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PROOF OF INSURANCE (2015) CLOSEDClient#: 1255108 305A1 ENT MM /DD/YYYY) ACORDr. CERTIFICATE OF LIABILITY INSURANCE DATE ( 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 CANT CT Buffy Shaver BB8rT Insurance Services x 714 941 -2856 (m )' )" 877- 297 -1116 of Orange County ..,_..o ° ° ° ° °° bshaver@—bbandt.com E-MAIL „RFSGbshaver @bbandt.c 2400 Katella Avenue Ste 1100 . �. -:.; .�.;•. ;.-:;,� .... .......................... ............................... _ ��...INSURER(S) AFFORDING COVERAG......................... E NAIC # Anaheim, CA 92806 INSURERA:Ja mes River Insurance Company 12203 INSURED........ ,....,., .. ..... ................. ........�.,....,,,..,,,,,.. .. ..... . „ „ ,.... ......... INSURER B : TOpa Insurance-Company ..,,,..,... „ ... rance Company ..- ....... ..------ -- 18031 A -1 Enterprises Inc. - - -- ! si RER c : Zurich American Insurance Co 16535 dba A -1 Fence Company _URE ...... ........_ ----------------------------- 2831 E La Cresta Ave INSURER D . Anaheim, CA 92806 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 CONTRACTOR 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. FINS............_......... ". ADD SUBI ... RR INSURANCE CYOL SUB' POLICY NUMBER LA * POLICY EFF * POLICY EXP.�.. TS IMMIDDIYYYYI LIMITS ,. ,... GENERAL LIABILITY 000202728 12/01/2014 2/01 /201 EACH OCCURRENCE �.... $1 .000.. 000 X, COMMERCIAL GENERAL LIABILITY DAAC, ttt� )tLNtf G) pRpMISS Eao0gurrenpo ) .m $50000 ''. �. � CLAIMS -MADE � OCCUR . .ED EXP Ann one oe M (An � n,e�erson) ,�. E.xcluded ..................... $..... .,.,..,.,., ..... X BI /PD Ded: ............ $5,000 PERSONAL & ADV INJURY .... $1.000.000 ...._. ................... GENERALAGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OPAGG $2,000,000 �POLICY_��� OT LOC $ A . AUTOMOBILE LIABILITY COMBI4VED N �9C"r9.�E LVPV kT rRa aoclden„ ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS ....BODILY INJURY .. ( ..... ................�.............. Per accident) $ .. NON-OWNED ROM EFR Y UA P«�.AGE $ HIRED AUTOS AUTOS � Per accident). $ - ......... B ----------- UMBRELLA LIAB OCCUR ......... XL660584601 2/01/201412/01/201 - .- ._..... EACH OCCURRENCE ------- ------ ........-------------------- - a"--- ------ $5.000.000' AGGREGATE $5,000,000 �( - - - -- EXCESS LIAB CLAIMS MADE �_] - - - - -- -- -- DED X RETENTION $0 $ C WORKERS COMPENSATION WC966159202 1/01/20101/01/201 5 WC X STATU- TS FDRH + AND EMPLOYERS' LIABILITY ANY PROP fiIETOR /PARTNER/EXECUTIVE N _- - -- E L. EACH ACCIDENT - $1.000.000 OFFICER1MEMBER EXCLUDED? � (MandatorylnNH) NIA - -- -- - E DISEASE - EA EMPLOYEE - — $1,000.000 If yes, describe under DESCRIPTION OF OPERATIONS below E L DISEASE POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) RE: Covered CA Operations Performed By Or On Behalf of the Named Insured. The City of El Segundo, its officers, officials, employees, agents, and volunteers are named additional insured as respects general liability and this insurance is primary and noncontributory with any other insurance of the additional insured; and waiver of subrogation applies as respects workers compensation as required by written contract, per endorsements attached. (See Attached Descriptions) City of El Segundo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ty g THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 150 Illinois Street ACCORDANCE WITH THE POLICY PROVISIONS. El Segundo, CA 90245 AUTHORIZED REPRESENTATIVE Signature not on file. ©1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) 1 of 2 The ACORD name and logo are registered marks of ACORD #S14966395/M14901868 BMSHA DESCRIPTIONS (Continued from Page 1) Should any policy be cancelled before the expiration date, BB &T Insurance Services will mail 30 (thirty) days written notice to the certificate holders which require such action per written contract or agreement, except 10 days notice of cancellation for non - payment of premium. 