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PROOF OF INSURANCE (2013) CLOSEDPolicy Number: 0400700895 Date Entered: 2/16/2012 A CERTIFICATE OF LIABILITY INSURANCE DATE(MMDDIYYYY) 2/16/2012 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 NA Pe E.. arl M Camarena Mary Barnard Insurance PHONE - ` F„ ... 2190 Stokes Street y (408%286 -1334 t�e]: (408) 286 6425 CATL Suite 01 IINSAMIfkIG"R(S) Al! I'L'111AIpVNT�I CI4'�IrIITACSE NRIG p San Jose CA 95128 INSU1' RA IN SPECIALTY INSURANCE COMPANY INSURED Ranae Maintenance Services, L.L.C„ RD. John and Donna Foggiato P. O. Box 2270 Arnold, CA 95223 I4VSURA•,n•,F4 C INSURER D : NN'SMIRER E' ; 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, tlu TYPaOFINSU E 9ADDC'SUBRI _. POUOYNUMDER� fWhauc 0— -15 UC'r*P V._ LIMITS T MWDMYY I GENERAL LIABILITY aamlLuTY 0400700695 MAI tNr] r 6 1000 ^r,,�E I 1 000 00 'a' �^�,„� CO"�ICLAI MI'S- -MADT. R`AI D1 /2rJ,J2012 1.,/ZdS /2013 MEOE P IA &ADV INJURY $1,000,000 000 I�i OC�uaea �..,._ oneParsarat s _ 100 .. s GENERAL AGGREGATE i PERSONAL GOREGATE GEHL ArjGRFG"ATL. LUAd APPLASPIEW C PROOUCIS- COMPIOPAGG SINCL L7�r'D PftO ) � _.. �. �es _e Lam' f LqC POLICY T —... cW....._... .........- .............._...... ........ LIABILITY COMbIN 15VAUCEUMO LA - BODILY INJURY (Per person) s D SCHEDULED BBOpILYINJURY PeracGdent 5 ( ]OS ,.. AUT05 4 r RDP.f1.'a ACE ..� w S _. NON -OWNED Pgrac,aelp °]]b .. „ UMBRELLA GESS LIAB,. . _,.. OCCUR �,,........ ..........�.., o- i i EACI I CM",CUfARENCE t G LIA AI ArIE Aru4`RIMPATE R�rENTIO.�.. - ._����.. D RS COMPENSATION $ E' S _ ..,..— ......;.......... ....s. WC 9'T'A qq LP pp.07, 0 AND ICERIMEMBER EXCLUDED? E I NIA f i. T. TORY LMCMCII Nr.._.I.„ RWS. , WORKERS (Mandatory I H AE EA EMPLOYEE b„ YIN ANY OPRIETOR/PARTNERlEKECUTIVE I E I E.A,f Mandato in NH f E L OISEAS ...IIf yes, describe under 66 .. DESCRIPTION OF OPERATIONS below 1 g i EL DISEASE - POLICY LIMIT 4 S l DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES tAttach ACORD 101, Additional Remarks Schedule, If more space is required *TEN DAYS NOTICE OF CANCELLATION APPLIES FOR NON - PAYMENT OF PREMIUM, 30 DAYS FOR ALL OTHER, CERTIFICATE HOLDER IS NAMED AS ADDITIONAL INSURED AS PER ADDITIONAL INSURED ENDORSEMENT FORM NUMBER CG 20 10 07 04 ATTACHED. CERTIFICATE HOLDER CANCELLATION CITY OF EL SEGUNDO, CITY CLERK ATTN: BRIAN EVANSKI 350 MAIN STREET EL SEGUNDO, CA 90245 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED ©1888 -20' ACORD 25 (2010105) The ACORD name and logo are registered marks of AC Produced using Forms Bass Pius software.. wwl`ormsBoss.com; Impressive Publish; BM -208 -1977 &.44 a, RD CORPORATION. All rights reserved. POLICY NUMBER: 0400700895 COMMERCIAL GENERAL LIABILITY CG 2010 02 04 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 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" "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) desig- nated above. B. With respect to the insurance afforded to these additional insureds, the following additional exclu- sions apply; This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equip- ment 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 in- tended use by any person or organization other than another contractor or subcontractor en- gaged in performing operations for a principal as a part of the same project, ,a v CG 20 10 07 04 Q 150 Properties, Inc., 2004 Page 1 of 1 L Policy Number: BAP0165200 Date Entered: 11/10/2011 CERTIFICATE OF LIABILITY INSURANCE DATE 1/101 /2011 11/10/2011 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 NAME.' PEARL M. CAMARENA Mary Barnard Insurance 2190 Stokes Street Suite 201 San Jose CA 95128 INSURED Range Maintenance Services, L „LoC. John and Donna Foggiato P. O. Box 2270 Arnold, CA 95223 P �408) 286 .1334A,rNl (408) 286 6425 EMAIL � WC q'V'ATU _ 01 fl, p TO.RYV..D'vIITS e _� ER �. .... _... APPR �; VNSU-R'ER(SJAFFORDINGCOVERAGE! NAIC# IN5URERA:CENTURY NATIONAL INSURANCE COMPAWE INSURER B : E L DIaFASF:. EA iVPLCYYr'F $ .._ INSU RE R C EL OtSEA"aE POLICY LIMIT S ,. ..