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PROOF OF INSURANCE (2017) CLOSEDCERTIFICATE OF LIABILITY INSURANCE °ATE`MM, °°,YY' 08/17J2018 YYY9 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 pollcy(les) 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 BIII Sleb M1AtE e SL Insurance Associates (408) 776 -8800 (4.08) 776-8602 275 Tennant Ave. #207 AL w+I bill sllnsure.com _._._._�,.�. ... ........ ., ......... ....mm............. ....... 4 COMMERCL4L GENERAL LIABILITY INSURER( AFFORDING COVERAGE NAIL N �.... ........__ ,.,.,.N.. ............ Morgan HIII CA 95037 W ...... .. .......w... _........, INSURER A : NATIONAL FIRE INS CO OF HARTFORD 20478 ............ .._ .... -_ INSURED ...._ INSURERB: HARTFORD INS CO OF THE MIDWEST 37478 PACIFIC SERVICES, INC. INSURERO. ' __......, _, dba: Pacific Datacom _..... — , ... .__........... INSURERD: 927 Calle Negocio suite L INSURER E: .. . _ ........ San Clemente CA 92673 ._......... 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. Twiff _ . ... 1�_ - .m..... .. ...................... _ h60 Y E (0Y10 L TYPE OF INSURANCE POLICY NUMBER ME FF D _.. ........,a_ _....�,.,....- ._._� LIMITS 4 COMMERCL4L GENERAL LIABILITY EACH OCCURRENCE $ 2,000 000 CLAIMS -MADE � OCCUR _. _ _ Otv'II�L tOE�ao,�rxr�rra .,�„ $ 300 000 ....--- . ................ MED EXP (Any one person) $ 10,000 A Y Y B4031343323 01/20/2016' 01/20/2017 PERSONALdADVINJURY $ 2,000,000 CaEN '4 AGGREGATE APP PER' GENE RAL AGGREGATE 4,000,000 LOC POLICY C PRODUCTS - COM OP AGG $ _ OTHER! $ AUTOMOBILE LIABILITY (Ee�BII.ii ED l $ 1,000,000 _............ ANY AUTO BODILY INJURY (Per person) . ALL OWNED SCHEDULED AUTOS Auros Y Y B4031343323 01/2012016 01/20/2017 BODILY INJURY (Per accident) $ NON -OWNED PROPERTYt3AMd2AGE , ,. $ HIRED AUTOS. AUTOS (Per_sc.ddentJ,ITIT,„ „_ ,, UMBRELLA UAB OCCUR EACH OCCURRENCE .. $ ..............� EXCESS LIAB CLAIMS -MADE( _ �..._..._ p AGGREGATE $ ... .......... _........... DEC) RETENTION $ $ WORKERS COMPENSATION PER TH- X.. AND EMPLOYERS' LIABILITY Y /� N - _STATUTE ,; ER B ANY PROPRIETOR /PARTNER/EXECUTIVE OFFICERWEMBER EXCLUDED? �Y NIA Y 67WECES7871 01/09/2016 01/09/2017 EACH m WWWWWWWWWW (Mandatory In NH) E L EASECIEA EMPLOYE $ 1,000,000 If es, descl be under .m ....�.IM „- .0,... .... DESCRIPTION OF OPERATIONS below E.L....DISEASE - POLICY LIMIT $ 1,000,000 , L DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) As it pertains to its California operations, and where required by contract for any and all locations for that contract, the following is named as additional insured interest. The City of El Segundo "30 Days notice of Cancellation” "10 day notice for Non -Pay TE HOLDER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN The City of El Segundo ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 350 Main St El Segundo Ca 90245 $ 3+Gfic ©1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD Policy: B 4031343323 SB- 146935 -C (Ed. 06111) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED — OWNERS, LESSEES OR CONTRACTORS — WITH PRODUCTS COMPLETED OPERATIONS COVERAGE This endorsement modifies insurance provided under the following: BUSINESSOWNERS LIABILITY COVERAGE FORM A. Paragraph C. WHO IS AN INSURED is amended to include as an additional insured: 1. Any person or organization whom you are required by written contract to add as an additional insured on the Businessowners Liability Coverage Form. B. The insurance provided to the additional insured is limited as follows: 1. The person or organization is an additional insured 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 b. The acts or omissions of those acting on your behalf C. The insurance provided to the additional insured does not apply to "bodily Injury," "property damage," or "personal and advertising injury" arising out of: a. 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; and (2) Supervisory, inspection, architectural or engineering activities. b. "Bodily Injury," "property damage," or "personal and advertising injury" arising out of any premises or work for which the additional insured is specifically listed as an additional insured on another endorsement attached to this Policy. D. Section E. of the Businessowners General Liability Conditions is amended as follows: The Duties in the Event of Occurrence, Offense, Claim or Suit condition is amended to add the following additional conditions applicable to the additional insured: An additional insured under this endorsement will as soon as practicable: a. Give us written notice of an 'occurrence" or an offense which may result in a claim or "suit" under this insurance, and of any claim or "suit" that does result; b. Tender the defense and indemnity of any claim or "suit" to any other insurer or self insurer whose policy or program applies to all loss we cover under this Policy; c. Except as provided in Paragraph 13,3. of this endorsement, agree to make available any other insurance the additional insured has for a loss we cover under this Policy; and d. Send us copies of all legal papers received, and otherwise cooperate with us in the investigation, defense, or settlement of the claim or "suit." We have no duty to defend or indemnify an additional insured under this endorsement until we SB- 146935 -C Page 1 of 3 (Ed. 06/11) in the performance of your ongoing operations specified in the written contract; or c. "Your work" that is specified in the written contract but only for "bodily injury" or "property damage" included in the products completed operations hazard, and only if : (1) The written contract requires you to provide the additional insured such coverage; and (2) This Coverage Form provides such coverage. 2. We will not provide the additional insured any broader coverage or any higher limit of insurance than the least that is: a. Required by the written contract; b. Described in B.I. above; or c. Afforded to you under this policy. 