PROOF OF INSURANCE (2017) CLOSED 2T2M5
li. ' CERTIFICATE OF LIABILITY INSURANCE °A `14/20""YY'
4 ,,,,..-" 11/4/2016
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON ' 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.
If
IMPORTANT:
UBROGATION certificate holder is an
subject to the terms and con in lieu of such (I )must have policies may require ENSURED provisions A be endorsed.
INSURED the olio
conditions of the policy,certain policies may require an endorsement A statement on
this certificate does not confer rights to the certificate h endorsement(s).
PRODUCER .. CONTACT ...
85591-0974 NAME: Claudia Cazares
JXc o ct;623 499-3141 _I FAX Nol: "359390
Wells Fargo Insurance Services USA,Inc. E-MAIL SS: Claudia.Cezares@wetlsfar-go.com
wetlsfargo.com
550 Min South 4th N INSURERIS)AFFORDING COVERAGE NAIC#
Minneapolis,MN 55415 INSURERA: Nationwide Mutual Insurance Company 23787
INSURED INSURER B: State Compensation Insurance Fund 35076
THE GLASS MIRROR&STOREFRONT COMPANY INC INSURERC:
DBA THE GLASS PROFESSIONALS
INSURER D
239 S.La Brea Avenue
INSURER E:
Inglewood,CA 90301 RISURER F:
COVERAGES CERTIFICATE NUMBER: 11083995 REVISION NUMBER: See below
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 rPAID CLAIMS.
LTR TYPE OF
X COMMERCIAL GENERAL LIABILITY X ACPGL07 5 3/1 2016 r 3/1D/2 Y P -1 LIMITS
INSR INSURANCE AtI0 s'li"s'ff
r� POLICY NUMBER (MMFOIIIh'Y DI YY3
CLAIMS-MADE X OCCUR 1EAM 1.':"i RENTED ) 00.,..,.
B" � 80214304 017 I�a�In1,m��;suEaa rurmm�Gn $ 1.aacoc1o000 ...
h1ELOFXP(Arty one pws,roi°a1 S 5,000
PERSONAL&ADV INJURY S 1,000,000
GL:NI,ACiC4RC:GA'I"t LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
PR
X I POLICY X C [ }L®0 PRODUCTS-COMPIOP AGG S 2,000,000
OTHER: S
A AuroMOBILE LIABILITY ACPGL07802143045 31112016 3/1/2017 COMBINED 9111GaLE LIMIT $ 1,000,0)0
X ,I ANY AUTO � rILYI ,15 ten) $
OWNED A OS ONLY SCHEDULED BBODILY ODILY INJURY(Per„p
X HIRED X NON-OWNED PROPEH .....m .
INJURY era dent
ia AUTOS ONLY Y yr vj DAMAGE'
A i X 'UMBRELLALUiB A' OCCUR i' � ACPGL07802143045 611712016 31112017 b:-ACI'��I OCCURRENCE S 2,000,000
EXCESS LIAa �Ali AR�Fh`sAT6 $ - ..—_ 2.000 ....
I -W
Y CLAIMS-MADE 000
DED RET'F'NTION'S S
B vlND E MPL coM N 9100673-16 6/8/2016 6/8!2017 X DTRH
E L EACH ACCIDENT_.I IT _ »
PENSATION
AND EMPLOYER$'LIABILITY �STATUTE. F
OFFICE NIFMOR1PXCLU E0IGr::CUTIVE YIN $ 1,000.000
IOFFtle;ERlMFMO'EREXCLUDk?O"� C'�N!A .
(Man dalory in NHl E.L.DISEASE-EA EMPLOYEE 5 1,000,000
II' oa„d PTION under 1,000,000
—;D FI�C'F34PI"'IDN OF OPERATIONS I>P]nw a, E.L DISEASE-POLICY LIMIT�S
DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEMCLES(ACORD 101,Additional Remarks Schedule,may be ansched V more space is required)
The City of El Segundo,its officials,and employees is named as additional insured as it relates to general&auto liability in accordance with the terns and
conditions of the policy.Umbrella follows forth as it relates to additional insureds. The above coverage is primary and noncontributory where required by
written contract.
CERTIFICATE HOLDER CANCELLATION
City of Ell Segundo-City Clerk SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
350 Main Street Room 5 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
El Segundo,CA 90245-3813
AUTHORIZED REPRESENTATIVE
I
The ACORD name and logo are registered marks of ACORD 9)1988-2015 ACORD CORPORATION. All(rights reserved.