�....._......a....m......_._ �....._........_.� INSURER 0: INSURER E: 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. m..._ _ INSR GENERAL LIABILITY OF INSURANCE .�. , _.._ PO'IDD yy vl 06g, OlynXY i POLICY NUMBER M�pMdDDCYYI!Y tlI�MIYOli9dYYYYN,j,,,,. LIMITS 4 EACH OCCURRENCE 3 ' d Q)AMAGE TCJ RENTED” <X Val.:RC1A1 r E f q: PIAI E IY.V,N I't i' PREMiSEer_LEa.occurrence)_. yyy, 0 _AdAdV Iflrk'lf' rai ?GUN ° � ? � 02V V➢II WV"tlAonlp L�urrn Fvir�u:uip S .. @ 1 111 "1 RS(XIIA N YA0V VV d 11LII'Y GENERAL AGGREGATE f S LnI: 14 L AGGREGATE LIMIT APPLIES PER PRODUCTS . COMPIOP AGG PIiV7; $ POLICY LOG U .._,� I.. MBVNEOSIN EL3 V' AYA ELIABILITV I I Ae de t) X1,000,000 AUTOMOBILE BODILY INJURY (Per person) ,S ALLOWNED SCHEDULED BODILY INJURY (Per accident) S AUTOS AUTOS NON- O%NNED iSAP ©165200 �tLp2� /2aar °Ld211/2012, u'mowual ll lluY DAIWAUE HIRED AUTOS ...._ 13ev ruraldent� „ S AUTOS (_ ) _ UMBRELLA LIAB OCCUR 1 I EACH OCCURRENCE a EXCESS LIAR CLAIMS-MADE' RETENTION $ r —..ODED ..- ,..,. M COMPENSATION nON � WC q'V'ATU _ 01 fl, p TO.RYV..D'vIITS e _� ER �. .... _... Y 1 N AND EMPLOYEDRAR �; ANY PRC;,)Nq 'NrRdtl"YGfCur]VE ¢ I; f E L EACH ACCIDENT S. '^- G'F ICa:B�I,Ifl, 0811EX'CLUM NIA! _. C Y (M.and�illo'ry in NH) I I j E L DIaFASF:. EA iVPLCYYr'F $ .._ um drtr 0.4 yes' dlescdtlle Mr`OPIwkGAPUONSbrdB a ) .... .._....v....... ..... _. ................. — .L. .,........ EL OtSEA"aE POLICY LIMIT S ,. ..�....._......a....m......_._ �....._........_.� 1 DESCRIPTION OF OPERATIONS / LOCATIONS i VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) TY OF EL SEGUNDO, CITY CLERK ARE NAMED AS ADDITIONAL INSURED AS PER ADDITIONAL INSURED ENDORSEMENT CERTIFICATE HOLDER CANCELLATION ATTENTION: 1 E 1 CITY OF EL SEGUNDO — CITY CLERK 350 MAIN STREET IV EL SEGUNDO, CA 90245 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED `. ©1988 -2010 OR'D CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACO Praduced using Forrns Boss Plus sofWare. unwr.FormsBoss -com; Impressive Publishing 800 -208 -5977 CENTURY NATIONAL INSURANCE COMPANY POLICY NO.: BAP0165200 BUSINESS AUTO POLICY - ENDORSEMENT PAGE: 1 CONTRACTORS BROT[ER NO.; 122800 POLICY PERIODr Policy covers FROM 12:01 AM ON 11124/2011 TO 11/24/2012 ENDORSEMENT NO.; 16 ENDORSEMENT EFFECTIVE DATE : 11/24/2011 FROM 12101 AM INSURED: BROKER: RANGE MAINTENANCE SVCS LLC CHAIX & ASSOC INS BROKERS INC JOHN & DONNA EOGGIATO DBA PO BOX 2270 41 CORPORATE PARK STE 310 ARNOLD CA 95223 IRVINE CA 92606 -5181 ADDITIONAL INSURED ENDORSEMENT CN613 5/99 IT IS AGREED THAT INSURANCE AFFORDED BY THE ABOVE POLXCY SHALL APPLY TO THE PARTY(S) NAMED BELOW, AS THEIR INTEREST MAY APPEAR BUT SHALL NOT OPERATE TO INCREASE THE LIMITS OF THE COMPANY'S LIABILITY. ANY ADDITIONAL INSURED LANGUAGE ON A CERTIFICATE OF INSURANCE IS VOID. The additional insured named below is only an insured for liability which is the result of an act or omission of the "NAMED INSURED" of the policy and shall have no coverage under this endorsement or the policy for its own acts or omissions, those of its agents or employees, or those of any other person or entity for which it is vicariously liable, save for acts of omissions of the "NAMED INSURED" of the policy. Further, any insurance