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PROOF OF INSURANCE (2017) CLOSED CERTIFICATE OF LIABILITY INSURANCE °"n 09/3 01201 I01M6 "' 8 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: It the cartlAcato holder to an ADDITIONAL INSURED, the polloyflesj must be endorsed, If BUSROCATION 10 WAIVED,subject to the terms and conditions or the policy,cortaln policies my require an endorsement A statement on this certificate does not confer rights to the certlncato holder In Ilau of such endo'rsemon4sj. PRODUCER Raw (677)ee7-ase7 Fax (en)373-OM c00ACIT Saccarella Insurance Services,Inc. _ BACCARELLA INSURANCE SERVICES,INC. I'" 8'77 887,5887 (877)3736808 6864 INDIANAAVE.0201 aI"rt" ( ) I .IC�.. e° & J'ohn@b'aclns.com RIVERSIDE CA 82608 Il,�,�,w.��..�.�.�., �,,,,,,...�.�.... INSURER($) AFFORDING COVERAGE NAIC a Agenry UcA:os7s A Crum B Forster Spoclalty Insurance Company 44520 STOSH,INC. DBA THE STANLEY LOUIS COMPANY ac 2230 AMAPOLA COURT NB TORRANCE CA 90501 Re F COVERAGES CERTIFICATE NUMBER. 95534 RE'VI'SION NU'MB'ER: THIS IS TO CERTIFY THAT THE POLICIES OF INSU'RAN'CE LISTED BLOWY HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, N07WITHSTANDINO ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, �iB� ME DF INS MAY HAVE BEEN REDUCED BY PAID CLAIM �� ROK ..A .,.,INSURANCE M2 POLICY NUMBER dMMeaP?XR Y,YI LUARe A It COMMERMAL GENERALUAB Lay EPK111928 03/18/16 03118117 � (KC(AA r q s 1,000,000 �CLA1Af;-rtw�rrl m C LR Iu�whu 50,000 �o ( ano d i$ 5,000 A VIN Y i 1,000,000 GENL RCOA E,LIMIT LIES PER Gvt N.RAL A:66RUGAM i 2,000,000 PRO ICY .......CTS-C........ AVrOMONU LMNIRY ANY O I �Ot'a Da�ILtrtY I s xl Por ) ,.i$. ..................... ® .'.. aP�Di.EC DILY iNjuRY P®r occimi i �HIREOAUTO6 t°C',SatrmrFl i AU UMtaeLLA LW 4C ....,,e,....,,w.«w N.OCCURRENCE i sxoers uAe CLAIMS-MADE IAGWGATE DED V IRETENTIDN i i AM 1I qF eNfATIDN EµIL DISK C7YICE .. .. AND IihMLO lM' LIANLITY ANY eN' amAAxNO'Nroxolsuowr E l CI OFF101W�IOMMIR O'�KCLWDO'D'J IM►nd"OryInNN) ..........,. NIA Yw'e, ditr ap a mod' E L DISEASE-POLICY LIMIT i Dee'�'PlPreINI CAF aERA1I�'gGIG p A CurNocWs P® on UaWly EPK111928 03118116 03M$/17 Each Pollution condlikh Un*$1,000,000 W Y'W W 11 Deductible$51K per Pollution Condhion Ds$t Ru►nON OF OPSRaYSyFa r LOCH'°° `� ` -�-�YIONe I VaNIt;Laa(ACDRO 1a1,AdepbnU RAnIVNrI aeMdulA.my b•attAeMe N me..xPaa N required) IRE: 615 E.Holly Avenue,EI Segundo,CA 90245. The City of Et Segundo,Its officers,ofBolals,a'mployess,agants,and volunteers are hereby added as an Additional Insured as their Interest may appear per Blanket Additional Insured form MEN0111-0211 attached. Primary and Non-ConMbutory Additional Inured w/Welver of Subrogation Included per form#EN0118-0211 attached. TFICA'TE HOLDERM. City of EI Segundo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES SE CANCELLED'BEFORE 350 Main$treat THE EXPIRATION DATE THEREOF, NOTICE' HALL BE DELIVERED IN El Segundo,CA 80245 ACCORDANCE WITH THE POLICY PROVISION$. I1U9NCWYMt'aG. �aeNYArNA Attention: fL (Izabeth Vanden Akker ACORN 25 00^14101) 0 1688.2014 ACORO CORPORATION, All rights reserved. The ACORD name and logo are registered marks ofACORD THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ,ADDITIONAL INSURED ft" OWNERS, LESSEES OR CONTRACTORS, This endorsement modifies Insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART CONTRACTORS POLLUTION LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Persons)or Organization(s) Where Required by Written Contract SECTION III —WHO IS AN INSURED within the Common Provisions is amended to include as an additional Insured the person(s) or organization(s) Indicated In the Schedule shown above, but only with respect to liability caused, In whole or in part, by"your work"for that Insured which Is performed by you or by those acting on your behalf. