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PROOF OF INSURANCE (2016) CLOSED�1 ACORO° CERTIFICATE OF LIABILITY INSURANCE DATE(MM /DD/YYYY) `� 6/1/2016 1 5/26/2015 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. 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. PHONE No EXt): _ Arc rI CA License #OF15767 EMAIL Los Angeles CA 90017 895-' (213) 689 -0065 INSURgR(S) AFFORDING COVERAG NA INSURED ,foe's Sweeping, Inc, 1047663 dba: Nationwide Environmental Services and ,INL Building Services 11914 Front St, Norwalk CA 90650 The First Liberty Insurance Corporation EmDlovers Insurance Comnanv of Wausau 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 TR TYPE OF INSURANCE IDDL BURR POLICY NUMBER LICY FP M/ Y PO ICY IEXP M',MI g P1r r y LIMITS A X I COMMERCIAL GENERAL LIABILITY Y Y TB6 -Z91- 449522 -115 6/1/2015 6/1/2016 EACH OCCURRENCE 1,000,000 CLAIMS -MADE OCCUR C.a§AM'AGE t IaLN rED, 1,000,000 ED F RE 1 So., �rm�nce MED EXP (An one erson ) 10,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2 000_000 GEN'LAGGREGATE LIMIT APPLIES PER: POLICY JE� LOC PRODUCTS - COMP /OP AGG $ 2,000,000 OTHER $ B AUTOMOBILE LIABILITY N N ASC -Z91- 449522 -035 6/1/2015 6/1/2016 ^; � .' rfN4aLfi: LIMIa MBINE ypj ,$ 1,000,000 X ANY AUTO BODILY INJURY (Per person) $ XXYYXYM AUTOS NED AUTOSULED BODILY INJURY (Per accident, $ XXXXXXX (��(iaPcE(eYt DAMAGE $ XXXXXXX NON-OWNED HIRED AUTOS X Com & Coll Ded $ 1,000 C 1 X UMBRELLA LIAB X OCCUR N N TH7 -Z91- 449522 -065 6/1/2015 6/1/2016 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 EXCESS LIAB CLAiMsWADE:= DED RETENTION $ $ XXXXXXX D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y 710150036 6/1/2015 6/1/2016 P R OTH X STATUTE X Y / N ANY PROPRIETOR/PARTNE JEXECUTIVE N/A E. L EACH ACCIDENT $ 1000000 OFFICERIMEMBER EXCLUDED? (Mandatory in NH) E,.L. DISEASE-EA EMPLOYEE 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below IEI. DISEASE - POLICY LIMIT 1.000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Catlx 01 ,11 Scguauh% its otfleers, officials, Can loyees, agents and volunteers are included as Additional Insured '� hat hlae extent provided by the policy ".,wcrtage ltratgua�gc of cndorscnnent issued or approved by the insurance carrier. (� provided is primary and nitre - contributory. Waiver of Subrogation applies per atttaohtd endorsenent(s) or poliq language. CERTIFICATE HOLDER CANCELLATION See Atta chinents SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 1876365 AUTHORIZED REPRESENTATIVE City of El Segundo Attn: Floriza Rivera, PW Dept. 350 Main St. El Segundo CA 90245 ACORD 25 (2014/01) ©1 38201 C D CORPORATION, All rights reserved The ACORD name and logo are registered marks of ACORD 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 out payments from anyone liable for an injury covered by this policy. We will not enforce out right against the person or organization named in the Schedule. (Phis 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. 604ffllm- Person or Organization Job Description *The premium charge for this endorsement shall be 2% of the premium developed in the State of California, but not less than $500 policy minimum premium. This endorsement changes the policy to 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 6/1/2015 Policy No. 710150036 Endorsement No. 12 Insured Joe's Sweeping, Inc. Policy Effective Date 6/1/2015 Insurance Company Torus National Insurance Company 0040306 (Ed. 4-84) 1998 by the Workers' Compensation Insurance Rating Bureau of California. All rights reserved. Attachment Code: D448503 Certificate ID : 1876365 Policy Number: TB6- Z91- 449522 -115 Item 10. Blanket Additional Insured Where Required By Written Contract Paragraph 2. of Section II - Who Is An Insured is amended to add the following: e. Additional Insured by Written Contract or Written Agreement The following are insureds under the policy when you have agreed in a written contract or written agreement to provide them coverage as additional insureds under your policy: (1) Lessors of Leased Equipment: The person(s) or organization(s) from whom you lease equipment, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your maintenance, operation or use of equipment leased to you by such person(s) or organization(s). (2) Managers or Lessors of Premises: Any manager or lessor of premises leased to you in which the written lease agreement obligates you to procure additional insured coverage. The coverage afforded to the additional insured is limited to