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PROOF OF INSURANCE (2016) CLOSEDy,� OP ID: CO CERTIFICATE OF LIABILITY INSURANCE DATE 11/30 /201 YY) 11130/2015 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 PIASC Insurance Services, Inc. Lic.# 0747420 P.O. Box 910936 Los Angeles, CA 90091 -0936 Pauline B. Ornelas, CIC MARTIN2 INSURED Martin & Chapman Company INSURER A: The Hanover Insurance Group 36064 Attn: SCOtt Martin INSURER B: Preferred Employers Ins. Co. 10900 1951 Wright Circle Anaheim, CA 92806 -6028 INSURERC: INSURER D: 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, JJ& A TYPE OF INSURANCE I AM P ICY NUMER POLI Y EFF P POLECY E XPIN R LIMITS.... GENERAL LIABILITY ' '... EACH OCCURRENCE $ $ 1,000,00 A X X COMMERCIAL GENERAL LIABILITY X X;ZH3 9 9012496 04 0 02/18/2015 0 02/18/2016 P PAR i`MI�S r•I otamrro $ $ 1,000100 y CLAIMS -MADE OCCUR'' M MED EXP (Any one person) $ $ 10,00 PERSONAL & ADV INJURY $ $ 1,000,00 GENERAL AGGREGATE $ $ 2,000,00 X GL BROAD FORM END G . _.............--- GERL AGGREGATE LIMIT APPLIES PER: P PRODUCTS - COMP/OP AGG $ $ 2,000,00 Empl. Ben $ $ 1,000,00 X I POLICY PRO_ LOC E AUTOMOBILE LIABILITY X X C COMBINED SINGLE LIMIT $ $ 1,000,00 A X X ANY AUTO A AW3 9033498 04 0 02/1812015 0 02118/2016 B (Ea accdent) BODILY INJURY (Per person) $ $ ALL OWNED AUTOS " "°°'"""""" " "' CITYELS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City Of El Segundo ACCORDANCE WITH THE POLICY PROVISIONS. Attn. Office of the City Clerk 350 Main Street AUTHORIZED REPRESENTATIVE El Segundo, CA 90245 , © 1988 -2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CALIFORNIA COMMERCIAL GENERAL LIABILITY SPECIAL BROADENING ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SUMMARY OF COVERAGES 1. Additional Insured by Contract, Agreement or Permit Included 2. Additional Insured - Broad Form Vendors Included 3. Aggregate Limit per Location Included 4. Alienated Premises Included 5. Bodily Injury Redefined Included 6. Broad Form Property Damage - Borrowed Equipment, Customers Goods & Included Use of Elevators 7. Extended Property Damage Included 8. Incidental Malpractice (Employed nurses, EMT's & paramedics) Included 9. Knowledge of Occurrence Included 10. Liberalization Clause Included 11. Medical Payments - Increased Limit $ 10,000 12. Mobile Equipment Redefined Included 13. Newly Acquired or Formed Organizations - Covered until end or policy period Included 14. Non -owned Watercraft 51 ft. 15. Personal Injury - Broad Form Included 16. Product Recall Expense - Each Occurrence Limit $ 25,000 - Aggregate Limit $ 50,000 17. Property Damage Legal Liability (Fire, Lighting, Explosion, Smoke or Leakage Damage) $500 „000 18. Supplementary Payments Increased Limits - Bail Bonds $ 2,500 - Loss of Earnings $ 300 19. Unintentional Failure to Disclose Hazards Included 20. Unintentional Failure to Notify Included This endorsement amends coverages provided under the Commercial General Liability Coverage Form through new coverages, higher limits and broader coverage grants. 1. Additional Insured by Contract, Agreement or (2) Premises you own, rent, lease or occupy. Permit This insurance applies on a primary Under Section II - Who Is An insured, Paragraph 4. basis if that is required by the written is added as follows: contract, written agreement or permit. 4. a. Any person or organization with whom you b. This provision does not apply: agreed, because of a written contract, written (1) Unless the written contract or written agreement or permit to provide insurance, is agreement has been executed or permit an insured, but only with respect to: has been issued prior to the "bodily injury”, (1) "Your work" for the additional insured(s) "property damage ", "personal injury" or at the location designated in the contract, "advertising injury". agreement or permit; or Page 1 of 6 Includes copyrighted material of ISO Insurance Services Office, Inc. with its permission,. 421 -0778 09 09 (2) To any person or organization included as an insured by an endorsement issued by us and made part of this Coverage Part. (3) To any person or organization included as an insured under item 2 of this endorsement. (4) To any lessor of equipment: (a) After the equipment lease expires; or (b) If the "bodily injury", "property dam- age", "personal injury" or "advertising injury" arises out of sole negligence of the lessor. (5) To any: (a) Owners or other interests from whom land has been leased which takes place after the lease for the land ex- pires; or (b) Managers or lessors of premises if: (i) The occurrence takes place after you cease to be a tenant in that premises; or (ii) The "bodily injury", "property damage ", "personal injury" or "advertising injury" arises out of structural alterations, new con- struction or demolition operations performed by or on behalf of the manager or lessor. 