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PROOF OF INSURANCE (2016) CLOSED"" sn DATE(MM,DD,YYYY) CERTIFICATE OF LIABILITY INSURANCE F 02,26/2016 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 CONTACT Aon Risk insurance Services West, Inc, HAME Los An el es CA Office QAlc No. (866) 283 -7122 X Nd , (800) 363 -0105 707 Wilshire Boulevard E-MAIL Suite 2600 ADDRESS: LOS Angeles CA 90017 -0460 USA INSURED ACCO Enqineered Systems, Inc. 6265 San Fernando Road Glendale CA 91201 USA [ejsjTj4zUe &� CERTIFICATE NUMBER: 5 INSURERS) AFFORDING COVERAGE NAIC q INSURER A: AIG Specialty Insurance Company 26883 INSURER B: Greenwich Insurance Company 22322 INSURER C: XL specialty Insurance Co 37885 INSURER D: Catlin Specialty Insurance Company 15989 INSURER E: North American Elite Insurance Company 29700 INSURERF: ,..... m ................. " ._._............_......_._... ,. ...... .........�.....,.....,........ LO co E Lu 0 d w c d d 0 2 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 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE 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. Limits shown are as requested INSR T TYPE OF INSURANCE INSO WV POLICY NUMBER MMtDC1d'rYYY MMT Ct[Sri PYY LIMITS IN ACCORDANCE WITH THE B X COMMERCIAL GENERAL LIABILITY y Y RGD500615069 EACH OCCURRENCE S1,000,000 its officials, officers, agPllts es CLAIMS -MADE OCCUR and employees Public works Departmentti 3 W AV Ais".` N . $300,000... 350 Main Street, rn E1 Segundo CA 90245 USA PR',EMIESa r &cemn� MED EXP (Any one person) 15,000 0 PERSONAL& ADV INJURY $1,000,000' GENERAL AGGREGATE $2,000,000 Oo GEN'L AGGREGATE LIMIT APPLIES PER: POLICY �,. PE ® F LOC PRODUCTS - COMP,OPAGG $2 , 000,000 O OTHER: O r B AUTOMOBILE LIABILITY Y Y RAD 500014908 10/01/2015 10/01/2016 COMBINED SINGLE LIMIT !Fa arririanll $2,000,000 LO X ANY AUTO 0 Z BODILY INJURY ( Per person) BODILY INJURY (Per accident) ALL OWNED SCHEDULED d AUTOS AUTOS PROPERTY DAMAGE tD HIRED AUTOS NON -OWNED X X (Per,ar.iden4l t� AUTOS d E X 11 UMBRELLA LIAB X OCCUR Y Y uMB200002602 10/01/2015 10/01/2016 EACH OCCURRENCE $4,000,000 V EXCESSLIAB CLAIMS -MADE .AGGREGATE $4,000,000 _. IDED X RETENTION $25,000 C WOAXERS COMPENSATION AND Y RWD500014808 10/'01/ '2015 10/01/20161 X I PER STATUTE OTH- EMPLOYERS' LIABILITY FP ANY PROPRIETOR / PARTNER / EXECUTIVE N E,L, EACH ACCIDENT $1,000,000 [4- OFFICER /MEMDER EXCLUDED? I W (Mandatory in NH) 444 V N I A E L, DISEASE -EA EMPLOYEE S1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE- POLICY LIMIT $1,000,000 D contractor Prof CPL973431016 10/01/2015 10/01/2016 Aggregate /Each LOSS 1,000,000 Claims Made SIR applies per policy terms & condi'ions DESCRIPTION OF OPERATIONS I LOCATIONS, VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached it more space is required) [Re: Service, All operations at the City of El Segundo] [AI: City of El Segundo, its officials, officers, agents, and employees] are included as Additional Insured with respect to the General Liability, Automobile Liability and Umbrella Liability policies; granted a waiver of Subrogation for General Liability, Automobile Liability, Umbrella Liability and workers' compensation and the General Liability evidenced herein policies; policy is Primary and Non- Contributory to other insurance available, as required by written contract, but limited to the operations of the Insured under said contract. umbrella Liability follows form over General Liability, Automobile Liability and Employers' Liability. Imo+ CERTIFICATE HOLDER CANCELLATION ©1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED POLICY PROVISIONS. IN ACCORDANCE WITH THE City of El Segundo AUTHORIZED REPRESENTATIVE its officials, officers, agPllts es and employees Public works Departmentti 3 350 Main Street, rn E1 Segundo CA 90245 USA ©1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: RGD 500015008 COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 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 Person(s) Or Ornanization(s) Location(s) Of Covered Operations Any person or organization for whom the Named Insured All Locations has agreed to provide insurance prior to loss as provided by this policy but only to the limit and scope of insurance agreed to by the Named Insured. ** *Full name ofAdditional Insured Person(s) Or * * *Gocation(s) of'Covered Operations Organization(s) listed on the next page * ** listed on the next page * ** F ,7 Information reauired 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 ", "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. 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 required by the contract or agreement to provide for such additional insured. 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 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 2 C. 