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PROOF OF INSURANCE (2017 - 2018) CLOSED DATE(MMIDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 3/14/17 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 pollcy(les) 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 nr1,I,�.,Fx1,„94.9-336-434,3... ...... �,( A 4V 4 I AL MTNICOLA GENERAL INSURANCE ' Nl (N ! '�Na'ab949" 36-4347 16811 HALE AVENUE, SUITE A S ADDRESS CERTS@ALMINICOLA COM IRVINE, CA 92606-5066 INSURER COVERAGE Abp � NAICM D P..... _U ERA ANSTONOINSURANN INSURED ARACLETE FIRE & SAFETY, INC. INSURER B:EV uRERka1 AFFORDING ......... CE COMPANY.......... INSURER C:STATE FUND 2950 SATURN, UNIT I INSURER BREA, CA 92821 INSURER E'. INSURER F: COVERAGES CERTIFICATE NUMBER:*UPDATED CERTIFICATE* 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. naT ..... .... ... ....... C5 suak .,.. .. . „ . __.W14T'a Eb ......... LTR ......... OF INSURANCE SR :.NN1 POLICY NUMBER ., ... .. ., .,, ...., uldtl�RiL„L7P5"V1St �IgPglflLkd"✓ MVP LIMITS OOO OOO ..�............ _..� DRM9at,CT1)nl"C�9rE ru;�wL........$........1...t,..................r ... �, 100 000 X COMMEIRCIA GENERAL LIABILITY PREMISES CC oRRENCD r GENERAL A X E&OLAINCLE X OCCUR Y SPGO17145 03/28/17 03/28/18 PERSONAL&ADV INJURY $ 1,000,11000 X $2,500 DED. GENERAL AGGREGATE S 2,000, 000 UCTS�COMPIOPAGG S 2,OOO,OO GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS 0 FiA AUTOMOBILEILIAL"I'9 E LOC $ I' _ (Qmta.Ong a.la,B pewutll $.. _ ANYAUTO person) $ ALL NON-OWNED BODILY NJURY(Per accident) $INJURY _ AUTOS OWNED SCHEDULED BODILYI Per eccti,)" IMAM HIRED AUTOS AUTOS ( dent UMBRELLA IAB OCCUR XOBW7019317 03/28/17 03/28/18 --EACH OCCURRENCE � '1. B X EXCESS LIAB X CLAIMS-MADE AGGR GATE s 2,000,,000 DED I RETENTION$ I R $ WORKERS COMPENSATION X TORYI,AIU- l....._ml.UIFI C CFC ER�MBERRE RTNER/E ECUTIVE YIN NIA Y — 12 13 16 �2 13 17 E.L.EACH ACCIDENT V�H,,, $ 1,000,000 (Msndstary In NH) 9170545-2016 / / / / 1,000,000 E.L.E ,.,DISEASE-A EMPLOYEI . ................... if is,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 1,000,000 ...-.._.........._.�.,, DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) JOB LOCATION W : ALL CALIFORNIA OPERATIONS OF THE NAMED INSURED. CERTIFICATE HOLDER IS NAMED AS ADDITIONAL INSURED WITH RESPECT TO GENERAL LIABILITY. WAIVER OF SUBROGATION APPLIES WITH RESPECT TO WORKER'S COMP. *EXCEPT 10 DAY NOTICE OF CANCELLATION FOR NONPAYMENT OR NONREPORTING* CERTIFICATE I-IOLDER CANCELt.A"1°ION CITY OF EL SEGUNDO SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 350 MAIN STREET THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN EL SEGUNDO, CA 90245. ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE I 1988.2010 ACORD CORPORATION. All rights reserved. ACORD25(2010I05) The ACORD name and loco are registered marks of ACORD POLICY# SPGO17145 This Endorsement Modifies Your Policy. Please Read It Carefully. LIMITED BLANKET ADDITIONAL INSURED ENDORSEMENT INCLUDING PRIMARY AND NONCONTRIBUTORY PROVISION AND WAIVER OF SUBROGATION This endorsement modifies insurance provided under the following: _ COMMERCIAL GENERAL LIABILITY COVERAGE PART A. The insurance afforded by this policy for"bodily injury, property damage" or"personal and advertising injury" shall also apply to any "additional insured". Such coverage for the "additional insured" is provided for claims, "suits" and/or damages made against the "additional insured," but only: 1. To the extent the "additional insured" is being held responsible for the acts, omissions and/or negligence of the "named insured"; 2. During the ongoing operations of the "named insured"; and 3. "Your work", as included in the "products-completed operations hazard". The inclusion of the "additional insured(s)" shall not operate to increase the Limits of Insurance. B. This insurance afforded shall not apply to claims, "suits" and/or damages arising out of the acts, omissions and/or negligence of the "additional insured(s)." C. With respect to the insurance afforded to these additional insureds,the following additional exclusion applies: This insurance does not apply to: "Bodily injury", "property damage" or"personal and advertising injury" arising out of the rendering of or the failure to render, any professional architectural, engineering or surveying services, including: 1. The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or 2. Supervisory, inspection, architectural or engineering activities. Page 1 of 2 SP BAI PNW (02/15) D. Primary and