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PROOF OF INSURANCE (2015) CLOSED`w 1 0 DATE (MMIDDIYYYY) +� CERTIFICATE OF LIABILITY INSURANCE 9/2/2015 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 PRODUCER San Marcos - Alliant Insurance Services, Inc. 570 Rancheros Dr Ste 100 San Marcos CA 92069 INSURED DOWNSER -01 Downstream Services, Inc. 2855 Progress Place Escondido CA 92029 NAMF' Kav Helmick INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS ;HONE ti% 760 -304 -7121 „ d 76......... FA�h 0- 300 4 -7743 E•MAiL k heirnick alliant.com k.D6 _.,. ,. INSURER(S) AFFORDING COVERAGE CLAIMS -MADE OCCUR PRFM15E tao pilrrtinta) $100000 NAIC INSURERA:Vallev Forge Insurance COmpany GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $2,000,000 20508 INSURERB:Contlnental Insurance Company_ B 35289 INSURERC:National Fire Insurance Cc of Hartf 20478 INSURER R,_ 11115/2014 11/15/2015 / INSURER E ; $2,000,000 _ INSURER F: COVERAGES CERTIFICATE NUMBER; 690957824 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. ----- ..... ... . ADDLISU'BTi ...- ............... .... POLICY ...... ...,._ ............ ....... __ _.....,,,, ................. _, e_-_ LIMITS NTn TYPE OF INSURANCE INCH wvn POLICY NUMBER IMMIDD�1 MMIDpJYYYY. C X COMMERCIAL GENERAL LIABILITY Y Y 2094163615 11/15/2014 11/1512015 EACH OCCURRENCE $1,000,QpO _ 51 CLAIMS -MADE OCCUR PRFM15E tao pilrrtinta) $100000 MED EXP (Any one person) $5,000 NAL &ADVINJURY $1,000,000 _� __ ........ h......,.,-.�..�.,.,.,.,,,, GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $2,000,000 POLICY [ X LOC RRO PR.ODU TS _ COM.P /O.P WAG.G $2,000,000 __. ..........................._... . ,, �� _ _.. .. . _ . . .................. .�.. ,_,,, _ ._.. .. OTHER: PD deductible $$5,000 B AUTOMOBILE LIABILITY Y Y 5091396971 11115/2014 11/15/2015 / C0 {dint . ........ $2,000,000 _ X ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED -, BODILY INJURY (Per accident) $ —. NON- OWNED X X STaFA� ...,. HIRED AUTOS AUTOS „mPeracclderrk $ A X UMBRELLA LIAB I X IOCCUR 2094163629 11/15/2014 11115/2015 EACH OCCURRENCE $2,000,000 EXCESS LIAB CLAIMS -MADE _.� AGGREGATE ...�._.........,.,,,,,,. .... ...... $2 000,000 ....�- ,.,...� ....�,.., X_ - -RETEN ,. ................r, DED TI ON $10,000 $ WORKERS COMPENSATION OT H- CTATI ITF '.. FR AND EMPLOYERS' LIABILITY YIN..:.:.......:.... -...— . ....................,.,.,.,.... .. ......... ANY FROPRIEtORIPARTNEWCKECUTIVE ❑ E.MCI.kADCC.1`,� I°anddattory N / A E L, EACH ACCIDENT $ mm i y�NH) E.L DISEA,SE EA EMPLOYEE $ LL - -� -- If yes, describe under DESCRIPTION OF OPERATIONS below E L, DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) RE: MAINTENANCE AGREEMENT, CITY WIDE LOCATIONS INSTRUMENTATION MAINTENANCE. CITY OF EL SEGUNDO, ITS OFFICIALS AND EMPLOYEES ARE NAMED AS ADDITIONAL INSURED, WAIVER OF SUBROGATION APPLIES. 30 DAY NOC APPLIES. red -i � l � r�7,� � �xTri1• rl I+�: rA1JrI =I I ATInN V I VtfS -ZU14 AUUKU GUKVUKA I IUIV. Ali rignLs reserveu. ACORD 25 (2014/01) 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 CITY OF EL SEGUNDO ACCORDANCE WITH THE POLICY PROVISIONS. PUBLIC WORKS 350 MAIN STREET REPRESENTATIVE AUTHORIZED REP EL SEGUNDO CA 90245 -3813 V I VtfS -ZU14 AUUKU GUKVUKA I IUIV. Ali rignLs reserveu. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD CNAINSURED: Downstream Services, Inc. POLICY NO.: 2094163615 G- 140331 -A (Ed. 01101) IMPORTANT: THIS ENDORSEMENT CONTAINS DUTIES THAT APPLY TO THE ADDITIONAL INSURED IN THE EVENT OF OCCURRENCE, OFFENSE, CLAIM OR SUIT. SEE PARAGRAPH C.1. OF THIS ENDORSEMENT FOR THESE DUTIES. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTRACTOR'S SCHEDULED AND BLANKET ADDITIONAL INSURED ENDORSEMENT WITH PRODUCTS- COMPLETED OPERATIONS COVERAGE This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART;' SCHEDULE Name of Person or Organization: Designated Project: WHERE REQUIRED BY WRITTEN CONTRACT (Coverage under this endorsement is not affected by an entry or lack of entry in the Schedule above.) A. WHO IS AN INSURED (Section II) is amended to not in addition to, the Limits of Insurance shown Include as an insured any person or organization, in the Declarations. including any person or organization shown in the 3. The coverage provided to the additional insured schedule above, (called additional Insured) whom by this endorsement and paragraph f. of the you are required to add as an additional insured on definition of "insured contract" under this policy under a written contract or written DEFINITIONS (Section V) do not apps y to agreement; but the written contract or written "bodily injury" or "property damage" ariorig agreement must be: of the "products - completed operationehazard" 1. Currently in effect or becoming effective during unless required by the written contract or the term of this policy; and written agreement. 