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PROOF OF INSURANCE (2016) CLOSEDPETHYD -001 DOJU DDIYYYY) TE(MMI DA w CERTIFICATE OF LIABILITY INSURANCE TE(MM/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). CONTACT PRODUCER (888) 825 -4322 NAME: Michelle Vedas Bowermaster &Associates IpI /C N ., E�tI 888 - 825-43 FAX P.O. Box 6026 -- 281 Arc, Nv)s 714-252...-....8......2.......5.......3 ..,...�_........ _.ww. 10805 Holder Street - Suite 350 ADDRESS: ITIVedas bowermaster.com Cypress, CA 90630 INSURER(S) AFFORDING COVERAGE NAIC # INSURED Peterson Hydraulics, Inc. 1653 W. El Segundo Blvd. Gardena, CA 90249 - COVERAGES CERTIFICATE NUMBER: INSURER A: Navigators Specialty Insurance ... ............................... INSURERB :Admlral.Insurance Co,m,p,any INSURER C: Everest National Insurance Co. ........ .... ............................... INSURER D :: INSURER E : _..r ................... .........-___— ..............................- ---......------................ ....._..___�...........�...,... INSURER F : REVISION NUMBER: 10120 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. ,R .... TYPE OF INSURANCE ._._._... X.DDn ------ POLICY NUMBER POLICY EFF' POLICY EXP .. ............................. LIMITS.... .... ...., R !._ MM001YYYY 1MM /DDIYYYYI', X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,a DAMAGE TURF � Q CLAIMS -MADE X,� OCCUR Y Y LA15CGL1529611C 4/28/2015 4128/2016 , _I REtw91��,� Ea oEl,�i�rrbuvc,� $.. .. 50'.... GEN'L AGGREGATE LIMIT APPLIES PER: ..... POLICY �.,X..� PRO- ❑ LOC - JECT AUTOMOBILE LIABILITY ANY AUTO A O SCHEDULED AUTOS AUTOS HIRED AUTOS NON -OWNED AUTOS UMBRELLA LIAB X OCCUR B X EXCESS LIAB CLAIMS MADE N N SEX0961141206 D E D 17, RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY C ANY PROPRIETOR /PARTNER/EXECUTIVE Y / N Y CA10001357151 OFFICER/MEMBER EXCLUDED ?, NIA '.(Mandatory In NH) B (Contractors Pollution Liab I N I N IFEIECC1942001 , E L DISEASE - EA EMPLOYE $ 71112015 71112016 E EACH ACCIDENT 1 000 1,000 E. L. DISEASE - POLICY LIMIT $ 1,000 4/2812015 4/28/2016 1 Each Occur I Aggregate 1.000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) The following endorsements apply in favor of The City of El Segundo, its officials, officers, agents and employees to the extent required by written consent: General Liability: Additional Insured #CG2038 0413 & CG2037 0413, Waiver of Subrogation #CG240740509 Worker's Compensation: Waiver of Subrogation #WC040306 CERTIFICATE HOLDER CANCELLATION 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 ACCORDANCE WITH THE POLICY PROVISIONS. El Segundo, CA 90245 - a AUTHORIZED REPRESENTATIVE ......_ .'".. ©1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD MED EXP (Any one person) ............... .........,.... $ 5 .. ­ PERSONAL & ADV INJURY _—_.... ------ .... .....-,,... $ 1,000 ....... ............ — .............................. GENERAL AGGREGATE ............................... $ 2,000 PRODUCTS -. COMP/OP ......... .........................2,000 .A.G.G.- ....$ COMBINED SI NG q $ ....... ''. BODILY INJURY (Per person) $ . ......... ............................................................................................ accident) ............................... IDER M DAAG' t... - (FOB+' . �.....$ ........................ ............................... EACH OCCURRENCE $ 4,000 4/28/2015 4/28/2016 AGGREGATE $ 4,000 , E L DISEASE - EA EMPLOYE $ 71112015 71112016 E EACH ACCIDENT 1 000 1,000 E. L. DISEASE - POLICY LIMIT $ 1,000 4/2812015 4/28/2016 1 Each Occur I Aggregate 1.000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) The following endorsements apply in favor of The City of El Segundo, its officials, officers, agents and employees to the extent required by written consent: General Liability: Additional Insured #CG2038 0413 & CG2037 0413, Waiver of Subrogation #CG240740509 Worker's Compensation: Waiver of Subrogation #WC040306 CERTIFICATE HOLDER CANCELLATION 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 ACCORDANCE WITH THE POLICY PROVISIONS. El Segundo, CA 90245 - a AUTHORIZED REPRESENTATIVE ......_ .'".. ©1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: LA15CGL1529611C COMMERCIAL GENERAL LIABILITY CG 20 38 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - AUTOMATIC STATUS FOR OTHER PARTIES WHEN REQUIRED IN WRITTEN CONSTRUCTION AGREEMENT 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: 1. 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; and 2. Any other person or organization you are required to add as an additional insured under the contract or agreement described in Paragraph 1. above. Such person(s) or organization(s) is an additional insured 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. However, the insurance afforded to such additional insured described above: a. Only applies to the extent permitted by law; and b. 