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PROOF OF INSURANCE (2017) CLOSEDACS CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 4/6/2016 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 Ileu of such ondorsoment PRODUCER NAME,; RTAr NyBa Gallegos Knight Insurance Services PHONE Far1i (818) 662 -4200 No): (818)662 -9312 ��nMAIL ..... ®.,,,., _ 535 North Brand Boulevard AppREs� isaGOtCraigh tIns.net Suite 1000 gNSIDFtEf1(9AFroRdipEOCOVERA e NAUC r INSUR RA 1ibP�rty Su plaas. Glendale CA 91203 comp p 10725 INSURED rNSUeS,B1e tors, Insurance,Company_ _ 19445 All City Management Services Inc IjNsupetcThe n Burlington In a ance Company 23620 10440 Pioneer Blvd # 5 ­a, r, ,,,,, SURER E ISanta Fe Springs CA 90670 IN INSURER F. COVERAGES CERTIFICATE NUMBER:16 /17 MASTER 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, .. �..... ".. , ADDC; ^ ^SN,I1B ......... POLICY NUMBER ..... MMtl nm F POLI W. m „ _. .. T TYPE OF INSURANCE w OLICY E • ,,.CY ERP „� YY MMIOOIYYYY LIMITS X COMMERCIAL GENERAL LIABILITY � EACH OCCURRENCE t l$ g 1,000,000 A CLAIMS rXOCCUR �` frO7 EUI`L r� 50,000 Xa , ����) X Y 100020084301 4/1/2016 4/1/2017 MED EXP (Any one person) g Excluded r PER SOFIAL & ADV INJURY $ 1,000,000 GETArL AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 ...X I"^CYI...IL:`�P p:,q V...`1C% PRODUC"T"S - COMP /OPAGG ,g ,.... 2,000,000,. ......... $ AUTOMOBILE LIABILITY ".I I AI $ 1,000,000 s- G p �PNIr1gi ........ .,_. B ” X ANY AUTO _ BODILY INJURY (Per person) $ ALL OWNED SCHEDULED ACP7835954504 12/21/2015 12/21/2016 BODILY INJURY Per accadent $ '..,. AUTOS ....... AUTOS X Y ( i X HIRED AUTOS . X,., NON-O FD Pp' OPERTY C) ACHE AUTOS Ip�x r dcc at ,09._ S $ UMBRELLA LIAR oceuR n -Ac, ll' $ 0,000,000 EXCESS LIAB C � _ X EFF0003353 4/1/2016 4/1/2017 AGGREGATE '( B4OOGip000 X _ CLAIMS -MADE DPD HLIIILINfI101INE 0 WORKERS COMPENSATION E f A °I AND EMPLOYERS' LIABILITY ANY PROPRIETOMPARTNEW(EXECUTIVE Y p NIA A Not Applicable E L EACH ACCIDENT $ ' �(, FPCFIi'I{tiA6'tlaRE9i-'REXCLUDED? I ... ... .. IMM1andalory in NHi . --- E L DISEASE - EA EMPLOYEE"~' � r1 eI descdbetoldal D SC.RVW"ti"Id;71d Of OPE�RATIO� 6 betoww E L DISEASE - POLICY LIMIT I$ Not Applicable DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached K more space Is required) As respects General Liability and required by written contract; Certificate Holder is named as additional insured. Insurance is Primary S Non - Contributory. Waiver of Subrogation applicable. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE El Segundo;Deborah Cullen THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Finance Director ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street El Segundo, CA 90245 AUTHORIZED REPRESENTATIVE ir7cT71.7'�11 MI-1 ",hl lOud /N Y 6`iGA7..., C 1988 -2014 ACORD CORPORATION. All rights reserved.. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS025 (2n14o1+ Liberty n. Surplus Insurance Conunercial General Liability orIx)° °o LIBERTY SURPLUS INSURANCE CORPORATION (A New I ]ampshire Stock I nsurance Company, hereinafter the "Company ") ENDORSEMENT NO. Effective Date: 04/01/16 - 04/01/17 Policy Number: 100020084301 Issued To: All City Management Services, Inc. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, ADDITIONAL INSURED — OWNERS, LESSEES OR CONTRACTORS — SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: .'C)� MERCI, Cd GENERAL, LIAB11,1TY COVERAGF l>AR'V SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Locations) Of Covered Operations Any person or organization for whom you are performing operations when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy; Any other person or organization you are required to add as an additional insured under the contract or agreement described in the paragraph above. All locations of covered operations. (Information required to complete dais 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 ", "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) at the location(s) designated above. 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 WE CG 20 10 07 04 © ISO Properties, Inc., 2004 �. A berty, Commercial General Liability �n�rfix) ral io'n 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. WE CG 20 10 07 04 © ISO Properties, Inc., 2004 tmt°ph "Is lrrs '404 V Conunercial General Liability Co1°°ix w a l iot1 LIBERTY SURPLUS INSURANCE CORPORATION (A New Hampshire Stock Insurance Company, hereinafter the "Company") ENDORSEMENT NO. Effective Date: 04/01/16 - 04/01/17 Policy Number: 100020084301 Issued To: All City Management Services, Inc. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, PRIMARY INSURANCE CLAUSE ENDORSEMENT To the extent that this insurance is afforded to any additional insured under the policy, such insurance shall apply as primary and not contributing with any insurance carried by such additional insured, as required by written contract. Nothing herein contained shall be held to waive, vary, alter or extend any condition or provision of the policy other than as above stated. 1 CGL 10 3104 03 Effective Date: 04/01/16 - 04/01/17 Policy Number: 100020084301 Issued To: All City Management Services, Inc. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE E PAf T PT ODUCTS /COMPLEFED OPERATIONS LIABILITY " CO" ERAGE PART SCHEDULE Name Of Person Or Organization: As required by written contract signed by both parties prior to any "occurrence" in which coverage is sought under this Policy. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV — Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products - completed operations hazard ". This waiver applies only to the person or organization shown in the Schedule above. 1 CG 24 04 05 09 U' Insurance Services Office, Inc., 2008 o CERTIFICATE OF LIABILITY INSURANCE °A9j6 /2016 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(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 NAI Trend Certificate Coordinator _ ROBERTS s CROW, INC. PHONE (214) 553 -5505 ( FA X NP)I (214)553 -5525 O. M EaU. ANL ......... 0 12221 Merit Drive 41 e Suite 300 INSU",5 AFFORDING COVERAGE NAICA Dellas TX 75251 INSURERA.T2chnOlOgy Insurance Co.........Inc. 42376 ...., ......M .. ,.,m.,... .... .... .. .. ... ........ . .. _,.,. ., INSURED INSURER B : Trendsetter BR, LLC INSURER C: 11-111,11, L /C /F All City Management Services, Inc. INSURER D: 2701 Sunset Ride Drive Suite 500 INSURER E: Rockwall TX 75032 IN SURERF, COVERAGES CERTIFICATE NUMBER:All City Management 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. m._,� ..... .................. X001 U6R& �W ILTRR D1 PYF W - PMMIC I TYPE OF INSURANCE POLICY NUMBER f YVXYP LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE ti 4 OAMIIOE TO AtN Lb I CLAIMS -MADE D OCCUR 5 MED EXP (Any one person) PERSONAL "q INJURY F GEN L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 6 POLICY � E LOO PRODUCTS - COMP /OPAGG 5 OTHER: $ AUTOMOBILE LIABILITY CO BINED S NGLE LIMIT $'. ANY AUTO arson) OWNED SCHEDULED BODILY INJURY (Per. accident) S $ 666 AUTOS ,. "I'll ..,.. a .,,,,,,,... NON -OWNED I RL7t LR O.A� � HIRED AUTOS AUTOS '.... (Pdr iwr,dSlr /teal) UMBRELLA LIAB OCCUR I EACH OCCURRENCE i EXCESS LIAB CLAIMS -MADE AGGREGATE T DED � .m RETENTION 5 ...,.�,� _ _ .... WORKERS COMPENSATION i FER I � 1H STATI BTE 1 ER , AND EMPLOYERS' LIABILITY YdN !ANY PROPRIETORIPARTNERIEXECUTIVE TWC3546735 - Texas 4/1/2016 i 4/1/2017 EL EACH ACCIDENT .$, 1"000,000 OFFICERIMEMBER EXCLUDED? J N N l A A (Mandatory In NH) SWC1106555 - Other Than TX 4/1/2016 " """' " " "" 4/1/2017 E L DISEASE - EA EMPLOYEE $ 'I" c f,Io r 111,0 If jyars, describe under 17 - SCHIP'TiON OF OPFRATION:S below I E.L. DISEASE . POLICY LIMIT t 1,000,000 Location Coverage Period 4/1/2016 4/1/2017 Udeirulft,331371 I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) Coverage is provided for only those employees leased to but not subcontractors of All City Management Services, Inc. Waiver of Subrogation in favor of the Certificate Holder applies, CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of El Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 350 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. E1 Segundo, CA 90245 AUTHORIZED REPRESENTATIVE ©1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD IENS025oniznil WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY INSURANCE POLICY WC 124 (4 -84) WC 00 03 13 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different date is indicated below. (The following "attaching clause" need be completed only when this endorsement is issued subsequent to preparation of the policy) This endorsement, effective on 411/2016 at 12:01 A. M. standard time forms a part of DATE Policy No. SWC1106555 of the Issued to Trendsetter HR, LLC Premium $ All City Management Services, Inc. SECURITY NATIONAL INSURANCE COMPANY NAME OF INSURANCE COMPANY Authorized Representative 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. City of El Segundo 350 Main Street El Segundo, CA 90245 WC 124 (4 -84) WC 00 03 13 Copyright 1983 National Council on Compensation Insurance Page 1 of 1