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PROOF OF INSURANCE (2017) CLOSEDEXCEELE -02 MSANDY AI L ORO DATE (MM /DD/YYW') CERTIFICATE OF LIABILITY INSURANCE 5/10/2016 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 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). ---- - -___M WW. PRODUCER NAME: Certificate Department c.Mll. 5940. _..,._... _ _.. 4Oa3 Ridge Insurance Suite 1'50c Etl, .... fl nal Q703) 991 -4838 703 667 ADDRESS- CertS{,p preferins.com .... . "., INSURER�S'�AFFORDING COVERAGE .... _ ....._ NAIC # wsURERA:The Hartford Fire Insurance Company 19682 ..... --- -_- .....--- --- _...... INSURER B: National tional UnlOn Fire Ins CO _ 19445 Excelsior Elevator Corporation ....w"...... �. . _ ey, m _ 10900 P wsuRERC:Preferred Employers Insurance Company _ 1961 Blair Avenue INSURER D SantaAna, CA 92705 _ ..... ....................�.......... ..... ...... _..... ....................... INSUR ._ ER E : ..........— ......... ------- _ ............ ............. ....__..m..,..,. INSURER F: COVERAGES C CERTIFICATE N . . .. . NUMBER: R REVISION NUMBER: THIS I IS TO CERTIFY THAT THE POLICIES O OF I INSURANCE L LISTED BELOW HAVE BEEN I ISSUED T TO THE INSURED N ..... _ INDICATED. N NOTWITHSTANDING ANY REQUIREMENT, T TERM OR CONDITION OF ANY C CONTRACTOR O OTHER D DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE M MAY BE ISSUED OR MAY P PERTAIN, T THE INSURANCE AFFORDED BY T THE POLICIES D DESCRIBED H HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS A AND CONDITIONS OF SUCH P POLICIES, L LIMITS SHOWN MAY HAVE BEEN R REDUCED BY P PAID CLAIMS. NSA K TYPE OF INSURANCE , KOUL`SUER . min P .._... ,,,.... , 1' MLICY yy P PMIDDI EXP ,,. ................ A X X COMMERCIAL GENERAL LIABILITY . _saw M ..�._..._ " " " "�� -� mm,m CLAIMS -MADE 0 OCCUR X X X X 1 13UENOJ6536 0 04/01/2016 0 04/01/2017 � �CTC IFITtC 300 0 C?kC Mf,E (iC carc rrrarara)" $.. __._ -_, ' ........ ..,. " .. ................. M MED EXP (Anv one ,person) $ 10,0 ... ..- .......... _ _.�,,.... ........' P PERSONAL 8 ADV INJURY . GEN'L AGGREGATE LIMIT APPLIES PER: G GENERAL AGGREGATE DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) City, its officials, and employees are Additional Insured with respect to General Liability for ongoing and completed operations, regarding all work orrl'tltd by the named insured. A Waiver of Subrogation applies in favor of the Additional Insured with regard to General Liability and Worker's 1pensation. Excess Liability Follows form. Primary & non - contributory wording applies to General Liability as required by written contract. 30 Days Collation. \ CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of El Segundo City Street ACCORDANCE WITH THE POLICY PROVISIONS. 350 El Segundo, CA 90245 -3813 n 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: 13UENOJ6536 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 M1601PA ilklPFAA060 This endorsement modifies insurance provided under the following COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Oraanization(s) Information required to complete this Schedule, if not shown 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 1. Your acts or omissions; or respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 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: The insurance afforded to such additional insured only applies to the extent permitted by law; and 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. Location(s) Of Covered Nny location within the ° coverrege teirritory " A will be shown in the Declarations. U. With respect to the insurance attorded to additional insureds, the following additional exclusions apply: furnished in connection