ACORD 25(2016103)
rneosa� , raoaraaab"_dWIsrarMq
POLICY NUMBER: COMMERCIAL GENERAL LIABILITY
CG 20 10 04 13
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INS RE - OWNERS, LESSEES O
CONTRACTORS - SCHEDULED PERSON O
ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person(s)Or Organization(s)
CITY OF EL SEGUNDO -CITY CLERK
ITS OFFICIALS AND EMPLOYEES
3519 MAIN STRF9T, ROOM 5
EL SEGUNDO, CA 90245-3613
Locatlon(s)Of Covered Operations m
ALL CALIFORNIA LOCATIONS
I�
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 2. If coverage provided to the additional insured is
include as an additional insured the person(s) or required by a contract or agreement, the
organization(s) shown in the Schedule, but only insurance afforded to such additional insured
with respect to liability for"bodily injury", "properly will not be broader than that which you are
damage" or "personal and advertising injury" required by the contract or agreement to
caused,in whole or in part,by: provide for such additional insured.
1. Your acts or omissions;or B. With respect to the insurance afforded to these
2. The acts or omissions of those acting on your additional insureds, the following additional
behalf; exclusions apply:
In the performance of your ongoing operations for This insurance does not apply to "bodily injury" or
the additional insured(s) at the location(s) "property damage"occurring after:
designated above. 1. All work, including materials, parts or
However: equipment furnished In connection with such
1. The insurance afforded to such additional worts, on the project (other than service'"
insured only applies to the extent permitted by maintenance or repairs)to be performed by or
law;and on behalf of the additional insured(s) at the
location of the covered operations has been
completed;or
CG 2010 0413 m Insurance Services Office, Inc.,2012 Page 1 of 2
ACP GLO 7802143045 LrEX 16312 AGENT COPY 78 0002237
CG 2010 0413
2. That portion of "your work"' out of which the 1. Required by the contract or agreement;or
Injury or damage arises has been put to its 2. Available under the applicable Limits of
intended use by any ,person or organization Insurance shown in the Declarations;
other than another contractor or subcontractor whichever is less.
engaged In performing operations for a
principal as a part of the same project. This endorsement shall not increase the
C. With respect to the insurance afforded to these applicable Limits of Insurance shown in the
additional insureds, the following is added to Declarations.
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:
All terms and conditions apply unless modffled by this endorsement.
Page 2 of 2 ®Insurance Services Office, Inc., 2012 CG 2010 0413
ACP GLO 7802143045 L7EK 16312 AGENT COPY 78 0002298
ENDORSEMENT AGREEMENT
WAIVER OF SUBROGATION
910067316
RENEWAL
NA
w 3-2.8-94-93
PAGE 1
HOME OFFICE EFFECTIVE NOVEMBER 18 2016 AT 12 .01 A.M.
SAN FRANCISCO r
AND EXPIRING JUNE 8, 2017 AT 12.01 A.M.
ALL EFFECTIVE DATES ARE
AT 1201 AM PACIFIC
STANDARD TIME OR THE
TIME INDICATED AT
PACIFIC STANDARD TIME
THE GLASS PROFESSIONALS
239 S LA BREA AVE
INGLEWOOD, CA 90301
ANYTHING IN THIS POLICY TO THE CONTRARY NOTWITHSTANDING,
IT IS AGREED THAT THE STATE COMPENSATION INSURANCE FUND
WAIVES ANY RIGHT OF SUBROGATION AGAINST,
CITY OF EL SEGUNDO
WHICH MIGHT ARISE BY REASON OF ANY PAYMENT UNDER THIS
POLICY IN CONNECTION WITH WORK PERFORMED BY,
THE GLASS PROFESSIONALS
IT IS FURTHER AGREED THAT THE INSURED SHALL MAINTAIN
PAYROLL RECORDS ACCURATELY SEGREGATING THE REMUNERATION
OF EMPLOYEES WHILE ENGAGED IN WORK FOR THE ABOVE
EMPLOYER.
IT IS FURTHER AGREED THAT PREMIUM ON THE EARNINGS OF SUCH
EMPLOYEES SHALL BE INCREASED BY 03%.
NOTHING IN THIS ENDORSEMENT CONTAINED SHALL BE HELD TO VARY,, ALTER, WAIVE
OR EXTEND ANY OF THE TERMS„ CONDITIONS, AGREEMENTS, OR 'LIMITATIONS' OF THIS
PO'L'ICY' OTHER THAN AS STATED. NOTHING ELSEWHERE IN THIS POLICY SHALT. Be
HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR
LIMITATIONS OF THIS ENDORSEMENT,
COUNTERSIGNED AND ISSUE01 AT SAN FRANCISCO. NOVEMBER 21, 2016 2570
AIJIIIO'RI'ZED R'EPRI SENT IVE PRESIDENT AND CEO
SCIF FORM 10217 lREV.7-2014) OLD DP 217