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PROOF OF INSURANCE (2016) CLOSEDHLMOE -1 OP ID: T2 CERTIFICATE OF LIABILITY INSURANCE DATE,MMDD/YYYY,� 07/30/15 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 Phone: 818 - 643 -2300 CONTACT encies, Inc, T NAME Kristen Smith United A '9 ( ) PHONE FAX CA License //02�a263'6 Fax: (A/c No EXt) 818 643 2312 (A/C, No),_ 450 N. Brand Blvd., Ste. 820 F MAI ksmith uniteda efzcies.com Glendale, CA 91203 a a s s............ .., .� g.., Jim Stone INSURERS) AFFORDING COVERAGE NAIC # INSURER A: James River Insurance Co. ,12203 INSURED H.L. Moe Company, Inc. INSURER B Admiral Insurance Company DBA John K. Keefe Company DBA: Advance Mechanical INSURER C AIG Specialty Insurance Co. 26883 Contractors, Inc. INSURER D Mike Davis 526 Commercial Street INSURER E Glendale, CA 91203 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. LTR TYPE OF INSURANCE DDL UBR POLICY NUMBER MM DID/YYYY MM/DD/YYYY TS LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY 00054362-3 08/01/15 08/01/16 DAMAGE16 $ 5 0 000 X OCCUR ,CLAIMS -MADE C, a PREMISES (Ea occurrence MED EX P(An one $ v ) Excluded EXCI PERSONAL & ADV INJURY ! $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG � $ 2,000,000 POLICY X � hRa�m LOC Emp. Ben. $... ,.. 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ., ........ . ANY AUTO BO (Per person) DILY INJURY Per $ _ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) - $ _ NON -OWNED PROPER Y DAMAGE HIRED AUTOS AUTOS (Par acne . dank) UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 B X EXCESS LIAB CLAIMS -MADE BEX09614462 -02 08/01115 08/01/16 AGGREGATE $ 5,000,000 DED I X I RETENTION $ $ WORKERS COMPENSATION WC STATU AND EMPLOYERS' LIABILITY YIN �OTH . T,0 " LIMI�.S.,.,,�......E • -•- ..... ..... ...., ANY PROPRIETOR/PARTNER /EXECUTIVE EL EACH ACCIDENT $ OFFICER /MEMBER EXCLUDED? I N l A ....._ -- ..._.____ _.._._ .e ...... ....... ..,. I (Mandatory in NH) EL DISEASE EA EMPLOYEE: $ If yes, describe under DESCRIPTION OF OPERATIONS below EL DISEASE - POLICY LIMIT $ C Pollution CP017662688 04/03/15 04/03/17 Each Loss 5,000,000 Aggregate 5,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Subject to all policy terms, conditions and exclusions. 30 days NOC except 10 for non - payment of premium. CERTIFICATE HOLDER CANCELLATION CITYELS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of El Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN y g ACCORDANCE WITH THE POLICY PROVISIONS. Dept of Building & Planning 350 Main Street El Segundo, CA 90245 AUTHORIZED REPRESENTATIVE ©1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY SCHEDULE Name Of Additional Insured Person(s) Covered Operations Or Organization(s): Where required by written contract or agreement All non - residential construction projects of the Named Insured Information re uired to complete this Schedule„ if not shown above„ will be shown in the Declarations. A. SECTION II — Who Is An Insured is amended to include any person or organization shown in the Schedule for which you are required to include as an additional insured on this policy by written contract or written agreement in effect during this policy period and executed prior to the `occurrence" of the "bodily injury" or "property damage." Coverage provided such additional insured is 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), providing that: "your work" or "your product" related to Covered Operations shown in the Schedule above, is other than "residential development' of any description. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "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. MC2010US 09 -12 Page 1 of 2 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. C. For the purposes of this endorsement, the following is added to the Other Insurance Condition and supersedes any provision to the contrary: Primary and Noncontributory Insurance This insurance is primary to and will not seek contribution from any other insurance available to the additional insured designated in the Schedule, provided that: (1) The additional insured is a Named Insured under such other insurance; and (2) You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. The following definitions are added to SECTION V — DEFINITIONS of this policy: "Residential development" means a structure or structures, including the land upon which it is situated, designed or intended for occupancy in whole or in part as a residence by any person or persons. "Residential development" dares not include "apartments" or " "apartment buildings, " "Apartments" means one or more rooms of a building used as a dwelling unit separate from others in the building and which are rented from others by those dwelling in them. "Apartments building" means a structure containing two or more separate "apartments." ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. Includes copyrighted material of Insurance Services Office, Inc., with its permission. MC2010US 09 -12 Page 2 of 2 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY SCHEDULE Name Of Additional Insured Person(s) Covered Completed Operations Or Organization(s): Where required by written contract or All non- residential construction projects of the agreement Named Insured 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 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 ", as described in the schedule of this endorsement performed for that additional insured and included in the "products- completed operations hazard" as described in the Covered Completed Operations, schedule above. B. The insurance provided to the additional insured under this endorsement is limited as follows: Covered Completed Operations shown in the schedule above shall not include "residential development' of any description. C. For the purposes of this endorsement, the following is added to the Other Insurance Condition and supersedes any provision to the contrary: Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution from any other insurance available to the additional insured designated in the Schedule, provided that: (1) The additional insured is a Named Insured under such other insurance; and (2) You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. D. The following definitions are added to SECTION V — DEFINITIONS of this Policy: "Residential development" means a structure or structures, including the land upon which it is situated, designed or intended for occupancy in whole or in part as a residence by any person or persons. "Residential development" does not include "apartments" or "apartment buildings." MC2037US 09 -12 Page 1 of 2 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. "Apartments" means one or more rooms of a building used as a dwelling unit separate from others in the building and which are rented from others by those dwelling in them. "Apartments building" means a structure containing two or more separate "apartments." ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. Includes copyrighted material of Insurance Services Office, Inc., with its permission. MC2037US 09 -12 Page 2 of 2 AC40RD CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDNYYY) 12/31/2015 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 Bolton & Com an NAME CT 3475 E, Foothill Blvd., Suite 100 E FAX _..._ Pasadena, CA 91107 -UAII � w � ��z �)� 799-7000 _ _..�. -... c H � � _� 583 -211 ..._ t9WriurCat,f ARA^hN�DINGiY?E RAk.S3 .w�ww.bou ltonco com 0008309 ., ,,,..... .�.� _ _.e�.... __� �NAIC . NSURERA raveers indemni q ?. 25682 >! _....... INSURED INSURER B Travelers Property Casualfy CG of Amer 25674 H.L. Moe Cornpany Inc. �. I BA :.John K, Keefe Company INSuRERC .wwww� �...� BA: Advance Mechanical Contractors, Inc. INSURERD. Glenda le e cial Street 91203 DVERAGES CERTIFICATE NUMBER: 27964638 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. R .... ..CE r��aLlcY NuMBER .. ���cuti �q�IC��� '. ....... ._ .. R TYPE OF INSURANCE LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S - GWAG9`f( REv � .__.....�,_ a � CLAIMS -MADE ., w„ I OCCUR '. I ........ , ......._,..._,.... _ ., ...� .(Any one person) 1 $ PERSON I _ ......_._ w � ......._.. ... ... .... .......,,,....... -,_„ •.......__.. .. --- — AL & ADV INJURY S G'EN'L AGGREGATE LIMIT APPLIES PER: G GENERA AGGREGATE Is POLICY I PRODUCTS - COMPIOP AGG I S I OTHER i $ $ A AUTOMOBILE LIABILITY I DT8105G679242TCT16 1/1/2016 1 1/1/2017 M MBINEO s)NC,L L1'MI $ ANY AUTO B BODILY INJURY (Per person) $ ALL OWNED '.. SCHEDULED ° °° mm ° °—• L OAIa1A c HOLDER -A L L Clty of EL Segundo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 350 Main Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN EL Segundo, et 90245 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Chau Tran ®1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD 27964638 1 16 -17 NC and Auto I ALiza Looez i 12/31/2015 12:11:59 PM (PST) 1 Pace 1 0f 2 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 .d. a-8a WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT — CALIFORNIA 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 agreement from 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 such remuneration. Person or Organization ALL PERSONS OR ORGANIZATIONS City of EL Segundo, as required by written contract. Endorsement Effective 1/1/2016 Insured H.L. Moe Company, Inc. WC 262 (4-84) WC 04 03 06 (Ed. 4 -84) % of the California workers' compensation premium otherwise due on Schedule Job Description Policy No. DTJUB5G67924216 Insurance Company Travelers Indemnity Company of CT Countersigned By I 15 -17 WC and AU -0 I All,.aa LoPex i 12/31/7015 12c1. l.,59 Plo 6PS;,ID I IFace 2 of 2 Endorsement No. M Page 1 of 1