2. Executed prior to the "bodily injury," "property 4. The insurance provided to the additional damage," or "personal and advertising injury". insured does not apply to "bodily injury," "property damage," or "personal and advertising B. The insurance provided to the additional insured is injury" arising out of an architect's, engineer's, limited as follows: or surveyor's rendering of or failure to render 1. That person or organization Is an additional any professional services including: insured solely for liability due to your/ a. The preparing, approving, or failing to negligence specifically resulting from "your prepare or approve maps, shop drawings, work" for the additional insured which is the opinions, reports, surveys, field orders, subject of the written contract or written change orders or drawings and agreement. No coverage applies to liability specifications, and resulting from the sole negligence of the additional insured. b. Supervisory, or inspection activities performed as part of any related 2. The Limits of Insurance applicable to the architectural or engineering activities. additional insured are those specified In the written contract or written agreement or in the C. As respects the coverage provided under this Declarations of this policy, whichever is less. endorsement, SECTION IV — COMMERCIAL These Limits of Insurance are inclusive of, and GENERAL LIABILITY CONDITIONS are amended as follows: G- 140331 -A Page 1 of 2 (Ed. 01101) V11 I 1. The following is added to the Duties In The Event of Occurrence, Offense, Claim or Suit Condition: e. An additional insured under this endorsement will as soon as practicable: (1) Give written notice of an occurrence or an offense to us which may result in a claim or °suit" under this insurance; (2) Tender the defense and indemnity of any claim or "suit` to any other insurer which also has Insurance for a loss we cover under this Coverage Part; and (3) Agree to make available any other insurance which the additional insured has for a loss we cover under this Coverage Part. G- 140331 -A (Ed. 01/01) G- 140331 -A (Ed. 01101) f. We have no duty to defend or indemnify an additional Insured under this endorsement until we receive written notice of a claim or "suit" from the additional insured. 2. Paragraph 4.b. of the Other Insurance Condition is deleted and replaced with the following: 4. Other Insurance b. Excess Insurance This insurance is excess over any other insurance naming the additional Insured as an insured whether primary, excess, contingent or on any other basis unless a written contract or written agreement specifically requires that this insurance be either primary or primary and noncontributing. Page 2 of 2 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AMENDMENT OF OTHER INSURANCE CONDITION INSURED: Downstream Services, Inc. POLICY NO. 2094163615 This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. The following is added to provision a. Primary Insurance of paragraph 4. Other Insurance under SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: However, when an additional insured has been added to this Coverage Part by attachment of an endorsement, we will not seek contribution from the "additional insured's own insurance" provided that: (1) You and the additional insured have agreed in a written contract that this insurance is primary and non- contributory', and (2) The "bodily injury" or "property damage" occurs, or the "personal and advertising injury" is committed, subsequent to the execution of such contract. B. For the purposes of this endorsement the following is added to SECTION V — DEFINITIONS: "Additional insured's own insurance" means other insurance for which the additional insured is designated as a Named Insured. Includes copyrighted material of Insurance Services Office, hic., with its pennission. 