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PROOF OF INSURANCE (2014) CLOSED�,��� DATE (MMIDDIYYYY) A�„ CERTIFICATE OF LIABILITY INSURANCE 06/254201 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 1EPRESENTATIVE 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 endorsernenf(s).. PRODUCER o EA ' NAMP� Fran Thomas . .......... , ... ®,_.,... DFI - DiGerolamo Family Insurance Services PHONE 951 735 5335 FAX No): (9 1 893.2750 .m ...... _ 2027 Hamner Ave AF-MAIL flrardfiinsurance com Norco, CA 92860 INSURERjs) A FFORDING COVERAGE , NAIL-11- License #: OD26889 ....,..r. rNS,uftERA .....E. 1 (NG ON IN$URANCE QQMPAJNY ... INSURED iNSUReRe , . GOLDEN .EAG LEI, ,INS URANC.E,,CORP ......... KNORR SYSTEMS, INC. wsuRERC: N iTIt IWAL.0 .f+1,PIItl, FIRI I.NS, COMPANY .............n .,.,........... 2221 S Standard Ave INSURER': MARKEL INSURANCE., COMPANY..._ ._ --- ----- Santa Ana, CA 92707 tNs0ER.E.111 I ......... .......... INSURER F ; COVERAGES CERTIFICATE NUMBER: 00004675- 3860763 REVISION NUMBER: 327 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.. INS .... ,,,. .........TYPE OF IN..... E ........_, _ 9 ..M ODY h1 Y EYYY........ LTR A�tiYiL'S POLICY NUMBER -- LIMITS A Y HGL0035131 06/23/2013 06/23/2014 EACH OCCURRENCE $ 1W�000b000 GENERAL LIABILITY i)AMAV�'TG�Nt1 =mm � . -. ...__...... a ,,...,. _X COMMERCIAL GENERAL LIABILITY JPPRTiEMI F5.,(9@spno renre 5._ 5 .d CLAIMS -MADE IL ^ ] OCCUR MED EXP (Any one person) $ X CONTRACTUAL PERSONAL &ADVINJURY s 11000,000 GENERAL AGGREGATE X XCU -BF PD a, GEN'L AGGREGATE LIMIT AJ- "RI IINi:S PER: .. PRODUCTS COMP /OPAGG $ 2,000,000 POLICY X LOC $ BA6923381 06/23/2013 06/23/2014 [CAAr1°t"IFDLt --- nE-- .. AUTOMOBILE LIABILITY � %a,�r��I,J��q) -_ gMm, ya ...... ,,.r ANY AUTO -BODILY INJURY (Per P I a I FSo . n) $ AUTOS NE AUTOS BODILY DPERTYUCWY (Per accident) , $ � ALL OWNED SCHEDULED NON OWNED .. $ HIREDAUTOS AUTOS _( Per acidenl) .............. ........... `` UMBRELLA LIAB X OCCUR BE018085964 06/23/2013 06/23/2014 EACH OCCURRENCE $ _„ 3,000,000 -_- 3,04,6160" 0 m_X .....EXCESS LI� B..,, .... uICLAIMS MADE i'�J"aJar4- -- AcTE $.,. .. .. OED RETENTION S WORKERS COMPENSATION D NIA A MWC0034056 02 06/06/2013 06/06/2014 X 0TH WC STATU OP.'PRMEETOR/P PROPRIETOR/PARTNER/EXECUTIVE /E — A?ftY-UlCID AN l' PROPRIETOR /PARTNER /EXECUTIVE � E L EACH,ACCIDENT,= $ 1,000,000 (Mandatory in NH) " E L DISEASE EA EMPLOYE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below EL. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) 10 DAYS N.O.C. FOR NON PAYMENT OF PREMIUM. CERTIFICATE HOLDER IS NAMED AS ADDITIONAL INSURED ON GL & INCLUDES: THE CITY OF EL SEGUNDO, ITS OFFICERS, OFFICIALS, EMPLOYEES, AGENTS AND VOLUNTEERS. COVERAGE IS PRIMARY & NON CONTRIBUTORY ON GL & AUTO. ON GOING POOL SERVICE AT VARIOUS LOCATIONS. 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 ATTN: ALISON FIORINI ACCORDANCE WITH THE POLICY PROVISIONS. 401 SHELDON STREET EL SEGUNDO, CA 90245 AUTHORIZED REPRESENTATIVE FHT ©1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD Printed by FHT on June 25, 2013 at 11:29AM KNORR SYSTEMS, INC. HGL 0035131 COMMERCIAL GENERAL LIABILITY CG 20 10 07 04 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: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) ........ Or Organization(s): Locations Of Covered Operations Any person or organization with whom you have agreed, in Any and all covered locations. a written contract, that such person or organization should be added as an additional insured on your policy, provided such written contract is fully executed prior to an "Occurrence" in which coverage is sought under this policy. Information Leguired to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following additional exclu- organization(s) shown in the Schedule, but only sions apply: with respect to liability for "bodily injury", "property This insurance does not apply to "bodily injury" or damage" or "personal and advertising injury" "property damage" occurring after: caused, in whole or in part, by: 1. All work, including materials, parts or equip- 1. ;Your acts or omissions; or ment furnished in connection with such work, 2. The acts or omissions of those acting on your on the project (other than service, mainte- behalf; nance or repairs) to be performed by or on be- in the performance of your ongoing operations for half of the additional insured(s) at the location the additional insured(s) at the location(s) desig- of the covered operations has been completed; nated above. or 2. That portion of "your work" out of which the injury or damage arises has been put to its in- tended use by any person or organization other than another contractor or subcontractor en- gaged in performing operations for a principal as a part of the same project. CG 20 10 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AMENDMENT - OTHER INSURANCE (PRIMARY AND NON - CONTRIBUTORY COVERAGE) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS - COMPLETED OPERATIONS LIABILITY COVERAGE PART Schedule of Additional Insured(s): ANY PERSON OR ORGANIZATION WITH WHOM YOU HAV E PERSON OR ORGANIZATION SHOULD BE ADDED AS AN SUCH WRITTEN CONTRACT IS FULLY EXECUTED PRIOR SOUGHT UNDER THIS POLICY. A. Paragraph C. of this endorsement replaces paragraph 4. Other Insurance of Section IV- Commercial General Liability Conditions, but only with respect to the insurance afforded to the additional insured(s) scheduled above. B. Paragraph C. of this endorsement replaces paragraph 4. Other Insurance of Section Iv- Products-Completed Operations Liability Conditions, but only with respect to the insurance afforded to the additional insured(s) scheduled above. C. Other Insurance Notwithstanding other valid and collectible insurance available to the insured for a loss we AGREED, IN A WRITTEN CONTRACT, THAT SUCH ADDITIONAL INSURED ON YOUR POLICY, PROVIDED TO AN "OCCURRENCE" IN WHICH COVERAGE IS cover under the applicable Coverage Part to which this endorsement is modifying, this insurance is primary and non - contributory. However, this endorsement: 1. Applies only when you are required by contract, agreement or permit to provide primary and non - contributory coverage for the additional insured, provided such written contract, agreement or permit is fully executed prior to an "occurrence" in which coverage is sought under this policy, and 2. Does not apply to any claim, loss or liability due to the sole negligence of the additional insured. IFG -G -0094 02 12 Includes copyrighted material of Page 1 of 1 ISO Properties, Inc., with permission