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PROOF OF INSURANCE (2018 - 2018) CLOSED � CERTIFICATE OF LIABILITY INSURANCE DATE 05123r2017 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 WANED, 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 cerdflcate holder In lieu of such endomement(s). PRODUCER JOHN PLUMMER INSURANCE AGENCY INC r John Plummer,Agent m. .r Ax N . _ CcINrAC 35 805-482-2701 805�82.2T JOHN PLUMMER.AGENT LIC.IIOE63435 A 4 wljohn yofi;nplurnmw.net d�NIA}. 41......._.... ..._........... ....... 340 ROSEWOOD AVE,STE I INSURE 8'I AFFORDING COVERAOF ....._. . ..._.. NAAC 0 CAMARILLO CA 93010 ,NSUR" ... State Fans General Insurance Ccmvany 25151 ENSURER e: Fire' l „......... y ursuREO State Faun Mutual Automobile Insurance GOfrtl'Inn.... 25178 ROBINSON WHEELER l R R,c State Farm Fire and Casually Compaf1y 25143 DBA NOVA GRAPHICS SYSTEMS mt1RER ap:,„......................._......_ 193 RINALDI ST,STE 187 INSUPIER E. PORTER RANCH CA 91326 _I UiACR F CO'VEIfJIGE$ CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE UtChl 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- fgR �y�Y.-EE.. m. .._... LIMITS rR POLICY NUMBER ADfYMYYi MrIOL . � P ICY Etfp G:�Cf,.UfRldlr.4+"I':I» ta. -._.._ TYPE OF INStiJRANC X COMWJMAL GENERAL uAmL.rTY Y 90-CC-8424-6 G 05/3012018 rACIt 5,000,000 r C IIIENrI rA . CLAIMS-WDE GccuR I_.._.I A _ I't-fg80N I...A AI)x INJURY $ 5 000 AI fI AffUdN.1IaR9" 5 5.000,000 000 ar,Etl POLICY d q�T APPLIES rEri PR,CK JC t 5-(X)t 9 AGG s lo-OW-000 Il_ll f . C41 2724-A24.55E 01/2412417 01!272018 BODILYINJSiuYp NrITro�d'I l ANY AUTO Jr-11 INJURY(Per acddent} i 1,000 OOD BODILY INJURY per person i l,000' AUTOMOBILE LIABILITY C427287-F_22-S5K 0512212017 11 B 01NNED SCHEDULED AUTOS ONLY AUTOS NrLOI TYUA-07 F.......... ... ...s.1."' 000 WRED NON-OWNED d00 ......._„_,AUTOSONLY AUTOSONLY .,. ..f�.9.1. ' UMBRELLA FJICH OCCURRENCE 5 OICM UTAS C LAIMS-MADE _AGGI�EGAT_E p $ WORKERSCOMPENSATION Ir.P..NFIr�1.T.. ...,'..........d.. F�r,1...................... AND EMPLOYERS,LIABILITY 9MP-K627.9 F 0711012017 1 ANY pRQPRIETORIPARTHERIE}(ECLIiTVE � N ' C L 2::fNl"V,�'G�C'XpENr j ,000,000 C (111an 0c i EXCLUDED? Y N f A F.L 01 I 000,040 DI;r ACS EAI kpLKfYrr i yes,desuibe under AWE OILICY LIM11 I 1,000,1OD i DUSCRIPTION OF OPERATIONS I LOCATIONS I VENICLIM IACORO 101,A"Ifienal Remote z0wdula6 array bo anachad H more space Is r"Ared) BUSINESS OFFICE MACHINE SERVICE AND MAINTENANCE ADDITIONAL INSURED; THE CITY OF EL SEGUNDO,ITS OFFICERS,OFFICIALS,EMPLOYEES,AGENTS AND VOLUNTEERS:PLANNING 8 DEVELOPMENT,CITY CALL,350 MAIN ST.EL SEGUNDO.CA 90245-3913 WORKERS COMPENSATION POLICY INCLUDES WAIVER OF SUBROGATION CERTIFICATE HOLDER 'C ANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CITY OF EL SEGUNDO ACCORDANCE WITH THE POLICY PROVISIONS. PLANNING AND DEVELOPMENT,CITY HALL AUTHOti12ED REPRESENTATIVE 350 MAIN ST ()t, ELSEGUNDO CA 902453913 ` .t I*i .yL I 6 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo, registered marks of ACORD 1D01486 132549.10 0222-2014 JG Policy No. 90-CC-7_RL424-6 CtdP4786.1 Page I of 2 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CMP-4786.1 ADDITIONAL INSURED—OWINERS, LESSEE'S,OR CONTRACTORS (Scheduled) This endorsement modifies insurance pro ided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE Policy Number:90-CC-R_24-6 Named Insured: WHEELER, ROBINSON DHA NOVA GRAPHICS SYSTEMS =9360 RINALQI ST STE 187 PORTER R"::H CA 91326-1607 Name And Address Of Additional Insured Person Or Organization: THE CITY OF EL SEGUNDO, ITS OFFICERS, OFFICIALS, EMPLOYEES, AGENTS AND 'VOLUNTEERS PLANNING 6 DEVELOPMENT, CITY BALL 350 MAIN ST EL SEGUNDO CA 90245-3895 I. SECTION 11 — WHO IS AN INSURED of b. If coverage provided to the additional in- SECTION It -- LIABILITY is amended to in sured is wired by a contract or agree- olude, as an additional insured, aany person or ment, the insurance provided to the organization shown In the S+ched- e, but on: l with respect to liability for 'bodily injury" additional insured will not b broader than 1.property damage'" or`''personal and aadvertis- that which you are required by the contract or agreement to provide for such additan- ing injury caused, in whole or In park, by: al insured; and a. Ongoing Operations C. if the contract or agreement between ou (i) Your acts or omissions;or and the additional insured is goverrlect by (2) The acts or omissions of those acting Californian Civil Code Section 