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PROOF OF INSURANCE (2017) CLOSEDCERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD /YYYY) 03/18/2016 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 MARSH USA, Inc. NAMEt PHONE FAX 501 MERRITT 7 AI , N9. Ext); (A/C; Not: NORWALK, CT 06856 -6010 EMAIL Aft Norwalk.cearequest @Marsh.com Fax: 212 - 948 -0929 ADDRESS: 071217 -NW- CAS -16 -17 X INSURED READYREFRESH BY NESTLE ATTN: RISK MANAGEMENT 800 N BRAND BOULEVARD GLENDALE, CA 91203 INSURERS) AFFORDING COVERAGE NAIC # GARDE INSURER A: ACE American Insurance Company 22667 INSURER B : Indemnity Ins Co Of Noah America 43575 INSURER C : ACE Fire Underwriters Insurance Company 20702 INSURER E : COVERAGES CERTIFICATE NUMBER: NYC- 007723254 -19 REVISION NUMBER:33 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, YN LTR ,.. ...,TYPE OF INSURANCE„ ,....�,ucn unm.. ,,,,,,,,, POLICY NUMBER .......................... fiyGMdDD7Yb"'ro'Y MMkPODfYYYY . LIMITS- ,-,�,. LIABILITY COMMERCIAL GENERAL.. HDO G2740263A 01/01/2016 01/01/2017 EACH OCCURRENCE $ 1,000000 CSAM`AG`E"Yi5''A'EtwlTU?. — .�.,. .... ., mm... CLAIMS -MADE X OCCURPR nnlcFC- rF�ra'r- uu.upla.lnra) ®_. _.P , ., �, $ 1000,000 ,-- .- ,..... ,. ,,....... .�.. ..... MED EXP (Any one Person) $ 10,000 .. PERSONAL .E 000000 GENT ., L AQGREGATF LIMIT APPLIES PER: Afa`d".aR GENERAL AGGREGAT $... 2,000,000 X J1OI­ICY .., f RO LOC � . ....� JEST ❑ .. PRODUCTS COMPIOP AGCY .- ..1 S 1.0K000 . ... - OTHER:: $ A AUTOMOBILE LIABILITY ISA H08866260 01/01/2016 01/01/2017 COMBINED SINGLE LIMIT $ 2.000.000 .... „. ..., p, aimW nt). X ANY AUTO ',, BODILY INJURY (Per person) $ ALL OWNED - e SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS m NON -OWNED p„ PROP'ERPY DAMAGE $ mm 1O1mm HIRED AUTOS mml AUTOS --... UMBRELLA LIAB OCCUR ,.....,� EACH OCCURRENCE ...AGGREGA� $ EXCESS LIAR CLAIMS -MADE ATE S DF „D RFTFN,TIQN $ $ B WORKERS COMPENSATION WLRC48599345(AOS) 01/01/2016 01/01/2017 OrH AND EMPLOYERS' LIABILITY FR A YNN ANY ECUTIVE f WLR 048599382 AZ, CA & MA ) 01101/2016 01/O1/'2U1Y EL�EACHIACCIDEN1 $ C (Mandatory m H� EXCLUDED ( mmm NIA -SCF C48599424 (WI) 01/01/2016 01/01/2017 E.L. DISEASE - EA EMPLOYEEk, $ 1 ooa ooa Y If yes, describe under 1,000,000 I DESCRIPTION OF OPE- RATIQNS below E L DISEASE- POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 161, Additional Remarks Schedule, may be attached If more space Is required) CITY OF EL SEGUNDO IS INCLUDED AS ADDITIONAL INSURED (EXCEPT WORKERS COMPENSATION) WHERE REQUIRED BY WRITTEN CONTRACT, WAIVER OF SUBROGATION IS APPLICABLE WHERE REQUIRED BY WRITTEN CONTRACT. CERTIFICATE HOLDER CITY OF EL SEGUNDO ATTN: CITY CLERK 350 MAIN STREET EL SEGUNDO, CA 90245 -0989 CANCELLATION 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 REPRESENTATIVE of Marsh USA Inc. Kristy A. Dreher R • 191 4­4 ©1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: HDO G2740263A Endorsement Number: 99 COMMERCIAL GENERAL LIABILITY CG 20 37 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTSICOMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional L , ....v........ .. --.­ -- a.... ,,, nsured Persons) .._ r __.... �. .r Of Completed Operations � y Or Or�antzationfa) .y ... _ Location And Doperation�� "......_w ����­��`������r _,.,....,,.., ..._ An Owner Lessee or Contractor whom ou have All locations and s of the Named Insured. agreed to include as an additional insured under a written contrail, provided such contract was executed prior to the date of loss. Information required to complete this Schedule, if not show......e....... in . � . „ ............................ shown above, will be shown in the Declarations. A. Section 11 -- 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 endmsenient 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. 