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PROOF OF INSURANCE (2017) CLOSEDDATE(MM /DD/YYYY) 46 '1 CERTIFICATE OF LIABILITY INSURANCE 10/06/2016 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 have ADDITIONAL INSURED provisions or 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: Aon Risk Insurance Services West, Inc. PHONE Newport Beach CA Office NC. NO. Ext); (949) 608 -6300 ' Nn I, (949} 608 -6459 100 Bayvi ew Ci rcl a E -MAIL Newport Beach CA 92660 USA ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC p INSURED INSURER A: Old Republic General Ins Corp 24139 Danny Letner, Inc. INSURER B: Endurance Risk Solutions Assurance CO, 43630 DBA: Letner ROofin9 Company - 1490 North Glassell St. INSURER C: Orange CA 92867 USA INSURER D: INSURER E: ...INSURER F .:....... .................- ........... • : _ •3���1y[•li��:19uI��:i7fli�t[3! :iii *IfMiir]�l�f�lt'a1�91;�1 in LL 00 00 m w c d V d v 0 THIS I$ TO CFRTgFY 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. Limits shown are as requested ILTR TYPE OF INSURANCE E.SCk V, N0 POLICY NUMBER p,N1Md:CpD,dY' y MmotwYYYY' LIMITS X COMMERCIAL GENERAL LIABILITY A, C.C, EACH OCCURRENCE $1,000,000 CLAIMS -MADE X OCCUR PREMISES Ea o,,u ,0........ ence .............. ............................... $100,000 MED EXP (Any one person) $5,000 X Ded: $25,000 PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 0 GEN'LAGGREGATE LIMITAPPLIES PER: POLICY X PRO LOC ] JECT m PRODUCTS - COMP /OP ASS $2,000,000 OTHER: 0 o n A AUTOMOBILE LIABILITY AlCA92541608 07/01/2016 07/01/2017 COMBINED SINGLE LIMIT $1,000,000 LO .,(F a A..a.t)...... ......................... _� .. X ANYAUTO BODILY INJURY( Per person) O Z BODILY INJURY (Per accident) OWNED SCHEDULED y AUTOS ONLY AUTOS NON •---- ,-•-,- PROPERTY DAMAG E •-,- •-- •- """- •--- •-- •- """- •-- ---" -• N X HIRED AUTOS X -OWNED Per accident) ''. w 1.. ONLY AUTOS ONLY t: X Comp Ded $1,000 X Coll Ded $1,000 d B UMBRELLALIAB X OCCUR EXCIOOOS181202 07/01/2016 0710112017 EACH OCCURRENCE $5,000,000 V X EXCESS LIAB CLAIMS -MADE AGGREGATE $5,000,000 .._ DED ...... RETENTION A COMPENSATION AND A1CW92541608 07/01/2016 0710112017 X PER STATUTE 0TH - 7 Nr EEMPLO ERIETLR/BPAT E.L. EACH ACCIDENT $1,000,000, OFFICER/MEMBER EXCLUDED? I N/A 1__ (Mandatory in NH) 1111 ...JJJ E.L, DISEASE -EA EMPLOYEE $1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below EL DISEASE- POLICY LIMIT $1,000,006 DESCRIPTION OF OPERATIONiS l LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached A more space is required) Re: Letner Job No, 8089 Fire Station Roof Replacement. City of El Segundo, its officials, employees, agents, and volunteers are additional insured on primary and non - contributory basis and waiver of subrogation applies in their favor. GL, Cancellation & Auto endorsement and GL, Auto & WC waiver =• attached, CERTIFICATE HOLDER CANCELLATION it SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of El Segundo AUTHORIZED REPRESENTATIVE " Attn : City Cl e rk 350 Main Street al/. 4f14 ii1 r ✓if?/@Td �f�• ✓�tu E1 Segundo CA 90245 USA ©1988 -2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Issued in lieu of certificate dated: 9/21/2016 OLD REPUBLIC GENERAL INSURANCE CORPORATION CANCELLATION OR NON - RENEWAL TO SPECIFIED PERSONS OR ORGANIZATIONS ENDORSEMENT THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING: BUSINESS AUTO COVERAGE FORM COMMERCIAL GENERAL LIABILITY COVERAGE FORM PART OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PRODUCTS /COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART If we cancel or non -renew this policy for any reason other than non - payment, we will deliver notice of the cancellation or non - renewal to all Specified Persons or Organizations on file with us THIRTY (30) days prior to the effective date of cancellation or non - renewal. If we cancel this policy for non - payment, we will deliver notice of the cancellation to all Specified Persons or Organizations on file with us TEN (10) days prior to the effective date of cancellation. If notice is mailed, proof of mailing will be sufficient proof of notice. v_ ...... Named Insured Danny Letner Inc. DBA: Letner Roofing Company _ __.. ....... .......... ....... _._._. Policy Number AlCA92541608 Endorsement No. Al CG92541608 Policy Period 07/01/16 to 07/01/17 Endorsement Effective Date: 07/01/16 _. ._. . .... -- ...