liability in connection with the ownership, maintenance or use of the premises leased to you and caused, in whole or in part, by some negligent acts or omissions of you, your employees, your agents or your subcontractors. There is no coverage for the additional insured for liability arising out of the sole negligence of the additional insured or those acting on behalf of the additional insured, except as provided below. If the written agreement obligates you to procure additional insured coverage for the additional insured's sole negligence, then the coverage for the additional insured shall conform to the agreement, but only if the applicable law would allow you to indemnify the additional insured for liability arising out the additional insured's sole negligence. This insurance does not apply to: (a) Any "occurrence" which takes place after you cease to be a tenant in that premises or to lease that land; or (b) Any premises for which coverage is excluded by endorsement. (3) Mortgagees, Assignees or Receivers: Any person(s) or organization(s) with respect to their liability as mortgagee, assignee or receiver and arising out of the ownership, maintenance or use of your premises. This insurance does not apply to structural alterations, new construction and demolition operations performed by or for that person or organization. (4) Any Person or Organization Other Than a Joint Venture: Any person or organization (other than a joint venture of which you are a member) for whom you are obligated by a written agreement to procure additional insured coverage, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: (a) In the performance of your ongoing operations; or (b) In connection with premises owned by you. This insurance does not apply to: 1. Any construction, renovation, demolition or installation operations performed by or on behalf of you, or those operating on your behalf; 2. Any person or organization whose profession, business or occupation is that of an architect, surveyor or engineer with respect to liability arising out of the preparation or approval of maps, drawings, opinions, reports, Attachment Code : D508870 Certificate ID : 1876365 surveys, change orders, designs, specification or the performance of any other professional services by such person or organization; or 3. Any person or organization more specifically covered in Paragraphs e.(1) through (4) above. The insurance afforded to any person or organization as an insured under this Paragraph 2.e.: (1) Applies only to coverage and minimum limits of insurance required by the written agreement or written contract, but in no event exceeds either the scope of coverage or the limits of insurance provided by this policy; (2) Does not apply to any person or organization for any "bodily injury", "property damage" or "personal and advertising injury" if any other additional insured endorsement attached to this policy applies to that person or organization with regard to the "bodily injury", "property damage" or "personal and advertising injury"; (3) Applies only if the "bodily injury" or "property damage" occurs, or offense giving rise to "personal and advertising injury" is committed, subsequent to the execution of the written agreement; and (4) Applies only if the written agreement is in effect at the time the "bodily injury" or "property damage" occurs, or at the time the offense giving rise to the "personal and advertising injury" is committed. Item 11. Blanket Additional Insured - Grantors Of Permits Paragraph 2. of Section II - Who Is An Insured is amended to add the following: Any state, municipality or political subdivision with respect to any operations performed by you or on your behalf, or in connection with premises you own, rent or control and to which this insurance applies, for which the state, municipality or political subdivision has issued a permit. However, this insurance does not apply to: 1. 'Bodily injury", "property damage" or "personal and advertising injury" arising out of operations performed for the state, municipality or political subdivision; 2. Any "bodily injury" or "property damage" included within the "products- completed operations hazard ", except when required by written contract or agreement initiated prior to loss; or 3. "Bodily injury", "property damage" or "personal and advertising injury", unless negligently caused, in whole or in part, by you or those acting on your behalf LC 04 44 04 12 Attachment Code: D508870 Certificate ID : 1876365