22 -111 (01107) Page 1 of 1 INSURED: Downstream Services, Inc. POLICY NUMBER: 2094163615 COMMERCIAL GENERAL LIABILITY CO 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVER` AGAINST" OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTSICOMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: As required by written contract. I Information required to complete this Schedule. if not shown above, will be shown in the Declarations. I 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 world' 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 06 09 0 Insurance Services Office, Inc., 2008 Page 1 of 1 0 V S INSURED: Downstream Services, Inc. Policy No: 2094163615 IL 02 70 09 07 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CALIFORNIA CHANGES - CANCELLATION AND NONRENEWAL -this orworsement Modifies insurance provided under the following: CAPITAL ASSETS PROGRAM (OUTPUT POL" COVERAGE PAIN COMMERCIAL AUTOMOBILE COVERAGE FART COMMERCIAL GENERAL LIABILITY COVERAGE PART COMMERCIAL INLAND MARINE COVERAGE PART COMMERCIAL PROPERTY COVERAGE PART CRIME AND FIDELITY COVERAGE PART EMPLOYMENT-RELATED PRACTICES LMILrFY COVERAGE PART EQUIPMENT BREAKDOWN COVERAGE PART FARM COVERAGE PART LIQUOR LIABILITY COVERAGE PART POLLUTIDN LIABILITY COVERAGE PART PRODUCTSICOMPLETED OPERATIONS LMILI s Y OOVERAGE PART PROFESSIONAL LIABILITY COVERAGE PART A. Paragraphs 2. and 2. of the Carwallistlim Common (2) Discovery of fraud or material Poky Condition ate replaced by the following` fr9srepresent,ation by: 2. All Polklies In Effect For 60 Days & Less (a) Any Insured or his or her If this policy has been In effect for 60 days or represerttathm in obtaining this less, mW is not a renewal of a policy we have insurance; or previously Issued, we may cancel this policy by (b) You or your representative in avillog or delivering to The fist Narrwd Insurod pursuing a dainn unclar this policy. al the mailing address shown in the policy and (3) A )udgntent by . a court of an to the producer of record, advance written notice administrative tribunal that you have of cancellailon, stating the reason for violated a California or Faderai law, can effawn. at least: having as era} of its n"assaty a. 10 mays before the effoctvo date of aleffmis an act which matarially can flation'lf vie cancel for. Increases any of the risks imured (1) Nonpayment of prvn,iurrt; or against. (2) Discovery of fraud by: (4) [1 oovary of willful or grossly negligent aoft or ornWslons, or of any violations (a)' insured or his or her of state lava or regulations establishing representative in obtaining this safety standards, by you or your insurance; or raproserfttive. which materially (b) You or your repr,esenta>ive is increm any Of itte fi$R$ insured pursuing a claim under this policy. against. fa. 30 clays before the offective date of (6) Failure by you or your representative to cancellation if we cannel for any other implement reasonable loss control reasOn. re0u*emanls, agrees to by you as a ?l. All Policies in Eft d For More 7hm 60 Days condition of policy Issuance, or which were conditions precedent to our use of a. If this policy has boon in effect for rnore a particular rate or rating plan, If that than 60 days, or Is a renewal of a policy we failure materially increases any of the Issued, we may cancel this policy only upon risks insured against. the occurrence, ,after lfta affacthm rletca of (0) A try the Commissioner III,* pcalipy, of o of of tite fcrttowing: Insurance of lrtsuraftoar that the, (1) fVvnpayment of pternium, Indudln$ {e) LM of, or changes in, our payment due on a prior policy we issued IiRd Citl6 dtaritlp the carront reinsma nce covering all or part of policy term covering the write risks. IL 02 70 09 07 Copyright, ISO Propeeties, Inc., 2006 Page 1 of 3 the risk wouldlhreaten our financial Integrity or solvency; or (b) Continuation of the policy coverage would: (l) Place us in violation of California lawn or The laws of the state vvwa we are