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PROOF OF INSURANCE (2017 - 2017) CLOSED Client#: 1255108 305A1 ENT DATE(MM/DDIYYYY) ACORDTM CERTIFICATE OF LIABILITY INSURANCE 2/23/2017 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. IMPO12TANT If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must 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 CON fi C•AC' Allie Mosier NAM : BB&T Insurance Services PHONE 714 941-2900 FAX y 877-297-1116 (AIC,No,Extl: (AIC„No of Orange County E-MAIL ADDREsst amosier@bbandt.com 2400 Katella Avenue Ste 1100 INSURERS)AFFORDING COVERAGE NAIC# AnaheimCA 92806 ........................................................................................................................................................................................................................................................................ ' INSURER A:James River Insurance Company 12203 INSURED INSURER B:Cypress Insurance Company(CA) 10855 Company INSURER C Enterprises, Inc.dba A-1 Fence Nationwide Insurance Co of Amer 25453 Co 4, 2831 E. La Cresta Ave. INSURER D: INSURER E Anaheim,CA 92806 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 CONTRACTOR 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, LTRR INSURANCE ADDL'SUBR I POLICY EFF POLICY EXP IJC POLICY NUMBER (MMIDD(YYYY) (MMIDDIYYYY) LIMITS ��� ...TYPE OF L..... .. 1+T'.�.N„IMp ,I CLAIMS-MADE G XJ occUR A CI RREN 1, , ) $ ,000s OO A X" COMMERCIAL GENERAL 0002027210 12/01/2016 12/01/2017 EACHOCCUF ,ENFd�,(A�rt $1 00 X BI/PD Ded:5,000 MED EXP(Any one person) $5 000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 PRO- ------ X" JECT LOC PRODUCTS-COMP/OP AGO $2,000,000 OTHER: C AUTOMOBILE LIABILITY ACP3087924950 '08/2912016 08/29/2017 COMBINED SINGLE LIMIT (eaacparfenl) 11,000,000 X ANY AUTO BODILY INJURY(Per person) $ -- ALL OWNED SCHEDULED ........................................................................L.............. AUTOS AUTOS BODILY INJURY(Per accident) $ X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS Q;d;*esntr:�,;IrPe(n,l), X Dr(Ye Oth Car $ UMBRELLA L AB UR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ $ AND EMPLOYERS'LIABILITY 1 -- —"DED RETENTION$ .... 1�STA. .�... I WORKERS COMPENSATION X PER I1TF ORH- B AOWC813700 01/ 01/2017 01/01/201 8�Y N ANY PROPRIETOR/PARTNER/EXECUTIVE E L.EACH ACCIDENT $1,000,000 EXCLUDED? NIA EMPLOYEE(Mandatory In NH) If DESCRIPTION O FOPERATIONS below � �������" E.L.DISEASE-POLICY LIMIT $1,000,000............................ ---- DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) RE: On Call Fence Repair Services on City-Owned Facilities(All Operations) City of El Segundo, its officials,officers,agents and employees are named as additional insured as respects general and auto liability,this insurance is primary and noncontributory with any other insurance of the additional insured;waiver of subrogation applies as respects workers compensation as required by written contract,per endorsements attached. (See Attached Descriptions) CERTIFICATE HOLDER CANCELLATION City of El Segundo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE y g THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Public Works Department ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street, Room 5 El Segundo,CA 90245 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014/01) 1 of 2 The ACORD name and logo are registered marks of ACORD #S 17686731/M 17343757 ACM OS DESCRIPTIONS (Continued from Page 1) Should any policy be cancelled before the expiration date, BB&T Insurance Services will mail 30(thirty) days written notice to the certificate holders which require such action per written contract or agreement, except 10 days notice of cancellation for non-payment of premium. SAGITTA 25.3(2014/01) 2 of 2 #S17686731/M17343757 POLICY NUMBER: 0002027210 COMMERCIAL GENERAL LIABILITY CG 20 10 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNIE S, 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 Where required by written contract or agreement All operations of the Named Insured's. 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- organization(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 oth- er than another contractor or subcontractor engaged in performing operations for a prin- cipal as a part of the same project. CG 20 10 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 POLICY NUMBER: 0002027210 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) Location And Description Of Completed Opera- Or Organization(s): tions Where required by written contract or agreement All operations of the Named Insureds, Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section II—Who Is An Insured is amended to include as an additional insured the person(s) or organiza- tion(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 desig- nated and described in the schedule of this endorse- ment performed for that additional insured and included in the "products-completed operations hazard". CG 20 37 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 D Policy#0002027210 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NON CONTRIBUTORY ENDORSEMENT This endorsement modifies insurance provided under the following: ALL COVERAGE PARTS ........ Name Of Additional Insured Person(s) ....................................................................... Or Organization(: Blanket as required by written contract If no entry appears above, this endorsement applies to all Additional Insureds covered under this policy. Any coverage provided to an Additional Insured under this policy shall be excess over any other valid and collectible insurance available to such Additional Insured whether primary, excess, contingent or on any other basis unless a written contract or written agreement specifically requires that this insurance apply on a primary and noncontributory basis ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. AP5031 US 04-10 Page 1 of 1 POLICY NUMBER:ACP3087924950 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: Endorsement Effective Date: SCHEDULE Name Of Person(s)Or Organization(s): Where required by written contract or agreement Information required to complete this Schedule, if not shown above, will be shown in the 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 A.1. 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 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 04 10B (Ed. 9-14) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT-CALIFORNIA BLANKET BASIS 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.) The additional premium for this endorsement shall be 2% of the total manual premium otherwise due on such remuneration. The minimum premium for this endorsement is $350. This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. SCHEDULE BLANKET WAIVER Person/Organization Blanket Waiver— Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. Job Description Waiver Premium All CA Operations 4571.00 This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 01/01/2017 Policy No. AOWC813700 Endorsement No. Insured Premium$ Insurance Company Cypress Insurance Company Countersigned b WC 99 04 10B (Ed.9-14)