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PROOF OF INSURANCE (2016) CLOSEDCERTIFICATE OF LIABILITY INSURANCE DA 527/2015 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 on A Jenna La Fond Van k Risk Solutions T� y E M RESS �JennaL @vanwykcorp.com We (616) 942 8199 2237 Wealth Street SEoNE PAx5 Suite 200 a n Grand Rapids, MI 49506 iNCnrrFnia arrnnnlNrcnucnara Nair.9 INSURED dba: G/M Business Interiors 110 West A Street Ste 140 San Diego, CA 2101 116TOITIffoT.TKIL3 r #73VwdiwAVr :ff, 11X103 B: National Union Fire R'FV'tgIr'1N 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. uN6.. ADOL5 BR _.._..... _.....�. .....�.mm__ ......._.... POLllCY EFF POLICY EXP LTP-0 TYPE OF INSURANCE co un {n, POLICY NUMBER MMfDOJYYYY MMfDD Y' ._.. ........_.. ...................�......,.,.. LIMITS GENERAL LIABILITY ACCORDANCE WITH THE POLICY PROVISIONS AUTHORIZED REPRESENTATIVE h I� EACHOOCURRENCE'.. S 1,000,000 . JfiPAEACIA.L GLN"AL LIABILITY GL 704 -64-11 311/2015 3/1/ 2016 -DAVAW. IMWERMU 300,000. 000 CLAIIAS•MADE OCCUR MED EXP (Any one person) �. S 10,000 W PERSONAL BADVINJURY $ 1,000,000 GENERAL AGGREGATE S 2,000,000 w_ .,.,...._._.__ _ ............._..._...... .......,......�....._._.,..__. PR_ ...,�._ ODUCTS - COMP /OP AGG m m� 2,000,000 S N'. LAGGREGATELIMITAPPUESPER: GE" ....._. I��""".. PRO P'OL1CY V Ply, LOC: W�..._ ....._...,.........._.._..._._ _ .....,._.... ......�_ .................m.M... S A AUTOMOBILE LIABILITY COMMI4ED SINGLE. LIMIT ...0 j axrnd). 0 .� S 1,000,000 BODILY INJURY (Per person) $ ANY AUTO 2248254 3/112015 3/112016 ALL OWNED SCHEDULED BODILY INJURY (Per accident) ',, S AUTOS AUTOS NON -OWNED . HIRED AUTOS ''. AUTOS �. 6' _._..._.... ROPER "r AE ra da O'AMAC"E 6 ��p,),,,, S W Medical Payments $ 5,000 UMBRELLALIAB OCCUR EACH OCCURRENCE S EXCESS LIAR CLAIMS -MADE AGGREGATE S - ----- DEL) RFTFNTION S _ ..........: _ NA - s A ppp OTH Irrwv�ITiuire co ACC X AND EMPLOYERS'LIABILITY Y.� E L EACH DENT S 0 .000,000 ANY PROPRIETORIPARTNERIEXECUTIVE 049101993 311/2015 3/1/2016 OFOFRCEW N f A mIT Xm mmm mITm (Mandatory In NH) El, DISEASE EA EMPLOYEE $ 1 If es, descnee under DE SCR IPTIONOFOPFRATIONSbelow E,L.DISEASE - POLICY LIMIT S 1,000,000 DESCRIPTION OF OPERATIONS f LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) City of El Segundo, its officials, and employees are added as "additional insured's" under said insurance coverage and that such insurance All be deemed "primary" such that any other insurance that may be carried by the City Will be excess thereto. Such insurance must be on an "occurrence," not a "claims made," basis and will not be cancelable or subject to reduction except upon thirty (30) days prior written notice to the City. @ 1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD I w, SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of El Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 350 Main Street El Segundo, CA 902450989 ACCORDANCE WITH THE POLICY PROVISIONS AUTHORIZED REPRESENTATIVE h I� I @ 1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD I w, Page of The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 6551 LOC #: ACCOR" ADDITIONAL REMARKS SCHEDULE AGENCY NAMED INSURED Van Wyk Risk Solutions GOFORTH & MARTI _.._.._.__.. . . ..... . m ..... .._ ... .............. ._._.... _............... . ....... dba: G/M Business Interiors POLICY NUMBER 110 West A Street Ste 140 CARRIER NAIC CODE San Diego, CA 2101 19445 EFFECTIVE DATE: Page of The ACORD name and logo are registered marks of ACORD POLICY NUMBER: GL 704 -64 -11 COMMERCIAL GENERAL LIABILITY CG 20 01 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: W COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS /COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance Condition and supersedes any provision to the contrary: Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and (2) You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribu- tion from any other insurance available to the additional insured. CG 20 01 04 13 0 Insurance Services Office, Inc., 2012 Page 1 of 1 POLICY NUMBER: GL 704 -64 -11 COMMERCIAL GENERAL LIABILITY CG 20 37 04 13 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 PRODUCTS /COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Location And Description Of Completed Operations Or Organization(s) ANY PERSON OR ORGANIZATION PER THE CONTRACT OR AGREEMENT, WHOM YOU BECOME OBLIGATED TO INCLUDE AS AN ADDITIONAL INSURED AS A RESULT OF ANY CONTRACT OR AGREEMENT YOU HAVE ENTERED INTO. 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" 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 ". 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 agree- ment, the insurance afforded to such addi- tional insured will not be broader than that 'w 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 III - Limits Of Insurance: 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 Insu- rance shown in the Declarations; whichever is less. This endorsement shall not increase the appli- cable Limits of Insurance shown in the Decla- rations. CG 20 37 04 13 0 Insurance Services Office, Inc., 2012 Page 1 of 1 11 POLICY NUMBER: GL 704 -64 -11 COMMERCIAL GENERAL LIABILITY CG 20 15 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - VENDORS This endorsement modifies insurance provided under the following:. COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS /COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) (Vendor) Your Products VENDORS WHO SELL OR DISTRIBUTE YOUR ALL PRODUCTS PRODUCTS y . _...... .._. . _...... I _ nformation 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 a. "Bodily injury" or "property damage" for include as an additional insured any person(s) or which the vendor is obligated to pay organization(s) (referred to throughout this damages by reason of the assumption of endorsement as