domiciled, or (III threaten our solvency. (T) A charge by you or your representative In the activities or properly pf t" commercial or industrial enterprise, which results In a mafsrially added, increased or changed risk, unto% tho added, increased or ct mged risk Is included in the policy. b. We will mail or deliver advance written notice of cancellation, stating #se reason for cancellation, to the first Named Insured, at the mailing addrass atKwwi in ftte policy. and to the producer of record, at least: However, we shall cancel this policy a the ftrsi Named insured has aoc ipted a now or renewal policy Iced by the CEA that includes an earthquake policy pr®ttrium surcharge but falls to pay the aarihquake policy premium surcharge authorized by ttre CEA. c. We may not cancel such rpveraga solely because corrosive soh# conditions exist on the presses. IM Resinctton (o,) applies only if coverage is subsea to one of the following, which exclude loss or damage caused by or resulting from corrosive soil conditions: (1) Capital Assets Program Coverage Form (Output Policy); (2) Commercial Prop" Coverage Part — Causes Of Loss - Special Form; or 43) Farm Coverage Part — Causes Of Loss Form — Farm Property, Paragraph Q. Covered Causes Of Loss -6pocial, (1) 10 days before the effective date of C. she following is added and supersedes any cancellation If we cancel for provisions to the 4NMary: nonpayment of premium or discovery of NONRENEWAL fraud; or 1. Subject to the Vnwisions of Paragraphs CZ (2) 30 days before the effective data of and C.3. b ©low, if we elect not to renew this cancellation If we cancel for any other policy, we will mail or deliver written notice reason listed in Paragraph 3& stating the reason for norr{enewal lo the first B. The following provision is added to the CanoWtatkn Narned InmHad shown in the Decfarations and Common Policy Condition: to the producer of rr;oaod, at team tit) days, but not more than 120 days, before the expiration or 7. Reekwalal Prapsriy anniversary date. This provision applies to coverage on real We will mail or deliver our notice to the first properly which is used predominantly for Named Insured, and to the producer of record, realdenU purposes and oonslailing of not snore at the smiling address shown in the policy. . than fear dwelling units, and to coverage on 2• Alai Propedy tenants' household persorrml property in a residential unit, if such coverage is written under This provision applies to coverage on real one of tare following; properly used prsdo ninartky for residential Commercial Property Coverage Part purposes and oonstsbnq of not more than fair Farm Coverage Fart —Fan ProWty — f=arm dwelfiro units., and to aworage on tenant!0 household property corttafned in a residardial Dwallings, Appurtenant Structures And Household Personal Property Coverage Form unit If such coverage is written under one of the following: a. If such coverage has been in effect for 60 Capital Assets Program (Output Policy) days or loss, and is not a renewal of Coverage Part coverage we previously issued, we may cancel this coverage for any reason. except Commercial Property Coverage Part as pro%OW in b and c. below. Fsami Coverage Part —Farm Ptopedy —Farm b. We may not awcgl this poky solely Dwellings. Appurtenant Structures And Houeohold Persona[ Property Coverage Forms because the first Named Insured has: (1) Accepted an offer of earthquake o. Wo may sled not to team such coverage tar any reason, except as provided in b., c. coverage; or and d. below: (2) Cancelled or did not rartaw a policy b. We will rigs refuse to renew such coverage issued by the California Earthquake solely because the First Named Insured has Autho* (CEA) that included an accepted an rimer of oa rthquske coverage. earthquake policy premium surcharge, However, the following applies only to insurers who are associate partielpating PaW2 of 3 Copyright, ISO Properties, Inc., 200 IL 02 70 09 07 insurers as established by Cal. Ins. Code included an earthquake policy premium Section W089.16. We may elect not to surcharge, renewr such coverage afar #w first Named d. We will not refuse 10 romw saoh coverage Insured has accepted an otter of solely, bemuse oomsh% soil conditions