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PROOF OF INSURANCE (2016) CLOSEDClient #: 396700 WESCOSIG ACORD. CERTIFICATE OF LIABILITY INSURANCE C�TE 0 7 /20D/YYYY) /07/2016 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 _-.____. r........m.... -- ODITIONAL INSURED„ the policy('ies) must be endorsed. If SUBROGATION IS WAIVED, stab)ect 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' Karina Sefilian USI Insurance NAME: ..T Lic # OG11911 Services LLC -SCL (A/C. No EXa 8 251 -3013 CN�i 484 652 -5418 (A/c 21700 Oxnard Street, Suite 1200 ass,, karina.sefilian@usi.biz kan INSURER(S) AFFORDING COVERAGE NAIC # Woodland Hills, CA 91367 INSURER A: Ohio Security Insurance Company ... ' y p ny 24082 IN8UR......... Si nco .L... ..... - - -- .._ ................ ... .. American�Fire & . .........lty - - - - -- ED INSURER C : INSURER B: Casualty CO 24066 g Inc. Dba: Wesco Signs Wesco Signs, Inc. __...,._ ,. __...,..__. 2413 Amster Street INSURER D Torrance, CA 90505 INSURER E 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 CONTRACTOR 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. LTft ...... �IN 4R 5U R� POLICY EFF ,z.POLICY.E YP .... 5. ONSR TYPE OF INSURANCE AD DL 5 n POLICY NUMBER 1MM/DD/YYYYI IMM /oorvv I LIMIT _ A X COMMERCIAL GENERAL LIABILITY BKS56469691 1411512015 04115/201 EACH OCCURRENCE $1.000.000 DAMAGE TO RENTED CLAIMS -MADE X. OCCUR PREMISES (Ea occurrencP1 $500.000 _ . _.,........e.,.., .. ................ __�. MED EXP (Any one person) $15.000 PERSONAL & ADV INJURY $11000.000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 .. � � _]... _....,,,,. .... ........ . ------ . _ .... _ ........ ... . .$ 000 ., ,.. POLICY PRO- ECOT X LOC PRODUC _ OTHER: . .. TS COMP ....... .. _. AUTOMOBILE LIABILITY Comm m D SPN'C:;I t LIMIT A BAS56469691 4/15/2015 04/15/201 y�Jlaraswalnt} $1,000,000 _ ANY AUTO BODILY INJURY (Per person) .............. I. __ A O SCHEDULED (Per accent) AUTOS BODILY INJURY P id AUTOS ( $ X NON -OWNED PROPER'rY iDAMAGfl: $ HIRED AUTOS X ANON-OWNED (Pea [ncu•1dmn9l B , , X EXCESS L ABIAB---- OCCUR LAIMS -MADE , .,....... ESA...... -- ----.._ ..... .. 56469691 4/15/2015 04/15/201 EACH OCCURRENCE s5.000.000 AGGREGATE s5.000.000 DED X RETENTION $O $ iN__..R -------- ,m........... ....- ...... ......... ..............._,. , ............. ........ .. ...... WORKERS COMPENSATION PER 0TH AND EMPLOYERS' LIABILITY �CTATI ITF FR ANY PROPRIETOR/EXCLU R/EXECUTIVE E L EACH ACCIDENT $ OFFICER/MEMBEREXCLUDED? � ��,� N/A �,• -�� •���� ->> - .,.. -.. (Mandatory in NH) E,L. DISEASE - EA EMPLOYEE $ If yes, describe under "" -- " ""."'�' DESCRIPTION OF OPERATIONS below E.L. DISEASE- POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: El Segundo Police Department/348 Main Street, El Segundo, CA 90245 City of El Segundo - Public Works Department its Officials and Employees are included as Additional Insured's per attached form #CG8810 (04/13). Primary and Non - Contributory applies to General Liability. Additional Insured status is valid only if a written contract/agreement is required of the insured and is in effect. CERTIFICATE HOLDER CANCELLATION City of El Segttnd0-Public Works SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Department �, ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street El Segundo, CA. 902455 AUTHORIZED REPRESENTATIVE ©1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) 1 of 1 The ACORD name and logo are registered marks of ACORD #S17630530/M17361478 SZKJA COMMERCIAL GENERAL LIABILITY CG 88 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. COMMERCIAL GENERAL LIABILITY EXTENSION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 1 INDEX SUBJECT PAGE NON -OWNED AIRCRAFT 2 NON -OWNED WATERCRAFT 2 PROPERTY DAMAGE LIABILITY — ELEVATORS 2 EXTENDED DAMAGE TO PROPERTY RENTED TO YOU (Tenant's Property Damage) 2 MEDICAL PAYMENTS EXTENSION 3 EXTENSION OF SUPPLEMENTARY PAYMENTS — COVERAGES A AND B 3 ADDITIONAL INSUREDS — BY CONTRACT, AGREEMENT OR PERMIT 3 PRIMARY AND NON - CONTRIBUTORY — ADDITIONAL INSURED EXTENSION 5 ADDITIONAL INSUREDS — EXTENDED PROTECTION OF YOUR "LIMITS OF INSURANCE" 6 WHO IS AN INSURED — INCIDENTAL MEDICAL ERRORS /MALPRACTICE AND WHO IS AN INSURED — 6 FELLOW EMPLOYEE EXTENSION — MANAGEMENT EMPLOYEES NEWLY FORMED OR ADDITIONALLY ACQUIRED ENTITIES 7 FAILURE TO DISCLOSE HAZARDS AND PRIOR OCCURRENCES 7 KNOWLEDGE OF OCCURRENCE, OFFENSE, CLAIM OR SUIT 7 LIBERALIZATION CLAUSE 7 BODILY INJURY REDEFINED 7 EXTENDED PROPERTY DAMAGE 8 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US — 8 WHEN REQUIRED IN A CONTRACT OR AGREEMENT WITH YOU © 2013 Liberty Mutual Insurance CG 88 10 04 13 Includes copyrighted material of Insurance