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PROOF OF INSURANCE (2014) CLOSEDACORO' CERTIFICATE OF LIABILITY INSURANCE 12iv2o14 DATE /25/2013 11/25/2013 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 policy(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 Lockton Insurance Brokers, LLC 725 S. Figueroa Street, 35th Fl. CA License #IOF15767 Los Angeles CA 90017 (213) 689 -0065 NAME: PHONE I-A Ext): (A /C, No): EAMAILo, ADDRESS: INSURERS AFFORDING COVERAGE NAIC # INSURER A : Zurich American Insurance Company 16535 INSURED Best Contracting Services, Inc. 1327880 19027 S. Hamilton Ave. Gardena CA 90248 INSURER B: American Guarantee and Liab. Ins. Co. 26247 INSURER C: American Zurich Insurance Company 40142 INSURER D: PREMISES (Ea RENTED ) INSURER E: MED EXP (Any one person) INSURER F: PERSONAL & ADV INJURY COVERAGES BESR001 CERTIFICATE NUMBER: 12537237 REVISION NUMBER: XXXXXXX 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. INSR LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF MM /DD /YYYY POLICY EXP MM /DD /YYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FK OCCUR • XCU Coverage Y Y GL0980519702 12/1/2013 12/1/2014 EACH OCCURRENCE $ 1,000,000 PREMISES (Ea RENTED ) $ 1,000,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 11000,000 • Contractual Liab GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRO - POLICY X JECT X LOC PRODUCTS - COMP /OP AGG $ 2,000,000 $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS DULED NON -OWNED HIRED AUTOS X AUTOS Y Y BAP980519602 12/1/2013 12/1/2014 EOa aBINEDtSINGLE LIMIT $ 1,000,000 X BODILY INJURY (Per person) $ X'X'X'X'XXX X BODILY INJURY (Per accident $ XX'X'X'XXX X PROPERTY DAMAGE Per accident $ Xr�r�r�r�r�r�r Comp/Coll Ded $ 1,000 B X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE N N AUC594465705 12/1/2013 12/1/2014 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 DED I I RETENTION $ $ XXXXXXX C AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR /PARTNER /EXECUTIVE OFFICER /MEMBER EXCLUDED? FN (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A Y WC980519802 12/1/2013 12/1/2014 X TORY LIMITS 0ER E.L. EACH ACCIDENT $ 1 000 000 E.L. DISEASE - EA EMPLOYEE $ 1:000:000 E.L. DISEASE - POLICY LIMIT S 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES /(Attach ACORD 101, Additional Remarks Schedule, if more space is required) Project: Park Vista Senior Housing Roof Repairs Project No. PW 13 -20. The City, its officers, officials, employees, agents, and volunteers are an Additional Insured to the extent provided by the policy language or endorsement issued or approved by the insurance carrier. Insurance provided to Additional Insured(s) is primary and non - contributory as per the attached endorsements or policy language. Waiver of Subrogation applies per attached endorsement(s) or policy language. CERTIFICATE HOLDER CANCELLATION See Attachments SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 12537237 AUTHORIZED REPRESENTATIVE City of El Segundo 350 Main Street El Segundo CA 90245 ACORD 25 (2010/05) ©1 9188-2011 CQRD CORPORATION. All rights reserved The ACORD name and logo are registered marks of ACORD POLICY NUMBER: GL0980519702 COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/ COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: ANY PERSON OR ORGANIZATION THAT REQUIRES YOU TO WAIVE YOUR RIGHTS OF RECOVERY, IN A WRITTEN CONTRACT OR AGREEMENT WITH THE NAMED INSURED THAT IS EXECUTED PRIOR TO THE ACCIDENT OR LOSS. 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. CG 24 04 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 1 Attachment Code : D469017 Certificate ID : 12537237 POLICY NUMBER: BAP980519602 COMMERCIAL AUTO CA 20 48 02 99 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY DESIGNATED INSURED This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" under the Who Is An Insured Provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Endorsement Effective: 12/1/2013 Named Insured: Best Contracting Services, Inc. SCHEDULE Name of Person(s) or Organization(s): Blanket as required by written contract (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to the endorsement.) Each person or organization shown in the Schedule is an "insured" for Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in SECTION II of the Coverage Form. CA 20 48 02 99 Copyright, Insurance Services Office, Inc. 1998 Page 1 o 1 Attachment Code : D476096 Certificate ID : 12537237 Waiver Of Transfer Of Rights Of Recovery Against Others To Us THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Policy No. Eff. Date of Pol. Exp. Date of Pol. Eff. Date