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PROOF OF INSURANCE (2016) CLOSEDA,C09D. CERTIFICATE OF LIABILITY INSURANCE °AT 110815 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Doctor Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE LTR. TVPF nF IN CIIRANf:F POLICY NUMBER nATF 1 M�r1NYV1 f)ATF /MM12 _ /YYI LIMITS HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 10216 Reseda Blvd. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Northridge, CA 91324 EACHOCCURRENCE $ 2,000,000 INSURERS AFFORDING COVERAGE NAIC # SURED INSURER A:MERCURY INSURANCE�„ ................................... ............................... 38342........ ................ - -.. N E P PAINTING CONTRACTORS INC INSURER B:SECIJRITY NATIONAL DNS19879�f ��� �- NICHOLASPOLAKIS ............................................................................................................................................................... ............�.----- INSURER. ---- --- - - -- -- 11024 BALBOA BLVD #733 INSURER D :............................................................................................................................................ .................. ��........... CLAIMS MADE OCCUR GRANADA HILLS CA 91344 I INSURER E: -------- - - - - -- COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INS R.. OUT( ................................. ..............................� ...............................................,................................. ............................._. . �..........................,....................,,.........,,........ ......._....v_...._____________ POLICY EFFECTIVE POLICY EXPIRATION. LTR. TVPF nF IN CIIRANf:F POLICY NUMBER nATF 1 M�r1NYV1 f)ATF /MM12 _ /YYI LIMITS B GENERAL LIABILITY EACHOCCURRENCE $ 2,000,000 jwnr. r-rc "ArNTr 100 000 COMMERCIAL GENERAL LIABILITY PREMISES $ ISE (Ea orruran -1 CLAIMS MADE OCCUR __... ,., _ME EXP (Anv one person) $ 5,0 00 - NA110927700 5.6.15 5.6.16 PERSONAL aADVINJURY $ .............. ............................................................... ............................... GENERALAGGREGATE ..............._ .$ . ................_...3,000,000 - ---- - - - - -- GEN'L AGGREGATE LIMIT APPLI ES PER: PRODUCTS - COMP /OPAGG $ PR4k• POLICY LIM =LOC . ......... ........ ... ...........__.,. '..... A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 ANY AUTO (Ea accident) ......---- --------------- — ......�.r.... ALL OWNED AUTOS BODILY INJURY $ Y SCHEDULEDAUTOS (Per person) BA040000012358 1.27.15 1.27.16 -- - - - - -- BODILY INJURY $ HIRED AUTOS NON -OWNED AUTOS (Per accident) ................ ......................... PROPERTY DAMAGE $ (Peraccident) GARAGE LIABILITY AUTO ONLY ACCIDENT $ ...— ----- -- -.. __ ANYAUTO OTHER THAN EAACC $ _----- --- ...........----.....__..... AUTO ONLY: AGG $ EXCESS /UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR ''.. CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ '... $ WORKERS COMPENSATION AND rnRV inAITc OFa EMPLOYERS' LIABILITY a.,. rya.,.. ,��:..,..- ..........� -11., ........ _. _. .. .... E.L EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? E.L. DISEASE -EA EMPLOYE If yes, describe under SPECIAL PROVISIONS halo. E.L. DISEASE -POLICY LIMITµ OTHER j .... .. . ..... '.. DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS N E P - PAINTING CONTRACTOR Addional Insured clause: The City of El Segundo, its officials, officers, agents and employees are named additional insured for all liability arising out of the operations by or on behalf of the name insured if required by contract per attached endorsements. Primary and Non - contributory applies to General Liability. Waiver of subrogation applies to all policies. R THE CITY OF EL SEGUNDO�; °„ 350 MAIN STREET�" EL SEGUNDO CA 90245 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL _jQ__ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE SCOTT DOCTOR ACORD 25 (2001/08) © ACORD CORPORATION 1988 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25 Location: VARIOUS LOCATIONS THROUGHOUT EL SEGUNDO, CA (If no entry appears above, information required to complete this endorsement will be shown in the Declarafions as applicable to this endorsement.) A. Section II —Who Is An Insured is amended to include as an insured the person or organization shown in the Schedule, but only to the extent that the person or organization shown in the Schedule is held liable for your acts or omissions arising out of your ongoing operations performed for that insured. B. With respect to the insurance afforded to these additional insured, the following exclusion is added: 2. Exclusions 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 site 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. C. The words "you" and "your' refer to the Named Insured shown in the Declarations. D. "Your work" means work or operations performed by you or on your behalf; and materials, parts or equipment furnished in connection with such work or operations. prima Word'Jn If required by written contract or agreement: Such insurance as is afforded by this policy shall be primary insurance, and any insurance or self- insurance maintained by the above additional insured(s) shall be excess of the insurance afforded to the named insured and shall not contribute to it. Walver of SubLog@t ion If required by written contract or agreement: We waive any right of recovery we may have against an entity that is an additional insured per the terms of this endorsement because of payments we make for injury or damage arising out of "your work" done under a contract with that person or organization. 