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 additional insured under this endorsement ends when your operations for the person or organization described in Paragraph 1. above are completed. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to: 1. "Bodily injury ", "property damage" or "personal and advertising injury" arising out 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 wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence" which caused the "bodily injury" 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 CG 20 38 04 13 © Insurance Services Office, Inc,, 2012 Page 1 of 2 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. C. With respect to the insurance afforded to these additional insureds, the following is added to Section III - Limits Of Insurance: The most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement described in Paragraph A.1.; 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. CG 20 38 0413 © Insurance Services Office, Inc,, 2012 Page 2 of 2 POLICY NUMB ER:LA15CGL152961IC 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 Persons) Or Organization(s) Location And Descrintion Of Completed Ooerations Any person or organization for whom you are performing "commercial construction" during the period of this policy and have agreed in a written contract to add as an additional insured for products - completed operations. "Commercial construction" does not include any habitational or residential construction other than hotels or apartments. . I 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 B. 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 agreement, the insurance afforded to such additional insured will not be broader than that which you are 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 Insurance shown in the Declarations, whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 37 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 2 required by the contractor agreement to provide for such additional insured. CG 20 37 0413 © Insurance Services Office, Inc., 2012 Page 2 of 2 POLICY NUMBER: LA15CGL152961IC COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS /COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: Any person or organization when you and such person or organization have agreed in writing in a contract or agreement that you will waive any right of recovery against such person or organization. Information required to complete this Schedule, if not shown above, will be shown in the Declarations, The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV -Conditions; 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 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 1 Policy # CA10001357151 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 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. IMe will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform 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 5 % of the California workers' compensation premium otherwise due on such remuneration. PERSON OR ORGANIZATION ANY PERSON OR ORGANIZATION FOR WHOM THE NAMED INSURED AGREEED BY WRITTEN CONTRACT TO FURNISH THIS WAIVER. SCHEDULE JOB DESCRIPTION ALL OPERATIONS -19W by the Worker# ConVermlon Insurance Ratlrg Bureau of CaINbrNa. NI dghb reserved. From the WCIRB's Caltomia Workers' Compensation Insurance Forms NbnLud -1999. IN"M coPY CERTIFICATE OF LIABILITY ::liTlE 27/2016 PRODUIR THIS CERTIFICATE IS ISSUED A MATTER OF INFORMATION 12 /4 /2015STATE F INSURANCE -KEN BULLOCK, LIC# ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 0722261 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 4490 PIEDMONT AVE ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. OAKLAND, CA 94611 INSURERS AFFORDING COVERAGE NAIC S INSURED PETERSON HYDRAULICS, INC. t. i a. , --_", DuranC� 4 Parr � 25151 25151 .._... INSURERAAtAtp1 CEDE�7 R1 Zn 1653 W. EL SEGUNDO BLVD. INSURER B: GARDENA, CA 90249 INSURER C: INSURER D: INSURER E: CMERAGES 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 Y HAVE BEEN REDUCED BY PAID CLAIMS. uWSw Nnlr ..._..._...... - ILi " "0 it/ a "wLir.r " " "EIIwIIiJltl ...... L'M '.Iw>3slo. r"E.OF INSURANCE POLICY NUMBER DATE IMWDDMII DATE tmwDnn.m umrrs GENERAL LIASILITY EACH OCCURRENCE S . COMMERCIft GENI:NAL UABILITY PIiE'MI Fa cwr'af+9qtr, f - CLAIMS MADE iL6 _ MED Mn ® � .