2. Additional Insured - Broad Form Vendors Under Section II - Who Is An Insured, Paragraph 5. is added as follows: 5. a. Any person or organization with whom you agreed, because of a written contract or written agreement to provide insurance, but only with respect to "bodily injury" or "property damage" arising out of "your products" which are distributed or sold in the regular course of the vendor's business, subject to the following additional exclusions: b. The insurance afforded the vendor does not apply to: (4) Repackaging, unless unpacked solely for the purpose of inspection, demonstration, testing, or the substitution of parts under instruction from the manufacturer, and then repackaged in the original container; (5) Any failure to make such inspection, ad- justments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business in connection with the sale of the product; (6) Demonstration, installation, servicing or repair operations, except such operations performed at the vendor's premises in connection with the sale of the product; (7) Products which, after distribution or sale by you, have been labeled or relabeled or used as a container, part or ingredient of any thing or substance by or for the vendor. c. This insurance does not apply to any insured person or organization, from whom you have acquired such products, or any ingredient, part or container, entering into, accompany- ing or containing such products. 3. Aggregate Limit Per Location (1) Under Section III - Limits of Insurance the General Aggregate Limit applies separately to each of your "locations" owned by or rented to you. (2) Under Section V - Definitions, definition 23. is added as follows: 23. "Location" means premises involving the same or connecting lots, or premises whose connection is interrupted only by a street, roadway, waterway or right -of -way of a rail- road. 4. Alienated Premises (1) "Bodily injury" or "property damage" for which the vendor is obligated to pay dam- ages by reasons of the assumption of li- ability in a contract or agreement. This exclusion does not apply to liability for damages that the insured would have in the absence of the contract or agreement; (2) Any express warranty unauthorized by you; (3) Any physical or chemical change in the 5. product made intentionally by the vendor; Under Section I - Coverage A, paragraph 2. Exclu- sions, j. (2) is replaced in its entirety with the following: (2) Premises you sell, give away or abandon, if the "property damage" arises out of any part of those premises and occurred from hazards that were known by you, or should have reasonably been known by you, at the time the property was transferred or abandoned. Bodily Injury Redefined Under Section V - Definitions, definition 3. "bodily injury" is replaced in its entirety with the following: Page 2 of 6 Includes copyrighted material of ISO Insurance Services Office, Inc. with its permission. 421 -0778 09 09 3. "Bodily injury" means bodily injury, sickness or disease sustained by a person. This includes mental anguish, mental injury, shock, fright or death resulting from "bodily injury", sickness or disease. 6. Broad Form Property Damage - Borrowed Equipment, Customers Goods, Use of Elevators (1) Under Section I - Coverage A, paragraph 2. Exclusion j. is amended as follows: Paragraph (4) does not apply to "property dam- age" to borrowed equipment while at a jobsite and not being used to perform operations. Paragraphs (3), (4) and (6) do not apply to "property damage" to "customers goods" while on your premises nor do they apply to the use of elevators at premises you own, rent, lease or occupy. (2) Under Section V - Definitions, definition 24. is added as follows: 24. "Customers goods" means property of your customer on your premises for the purpose of being: a. worked on; or b. used in your manufacturing process (3) The insurance afforded under this provision is excess over any other valid and collectible prop- erty insurance (including deductible) available to the insured whether primary, excess, contingent or on any other basis. 7. Extended Property Damage Under Section I - Coverage A, paragraph 2. Exclusions, Exclusion a. is replaced in its entirety with the following: a. "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. 