earthquake coverage, if one or more of the exist on the premises. This Restriction (d following reasons applies: applies only it coverage is subject to one of (1) The nonrenewal is based on sound the following, which exclude loss or damage underv,writing principles that Maio to the caused by or resulting from corrosive soil coverages provided by this policy and conditions: that are consistent with the approved (1) Capital Program CevaragO rating plan and related doaurr w is fflad Form {Output Policy)• wi #h the Department of Insurance as required by sxisting law; (2) Commardal Property Coverage Part -- Causes Of L -Special Fes: or (2) The Commissioner of insurance nce finds that the exposure to potential losses (3) Farm Coverage hart - 413susas Of Loss Oil threaten our solvency or place us in Form —Form Property, Paragraph D. a hazardous condition. A, hazardous Covered Causes Of Loss especial. conttitian Inclu(es, but is not timi#ed to, 3. We are not required to send notice of a condition in which we make -claims nanrenewal in the fallowing situations: payments for losses resulting from an & If The transfer or renOMI of a pollcy, without oarthquaka that occurred within the arty changes In torms. conditions, or rates, preceding two years and that required a Is between us and a member of our reductiort In polioyhotder surplus of at Insurance grow. least 25% for payment of those claims; or b. If the pcbouy has been extended for 90 days or less. provided that notice has been given (3} We #►ova: its accordance with Paragraphs C.I. (a) Lost or experienced a substantial c. If you have obtained tephmement coverage, redaction in the avahabithy or or 9 the ibst Named Insured has aoresd, In scope of reiftsmanoe coverage: V writing, within 6D days cf ft termination of (b) Experienced a subolantial hwease the policy, to obtain that coverage. in the premium charged for d if ft policy is for a petiod of no more than reinsurance coverage of our residential Property irasurane,e 6Q days and you are notified at the time at _ policies; and Issuance that it will not be renew ad. tln�? Cvm�reis�sloner has approved a plan e• If the first Named Insured requests a cfnartga to tMo •tar tiara of risks for the nortrsren►al$ that s fair and a t� Rch�t in 60 dam at the equitable, and that is respwsive to the end of the Ixaiic`y peritaaa�. f t changes in our rsinsurartpe position. e, We will not refuse to renew such owerage t: It we have made a ra+rittsn offer to the :first accordance With the Nomad Insured, in accordan solely because the first Named Insured has timaframes shown in Paragraph C.11, to cannelled of did nevi re a policy, issued the policy under #urnQad terms a er by the California Earthquake Authority that ctrraW conditions or at an increased premium refs, when the increase exceeds 26%. . IL 42 70 09 07 Gopyrigirt, 180 Properties, tno., 2006 ills3of3 Policy# 5091396971 DOWNSTREAM SERVICES, INC. LA THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTRACTORS EXTENDED COVERAGE ENDORSEMENT - BUSINESS AUTO PLUS - This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM I. LIABILITY COVERAGE A. Who Is An Insured The following is added to Section II, Paragraph A.1., Who Is An Insured: 1. a. Any incorporated entity of which the Named Insured owns a majority of the voting stock on the date of inception of this Coverage Form; provided that, b. The insurance afforded by this provision A.I. does not apply to any such entity that is an "insured" under any other liability "policy" providing "auto" coverage. 2. Any organization you newly acquire or form, other than a limited liability company, partnership or joint venture, and over which you maintain majority ownership interest. The insurance afforded by this provision A.2.: a. Is effective on the acquisition or formation date, and is afforded only untll the end of the policy period of this Coverage Form, or the next anniversary of its inception date, whichever is earlier. b. Does not apply to: (1) "Bodily injury" or "property damage" caused by an "accident" that occurred before you acquired or formed the organization; or (2) Any such organization that is an "insured" under any other liability "policy" providing "auto" coverage. 