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PROOF OF INSURANCE (2016 - 2016) CLOSEDACCOR0 CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDNYYY) 3/5/2015 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 CONTACT Veronica Woole PIloNE . -. I- ,�j�_.. Brennan and Associates Risk Mgmt & Insurance (800) 509 -6452 (562) 429 -6511 License # 0649629 E -MAIL E s' 6621 E. Pacific Coast Highway, Suite 200 g Y. NAIC# INSLrRER S �f��TrzolwG Cov_ _m w Long Beach CA 90803 INSURERA:Colony Insurance Comioanv INSURED Krause ACT, Inc. DBA: Air Cleaning Technology 411 Rowland Avenue INSURER B:RepublimcmmmmU /W Ins Cc INSURER C:Sentinelmmm.2II8........... �.�. C Insurance C INSURER D: INSURER E :. Santa Ana CA 92707 INSURER F: COVERAGES CERTIFICATE NUMBER:15 /16 GL & XS Renewal 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 ucD WVD POLICY NUMBER POLICY EFF POLICY EXP /M MIDDIYYYYI LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 11000,000 . . X COMMERCIAL LIABILITY 1 ^ ZF C�� n l)$ . 300 00O A OCCUR � X ACE303159 3/7/2015 3/7/2016 .I MEDEXP (Any one person) $ 2 5, 06"0" 0 0 X $2,500 Deductible i PERSONAL& ADV INJURY $ 1,000,000 each occurrence GENERAL AGGREGATE $ 2,000,000 GEN'L AGG::RIGKFE! LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 2,000,000 POLICY X P'R3 LOC $ AUTOMOBILE LIABILITY COM 8INEO SINGLE LIMIT rF - ANY AUTO BODILY INJURY (Per person) $ ALL AUTOS OWNED '', SCHEDULED BODILY INJURY (Per a ccident) $ .. -_... . m...w,...,.,- NON -OWNED ..PROPER n HIRED AUTOS AUTOS P _— on IpAra $ _..,,...,... UMBRELLA LIAR X OCCUR '.. EACH OCCURRENCE $ 4, 000,000 A X EXCESS LIAB ......... ..__.. CLAIMS -MADE .�.. '.. AGGREGATE $ 4,000,000 DED '., RETENTIONS XC302111 3/7/2015 3/7/2016 $ B WORKERS COMPENSATION }( j WCST'ATt1,- CTH. X AND EMPLOYERS' LIABILITY YIN Tn, RY_LR.& ry, co ^000 ANY PROMEMBERI EXCLUDED? OFFICERIMEMBER EXCLUDED NIA E L E?C „H ACCIDENT �.�- .- .... -. $ 1, 000 00 (Mandatory In NH) T .1/1/2015 1/1/2016 L EL.DIS SE - EA EMPLOYE $ 1 , 000, If yes describe under DESCRIPTION OF OPERATIONS below '�� EASE POLICY LIMIT E L DISEASE .__ $ 1, 000, 000 ...... C Contractors Equip /Tools 2SBAAF4796 /1/2015 /1/2016 Limit(s) $10,000 /$10001 A Errors & Omissions FACE303159 3/7/2015 3/7/2016 Aggregate $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) RE: E1 Segundo Fire Department, 314 Main Street, E1 Segundo, CA 90245. The City of E1 Segundo is included as Additional Insured with regard to General Liability per attached forms EPACEIOO -0814 & EPACE101 -0814. Waiver of Subrogation applies to Workers' Compensation per attached form WC 04 03 06. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of E1 Segundo yti ACCORDANCE WITH THE POLICY PROVISIONS. Attn: City Clerk w 350 Main Street AUTHORIZED REPRESENTATIVE E1 Segundo, CA 90245 Greg Havill /ML ACORD 25 (2010105) ©1988 -2010 ACORD CORPORATION. All rights reserved. INS17125 (9n1no,) n1 The ArOPn nnme nnrl Innn arc rnnicfererl mnrlre of Ar:r1Rr1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. �t This endorsement modifies insurance provided under the following: EnviroPACE Insurance Policy A. Section XX. WHO IS AN INSURED, Coverage Part 1 and Part 2 is amended to include as an additional insured the person(s) or organization(s) shown in the SCHEDULE above, but only with respect to liability for bodily injury, property damage, environmental damage, or cleanup costs caused, in whole or in part, by your work at the location designated and described in the SCHEDULE of this endorsement performed for that additional insured and included in the products - completed operations hazard. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 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. B. With respect to the insurance afforded to these additional insureds, the following is added to section XXI. LIMITS OF LIABILITY AND DEDUCTIBLE: 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 Liability shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Liability shown in the Declarations. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED, EPACE100 -0814 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 1 with its permission. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. 610*101,01,11 1" This endorsement modifies insurance provided under the following: EnviroPACE Insurance Policy Name Of Additional Insured Person(s) Or Organization(s) Location(s) Of Covered Operations Where Required By Written Contract Where Required By Written Contract A. Section XX. WHO IS AN INSURED, Coverage Part 1 and Part 2 is amended to include as an additional insured the person(s) or organization(s) shown in the SCHEDULE above, but only with respect to liability for bodily injury, property damage, personal and advertising injury, environmental damage, or cleanup costs 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) at the location(s) designated above. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 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. 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. EPACE101 -0814 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 2 with its permission. C. With respect to the insurance afforded to these additional insureds, the following is added to section XXI. LIMITS OF LIABILITY AND DEDUCTIBLE: 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 Liability shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Liability shown in the Declarations. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. EPACE101 -0814 Includes copyrighted material of Insurance Services Office, Inc., Page 2 of 2 with its permission. 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 2_5% of the California workers' compensation premium otherwise due on such remuneration. Schedule 1 si "5 Person or Organization ';i Job Description Blanket Waiver of Subrogation As respects to all CAjobs performed by the named insured during the policy period where by written contract a waiver of subrogation is required prior to the commencement of work. This endorsement changes the policy to which it is attached and Is effective on the date Issued unless otherwise stated (The Informatlon below Is required only when this endorsement Is Issued subsequent to preparation of the policy,) Endorsement Effecllve 01 -01 -2015 Policy No, ATW 001779 -02 Endorsement No. Insured Insurance Company Krause ACT, Inc. (A Corp) Republic Underwriters Insurance Company Countersigned By- ©1998 by the Workers' Compensation Insurance Rating Bureau of California. All rights reserved. A" R CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD"'"Y) 11 /02/2015 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. IMP ORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(Jos) must be endorsed, If SUBRUGATI'1�N 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 ondorsoment(s). PRODUCER Kalhn Pe Dan Rickabus N Mwr!ry PIION 949-495-2515 rAX 949 363 -1836 eef'fI State Farm Insurance �INAI�I.O 6- t�. m..., ._ �(; �w �Igl.....�"_..W_...�_..._,.... 30131 Town Center Drive, Suite 275 A' tefarm m kathenne er litif sta: .,-- ..._.�........ -1 _n.. —.. �......w Laguna INSURE Niguel CA 92677 ^ mlNSUItI8fs)AFrt7lofiNG COI/ERAGE ..........P�y. NAic x .., .. ..... muse A C. _, .... .... .w.... INSURERS INSURER a . DBA Air Cleaning Technology to Farm Mutual Automobile Insurance Company an 25178 " INSURER 411 Rowland Ave C Y INSUR�'R O Santa Ana, CA 927073445 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 EX DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, CONDITIONS OF SUCH E BEEN REDUCED uCOMMERCIALGENERALLIABILnY POLICIES. LIMITS SHOWN _ mm .. I TR TYPE OF INSURANC AM $009 POLICY NUMBER BY PAID CLAIMS. ICY EFV- DP' YY M D YYYY LIMITS_ CLAIMS -MADE �J OCCUR EACH OCCURRENCE $ 07�II COF II/LE' ....... E QArur o m porsan) $ ._ Ww PERSONAL & ADV INJURY $ PEN'q. AGGREGATE LIMIT APPLIES PER; ' CY LOC GENERAL AGGREGATE $ JECOT L PRODUCTS COMP /OPAGG $ R1 k A AUTOMOBILE LIABILITY Y 252 6913- C01 -75 $ 09/01/2015 03/0112016 f 1,000.000 ANY AUTO 284 3100- C01 -75 AUTOS WNED SCHEDULED 309 0552- C01 -75 BODILY INJURY Per 09/01/2015 03/01/2016 person) $ BODILY INJURY Per a cadenq $ 09/01/2015 (. NON -OWNED HIREDAUros 03/01/2016 PROPER Auros 3093182- C01 -75 i Y DAMAGE Pall $ 09/01/2015 03/01/2016 ",. UMBRELLA UAB OCCUR $ EXCESS LIAB wEwC#I C1C� tIRRe NCE $ - -. .. " , - - CLAIMS -MADE ..... "._ w�. AGGREGATE $ DEO RE'HENHION ... - . _.._ ..... "a ........, WORKERS COMPENSATION $ AND EMPLOYERS' LIABILITY YIN TH. ST' 1" T `" R ANY PROPRIE"'}`OPtPAI' TNER/EXECUTIVE OFFICER/MEMaER EXCLUDED? NIA ` ` E L EACH ACCIDENT $ (Mandatory In NH) - .,_. If yyes, dwfto under E L. DISEASE • EA EMPLOYEE $ _ �... . . m , DiSCRlP'rroNoFOPERATIONStWcw A EN t _ .._ .... E.L DISEASE- POLICY LIM # "¢ $ Y 391 3576- C01 -75 09/01/2015 03/01/2016 $250 Physical Damage deductible DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached it more space Ise required) City of El Segundo, its officials and employees are named additional insured Location: El Segundo Fire Department CERTIFICATE HOLDER CANCELLATION EI -Segundo FIfWg Department 350 Main St SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE EI Segundo, CA 90245 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE P �� V. r,. ©1988 -2014 ACOAD COOORATION, rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD 1001486 132849.9 02-04 -2014