8. Incidental Malpractice - Employed Nurses, EMT's and Paramedics 9. Knowledge of Occurrence Under Section IV - Commercial General Liability Conditions, Condition 2 - Duties in the Event of Occurrence, Offense, Claim or Suit, paragraph e. is added as follows: e. Notice of an "occurrence ", offense, claim or "suit" will be considered knowledge of the insured if reported to an individual named insured, partner, executive officer or an "employee" designated by you to give us such a notice. 10. Liberalization Clause Under Section IV - Commercial General Liability Conditions, condition 10. is added as follows: 10. Liberalization Clause If we adopt any revision that would broaden the coverage under this Coverage Form without additional premium, within 45 days prior to or during the policy period, the broadened coverage will immediately apply to this Coverage Part. 11. Medical Payments -increased Limits (1) Under Section I - Coverage C, paragraph a. (3)(b) is replaced in its entirety by the following: (3)(b) The expenses are incurred and reported to us within three years of the date of the accident; and (2) Under Section III - Limits of Insurance, paragraph 7. is replaced in its entirety by the following: Under Section II - Who Is An Insured, paragraph 12. 2.a.(1)(d) does not apply to a nurse, emergency medical technician or paramedic employed by you if you are not engaged in the business or occupation of providing medical, paramedical, surgical, dental, x- ray or nursing services. 13 7. Subject to 5. above, the higher of: a. $10,000; or b. The amount shown in the Declarations for Medical Expense Limit is the most we will pay under Coverage C for all medical expenses because of "bodily injury" sustained by one person. (3) This coverage does not apply if Coverage C - Medical Payments is excluded either by the provisions of the Coverage Part or by endorsement. Mobile Equipment Redefined Under Section V - Definitions, definition 12, Mobile Equipment, paragraph f.(1)(a)(b)(c) does not apply to self - propelled vehicles of less than 1,000 pounds gross vehicle weight. Newly Acquired Or Formed Organizations Under Section II - Who Is An Insured, paragraph Page 3 of 6 Includes copyrighted material of ISO Insurance Services Office, Inc. with its permission. 421 -0778 09 09 3.a. is replaced in its entirety by the following: a. Coverage under this provision is afforded only until the end of the policy period. 14. Non -Owned Watercraft Under Section I - Coverage A, paragraph 2 Exclusions, g.(2) is replaced in its entirety by the following: (2) A watercraft you do not own that is: (a) Less than 51 feet long; and (b) Not being used to carry persons or property for a charge; This provision applies to any person, who with your consent, either uses or is responsible for the use of a watercraft. 15. Personal Injury - Broad Form (1) Under Section I - Coverage B, paragraph 2.e. is deleted in its entirety. (2) Under Section V - Definitions, definition 14, paragraph b. is replaced in its entirety by the following: b. Malicious prosecution or abuse of process. (3) Under Section V - Definitions, definition 14, paragraph h. is added as follows: h. Discrimination or humiliation (unless insurance thereof is prohibited by law) that results in injury to the feelings or reputation of a natural person, but only if such discrimination or humiliation is: (1) Not done intentionally by or at the direction of: (a) The insured; (b) Any officer of the corporation, director, stockholder, partner or member of the insured; and (2) Not directly or indirectly related to an "employee ", not to the employment, prospective employment or termination of any person or persons by an insured. (4) This coverage does not apply if Coverage B - Personal and Advertising Injury Liability is excluded either by the provisions of the Coverage Part of by endorsement. 