3. Any person or organization that you are required by a written contract to name as an additional insured is an "Insured" but only with respect to their legal liability for acts or omissions of a person, who qualifies as an "insured" under Section I1— Who Is An Insured and for whom Liability Coverage is afforded under this policy. If required by written contract, this insurance will be primary and non- contributory to insurance on which the additional insured is a Named Insured. 4. An "employee" of yours is an "insured" while operating an "auto" hired or rented under a contract or agreement in that "employee's" name, with your permission, while performing duties related to the conduct of your business. "Policy," as used in this provision A. Who Is An Insured, includes those policies that were in force on the inception date of this Coverage Form but: 1. Which are no longer in force; or 2. Whose limits have been exhausted. B. Bail Bonds and Loss of Earnings Section II, Paragraphs A.2. (2) and A.2. (4) are revised as follows: 1. In a.(2), the limit for the cost of bail bonds is changed from $2,000 to $5,000; and 2. In a.(4), the limit for the loss of earnings is changed from $250 to $500 a day. C. Fellow Employee Section ll, Paragraph B.5 does not apply. Such coverage as is afforded by this provision C. is excess over any other collectible insurance. If. PHYSICAL DAMAGE COVERAGE A. Glass Breakage —Hitting A Bfrd Or Animal —Failing Objects Or Missiles Policy# 5091396971 The following is added to Section III, Paragraph A.3.: With respect to any covered "auto," any deductible shown in the Declarations will not apply to glass breakage if such glass is repaired, in a manner acceptable to us, rather than replaced. B. Transportation Expenses Section III, Paragraph AA.a. is revised, with respect to transportation expense incurred by you, to provide: a. $60 per day, in lieu of $20; subject to b. $1,800 maximum, in lieu of $600. C. Loss of Use Expenses Section III, Paragraph A.4.b. is revised, with respect to loss of use expenses incurred by you, to provide: a. $1,000 maximum, in lieu of $600. D. Hired "Autos" The following is added to Section III. Paragraph A.: 5. Hired "Autos" If Physical Damage coverage is provided under this policy, and such coverage does not extend to Hired Autos, then Physical Damage coverage is extended to: a. Any covered "auto" you lease, hire, rent or borrow without a driver; and b. Any covered "auto" hired or rented by your "employee" without a driver, under a contract in that individual "employee's" name, with your permission, while performing duties related to the conduct of your business. c. The most we will pay for any one "accident" or "loss" is the actual cash value, cost of repair, cost of replacement or $75,000, whichever is less, minus a $500 deductible for each covered auto. No deductible applies to "loss" caused by fire or lightning. d. The physical damage coverage as is provided by this provision is equal to the physical damage coverage(s) provided on your owned "autos." e. Such physical damage coverage for hired "autos" will: (1) Include loss of use, provided it is the consequence of an "accident" for which the Named Insured is legally liable, and as a result of which a monetary loss is sustained by the leasing or rental concern. (2) Such coverage as is provided by this provision will be subject to a limit of $750 per "accident." E. Airbag Coverage The following is added to Section III, Paragraph B.3.: The accidental discharge of an airbag shall not be considered mechanical breakdown. F. Electronic Equipment Section Ill, Paragraphs B.4.c and B.4.d. are deleted and replaced by the following: c. Physical Damage Coverage on a covered "auto" also applies to "loss" to any permanently installed electronic equipment including its antennas and other accessories. d. A $100 per occurrence deductible applies to the coverage provided by this provision. G. Diminution In Value The following is added to Section III, Paragraph B.6.: Subject to the following, the "diminution in value" exclusion does not apply to: a. Any covered "auto" of the private passenger type you lease, hire, rent or borrow, without a driver for a period of 30 days or less, while