Services Office, Inc., with its permission, Page 1 of 8 24819686 1 56469691 1 15 -16 Master Certificate I Alyssa Anderson 1 5/26/2015 4:44:09 PM (PDT) I Page 4 of 12 b. The last paragraph of subsection 2. Exclusions is replaced by the following: Exclusions c. through n. do not apply to damage by fire, lightning, explosion, smoke or leakage from automatic fire protection systems to premises while rented to you or temporarily occupied by you with permission of the owner. A separate limit of insurance applies to Damage To Premises Rented To You as described in Section III — Limits Of Insurance. Paragraph 6. under Section III — Limits Of Insurance is replaced by the following: 6. Subject to Paragraph S. above, the Damage To Premises Rented To You Limit is the most we will pay under Coverage A for damages because of "property damage" to: a. Any one premise: (1) While rented to you; or (2) While rented to you or temporarily occupied by you with permission of the owner for damage by fire, lightning, explosion, smoke or leakage from automatic protection systems; or b. Contents that you rent or lease as part of a premises rental or lease agreement. 3. As regards coverage provided by this provision D. EXTENDED DAMAGE TO PROPERTY RENTED TO YOU (Tenant's Property Damage) - Paragraph 9.a. of Definitions is replaced with the following: 9.a. A contract for a lease of premises. However, that portion of the contract for a lease of premises that indemnifies any person or organization for damage by fire, lightning, explosion, smoke, or leakage from automatic fire protection systems to premises while rented to you or temporarily occupied by you with the permission of the owner, or for damage to contents of such premises that are included in your premises rental or lease agreement, is not an "insured contract ". E, MEDICAL PAYMENTS EXTENSION If Coverage C Medical Payments is not otherwise excluded, the Medical Payments provided by this policy are amended as follows: Under Paragraph 1. Insuring Agreement of Section I — Coverage C — Medical Payments, Subparagraph (b) of Paragraph a. is replaced by the following: (b) The expenses are incurred and reported within three years of the date of the accident; and F. EXTENSION OF SUPPLEMENTARY PAYMENTS — COVERAGES A AND B Under Supplementary Payments — Coverages A and B, Paragraph 1.b. is replaced by the following: b. Up to $3,000 for cost of bail bonds required because of accidents or traffic law violations arising out of the use of any vehicle to which the Bodily Injury Liability Coverage applies. We do not have to furnish these bonds. 2. Paragraph 1.d. is replaced by the following: d. All reasonable expenses incurred by the insured at our request to assist us in the investigation or defense of the claim or "suit ", including actual loss of earnings up to $500 a day because of time off from work. G. ADDITIONAL INSUREDS - BY CONTRACT, AGREEMENT OR PERMIT 1. Paragraph 2. under Section II — Who Is An Insured is amended to include as an insured any person or organization whom you have agreed to add as an additional insured in a written contract, written agreement or permit. Such person or organization is an additional insured but 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 the acts or omissions of those acting on your behalf, in the performance of your on going operations for the additional insured that are the subject of the written contract or written agreement provided that the "bodily injury" or "property damage" occurs, or the "personal and advertising injury" is committed, subsequent to the signing of such written contract or written agreement; or © 2013 Liberty Mutual Insurance CG 88 10 04 13 Includes copyrighted material of Insurance Services Office, Inc., with its permission, Page 3 of 8 4611:ar13t; � 564e96911 1 i. -a.c master Cex:tnkxcate I Alyssa. Anderson I 5/2r > >/2015 4,44:09 PM (G:ULI I Page G of 1.2 b. Premises or facilities rented by you or used by you; or C. The maintenance, operation or use by you of equipment rented or leased to you by such person or organization; or d. Operations performed by you or on your behalf for which the state or political subdivision has issued a permit subject to the following additional provisions: (1) This insurance does not apply to "bodily injury", "property damage ", or "personal and advertising injury" arising out of the operations performed for the state or political subdivision; (2) This insurance does not apply to "bodily injury" or "property damage" included within the .,completed operations hazard ". (3) Insurance applies to premises you own, rent, or control but only with respect to the following hazards: a) The existence, maintenance, repair, construction, erection, or removal of advertising signs, awnings, canopies, cellar entrances, coal holes, driveways, manholes, marquees, hoist away openings, sidewalk vaults, street banners, or decorations and similar exposures; or (b) The construction, erection, or removal of elevators; or (c) The ownership, maintenance, or use of any elevators covered by this insurance. 