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PROOF OF INSURANCE (2017) CLOSEDSHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City Of E) Segundo ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street EI Segundo, CA 902450989 AUTHORIZED REPRESENTATIVE 01988 -2014 ACORD CORPORATION. Ali rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: GL 704-64-11 COMMERCIAL GENERAL LIABILITY CG 20 01 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONITRISUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance policy provided that: Condition and supersedes any provision to the (1)The additional Insured is a Named Insured contrary: under such other insurance; and Primary And Noncontributory Insurance (2)You have agreed in writing in a contract This insurance is primary to and will not or agreement that this insurance would seek contribution from any other insurance be primary and would not seek contribu- available to an additional insured under your tlon from any other Insurance available to the additional insured. CG 20 01 04 13 0 Insurance Services Office, Inc., 2012 Page 1 of 1 POLICY NUMBER: GL 704-64-11 COMMERCIAL GENERAL LIABILITY CO 20 37 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name t oria nsarr P rrsonls Location And Description Of Completed Operations Or Organization(a) ANY PERSON OR ORGANIZATION PER THE CONTRACT OR AGREEMENT. WHOM YOU BECOME OBLIGATED TO INCLUDE AS AN ADDITIONAL INSURED AS A RESULT OF ANY CONTRACT OR AGREEMENT YOU HAVE ENTERED INTO. 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 which you are required by the contract or include as an additional insured the person(s) or agreement to provide for such additional orgenization(s) shown in the Schedule, but only insured. with respect to liability for "bodily injury" or B. With respect to the insurance afforded to these "property damage" caused, in whole or in part, additional insureds, the following is added to by "your work" at the location designated and Section III-Limits Of Insurance: described in the Schedule of this endorsement If coverage provided to the additional insured is performed for that additional insured and required by a contract or agreement, the most included in the "products-completed operations we will pay on behalf of the additional insured hazard". is the amount of insurance: However: 1. Required by the contract or agreement; or 1. The insurance afforded to such additional 2. Available under the applicable Limits of Insu- Insured only applies to the extent permitted rance shown in the Declarations; by law; and whichever is less. 2. If coverage provided to the additional insured is required by a contract or agree- This endorsement shall not increase the appli- ment, the insurance afforded to such addi- cable Limits of Insurance shown in the Decla- tional insured will not be broader than that rations. CG 20 37 04 13 *insurance Services Office, Inc., 2012 Page 1 of 1 13 POLICY NUMBER: GL 704-64-11 COMMERCIAL GENERAL LIABILITY CG 20 16 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - VENDORS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Or anization(s) (Vendor) Your Products VENDORS WHO SELL OR DISTRIBUTE YOUR ALL PRODUCTS PRODUCTS 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 a. "Bodily injury" or "property damage" for Include as an additional insured any person(s) or which the vendor is obligated to pay organization(s) (referred to throughout this damages by reason of the assumption of endorsement as vendor) shown in the Schedule, liability in a contract or agreement. This but only with respect to "bodily injury" or exclusion does not apply to liability for "property damage" arising out of "your damages that the vendor would have in products" shown in the Schedule which are the absence of the contract or distributed or sold in the regular course of the agreement; vendor's business. b. Any express warranty unauthorized by However: you; 1. The insurance afforded to such vendor only c. Any physical or chemical change in the applies to the extent permitted by law; and product made intentionally by the vendor; 2. If coverage provided to the vendor Is d. Repackaging, except when unpacked required by a contract or agreement, the solely for the purpose of Inspection, insurance afforded to such vendor will not demonstration, testing, or the be broader than that which you are required substitution of parts under Instructions by the contract or agreement to provide for from the manufacturer, and then such vendor, repackaged in the original container; B. With respect to the insurance afforded to these e. Any failure to make such inspections, vendors, the following additional exclusions adjustments, tests or servicing as the apply: vendor has agreed to make or normally 1. The insurance afforded the vendor does not undertakes to make in the usual course apply to: of business, in connection with the distribution or sale of the products; CG 20 15 04 13 0 Insurance Services Office, Inc., 2012 Page 1 of 2 f. Demonstration, installation, servicing or in connection with the distribution or repair operations, except such operations sale of the products. performed at the vendor's premises in 2. This insurance does not apply to any Insured connection with the sale of the product; person or organization,from whom you have g. Products which, after distribution or sale acquired such products, or any Ingredient, by you, have been labeled or relabeled or pert or container, entering into, accom- used as a container, part or ingredient of panying or containing such products. any other thing or substance by or for C. With respect to the insurance afforded to these the vendor; or vendors, the following Is added to Section III - h. "Bodily Injury" or "property damage" Limits Of Insurance: arising out of the sole negligence of the If coverage provided to the vendor Is required vendor for Its own acta or omissions or by a contract or agreement, the most we will those of its employees or anyone also pay on behalf of the vendor is the amount of acting on Its behalf. However, this insurance: exclusion does not apply to: 1. Required by the contract or agreement; or (1)The exceptions contained in Sub- 2. Available under the applicable Limits of paragraphs d. or f.; or Insurance shown in the Declarations; (2)Such Inspections, adjustments, tests whichever is lees. or servicing as the vendor has agreed to make or normally undertakes to This endorsement shell not increase the make in the usual course of business, applicable Limits of Insurance shown in the Declarations. Page 2 of 2 *insurance Services Office, Inc., 2012 CG 20 15 04 13 O BLANKET WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement changes the policy to which It Is attached effective on the Inception data of the policy unless a different date Is Indicated below. (The following"etteohing douse" need be completed only when this endorsem m Is Issued eubeeque t to pâ–șeparodw of the polloy). This endorsement, effective 12:01 AM 03/01/2016 forms a part of Policy No.WC 080-75-6387 Issued to GOFORTH dr MART I - DBA: GM BUS I NESS I LATER I ORS By NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA. We have a right to recover our payments from anyone liable for an Injury covered by this policy. We will not enforce our right against any person or organization with whom you have a written contract that requires you to obtain this agreement from us, as regards any work you perform for such person or organization. The adds lonal premium for this endorsement shall be 2.00 % of the total estimated workers compensation premium for this policy. WC 04 03 01 Countersigned by- - _ (Ed. 11190) Authorised Representative