of End. Agency No. Addl. Prem. Return Prem. BAP980519602 12/1/2013 12/1/2014 12/1/2013 Named Insured: Best Contracting Services, Inc. Address (including ZIP code): 19027 S. Hamilton Ave. Gardena, CA 90248 This endorsement modifies insurance provided under the: Business Auto Coverage Part Truckers Coverage Part Garage Coverage Part SCHEDULE Name of Person or Organization: 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 UNDER THIS POLICY We waive any right of recovery we may have against the designated person or organization shown in the schedule because of payments we make for injury or damage caused by an "accident" or "loss" resulting from the ownership, maintenance, or use of a covered "auto" for which a Waiver of Subrogation is required in conjunction with work performed by you for the designated person or organization. The waiver applies only to the designated person or organization shown in the schedule. U -CA -320 -A (cam (4/92) Page 1of1 Attachment Code : D469014 Certificate ID : 12537237 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 4 -84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA 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 12/1/2013 Policy No. WC980519802 of the Issued to BEST CONTRACTING SERVICES, INC. Premium (if any) $ at 12:01 AM. standard time, forms a part of Endorsement No. American Zurich Insurance Company 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. 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 UNDER THIS POLICY FOR WORK PERFORMED BY YOU FOR THAT PERSON AND /OR ORGANIZATION WC 252 (4-84) WC 04 03 06 (Ed. 4 -84) Attachment Code : D469013 Certificate ID : 12537237 Page 1of1 Additional Insured- Owners,Lessees Or Contractors - Ongoing Operations - Scheduled Policy No Eff. Date of Pol Exp. Date of Pol Eff. Date of End. GL0980519702 12/1/2013] 12/1/2014 12/1/2013 ZURICH Producer No. Add'!. Pram Return Prem THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the: Commercial General Liability Coverage Part SCHEDULE Name of Person or Organization: Location and Description of Ongoing Operations: The City' its officers, officials, employees, agents, and volunteers A. Section II - Who Is An Insured is amended to include as an insured any person or organization shown in the Schedule of this endorsement, but only with respect to liability arising out of your ongoing operations performed for that insured at or from the corresponding location designated and described in the Schedule. However, if you have entered into a construction contract with an additional insured person or organization shown in the Schedule of this endorsement, the insurance afforded to such additional insured only applies to the extent permitted by law. B. With respect to the insurance afforded to any additional insured shown in the Schedule of this endorsement, the following additional exclusion applies: 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 site of the covered operations has been completed; or 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. All other terms and conditions of this policy remain unchanged. U -GL- 1465 -B CW (04/12) Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc., with its permission Attachment Code : D471476 Certificate ID : 12537237 Additional Insured - Owners, Lessees Or Contractors - Completed Operations - Scheduled ZURICH Policy No. Exp. Date of Pol. Eff. Date of End. Agency No. Addl. Prem. Return Prem. GL0980519702 12/1/2014 12/1/2013 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the: Commercial general Liability coverage Part SCHEDULE Name of Person or Organization: Location and Description of The City' its officers, officials, employees, agents, and Completed Operations: volunteers See Description of Operations on Certificate attached Section II - Who Is An Insured is amended to include as an insured any person or organization shown in the Schedule of this endorsement, but only with respect to liability arising out of "your work" at or from the corresponding location designated and described in the Schedule performed for that insured and included in the "products- completed operations hazard ". However, if you have entered into a construction contract with an additional insured person or organization shown in the Schedule of this endorsement, the insurance afforded to such additional insured only applies to the extent permitted by law. All other terms and conditions of this policy remain unchanged. Includes copyrighted material of Insurance Services Office, Inc., with its permission. Attachment Code : D471477 Certificate ID : 12537237 U -GL- 1466 -B CW (04/12) Page 1of1