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 Paragraph 1.a. above, a person's or organization's status as an additional insured under this endorsement ends when: (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. With respect to Paragraph 1.b. above, a person's or organization's status as an additional insured under this endorsement ends when their written contract or written agreement with you for such premises or facilities ends. With respects to Paragraph 1.c. above, this insurance does not apply to any "occurrence" which takes place after the equipment rental or lease agreement has expired or you have returned such equipment to the lessor. The insurance provided by this endorsement applies only if the written contract or written agreement is signed prior to the "bodily injury" or "property damage ". We have no duty to defend an additional insured under this endorsement until we receive written notice of a "suit" by the additional insured as required in Paragraph b. of Condition 2. Duties In the Event Of Occurrence, Offense, Claim Or Suit under Section IV — Commercial General Liability Conditions. © 2013 Liberty Mutual Insurance CG 88 10 04 13 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 4 of 8 22619685 1 56469691 1 1>...16 Master C— Li£icate I Al.y.ssa Anderson 1 5/26/2015 4:42:09 IPM (PUE) I Page 7 of 12 2. With respect to the insurance provided by this endorsement, the following are added to Paragraph 2. Exclusions under Section I - Coverage A - Bodily Injury And Property Damage Liability: This insurance does not apply to: a. "Bodily injury' or "property damage" arising from the sole negligence of the additional insured. b. "Bodily injury' or "property damage" that occurs prior to you commencing operations at the location where such "bodily injury" or "property damage" occurs. C. "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: (1) The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or (2) 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. d. "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. e. Any person or organization specifically designated as an additional insured for ongoing operations by a separate ADDITIONAL INSURED — OWNERS, LESSEES OR CONTRACTORS endorsement issued by us and made a part of this policy. 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: a. Required by the contract or agreement; or b. 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. H. PRIMARY AND NON - CONTRIBUTORY ADDITIONAL INSURED EXTENSION This provision applies to any person or organization who qualifies as an additional insured under any form or endorsement under this policy. Condition 4. Other Insurance of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS is amended as follows: The following is added to Paragraph a. Primary Insurance: If an additional insured's policy has an Other Insurance provision making its policy excess, and you have agreed in a written contract or written agreement to provide the additional insured coverage on a primary and noncontributory basis, this policy shall be primary and we will not seek contribution from the additional insured's policy for damages we cover. © 2013 Liberty Mutual Insurance CG 88 10 04 13 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 5 of 8 2481.9666 1 564696.97.. 1 :1..5 -1G IW.a ter Cort:[fr.Cate I Al.yaza Anderson 1 5(26/207.5 4:44:09 PM (PDT) I Page 8 of 12 b. The following is added to Paragraph b. Excess Insurance: When a written contract or written agreement, other than a premises lease, facilities rental contract or agreement, an equipment rental or lease contract or agreement, or permit issued by a state or political subdivision between you and an additional insured does not require this insurance to be primary or primary and non - contributory, this insurance is excess over any other insurance for which the additional insured is designated as a Named Insured. Regardless of the written agreement between you and an additional insured, this insurance is excess over any other insurance whether primary, excess, contingent or on any other basis for which the additional insured has been added as an additional insured on other policies. ADDITIONAL INSUREDS - EXTENDED PROTECTION OF YOUR "LIMITS OF INSURANCE" This provision