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PROOF OF INSURANCE (2017) CLOSEDOct 0516 07:66a p.2 0 DAIDD CERTIFICATE OF LIABILITY INSURANCE M TE(MM2=6 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 have ADDITIONAL INSURED provisions Or be endorsed. if SUBROGATION IS WAIVED, subject to the temks and conditlons; of the policy, certain policies may require an endorsement. A statement on thin cartificate does not confer riahts to the certificate holder In lieu of such endorsemer0s), PRODUCER' .. � John Plummer, Agent . . . . . . . ......................................... . . . ............ .. St&eFarM JOHN PLUMMER INSURANCE AGENCY INC I PHONE 805482-2735 fAX -2701 JOHN PLUMMER, AGENT LTC. 1EOE63435 *kk I I . ........................ E4ML john@johnplumrner.net 340 ROSEWOOD AVE, STE I qRkR 3 �FFqROtR COVFF�� fwC 0 CAMARILLO CA 93010 INSURERA' State Farm General Insurance Company 25151 INSURED INSURER 8. State Farm Mutual Automobile Insurance Cornpany 25178 4— ROBINSON WHEELER INSURER c. State Form Fire and Casualty Company DBA DBA. NOVA GRAPHICS SYSTEMS INSURER D: 193 RINALDI ST, STE 187 E PORTER RANCH CA 91328 wisuRER,F. COVET AGE$ 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 13Y 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. 'F"7 AWL 9WR LIV ........................... 2PECrINSURANCE C. N'U"Set d;0F, --F;6�Y OW ------- . . . . . ............ 0,; Yy 1MNMRM= UNIT$ X COMMERCIAL GENERAL LIABILITY Y 05/30=17 EACH OCCURRENCE S CLAIMS-MADE E OCCUR , D - X (ay 3 5,000 ME ST�Lps rsm) I 90-CC-R424-6 G A PERSONAL & ADV INJURY 5 5,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE IS 10,0150,000 PRO- POLICY E JECT El LOC PRODUCTS-CONIPJOPAGG i0.01)DA00 I MEk S — AUTONIOBILE LIAO ILJTY C42 7287-E22-55K 06r2=016 11222016 C $ NY AUTO C41 2724-A24-55E BODILY INJURY (Per pn) S 1,000,000 07r2412016 Ot/27=17 B A94ED SCREDUY H INURr a=dwt) S 1,000,000 UTOS ONLY AUTOS INED IRED N --- E---, PR A 1,WD,000 AUTOS ONLY AUTOS ONLY UMBRELLALLAR OCCUR EACH OCCURFMNCE s EXCESS LIAO CLAMS-WOE AWRIEGATE III DED F­LPETE)%MON$ R-KE-ROCOUP9 InOM 90-BP-K627-9 F OW10=16107111=0 P&T OTH 17 J AND EMPI YM'UAS1UtY Y)N 1,000 r—V-1 NIA Y I E.,L,EAC,H.,ACC1"DE N,T 111 '000 iMPROPRIETORMARTNERAEAF 0" CeRIMEMOCIR F-I(CLUMErP (UmadatoryInNHI EL IDISEASE - EA SW 5 1,000,000 fif below EL INSEME - POLICY LIMIT 13 1,00,150 DrSUMMIZZIPERAMNS . ....... . . . DEWaPrION or- OPEIRATMS I LOCATIONS I VEHICLES (ACORD 101. Adcodonal Rerworks Sth#dLde, may be attactwd 0 more apace Is rwitdroo BUSINESS OFFICE MACHINE SERVICE AND MAINTENANCE ADDITIONAL INSURED: THE CITY OF EL SEGUNDO, ITS OFFICERS, OFFICIALS, EMPLOYEES, AGENTS AND VOLUNTEERS; PLANNING & DEVELOPMENT, CITY CALL, 350 MAIN ST, EL SEGUNDO, CA 9D245-3913 WORKERS COMPENSATION POLICY INCLUDES WAIVER OF SUBROGATION CERTIFICATE HOLDER CANCELLATION 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. PLANNING AND DEVELOPMENT, CITY HALL AUTHOFIZEDReTTIVE A 350 MAIN ST EL SEGUNDO CA 902453913 ®19118»2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks cfAGORD IDD140e 13284.10 02-22-2015 May 20 16 02:06p p.2 JL Policy No. 90— CC—s424 -6 CMP- 4786.1 Page 1 of 2 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CMP - 4786.1 ADDITIONAL INSURED — OWNERS, LESSEES, OR CONTRACTORS (Scheduled) This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE Policy Number: 90— CC— R:29 -6 Named Insured: WHEELER, ROBINSON DBA NOVA GRAPHICS SYSTEMS 9360 RINALDI ST STE 187 PORTER RANCH CA 91326 -1607 Name And Address Of Additional Insured Person Or Organization: THE CITY OF EL SEGUNDO, ITS OFFICERS, OFFICIALS, EMPLOYEES, AGENTS AND VOLUNTEERS PLANNING & DEVELOPMENT, CITY FALL 350 MAIN ST EL SEGUNDO CA 90245 -3895 1. SECTION II — WHO IS AN INSURED of SECTION II — LIABILITY is amended to in- clude, as an additional insured, any person or organization shown in the Schedule, but only with respect to liability for "bodily injury", ' "property damage ", or "personal and advertis- ing injury„ caused, in whole or in part, by: a. Ongoing Operations (1) Your acts or omissions; or (2) The acts or omissions of those acting on your behalf; in the performance of your ongoing opera- tions for that additional insured; or b. Products – Completed Operations "Your work" performed for that additional insured and included in the "products - completed operations hazard ". However, Paragraph 1. above is subject to the following: a. The insurance afforded to the additional insured only applies to the extent permit- ted by law; b. If coverage provided to the additional in- sured is required by a contract or