5AGITTA 25.3 (2010/05) 2 Of 2 #S14966395/M14901868 POLICY NUMBER: 000202728 COMMERCIAL GENERAL LIABILITY CG 20 10 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. IP FAM I il! -1 I hL T �» This endorsement modifies insurance provided under the following; COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Or anization 's : '' Location(s) Of Covered Ooeratlons Where required by written contract or agreement. All operations of the Named Insured's. 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 B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following additional exclu- organization(s) shown in the Schedule, but only sions apply: with respect to liability for "bodily injury", "property This insurance does not apply to "bodily injury" or damage or personal and advertising injury "property damage" occurring after: caused, in whole or in part, by: 1. All work, including materials, parts or equip - 1. Your acts or omissions; or ment furnished in connection with such work, 2. The acts or omissions of those acting on your on the project (other than service, maintenance behalf; or repairs) to be performed by or on behalf of in the performance of your ongoing operations for the additional insured(s) at the location of the the additional insured(s) at the location(s) desig- covered operations has been completed; or nated above. 2. That portion of "your work" out of which the injury or damage arises has been put to its in- tended use by any person or organization oth- er than another contractor or subcontractor engaged in performing operations for a prin- cipal as a part of the same project. CG 20 10 07 04 0 ISO Properties, Inc., 2004 Page 1 of 1 0 POLICY NUMBER: 000202728 COMMERCIAL GENERAL LIABILITY CG 20 37 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. N i A 40 t ! This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Location And Description Of Completed Opera - Or Orsaanization(s): c�, tions Where required by written contract or agreement All operations of the Named Insureds. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organiza- tion(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" at the location desig- nated and described in the schedule of this endorse- ment performed for that additional insured and included in the "products- completed operations hazard ". CG 20 37 07 04 0 ISO Properties, Inc., 2004 Page 1 of 1 'OI ICy ;;UUULUL / zd THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. .� x. This endorsement modifies insurance provided under the following: ALL COVERAGE PARTS Any coverage provided to an Additional Insured under this policy shall be excess over any other valid and collectible insurance available to such Additional Insured whether primary, excess, contingent or on any other basis unless a written contract or written agreement specifically requires that this insurance apply on a primary and noncontributory basis. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED, . AP5031 US 04 -10 Page 1 of 1 Policy No. WC966159202 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. (This 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 0 mium otherwise due on such remuneration. Person or Organization ANY PERSON OR ORGANIZATION FOR WHOM YOU ARE REQUIRED BY WRITTEN CONTRACT OR AGREEMENT TO OBTAIN THIS WAIVER OF RIGHTS FROM US. WC 252 (4 -84) WC 04 03 06 (Ed. 4-84) Schedule % of the California workers' compensation pre- 41 Job Description r' BLANKET WAIVER OF SUBROGATION Page 1 of 1 AIFFN, I OP W� TT CERTTF�ICATE1111, OFLABIL 17 Y 114SUIRANCE DD 9N�iN�".DtiWmm THM Cf. �IRTWDCATE, IS ISSUE AS A MATTER OF IIIOFORMATIO114 ONLY AND CONFERS NO RilGI-03 UPON THE CERT'IHCATE HOLDER. ii-,iis- CER"Ti[F)CA"m DOEI N07' AFIRRMATIVE1 Y OR N50ATIVE11 Y AMEND, EXTi 011R At..TER Tllifi-, COVERAGIE AFFORDED IBY niE POI.ICHTS BEq OW, Til-flS CERTIRCATE OF INSURMCE DOES NO"r CONSTilil REPRESENTATWE OR PRODUCER, ANI::) THE CERTIFICATE HOLDER. .1 A CONTRACT BE'TWEEN nii issUING INSUFWR(S), AVR(Offliiil) iflha cawtlficata Wder Is an ADDITONAL the teumis and condftions of 9w, poncyl, cwtatn jsoflc@es rill require an endorsement A �uaen�t o on 4hls cortfflGate doem not coinfer rights to the walkwo Wdor W jWij of uvchi endorvernenom. COVERAGES CEATIFICA1 E NIJMBER� t Al, UMSER� 'F- S 77f,'W 1" 'FY THAT THE MUCIES OF WSURANCP LISTLA) RIELOW HAVE IWA.",N ISSSUED "TO THE 1NsUfwu mwj) ABOVE FOR TH�, �:'OU�Tl:,F`r,q—�00' Ef . 