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PROOF OF INSURANCE (2016) CLOSEDA� DATE (MWDD /YYYY) CERTIFICATE OF LIABILITY INSURANCE 1/21/2016 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 Sparrow #281 Agency .', (N310 -379- -0605 _. asc qy 310w379w0631 Hermosa Beach CA 90254 'nnPL Nancl c�'" SDarro wCenefal,com �rm I E INSURERISI AFFORDING COVERAGE NAIC,# Phone: 310 - 379 -0605 Fax: 310 - 379 -0631 INSURERA: .... CNA Insurance Companv ..... .South_---- .....Vital Si ... ....m�.. ..._.. _ .. .........._W ................. W_. INSURED y gns, Inc. INSURERB: CNA Insurance Companv w_ ......... .. ... .... .... ...._... . .. .,.�.... ..... _ �..�.�.. 1001 E. Franklin Ave. INSURERC- EL SEGUNDO CA 90245 INSURERD 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 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. INSR —.._ p?7iiL 1173 ��'POUCY'E�FF POUCYY XP LTR TYPE OF INSURANCE imsn unrn _....._.....�..... POLICY NUMBER MfA1pD01YY (MMI4>DlYYY'Y _ LIMITS X C OMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 2.000.000 300,000 CLAIMS -MADE L - J OCCUR R ,�.. E�:i� a7:tuPNOxir.l S MED EXP (Any one person) $ 10.000 PERSONAL& ADV INJURY S 2,000,000 Y 4030806739 07/31/2015 07/31/2016 GEN`LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 5 _ 4,000,000 X I POLICY JECOT- LOC PRODUCTS - COMPEGPAGO S 4,000,000 5 OT�IERr AUTOMOBILE LIABILITY C*OMIINE.i� SdNGLE LIMX'G'" S 1 .000,000 BODILY INJURY (Per person) S ANY AUTO A ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) S X x NON -OWNED Y 4030806739 07/31/2015 07/31/2016 TiCPERTYDAMAGE 5 HIRED AUTOS AUTOS S I UMBRELLA LIAB OCCUR EACH OCCURRENCE S EXCESS LIAB CLAIMS -MADE ' AGGREGATE S nFn RETENTIONS S WORKERS COMPENSATION PER - X crATiirE AND EMPLOYERS' LIABILITY ANY PROPRIETOR /PARTNER/EXECUTIVE FR_. 1 B 430929070 09/14/2015 09/14/2016 E.L. EACH ACCIDENT $ _ ,000,000 0 000 If yyes, describe under DESCR(Mandatory ON OF OPERATIONS below EL. DISEASE- POLICY LIMIT S 1 .000.000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached If more space Is required) The City of El Segundo, its officials, and employees are named as Additional Insured SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of El Segundo — City Clerk THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 350 Main Street, Room 5, ACCORDANCE WITH THE POLICY PROVISIONS. El Segundo, CA 90245 -3813 AUTHORIZED REPRESENTATIVE ©1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 26 (2014/01) The ACORD name and logo are registered marks of ACORD SB- 300120 -C (Ed. 06/11) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION - WITH PRODUCTS COMPLETED OPERATIONS COVERAGE This endorsement modifies insurance provided under the following: BUSINESSOWNERS LIABILITY COVERAGE FORM SCHEDULE* Name Of Person Or Organization: Information required to complete this Schedule, if not shown on this endorsement, will be shown in the Declarations. A. The following is added to Paragraph C. Who Is An Insured: 4. Any person(s) or organization(s) shown in the Schedule is also an additional insured, but only with respect to liability for "bodily injury," "property damage" or "personal and advertising injury," caused, in whole or in part, by: a. Your acts or omissions; or b. 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; or c. "Your work" that is included in the "products - completed operations hazard" and performed for the additional insured, but only if this Policy provides such coverage, and only if the written contract or written agreement requires you to provide the additional insured such coverage. B. The insurance provided to the additional insured does not apply to "bodily injury," "property damage," or "personal and advertising injury" arising out of: SB- 300120 -C (Ed. 06/11) 1. The rendering of, or the failure to render any professional architectural, engineering, or surveying services, including: (a) The preparing, approving, or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; and (b) Supervisory, inspection, architectural or engineering activities. 2. 'Bodily Injury," "property damage," or "personal and advertising injury" arising out of any premises or work for which the additional insured is specifically listed as an additional insured on another endorsement attached to this Policy. C. The following is added to Paragraph H. of the Businessowners Common Policy Conditions: H. Other 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 1 of 1