------ Podu rcer's Name: Aon Risk Insurance Services West, Inc. Producer Number: .................................... See certificate AUTHORIZED REPRESENTATIVE DATE IL EN GN 0004 01 11 PAGE 1 OF 1 OLD REPUBLIC GENERAL INSURANCE CORPORATION WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY Cancellation or Non - Renewal to Specified Persons or Organizations Endorsement THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING: WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE If we cancel or non -renew this policy for any reason other than non - payment, we will deliver notice of the cancellation or non - renewal to all Specified Persons or Organizations on file with us Sixty (60) days prior to the effective date of cancellation or non - renewal. If we cancel this policy for non - payment, we will deliver notice of the cancellation to all Specified Persons or Organizations on file with us Ten (10) days prior to the effective date of cancellation. If notice is mailed, proof of mailing will be sufficient proof of notice, Named Insured Policy Number Policy Period Producer's Name: Producer Number: Danny Letner Inc. DBA: Letner Roofing Company AlCW92541608 I Endorsement No. 07101/16 to 07/01/17 l Endorsement Effective Date: 1 07/01/16 Aon Risk Insurance Services West, Inc. . �}�r ,✓fi.J,au�+ /',da�J�'A"A✓7� /v.`l- ^°'%JV;�r a ,✓%%„��J/,"r , %rrr. AUTHORIZED REPRESENTATIVE WC 99 03 58 (01 /11) See certificate DATE OLD REPUBLIC GENERAL INSURANCE CORPORATION ADDITIONAL INSURANCE WHERE REQUIRED UNDER CONTRACT OR AGREEMENT THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING: BUSINESS AUTO COVERAGE FORM The following is added to Section II — Liability Coverage, A. — Coverage, 1. Who is an Insured D. Any person or organization to whom you become obligated to include as an additional insured under this policy, as a result of any contract or agreement you enter into which required you to furnish insurance to that person or organization o the type provided by this policy, but only with respect to liability arising out of your operations or premises owned by or rented to you. However, the insurance provided will not exceed the lesser of: (1) The coverage or limits of this policy, or (2) The coverage or limits required by said contract or agreement. mmN.amed Insured Danny mDanny Letner Inc. DBA: Letner Roofing Company .� . —. — _.._._.__..... ............ —._._....... �.... �... �... �...... ..— _ ------ .�...�...�...�... Policy Number A1CA92541608 Endorsement No. Policy Period 07/01/16 to 07/01/17 Endorsement Effective Date: 07/01/16 Producer's Name: Aon Risk Insurance Services West, Inc. Producer Number: „ , '" r • .. > P, ,e,:�.r .i .,. See certificate AUTHORIZED REPRESENTATIVE DATE CA EN GN 0020 09 06 POLICY NUMBER: Al CA92541608 COMMERCIAL AUTO CA 04 44 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: Danny Letner Inc. DBA: Letner Roofing Company Endorsement Effective Date: 7/1/16 SCHEDULE Name(s) Of Person(s) Or Organization(s): WHERE REQUIRED BY Information required to complete this Schedule, if not shown above, will The Transfer Of Rights Of Recovery Against Others To Us condition does not apply to the person(s) or organization(s) shown in the Schedule, but only to the extent that subrogation is waived prior to the "accident" or the "loss" under a contract with that person or organization. CONTRACT Declarations. CA 04 4410 13 C Insurance Services Office, Inc., 2009 Page 1 of 1 POLICY NUMBER: AICG92541608 COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 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 A. Section II — Who Is An Insured is amended to B. include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily 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) designated above. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equipment 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 However: 2. That portion of "your work" out of which the 1. The insurance afforded to such additional injury or damage arises has been put to its insured only applies to the extent permitted intended use by any person or organization Y PP P other than another contractor or by law; and subcontractor engaged in performing 2. If coverage provided to the additional insured operations for a principal as a part of the is required by a contract or agreement, the same project. insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. CG 20 10 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 POLICY NUMBER: AlCG92541608 COMMERCIAL GENERAL LIABILITY CG 20 37 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURE - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS /COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Location And Description Of Completed Or Organization(s) Operations Where required by written contract, but only when coverage for Completed Operations is specifically required by that contract. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. 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 "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the Schedule of this endorsement performed for that additional insured and included in the "products- completed operations hazard." However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 37 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 OLD REPUBLIC GENERAL INSURANCE CORPORATION CHANGES ADDITIONAL INSURED PRIMARY WORDING SCHEDULE THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING;. COMMERCIAL GENERAL LIABILITY COVERAGE FORM Name Of Additional Insured Person(s) Or Organization(s): Location(s) Of Covered Operations As required by written contract. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The insurance provided by this endorsement is primary insurance and we will not seek contribution from any other insurance of a like kind available to the person or organization shown in the schedule above unless the other insurance is provided by a contractor other than the person or organization shown in the schedule above for the same operation and job location. If so, we will share with that other insurance by the method described in paragraph 4.c. of Section IV — Commercial General Liability Conditions. All other terms and conditions remain unchanged. Named Insured Danny Letner Inc. DBA: Letner Roofing Company Policy Number AlCG92541608 Endorsement No. Policy Period 07/01/16 to 07/01/17 Endorsement Effective Date: 07/01/16 ........... Producer's Name: I Aon Risk Insurance Services West, Inc. Producer Number See certificate AUTHORIZED REPRESENTATIVE DATE CG EN GN 0029 09 06 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CG 24 04 10 93 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Endorsement effective: 07/01/16 Policy No. AlCG92541608 12:01 A.M. standard time Named Insured: Countersigned by Danny Letner Inc. DBA: Letner Roofing Company 111_11;�,_ ', '. (Authorized Representative) SCHEDULE Name of Person or Organization: Where required by written contract (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) The TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Condition (Section IV— COMMERCIAL GENERAL LIABILITY CONDITIONS) is amended by the addition of the following: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products- completed operations hazard." This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 10 93 Copyright, Insurance Services Office, Inc., 1992 Page 1 of 1 OLD REPUBLIC GENERAL INSURANCE CORPORATION WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT (CALIFORNIA) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING: WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY INSURANCE 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. This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule Name of Person or Organization: WHEN REQUIRED BY WRITTEN CONTRACT. The premium charge for this endorsement is $0.00 _.......__.......... A-1-11 ns u, ..... ..............._. . ......_......... Policy Number A AlCW92541608 E Endorsement No. Policy Period 0 07/01/16 to 07101117 E Endorsement Effective Date: 0 07/01/16 Producer's Name: A Aon Risk Insurance Services West, Inc. Producer Number: _._._. . ._ ............ _ ..................... ............................... See certificate AUTHORIZED REPRESENTATIVE DATE WC 99 03 15 (09/06)