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 ame of Additional Insured Person(s) Or Organization(s): ity of El Segundo, its officials, officers, agents, and employees 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. cation(s) of Covered Operations: °e ice, ia11 operations at the City of El Segundo Page 2 of 2 © Insurance Services Office, Inc., 2012 CG 20 10 04 13 POLICY NUMBER: RGD5000150 -08 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) Or Organizations) Location And Description Of Completed Operations Any person or organization for whom the Named All locations Insured has agreed to provide insurance prior to loss as provided by this policy but only to the limit and / scope of insurance aqreed to by the Named Insured/ City of El Segundo, its officials, officers, agents, and employees �I, Service, All operations at the City of El Segundo 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 agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. CG 20 37 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 2 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 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 © ISO Properties, Inc., 2004 CG 20 37 0413 17 POLICY NUMBER: RGD 500015008 COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. 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: ** *Full name of Additional Insured Person(s) Or Organization(s) listed below * ** Where required by written contract or agreement executed prior to loss (except where permitted by law). (Information required to complete this Schedule, if not shown above will be shown in the Declaration) The following is added to Paragraph B. 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. City of El Segundo, its officials, officers, agents, and employees CG 24 04 05 09 Insurance Services Office, Inc., 2008 Page 1 of 1 ENDORSEMENT #009 This endorsement, effective 12:01 a.m., October 1, 2015 forms a part of Policy No. RGD 500015008 issued to ACCO ENGINEERED SYSTEMS, INC. by Greenwich Insurance Company. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, PRIMARY INSURANCE CLAUSE ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS /COMPLETED OPERATIONS COVERAGE PART It is agreed that to the extent that insurance is afforded to any Additional Insured under this policy, this insurance shall apply as primary and not contributing with any insurance carried by such Additional Insured, as required by written contract. All other terms and conditions of this policy remain unchanged. XIL 424 0605 ©, 2005, XL America, Inc. POLICY NUMBER: RAD 500014908 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM BUSINESS AUTO PHYSICAL DAMAGE 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 the endorsement. This endorsement changes the policy effective on inception date of the policy unless another date is indicated below. [lamed Insured: ACCO ENGINEERED SYSTEMS, INC. Endorsement Effective Date: October 1, 2015 SCHEDULE Name of Person(s) or Organization(s): Where required by written contract or agreement executed prior to loss (except where not permitted by law). Information required to complete this Schedule,, il` "not shown above, will be shown in All other terms and conditions remain the same. City of El Segundo, its officials, officers, agents, and employees CA 04 44 03 10 © Insurance Services Office, Inc., 2009. POLICY NUMBER: RAD 500014908 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 "insured" under the Who Is An Insured Provision of the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Endorsement Effective Date: October 1, 2015 Named Insured: ACCO ENGINEERED SYSTEMS, INC. .................... . . . . . . . . . . . . ............................................ . ....... SCHEDULE Name of Person(s) or Organization(s): Where required by written contract or agreement executed prior to loss. (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 extent that person or organization qualifies as an "Insured" under the Who Is An Insured Provision contained in Section II of the Coverage Form. City of El Segundo, its officials, officers, agents, and employees CA 20 48 02 99 ©Copyright, Insurance Services Office, Inc., 1998. WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 4 -84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different date is indicated below. (The following "attaching clause" need be completed only when this endorsement is issued subsequent to preparation of the policy.) This endorsement, effective on October 1, 2015 Policy No. RWD 500014808 of the XL Specialty Insurance Company issued to ACCO ENGINEERED SYSTEMS, INC. Premium (if any) $ Included at 12 01 A.M. standard time, forms a part of f' Endorsement No. 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 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 2% of the California workers' compensation premium otherwise due on such remuneration. Schedule Person or Organization Where required by written agreement signed prior to loss. City of El Segundo, its officials, officers, agents, and employees Job Description Service, All operations at the City of El Segundo WC 252 (4 -84) WC 04 03 06 (Ed. 4 -84) Page 1 of 1 © Copyright 1998 by the Workers Compensation Insurance Rating Bureau of California. All rights reserved,