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PROOF OF INSURANCE (2017) CLOSEDC""; CERTIFICATE OF LIABILITY INSURANCE DATE PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Doctor Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 10216 Reseda Blvd. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Northridge, CA 91324 INSURERS AFFORDING COVERAGE NAIC # ..IN.... . -.- IN_SURERA: INSURED MERCURY INSURAfJ�CE '� .... .. ° ° ° ° °° ° ° _ .... 3834........... N E P PAINTING CONTRACTORS INC INSURERB:SECURITY NATIONAL INS � �� �� 19879 NICHOLAS POLAKIS - .r. - .- .- .-..... _m..... .. .. ... INSURER C: 11024 BALBOA BLVD #733 INSURER D� GRANADA HILLS CA 91344 INS.... URER E: COVERAGES 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 MAY HAVE BEEN REDUCED BY PAID CLAIMS. ACORD 25 (2001108) © ACORD CORPORATION 1988 S I a P... NUMBER POLICY EXPIRATION . .. .. ................ LIMITS B LIABILITY EACH OCCURRENCE $ 2,000 000„ .GENERAL L COMMERCIAL E P yHe. .000, ( MS MADE OCCUR ED EX An $CLA . NA110927700 5.6.15 5.6.16 °5, T PERSONAL &ADV INJURY $ . - - -- .....- ... ....... --.�. .... .....:GENEF2AL AGGREGATE -� .- .- ....$. _.._3.,000,000' GEN'LAGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OPAGG $ d OLICY LOC iJ.�.. _ .......... _ A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 ANYAUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY SCHEOULEDAUTOS rperson) ° BA040000012358 1.27.15 1.27.16 HIRED AUTOS '' .................. BO BODILY INJURY $ NON -OWNED AUTOS (Per accident) ......... .. ........... .,.,.,.,.,..... ...,........... . °. PROPERTY DAMAGE $ (Peraccidant) GARAGE. LIABILITY AUTO ONLY -EA ACCIDENT .. ANYAUTO EAACC $ OTHERTHAN ,,. _- „...... ..... -..,. ... AUTOONLY: AGG $ EXCESS /UMBRELLA LIABILITY - -- EACH OCCURRENCE $ ............. OCCUR CLAIMS MADE GATE..,.,_ AGGRE, .S DEDUCTIBLE $ RETENTION $. 5 AT TATaN Ov WORKERS COMPENSATION AND rnav LT F ”, "' "�' ' -..... ` , EMPLOYERS' LIABILITY °...... '­­- " " .....' E L EACH ACCIDENT ANY PROPRIETOILPARTNER /EXECUTIVE ANY OFFICER/MEMBER EXCLUDED? E,L, DISEASE- EA EMPLOYEE L.S ........................... under {f ye.s m m .... ._...,. ............. .,.- ........ _ .describe C Ff- .IAI PRnVI N9h aE.L. .. L Dl.S..E...A...S..Eee - POLICY LIMIT I $ OTHER DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS ............ _J N E P - PAINTING CONTRACTOR Addional Insured clause: The City of El Segundo, its officials, officers, agents and employees are named additional insured for all liability arising out of the operations by or on behalf of the name insured if required by contract per attached endorsements. Primary and Non - contributory applies to General Liability. Waiver of subrogation applies to all policies. CERTIFICATE HOLDER CANCELLATION THE CITY OF EL SEGUNDO "" d II SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION ti 350 MAIN STREET DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL �Q_ DAYS WRITTEN S EL SEG U N DO CA 90245 W� NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR ''... REPRESENTATIVES. ........ . ... �. AUTHORIZED REPRESENTATIVE SCOTT DOCTOR ACORD 25 (2001108) © ACORD CORPORATION 1988 VARIOUS LOCATIONS THROUGHOUT EL SEGUNDO, CA �If no entry appears above, information r gWed to compla( as applicable to this endorsement.) A. Section II —Who Is An Insured is amended to include as an insured the person or organization shown in the Schedule, but only to the extent that the person or organization shown in the Schedule is held liable for your acts or omissions arising out of your ongoing operations performed for that insured. B. With respect to the insurance afforded to these additional insured, the following exclusion is added: 2. Exclusions 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 site 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. C. The words "you" and "your" refer to the Named Insured shown in the Declarations. D. "Your work" means work or operations performed by you or on your behalf; and materials, parts or equipment furnished in connection with such work or operations. I r gprv_"A+'ordin If required by written contract or agreement: Such insurance as is afforded by this policy shall be primary insurance, and any insurance or self- insurance maintained by the above additional insured(s) shall be excess of the insurance afforded to the named insured and shall not contribute to it, Vi p of Sub_Toggtiot1 If required by written contract or agreement: We waive any right of recovery we may have against an entity that is an additional insured per the terms of this endorsement because of payments we make for injury or damage arising out of "your work" done under a contract with that person or organization. 