applies to any person or organization who qualifies as an additional insured under any form or endorsement under this policy. The following is added to Condition 2. Duties In The Event Of Occurrence, Offense, Claim or Suit: An additional insured under this endorsement will as soon as practicable: a. Give written notice of an 'occurrence" or an offense that may result in a claim or "suit" under this insurance to us; b. Tender the defense and indemnity of any claim or "suit' to all insurers whom also have insurance available to the additional insured; and C. Agree to make available any other insurance which the additional insured has for a loss we cover under this Coverage Part. d.. We have no duty to defend or indemnify an additional insured under this endorsement until we receive written notice of a "suit' by the additional insured. 2. The limits of insurance applicable to the additional insured are those specified in a written contract or written agreement or the limits of insurance as stated in the Declarations of this policy and defined in Section III — Limits of Insurance of this policy, whichever are less. These limits are inclusive of and not in addition to the limits of insurance available under this policy. J. WHO IS AN INSURED - INCIDENTAL MEDICAL ERRORS / MALPRACTICE WHO IS AN INSURED - FELLOW EMPLOYEE EXTENSION - MANAGEMENT EMPLOYEES Paragraph 2.a.(1) of Section II - Who Is An Insured is replaced with the following: (1) "Bodily injury" or "personal and advertising injury ": (a) To you, to your partners or members (if you are a partnership or joint venture), to your members (if you are a limited liability company), to a co- "employee" while in the course of his or her employment or performing duties related to the conduct of your business, or to your other "volunteer workers" while performing duties related to the conduct of your business; (b) To the spouse, child, parent, brother or sister of that co- "employee" or "volunteer worker" as a consequence of Paragraph (1) (a) above; (c) For which there is any obligation to share damages with or repay someone else who must pay damages because of the injury described in Paragraphs (1) (a) or (b) above; or (d) Arising out of his or her providing or failing to provide professional health care services. However, if you are not in the business of providing professional health care services or providing professional health care personnel to others, or if coverage for providing professional health care services is not otherwise excluded by separate endorsement, this provision (Paragraph (d)) does not apply. © 2013 Liberty Mutual Insurance CG 88 10 04 13 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 6 of 8 24B][9F6G 1 5646969 1 15 -1.G Martr_r Certificate I Alt's a Anderson 1 5/26/201.5 1A4:09 PM (Px:M I Page 9 of 12 P. EXTENDED PROPERTY DAMAGE Exclusion a. of COVERAGE A. BODILY INJURY AND PROPERTY DAMAGE LIABILITY is replaced by the following: a. Expected Or Intended Injury "Bodily injury" or "property damage" expected or intended from the standpoint of the insured. This exclusion does not apply to "bodily injury" or "property damage' resulting from the use of reasonable force to protect persons or property. Q. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US — WHEN REQUIRED IN A CONTRACT OR AGREEMENT WITH YOU Under Section IV — Commercial General Liability Conditions, the following is added to Condition 8. Transfer Of Rights Of Recovery Against Others To Us: We waive any right of recovery we may have against a person or organization 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" provided: 1. You and that person or organization have agreed in writing in a contract or agreement that you waive such rights against that person or organization; and 2. The injury or damage occurs subsequent to the execution of the written contract or written agreement. © 2013 Liberty Mutual Insurance CG 88 10 04 13 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 8 of 8 2W196x6 1 56469691 1 :15...7.6 Mast— C—tifi —t. I Alys— a..de: — 1 5/26/2015 4A4:09 PM (PD'c) I Pag. 11 of 12 ��� ����� ^ �� ���������Certificate ��Insurance Note: The underlined sentences below should only ba used in states that require certificates tobe filed. 