performing duties related to the conduct of your business; and b. Any covered "auto" of the private passenger type hired or rented by your "employee" without a driver for a period of 30 days or less, under a contract in that individual "employee's" name, with your permission, while performing duties related to the conduct of your business. c. Such coverage as is provided by this provision is limited to a "diminution in value" loss arising directly out of accidental damage and not as a result of the failure to make repairs; faulty or incomplete maintenance or repairs; or the installation of substandard parts. d. The most we will pay for "loss" to a covered "auto" in any one accident is the lesser of: Policy# 5091396971 (1) $5,000; or (2) 20% of the "auto's" actual cash value (ACV). III. Drive Other Car Coverage — Executive Officers The following is added to Sections II and III: 1. Any "auto" you don't own, hire or borrow is a covered "auto" for Liability Coverage while being used by, and for Physical Damage Coverage while in the care, custody or control of, any of your "executive officers," except: a. An "auto" owned by that "executive officer" or a member of that person's household; or b. An "auto" used by that "executive officer" while working in a business of selling, servicing, repairing or parking "autos." Such Liability and /or Physical Damage Coverage as is afforded by this provision. (1) Equal to the greatest of those coverages afforded any covered "auto'; and (2) Excess over any other collectible insurance. 2. For purposes of this provision, "executive officer" means a person holding any of the officer positions created by your charter, constitution, by -laws or any other similar governing document, and, while a resident of the same household, includes that person's spouse. Such "executive officers" are "insureds" while using a covered "auto" described in this provision. IV. BUSINESS AUTO CONDITIONS A. Duties In The Event Of Accident, Claim, Suit Or Loss The following is added to Section IV, Paragraph A.2.a.: (4) Your "employees" may know of an "accident" or "loss." This will not mean that you have such knowledge, unless such "accident" or "loss" is known to you or if you are not an individual, to any of your executive officers or partners or your insurance manager. The following is added to Section IV, Paragraph A.2.b.: (6) Your "employees" may know of documents received concerning a claim or "suit." This will not mean that you have such knowledge, unless receipt of such documents is known to you or if you are not an individual, to any of your executive officers or partners or your insurance manager. B. Transfer Of Rights Of Recovery Against Others To Us The following is added to Section IV, Paragraph A.5. Transfer Of Rights Of Recovery Against Others To Us: We waive any right of recovery we may have, because of payments we make for injury or damage, against any person or organization for whom or which you are required by written contract or agreement to obtain this waiver from us. This injury or damage must arise out of your activities under a contract with that person or organization. You must agree to that requirement prior to an "accident" or "loss." C. Concealment, Misrepresentation or Fraud The following is added to Section IV, Paragraph B.2.: Your failure to disclose all hazards existing on the date of inception of this Coverage Form shall not prejudice you with respect to the coverage afforded provided such failure or omission is not intentional. D. Other Insurance The following is added to Section IV, Paragraph B.5.: Regardless of the provisions of Paragraphs 5.a. and 5.d. above, the coverage provided by this policy shall be on a primary non - contributory basis. This provision is applicable only when required by a written contract. That written contract must have been entered into prior to "Accident" or "Loss." E. Policy Period, Coverage Territory Section IV, Paragraph B. 7.(5).