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED, END111-0211 Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NON-CONTRIBUTORY ADDITIONAL INSURED WITH WAIVER OF SUBROGATION This endorsement modifies Insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART CONTRACTORS POLLUTION LIABILITY COVERAGE PART ERRORS AND OMISSIONS LIABILITY COVERAGE PART THIRD PARTY POLLUTION LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s)or Or ani'zatlon(s) Where Required By Written Contract. A. SECTION III — WHO IS AN INSURED within the Common Provisions is amended to include as an additional Insured the person(s) or organizations) Indicated in the Schedule shown above, but solely with respect to "claims" caused In whole or in part, by "your work" for that person or organization performed by you, or by those acting on your behalf. This Insurance shall be primary and non-contributory, but only in the event of a named Insured's sole negligence. B. We waive any right of recovery we may have against the person(s) or organization(s) indicated in the Schedule shown above because of payments we make for"damages" arising out of"your work' performed under a designated project or contract with that person(s) or organization(s). C. This Endorsement does not reinstate or Increase the Limits of Insurance applicable to any "claim"to which the coverage afforded by this Endorsement applies. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. EN0118-0211 Page 1 of 1 CI CW A021011 CERTIFICATE OF INSURANCE This certificate is issued for informational purposes only. It certifies that the policies listed in this document have been Issued to the Named Insured. It does not grant any rights to any party nor can It be used, In any way, to modify coverage provided by such policies.Alteration of this certificate does not change the terms, exclusions or conditions of such policies. Coverage Is subject to the provisions of the policies, Including any exclusions or conditions, regard- less of the provisions of any other contract, such as between the certificate holder and the Named Insured. The limits shown below are the limits provided at the policy inception.Subsequent paid claims may reduce these limits. Certificate Holder. Named Insured: CITY OF EL SEGUNDO STOSH INC. 350 MAIN ST 2230 AMAPOLA CT STE 6 EL SEGUNDO, CA 90245-3813 TORRANCE CA 90501-1441 Automobile Liability Insurer Name: Allstate Insurance Company Policy Number. 048160317 1-Any Auto 2-Owned Autos Only _�3-Owned Priv.Pass.Autos Only 4-Owned Autos Other Than Priv. 5-Owned Autos Subject to No Pass.Autos Only Fault 8-Owned Autos Subject to a Compulsory UM Law X 7-Specifically Described Autos 8-Hired Autos Only 9-Non-owned Autos Only Policy Effective Date: 05-10-2016 Polio,►Expiration Date: 05-10-2017 Limits Of $ 1,000,000 Combined Single Limit(each accident) Insurance: BI Per Person BI Per Accident PD Per Accident Description of Operati inn/Locations/Vehides/Endorsements/Special Provisions RE: 615 E HOLLY AVENUE, EL