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PROOF OF INSURANCE (2016) CLOSED4C "R" i CERTIFICATE OF LIABILITY INSURANCE F DATE (MMIDDIYYYY) 2/11/2016 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 pollcyoos) 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 CAD FrankCrum Insurance Agency, Inc. Ear (727)412 7765 (727)eoe -15ze 100 South Missouri Avenue FCIA @fran FCIA@frankcrum.com INSURER(S) AFFORDING COVERAGE NAIC N Clearwater FL 33756 INSURER A S,l London . ovd's Of INSURED .......... ... .. .. .. .. .................... ..... James Michael McNary dba Bino Construction 12101 Van Nuys Blvd #34 Sylmar CA 91342 1 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. ... .............. ......... ......... ....--- -. "DT .,Uff __..�_....._ POLiCY EFF POLICY EXP ....... .............._w LTR TYPE OF INSURANCE wcn wvn . POLICY NUMBER M D . I . Y L4MaDD YYYY LIMITS f, X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A w CLAIMS -MADE X OCCUR q N'FtWlp,'[E �1�/) "01 $ 300,000 X Y PGIARK0503800 5/29/2015 5/29/2016 MED EXP (Any one person) ......... ..._.... $ 10,000 . ___ .......... ___.___..._�. PERSONALBADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY 1 PRO - JECT LOC PRODUCTS COMP /OP AGG $ 2,000,000 OTHER: AUTOMOBILE ,..........Fa�C({1)......... LIABILITY COMBINE $ ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (P ..�. er accident) ..w - $ AUTOS AUTOS ... ...... NON -OWNED PROPERTY DAMAGE - ..$.... ---... HIRED AUTOS AUTOS rPerr a�u.pdarKli, ,,,,, X UMBRELLA LIAB X OCCUR ........ EACH OCCURRENCE $ 1 , 000 , 000 A''I'll ,EXCESS LIAB CLAIMS -MADE .. ........ _ AGGREGA TE $ --- DED RETENTION $ PGIXS0036900 2/10/2016 5/29/2016 S WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN STATUTH- E E ER ANY PROPRIETOR /PARTNER /EXECUTIVE `--'-I. E L EACH ACCIDENT $ OFFICER /MEMBER EXCLUDED? �[ N/A (Mandatory In NHI " "" E.L DISEASE - EA EMPLOYE $ If describe undetl dy ---__ _ _...._....,�,.,�.. .... ........ 0 SCRIPTION OF OPERATiow wow E L DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) GC doing remodeling, structural drying, Water extraction, fire /water restoration (including mold remediation and roofing repairs) Certificate holder is included as additional insured with respect to the general liability only where there is a written contract that requires such status to the extent provided in form #CG 20 10 07 04 / CG 20 37 070 4. The General Liability policy contains a special endorsement with "primary and noncontributory" wording as per form PGI ELO 10 0210. A waiver of subrogation in favor of certificate holder is included under the general liability only where there is a written contract that requires such status. This is per form #CG 24 04 10 93 jhegvold @elsegundo.org SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of E1 Segundo ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street EI Segundo, CA 90245 AUTHORIZED REPRESENTATIVE Matt Crum /RS ©1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD N S025 (901401) CC fryp DATE (MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 5/5/2015 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 N8 ME: C.. Robert Romar I N B & B Premier Insurance Solutions PHONE _N (818) 223 -8383 -- -_FacX Npr [sle)zz3 -e>ei 5008 Chesebro Road Suite 200 . robe rtr bbpremlerins.com Hills CA 91301 INSURED James McNary DBA: Bino Construction 9520 Topanga Canyon Blvd # 204 INSURERA:Gemini Insurance Companv INSURER B Mercury Insurance Group INSURER C.-National Union Fire Ins. Co. Chatsworth CA 91311 1 INSURER F COVERAGES CERTIFICATE NUMBER:CL155509391 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSUF INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBI EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIM Innm POLICY NUMBER /MNllnrlu ........ ..... _... TYPE OF INSURANCE POLNOY EXP NSR POLtC,'Y I TR _co Inlco IYvvY1 ryVApCp!,I)p^y+"Crl„'Y GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY A (CLAIMS -MADE X OCCUR GR1001576 -01 4/29/2014 /29/2015 GEN'L AGGREGATE LIMIT APPLIES PER: n X1 POLICY �'JEC L C AUTOMOBILE OLIABILITY X, B Ix ALL OWNED �X] SCHEDUV AUTOS AUTO.O HIRED AUTOS n[ ITO.q WNEd C [d UMBRELLA LIAB _OCCUR X EXCESS LIAB CLAIMS -MADE AND EMPLOYERS' LIABILITY YIN ANY PROPRI'IETOR /PARTNER /EXECUTIVE OFNCERFMEM..BER EXCLUDED? ❑ NIA (Mandatory lit NH) If yes, describe under DESCRIPTION OF OPERATIONS below 0000006286 0/1/2015 VS/l/2016 020703513 "//14/2014 5/29/2015 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) Certificate Holder is named as an additional insured as per policy terms, and exclusions as their interests may appear in the operation of the namec h City of El Segundo, its offiers�,.,official employees, agents, and volunteers 350 Main Street E1 Segundo, CA 90245 -3813 Robert Romar /KYLE ©1988 -2010 ACORD CORPORATION. All rights reserved. The Arr)pn nnmc nnrl Innn arc rcnicfarcrl mnrtrc of Ar(1Rr1 ACORD 25 (2010/05) INS025 (?tunne) m CANCELLATION REVISION NUMBER: ED NAMED ABOVE FOR THE POLICY PERIOD DOCUMENT WITH RESPECT TO WHICH THIS D HEREIN IS SUBJECT TO ALL THE TERMS, LIMITS EACH OCCURRENCE $ 1,000,000 PREM„I10„F„S Imo,Qc�xi,�r'eMe $ 300,000, _MED EXP (Anv one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 PRODUCTS COMP /OP AGGIT ....._..... $ 2,000,000 COMBINED SIMILE LIMP 'Ps A 1 . 