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PROOF OF INSURANCE (2015) CLOSEDACORDn, CERTIFICATE OF LIABILITY INSURANCE DATE 5/299 /2014 /2014 PRODUCER THIS CERTIFICATE IS ISSUEDAS A MATTER OF INFORMATION Bornstein Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 22850 Crenshaw Blvd. , Ste. 203 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Torrance, Ca 90505 POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. -- (31 4)- 325343 COVERAGE # _ - ........ .......... INSURED EAGLE PROTECTION SERVICE INC. INSURER A: Arch Specialty Insurance Company DBA: EAGLE PROTECTION OF CALIFORNIA . ............................... - ..... ._ INSURER B: Philadelphia Insurance company ,.,.,.,._...,. Indemnity Inau .... ......... ....---- u 2700 W. 182nd St., #200 INSURER C: Torrance, CA 90504 INSURER D �. _.... `�'0 n $ M "0 Q INSURER E: COVERAGES 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 ALLTHE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IN D ....... .............. _LTfi . ,R,.. ,yyyy..,, TYPE 4F INSURANCE POLICY NUMBER-- POLICY EFFECTIVE POLICY EXPIRATION DATE (MMIDDIYY) _ -..., DATEJMMLDDIYY) LIMITS.,.,..... ........... E,,,,,,,,. G NERAL LIABILITY EACH OCCURRENCE $ j �–,f ' COMMERCIAL GENERAL LIABILITY �SI� a occ [PREMISES (Ea occurence) 11,11,11,11111, 11 `�'0 n $ M "0 Q ^� CLAIMS MADE Nil OCCUR MED EXP (Any onaperson) $ A X BAPKG0002705 04/13/14 04/13/15 PERSONAL 8 ADV INJURY - ��40.A000 . �__-- __ - - - - -- ..........._. AGGREGATE GENERAL.. $ 51000,000 GEN L AGGREGATE (MIT APPLIES SPER ...,..... ...._u, PRODUCTS CO COMP /O P AGG ... --. $ ,� O m... — POLICY JL LOC - a.,_ ^W AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANYAUTO (Ea accident) 1,000,000 ALLOWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) B X HIRED AUTOS PHPK1181640 06/01/14 06/01/15 BODILY INJURY NON -OWNED AUTOS (ParacadanI) $ PROPERTY DAMAGE. _. $.... .... .......... .. ......� —.___. _ ..... .GARAGE (Per accident) ._ -_ .... L.... (ABILITY ........... ..... ..000da AUTO ONLY - EA ACCIDENT .� ,,,�„,�... $ _. ......................... ANYAUTO AN EAACC OTHER THAN $ AGG ''$ ,,,m. AUTO ON........... ..._._.... EXCESS /UMBRELLA LIABILITY EACH OCCURRENCE $ '.00CUR CLAIMS MADE ....... �, ....... AGGREGATE ...........................� ....... $ ............................ __ _........... ....., ..... DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND TORY I IMITS ER ''. EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNERIEXECUTIVE EL EACH , ACCIDENT '...,$,,,,,,,,,,, OFFICER/MEMBER EXCLUDED? E.L. DISEASE- EA EMPLOYEE $ Ifyes, describe under ............ SPECIAL PROVISIONS below -.._ E.L.. DISEASE - POLICY LIMIT ''... $ ROTHE-- _ .......- ............. -r�. - - -- DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT /SPECIALPROVISIONS - Coverage afforded by this policy is Primary and Non - contributory - Certificate Holder is named as Additional Insured with respect to Liability for services performed by the Named Insured, per Blanket Additional Insured Endorsement Form 00 GL0486 00 07 08 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION City of El Segundo DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN its officials, and employees NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL City Clerk IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR 350 Main Street, Room 5 REPRESENTATIVES. El Segundo, CA 90245-3813 - ..AUTHORIZED REPRESENTATIVE .------ ___ .- ..- .. -.-.� ............... ............................... ......................... ............................... ACORD25 (2001/08) © ACORD CORPORATION 1988 ACORD- CERTIFICATE OF LIABILITY INSURANCE DATE /YYYY) 6/300 /20/20 19 PRODUCER THIS CERTIFICATE IS ISSUEDAS A MATTER OF INFORMATION Bornstein Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE ANY REQUIREMENT, TERM OR CONDITION OF ANY HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 22850 Crenshaw Blvd., Ste. 203 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Torrance, Ca 90505 TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH - _�3 -10�_ 32r -434 INSURERS AFFORDING COVERAGE _ NAIC# INSURED EAGLE PROTECTION SERVICE, INC. INSURER A: Arch Specialty Insurance Company DBA: EAGLE PROTECTION OF CALIFORNIA _ 11 Phil Indemnity Ins Comps INSURER B: Phi ny �- 2700 W. 182nd St., #200 INSURER C: Torrance, CA 90504 .,.INSURER D: ''.INSURER E: COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS 448iz thti'L.. � { _ TYPE OF INSURANCE POLICY NUMBER mm POLICY EFFECTIVE POLICY EXPIRATION DATE (MM /DD1YY) DATE MM�m.) '... LIMITS _____�_ �� __� GENERAL LIABILITY EACH OCCURRENCE (ABILITY COMMERCIAL GENERAL LIABILITY , PREMISES (Ea occurence) $0,0_1 D -00 CLAIMS MADE y�hOCCUR �I MED E X P (Any one person) _$ ....