16. Product Recall Expense (1) Under Section I - Coverage A, paragraph 2 Exclusions, n. is replaced in its entirety by the following: n. Recall of Products, Work or Impaired Property Damages claimed for any loss, cost or expense incurred by you or others for the loss of use, withdrawal, recall, inspection, repair, replacement, adjustment, removal or disposal of: (1) "Your product "; (2) "Your work "; or (3) "Impaired property "; if such product, work, or property is withdrawn or recalled from the market or from use by any person or organization because of a known or suspected defect, deficiency, inadequacy or dangerous condition in it, but this exclusion does not apply to "product recall expenses" that you incur for the "covered recall' of "your product'. The exception to the exclusion does not apply to "Product recall expenses" resulting from: (1) Failure of any products to accomplish their intended purpose; (2) Breach of warranties of fitness, quality, durability or performance; (3) Loss of customer approval, or any cost incurred to regain customer approval; (4) Redistribution or replacement of "your product' which has been recalled by like products or substitutes; (5) Caprice or whim of the insured; (6) A condition likely to cause loss of which any insured knew or had reason to know at the inception of this insurance; (7) Asbestos, including loss, damage or clean up resulting from asbestos or asbestos containing materials; (8) Recall of "your products" that have no known or suspected defect solely because a known or suspected defect in another of "your products" has been found. (2) Under Section II - Who Is An Insured, paragraph 3.d. is added as follows: d. Coverage A does not apply to "product recall expense" arising out of any withdrawal or recall that occurred before you acquired or formed the organization. (3) Under Section III - Limits of Insurance, paragraph 8. is added as follows: 8. The Limits of Insurance and rules stated below fix the most we will pay under this coverage part. Page 4 of 6 Includes copyrighted material of ISO Insurance Services Office, Inc. with its permission. 421 -0778 09 09 (1) The Aggregate Limit is the most we will (1) Give us prompt notice of any discovery reimburse you for the sum of all "product or notification that "your product" must recall expenses" incurred for all "product be withdrawn or recalled. Include a recall expenses" initiated during the policy description of "your product" and the period. reason for the withdrawal or recall; (2) The Each Occurrence Limit shown in the (2) Cease any further release, shipment, Summary of Coverages Declaration is the consignment or any other method of most we will pay in connection with any distribution of like or similar products one defect or deficiency. until it has been determined that all (a) All "product recall expenses" in such products are free from defects connection with substantially the same that could be a cause of loss under this general harmful condition will be insurance. deemed to arise out of the same defect (5) Under Section V - Definitions, the following or deficiency and considered one definitions are added: occurrence. 25. "Covered recall," means a recall made (b) Any amount reimbursed for "product necessary because you or a government recall expenses" in connection with body has determined that a known or any one occurrence will reduce the suspected defect, deficiency, inadequacy, amount of the Aggregate Limit or dangerous condition in "your product' available for reimbursement of has resulted or will result in "bodily injury" "product recall expenses" in or "property damage ". connection with any other defect or 26. "Product recall expense" means: deficiency. a. Necessary and reasonable expenses (c) If the Aggregate Limit has been for: reduced by reimbursement of "product (1) Communications, including radio or recall expenses" to an amount that is television announcements or less than the Each Occurrence Limit, printed advertisements including the remaining Aggregate Limit is the stationery, envelopes and postage; most that will be available for (2) Shipping the recalled products reimbursement of "product recall from any purchaser, distributor or expenses" in connection with any other user to the place or places defect or deficiency. designated by you; The Limits of Insurance of Product Recall Expense apply separately to each consecutive annual period and to any remaining period of less than 12 months, starting with the beginning of the policy period shown in the Declarations, unless the policy period is extended after issuance for an additional period of less than 12 months. In that case, the additional period will be deemed part of the last preceding period for the purposes of determining the Limits of Insurance. (3) A Deductible of $500 applies for Each Occurrence. (4) Under Section IV - Commercial General Liability Conditions, Condition 2 - Duties in the Event of Occurrence, Offense, Claim or Suit, paragraph f. is added as follows: (3) Remuneration paid to your regular "employees" for necessary over- time; (4) Hiring additional persons, other