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PROOF OF INSURANCE (2015) CLOSEDDATE (MMIDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE DA 16/2014 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 CANT: C Nancy Erickson Walter Mortensen Insurance / INSURICA (760) 379 -4651 FAX (760)379 -8722 PHONE CA License #OD44424 E-MAIt, ,nerickson @INSURICA.com 5520 G4 Isabella Bl, POBx 2663 INSURERS AFFORDING COVERAGE NAIC# Lake Isabella CA 93240 )NSURERA:AIX S ealty Insurance CoTpany 12833 .. ...... ._ ................... __ INSURED INSURER B Rite, Inc. INSURER C: The Perfect Field INSURER D ; ........ _.. .. ............................... 2075 Corte del Nogal,Suite X INSURER E: Carlsbad CA 92011 INSURER F: COVERAGES CERTIFICATE NUMBER:14 -15 GL REVISION NUMBER: 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, "N °- _ ADDL INSR TYPE OF INSURANCE POLICY EFF POLICY EXP LTR POLICY NUMBER MM/ D MMI ... .......... _... LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL PRFMISES Fy ccctence$ 100, 000 A CLAIMS -MADE X OCCUR 13A90154500 /9/2014 /9/2015 MED EXP An one person) $ 2,500 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGA "rE $ 2 , 000 , 000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG Is 2,000,000 PRO- X POUCY 17 LOC .._._.__._:..... $ AUTOMOBILE LIABILITY B D IN "LE LIMIT a ,I nt $ BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ NON -OWNED PROPERTY DAAW4AGP $ HIRED AUTOS AUTOS Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE $ ................ TION _. DIED RETEN $ $ WORKERS COMPENSATION WC STA7U- OTH- AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR /PARTNER /EXECUTIVE E L. EACH ACCIDENT $ OFFICER /MEMBER EXCLUDED? N/A WWWW. (Mandatory in NH) E L, DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below T. E,L DISEASE - POLICY LIMIT $ . . .................... .... DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) When required by written contract The City of E1 Segundo, its officers, officials, employees, agents & volunteers are added to the General Liability policy as Additional Insureds, per form CG 20 37 7/04 attached, subject to the terms, conditions and exclusions of the policy. Insurance is primary and non contributory per form 801 -0073 (06/13). CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of E1 Segundo ACCORDANCE WITH THE POLICY PROVISIONS. its officials & employees Attention: City Clerk AUTHORIZED REPRESENTATIVE 350 Main Street E1 Segundo, CA 90245 Ron Burcham /JDEMPS ✓ >r ACORD 25 (2010/05) ©1988 -2010 ACORD CORPORATION. All rights reserved,. INS025 (201005).01 The ACORD name and logo are registered marks of ACORD ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organizations : Location And Descri tion Of Com leted O erations 1) State of California 2) City of El Segundo Information re ui'red to complete this Schedule, if not shown above, will be shown in the Declarations.. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury°" or "property dam- age" caused, in whole or in past, by "your wort" at the location designated and described in the sched- ule of this endorsement performed for that additional insured and included in the "products- completed operations hazard ". CG 20 37 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY NON - CONTRIBUTORY ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS /COMPLETED OPERATIONS LIABILITY COVERAGE PART When required by written contract or agreement, the insurance provided by endorsement CG 0 26 is primary insurance and we will not seek contribution from any other insurance available to the person or organization covered as additional insured hereunder unless the other insurance is provided by a contractors other than you, for the same operations and job location. Then we will share that other insurance by the method described in SECTION IV — CONDITIONS, Paragraph 4. Other Insurance subparagraph c. Method Sharing. ALL OTHER TERMS, CONDITIONS, AND EXCLUSIONS REMAIN UNCHANGED. 801 -0073 06 13 Includes copyrighted material of Insurance Services Office, Inc., with its permission Page 1 of 1 CERTIFICATE OF LIABILITY INSURANCE DATE,MM /DD /YYYY) 3/11/2014 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 CONTA N,"f�;nO'�(' ErlCkson NAE� Walter Mortensen Insurance / INSURICA PHONE (760) 379 -4651 FAX ner -- . (7e0)3 79 -e 722 IAIC No) CA License #OD44424 r_ "N'A1L ickson @INSURICA.com 5520 G4 Isabella Bl, POBX 2663 INSURERS AFFORDING COVERAGE NAIC# Lake Isabella CA 93240 INSURERA:Wesco Insurance Comnanv 61011 INSURED INSURER Rite, Inc. INSURER C: The Perfect Field INSURER 0; 2075 Corte del Nogal, Suite X INSURER E_ Carlsbad CA 92011 INSURER F: COVERAGES CERTIFICATE NUMBER:14 -15 BA REVISION NUMBER: 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 A ................... L POLICY EFF POLICY E.P LIMITS LTR TYPE OF INSURANCE POLICY NUMBER M M f0 GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED PREMI, ES Ea ocrAirrence $ COMMERCIAL GENERAL LIABILITY CLAIMS -MADE V OCCUR _ - - - -. MED EXP (Any one person) $ PERSONAL & ADV INJURY $ _- -_-_ -� GENERAL AGGREGATE $ _ GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ POLICY El f'PCY- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Eaacdent $ 1 000 000 p' ANY AUTO ALL OWNED mmX SCHEDULED AUTO S AUTOS WPA103308100 3/16/2014 "3/16/2015 BODILY INJURY (Per person) BODILY INJURY (Per accident) $ $ X — HIR DAUTOS X NON OWNED P DAMA Renn 3E $ Underinsured motorist $ 500,000 UMBRELLA LIAB OCCUR HCLAIMS-MADE EACH OCCURRENCE $ EXCESS LIAB AGGREGATE $ DER RETENTION $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS' LIABILITY Y / N_ ANY PROPRIETOR /PARTNER /EXECUTIVE OFFICER /MEMBER EXCLUDED? N / A E L. EACH ACCIDENT $ "......"""""""""""""""" " " " " " " " " " " " " " " " " " "'"""'"""""'"" (Mandatory in NH) �EL DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below DISEASE POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CERTIFICATE HOLDER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of E1 Segundo ACCORDANCE WITH THE POLICY PROVISIONS. its officials & employees c/o City Clerk AUTHORIZED REPRESENTATIVE 350 Main Street, Room #5 E1 Segundo, CA 90245 -3813 Q S Ron Burcham /NERICK ACORD 25 (2010105) ©1988 -2010 ACORD CORPORATION. All rights reserved. INS025 (201005),01 The ACORD name and logo are registered marks of ACORD