0DQ . QQ0 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PR PERTY DAMA E $ IPgt d!ccidrrm Medical payments $ 5.000 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1 , 000 , 000 WC STATU -..I OT}{_.... TnDV I IRAITC F{] E,.L. EACH ACCIDENT.n...$ .. ................__..........._� _v EL, DISEASE - EA EMPLOYEE $ E L DISEASE - POLICY LIMIT $ vv -vv limits, conditions, coverages insured. 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 ENDORSEMENT -- ADDITIONAL INSURED COMPLETED OPERATIONS - SCHEDULED PERSON OR ORGANIZATION - PRIMARY COVERAGE THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: FIRE AND WATER DAMAGE RESTORATION CONTRACTOR'S LIABILITY POLICY SCHEDULE dame Of Additional Insured Persons or Or aNzatlon s : Location(s) overe Operations CITY OF EL SEGUNDO, ITS OFFICERS, OFFICIALS, AS REQUIRED BY WRITTEN CONTRACT PRIOR EMPLOYEES, AGENTS AND VOLUNTEERS 01 BYO THE COMMENCEMENT OF WORK by t A. SECTION V -- Who is an insured 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 "" or "property damage" 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 and in connection with "your work" and included in the "prod ucts- cornpleted operations hazard "" you have done on behalf of the additional insured(s) at the location, ,designated above. B. With respect to the insurance afforded to the additional insured(s), the following additional exclusion applies: This insurance does not apply to "bodily injury" or "property damage" occurring before; 1 The contract or agreement has been executed'. Execution of the contract or agreement will be considered to happen when your performance begins or when the contract or agreement is signed, whichever happens first; or 2. The inception of this insurance. C. This insurance for the benefit of the additional Insured s) shown in the Schedule is primary Insurance, Any other insurance maintained by the additional Insureds shall be excess and noncontributory but only as respects "bodily Injury " or "property dama a " caused by your operations It the injury or damage is determined to be the result of your negligence or soleMy your responsibility. THIS ENDORSEMENT MUST BE ATTACHED TO A CHANGE ENDORSEMENT WHEN ISSUED AFTER THE POLICY IS WRITTEN. CG 75 75 05 07 0 2007 Gemini insurance Company Page 1 of 1 Includes material copyrighted by 180 Properties, Inc., with its permission Policy Number: PGIARK05038 -00 COMMERCIAL GENERAL LIABILITY CG 20 10 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE ._.�...........__._... ...... Name Of Additional Insured Persons) Or Organization(s): Location(s) Of Covered Operations ._______.. _.___w.________ Any person(s) or organization(s) whom the Named Insured agrees, in a written contract, to name as an Additional insured. However, this status exists only for the project specified in that contract. 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 include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" 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. 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. CG 20 10 07 04 m Policy number: PGIARK05038 -00 COMMERCIAL GENERAL LIABILITY CG 20 37 07 04 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 Insured Person(s) Location And Description Of Completed Or Organization(s): p Operations erson(s) or organization(s) w hom the Named ...... Insured agrees, in a written contract, to name as an additional insured. However, this status exists only for the proiect specified in that contract. Information reauired 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 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� © ISO Properties, Inc., 2004 PRIMARY AND NON - CONTRIBUTORY ENDORSEMENT This endorsement changes the Policy. Please read it carefully. SCHEDULE Name of Person or Organization: Any person(s) or organization(s) whom the Named Insured agrees, in a written contract, to provide Primary and /or Non - contributory status of this insurance. However, this status exists only for the project specified in that contract. In consideration of the premium charged, it is hereby agreed that this policy shall be considered primary to any similar insurance held by third parties in respect to work performed by you under any written contractual agreement with such third party. It is further agreed that any other insurance which the person(s) or organization(s) named in the schedule may have is excess and non - contributory to this insurance. PGI EL 020 0210 Page 1 of 1 COMMERCIAL GENERAL LIABILITY CG 