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PROOF OF INSURANCE (2017 - 2017) CLOSED 1 0 DATE(MMIDDIYYYY) C 'RV CERTIFICATE OF LIABILITY INSURANCE 09/29/2016 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. d con iti feu of policy, (ps�lic eDsDmayytrequi require endorsement. A state IMPORTANT: If the certificate holder Is an ADDITION 'ems must have D provisions or be endorsed, If SUBROGATION IS WAIVED,subject to the terms and conditions of the oil statement on this certificate does not confer rights to the certificate endorsement PRODUCER CONIArT-.Rich Higgins ...._.,-. Bannister & Associates Insurance Agency F . CA License #0691071 ApO,BIL 0 tItl! I71.4 5:16-6086 NAfC.NcA;(714) 536-4054 EMA 305 17th Street Apwt rihfbai-ins.tosn .....M Huntington Beach CA 92648 -�...Ntl�SUREtx ^FORtl)tlT('GCO'VEF1.IkGE� NAICp tlNSURERA:Houston Speeia ty Ine, Co. 12936 INSURED (310) 618-2600-......-.....,....W .. ._...-.. INS U"RVt Bq Natianwld MLtLa._l.........l..n....s..u.__r_a-..�n.-.c...e.. Co. 23787 ,� ....._ Carter Services, Inc. tlNSURERCSMer�cm'r insurance Co., 14478 _ g SURER a,securi r National .lasura'nce Co. 19879 2807 Oregon Court, F3 q!?.m... _ Torrance CA 90503 INS Eg'R'ERE: I INSUAERF COVERAGES CERTIFICATE NUMBER:Cert ID 124 REVISION N'U''MBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO TKE 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. _. _. .--.._.._ ,A,Dt•Y'4,5UE4'!i' POLIGYEPF POLICY EXP . tlNSR TYPE OF INSURANCE 0 IMMIDONYY'ryl LIMBS A.TR COMMERCIAL GENERAL LIABILITY NS Wr7 PON-NCYNUNe16'ER „fMVdNNDDBYYYY) AJ t3 RRENCE 5 1,000,000 A X � � e --• CIAIMS.MADE �JIi,OCCUR Y TEN-17722 06/15/201,6'106/15/201.N P pA1„" " )rr .� 5 100,000 I !AE'O FRCP(Any one PsMon) a .._5,coo PERSONAL&ADVIWURY $ 1,,000,000 GENT AGGREGATE LIMIT APPLIES PER: _ 2,000,000 PRO PRO00.JCTiSg-COMP.OPAGG 5 POLICY JECT LOC .,_„ 2,000,000 OTHER; -.-.—•• COMBINED SINGLE LIMIT $ 1,000,000 AUTOMOBILE LIABILITY jejZc"aden'n B X ANY AUTO ACP 3037747466 06/15/2016 06/15/2017 BODILY INJURY(Per person) S '-' OWNED SCHEDULED BODILY INJURY(Per accident) S AUTOS ONLY AUTOS - -- - — HIRED NON-OWNED g'I R"PERTY DAMAGE 8 AUTOS ONLY AUTOS ONLY I Per nccldenO $ C UMBRELLALIAB II g OCCUR 27305208 106/15/2016 06/15/2017 PAC';11',q'3C;G;'U6 REh '.E S 5,000,000_.... X EXCESS LIAB CLAIMS-MADE AGGREGATE _ S 5,000,000 CEO X I RETEN9TION'$ NIL _ r WORKERS COMPENSATION Yf N EA, �ACC ..�RH. � D 'LIABILITY SWC1106656 104/01/2016 04/01/2017 (4 W (e AND EMPLOYERS ANYPROPRa ETOR,OPART'NIF r-,XE<,'UTIVE N/A E A _ IDEf,tl"N' S 1,000,000 OFFICE`WME%IaERrXCWDED? 1,000,000 tMandatoay in NH) E.L.DISEASE-EA EMPLOYEE $ If g$.describe rrnaler r° 1,000'000 DBE.SC'RIPTION)OFOPERATIONS(mOvw _ El, LIMIT ,S _ S � I 5 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks S'chsdwile,may de attached If more space is required) The City of E1 Segundo,, its o'ffic'ials and employees art) named as additional insureds with respects general liability policy limits. Primary and non-contributory wording applies with respects general liability policy limits. � I CERTIFICATE HOLDER CANCELLATION 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 E1 Segundo City Clerk 350 Main Street AUTHORIZED REPRESENTATIVE Room 5 E1 Segundo CA 902453813 J� P ©1988-2015 ACORD CORPORATION. All rights reserved„ ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD Page 1 of 1 Policy#TEN-17722 COMMERCIAL GENERAL LIABILITY CG 20 10 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 Organization(s): Location(s)Of Covered Operations Only those parties required to be named as an Addi- ALL tional Insured in a written contract with the Named Insured under this policy,entered into prior to loss or "occurrence". 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 B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following additional exclu- orgaNzation(s) shown in the Schedule„ but only sions apply: with respect to liability for "bodily injury"" ""property, This insurance does not apply to "bodily injury" or damage" or "personal and advertising injury" "property damage"occurring after: caused, in whole or in part, by: 1. Your acts or omissions;or 1. All work, including materials, parts or equip- ment furnished in connection with such work, 2. The acts or omissions of those acting on your on the project(other than service, maintenance behalf; or repairs) to be performed by or on behalf of in the performance of your ongoing operations for the additional insured(s) at the location of the the additional insured(s) at the location(s) desig- covered operations has been completed;or nated above. 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 en- gaged in performing operations for a principal as a part of the same project. CG 20 10 07 04 0 ISO Properties, Inc.,2004 Page 1 of 1 ❑ Policy#TEN-17722 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 Only those parties required to be named as an ALL Additional Insured in a written contract with the Named Insured under this policy, entered into prior to loss or"occurrence". Information required to complete this Schedule, if not shown above,will be shown in the Declarations. t Section If — Who Is An Insured is amended to include as an additional insured the person(s) or a�rganiation(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 0 ISO Properties, Inc.,2004 Page 1 of 1 ❑ Policy#TEN-17722 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. TEN0215 01 14 PRIMARY AND NON-CONTRIBUTING INSURANCE This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE FORM The following is added to SECTION IV-COMMERCIAL GENERAL LIABILITY CONDITIONS, Paragraph 4: Section IV: Commercial General Liability Conditions 4. Other Insurance: d. Notwithstanding the provisions of sub-paragraphs a, b, and c of this paragraph 4,with respect to the Third Party as defined below, it is understood and agreed that in the event of a claim or "suit" caused in whole or in part by the Named Insured's negligence,this insurance shall be primary and any other Insurance maintained by the additional insured named as the Third Party below shall be excess and non-contributory. The Third Party to whom this endorsement applies is: Absence of a specifically named Third Party above means this endorsement applies only to those third parties required to be named as an Additional Insured as Primary and Non-Contributory coverage specified in a written contract with the Named Insured under this policy,entered into prior to the"loss"or 0occ;urrence"°. All other terms, conditions and exclusions under this policy are applicable to this Endorsement and remain unchanged. TEN0215 01 14 Includes copyright material of Insurance Services Office, Inc. Page 1 of 1 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 2%of the California workers'compensation premium otherwise due on such remuneration. Schedule Person or Organization Job Description Any person or organization as required by written contract. $3,038.00 This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 4/1/2016 Policy No. SWC1106656 Endorsement No. WC 04 03 06 Insured Carter Services,Inc. Premium$ 89517 Insurance Company Security National Insurance Company Countersigned by WC 04 03 06 (Ed.01-84)