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PROOF OF INSURANCE (2017) CLOSED DATE(MM/DDIYYYY) C .>R,b CERTIFICATE OF LIABILITY INSURANCE 1/1812017 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 Partee Insurance Associates, Inc. CONTACT: Ana Arancibia 584 S. Grand Avenue PHONE E#);'' C FAX 6„6-966-1791 (alc,No) 626-331-8132 Covina, CA 91724-3409 �°' ,,perlenMifl"IS�ar�)rlCe,conl NSURERtSI AFFORDING COVERAGE NAIC# 33 Security Insurance Company 24082 www.parteernsurance.com License 7 INSURERn: OhioSecuri INSURED INSURER6: Amer Casualty Company 24066 Hinderliter de Llamas &Associates American Fire and 1340 Valley Vista Drive#201 INSURERC: Twin City Fire Insurance Company 29459 Diamond Bar CA 91765 INSURER D: INSURER E; INSURER F COVERAGES CERTIFICATE NUMBER: 33822°1.11 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 'AID CLAIMS. INSR ADDL SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WMD POLICY NUMBER (MM/DDIYYYY) (MMIDD/YYYY) LIMITS A �/ COMMERCIAL GENERAL LIABILITY ,� BKS56441197 11/15/2016 11/15/2017 EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE ✓ OCCUR PREMISESi Pla(�NcNrr .n ...............$.........................................500,000 MED EXP..^.y..°..e_.ef5.°.n..........., $. ........................................1.5,000 0, , INJURY $ ...... 100000 PERSONAL&.,,,. .... . GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 ✓ POLICY❑FRO- I LOC PRODUCTS COMPIOPAGG $ 2,000,008 ECT OTHER: $ A AUTOMOBILE LIABILITY BAS56441197 11115/2016 11/15/2017 „(g I i D()SIN LEUMI) $ 1,000,000 ✓ ANY AUTO BODILY INJURY(Per person) $ BODL,,,,,,,,,,,,,,,,,,,,,,,,,, OWNED SCHEDULED LY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PIW6IEH IY DAMAGE .�AUTOS ONLY C ..... AUTOS ONLY GPS_q£GIy4C'nYM........ ..............$r..... IV $ B UMBRELLA LIAR I ✓ C USA5W1197 11/15/2016 11/15/2017 REN,^CE 3 3,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE 3,000,000 DEC) I ✓I RETENTION$10,000 .$....................................m............m.......... A WORKERS COMPENSATION XWS56441197 11/15/2016 11/15/2017 ry ER IH- OFFl ER CER/RIETOREXCLUDED?ECUTIVE Y/❑N N/A E.L„EACHACCIDENT $ 1000000 DM SCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 C PROFESSIONAL LIABILITY �� 72PGO246728 11/15/2016 11/15/2017 EACH CLAIM $1,000,000 CLAIMS MADE FORM RETRO 2/15/2003 AGGREGATE $2,000,000 DEDUCTIBLE $25,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) City of El Segundo,it's officials,and employees are named as additional insured as respects to the General Liability. `30 day notice of cancellation applies except*10 days for non payment I CERTIFICATE HOLDER CANCELLATION Clt of El Segundo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE y g THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 350 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. El Segundo CA 90245 AUTHORIZED REPRESENTATIVE Sylvia Coronado ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 33822111 1 HINDE-1 1 16/17 GI./BA/XS/WC/PL - HINDERLITER ONLY I Ana Arancibia 1 1/18/2017 3:27:19 PM (PDT) I Page 1 of ;2; POLICY NUMBER: BKS56441197 COMMERCIAL GENERAL LIABILITY CG 20 26 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED 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): City of El Segundo it's officials,and employees 350 Main Street El Segundo CA 90245 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section li - Who Is An Insured is amended to B. With respect to the insurance afforded to include as an additional insured the person(s) these additional insureds, the following is or organization(s) shown in the Schedule, but added to Section III -Limits Of Insurance: only with respect to liability for "bodily in- If coverage provided to the additional insured jury", "property damage" or "personal and is required by a contract or agreement, the advertising injury" caused, in whole or in most we will pay on behalf of the additional part, by your acts or omissions or the acts or insured is the amount of insurance: omissions of those acting on your behalf: 1. Required by the contract or agreement; 1. In the performance of your ongoing oper- or ations; or 2. Available under the applicable Limits of 2. In connection with your premises owned Insurance shown in the Declarations; by or rented to you. whichever is less. However: This endorsement shall not increase the ap- 1. The insurance afforded to such additional plicable Limits of Insurance shown in the Dec- insured only applies to the extent permit- larations. ted by law; and 2. If coverage provided to the additional in- sured is required by a contract or agree- ment, 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. CG 20 26 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 3322111 1 HINDE-1 16/17 GL/BA/R8/WC/PL - HIHDERLiTER ONLY Ana Arancibia 1/18/2017 3:27:19 PFi (PDT) I Page 2 of 2