24 04 10 93 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following; COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: Any person(s) or organization(s) whom the Named Insured agrees, in a written contract, to provide a waiver of subrogation. However, this status exists only for the project specified in that contract. (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement). The TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Condition (Section IV — COMMERCIAL GENERAL LIABILITY CONDITIONS) is amended by the addition of the following: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products- completed operations hazard ". This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 10 93 Insurance Services Office, Inc., 1992 CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 02/10/2016 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 tho certificate holder Is an ADDITIONAL INSURED, the pollcy(los) 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 Hou of such ondorsornont s PRODUCER CONTACT _ ME Bouchard Insurance for Frank Crum PHONE FAX 101 Starcrest Drive 1.. ®# t<._.______ Arai _.__ _.... ro,r Aul- Clearwater, FL 33758 FPpu 6� ,m- ..................... . ....... .- ... -,.... INSURERfSI AFFORDING COVERAGE NAIC tl INSURER A: American Zurich Insurance ComDanv 40142 INSURED INSURER B FrankCrum 11, Inc. Labor Contractor, for co- employees of: McNary, James dba: Blno Construction A NSU�. E. R. 4�' .................................................._... .........­­�...........,. _.............._..._......_.... ,.- w_�.....�.... 100 South Missouri Avenue !S G! N: ED ..................................... ..........�.�........ ------- __. Clearwater, FL 33756 „INS.URI RE:..... _... _ m..__. w ... .............m..._��......�.. INSURER F COVERAGES CERTIFICATE NUMBER: 15FLO80850944f 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. POLICY E6F .PO LICY EXP I T R I . , ...mm �...,. ......m ..... ,...�,.. ....... .... _... „m,„....... ww , .. .m,a..,..,....,. ..................m.. .. ,�.,�,.. .�.�. .. .�.....�. ..... .,.. PO LIMITS TYPE OF INSURANCE INtn wvn POLICY NUMBER MM 0 I Y Y IMMIDDIYYYYI COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS -MADE Ll OCCUR DA1 A S RtS6 F 1i`Ct $ MED EXP (Anv one Person) $ ......... ...... _............ _ PERSONAL & ADV INJURY $ Gva rV 1. AGGREGATE LIMIT APPLIES PER GENERAL ................. AGGREGATE $ . POLICY ,.,, PAO_ � LOC ��PRODLICT$ COMP /OP AGG $ ...��� ���... ... �... _ POIER: W.._ ..__..... -.___ $_ AUTOMOBILE LIABILITY M5MM, " $ ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per eccldent) $ NON -OWNED 4kIIi lV A iWiA4F HIREDAUTOS AUTOS „tPeruecrlrlrrvil $ UMBRELLA LIAR OCCUR EACH OCCURRENCE EXCESS LIAB AGGREGATE $ _ CLAIMS- _... ..__ _ _._......_. DED RETENTION$ 9 $ OTH AND EMPLOYERS' LIA LIABILITY w- NIA X WC 54 -70- 649 -03 Y 08/01!2015 06/01/2016 YE . cA irF R -_ •• -^ ANYCERIMEMBER EXCLUDED? J E L EACH ACCIDENT $ 1,000,000 A (Mandatory In H) EXCLUDED? ...� . _S (Mandatory In NH) E.L. DISEASE - EA EMPLOYE S 1.000.000 ID RIPIPTI N under F OPERATIONS below E.L. DISEASE - POLICY LIMIT $ � 1,000,000 Location Coverage Period: 06101/2015 06/01/2016 Client# 11329 -CA DESCRIPTION OF OPEr1ATp6NS IL.00ATLONS I VEIilCLES (ACORD 10 1, Addlllonal Remarks Schedule, may be attached If more 9S ace Is requlredl CovaariaUa le provldod for McNar'y, ,lames dba: Birto Construction RV Patk Vista Sllding Door Replacement Project only phase c- o =omploye -es 9620 Topanga Canyon Blvd STE 204 al, but Taal strlro avullrnrlore Chatsworth, CA 91311 to: Endorsements: Waiver of Subrogatlon CERTIFICATE HOLDER CANCELLATION City of El Segundo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 350 Main Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN El Segundo, CA 90245 ACCORDANCE WITH THE POLICY PROVISIONS, AUTHORIZED REPRESENTATIVE ©1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 26 (20141011 The ACORD name and logo are registered marks of ACORD 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 per- form 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 $o of the California workers' compensation premium otherwise due on such remuneration. Person or Organization IN FAVOR OF: City of El Segundo 350 Main Street El Segundo, CA 90245 SCHEDULE Job Description Re: Park Vista Sliding Door Replacement Project N This endorsement changes the policy to which it is attached and is effectjv 11 the date issued unless otherwise stated. (The Information below is required only when this endorsement Is Issu bsquent to preparation of the policy.) Endorsement Effective, 02/10/2016 Policy No: WC 54 -70- 649 -03 Endorsement No; Insured: FrankCrum 11, Inc, Labor Contractor, for co- employees of: McNary, James dba: Bino Construction Insurance Company: American Zurich Insurance Company Countersigned by WC 04 03 06 Copyright 1983 National Council on Compensation Insurance