(a). is revised to provide: a. 45 days of coverage in lieu of 30 days. V. DEFINITIONS Section V. Paragraph C. is deleted and replaced by the following: "Bodily injury" means bodily injury, sickness or disease sustained by a person, including mental anguish, mental injury or death resulting from any of these. o CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD r�u,�t� 8/288(2015 /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 SUBROGRATION 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 OnPoint Underwriting Inc. CONTACT NAME: Steven McComb 8390 E Crescent Pkwy, Suite 200 PHONE (A/C, No Ext): (360) 828 -0644 FAX (A/C, NO): (360) 828 -0699 Greenwood Village, CO 80111 EMAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: ACE American Insurance Company 22667 INSURED INSURER B: Barrett Business Services, Inc. L/C /F INSURER C: DOWNSTREAM SERVICES, INC. INSURER D: 2855 PROGRESS PLACE INSURER E: ESCONDIDO, CA 92029 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 ISSUES 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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSR WVD (MM /DD/YYYY) (MM /DD /YYYY) GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES (Ea $ CLAIMS -MADE I occurence) fOCCUR .my MED EXP (Any one person) $ •• PERSONAL & ADV INJURY $ GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ PRODUCTS - COMP /OP AGG $ POLICY F ECT LOG AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) BODILY INJURY (Per person) $ - al.➢a.OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident) $ HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ ..mom EXCESS LIAB OCCUR AGGREGATE $ DED RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' RWC 05/01/15 05/01/2016 �/ WC STATU- OTH- LIABILITY Y/N TORYLIMITS ER 048541069 ..........., .. ANY PROPRIETOR /PARTNER/ EXECUTIVE Y N/A E,L EACH ACCIDENT $2,000.000 OFFICER /MEMBER EXCLUDED? Covered states: 0 EL. DISEASE - EA EMPLOYEE $2,000,000 (Mandatory In NH) If yes, describe under CA DESCRIPTION OF OPERATIONS below E,L, DISEASE - POLICY LIMIT $2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) In the event of any payment under this policy for a Loss for which the named insured has waived the right of recovery in a written contract entered into prior to the Loss, insurer hereby agrees to also waive our right of recovery but only with respect to such Loss. CERTIFICATE HOLDER CANCELLATION City of El Segundo - Public Works, It's officers and SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE y g EXPIRATION DATA THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE employees ( POLICY PROVISIONS. 350 Main Street AUTHORIZED REPRESENTATIVE El Segundo, CA 90245 1 Richard Poling c) 1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD. AGENCY CUSTOMER ID: LOC: #: " w r%r%1 -r10%u w r Mr—AA w rive+ t%^1 Ir-r%l n r- /`1VV1 I IVIV/`1L RGIYIiP111f \%7 •7Vf7GVVLL Page 1 of 1 AGENCY NAMEDINSURED Barrett Business Services, Inc. OnPoint Underwriting Inc. 8100 NE Parkway, Suite 200 POLICY NUMBER Vancouver WA 98662 RWC C48541069 CARRIER NAIC CODE ACE American Insurance Company 22667 EFFECTIVE DATE: 05/01/15 ADDITIONAL REMARKS ACORD 101 (2008/01) c) 1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD. Workers' Conmensartlon and Ernolovers'Llabilitv Poll BARRETT BUSINESS SERVICES, INC. L /CIF DOWNSTREAM SERVICES, INC. 8100 NE PARKWAY DRIVE, STE. 200 VANCOUVER WA 98662 �-ffective Date of Endorsement 05-01-2015 r lil 11 +� R^ ,i Yl I � YO�il 11 lilt lWYl ill i i CALIFORNIA WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT ���� y„ This endorsement applies only to the insurance provided b the policy because California is shown in I e1 ,.A, of pp y p y y the Information Page. 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, but this waiver applies only with respect to bodily injury arising out of the operations described in the Schedule, where you are required by a written contract to obtain this waiver from us. You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. Schedule 1. ( ) Specific Waiver Name of person or organization: ( X ) Blanket Waiver Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. 2. Operations: ALL CALIFORNIA OPERATIONS 3. Premium: The premium charge for this endorsement shall be 2.0 percent of the California premium developed on payroll in connection with work performed for the above person(s) or organization(s) arising out of the operations described. 4. Minimum Premium WC 99 03 22 $0 Auffiahzed Agent