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PROOF OF INSURANCE (2017) CLOSED CERTIFICATE OF LIABILITY INSURANCE 12/26/2016 Dom' 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. YIMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the pollcy(les)must be endorsed, If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsemervI A statement on this certificate does not confer rights to the certdflcate holder In lieu of such endorsement(s), PRODUCER I CONTACT HELEN SHERLOCK TRI WORLD INSURANCE AGENCY INC PIN INE xly (949)756.O86 — jvg x,)(949)756-1356 4000 Birch Street, Ste 2018 D� haherltcktrVYrprlins.cOCn Newport Beach, CA 92660 --...... 800-617-8428 INSURERM) AFFORDING COVERAGE NAICe INSURER A:JAMES RIVER INSURANCE CO. A-IX 12604 INSURED MARX BROS. FIRE EXTINGUISHER CO. INSURER 8:RSUI INDEMNITY CO.A X11 22:1 &COOK FIRE EXTINGUISHER INSURER C:SECURITY NATIONAL INS. 11)879 1159 S. SOTO STREET INSURER 0: LOS ANGELES,CA 90023 INSURER E R 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. INSR 'A0 "RG'ak pti '"–°°'""`"""'°°""` LTR TYPE OF INSURANCE MR WYO POLICY NUMBER CI�R M p Iluf 9Y N LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE OCCUR MED EXPS(Any one person) s 50,000 CO PREMISE Cd oFcnarak, 000 A X OCP Y 000525083 03/26/16 03/26/17 PERSONAL B ADV INJURY _ $ 1,000,006 ,000 1, 0,000 T$5000 Ded/OOC GENERAL AGGREGATE S 2,000,000 GEN,L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 -I POLICY FII�PRO. LOC $ AUTOMOBILE LIABILITY COMO NEE SIN4aLE,LIMIT �c�Ids�nt�,,. S ANYAUTO BODILY INJURY(Per person) S ALL UTOS�ED AUTOSULED BODILY INJURY(Per accident) S HIRED AUTOS NON-OWNED PERTY DAMAGE —.. S AUTOS Psa uecldSailb $ UMBRELLA LIAR X I OCCUR E NHA237525 03/26/16 '03/26/17 -ACH OCCURRENCE $5,000,000 B X EXCESS LIAR CLAIMS.MADE AGGREGATE $5,000,000 m DED RETENTIONS PRODUCTS/OPS $6,600,OOO WO IKERS COMPENSATION X... AND EMPLOYERS'ER oBTM NIA Y mmE.L EACH _. ...._..u ........ "SrATU- OTH- . 11i) R_. C OFF PR/MIBE R/EXCLUDED? Y/" SWC1102355 02/18/16 02/18/17 ACCIDENT $ 1,000,000 (Mandnory In NH) E.L.DISEASE•EA EMPLOYEI i S 1,000,000 If DTgCR i TIGPt OF OPERATIONS below E.L.DISEASE-POLICY LIMIT DEE 6 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space Is required) ALL OPERATIONS-SERVICE AGREEMENT CITY OF EL SEGUNDO, ITS EMPLOYEES, REPS, OFFICERS AND AGENTS ARE ADDITIONAL INSURED PER ATTACHED ENDORSEMENTS. WORK COMP WAIVER OF SUBROGATION ENDORSEMENT ATTACHED. THIRTY(30)DAYS NOC APPLIES TO ALL LISTED POLICIES. CERTIFICATE HOLDER CANCELLATION CITY OF EL SEGUNDO SHOULD NY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ATTN CITY CLERK THE E. IRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 350 MAIN STREET, ROOM 5 ACCOR ANCE WITH THE POLICY PROVIS S, EL SEGUNDO, CA 90245-3813 AUi'IIOR REPP'dESES'I'rvE 01 8-201 O Aco ACORD25 2010/05 The ACORD name and logo are r RD CORPORATION. All rights reserved. ( ) g egisred marks of ACORD JAMES RIVER INSURANCE CO. COMMERCIAL GENERAL LIABILITY CG 20 37 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LEASEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: CITY OF EL SEGUNDO, ITS EMPLOYEES, REPS, OFFICERS AND AGENTS RE: ALL OPERATIONS (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) Section II - Who is An Insured Is amended to Include as an insured the person or organization(s) shown in the Schedule, but only with respect to liability for"bodily injury" or "property damage" caused, in whole or in part, by "your work"at the location designated and described in the schedule of this endorsement performed for that additional insured and included in the"products-completed operations hazard". PRIMARY INSURANCE CLAUSE: To the extent that this insurance Is afforded to any additional insured under this policy, such insurance shall apply as primary and not contributing with any insurance carried by such additional insured, as required by written contract. CG 20 37 07 04 © ISO Properties, Inc., 2000 Page 1 of 1 + jl JAMES RIVER INSURANCE CO. COMMERCIAL GENERAL LIABILITY CG 20 10 07 04 THIS ENDORSEMENT CHANGESTHE 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 PERSON OR ORGANIZATION: CITY OF EL SEGUNDO ITS EMPLOYEES, REPS, OFFICERS AND AGENTS RE: ALL OPERATIONS A. Section II—Who is An Insured is amended to include as an insured any person(s) or organization(s)shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and ), advertising injury"caused, in whole or in part by: 1. Your acts or omissions;or 2. The acts or omissions of those acting on your behalf: In the performance of your ongoing operations for the additional insured(s)at the location(s)designated above. B. With respect to the Insurance afforded to these additional insureds, the following additional exclusions applies: This insurance does not apply to"bodily injury"or"property damage"occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs)to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed;or 2. That portion of"your work"out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. PRIMARY INSURANCE CLAUSE: To the extent that this insurance is afforded to any additional insured under this policy, such insurance shall apply as primary and non contributory with any insurance carried by such additional insured, as required by written contract. CG 20 10 07 04 ©ISO Properties, Inc., 2004 Page 1 of 1 I SECURITY NATIONAL INSURANCE CO. Policy Number: SWC1102355 Named Insured: MARX BROS FIRE EXTIINGUISHER CO. The information above is required only when this endorsement is Issued subsequently to preparation of the policy. 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.) SCHEDULE PERSON OR ORGANIZATION CITY OF EL SEGUNDO ATTN: FACILITIES MANAGER 150 ILLINOIS AVENUE EL SEGUNDO, CA 90245-3895 This endorsement changes the policy to which it is attached and Is effective on the date issued unless otherwise stated. PRODUCER: TRI-WORLD INSURANCE AGENCY, INC. WC 00 03 13