vendor) shown in the Schedule, liability in a contract or agreement. This but only with respect to "bodily injury" or exclusion does not apply to liability for "property damage" arising out of "your damages that the vendor would have in products" shown in the Schedule which are the absence of the contract or distributed or sold in the regular course of the agreement; vendor's business, b. Any express warranty unauthorized by However: you; 1. The insurance afforded to such vendor only c. Any physical or chemical change in the applies to the extent permitted by law; and product made intentionally by the vendor; 2. If coverage provided to the vendor is d. Repackaging, except when unpacked required by a contract or agreement, the solely for the purpose of inspection, insurance afforded to such vendor will not demonstration, testing, or the be broader than that which you are required substitution of parts under instructions by the contract or agreement to provide for from the manufacturer, and then such vendor. repackaged in the original container; B. With respect to the insurance afforded to these e. Any failure to make such inspections, vendors, the following additional exclusions adjustments, tests or servicing as the apply: vendor has agreed to make or normally 1. The insurance afforded the vendor does not undertakes to make in the usual course apply to: of business, in connection with the distribution or sale of the products; CG 20 15 04 13 0 Insurance Services Office, Inc., 2012 Page 1 of 2 ❑ f. Demonstration, installation, servicing or repair operations, except such operations performed at the vendor's premises in connection with the sale of the product; g. Products which, after distribution or sale by you, have been labeled or relabeled or used as a container, part or ingredient of any other thing or substance by or for the vendor; or h. "Bodily injury" or "property damage" arising out of the sole negligence of the vendor for its own acts or omissions or those of its employees or anyone else acting on its behalf. However, this exclusion does not apply to: (1)The exceptions contained in Sub- paragraphs d. or f.; or (2) Such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products. 2. This insurance does not apply to any insured person or organization, from whom you have acquired such products, or any ingredient, part or container, entering into, accom- panying or containing such products. C. With respect to the insurance afforded to these vendors, the following is added to Section III - Limits Of Insurance: If coverage provided to the vendor is required by a contract or agreement, the most we will pay on behalf of the vendor is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. Page 2 of 2 0 Insurance Services Office, Inc., 2012 CG 20 15 04 13 ❑ POLICY NUMBER: GL 704 -64 -11 COMMERCIAL GENERAL LIABILITY CG 20 33 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU This endorsement modifies insurance provided under the following; COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section II - Who Is An Insured is amended to include as an additional insured any person or organization for whom you are performing operations when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy. Such person or organization is an addi- tional insured 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. However, the insurance afforded to such additional insured: 1. Only applies to the extent permitted by law; and 2. Will not be broader than that which you are required by the contract or agreement to provide for such additional insured. A person's or organization's status as an addi- tional insured under this endorsement ends when your operations for that additional insured are completed. B. With respect to the insurance afforded to these additional insureds, the following additional ex- clusions apply: This insurance does not apply to: 1. "Bodily injury ", "property damage" or "personal and advertising injury" arising out C of 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; or b. Supervisory, inspection, architectural or engineering activities. This exclusion applies even if the claims against any insured allege negligence or other wrong- doing in the supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence" which caused the "bodily in- jury" or "property damage ", or the offense which caused the "personal and advertising injury ", involved the rendering of or the failure to render any professional architectural, engineering or surveying services. 2. "Bodily injury" or "property damage" occurring after: a. 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 b. 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. With respect to the insurance afforded to these additional insureds, the following is added to Section 111 - Limits Of Insurance: The most we will pay on behalf of the additional insured is the amount of insurance: CG 20 33 04 13 0 Insurance Services Office, Inc., 2012 Page 1 of 2 ❑ 1. Required by the contract or agreement you have entered into with the additional insured; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. Page 2 of 2 * Insurance Services Office, Inc., 2012 CG 20 33 04 13 11 BLANKET WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT By NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA. We have a right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against any person or organization with whom you have a written contract that requires you to obtain this agreement from us, as regards any work you perform for such person or organization. The additional premium for this endorsement shall be 2.00 % of the total estimated workers compensation premium for this policy. City of El Segundo, its officials, officers, agents and employees and volunteers WC 04 03 61 Countersigned by ,m _ � (Ed. 11/90) Authorized Representative