__ 5,, .,.0.11 A X BAPKG0002705 04/13/14 04113115 PERSONAL 1, ADVINJURY $ .Q(i ,_00 .... .. ._ ............................. ............................ ... .GENERAL AGGREGATE .... $ 1 ,..0.Sd_M._,,_ 0-010 '. GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS AGG 5..4...0.00 ,$ -- ,...0.00 POLICY MCOMP/OP AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANYAUTO (Ea accident) 1,000,000 . . .... . . . ........... . . . .... �$ ..................................... ............................... ..(PerDlpersINJURY ALLOWNED AUTOS SCHEDULED AUTOS ) .. B X HIRED AUTOS PHPK1181640 ........................ ...... ....... 06/01/14 ..06/01/15 BODILY INJURY - „,. NON -OWNED AUTOS (ParacadanI) $ ......__- PROPERTY DAMAGE$ ...... _.w.,,..e (Per accident) .......... .....� ... .............,.. ,,,,.,,..,,.,,_ ............ ...- GARAGE LIABILITY .... .... .... .... .... . _ ----------------------- AUTO ONLY- EA ACCIDENT $ ANYAUTO AN EAACC $ OTHER AUTO ON Y: A G G $ ............... _..., �...... ...,�.....�...........�,.... EXCESS /UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE J $ ................ ........... RETENTION $ �����..... —mm mm mmm mm� WORKERS COMPENSATION AND TORY LIMITS ER EMPLOYERS' LIABILITY - ANY PROPRIETOR/PARTNER/EXECUTIVE E,.. EACH ACCIDENT $ OFFICER /MEMBER EXCLUDED? E,L.DISEASE- EAEMPLOYEE $ Ityes, describe under - __....____... .......,,,�.,�,.....,�.....__._ _SP_ECIAL PROVISIONS below .... _________,,.,... ...........,,.,.........,,.,... ....... ....... ,.m...................._...,.m. .... EL, DISEASE- POLICY LIMIT $ .� ,,.,...... .. ........_, .. ,...... , , , ..., .. , , ...,-- OTHER____________ '... DESCRIPTION OP OPERATIONS (LOCATIONS /VEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT SPECIAL PROVISIONS - Coverage afforded by this policy is Primary and Non - contributory - Certificate Holder is named as Additional Insured with respect to General Liability for services performed by the Named Insured, per endorsement form CG 20 10 07 04 and CG 20 - 10 days notmee of canCellation 37 07 04 for non-pa=ent- of premium CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION City of E1 Segundo DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN its officials, and employees NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL City Clerk IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR 350 Main Street, Room 5p REPRESENTATIVES. El Segundo, CA 90245 -3813 AUTHORIZED REPRESENTATIVE ______ ....... ..........n ............................n, 1 ACORD25 (2001/08) © ACORD CORPORATION 1988 POLICY NUMBER: BAPKG0002705 COMMERCIAL GENERAL LIABILITY CG 2010 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 Or anization s : Locations Of Covered Operations THE PERSON, ORGANIZATION, TRUSTEE OR ESTATE TO WHOM YOU ARE OBLIGATED BY WRITTEN CONTRACT TO PROVIDE INSURANCE SUCH AS THAT IS AFFORDED BY THIS POLICY. Information re utred to com fete this Schedute if Trot shown above welt be shown in the Daolarations. A. 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 "bodity Injury", "property damage" or "personal and advertising Injury" caused, in whole or in part, by; 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) desig- nated above. B. With respect to the insurance afforded to these additional insureds, the following additional exclu- sions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after. 1. All work, including materials, parts or equip- ment 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 location 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 In- tended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a princi- pal as a part of the same project. CG 2010 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 ❑ POLICY NUMBER: BAPKG0002705 COMMERCIAL GENERAL LIABILITY CG 20 37 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. 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 Organization(s): Location And Description Of Completed Operations CITY OF EL SEGUNDO, ITS OFFICIALS AND 350 MAIN STREET, ROOM 5 EMPLOYEES EL SEGUNDO, CALIFORNIA 90245 -3813 Information required 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 part, by "your work" 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 11 EAGLPRO -02 LUVE CERTIFICATE OF LIABILITY INSURANCE DATE 61/11/211 /2014 D`1 4 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 CONTACT NAME: Automatic Data Processing Insurance Agency, Inc PHONE 1 ADP Boulevard AMA EyJ) ...... ~.. ...... ~_ ~~ ( c, No): �NPa Roseland, NJ 07068 ADDRESS: ... THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 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 POLICY NUMBER yPINOIIODfYYFYY MMID[ tYYY LIMITS EACH OCCURRENCE $ GENERAL LIABILITY DAMAGE TO RENTEO COMMERCIAL GENERAL LIABILITY C0� PREMISES ffit�dP 4argv_a_rurlt�_ .. $ -..... CLAIMS -MADE OCCUR MED EXP (Any one person) $ PERSONAL & ADV INJURY $ -, "„ ..... ............. . GENERAL AGGREGATE ------ --- ............ $ CCN'L ACCRCCATC LIMIT APPLICG f LYU PRODUCTO • COMP /OP AGO $ h PRi)•, POLICY LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIIMBI Ea 4ccOont@ $. ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED .. ,.. ....... .. BODILY INJURY (Per accident) _......... ._....... ------..... $ AUTOS AUTOS NON -OWNED ____ PROPERTY DAMAGE ........ - - -- ....... $ HIRED AUTOS AUTOS (,Per accident) ,. . UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS -MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION �----� W C S TCCI OTH YIN " I __ �R A ANYP PROPRIETOR/PARTNER/EXECUTIVE EXECUTIVE EAWC533230 5/1/2014 5/1/2015 EL E�A�CHAIMIT$ ACCIDENT $ 1,000,00 OFFICER/ MEMBER R EXCLUDED? N NIA (Myandatory In NH) E.L. DISEASE - EA EMPLOYEE $ 1,000,000 DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICYLIMIT $ 1,000,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) This certificate includes a waiver of subrogation in favor of the certificate holder. CFRTIFICATF Hf)l nFR PAMCIFI I ATICIN U 1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of El Segundo ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street El Segundo, CA 90245- AUTHORIZED REPRESENTATIVE U 1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) 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 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 i_os__% of the California workers' compensation premium otherwise due on such remuneration. Person or Organization City of El Segundo Schedule Job Description fire alarm monitoring tests 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 Policy No. EAWC 533230 Endorsement No. Insured Insurance Company Countersigned By 01998 by the Workers' Compensation Insurance Rating Bureau of California. All rights reserved Important Information Eagle Protection of California 2700 West 182nd St 201 Torrance, CA 90504 BERKSHIRE HATHAWAY GUARDINSURANCE COM ANIES Agency AUTOMATIC DATA PROCESSING INSURANCE AGENCY, INC. 1 ADP Boulevard Roseland, NJ 07068 Changes to Your Workers' Compensation Policy with NorGUARD Insurance Company Policy Number EAWC533230 Policy Period From May 1, 2014 to May 1, 2015, 12:01 AM, standard time at the insured's mailing address. - Party Requesting the Change- and - Type of Endorsement The Agent - Added Waiver of Subrogation effective 05/01/2014 Name: City of El Segundo; Job Description: fire alarm monitoring tests The Agent - Added Waiver of Subrogation Class Code effective 05/01/2014 State: CA; Code: 7605 BURG /SECURTY SYS ALARM INST,SVC,REP; Payroll: $1,500 Premium change: $ 99.00 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 See Above Policy No. EAWC533230 Endorsement No. 1 Insured Eagle Protection of California Premium $99 Insurance Company NorGUARD Insurance CompanyCountersigned by Thank You Again for Choosing Berkshire Hathaway GUARD Insurance Companies! Call our Customer Service Hotline at 1- 800 - 673 -2465, Ext. 1300 with any questions. Endorsement WC 99 00 13 He void, Julie From: Garcia, Angelina Sent: Wednesday, July 02, 2014 4:00 PM To: Hegvold, Julie Subject: RE: Eagle Protection Agmt - Fire Alarm Testing Looks good. Please stop by for signatures. I will not be in tomorrow. Angelina Garcia From: Hegvold, Julie Sent: Monday, June 30, 2014 11:42 AM To: Garcia, Angelina Cc: Whitehead, Martin; Shilling, Mona Subject: Eagle Protection Agmt - Fire Alarm Testing Hello Angie, Here are all the endorsements, etc. for the Service Agreement with Eagle Protection (current vendor) for our Annual Fire Alarm Testing (repeat of prior years) for your review and sign -off. Please let me know when I can bring this by your office for initials. Thank you, jull:ie . Hegvol , - ?arxrtryertieratAnalyst CITY OF EL SECiUNDO I Public Works Dept. 3507 Main Street, El. Segundo, CA 90245 Tel.. (.310) 524 -2365 j LI ttrtt vo1d@else cl�o.orr a 'A.' HzV° _J] k" i.,OSN h �i': °, u4 "Qull 11 Y�: From: Andrea Trejo fmailto:andrea @bornins.coml Sent: Monday, June 30, 2014 11:30 AM To: Hegvold, Julie Subject: RE: Eagle Protection Policies Importance: High Good morning, We were finally able to get the correct endorsement issued for our insured. Please seethe attached and advise if any additional information is needed. If you have any questions, please contact our office. Thank you. Andrea Trejo Eddings For Richard Bornstein