8esure hn check each statement below tu make sure that it accurately reflects your state laws and agongvtnnpany aQ/noonento. Then delete this paragraph and any other inapplicable comments before providing a copy of this form boa certificate nequenbxc In September 2009, ACORD revised the ACORD 25 Certificate of Insurance form. One of the major changes was the removal of the cancellation notice provision. For the following reasons, we are unable to issue an older edition of this form, modify the current form, or complete a proprietary form you provide: • ACORD certificate forms must be filed and approved for use in our state. When a new form is approygd,_prior versions can no loncier be used. Therefore, it is illegal. for us to issue anything other than the currently approved ACODRD form' • Ncdioo of cancellation is a policy right, not an unregulated oon/ioo. No insurer shown on this certificate is able to provide the cancellation notice you desire by endorsement. For example, the insured can cancel immediately, so it would be impossible for the insurer to give you the notice you request. State law also grants the insurer the right to cancel for reasons such as nonpayment with less notice than you require. • For the reason just cited, if our agency were to issue a certificate that provides the cancellation notice you request, we would do so with the full knowledge that it would be impossible to actually give that amount of notice under certain circumstances. As such, the certificate could be alleged to constitute a misrepresentation or fraud which could subject our agency and staff to serious civil and criminal penalties. • If a certificate purports to provide a policy right different from that provided by the policy itself, then the certificate effectively purports to be a policy form. Policy forms must be filed and approved by our state department of insurance. Use of non-filed policy forms is illegal and could result in legal sanctions distinct from the assertion that the certificate iofraudulent. • Under the ACORD Corporation's licensing agreement, the prior editions of superseded forms can be used for one year from the time the new forms are introduced. Beginning in September 2010, this is another reason we cannot use an older edition of the ACORD 25. Doing so would violate ACORD's licensing agreement and, as a copyrighted document, federal copyright law. • Likewise, we are unable to modify the new certificate to add a notice of cancellation. ACORD forms are designed to be completed, not altered. ACORD's Forms Instruction Guide says that a certificate should not be used "To waive rights ... To quote wording from a contract ... To quote any wording which amends a policy unless the policy itself has been umandad.^ Also, since our state reguires ACORD forms to filed form would require its refifing, |n addition, our insurance company contracts only allow untoissue unaltered ACORDforms. • We are often asked to issue proprietary certificates provided by the certificate requestor. Again, our insurance company contracts only U issue unaltered ACORDhx _�gLaoltlon quires., the -filing of al certificates of insurance and has very specific regulatory guidelines on certifica!g language. Many proprietary certificates include broad, vague or ambiguous language that may or may not be incompliance with state laws, regulations, and insurance department directives. Therefore, we cannot issue any proprietary certificates that have not been reviewed by our state insurance department. We appreciate your understanding of the legal restrictions on our ability to fully comply with your request. CERTIFICATE OF LIABILITY INSURANCE DATE 4105 /2016 Y) 04/05/2016 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 NA CONTACT Justin Benhoor Brookhurst Insurance Services LLC PHONE X818 465 7860 aNeJ�(818 465 7856 ................. 16260 Ventura Blvd. Ste 720 E- DRE uslin brookhursfins.com INSURER(S) AFFORDING COVERAGE NAIC # Encino CA 91436 INSURER A : ........ ............._ INSURED �..,.,....... . ..... .............. INSURER B: SIgnCO, Inc. '. INSURER C: _____.__------------__.__--....,.,...... M,._........ � ................................................... ............................... �. �. �. �. �. �. �. �. �. �. �. �. � .�.�.�.......�......�....�.�... ......... .�.�.�.�.�.�.�.�.�.�.�.�.�.�... DBA Wesco Signs INSURER D: : Midwest Employers Casualty .. Company ............................................................... ........... .....— —. _- �__ .__....m.__...<�.- .._.......... 2413 Amsler St. INSURER E: Torrance, CA 90505 INSDRER 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, INTR ............ TYPE OF INSURANCE ..... /C'00L8 .... POLICY NUMBER.. .. �.. ___ _..,-- _........_ ..... ........_._.... POL)C'r..,EFF' poudYElUT...... -- LIMITS _....... ........ .._... -... MMJDDP'd°d"YY, M!MJDd1YYYY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ L DAVACL'�T R9 f -- ._.,---- -,_ -,. .,,,,� CLAIMS -MADE � � OCCUR Pr�Hth�lad�' S1Fad� °('�[prt�YUC:�t?_....,.,..,.,.$ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY F—] LOC PRO- JECT OTtl•tER: AUTOMOBILE LIABILITY ANY AUTO ALL OWNED „ SCHEDULED .