4 WiDlICATEID, IiSTANUNG ANY �IEO :: UiRMENT, TIERM OR coryornorg OF ANY C Ofil RAC"T Orl OrHER DOCUMENT WiTill riflESPECI 110 WII�CH CEIRTIACATE MY BE MSUEID 01JR MAY j11FRIAIN, 7HE 04W?AP1K;E AFII:�01111)F[). 6'11( U1411F POILVES D11:11SCRIBE113 WIEREW flSi SU11:MECT TO ALL THE V'E EXCLUSlOINS AIND corqDlir�ONS OF SUCH POLVES U11i WIOWN MAY 1--(AVE B11 ::.EN REDUCED BY PAiD M.AIMS w,Mk �AMXXAJV"� 11 1__­ "1 1­1111 ",-I'll"­ 11 11 101, "I'll, 1 11 [ W010 "PEOF919,9UNANrM 3"my whwco ..... ...... . .. ....... q'"mmmAk II JAEM . . ....... ... 0c C', u P wx, f1i y y P _P 44GOKk & AVV 1NjlAV AW_'�WXLAIL, 011101 ARIN IFS . .... ... �T PRODUOS, X:W­, ............. . .. ........... . . . ....... All, 11M111: X LIA.111 111Y A X AINY Al A 110 X X ACIP BAZ 2572860'196 W=016 =2912018 f'1801Dft,YrNJURY(Pvf wemonp ALL OWNED SCMDULEID AUT06 AUT58 900ILY INJURY Pw mmkjofgll S HIRFUAll)706 NON-OWNED AUTOS LAU E:n�2!1 occrumu PA 3 XCERI UAR LiTl4 Ma AND EMPLOYrns, VABJUTY yE ICG YAD W Nil) P I ON ....... .. . ........... .. .. ....... (ACMAD 101, A*NdmiW Re"""" 111m 80%du is, miliV be aftolud N nwom space dw 36 DAY 'NariCE - PROJECT- PUMPSTA110N 18 A"T tl ',iAS7 END OF) 2050 FAST FlUGHES WAYEN.SEGUN130 CA THr(MYOFEL MO !Tcl k4k,rl) EPAPLO A E ViE )IERV NAMI-1) AS AD[AT6hAL INSURED, PR) MARY NON- IGLA`41TMW OHY AND, WMVER OF SLIBROGATION COVERAGE APPLIES. .. .. .. ....... viv "em r"rn FUMPSTA 311OULDANY OFT14EABOVE, 1W.-SiClIVIBED POUCHES BE CANCIELLED BEFORE THE EXT'i DATE 144111l 140"rX.F, WIL BE CITY OF I:U. SEGUNDO ACCORDANCE VA""i 'rt§E P*Uj.-'C juRoVWjll FLORIZAIRIVERA, M IDII!:II`T. 350 MAM s"rREI-M Nu u�DADD� V .. 8II, .-MIND01, CA 90245 C01 0: CORPORA D 10N, A0 digifift reserved° ACORID 25 (2014101) The ACORD insime And bgo airs mgiatfilvd marks of ACORD r THIS Ilw YE: II hAEwr C11ANGII TN °Ili!w P LiCY. PLEASE REM IT i.. :. LlL.1Y, MIGRATED IlNSURE D s � s ♦- With respect to cove ra,,FjLm.rov Ided b;,i this endorseljant,.�Jt-. by this endorsement, M10 1'44,l11,n'i;V iur iii) " orj jIII an�z �iall'D p(;s) CITY OF EL. SEGUNDO, ITS OFINCIALS & lIrMPI OYIEES no entry appears above, Each person or organization shown In the the l Is an "insured" for Liability Coverage, but only to ilia extent that person or organization qualifies as an "Incur " under the Who Is An Insured Provision contained In Saction II of the Coverage Form. CA 20 48 ( - ) CP BAZ 26-7-060126 LUV3 16199 OT COPY CA2048100900 0240 25 00M66 SU&NESS M)"TO AC 20 410110 TIM I'CVIANG�1:11S TIM POL.ICY, ll EASE III!' EAD IT CXCREF� 11 LY. VIII INSt.11ZED PRIMARYAND NON 111111111CONTRI B 1JT0 �RY ENDORSEMENT SCIiEDULE 4ame of Person(s) or Organization(s): I F LAI C -]�: v OF wk 10 RI., AMR ;&E tions as applicable to the endorsement.) Mar, out of ongoing operations perfr Tried for the Named Insured. 4. SECTION IV - BUSINESS AUyj CONDITIONS All terms and conditions at this policy apply unless mod Mad by this endorsement, AC 20 410110 Includes copyrighted material of Insurance Services Office, Inc., Page 11 of I with Its permission. ACP BAZ 28-7-2860196 LUV3 101 89 AGENT COPY AC 1011000 0 220 26 M0130 COMMERCIAL AUTO 04 44 0 10 „n u ENDORSEMENT ti .I .., 1 ICY PLEASE READ IT CAREFULLY, WAIVER OF''T RANSFER OF RIGHTS OF RECOVIERY AGAINST OTHERS (WAIVER F I 1"Ns andorsernenl mwdlfies urusu.ur nce provided a rmdeir the Iofl Greg: BUSINESS AUTO COVERAGE FORM 6USlG i:::sS AUTO WHISK AL DAMAGE COVERAGE FOR GA RA6i COVERAGE FORM MO rOR CARRIER COVERAGE FORM TRUCK01S COVERAGE lw II :GA SCHEDULE Na (s) Of Person(s) r Or nl tlYou (s)) °i 'Il -iE CITY OF EL SEGUNDO, i i,, S FIG CIALS, G: fI ERS, I11141 "S, AND EMPLOYEES this, Schedule, K irurui slicrvl n m:o,.)vo, GYI bo .'Al awn 6 the l ee c'k)ra urns' • w 4. • . • 14111 Ila a U7*-Wm or .: a cuntracE 4111111al organization. I terms and condiltions of this Il l ess modified by this . 8:01" LUV3 15189 AGENT COPY i ,. 0. ,0i 0200 26 0000237