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PROOF OF INSURANCE (2017) CLOSED (2)SOUTCOA -04 TYAPP ( CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DD/YYYY) 4/25/2016 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 License # OE63493 NWf.r,,,., NAME: Orr & Associates Insurance Services PHONE rAX (sac w; Ext): (951) 506 -5859 d+cw N. (800) 474 3003 28780 Single Oak Dr EMAIL Ste 255 ADDRESS; service(a)_orrandassociates com Temecula, CA 92590 ......_. . INSURER(S) AFFORDING COVERAGE NAIC # INSURERA:U•S• Specialty Insurance Company 29599 _ INSURED __. __-----__. - ---- 0000..... . 0000....- 0000..... 0000..... INSURER B: Integon National ..I ...m........ p . � ........................... Insurance Company ............................... 29742 SOUTH COAST PAINTING INC. INSURER Compensation r . ...� ........................... ERC:Sta � 'on Insurance Fund .............................. 35076 Bobbie &George Mantiks .. ............................... 0000 '' i 28364 S Weatern Ave. #465 INSURER D Rancho Palos Verdes, CA 90275 ANf SURER E INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: _.�..�.. m. - ....... _ ................ 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.. ... .................. INSR .. .. .. .. ........ 0000.. ....... ADtiL SUER LTR TYPE OF INSURANCE IN4n wyn POLICY NUMBER _ ................. ...... ...........,,, POLICY EFF POLICY EXP .._ (MM /DD/YYYYI (MMIDD/YYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE OCCUR X X 'U16AC87006 -01 DAMAGE "rii RENTEC7 -- 05/01/2016 05/01/2017 PREMISES (Ea occurrence) $ -------- .......- ........, .... . 100,000 .. -. -_.,. MED EXP (Anv one person) $ 5,000 ...................................... ....._ . ......... PERSONAL & ADV INJURY $ 1,000,00 GEN'LAGGREGATELIMITAPPLIESPER, GENERAL AGGREGATE $ 2,000,00 __. X POLICY ❑ JEC'�I-, LOC - JB'f T' PRODUCTS COMP /OP AGG $ .. ... 2,000,000, O i'M-R; $ �......... - AUTOMOBILE LIABILITY ...................... t OMHONEO SINGLE 1 [MIT $ .,.._ 000,0. B ANY AUTO 12002234 04/27/2016 04/27/2017 BODILY INJURY (Per person) $ ALL OWNED .... X SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ 0000.. 1,000,QO(}, , NON OWNED PROPERTY DAMAGE $ 0 1,000,000'i HIRED AUTOS AUTOS 0000... ........, (Per accOent) _. .. ., UMBRELLA LIZ X OCCUR EACH OCCURRENCE $ 1,000,000 A X EXCESS LIAB CLAIMS MADE U16AC87006 -01 05/01/2016 05/01/2017 AGGREGATE $ 1,000,000 DED RETENTION $ $ ...... .......__..._..._____,...__ ...... ...... ........... ... -... WORKERSCOMPENSATION X PER 0TH - STATUTE ER AND EMPLOYERS' LIABILITY YIN 0000._ --- C ANY PROPRIETOR/PARTNERIEXECUTIVE 9125712 -2016 06101/2016 06/01/2017 EL EACH ACCIDENT $ 1,000,000 OFFICER /MEMBER EXCLUDED? N / A (Mandatory in NH) --- E L. DISEASE EA EMPLOYEE $ ---- .. 1,000,000 Ifyes, describe under DESCRIPTION OF OPERATIONS below ....... ....._ ................... ...... ................................................................................ E L.. DISEASE - POLICY LIMIT $ ............................... _... 1,000,000 0000......, ................................. ............................... ........... ..00_00__. ..._ DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) ..._.....,._. CITY OF EL SEGUNDO ITS OFFICIALS, AND EMPLOYEES ARE ADDITIONAL INSURED PER ATTACHED ENDORSEMENT FORMS. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITY OF EL SEGUNDO ITS OFFICIALS, AND EMPLOYEES THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 350 MAIN STREET ACCORDANCE WITH THE POLICY PROVISIONS. EL SEGUNDO, CA 90245 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: U16AC87006 -01 COMMERCIAL GENERAL LIABILITY CG 20 10 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. •_ l ]MONO This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Location(s) Of Covered Operations Any person or organization for whom you are performing operations during the policy period when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy. 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 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) desig- nated above. CG 20 10 07 04 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. © ISO Properties, Inc., 2004 Page 1 of 1„ POLICY NUMBER: U16AC87006 -01 COMMERCIAL GENERAL LIABILITY HCS 040 06 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. imam This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS /COMPLETED OPERATIONS LIABILITY COVERAGE PART A. PRIMARY AND NON - CONTRIBUTORY TO OTHER INSURANCE With respect to any person or organization that is an additional insured under this Coverage Part, the following is added to paragraph 4. of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: If you have agreed in writing in a contract or agreement that this insurance is primary and non- contributory relative to an additional insured's own insurance, then this insurance is primary and we will not seek contribution from that other insurance. For the purpose of this endorsement, the additional insured's own insurance means insurance on which the additional insured is a Named Insured. When this endorsement is attached to the policy it supersedes all other insurance conditions within. HCS 040 06 10 13 B. WAIVER OF SUBGROGRATION — BLANKET Under SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS, The Transfer Of Rights Of Recovery Against Others To Us Condition is amended by the addition of the following: We waive any right of recovery we may have against any person or organization because of payments we make for injury or damage arising out of: a. Your ongoing operations; or b. "Your work" included in the "products - completed operations hazard ". However, this waiver applies only when you have agreed in writing to waive such rights of recovery in a contract or agreement, and only if the contract or agreement: a. Is in effect or becomes effective during the term of this policy; and b. Was executed prior to loss. Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 1 ENDORSEMENT AGREEMENT WAIVER OF SUBROGATION 9125712 -15 -2 RENEWAL SP PAGE 1 HOME OFFICE SAN FRANCISCO EFFECTIVE FEBRUARY 12, 2016 AT 12.01 A.M. ALL EFFECTIVE DATES ARE AND EXPIRING JUNE 1, 2016 AT 12.01 A.M. AT 12:01 AM PACIFIC STANDARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME SOUTH COAST PAINTING INC 2255 PALOS VERDES DR N ROLLING HILLS ESTATES, CA 90274 ANYTHING IN THIS POLICY TO THE CONTRARY NOTWITHSTANDING, IT IS AGREED THAT THE STATE COMPENSATION INSURANCE FUND WAIVES ANY RIGHT OF SUBROGATION AGAINST, CITY OF EL SEGUNDO WHICH MIGHT ARISE BY REASON OF ANY PAYMENT UNDER THIS POLICY IN CONNECTION WITH WORK PERFORMED BY, SOUTH COAST PAINTING 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: FEBRUARY 19, 2016 2570 AUTHORIZED REPRESENT IVE PRESIDENT AND CEO