2752 or on your behalf; 27 2.05M, the insurance provided to the in the performance of our�on�oing opera- additional insured is the lesser of that tions for that add ttlone insured;or b. Products-Completed Operations (1) Is allowed or i for indemnity-satisfaction I f a dali- fi�n or indernnity obligation ' Cali. "Your work" performed for that additional faornia Civil Code Section 2782 or insured and included in the 'products- 2782.05 for your sole liability;or completed operations hazard". (2)You are required by contract or However, Paragraph 1.above is subject to the agreement to provide for such addi- followrwring: tiona l insured. a. The insurance afforded to the additional We have no duty to defend or indemnify the insured only applies to the extent permit- additional Insured under this endomment un- ted by law; til a claim or"suit"is tendered to us. 0.CtaPyrig ht,5OW10 t"ararr„u Mularawl AulwnoUld 4pswNsice Ccenpawny,201 Mudn wpyrCgiftd matcTiaal or Nn rarw a�rvl a OraP r„Woe,,wvGUa Its a tPplf�ai °aDrrrIt�I @., CMP-4786.1 ps"2 of 2 2. Any insurance provided to the additional in- (3) The nature and location of any injury suredshall only apply with respect to a claim or damage arising out of the 'occur- made or a "suit" brought for damages for rence"or offense; which you are provided coverage. b. Tender the defense and indemnity of any 3. With, respect to the insurance afforded to the claim or "suit""` to us and to all other insur- additional insured, the following is added to eTs who may have insurance potentially SECTION 1:11—LIMITS OF INSURANCE: available to the additional Insured: and If coverage provided to the additional insured c. Agree to make availabia any other insur- is recluired by contract or agreement,the most ante the additional Insured has for de- we willry on behalf of the additional insured fense or damages for which we would will be a lesser of the amount of Insurance: provide coverage under SECTION 11 a. Required by the contract or agreement; or LIABILITY. b. Available under the applicable Limits Of S. With respect to the insurance afforded the aid- Insurance shown in the Declarations, dRional insured, the following replaces SEC. TION If —LIABILITY of Paragra h 7. Other This endorsement shall not increase the ap- Insurance of SECTION I AND 14F(CTION 11— �licable Limits Of Insurance shown in the COMMON POLICY CONDITIONS:eclaratiom a. This insurance is primary to and will not 4. With respect to the insurance afforded to the seek contribution from any other Insurance additional insured. Ina following Is added to available to the additional insured, provided Paragraph 3. Duties In The Event Of Occur- that the additional insured is a named in- rence, Offense, Claim Or Suit of SECTION sured under such other insurance. 11—GENERAL CONDITIONS: b. Regardless or any a reemani betwoon The additional insured must: you and the adc insured, this Insur- ance Is excess over any other insurance a. See to it that we are notified as soon as whether pri'mary. excess, contingent or on practicable of an "occurrence or an of- any other basis for which the additional in- fense which may result in a claim. To the sured has barerk added as an additional in- extent possible. notice should include-. sured on other policies. (1) How, when and where the "occur- There will be no refund of premium in the event ,rence"or offense took place. this endorsement is cancelled. (2) The names and addresses of any in- Jured persons and witnesses; and All other W--icy provisions apply- CUP4766.1 1007033 148011 06.21-2014 0. op' i it State Form Nutiot Autorrskile Insuw)ce ComMy,2013 Syr yrigMed,motarW of insurance Services omce,inr_w PWMtW13n_ WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 0313 (Ed.4-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT 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.) This agreement shall not operate directly or indirectly to benefit any one not named in the Schedule. Schedule '1'HP CTTY OF EL ry, P';.A.MNING � DF;''tu-oQ,476='KC:NT, C:TTY H A 1,L, 3SO MAIN ST :EL +".'.i EGUNk'O CA 9S 24.,•-."813 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 (18/2,2/16 Policy No. F go E3pK 62-i 9 Endorsement No. 15.00 Insured WHEELER,R, ROBINSON Premium E DBA 193 r�+.�Vr� ��R,Dti[��,i4Y40 187E�~�n Countersigned By... _.._....._� C �° T�:�6d� F�ll�tA.l�l.7k WC 00 0313 (Ed.4-84) Copyright 1963 National Council on Compensation Insurance. 1007729 124203.1 09.28-2015