3. This insurance is excess of all other insurance available to the additional insured, whether on a primary, excess, contingent or any other basis. —_ But if required by the written contract, this insurance will be primary and non - contributory =_ relative to Insurance on which the additional insured is a Named Insured. C. The insurance provided to the additional insured does not apply to "bodily Injury," "property damage," or "personal and advertising injury" arising out of: a. 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; and (2) Supervisory, inspection, architectural or engineering activities. b. "Bodily Injury," "property damage," or "personal and advertising injury" arising out of any premises or work for which the additional insured is specifically listed as an additional insured on another endorsement attached to this Policy. D. Section E. of the Businessowners General Liability Conditions is amended as follows: The Duties in the Event of Occurrence, Offense, Claim or Suit condition is amended to add the following additional conditions applicable to the additional insured: An additional insured under this endorsement will as soon as practicable: a. Give us written notice of an 'occurrence" or an offense which may result in a claim or "suit" under this insurance, and of any claim or "suit" that does result; b. Tender the defense and indemnity of any claim or "suit" to any other insurer or self insurer whose policy or program applies to all loss we cover under this Policy; c. Except as provided in Paragraph 13,3. of this endorsement, agree to make available any other insurance the additional insured has for a loss we cover under this Policy; and d. Send us copies of all legal papers received, and otherwise cooperate with us in the investigation, defense, or settlement of the claim or "suit." We have no duty to defend or indemnify an additional insured under this endorsement until we SB- 146935 -C Page 1 of 3 (Ed. 06/11) [.�I receive from the additional insured written notice of a claim or "suit." E. With respect only to the insurance provided by this endorsement, the first sentence of Paragraph H.1. Other Insurance Condition in the Businessowners Common Policy Conditions, is deleted and replaced with the following: Other Insurance 1. This insurance is primary and non - contributory except when rendered excess by this endorsement, or when Paragraph 2. below applies. F. The provisions of the written contract or written agreement do not in any way broaden or amend this Policy. G. Blanket Waiver of Subrogation We waive any right of recovery we may have against: 1. Any person or organization with whom you have a written contract that requires such a waiver. H. Broad Knowledge of Occurrence The following items are added to E. Businessowners General Liability Conditions in the Businessowners Liability Coverage Form: e. Paragraphs a. and b. apply to you or to any additional insured only when such 'occurrence," offense, claim or "suit' is known to: 1. You or any additional insured that is an individual; (2) Any partner, if you or an additional insured is a partnership; (3) Any manager, if you or an additional insured is a limited liability company; (4) Any "executive officer" or insurance manager, if you or an additional insured is a corporation; (5) Any trustee, if you or an additional insured is a trust; or (6) Any elected or appointed official, if you or an additional insured is a political subdivision or public entity. This paragraph e. applies separately to you and any additional insured. I. Bodily Injury Section F. Liability and Medical Expenses Definitions, item 3. "Bodily Injury" is deleted and replaced with the following: "Bodily injury" means bodily injury, sickness or disease sustained by a person, including death, humiliation, shock, mental anguish or mental injury by SB- 146935 -C (Ed. 06111) SB- 146935 -C (Ed. 06111) that person at any time which results as a consequence of the bodily injury, sickness or disease. J. Expanded Personal and Advertising Injury Definition A. The following is added to Section F. Liability and Medical Expenses Definitions, item 14. Personal and Advertising Injury, in the Businessowners General Liability Coverage Form: h. Discrimination or humiliation 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; or b. Any "executive officer," director, stockholder, partner, member or manager (if you are a limited liability company) of the insured; and 2. Not directly or indirectly related to the employment, prospective employment, past employment or termination of employment of any person or person by any insured. B. The following is added to Exclusions, Section B.: (15) Discrimination Relating to Room, Dwelling or Premises Caused by discrimination directly or indirectly related to the sale, rental, lease or sub -lease or prospective sale, rental, lease or sub -lease of any room, dwelling or premises by or at the direction of any insured. (16) Fines or Penalties Fines or penalties levied or imposed by a governmental entity because of discrimination. C. This provision (Expanded Personal and Advertising Injury) does not apply if Personal and Advertising Injury Liability is excluded either by the provisions of the Policy or by endorsement. D. Personal and Advertising Injury Re- defined Section F. Liability and Medical Expenses Definitions, item 14, Personal Advertising Injury, Paragraph c. is replaced by the following: c. The wrongful eviction from, wrongful entry into, or invasion of the right of private occupancy of a room dwelling or premises that a person or organization occupies Page 2 of 3 CNA SB- 146935 -C (Ed. 06111) committed by or on behalf of its owner, landlord or lessor. SB- 146935 -C Page 3 of 3 (Ed. 06111) Policy: 57WECES7871 F1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.. 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 % of the California workers' compensation premium otherwise due on such remuneration. Person or Organization ANY PERSON OR ORGANIZATION FOR WHOM THE NAMED INSURED HAS AGREED BY WRITTEN CONTRACT TO FURNISH THIS WAIVER SCHEDULE Job Description BLANKET WAIVER OF SUBROGATION Countersigned by e--6ew4�01 Authorized Representative Form WC 04 03 06 (1) Printed in U.S.A.