- n. l PE RSONAL b ADN INJURY _AGGREGATE $ ... _ GENERAL s s P01,1CY [­ JECT LOC A AUTOMOBILE UABLIT'Y 261 3105- F21 -05B 09/12/15 09/12/16 COMBINED SINGLE LIMIt 261 3110- C16 -05H ( a ant) f 1, 000, 000 C X ANY AUTO 261 3111 -C -OSE _ _... ALL OWNED AUTOS 2 61 3112 - F19 - 0 5 2 BODILY INJURY (P� n) 1, 000,000 " SCHEDULED AUTOS 265 9009- A30- 05B._,._., „s X HIRED AUTOS 269 4025-DO3-05B BODILY INJURY X NOWOWNED AUTOS 269 4027-D03-05S (PeraccIdent) 270 1481- E02 -05B ......... _. — .._.... 278 7338 - 1308 -05B 278 7339 -08 -05 258 9346- C12 -05C 258 9355- B27 -05C 258 9366- E15 -05C I PROPERTY D GE 258 9372- E25 -05C (Par ewldenQ f 1,000,000 258 9373- C28 -05C 258 9375- C14 -05 Ix GARAGE LIABILITY ALITOONLY- EAACCIDENT I ANY AUTO OTHER THAN EA ACC f AUTO ONLY: �..___�.......... _ AGG f EXCESS/UMBRELLALIABILITY EACH OCCURRENCE f OCCUR EDCLAWS MADE AGGREGATE $ . DEDUCTIBLE S RETENTION f $ WORKERS AND WCSTAT'U- OT_H -..,. EMPLOY ORY LIMIT, ER ANY PROPRIETOR/PARTNERIEXECUTIVE E L. EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? If dwdbe under - S El_ DISEASE .. E. _.. OYEE $ - rm, SPECIAL PROVISIONS balpw E.L. DI POLICY LIMIT I OTHER AC IRD 25 (2 1! ) The registration notices indicate ownership of the marks by their r ' e owners D CORPORATION 1988, 2007 132849 03-13 -2007 All rights reserved r : • •:: r • •:.... r:: :. • w WAIT-3711 r.• s PROJECT NAME JOB# 10-0 1-0366 CITY OF EL /' • 350 MAIN STREET EL O • CERTIFICATe or • L 7 , ' -ADDITIONAL !NSUiRSD"]�P'QUI�IlFt)/WA�IVER OF SUBROGATION: CITY OF EL SEGUNDO DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 350 MAIN ST L. DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER r TO THE LEFT, BUT IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(les) 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 (2001106) CERTIFICATE L S 'C o /27/2,0 ,' PRODUCER THIS CERTIFICATE IS 18 UED AS MATTER OI INFORM 1A'TION STATE FARM INSURANCE -KEN BULLOCK, LIC# 0722261 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 4490 PIEDMONT AVE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR OAKLAND, CA 94611 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, A­1 '­—, ­ ­111 INSURERS AFFORDING COVERAGE NAIL E INSURED PETERSON HYDRAULICS, INC. INSURERA State Fa General insurance Company 25151 25151 ...m -.n �... _.... ._,... , .. "" .., _.. ..,,,_.., 1653 W. EL SEGUNDO BLVD. INSURERB: GARDENA, CA 90249 INSURER C: INSURER rr: INSURER E: COVE GE 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 OL.ICIES AGGREKxAIt LIMIT SHOWN MAY HAVE BEEN EDUCED BY PAID CLAIMS, ... m ,..__...._ ...._ _ ... _. _ .... ........W.,,, ­ ..,....� . ..... .....� Lm INSRO TYPE OF INSURANCE POLICY NUMBER DATE (MWDDIYYI DATE IMUMMIYYI LIMITS GENERAL LIABILITY EACH OCCURRENCE COMMER'0At. GENERAL. LIADILITY B Ihpl b w Euaotcurmoraco E CLAIMS MADE OCCUR MED EXP (Anv one oeraonl Is �.._ ..,,,,,m ....................... .._ PERSONAL 8 ADV INJURY S , ,,•AM. ......................._. _ GENL AGGREGATE UhTrPF�S PEFC GENERAh AGGREGATE ,,.E X POLICY P cT LOC PRODUCTS COMPfOPAGG E A AUTOMOBILE LIABV_rY 261 3107- A03 -05D 09/12/15 09/12/16 COMBINED SINGLE LIMIT 258 9367- E28 -05D (Ea accident) S 2,000,000 X ANY AUTO 258 9368- E25- 05B•-- _-- - - -... ALL OWNED AUTOS 258 9374- BO3 -05C BODILY INJURY E 2,000,000 SCHEDULED AUTOS 259 5790- E25 -05B '.(Per person) X HIREDAUTOS BODILY INJURY $ X NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE (Per accident) $ 2,000,000 GARAGE LIABILITY AUTO ONLY - EA ACCIDENT E ANY AUTO OTHER THAN PA:AACC E AUTO ONLY: "- !S AGG FXX ESWUNDRE,LLALIABILITY EACH OCCURRENCE OCCUR a CLAIMS MADE AGGREGATE S ......_. S DEDUCTIBLE S RETENTION S E WORDS COMPENSATION AND WC S'TA'T "U- OTH- E!MPLOYERS, LIABILITY I'i RY LIMIT ER ANY PROPRIETOR/PARTNER/EXECUTIVE E,L EACH ACCIDENT s° OFFICERIMEI�ER EXCLUDED? - yy e_a under E.L DISEASE . EMPLOYEE S SPECIAL. PROVISIONS.helew EL DISEASE - POLICY LIMIT E X OTHER NO DEDUCTIBLE ON LIABILITY DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS PROJECT NAME; JOB #10 -01 -0366 CITY OF EL SEGUNDO 350 MAIN STREET IL SEGU "ADO, CA 90245 CERTIFICATE HOLDER CANCELLATION "Additional Insured" Required /Waiver of Subrogation SHOULD ANY OF THE ABOVE DESMfto POLICIES BE CANCELLED SUKM THE EXPIRATION CITY OF EL SEGUNDO DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN 350 MAIN STREET NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FALURE TO DO 80 SMALL EL SEGUNDO, CA 90245 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. ACORD 2512001108) The registration notices indicate ownership of the marks by their respective owners ®ACORD CORPORATION 1988, 2007 132849 03- :3.2LI(J7 All rights reserved KEN BULLOCK, AGENT ACORD 25 (2001/08) 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 (2001/08)