agree- ment, the insurance provided to the additional insured will not be broader than that which you are required by the contract or agreement to provide for such addition- al insured; and c. If the contract or agreement between you and the additional insured is governed by California Civil Code Section 2752 or 2782.05, the insurance provided to the additional insured is the lesser of that which: (1) Is allowed for the satisfaction of a de- fense or indemnity obligation by Cali- fornia Civil Code Section 2782 or 2782.05 for your sole liability; or (2) You are required by contract or agreement to provide for such addi- tional insured. We have no duty to defend or indemnify the additional insured under this endorsement un- til a claim or "suit" is tendered to us. tD, Cop: flgti4 $tote Faim Mutual .Aut nab4e Inswance Company, 2013 Includes oopynghteaf material of Insurance Services Office, Inc., with its permission. CONTINUED May 20 16 02:06p p.3 CM P- 4786.1 Page 2 of 2 2. Any insurance provided to the additional in- (3) The nature and location of any injury sured shall only apply with respect to a claim or damage arising out of the "occur - made or a "suit" brought for damages for rence" or offense; which you are provided coverage. b. Tender, the defense and indemnity of any 3. With respect to the insurance afforded to the claim or "suit" to us and to all other insur- additional insured, the following, is added to ers who may have insurance potentially SECTION It — LIMITS OF INSURANCE: available to the additional insured; and If coverage provided to the additional insured is required by contract or agreement, the most we will pay on behalf of the additional insured will be the lesser of the amount of insurance: a. Required by the contract or agreement; or b. Available under the applicable Limits Of Insurance shown in the Declarations. This endorsement shall not increase the ap- plicable Limits Of Insurance shown in the Declarations. 4. With respect to the insurance afforded to the additional insured, the following is added to Paragraph 3. Duties In The Event Of Occur- rence, Offense, Claim Or Suit of SECTION II — GENERAL CONDITIONS: The additional insured must: a. See to it that we are notified as soon as practicable of an "occurrence " or an of- fense which may result in a claim. To the extent possible, notice should include: (1) l'- -low, when and where the "occur- , rence" or offense took place; (2) The names and addresses of any in- jured persons and witnesses; and c. Agree to make available any other insur- ance the additional insured has for de- fense or damages for which we would provide coverage under SECTION II — LIABILITY. S. With respect to the insurance afforded the ad- ditional insured, the following replaces SEC- TION II --- LIABILITY of Paragraph 7. Other Insurance of SECTfON I AND SECTION II COMMON (POLICY CONDITIONS: a. This insurance is primary to and will not seek contribution from any other insurance available to the additional insured, provided that the additional insured is a named in- sured under such other insurance. b. Regardless of any agreement between you and the additional insured, this insur- ance is excess over any other insurance whether primary, excess, contingent or on any other basis for which the additional in- sured has been added as an additional in- sured on other policies. There will be no refund of premium in the event this endorsement is cancelled. All other policy provisions apply. CMP- 4786.1 1007033 1 48011 08-21 -2014 Q Copyright, state Farm Mutual Automobile Insurance Company, 2013 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Oct 0516 07:55a p.3 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 0313 (Ed. 4-84) WANER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT 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.) This agreement shall not operate directly or Indirectly to benefit any one not named in the Schedule. Schedule THE CITY OF EL SEGUNDO ITS OFFICERS, OFFICIALS, EMPLOYEES AGENTS AND VOLUNTEERS; °LANNING F& DEVELOPMENT, CITY HALL 350 14AI- ST EL SEGUNDO CA 90245 -3813 This endorsement changes the policy tD which it Is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement Is Issued subsequent to preparation of the policy.) Endorsement Effective 08/22/16 Insured WHEELER, ROBINSON DBA NOVA GRAPHICS SYSTEMS 19360 RINALDI ST # 187 PORTER RANCH CA 91326 -1607 WC 00 03 13 (Ed. 4-84) Policy No. F 90 BPK627 9 Endorsement No. 15.00 Premium $ Countersigned By Copyright 1983 National Council on Compensation Insurance. 1007729 124203.1 09-28 -2015