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 ® Insurance Services Office, Inc,, 2012 Page 1 of 1 NOTICE TO OTN ER B EN DO S EM ENT — BCH EDU L E rs 29 HDO I G2740263A 101101/2016 To 01101/2017 l sued By (Name of lnsurance C.;crr parry) ACE American Insurance Company THIS EN DOR 8 EMENT CHANGES THEPOLICY. PLEASE READ IT CAREFULLY. A. If we cancel the Policy prior to Its expiration date by notice to you or the first Named insured for any reason other than nonpayment of premium, we will endeavor, as set out below, to send written notice of cancellation, via such electronic or other form of notification as we determine, to the persons or organizations listed In the schedule that you or your representable provide or have provided to us (the "Schedula "). You or your representative must provide us with the physical and /or e-mail address of such persons or organizations, and we will utilize such &-mail address or physical address that you or your representative provided to us on such Schedule. E. The Schedule must be Initially provided to us within 15 days after. 1. The beginning of the Policy period, If this endorsement is effective as of such date; or fl. This endorsement has been added to the Policy, If this endorsement Is effective after the Policy period commences. C. The Schedule must be In an electronic format that Is acceptable to us; and must be accurate. D. Our delivery of the notification as described In Paragraph A. of this endorsement will be based an the most recent Schedule in our records as of the date the notice of cancellation is mailed or delivered to the first Named Insured, E. We will endeavor to send or deliver such notice to the e-mail address or physical address corresponding to each person or organization indicated in the Schedule at least 30 days prior to the cancellation date applicable to the Policy. F. The notice referenced in this endorsement Is Intended only to be a courtesy notification to the person(s) or organization(s) named in the Schedule in the event of a pending cancellation of coverage. We have no legal obligation of any Idnd to any such person(s) or orgaribmdon(s). Our failure to provide advance notification of cancellation to the person(s) or organization(s) shown In the Schedule shell impose no obligation or liability of any kind upon us, our agents or representatives, will not extend any Policy cancellation date and will not negate any cancellation of the Pollcy. G. We are not responsible for verifying any Information provided to us In any Schedule, nor are we responsible for any Incorrect information that you or your representative provide to us. If you or your representative does not provide us with a Schedule, we have no responsibility for taldng any action under this endorsement. In addition, If neither you nor your representative provides us with e-mail and physical address Information with respect to a particular person or organization, then we shall have no responsibility for taking action with regard to such person or antitty under this endorsement H. We may arrange with your representative to send such notice in the event of any such cancellation. L You will cooperate with us In providing the Schedule, or in causing your representative to provide the Schedule. J. This endorsement does not apply in the event that you cancel the Policy. AIL -32687 (05111) Page 1 at 2 All other terms and conditions of the Policy remaln unchanged, Authorized Representative ALL-32687 (05111) Page 2 oft 'Wgwrrrers' crm ns -e"On and NESTLE WATERS NORTHAM ERICA HOLDINGS, INC. Pbacy Number SW N. BRAND BLVD. Symbol: WLR Number: 048599382 TO oi-oi' -2017 ime of Ineur os ( 01 -01 -2019 CALIFORNlA V41VIER OF OUR Itlip'HTTO RECOVER FROM OTHER I END OR This endorsement applies only to the Insurance provided by the policy because California Is shown In Item 3.A. of the Informatlon Page. 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, but this waiver applies only with to bodily Injury arising out of the opemtIons described In the Schedule, where you are required by a written contract to obtain this waiver from us. You must maintain payroll records accurately segregating the remuneration of your employees while engaged In the work described in the Schedule. Schedule I. ( ) Specific VftWr Name of person or organization: ( X ) Bleniaet Wahw Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. 2. Operstionw. ALL OPERATIONS CONDUCTED BY AN INSURED PURSUANT TO SUCH WRITTEN CONTRACT 3. Premium: The premium charge for this endorsement shall be 2.0 percent of the California premium developed on payroll In connection with work performed for time above person(s) or organization(s) arising out of the operations described. 4. Minimum Premium: $ 0 AURFER n WC 99 03 22