provided by this endorsement shall be excess insurance to all other insurance available to any person or entity who becomes an insured by reason of this endorsement whether the other insurance be primary or excess and whether or not the other insurance be collectible. In the event the other insurer has a duty to defend any person or entity added to our policy by reason of this endorsement, we will have no duty to defend that person or entity however, we may elect to do so, and, if we do, we will be entitled to the rights of any person or entity we do defend against the other insurer, r By. k:orix.Mf c'• p r � esent ativa ADDITIONAL INSURED CITY OF EL SEGUNDO CITY CLERK ATTN BRIAN EVANSKI 350 MAIN STREET EL SEGUNDO CA 90245 Date Printed : 11/07/2011 CHRIS LANTELLO CENTURY NATiONIAL INSURANCE CONIPANY POLICY NO.: BAP0165200 BUSINESS AUTO POLICY - ENDORSEMENT PADS; 1 CONTRACTORS BROKER NO.; 122800 POLICY PERIOD: Policy covers PROM 12:01 AN ON 11/24/2011 TO 11/24/2012 ENDORSEMENT NO.: 15 ENDORSEMENT EFFECTIVE DATE : 11/24/2011 FROM 12:01 AM INSURED: BROKER: RANGE MAINTENANCE SVCS LLC CHAIR & ASSOC INS BROKERS INC JOHN & DONNA FOGGIATO DBA PO BOX 2270 41 CORPORATE PARK STE 310 ARNOLD CA 95223 IRVINE CA 92606 -5181 ALTERED CERTIFICATE ENDORSEMENT IN CONSIDERATION OF THE ADDITIONAL PREMIUM LISTED BELOW, CENTURY - NATIONAL INSURANCE COMPANY AGREES TO ISSUE A CERTIFICATE, REQUIRED BY AN ENTITY DOING BUSINESS WITH THE INSURED THAT IS NOT A STANDARD CERTIFICATE FORM. (OR AGREES TO ISSUE AN ACORD CERTIFICATE WITH ITS STANDARD LANGUAGE DELETED OR ALTERED). TO THE ENTITY LISTED BELOW. BECAUSE THIS IS NOT A STANDARD CERTIFICATE AND GENERATES ADDITIONAL PROCESSING TIME, THERE IS A FEE FOR THIS CERTIFICATE AS SET OUT BELOW. CN684 (1/01) CERTIFICATE HOLDER /PREMIUM CITY OF EL SEGUNDO CITY CLERK ATTN BRIAN EVANSKI 350 MAIN STREET EL SEGUNDO CA 90245 ALL OTHER TERMS AND CONDITIONS OF THIS POLIC F. � AUTHOR ZLD RESEtiTATIV'E Date Printed : 11/07/2011 CHRIS LANTELLO POLICYHOLDER COPY NG P_0, BOX 420807, SAN FRANCISCO,CA 94142 -0807 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 05 -31 -2012 CITY OF EL SEGUNDO NO CITY CLERK 350 MAIN ST £L SEGUNDO CA 90245 -3$13 GROUP: POLICY NUMBER: 1750432-2011 CERTIFICATE IQ: 57 CERTIFICATE EXPIRES: 11 -01-2012 11- 01- 2011!11 -01 -2012 This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy Is not subject to cancellation by the Fund except upon 30 days advance written notice to the employer,. We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter tho coverage afforded by the policy listed herein. NotwithstandinV any requirement, term or condition of any contract or other document with respect to which this certificate of Insurance may be issued or to which it may pertain, the insurance afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy. f 4"e— 6`A,thori.ed Representative President and CEO EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT #0015 ENTITLED ADDITIONAL INSURED EMPLOYER EFFECTIVE 2012 -05 -31 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. NAME OF ADDITIONAL INSURED: CITY OF EL SEGUNDO - ENDORSEMENT #1801 - JOHN FOGGIATO, MGR -MEM - EXCLUDED. ENDORSEMENT #1901 - DONNA RAE FOGGIATO, MGR -MEM - EXCLUDED. ENDORSEMENT #2085 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 11 -01 -2004 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. ENDORSEMENT #2570 ENTITLED WAIVER OF SUBROGATION EFFECTIVE 2012 -05 -31 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. THIRD PARTY NAME: CITY OF EL SEGUNDO EMPLOYER RANGE MAINTENANCE SERVICES, LLC NO PO BOX 2270 ARNOLD CA 95223 [B10,NGj PRINTED : 05 -31 --2012 tr+f: v,8.20 tai