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PROOF OF INSURANCE (2013) CLOSEDCERTIFICATE OF LIABILITY INSURANCE DATE(MMI °D/YY1Y) 0 6122120 1 2 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 terns 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. EON' CT _.. ..�_ .—._ �...$ _. y 1wrCCt .., ('51)735 5335 A/�,Nrrl ('951 893-2750 DFI - DiGerolamo Family Insurance Services PHONE FAX 2027 Hamner Ave E-MAIL -- „)_...- Norco, CA 92860 E" Fa s , .._.. fran @l flinsurance.com License #: OD26889 MNq, L°ULRA i m ..... NAlc a" . _.... �m _ �.�.....w_ m _ ,,. ... I!NSuRE A,, 4) LICwI� .i ENV iA l I(" "...... INSURED INSURER B GOLDEN EI��L'L F � KNORR SYSTEMS, INC. aNSrJRER c NA�.�.9�AI, LIN!QN FIR _I suRAN pE cq ,Per _.... 2221 S Standard Ave krfs)aR r D :....�P. L 11� � .N_CE_ M....:PA_N.. " .. .. Santa Ana, CA 92707 INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: 00004675. 2916402 REVISION NUMBER: 212 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, D CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Tra�UM..- __�W.� PfYL�fYEFftrgbrcYx... _.----- _.....�.� �� EXCLUSIONS AN A "Iii 69 ^. _Wy PE OF INSURANCE eFR V EFF MMd D 'Y.., LIMITS A GENERAL LIABILITY Y N HGL0031429 06/23/2012 06/23/2013 EACHOCCIIRRENCE $" 1 OOIq,000 ix1.. c0 MMERCIAL aENERA,I; �LIABILI "p v RR �� � LS lere9 L . $... ... 50,00 X CONTM CLAIMS-MADE . OCCUR PERSON m(A "Ej person) ACTUAL...... AL a AO "InuJURY ..�.. 10000 X XCU-BF PD ATE $ 2 OO GENERAL AGGREG " " mmm,m,J,m ,QQ d'aEN`L. AGGREGATE LIMIT APPLIES PER: PRODUCTS COMP /OPACG S„ ww 2,00 I7,t0'O P0LSCY p7p „ LCC $ GOMBINP SIR ILLIMIT B AUTOMOBILE LIABILITY �X. ANY AUTO N N BA 6923381 06/23/2012 06123/2013 � IoLY INJURY .._.. .......Op_ JURY(Perperson) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ NON-OWNED MllrO R.t'7�Aiw86�,.CF".. HIRED AUTOS F' AUTOS $ C X., EXCESS LJABAB OCCUR X CLAIMS MADE N N BE061731783 06/2312012 06/23/2013 GGREGATETRENC, ...�._w DED P RTE'rP:N�TION'S � S D WORKERS COMPrNSaTlON AND EMPLOYERS'LIABILJTY �, /N N MWC003405601 06/06/2012 06/06/2073 ANk PROPRIETOR /PARTNER /EXECUTIVE OFFICER.IMEMiSER EXCLUDED? � N/A E L EAOH ACCIDENT IhRendatrarY In NH) � If es„ desctIbe wder E L F DfSEASE EA ISEA E Pr LIZ Y LIMIT $ r000 000 yy _._..". OF. SCM rrON Of OPERATIONS be km 11 0 00 DESCRIPTION OF OPERATIONS I LOCATIONS I 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 CITY OF EL SEGUNDO ATTN: ALISON FIORINI 401 SHELDON STREET EL SEGUNDO, CA 90245 ACORD 25 (2010/05) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. REPRESENTATIVE FHT r ©1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Printed by FHT on June 22, 2012 at 10:51 AM This ent mocrf" kouranoo provided under the ioUowkv: �p E CIAL GENERAL LMILITY COVERAGE PART WA . GLE of ln6ured P . _�. ANg PERSON OR ORGANIZATION WITH WHOM YOU HAVE AO , IN A WRITTEN CONTRACT, THAT SUCH PERSON OR- ORGANIZATION 'SHOULD BE 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 POL k r■ 1N� .M�" MI +F. N ".i.r uwr POLICY NO. HGL0031429 KNORR SYSTEMS, INC. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAI.. INSURED - OWNERS, LESSEES OR CONT CTORS (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 Name of Additional Insured Persons) or Organization(s): ANY WITH, WHOM YOU HAVE AGREED, IN A WRITTEN CONTRACT, PERSON OR ORGANISATION THAT SUCH PERSON OR ORC I IION� NCONTRACT SE FULLY EXECUTED PRIOR ON PRIOR TO E YOUR POLICY, PROVIDED SUCK "OCCURRENCE" IN " MICH COVERAGE IS SOUGHT UNDER THIS POLICY. jred (Sgctiolnl 11) is amended A. V41110 Is An It's' i rso to 'include as an insured the pe n(s) or Schedule, but respect organizatiOn(s) shown in the only with .. work" for that insured by or « « respect " ° afforded « the additional « scheduled above, Paragraph, other Insurance of deleted replaced by 4. other Insurance . :, lid and collectible Notwithstanding other v insurance available « additional insured for a loss we cover under Coverage Part, this insurance aim,Primar and non - contributory if such loss or liability is due to the sole negligence of the Named Insured. However, this endorsement 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. IFG-G -0055 01 10 Includes copyrighted material of Page 1 of 1 ISO Properties, Inc., with permission.