49.0108 07 11 May Include Copyrighted Material of Insurance Services Offices, Inc. Page 1 of 1 ❑ Used with permission COMMERICAL GENERAL LIABILITY CG 20 37 07 04 Policy #: NA110927700 Insured Name: N E P PAINTING CONTRACTORS INC 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 ...�..... Persons) or Location and Description of Complet Organization(s): _ _ Operations CITYCLERK, CITYOF ELSEGUNDb, ITS PAINT ING G OFFICERS, OFFICIALS, EMPLOYEES, AGENTS VARIOUS LOCATIONS THROUGHOUT EL AND VOLUNTEERS SEGUNDO, CA 350 MAIN STREET EL SEGUNDO CA 90245 w ,,,...u.. �_. Nnlrsrmalion required 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 Copyright Iso Properties, Inc., 2004 Page 1 of 1 Insured ACCRA. ILIABILITY DA1 /22/2015 } PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Doctor Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 10216 Reseda Blvd. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Northridge, CA 91324 INSURERS AFFORDING COVERAGE NAIC # INSURED IdrURI.r A:C'�"dERCURY INSURANCE � [38342.. ... N E P PAINTING CONTRACTORS INC INSURERB.'SECLNRN't'Y NAhIONAL, INS 19879 ._.. ww. . ...,. . NICHOLAS POLAKIS NSURERC: 11024 BALBOA BLVD #733 WSUR7"Rffi) _ GRANADA HILLS CA 91344 WSURFRR. LL COVERAGES 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 MAY HAVE BEEN REDUCED BY PAID CLAIMS. aBsriw ®oF nEO rP s 2 000,000 �... COMv AERC.IA�LGFIdERALL1A01LITY �- �� ✓ Cm� T PFnGINSNReNrF POLICY NUMBER LJCYEiFCCTa7tigL POLIOYDXP }PEATIT}N LIMITS DD L NERA.L LIABILITY P'4, 1 .I �....... 4 MED EXP,(Anv one Pelson) $ .. ......5 000 u.. ✓� CLAIMS MADE A OCCUR 1 NA110927700 5.6.15 5.6.16 PERSONAL &ADV INJURY $ GENERALAGGREGATE ...5...,.. .....�i OOU OOO hTa LIMIT FxP'PLVESPER: PftODUCT°a COMP /OP AGG A 'AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S � �. , ® ® ®, ® ®® AN Y ALRO Ea accide,U F 6 ALLOWNFDAUTOS 0 II4'PfOJURY S *J SCHEDULED AUTOS er Prvvse } _ BA040000012358 r 1.27.16 127.17 s HIRED AUTOS I 'f BODILY INJURY S NON -OWNED AUTOS I (Peraccdenl) iI - ....... . ..._._.. J ... ....., I I PROPERTY DAMAGE 1 (Per accident) __. .. _._ W.... ...._....__ .................... ._.__..... _.. _..........._. d b ANY AUTO C AR6kf. L LIABILITY Pd OTNOFRTHAN ACC, A 0CL S m Y r AUTOONLY AGG 'CcWwPUMHRiiLLfw LIABILITY f p EACH OCCURRENCE $ EX I, OCCUR � CLAIMS R. AD 'c I AGGREGATE I % ( RETEhdTION S ,._....,.. � ............� _ .............._.�!��e ,.m ._� ... � S ........... DEDUCTIBLE EMPLOYE ' BFJZ EXCLUOED7 ECUTIVE WORKERS COMPENSATION AND J f 4;T TLU OTk T�I��Lw� }T €� T'L L.n.L6'kt L,L.RD� Pd'R ss 5 EL DISEA E EALT,SG+N. rS'C9 EY S ' Ityes dPSCntre urxter .., .... ... ,.... ... SPFC'IAL PROVIStOP {�S Lwow i' EL DI.�,EASE P6LICY LIflgi S 1 .._..._ ... .._ _...... d_... �. �..�....MI OTHER DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION'' SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL _3f�_ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. _ ___ ..,. ................. AUTHORIZED REPRESENTATIVE .................._.................._......_...—.. ...._..A......,.,...,.,...�,,,. SCOTT DOCTOR_ . _ o ACORDCORp_.. P CORPORATION 1968 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 POLICY NUMBER: COMMERCIAL AUTO CA 20 48 02 99 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" under the Who Is An Insured Provi- sion of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indi- cated below. Endorsement Effective: Named Insured: Countersigned By: Authorized SCHEDULE Name of Person(s) or Organization(s); (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to the endorsement.) Each person or organization shown in the Schedule is an "insured" for Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured Provision contained in Section II of the Coverage Form. CA 20 48 02 99 Copyright, Insurance Services Office, Inc., 1998 Page 1 of 1 ❑ DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 10108!