49 -0108 0711 May Include Copyrighted Material of Insurance Services Offices, Inc. Page 1 of 1 ❑ Used with permission COMMERICAL GENERAL LIABILITY CG 20 37 07 04 Policy #: NA110927700 Insured Name: N E P PAINTING CONTRACTORS INC� THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Additional Insu red Persons) or Location and Description of Com pleted Organization(s): Operations z ER„ CITYF LL SLCUNCO, I t "S FAINTING OFFICERS, OFFICIALS, EMPLOYEES, AGENTS VARIOUS LOCATIONS THROUGHOUT EL AND VOLUNTEERS SEGUNDO, CA 350 MAIN STREET, EL SEGUNDO CA 90245 li' atlrr.. nfo repulsed o rri Iete this ..� Schedule, if not shown above, wall be shown in the declarations Section II -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" or "Property damage" 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 ". CG 20 37 07 04 Copyright Iso Properties, Inc., 2004 Page 1 of 1 Insured California Automobile Insurance Company mmm P.O. Box 10730 MME Santa Ana, CA 92711 -0730 M E R U Y Customer Service: (800) 503 -3724 1 N S U R A N C E G R O U P BUSINESS A TO POLICY ADDITIONAL INSURED Amended Declarations Effective Date: 10/07/2015 NAMED INSURED: AGENT: N E P PAINTING CONTRACTORS INC DOCTOR & DOCTOR INS AGENCY 11024 Balboa Blvd # 733 10216 RESEDA BLVD Granada Hills, CA 91344 -5007 NORTHRIDGE, CA 91324 (818)368 -3764 SCHEDULE Insurance Company: California Automobile Insurance Company Policy Number: BA040000012358 Policy Period: From: 01/28/2015 to 01/28/2016 at 12:01 AM Standard Time at your mailing _ address Additional Insured: THE CITY OF EL DEGUNDO ITS OFFICIALS ETAL _._.... Address: 350 Main St , El Segundo CA 90245 .... _ ........ _.... Endorsements Attached: .......... ........._. CA 20 48 02 99 - Designated Insured MCADS910711 Page 1 of 1 POLICY NUMBER: COMMERCIAL AUTO CA 20 48 02 99 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" under the Who Is An Insured Provi- sion 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 indi- cated below. Endorsement Effective: Countersigned By:. Named Insured; (Authorized Representative) SCHEDULE Name of Person(s) or Organization(s): (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to the endorsement.) Each person or organization shown in the Schedule is an "insured" for Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured Provision contained in Section II of the Coverage Form. CA 20 48 02 99 Copyright, Insurance Services Office, Inc., 1998 Page 1 of 1 ❑ AC "RO CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DD/YYYY) 10/08/2015 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 pollcy(les) 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 NONT C' Eric Lanzillotta _..� CBIA Insurance Agency 9 Y AFICNN. F.tl (877) 900 -2242 SAX (866p 518 -4627 li (AVC ;...... 8001 CANOGA AVE, SUITE A E"Np' R AoDeESS: certsczctalanemter.crvs 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. DY iip L. .LR . ..m. .^ waa- + ^ ......^ .IMM DDYIWWI N.,,,,,,.... ..... .....,. TYPE OF INSURANCE IND POLICY !MM LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS OCCUR -MADE PR;MIq BµS (Lmr�(.Irwrrenrae,) . .$ . MED EXP (Any one person) $ ....... ............. PERSONAL R ADV INJUR GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: ❑ PRO. ............ .........1...111.... —. 1111.. POLICY /ECT LOC PRODUCTS - COMP /OP AGG $ OTHER: $ AUTOMOBILE LIABILITY GOMBINED SINGLE 04417 $ !Fa �rriAcnil ,..�.w,,... „wx... .s .... . .......... m .,, ,... ,1111... ANY AUTO BODILY INJURY (Per person) $ - 1111..._ ALL OWNED SCHEDULED- ,......�. 1111.___,., 1111.. BODILY INJURY (Per accident) - $ AUTOS AUTOS __- .. NON -OWNED PROF+tFYTY DAMAGE $ HIRED AUTOS AUTOS (PI UMBRELLA LIAB OCCUR -� � EACH OCCURRENCE _ ..... - $ ... „ ...................- EXCESS LIAB CLAIMS -MADE _ I AGGREGATE $ �DED RETENTION $ $ WORKERS COMPENSATION X I PER ORH AND EMPLOYERS' LIABILITY Y / N IT r= R EXCLUDED? PROPRIETOR/PARTNER/EXECUTIVE N A /M N / A 9052882 -2015 04/16/2015 04/16/2016 CIEA . ...... 0 (Mandatory in NH) E.L. DISEASE EMPLOYE $ 1,000.000 If yes, describe under """-"'""--°"""'"", �"""'"'"'"'"'"'"'"'""' " " " °.�" "" 0- ESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 I DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Evidence of Insurance Lic # 973759 CERTIFICATE HOLDER City Clerk City of El Segundo 350 Main Street El Segundo ACORD 25 (2014/01) CANCELLATION 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 CA 90245 ©1988.2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD iThyVIIJ of • I -• • • • _• AGREED 01.1'a 91"IM03111 pip- THAT THE INSURED SHALL MAINTAIN PAYROLL RECORDS ACCURATELY SEGREGATING THE REMUNERATION OF EMPLOYEES WHILE ENGAGED IN WORK FOR THE ABOVE EMPLOYER. �■' • ■ • 1 t• ■■ ON l s ■, � / NOTHING D• RSEMENT CONTAINED SHALL BE HELD TO VARY, ALTER, WAI OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF TH POLICY OTHER THAN AS STATED. NOTHING ELSEWHERE IN THIS POLICY ; HELD TO VARY, ALTER, WAIVE • • LIMIT THE TERMS, CONDITIONS, • LIMITATIONS OF r• COUNTERSIGNED AND ISSUED AT SAN FRANCISM AUrHORIZED RI"i"R I "c,SENT IV''E SCIF FORM 10217 MEV.7 -261V • • •' II!= PRESIDENT AND CEO