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PROOF OF INSURANCE (2016) CLOSEDGOVESTA -02 PPISANO CERTIFICATE OF LIABILITY INSURANCE DATE 7/YYYY) 7/22/2012015 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 NAME: CTK North American Insurance Services, LLC PHcONN e�ct: (714) 779 -2000 ;,47tc_ Not; (714) 779 -4129 1240 North Lakeview Avenue, #240 , ., - Anaheim, CA 92807 E -MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # — — INSURERA:Zurich American Insurance Co. of IL 27855 INSURED INSURER B: American Guarantee and Liability Ins. Co. 26247 Government Staffing Services INSURER C P.O. Box 718 INSURER D Imperial Beach, CA 91933 - INSURER E INSURERF: ...... ......... ......... ..... ....... , ,,,,,,,,,,,, ,,, , , 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 DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ,..�w.�...:n_...... _POLICY _ � LIMITS IL7R TYPE OF INSURANCE .,u¢ri Suwen POLICY NUMBER IMM /DDY/YYYYI IMO I %YEXP . A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 "DAMAGE TO RENTED CLAIMS -MADE X OCCUR X PRA969906303 05/10/2015 05/10/2016 PREMISES (Ea occurrortce) $ 100,000 MED EXP (Any one person) $ 10,000 PERSONAL 8 ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY a PRO. LOC PRODUCTS - COMP /OP AGG $ 2,000,000 PRO. _W ............... AUTOMOBILE LIABILITY COMBINED SENOLE LIMIT � .............. (Eeaocld�raR) ..$ _ 1,000,000 A ANY AUTO PRA969906303 05/10/2015 05/10/2016 BODILY INJURY (Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ X NON -OWNED PROPERTY DAMAGE — HIREDAUTOS X $ AUTOS (Per accident) X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 ®, „M, B EXCESS LIAB CLAIMS- MADE UMB946734703 05/10/2015 05/10/2016 AGGREGATE $ 1,000,000 DED X RETENTION $' 0 $ :. WORKERS COMPENSATION Ems- "Z�TR_ AND EMPLOYERS' LIABILITY Y / N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E L EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? �_ N/A --- -,. - °- ---- .... -- (Mandatory in NH) E,L DISEASE - EA EMPLOYEE; $ If yes, dascr lae under DESCRIPTION OF OPERATIONS below E.L.. DISEASE - POLICY LIMIT $ --- ._.- .- ._.- - - - .... ............. _ ........ ............... A Crime PRA969906303 05/10/2015 05/10/2016 2,500 Deductible 100,000 A ;Professional Liab PRA969906303 05/10/2015 05/10/2016 $1m /$2m ........mm _._..... _ ..... DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) Schedule of Named Insured(s) Government Staffing Service dba: Herrera & Associates Staffing Services Government Staffing Service dba: Munigroup Government Staffing Service dba: Munitemps Government Staffing Service dba: Munistaff City of El Segundo named as and additional insured as respects to general liability. CERTIFICATE 'HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of El Segundo City David King ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street El Segundo, CA 90245 AUTHORIZED REPRESENTATIVE 01988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD POLICYNUMBER: PRA969906303 COMMERCIAL GENERAL LIABILITY CG 20 26 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL_ LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Any person or organization who you are required to add as an additional Insured on this policy under a contract or agreement shall be an Insured, but only with respect to that person's or organization's liability arising out of your operations as a "Staffing Service" or premises owned by or rented to you, Information reouired to cornoleto this Schedule, if not shown above, will be shown In the declarations. Section 11 • Who Is An Insured Is amended to Include as an additional Insured the person(s) or organizations) shown In the Schedule, but only with respect IQ liability for "bodily injury% "property damage" or "personal and advertising Injury' caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: A. In the performance of your ongoing operations; or B. In connection with your premises owned by or rented to you. CG 20 26 07 04 0 150 Properties, Inc., 2004 Page t of 11 CERTHOLDER COPY SP P.O. BOX 8192, PLEASANTON, CA 94588 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 02 -02 -2015 CITY OF EL SEGUNDO SP DEPT OF BUILDING & SAFETY 350 MAIN ST EL SEGUNDO CA 90245 -3813 GROUP: POLICY NUMBER: 9008463 -2014' CERTIFICATE ID: 11 CERTIFICATE EXPIRES: 11- 01- 2015" 11 -01- 2014/11 -01- 2015'' This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 10 days advance written notice to the employer. We will also give you 10 days advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy. Authorized representative President and CEO EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT #1600 - HERRERA, JOHN PRESIDENT - EXCLUDED. ENDORSEMENT #1600 - HERRERA, MARRISAL VICEPRES - EXCLUDED. ENDORSEMENT #2570 ENTITLED WAIVER OF SUBROGATION EFFECTIVE 2015 -02 -02 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. THIRD PARTY NAME: CITY OF EL SEGUNDO EMPLOYER GOVERNMENT STAFFING SERVICES INC DBA: SP MUNITEMPS PO BOX 718 IMPERIAL BEACH CA 91933 [VM5,CS] (REV.7 -2014) PRINTED : 02-02 -2015 ENDORSEMENT AGREEMENT WAIVER OF SUBROGATION 9008463 -14 RENEWAL SP 7- 83 -77 -00 PAGE 1 HOME OFFICE EFFECTIVE FEBRUARY 2 2015 AT 12.01 A.M. SAN FRANCISCO r ALL EFFECTIVE DATES ARE AND EXPIRING NOVEMBER 1, 2015 AT 12.01 A.M. AT 12:01 AM PACIFIC STANDARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME MUNITEMPS PO BOX 718 IMPERIAL BEACH, CA 91933, INY IS HINGRE T THE CTO E CONTRARY NOTWITHSTANDING, OMPENSATION INSURANCE FUND WAIVES ANY RIGHT OF SUBROGATION AGAINST, CITY OF EL SEGUNDO WHICH MIGHT ARISE BY REASON OF ANY PAYMENT UNDER THIS POLICY IN CONNECTION WITH WORK PERFORMED BY, MUNITEMPS IT IS FURTHER AGREED THAT THE INSURED SHALL MAINTAIN PAYROLL RECORDS ACCURATELY SEGREGATING THE REMUNERATION OF EMPLOYEES WHILE ENGAGED IN WORK FOR THE ABOVE EMPLOYER. IT IS FURTHER AGREED THAT PREMIUM ON THE EARNINGS OF SUCH EMPLOYEES SHALL BE INCREASED BY 03%. NOTHING IN THIS ENDORSEMENT CONTAINED SHALL BE HELD TO VARY, ALTER, WAIVE OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS POLICY OTHER THAN AS STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR LIMITATIONS OF THIS ENDORSEMENT. COUNTERSIGNED AND ISSUED AT SAN FRANCISCO: na rra- tnpi7rm s k =0PtP:Z niT Ire FEBRUARY 4, 2015 2570 oQGCinGniT Amn rr-n 2570