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PROOF OF INSURANCE (2016) CLOSED69128 CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD /YYYY) 11/20/2015 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. )RTANT: If the certificate holder Is an ADDITIONAL INSURED, the pollcy(las) must be endorsed. If SUBROGATION IS WAIVED, subject to .arms 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 endorsements). PRODUCER NAME Kristin eldl /gig .w.. ,.,.. J _ Commercial Lines - (952) 252 -3100 PHONE FA7t eft 9)a, "952 252 3065 to /C rrt 866 710 7436 Wells Fargo Insurance Services USA, Inc. E•Agt Knstin. l_ eicill/ s�P�a�w�slpt;f�rrr.tr,�,e:caro�l 400 Highway 169 South, 8th Floor NAIL p _......___-- 1NSURER(8� AFFORDING COVERAGE__ ... ............................... St. Louis Park, MN 55426 INSURERA: Nationwide Mutual Insurance Company 23787 INSURED. - ....... _ ............ .............. INSURERS: Zurich American Insurance Co 16535 A- Throne Co., Inc. INSU.. .... - . - -- _.__...m.._..m,,,,,....._ : INSURER C; Attn: Corey Vane -- e .................... . MttslIDri; Rte ... .... . 1850 E. 33rd Street INSURER E Long Beach, CA 90807 -5208 . INSURER F: ... ......... .. _ ......... - - - - - --- - - - - -- COVERAGES CERTIFICATE NUMBER: 9817882 REVISION NUMBER: See below 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. ...... ......._ ... _. -- - _ W I . _ IITR TYPE OF INSURANCE POLICY NUMBER MMIDO/YYXY pNUDD XYYXa LIMBS -- - A X mCID MMERCIAL GENERAL LIABILITY ACP7173675981 11/22/2015 11/22/2016 OCCURRENCE $ 1,000,000 ,,,EACH CLAIMS -MADE OCCUR X.... 100,000 PRFMISES�Famaccurrencp�, $..... --- ---... .. _.,-----_ .... ..... .....m......... MED EXP (And one person) $ 1 _,....._- w. -., -, n ...-.m ... .........�. .. , .9000 PERSONAL 8 ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 � PRO- POLICY LOC [X_ -__ —_ JECT __- PRO DUCTS - COMP /OP AGG $ 2,000,000 OTHER: $ uroMOeILELIAeILIrr ACP7173675981 11122/2015 11!22/2016 rill DSI aLt L MIT $ 1,000,000 X ANY AUTO BODILY INJURY (Per person) $ ALL OWNED " SCHEDULED AUTOS AUTOS s .... -.. BODILY INJURY (Per acadenq $ X NED �_ - -_ _- 4GNfi D $ .. HIRED AUTOS X...... AUTOS tFy :d tlfl(A UMBRELLA LAB [OCCUR EACH OCCURRENCE $ EXCESS LIAR LAIMS -MADE 1. AGGREGATE $ "'DE D RETENTION $ Is WORKERS COMPENSATION B WC 6558298 06 PER or11- 11/22/2015 11/22/2016 X PTpTE� YIN m_ ' ECUTIVE ANY PROMEM E L EACH ACCIDENT $ 1,000 000 ERIEXCLUDED? NIA (Mandatory In NH) E L DISEASE - EA EMPLOYE $ 1,000,000 Ife — RIPTION OF OPERATIONS below E.L. DISEASE - POLICY LI.... MIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more apace Is required) Re: Covered CA Operations Performed By Or On Behalf of the Named Insured. The City of El Segundo, its officers, officials, employees, agents and volunteers are included as Additional Insured on a Primary and Non - Contributory basis for General Liability, A Waiver of Subrogation applies as respects Workers' Compensation as required by written contract. 30 day notice of cancellation on General Liability policy. CERTIFICATE HOLDER CANCELLATION'. City of El Segundo City Clerk Main St. Segundo, CA 90245 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE The ACORD name and logo are registered marks of ACORD ©1888 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) 11111111 Ill 1111111111111111111111 IN11111111111111111111111111111111111111111111Ill !Ill! cveol Azor000a eorovosrorororo A- Throne Co., Inc. Policy #ACP7163675981 COMMERCIAL GENERAL LIABILITY CG 71 57 08 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION CONTRACT PRIMARY AND NON - CONTRIBUTORY This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section If — Who Is An Insured Is amended to Include as an additional insured any person or or- ganization for whom you are performing opera- tions when you and such person or organization have agreed In a written contract that such person or organization be added as an additional Insured on your policy. Such person or organization is an additional Insured only with respect to liability for "bodlly 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. A person's or organization's status as an addl- tional insured under this endorsement ends when your operations for that additional In- sured are completed. No such person or organization Is an addi- tlonal Insured for liability arising out of the "products- completed operations hazard ". B. The following Is added to SECTION III — LIMITS OF INSURANCE: The limits of Insurance applicable to the additional Insured are those specified In the written contract between you and the additional Insured, or the lim- its available under this policy, whichever are less. These limits are part of and not in addition to the limits of Insurance under this policy. C. With respect to the insurance afforded to these additional insureds, the following additional exclu- sions apply: This Insurance does not apply to: CG 71 57 08 04 1. "Bodily injury", "property damage" or "personal and advertising Injury" arising out of the ren dering of, or the failure to render, any profes- slonal architectural, engineering or surveying services, Including: a. The preparing, approving, or failing to pre- pare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifica- tions; or b. Supervisory, Inspection, architectural or engineering activities. 