SEGUNDO, CA 90245. THE CITY OF EL SEGUNDO, ITS OFFICERS, OFFICIALS, EMPLOYEES, AGENTS, AND VOLUNTEERS ARE HEREBY ADDED AS AN ADDITIONAL INSURED AS THEIR INTEREST MAY APPEAR PER BLANKET ADDITIONAL INSURED FORM #EN0111-0211 ATTACHED. PRIMARY AND NON—CONTRIBUTORY ADDITIONAL INSURED W/WAIVER OF SUBROGATION INCLUDED PER FORM #EN0118-0211 ATTACHED. Interested Party Type: CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT GRANT ANY COVERAGE OR RIGHTS TO THE CERTIFICATE HOLDER. IF THIS CERTIFICATE INDICATES THAT THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED, THE POLICY(IES) MUST EITHER BE ENDORSED OR CONTAIN SPECIFIC LANGUAGE PROVIDING THE CERTIFICATE HOLDER WITH ADDITIONAL INSURED STATUS.THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED ONLY TO THE EXTENT INDICATED IN SUCH POLICY LANGUAGE OR ENDORSEMENT. Producer. HERMAN INSURANCE SERVICES INC. Authorized Representative: Date: 11-29-16 Includes copyrighted material of Insurance Services Office, Inc.,with its permission CI CW A021011 Allstate Insurance Company Page 1 of 1 Cerftale Copy Policy Number 048160317 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ[TCAREFULLY. COMMON POLICY CHANGE ENDORSEMENT EndoroementNo. 01-11 Allstate Insurance Company Named |naunad STO3H INC. EfeohvoDate: II-29-16 <388 NAMED INSURED 8ND0BSEMIE0I> 12:01A.M.. Standard Time AgiemLNeme 8E111!4Ay T03URANCE 1,'3,GD1JLCES INC. This endorsement will' not be used to decna000 coverages, increase rates or deductibles or alter any terms or / conditions of coverage unless ok the sole request of the insured. COVERAGE PART|4FORMAr|ON—Cmv� � pm�soff»d�dbythi��h�m- aoimdi��dby�dbe|ow. ' �� - Commercial Property . Commercial General Liability Y | Commercial Crime ElCommercial Inland Marine [�� / � [OMMERCIA T AUTOMOBILE ND C11 ARG E L The following iiom(o): " A | |nuumd'oNamo F--l |noued'oMmi|ingAddnmo � / Policy Number Company ' Effective/Expiration Date |neured's Legal Status/Business ofInsured Payment Plan i�] Premium Determination | | | Additional Interested Parties Coverage Forms and Endorsements y Limits/ re El Deduodb�s | Covered Property/Location Description Classification/Class Codes ! � � xmteo Underlying Exposure/Insurance is (,are) changed to mud (See Additional Page(s)) ----/ / | | | / The above amendments result ina change in the pmn/mnnaofoUowo� —i | This premium does not include taxes and surcharges, | F_VlNoChomgen i- JTobeAdj � uadatAudit � | ' Additional NO CHARGE | Return NO CHARGE | Tax and Surcharge Changes ---- - Additional Return Countersigned By. H EDMA0 I0S'DRA0CG 3P8VICES IK�. i AUTHORIZED | / DMCW30010 Allstate Insurance Company POLICY NUMBER_ 0481603'7 COMMERCIAL AUTO CA 20 48 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED FOR COVERED AUTOS LIABILITY COVERAGE 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 this endorsement. This endorsement identifies person(s) or organization(s) who are"insureds"for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: STOSH INC . Endorsement Effective Date: 11-29-2016 SCHEDULE Name Of Person(s) Or Organaon(s)e CITY OF EL. SEGUNDO 350 MAIN ST EL SEGUNDO, CA USA 902453813 Information required to complete this Schedule if not shown above will be shown in the Declaration p � Declarations. Each person or organization shown in the Schedule is an "insured"for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an 'insured" under the Who Is An