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PROOF OF INSURANCE (2018) CLOSEDo DATE(MMIDDIYYYY) 4CC>R" CERTIFICATE OF LIABILITY INSURANCE ice" 5/2/2017 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 pollcy(les) must be endorsed. If SUBROGATION I.S. 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 endorsemor s). PRODUCER - -- -CON Nysa Gallegos _. ,,,,,u. ,. ,u 535 North Brand Boulevard MAIL saG@KnightIns.net � FAX N�)R (ele) 662-9312 Knight Insurance Services PHONE (81 0 a& � ����w�� 2 - .... 0 ADORES @RnightIns. net Suite 1000 INSURERISj AFFORDING COVERAGE NAIC # Glendale CA 91203 INSURER „S�uxpl -B Insurance Comsaa�y 10725 ... ���. ..... .n...........� „� . „.. INSURED INS4RER.a,Depositors Insurance Company 42587, All City Management Services Inc INsuRc Houston Casualty "Company ey _ 42374__m,_ 10440 Pioneer Blvd # 5 INSURERD.The Burlinaton Insurance Companv 23620 Santa Fe Springs CA 90670 1 INJURER F. COVERAGES CERTIFICATE NUMBER:17 /18 Master 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. OR ILT TYPE OF INSURANCE -AWLS V4VD POLICY NUMBER tMM L _ m M oNYY'YY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 0 AGETI�It�LITtI� ____ A 9 CLAIMS -MADE I OCCUR X 100020084302 5/1/2017 5/1/2018 ME EXP (Any oneperson), :� Excluded ,..m.. -_ _ . __........_................._,. PERSONALBADV INJURY $ 1,000,000 GEN L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 ..X.,... POLICY F—] PRO- 1:1 LOC PRODUCFS'- COMPIOPAGC 5........... 2,000,000 .. JECT OMER:, S AUTOMOBILE LIABILITY CO 97RIturoIl, WAII $ 1,000,000 H X ANY AUTO BODILY INJURY (I ei parson) $ A ALL OWNED SCHEDULED_- .. - -- ... - - -... - AUTOS AUTOS X ACP7855954504 4/1/2017 4/1/2018 BODILY Y IIN1URY (R e a.mdertl) R oOeji:OY rh4.MAariE ..... . HIRED AUTOS AUTOS NON-OWNED APRP GR.+�p.�.� $ X R UMBRELLA LIAB OCCUR let Layer (Primary) EACII OCCURRENCE .... S ,.,.. 3,000,000 C X EIICESS LIAB CLAIMS -MADE - AGGREGATE 3 000 000 IDQ-..I X RETENTION 0 H17XC5074400 5/1/2017 5/1/2018 $ WORKERS COMPENSATION �I�A7lml;f,.E AND EMPLOYERS' YIN App _J R A6 H ACCIID N Y $ ANY PROPRIETOR /PARTNER /FJECUTIVE t "J N/A Not Applicable vanda or InpN H EXCLUDED? E.1 ' a I qTv I -.I D6uLrtaF: EA CIOPsF'LO`PI -I-I $ 8I yo desobeunder 9'Jk= S:R4IP1fPt:MR+d d "�E"3PSR,0.140N;y' flirt° E_I_ DISEASE - POLICY LIMIT 5 D Excess Liability 2nd Layer (Secondary) 5/1/2017 5/1/2018 E::ach Oacuire.,nw, in IIE.xmss of $5,000,000 Occ $0 Retention EFF0004884 $3M PdIFT1,2ry II.11V* $5,000,000 Agg DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) As respects General Liability and required by written contract; Certificate Holder is named as additional'' insured. Insurance is Primary & Non - Contributory. Waiver of Subrogation applicable. Auto Liability Additional Insured included as rquired by written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE E1 Segundo;Deborah Cullen THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Finance Director ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street El Segundo, CA 90245 AUTHORIZED RIEPRESENTATIVE Manny Mashhoud /NYSGAL ©1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS025 nm4ml Liberty_. Surd his (tt uramv Commercial General Liability Corp wation LIBERTY SURPLUS INSURANCE CORPORATION (A New Hampshire Stock Insurance Company, hereinafter the "Compan),") ENDORSEMENT NO. Effective Date: 05/01/17 - 05/01/18 Policy Number: 100020084302 Issued To: All City Management Services, Inc. THIS ENDORSEMENT CHANGES THE 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 Additional Insured Person(s) Or Orgartiization(s) Location(s) Of Covered Operations Any person or organization for whom you are performing operations when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy; Any other person or organization you are required to add as an additional insured under the contract or agreement described in the paragraph above. All locations of covered operations. (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 include as an additional insured the 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 apply: 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 CG 20 10 07 04 © ISO Properties, Inc., 2004 Commercial General Liability 2. That portion of "your wort' 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. 2 CG 20 10 07 04 © ISO Properties, Inc., 2004 Liberty ilt"[)1,u sIn t,tt,°tnce Commercial General Liability LIBERTY SURPLUS INSURANCE CORPORATION (A New Hampshire Stock Insurance Company, hereinafter the "Company ") ENDORSEMENT NO. Effective Date: 05/01/17 - 05/01/18 Policy Number: 100020084302 Issued To: All City Mana ement Services, Inc. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY INSURANCE CLAUSE ENDORSEMENT To the extent that this insurance is afforded to any additional insured under the policy, such insurance shall apply as primary and not contributing with any insurance carried by such additional insured, as required by written contract. Nothing herein contained shall be held to waive, vary, alter or extend any condition or provision of the policy other than as above stated. 1 CGL 10 3104 03 Surplws Insurance nee Commercial General Liability Corporation.. LIBERTY SURPLUS INSURANCE CORPORATION (A New Hampshire Stock Insurance Company, hereinafter the "Company ") ENDORSEMENT NO. Effective Date: 05/01/17 - 05/01/18 Policy Number: 100020084302 Issued To: All City Management Services, Inc. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS /COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: As required by written contract signed by both parties prior to any "occurrence" in which coverage is sought under this Policy. Information required to complete this Schedule, if not shown above, will be shown in the Declarations The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV — Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products- completed operations hazard ". This waiver applies only to the person or organization shown in the Schedule above. 1 CG 24 04 05 09 © Insurance Services Office, Inc., 2008 DATE (MMIDDIYYYY( CERTIFICATE OF LIABILITY INSURANCE Irsnr 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 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 certificate holder in lieu of such ondorsement s . PRODUCER 11 �9R!AUT .- a_._.r._ Assurance Agency, Ltd. One Century Centre 1750 E, Golf Road Schaumburg IL 60173- A INSURED Personnel Staffing Group, LLC dba K S Staffing. 1751 lake Cook Road', Suite 600 Deerfield IL 60015 COVERAGES CERTIFICATE NUMBER: 155624002,3 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. O I 'I;ND '.,_.m . ... .. ......... I 9T ,. .. .......... . TYPE OF.,...w _.._ ._,,.� POLICY MV1D E INSURANCE POLICY NUMBER MMIDD MM ODY� LIMITS 0ENERAL LIABILITY EACH OCCURRENCE 5 .. B 4,ME'LlN"RL�Id1L. GENERAL LIABILITY rJL1iJfAC`sE'7bRENiEO „- w CLAIMS -MADE OCCUR ME D EXP (Any one person) $ PERSONAL & ADV INJURY $ ._.. ............. ..... GENERALAE GREGATE $ GEN °L. AGGREGATE LIMIT APPLIES PER: ... .. ., ...,,,,,. PRODUCTS COMPIOP AGG $ POLICY %RQ1 LOC, ..n,.,. ,,,�.,.� .. , .__., , _, .............. . . $ .,. AUTOMOBILE LIABILITY ,... S ANY AUTO BODILY INJURY (Per person) S ALL OWNED SCHEDULED AUTOS E3:0 accident ODILY INJURY $ Per ( ) NON-OWNED w..... ,,, mm - PykERTY AGE $ HIR DSAUTOS AUTOS ,(MtppaP�, °a4lrlyt UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS MADE $ ,AGGREGATE DED RETENTIONS • WORKERS COMPENSATION RVV008962 1/1/2017 1/1/2018 x (p STA u- I 71 • AND EMPLOYERS'LIABILITY YIN VVD001482 1/1/2017 1/1/2018 „„,. ANY PROPRIETORIPARTNEREXECUTIVE OFFICERIMEMBER EXCLUDED? N� N I A � E L EACH ACCIDENT 31 000 000 - ..., (Mandatory in NH ) E.L DISEASE EA EMPLOYEE, $1.000.000 If y describe under i DESCRIPTION OF OPERATIONS below I E L DISEASE- POLICY LIMIT S1.000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) Proof of Insurance RE: Employees assigned by All City Management Services dba The Crossing Guard Company 10440 Pioneer Blvd Suite 5, Santa Fe Springs CA 90670 See Attached... CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of El Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN y 9 ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street El Segundo CA 90245 AUTHORIZED REPRESENTATIVE I a ©1988.2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: LOC #: 4C C>/?" AnnITIrIAIAll 0PMA0WQ CPWPn1 II 9: AGENCY Assurance Agency, Ltd.. —11-1111- -- . . ...................w POLICY NUMBER CARRIER NAIC CODE NAMED INSURED Personnel Staffing Group, LLC dba KBS Staffing 1751 Lake Cook Road, Suite 600 Deerfield IL 60015 F:I;li$a.J /=1.7_.1A Panes 1 of 1 ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 0313 (Ed. 4 -84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT We have (lie 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 anyone not named in the Schedule. Schedule Where required by written contract 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.) Policy Effective 01101/2017 Endorsement Effective 01/01/2017 Policy No. WD001482 Endorsement No. Insured PERSONNEL STAFFING GROUP, LLC DBA KBS STAFFING Premium Insurance Company Protective Insurance Company Countersigned by ,, .... — WC 00 03 13 (Ed. 4 -84)