with such work, on the This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equipment 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 0 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 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 2010 0413 POLICY NUMBER: 13UENOJ6536 COMMERCIAL GENERAL LIABILITY CG 20 37 0413 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 Oraanization(s) Location And Description Of Completed required to complete this Schedule, if not shown 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 "prod ucts- completed operations hazard ". However: The insurance afforded to such additional insured only applies to the extent permitted by law; and 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. y Vocation within the "coverage territory" and 0 cornpVeted operations be shown in the Declarations. 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. CG 20 37 0413 0 Insurance Services Office, Inc., 2012 Page 1 of 1 13UENOJ6536 O, GDVl: iF�AG" VS IS)".uO D AS AN An I�HE8 C II RV"iIG-K'1 " E OF MS�eJFryANC;t:. Aii..l.�y�;l-IEU R....N�:�. =��'�N .. I..�.:::� l Nla� I _N.i��~aAC, F IS 0� uud��,..i_.T.i d t OF: irwENIFC:aR AT.ION C;CM_Y M-, 0 C(.)N0=P::.RS NO RIGH FS i*"t:mJN ,II N E, KIA i E @- (Y M"R, 1-II.i4S) t.;"gw.pu_I�m�p���CC t.. I.�O S V"� OT �moi�_�t�_BP i/1 ..1.6' Im:a,_C OF' d 4N II."�: �:p..t.AO 'W,F II.°:: II.._.. II d�N�IR.. i'+ ���1D, P�� '�Nmmpp1 ^I_.Nryry?.,yynNN_XTF,C(�U}}i. T1yE�f��C�"d::y.pty,A(3c . -::AqI V ���i��>pI^II.�[Il:pY H(fI. a " /�B,..V�,ul..;ry:). pllp -II Y�y:I,p.�.Nn��...i_ OF Bl"A�Y4,FZP"��l'�V0..A�_. II_C'OJ .S N()'I... CfM.,. N:D .I.... �X. �... 4..) 0 V.pp. r"�'bk C'�y�.NV\H I':"Z.AC I 4�Im..II�'f�f�., ,�,'. 0 11 ��0.��,... /V JTiHi')Ma'6m.. _) REt :rW_Sa[_.`!,4_DA.N'q`v`liw` OR t.F_,' 1_JUd::;f I'. , VF "Vi3'A'fF HOLDER' (7)When You Add Others As An Additional Insured To This Insurance Any other insurance available to an additional insured. However, the following provisions apply to other insurance available to any person or organization who is an additional insured under this coverage part. (a) Primary Insurance When Required By Contract This insurance is primary if you have agreed in a written contract or written agreement that this insurance be primary. If other insurance is also primary, we will share with all that other insurance by the method described in c. below. (b) Primary And Non - Contributory To Other Insurance When Required By Contract If you have agreed in a written contract, written agreement, or permit that this insurance is primary and non - contributory with the additional insured's own insurance, this insurance is primary and we will not seek contribution from that other insurance. Paragraphs (a) and (b) do not apply to other insurance to which the additional insured has been added as an additional insured. When this insurance is excess, we will have no duty under Coverages A or B to defend the insured against any "suit" if any other insurer has a duty to defend the insured against that "suit ". If no other insurer defends, we will undertake to do so, but we will be entitled to the insured's rights against all those other insurers. When this insurance is excess over other insurance, we will pay only our share of the amount of the loss, if any, that exceeds the sum of: (1) The total amount that all such other insurance would pay for the loss in the absence of this insurance; and (2) The total of all deductible and self- insured amounts under all that other insurance. We will share the remaining loss, if any, with any other insurance that is not described in this Excess Insurance provision and was not bought specifically to apply in excess of the Limits of Insurance shown in the Declarations of this Coverage Part. POLICY NUMBER: 13UENOJ6536 COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO CIS 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: APPLICABLE ONLY TO ANY PERSON OR ORGANIZATION WHERE THERE IS A WRITTEN CONTRACT /AGREEMENT IN EFFECT. 