Noncontributory Provision The insurance afforded to the additional insured will be Primary Insurance and Noncontributory, but only if such claims, "suits" and/or damages arise out of the sole negligence of the Named Insured. E. Waiver of Subrogation Provision The TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Condition (Section IV - COMMERCIAL GENERAL LIABILITY CONDITIONS) is amended by the addition of the following: We waive any right of recovery we may have against those who are added as additional insureds by this endorsement because of payments we make for injury or damage arising out of your ongoing operations or"your work" performed under a contract with them. This waiver applies only when you are solely negligent. This waiver shall not apply to claims, "suits" and/or damages arising in whole or in part out of the acts, omissions, and/or negligence of those added as additional insureds by this endorsement. To the extent that this policy affords coverage to an "additional insured,"the "additional insured" is subject to all of the terms and conditions of the policy. This endorsement does not apply to any additional insured that has been added to this policy by another additional insured endorsement specifically naming that additional insured. Page 2 of 2 SP BAI PNW (02/15) DATE(MM/DDIYYYY) ACCOR" CERTIFICATE OF LIABILITY INSURANCE 16k..,..--" 1 03122/2017 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. IMPORTANT': If the certificate holder Is an ADDITIONAL INSURED,the policy(les)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 CONTACT NAME Adriana Ramirez .„ Pacific Partners Insurance Agency PHONE FAX 25283 Cabot Road Suite 224 -AIL ^H gas-s6o-1s h,D.!p): INSURER(S) 949-580-1963 APORES : O AFFORDI Laguna Hills,CA 92653 I , I L' G61086 INSURERA: Mercury Casualty 11908 INSURED INSURER B: Paraclete Fire&Safety,Inc. INSURER C: 2950 Saturn Unit I INSURERD: Brea, CA 92821 INSURERE INSURER F: COVERAGES CERTIFICATE NUMBER: 00000000-0 REVISION NUMBER: 7 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 IN7 A DL tUaR POLICY EFF POLICY EXP q TYPE OF IN SURANCE u V—AVD POLICY NUMBER, (MMIDD(YYYY),(MMIDDIYYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S DAMAGE TO RENTED I CLAIMS-MADE (OCCUR PREMISES(Ea occurrencq) 1$ MED EXP(Any one person) dl$ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ POLICY JET LOC PRODUCTS-COMP/OP AGG $ OTI�IE,R ... $ A AUTOMOBILE LIABILITY CCA0003309 11121/2016 11/21/2017 GLmtlaiacp dept)INSiLd�LIMIT $ 1 0,00,000 ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAM'AGI[t AUTOS ONLY AUTOS ONLY (Par acoren1) UMBRELLA $ LIAB OCCUR EACH OCCURRENCE $ EXCESS AB C I .... EXCESS.... CLAIMS-MADE AGGREGATE $ DIED „ RETENTION$ ( $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN 9TATVTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE EL EACH ACCIDE14T $ OFFICER/MEMBER EXCLUDED? N I A (Mandatory in NH) """"""'" EL DISEASE-EA EMPLOYEE S If yes,describe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) PROOF OF INSURANCE CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITY OF EL SEGUNDO THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Public Works Dept ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street El Segundo, CA 90245 AUTHORIZED REPRESENTATIVE (RAM) ©1988-2015 ACORD CORPORATION. All rights reserved, ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD Printed by RAM on March 22,2017 at 11:08AM ENDORSEMENT AGREEMENT STATE WAIVER OF SUBROGATION INSURANCIE BLANKET BASIS 9170545-16 FUND NEW SP HOME OFFICE SAN FRANCISCO EFFECTIVE DECEMBER 13, 2016 AT 12 .01 A.M. PAGE 1 OF 1 AND EXPIRING DECEMBER 13, 2017 AT 12 . 01 A.M. ALL EFFECTIVE DATES ARE AT 12:01 AM PACIFIC STANDARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME PARACLETE FIRE & SAFETY, INC. 2950 SATURN ST , STE I BREA, CA 92821 7L 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 2.00% OF THE TOTAL POLICY PREMIUM. SCHEDULE PERSON OR ORGANIZATION JOB DESCRIPTION ANY PERSON OR ORGANIZATION BLANKET WAIVER OF FOR WHOM THE NAMED INSURED SUBROGATION HAS AGREED BY WRITTEN CONTRACT TO FURNISH THIS WAIVER NOTHING IN THIS ENDORSEMENT CONTAINED SHALL BE HELD TO VARY, ALTER, WAIVE OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS POLICY OTHER THAN AS STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR LIMITATIONS OF THIS ENDORSEMENT. COUNTERSIGNED AND ISSUED AT SAN FRANCISCO: DECEMBER 14 , 20!116 AUTHORIZED REPRESENT /iV[ PRESIDENT AND CEO 2572 SCIF FORM 10217 (REV.7-2014) OLD DP 217