PROOF OF INSURANCE (2017) CLOSED A -, CERTIFICATE OF LIABILITY INSURANCE DAT,11A°l201
I PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Bornstein Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER.THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
22850 Crenshaw Blvd. , Ste, 203 ALIER THE MEMO AEE12HI2912 BY IHE EQU091
� Torrance, Ca 90505 i
(310) 3.25-4343 INSURERSAFFORDING COVERAGE NAICN
INSURED
EAGLE PROTECTION SERVICE, INC. INSURERA Arch Specialty Insurance company X1194 I
DBA. EAGLE PROTECTION OF CALIFORNIA INSURER B i zns.—c® P��Y Z17 En on Nate®n.. .. ,
2700 W. 182nd St. , #200 INSURER
Torrance, CA 90504 INSURERD
INSURFR F
C'OVERAG'ES
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
LTR N6R'D W YEE,nr 2w°yg'N r/!'F I POLICY NUMBER rr i,r E,Pp k'C.1u"yI 6'P.M y1 yf:;tl+tl7aAPpt:'�Cd LIMITS
GENERAL LIABILITY EACH
COMMIE If y.4,i@'.NENdAtl,0..1'AB!' I LiA'IIAI t a'OCCURRENCE ., .s I.,000,Ogg
.kS...
CLAIMSlAMAOf D OCCUR MED EXP(Anyarre n) $ QQQ
A Y i BAPKG0002707 04/13/16 04/13/17 PFRSONAI RADVINJlJRY $ 1�000r ,QO
�I GENERAL AGGREGATE $ 5,000
&^NPOU" RkC`4ATE p Rf"S A,PP01 �P,q.tlL"d'C P - 0 `
d;" PRODUCTS.COMPJOP AGG $ 5.0 0
AU'T'OMOBILE LIABILITY
ANYAUTO EOaa ,
BINEDSINGLELIMIT $ 1,000,000
_ ALL OWNED AUTOS
BODILY INJURY $
SCHEDULED AUTOS = (Perpemn) -
NON-OWNEDAUTOS = BODILY .
B , HIRED AUTOS 2003901412 06/01/16 06/01/17 INJURY
aem> $
-- PROPERTY DAMAGE $
GARAGE LIABILITY AI.ITOONLY.CA AE",CTDENY °S
«. ...�.......�ANYAUTO .., N EA ACC 8
......,,.AUTOONLHY AGX;-,$
LX4M OCCUR RLLLA LIABILITY
CLAIMSMADE ACCRATFRRENCE $
FG
i
€S
DEDUCTIBLE $ I
RETENNSA $ I�'IU- I $
WORKERSCOMPENSATIONAND WCSIA'I'U- OF'R-I
EMPLOYERS'LIABILITY
ANY PROPRIETORIPARTNER/EXECUTIVE ,!EL EACHACCIDENT $
OFFICERIMEMBER EXCLUDED? I "' " "• •,•••,••,•••••,••••• ""•
E L DISEASE-FA EMPT OYEE S
Y�. dY9�,n u,�una9es Fa(MII P'ROVI'oSYONS IxaM'wr
EL DISEASE-POLICY LIMIT -$ ,
OTHER IV
I
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT nd MENTlSPECIAL PROVISIONS
Coverage afforded by this policy is Primary y Non-contributory
- Certificate Holder is named as Additional Insured with respect to General
Liability for services performed by the Named Insured, per Blanket Additional
Insured Endorsement Form 00 GL486 00 07 08
for n„an"-ga a t _of_2rsmaVm
Qy
City of ZI Segundo SHOULDANYOF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF,THE ISSUING INSURER WLL ENDEAVOR TO MAIL 30 DAYS WRITTEN
its officials, and employees
City Clerk NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO 00 SO SHALL
350 Main Street, Room 5 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER.ITS AGENTS OR
El Segundo, CA 90245-3813
AUTHORIZED REPRESENTATIVE � -
II
ACORD25(2001/08)
0 ACORD CORPORATION 1968
...__..................
II
This endorsement modes insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART I
Section II—Who Is An Insured is amended by adding the following:
Any person(s)or organization(s)whose liability you have assumed under a valid written contract but only for
that person(s) or organization(s) liability arising solely out of your operations. In no event, shall coverage i
afforded to any additional person(s)or organization(s)be broader than coverage for the Named Insured.
Section I—Coverages,Coverage A Bodily Injury and Property Damage Liability, Paragraph 2.,Exclusions is
amended by adding the following:
This insurance does not apply to:
1. Any customer or a user of your goods or services who does not have a"standard contract".
2. Person(s) or organization(s) who are contractors for whom you are a subcontractor or for -
whom you are otherwise providing services unless a"standard contract"has been effected.
Services include but are not limited to leasing,maintaining,servicing,or monitoring of alarm
y systems.
3. Person(s)or organization(s)who is a manager, owner or lessor of premises leased to you
for:
(a) "bodily injury"or"property damage"occurring after you cease to be a tenant; or
(b) "bodily injury"or"property damage"of those acting on your behalf.
4. Person(s)or organization(s)who is an owner or lessor of leased equipment for:
(a) "bodily injury"or"property damage"occurring after the equipment lease expires;or
(b) "bodily injury"or"property damage"arising out of the sole negligence of the owner or
lessor.