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 E3 AC if CERTIFICATE OF LIABILITY INSURANCE DATE(MMJDDfYYYYI 04/29/2016 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(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 endorsement(s). IWDInsurance Centex PITt tae, PH fE exit.626-447-8068 .. �I, 626- 447 -6068 4115 E LIVE OAK 'AVENUE ...... _mw SUITE 4 INShIRN R S AFFMDING COVERAGE NAIC # ARCADIA CA 91006 _ m t InsuraNU RERo ol an INSURED R D Excelsior Elevator Corp. .... _ .... .... ...... ............................... ------ I P INSURER D. _ 1961 Blair Avenue. INSURER E; Santa Ana C% 92705 tN91IRERI COVERAGES CERTIFICATE NUMBER- THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOtiti 14AVE BEEN ISSUED TO THE INSUR 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 DESCRIBE EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIM; TYPE OF INSURANCE COMMERCIAL GENERAL LIABILITY mJ CLAIMS-MADE EJ OCCUR rW-.N L AGGREGATE LIMIT APPLIES µµµµµµX gI PER .. Poucy � ] ECT 71j LOC [AUTOMOBILE LIASIUTY CVA4003833 06111115 06/11/ ANY AUTO JI' ALL OWNED " SCHEDULED ][ A AUTOS � AUTOS ° I HIRED AUTOS I AUTOSWtJED p LfT05 IStiIV. C µ I UMBRELLA LIAB ..I " I OCCUR a EXCESS LIAB CLAUMSAIAOE AND EMPLOYERS' LIABILITY YIN NIA DESCRIPTION OF OPERATIONS! LOCATIONS! VEHICLES (ACORD lot, Addltlonal Remarks Schedule, may be attached If more space is requi City of El Segundo - Public Works is additional insured pe, 30 days notice of cancellation. All terms and conditions actual policy forms. TIFICA CANCELLATION 2PETIM4z ED NAMED-ABOVE FOR THE POLICY PERIOD DOCUMENT WITH RESPECT TO WHICH THIS D HEREIN IS SUBJECT TO ALL THE TERMS, LIMITS r EA CH OCCURRENCE PR MI :S e urrencel S MED EXP (Arty ale Wsm) S ._ $ ,..,.. I PERSONAL &AD V INJURY y_ GENERAL AGGREGATE r$ PRODUCTS - COMPIOPAGG $ q S 1,000,000 BODILY IN JURY (Per person) $ I"St4„Y I a INJURY (Per accdent)" ,$ _ �yy �y.VplpkAldAiiE ......... ....w.w.. A.E"�I5'6 �IIEII� . .............�...... ... ...,... w,ww IAC9 °q'O_CCU_RRENCE S 6uGGRC:I"aAkTC . � .................... ��s �.............�,,.._. �, w _.._.m......._._...... _....... I.. 6 E, L, EACH ACCIDENT S E.L.OISEASE•EAEMPL(YYEE S .LL DISEASE . P UCY LIMIT' i$ ad) form CWI -2018 05/00, are based upon the City of El Segundo - Public Works SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 350 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATNE E1 Segundo, CA 90245 © 1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 26 (2014101) The ACORD name and logo are registered marks of ACORD Preferred Epployers INSURANCE CrbMPAHY WC 99 07 00 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT — BLANKET 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 for which you perform work under a written contract that requires you to obtain this agreement for us. The premium charge for this endorsement shall be 3% of the Worker's Compensation premium, subject to a minimum charge of $500.00 This endorsement changes the policy to which it is attached effective on the date issued unless othervAse stated. (The Information below Is required only when this endorsement Is issued subsequent to preparation of the policy.) Endorsement Effective 04/01/16 Policy No. WKN146402 -4 Endorsement No. 2 Insured EXCELSIOR ELEVATOR CORPORATION Insurance Company PREFERRED EMPLOYERS INSURANCE COMPANY Countersigned By Authorized V19resentative