Insured provision contained in Paragraph Al. of Section II — Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms and Paragraph D.2. of Section I — Covered Autos Coverages of the Auto Dealers Coverage Form. CA 20 48 10 13 ©Insurance Services Office, Inc., 2011 Page 1 of 1 CERTIFICATE OF !LIABILITY INSURANCE °0107120"°°"YYY' 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:It the certificate holder Is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the forms and conditions of the poll'oy,certain policies may'roqulre an ondorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such ondorsement(a). PRODUCER & T Paychex Insurance Agency Inc PAYCHEX INSURANCE AGENCY,INC. 677- 850 F 585-389-7428 150 SAWGRASS DRIVE � G.tde) R'OCHE'S'TE'R„NY 14020 E-+I Celts®paychex.com INSURER($)AFFORDING COVERAGE NAIC 0 INSURED INSURER A: Wesco Insurance Company 25011 STOSH INC tto CORP INSURER B: I 223'0 AMAP LA CT SUITE 8 TORRANCE,CA 90501 INSURER C: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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, TYPE OP INSURANC! R POLICY NUMBER POLICY IEFF POLICY EXP LIMITS TRR kAL' lMMIODIYYYYI IMWDOIYYIY) OIEIIERAL LIABILITY EACH OCCURRENCE s COMMERCIAL GENERAL LIABILITY $AGE TO R'EN'TED S L WMS•MADE DCUR II PERSONAL R ADV INJURY S GBNERAL AGGREGATE 9 3EN'L AGGREGATE LIMIT APPLIS6 PER; '1 PRODUCTS.COMP/OPAOG s POUCY =NNOIEC= .................. AUTOMOBILE LIABILITY COMBINED SINGLE UMIT S ®s_U ANY AUTO IE��aldml) Au OWNED KHEOULED OODILY INJURY S AUTO@ AUTO@ (Perponm) �_,.w.. ... ..... detRY HIRCD AUTOS RD (Per s dn) 0 PROPERTY DAMAGE : (P @ l) . .UNIONELLA LUIS 0 R „OCCURRENCE -- uN 9x0954 LIAe S ..•• RLT94TIONS WORxER4 COM04NOATI09!ANO X wscE'R'ATYY. OTN• A @wLowmruAwuTr WWC3175909 01/01/2018101/01/2017 ��ER I sTO E,L.EACH ACCIDENT Is 1,,000,000.00 FC9 EKCLUD9OT E'.L.DISEASE-CA9MPLOYEE, S 1.000,000.00 In NHI rEy� N/A X E.L.DISEASE-POUCY LIMIT S 1,000,000.00 If d u I' I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLBS fAlteoh ACORD 101,Addltlonel Remarks Schedule,If more spew le required) Job Sits: 615 E.Holly Avenue El Segundo,CA.90245 WaNar of Subrogatlon granted In favor of the certificate holder CERTIFICATE HOLDER CANCELLATION M of El Segundo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Main St. DATE THBREOP,NOTICE WILL BO D19UVERED IN ACCORDANCE WITH THE POLICY El Segundo,CA 90245 PROVISIONS,BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY IONO UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 28(2010105) 1988.2010 ACORD CORPORATION. All rights reserved, The ACORD name and logo are registered marks of ACORD WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed.01.84) 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 09/6 of the California workers'compensation premium otherwise due on such remuneration, Schedule Person or Organization Job Description CItY of El Segundo replace(2)storage tanks,replace boiler,tube bundle, El Segundo,CA 90245 pi Not,refractory a This endorsement changes the Polley to which it Is aunehed and Is effective on the dale Issued unless otherwise slated. (Thus Informallon below is required only when this endorsement Is Issued subsequent to preparation of the policy.) Endorsement Elleclive 1/1/2019 Policy No. WW03176909 Endorsement No. 3 Insured Slosh Ino(A Corp) Premium I) 431100 Insurance Company Wesoo Insurance Company Counlerslgned by WC 04 03 09 (Ed.01.94)