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 cerfificate Holder is an ADDITIONAL INSURED, the policy(les) 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 endorsements) PRODUCER _AA" Eric Lanzillotta AXMC; CBIA Insurance Agency PHONE (8771900 2242 Net I86(5l 518627 r.^. .,,.,,.. 8001 CANOGA AVE, SUITE A a' MAK f.erts ci,cl (arltiarlTtJer.catn SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City Clerk ACCORDANCE WITH THE POLICY PROVISIONS. City of El Segundo ' AUTHORIZED REPRESENTATIVE 350 Main Street El Segundo CA 90245 ©1888.2014 ACORD CORPORATION. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD INSURER(Slr AFFORDING COVERAGE NAIC # _ CANOGA PARK A 91304 INSU INSURANCE "FiER a STATE COMPENSATION FUND (SCI INSURED INSURER R ..�W.�..�.......��..� ��....... �.. ��m.. �W ..................... �.................................................. ��... �.................................. ......,...�.�.................. ...._ N E P Painting ontractors, Inc. 9 INSURER C ............._,....,.................... .............�.mm...,_........,_ . ...... ............................... ... w...... .......... ,..----------------- 11024 Balboa Blvd Suite #733 INSURER D: INSURER E Granada Hills CA 91344 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. ...... ...,. �. ., en POL ...... ...... . _... �LTR TYPE OF INSURANCE mi � ICY NUMBER 4M DDfYYYti MMIDW LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE E yy t)i RCT tl fi (1(1�1i .........� CLAIMS -MADE OCCUR !'Rfi MWS (P ..., __ ............ ......... ... ....... ....... MED EXP (Anv one Derson) $ ,,,_.�,.�. ....,,,,, _....u,u ...... PERSONAL & ARV ,INJURY E GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ ® POLICY JECT D LOC .. , .. ... .. ......f PRODUCTS COMP /OP AGG E r, r1 ftt R, $ AUTOMOBILE LIABILITY 4;ONLnIC+9FC1 SlNrat.E I'.iP $ ANYAUTO BODILY INJURY (Per Person) $ ALL OWNED � .. SCHEDULED B II BODILY INJURY (Per accident) $ w ....... AUTOS '�. AUTOS NON -OWNED ,..,�, .... ..,��r�.,... PROPEFY7 v DAMN E .....�.., HIRED AUTOS ,., ..,�i AUTOS iP 9k ........,. .., ...,w. _.. ......... ...... ............. UMBRELLA LIAR OCCUR EACH OCCURRENCE E ,.. , EXCESS S L XCLAIMS-MADE r'rC fmPCL"�'A,TN" E .. ... , , DED RF`r0,1Tlr'1N$ $ WORKERS COMPENSATION � � era FsaH AND EMPLOYERS' LIABILITY YIN 1 __.. A0J1' PErvi fSII pen:,Pe ACLU If, °;Gt:Cll'IIV. �C�4Ct.uDEDi N � NIA 9052882 -2015 A ANYiCE:OPf rIf tl o L E L EACH ACCIDENT $ 1,000,000 04/1612015 04/1612016 _ __ _.... - -. (Mnndotory In NH) EL,. DISEASE - EA EMPLOYEE S 1 ,000.000 if 0 S' R T1 ()N OF ()PERA IRONS 00, � +• E L. DISEASE PO.... 000. , ucYUMlr $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more apace Is required) Evidence of Insurance Lic # 973759 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City Clerk ACCORDANCE WITH THE POLICY PROVISIONS. City of El Segundo ' AUTHORIZED REPRESENTATIVE 350 Main Street El Segundo CA 90245 ©1888.2014 ACORD CORPORATION. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD ENDORSEMENT AGREEMENT WAIVER OF SUBROGATION 9052882 -15 RENEWAL SC 3- 54 -53 -51 PAGE 1 HOME OFFICE SAN FRANCISCO EFFECTIVE OCTOBER 7, 2015 AT 12.01 A.M. ALL EFFECTIVE DATES ARE AND EXPIRING APRIL 16, 2016 AT 12.01 A . AT 12:01 AM PACIFIC STANDARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME N E P PAINTING CONTRACTORS, INC. 11024 BALBOA BLVD STE 733 GRANADA HILLS, CA 91344 ANYTHING IN THIS POLICY TO THE CONTRARY NOTWITHSTANDING, IT IS AGREED THAT THE STATE COMPENSATION INSURANCE FUND WAIVES ANY RIGHT OF SUBROGATION AGAINST, CITY CLERK, CITY OF EL SEGUNDO WHICH MIGHT ARISE BY REASON OF ANY PAYMENT UNDER THIS POLICY IN CONNECTION WITH WORK PERFORMED BY, N E P PAINTING CONTRACTORS, INC. 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: Ie' IV AU h 4( 14 &lLt) IT{"PriE SENT WE SCIF FORM 10217 (REV 7 -20141 OCTOBER 9, 2015 PRESIDENT AND CEO 2570 R � `