF'ICA'TE NU!MBER:15 -16 WC Incl Addl Named 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. INSH 1 TA TYPE OF INSURANCE POLICY EFC POLICY E P INRR wvn POLICY NUMBER 'MMJDDtYYY (MMt n /YYYY1 LIMITS GENERAL LIABILITY EACH OCCURRENCE . ',, $ LIABILITY COMCLAIMIS- DAMAGE $ MADEERAL �..... OCCUR MEDnEXP (Ag� (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ POLICY 221 LOC $ AUTOMOBILE LIABILITY M I LIMIT N .5 S NN "L •� r,r i '.. ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS NON -OWNED PROPERTY DAMAGE $— HIRED AUTOS AUTOS (Pa a_ _r rcidonf) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE RFTFNTI(1N P $ A WORKERS COMPENSATION Y WC STATU- (7TIi- AND EMPLOYERS' LIABILITY Y / N my i FR ANY PROPRIETOR /PARTNER/EXECUTIVE E,_ EACH ACCIDENT $ 500r000 OFFICER/MEMBEREXCLUDED? (Mandatory in NH) N/A iS— UB- 3F87925 —A -15 1/1/2015 !1/1/2016 EL.. DISEASE - EA EMPLOYEE $ 500_ 000 '.. If yes, describe under DF$CRIPTION OF OPERATIONS below E,L.. DISEASE - POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, AddWonal Remarks Schedule, if more space Is required) $1,Million /$1 Million /$l Million Limits Apply to the State of California per form WC9903F3 (00) attached to the policy. Waiver of Subrogation applies per form WC990376(A) attached to the policy, City of E1 Segundo, its officers,official employees, agents & volunteers 350 Main Street E1 Segundo, CA 90245 -3813 I;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 Michalenok /NERO,. ACORD 25 (2010/05) ©1988 -2010 ACORD CORPORATION. All rights reserved. INS025 polompi The ACORD name and logo are registered marks of ACORD � a dIM ..�,7....... ONE TONER SQUARE WORKERS COMPENSATION HARTFORD, CT 06183 AND EMPLOYERS LIABILITY INSURANCE POLICY ENDORSEMENT WC 99 03 F3 (00) POLICY NUMBER: (HSUB- 3F87925 -A -15) CALIFORNIA LIMITS OF LIABILITY ENDORSEMENT This endorsement applies only to the insurance provided by the policy because California is shown in Item 3.A. of the Information Page. The limits of our liability under Part Two of the policy are: Bodily Injury by Accident $1,000,000 or the amount shown In Item 3.13. of the Information Page, whichever is greater, each accident Bodily Injury by Disease $1,000,000 or the amount shown In Item 3.13. of the Information Page, whichever is greater, policy limit Bodily Injury by Disease $1,000,000 or the amount shown in Item 3.B. of the Information Page, whichever is greater, each employee This change applies to the Insurance this policy provides for California operations only. This endorsement changes the policy to which It is attached and is effective on the date Issued unless otherwise stated. (The Information below Is required only when this endorsement Is issued subsequent to preparation of the policy.) Endorsement Effective Policy No. Endorsement No. Insured�� Insurance Company Countersigned by DATE OF ISSUE: 01 -12 -15 ST ASSIGN: Page 1 of 1 Additional Named Insureds Other Named Insureds JEMSAR Biomedical Services, Inc, Equipment Management Service and Repair, Inc 122�1111 Penn Biomedical. Support Corporation, Additional Named Insured Corporation, Additional Named :Insured. Corporation, Additional Named Insured Doing Business As I OFAPPINF (02/2007) COPYRIGHT 2007, AMS SERVICES INC I Ar TRAVE LER WORKERS COMPENSATION II E AND ONE TOWSR SQUABS EMPLOYERS LIABILITY POLICY HARTFORD, CT 06183 ENDORSEMENT WC 99 03 76 ( A) — 001 POLICY NUMBER: (HSUB- 3FB7925 -A -15) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA (BLANKET WAIVER) 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. The additional premium for this endorsement shall be 01.00 % of the California workers' compensatlon pre- mium. Schedule Person or Organization Job Description ANY PERSON OR ORGANIZATION FOR WHICH THE INSURED HAS AGREED BY WRITTEN CONTRACT EBECUTED Pi PRIOR TO LOSS TO FURNISH THIS WAIVER. This endorsement changes the policy to which It Is attached and is effective on the date issued unless otherwise stated. (The Information below Is required only when this endorsement Is Issued subsequent to preparation of the policy.) Endorsement Effective Insured Insurance Company Policy No. Endorsement No. Premium Countersigned by DATE OF ISSUE: 04 -22 -15 ST ASSIGN: Page 1 of 1