- .........._ AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS UMBRELLA LIAB OCCUR EXCESS LIAR CLAIMS -MADE DED RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y fi N ANY PROPRIETOR/PARTNER /EXECUTIVE D ..OFFICER /MEMBER EXCLUDED? '..(Mandatory In NHI MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERALAGGREGATE $ PRODUCTS - COMP /OP AGG $ C MrA&Er 9M M,! t IMI $ (Ea ag,i Ciepltj _ _ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PI�O('Er +' "V'Y DA�hN,C'aE $ EACH OCCURRENCE $ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . AGGREGATE Is X STATUTE NIA E EACH ACCIDENT ER~ $ 1,000,000, BNUWC0135115 02/07/2016 02/07/2017 - - E,L,. DISEASE - EA EMPLOYE $ 1,000,000 E,L,' DISEASE - POLICYLIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Project: El Segundo Police Department 348 Main Street El Segundo, CA 90245 In regards to Workers Comp, Waiver of subrogation in favor of the cert holder per attached endorsement. 30 days notice of cancellation 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- Public Works Department ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street AUTHORIZED REPRESENTATIVE El Segundo, CA 90245 ©1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD DATE (MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 04106/2016 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 C' NTACT Justin Benhoor NA�ro: Brookhurst Insurance Services LLC PHONu F I (818) 465-7860 Nom) (818) 465 -7856 16260 Ventura Blvd. Ste 720 E-MAIL SS i ustlr) brookhurstins.com ADDRE ......, .. W,....- _ ....................... INSURER(S) AFFORDING COVERAGE ....._................�mm..... ....................... -...., NAIC # Encino CA 91436 INSURER A: —.______________ ____________---- _____.________. ____......__ � ____---.......,.,.....,.,.,..______________......____.....__.....__.....__.-________... ...............__...._..__..__. INSURED INSURER B: SIgnco, Inc. INSURERC: DBA Wesco Signs INSURER D . Midwest Employers Casualty Company 2413 Anlsler St. INSURER E : Torrance, CA 90505 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, CL AIM S. R ... r~ POLICY EFF pOLICY EP . ......... ... ...------------ -- -- _ LTR TYPE OF INSURANCE iucn unm POLICY NUMBER IMMIDD lVVVVI [MM10 D LIM...I..T.... S COMMERCIAL GENERAL LIABILITY _ EACH OCCURRENCE $ ....... DAWvTA�""E"Tti "...... ...... . _ . _ ._ . ....,. CLAIMS -MADE OCCUR PREMISES (Ea occurrence) $ MED EXP (Anv one person) $ PERSONAL & AD..INJURY $ GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ PRO- POLICY JFCD. LOG PRODUCTS COMPIOPAGG $ OTHER: $ AUTOMOBILE LIABILITY ...,,, COMBINED SINGLE LIM)r /Fa accldenq,) ... .- .w...,_ ........... $ .. ..... ......................... ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident ) $ AUTOS AUTOS PFm e�1eYr DfNNiiF1C $ HIRED AUTOS AUTOS a UMBRELLA LIAR OCCUR EACH OCCURRENCE $ . ... .... , EXCESS LIAB CLAIMS -MADE AGGRE GATE $ DED RETENTION $ $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS' LIABILITY Y/ N CTATI ITF FR ANY PROPRIETOR /PARTNER /EXECUTIVE E L EACH ACCIDENT $ 1,000 000 D OFFICER /MEMBER EXCLUDED? Y� N/A BNUWC0135115 02/07/2016 02/07/2017 ..................................... -1°°° ­ -- (Mandatory inNH) E,LDISEASE - EAEMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below ........ , , ,. ,. .. . . ...............— E, L, DISEASE - POLICY LIMIT - 1 $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) Santa Fe Springs Marketplace - Signage Approval Rite Aid Store #05495 - 7860 Norwalk Blvd., Whittier,CA CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Washington & Norwalk Associates, ACCORDANCE WITH THE POLICY PROVISIONS. LP and Coreland Companies AUTHORIZED REPRESENTATIVE C ©1988 -2014 ACORD CORPORATION. All rights reserved, ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: BNUWC0135115 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 04 -84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT CALIFORNIA (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 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 agreementfrom 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 2.0000 % of the California workers' compensation premium otherwise due on such remuneration. Schedule State Description CA Any party with whom the insured agrees to waive subrogation in a written contract. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below Is required only when this endorsement Is issued subsequent to preparation of the policy.) Endorsement Effective Cate: 02/07/2016 Policy Number: BNUWC0135115 Endorsement No Insured Name: Insurance Company: Midwest Employers Casualty Company Countersigned By