2. "Bodily Injury" or "property damage" occurring after: a. All work, Including materials, parts or equipment furnished In connection with such work, on the project (other than ser- vice, maintenance or repairs) to be per- formed by or on behalf of the additional in- sureds) at the location of the covered operations has been completed; or b. 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 subcon- tractor engaged In performing operations for a principal as a part of the same project. D. With respect to the Insurance afforded to these additional insureds, Condition 4. Other Insur- ance Is replaced by the following: 4. Other Insurance If other valid and collectible insurance Is avail- able to the Insured for a loss we cover under Coverages A or B of this Coverage Part, our obligations are limited as follows: Includes copyrighted material of ISO Properties, Inc., with Its permission. Page 1 of 2 IYIRIIIII111III111IIIIII111III11IIIIIIIYIII11111rlll ..,.... CG 71 57 08 04 a. Primary Insurance This Insurance Is primary except when It Is excess as provided under part b., below. When this Insurance Is primary, we will not seek contribution from other Insurance available to the person or organization shown In the Schedule of this endorsement. b. Excess Insurance This Insurance Is excess over: (1) Any of the other Insurance, whether primary, excess, contingent or on any other basis: (a) That Is Fire, Extended Coverage, Builder's Risk, Installation Risk or similar coverage for "your work "; (b) That Is Fire insurance for premises rented to you or temporarily occu- pled by you with permission of the owner; (c) That Is Insurance purchased by you to cover your liability as a tenant for "property damage" to premises rented to you or temporarily occu- pied by you with permission of the owner; or (d) If the loss arises out of the mainte- nance or use of aircraft, "autos" or watercraft to the extent not subject to Exclusion g. of Section I — Cov- erage A — Bodily Injury And Prop- erty Damage Liability When this insurance is excess, we will have no duty under Coverages A or B to defend the additional insured against any "suit" if any other insurer has a duty to defend the additional Insured against that "suit ". If no other insurer defends, we will undertake to do so, but we will be entitled to the addi- tional Insured's rights against all those other Insurers. When this Insurance Is excess over other Insurance, we will pay only our share of the amount of the loss, If any, that exceeds the sum of: (1) The total amount that all such other In surance would pay for the loss In the absence of this insurance; and (2) The total of all deductible and self - Insured amounts under all that other In- surance. We will share the remaining loss, If any, with any other Insurance that Is not described In this Excess Insurance provision and was not bought specifically to apply in excess of the Limits of Insurance shown in the Declara- tions of this Coverage Part. c. Method Of Sharing If all of the other insurance available to the additional insured permits contribu- tion by equal shares, we will follow this method also. Under this approach each Insurer contributes equal amounts until It has paid Its applicable limit of Insurance or none of the loss remains, whichever comes first. If any of the other insurance available to the additional Insured does not permit contribution by equal shares, we will contribute by limits. Under this method, each insurer's share is based on the ra- tio of Its applicable limit of Insurance to the total applicable limits of Insurance of all Insurers. All terms and conditions of this policy apply unless modified by this endorsement. Page 2 of 2 Includes copyrighted material of ISO Properties, Inc„ with Its permission. CG 71 57 08 04 ' GYB01 A2010004®0t0410510f0/0t0' WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY INSURANCE POLICY WC 04 03 06 Ed._ 4-84 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 trust 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 pre - mlurn otherwise due on such remuneration. Schedule Person or Organization Job Description ALL PERSONS AND /OR ORGANIZATIONS THAT ARE REQUIRED BY WRITTEN CONTRACT OR AGREEMENT WITH THE INSURED, EXECUTED PRIOR TO THE ACCIDENT OR LOSS. THAT WAIVER OF SUBROGATION BE PROVIDED FOR UNDER THIS POLICY FOR WORK PREFORMED BY YOU FOR THAT PERSON AND OR ORGANIZATION Insured: A- Throne Co., Inc. Policy #: WC655829805 Insurance Company: Zurich American Insurance Company WC 252 (4-84) Page 1 of 1 WC 04 03 08 (Ed. 4-84) 11111111111111111111111111111111 IN 1111111111111111111111111111111111111111111111111111111 _. _ .