than your regular "employees "; (5) Expenses incurred by "employees" including transportation and ac- commodations; (6) Expenses to rent additional ware- house or storage space; (7) Disposal of "your product', but only to the extent that specific methods of destruction other than those employed for trash discarding or disposal are required to avoid "bodily injury" or "property damage" as a result of such disposal; f. You must see to it that the following are You incur exclusively for the purpose done in the event of an actual or of recalling "your product'; and anticipated "covered recall' that may result b. Your lost profit resulting from such in "product recall expense ": "covered recall'. Page 5 of 6 Includes copyrighted material of ISO Insurance Services Office, Inc. with its permission. 421 -0778 09 09 17. Property Damage Legal Liability (Fire, Lightning, Explosion, Smoke or Leakage from Fire Protective Systems Damage) (1) The word fire is changed to fire, lightning, explosion, smoke and leakage from fire pro- tective systems where it appears in the Limits of Insurance section of the Declarations for the Commercial General Liability Coverage Part. (2) Under Section I - Coverage A, the last para- graph (after the exclusions) is replaced in its entirety by the following: Exclusions c. through n. do not apply to dam- age by fire, lightning, explosion, smoke or leak- age from fire protective systems to premises while rented to you or temporarily occupied by you with the permission of the owner. A sepa- rate limit of insurance applies to this coverage as described in LIMITS OF INSURANCE (SEC -TION III). This limit will apply to all damage proximately caused by the same event, whether such damage results from fire, lightning, explosion, smoke or leakage from fire protective systems or any combination of the five. (3) Under Section III - Limits Of Insurance, para- graph 6. is replaced in its entirety by the follow- ing: 6. Subject to 5. above, the higher of: a. $500,000; or b. The Fire, Lightning, Explosion, Smoke or Leakage from Fire Protective Sys- tems Damage Limit shown in the Dec- larations is the most we will pay under Coverage A for damages because of "property damage" from fire, lightning, explosion, smoke and leakage from fire protective systems to premises, while rented to you or temporarily occupied by you with permission of the owner. (4) Under Section IV - Commercial General Liability Conditions, Condition 4. Other Insurance, paragraph (1)(a)(ii) is replaced by the following: (ii) That is fire, lightning, explosion, smoke or leakage from fire protective systems insurance for premises rented to you or temporarily occupied by you with per- mission of the owner; or (5) Under Section V - Definitions, definition 9. 'Insured contract', a. is replaced in its en- tirety by the following: a. A contract for a lease of premises. How- ever, 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 fire pro- tective systems to premises while rented to you or temporarily occupied by you with permission of the owner is not an "insured contract'. (6) This coverage does not apply if Fire Damage Legal Liability of Coverage A is excluded either by the provisions of the Coverage Part or by endorsement. 18. Supplementary Payments Increased Limits Under Section I - Supplementary Payments, Coverages A and B, paragraphs 1.b. and 1.d. are replaced in their entirety as follows: 1.b. Up to $2,500 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. 1.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 $300 a day because of time off from work. 19. Unintentional Failure to Disclose Hazards Under Section IV - Commercial General Liability Conditions, Condition 6. - Representations, paragraph d. is added as follows: d. We will not disclaim coverage under this Coverage Part if you fail to disclose all hazards existing as of the inception date of the policy provided such failure is not intentional. 20. Unintentional Failure to Notify Under Section IV - Commercial General Liability Conditions, Condition 2. - Duties in the Event of Occurrence, Offense, Claim or Suit, paragraph g. is added as follows: g. Your rights afforded under this policy shall not be prejudiced if you fail to give us notice of an "occurrence ", offense, claim or "suit', solely due to your reasonable and documented belief that the "bodily injury" or "property damage" is not covered under this policy. Page 6 of 6 Includes copyrighted material of ISO Insurance Services Office, Inc. with its permission. 421 -0778 09 09