5. "Bodily injury" or "property damage" the person(s) or organization(s) has assumed from
another person(s)or organization(s)other than liability the person(s)or organization(s)would
have had if it had not been assumed.
All other terms and conditions of the Policy remain unchanged.
00 GL0486 00 07 08 Page 1 of 1
--,............... ... ''I'll, I'll",'',.. ....................................... .................
Important
I /Berkshire Hathaway
Information Insurance
GU:A R DComp,anies
Agency
Eagle Protection Service, Inc. AUTOMATIC DATA PROCESSING INSURANCE AGENCY,
2700 West 182nd St 201 INC.
Torrance, CA 90504 1 ADP Boulevard
Roseland, NJ 07068
Changes to Your Workers' Compensation Policy
with NorGUARD Insurance Company
Policy Number EAWC727242
Policy Period
From May 1, 2016 to May 1, 2017, 12:01 AM, standard time at the insured's mailing address.
................ ...................
......................-
Party Requesting the Change and Type of Endorsement
The Agent- Added 0040 effective 05/01/2016
State: CA; Code: 7605 BURG/SECURTY SYS ALARM INST,SVC,REP; Payroll: $30,000
The Agent- Added 0040 effective 05/01/2016
State: CA; Code: 7605 BURG/SECURTY SYS ALARM INST,SVC,REP; Payroll: $12,000
The Agent- Added Waiver of Subrogation effective 05/01/2016
Name: City of El Segundo; lob Description: Monitoring security systems
The Agent- Added Waiver of Subrogation effective 05/01/2016
Name: Snak King Corporation; Job Description: CCTV installation
Premium change: $ 224.00
.......... ...... ....... ._m ....... ......— ...............................
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. EAWC727242 Endorsement No. I
Insured Eagle Protection Service, Inc. Premium $224
Insurance Company Countersigned by
NorGUARD Insurance Company
Thank You Again for Choosing Berkshire Hathaway GUARD Insurance Companies!
Call Customer Service at 800-673-2465 with any questions.
Endorsement
WC 99 00 13
.................. 1111 Ill dl
�- I DATE(MMIDDNYYY)
CERTIFICATE OF LIABILITY INSURANCE 09,1912016
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(ios)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' ...... I
NAME;
Automatic Data Processing Insurance Agency,Inc. pIE�� No,Exst: �L�No):
1 Adp Boulevard ADDRESS'
Roseland,NJ 07068 INSURER(S)AFFORDING COVERAGE NAIC K
INSURER A: NorGUARD Insurance Company 31470
INSURED INSURER B
EAGLE PROTECTION SERVICE INC
2700 W 182ND ST STE 201 INSLIRER c
Torrance,CA 90504 INSURER D:
INSURER E
INSURER F'o
COVERAGES CERTIFICATE NUMBER: 649985 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, 'ADDL!SU'BR1 POLICY EFO POLICY EXP
Lyn TYPE OF INSURANCE INSD j WV POLICY NUMBER IMMfDDd1 YYYI @MMBDDdYYYY'1 LIMITS
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE
TO
l'9
CLAIMS-MADE �OCCUR i1wN &�RIti:ku"
C (R.�.uvyl;'cL,rn�»�op T
MED EXP RAny one paarr�wir $ .
PT,RSQNAL,8 ADV INJW4Y S
GENT AGGREGATE LIMIT
P l APPLIES PER
GENERAL AGGREGATE
$
J [ _POLICY ET LOC
PRODUCTS-COMPIOPAGG S
OTHER E
AUTOMOBILE LIABILITY COMBINED D wSINGLE LIMil S
(Ea rrrrcufaril)
ANY AUTO BODILY INJURY(Per person) E
ALL OWNED SCHEDULED
AUTOS AUTOS (P ) 3
BODILY INJURY(Per accident)
NON-OWNED PROPER FY DAM'AbE $
HIRED AUTOS AUTOS (Puir warciderol)
S
UMBRELLA LU1B
C EACH OCCURRENCE S CLAIMS-MADE
EXCESS UAB AGGREGATE $
DED I RETENTION S S
WORKERS ANPD F- ECL EACH ACCIDENT ERH
A AONY PRO RIE OREI ARINERIE -p, N/A Y EAWC727242 05/01/2016 05/01/2017 STATUTE E 1,000,000
T. II
TY
OPRIE RI N ErUTIVE I I
(Mandalory In NHI EXP E L DISEASE-EA EMPLOYEE $ 1,000,000
If y as,clo set"undar ............1,000,000
DESCRIPTION OT OPERATIONS Ueraww E L DISEASE-POLICY LIMIT $
i
DESCRIPTION OF OPERATIONS I LOCATIONS!VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached I more space Is required)
This certificate of Insurance includes a Waiver of Subrogatlon In favor of the certificate holder.
CERTIFICATE HOLDER CANCELLATION
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,Room 5
El Segundo,CA 90246 AUTHORIZED REPRESENTATIVE
1988-2014 ACORD CORPORATION,All rights reserved.
ACORD 26(2014,01) 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 1.05 % of the California workers' compensation premium
otherwise due on such remuneration.
Schedule
Person or Organization Job Description
City of El Segundo Monitoring security systems
Snak King Corporation CCTV installation
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. EAWC727242 Endorsement No.
Insured Insurance Company
Countersigned By