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PROOF OF INSURANCE (2014) CLOSED AC CERTIFICATE OF' LIABILITY INSURANCE DATE(MMIDDIYYYY)
6/27/2013
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 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 ... ....
N4411. . NAn y.N�M.�1 .h r Z... by. : aL
Earl Bacon Agency, Inc. PHONE FAX
P.O. Box 12039 . MxP Fxt1z850-878-2121 (AmG Nit O 87.8 21.28
Tallahassee FL 32317 .mL L w.bba on e'arlbacon•c'om
NSURER(S)AFFOR,D,I,NG,COVERAGE NAIC#
.. INSUR AmancaL_Gaa.Co.of Readina PA...... ?Q427
INSURED MGTOF-1 INSURER B )
...... ,ERA a .ey.,...lorga. ns.urarlce Co-
MGT of America, Inc. INSURER c CQ,ntlnefltal G ItV COMOa ?1,44
Public Resource Management Inc.
2123 Centre Point Blvd N R,RR Trar1$p rkation fin. z__ Q�llpanv 2Q494
2123 ..........................
Tallahassee FL 32308 INSURERE.:,
INSURERF:Travelers Casualtv&Surety Co :11194
COVERAGES CERTIFICATE NUMBER:9727117824 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 'OLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
ILTR TYPE OF INSURANCE ..................... NSR SWVD..................................POLICY.NU.MBER,,,,,,,,,,,, (MMIDWYYYY)I(MMIDDIYYYY) .................... ...............
OACH OCCURRENCE
POLICY EFF POLICY EXP LIMITS
C GENERAL COMMERCIAL LIABILITY
l,tlAl1ILI'q"Y Y Y P2093390918 7I1I2013 �I1I2014 .FA,EM SES REN i encP) $300,0001,0 1/
X (Any one person) $5„000
C'LAIMS•M�AV:7E' ... GJ("�C�U�R MED EXP An o......,
A-XV Rating INJURY $1„000,000
......... ...... ..................
........... .............................................................. ENERALAGGREGATE $2,000„000
POLICY ., FIF'�oy LOJ 0 ........T......:COMP/0
GEN'L AGGREGATE LIMIT APPLIES PER: � PRODUCTS P AGG $2„000,000
IIp I�Iq $
X AUTOMOBILE LIABILITY Y Y 2093563501 71112013 '7/1/2014 En 811 G/'"SING”L-k IMI
B ,q� _1�aMt1I,N�,}t1 $1,000,000
ANY AUTO BODILY INJURY(Per person) $
BODILY ALL OWNED SCHEDULED Y INJURY(Per accident) $
,...... AUTOS ...C.-.......
X..... A T rt ac Id.,.�a ...
HIRED AUTOS AUTOS ...Pe ag1,A'MA(sE', $
..... NORN'•CS'JWt�VED PR
X A-XV Rating $
C X UMBRELLA LIAB X 2093563496 7/1/2013 '7/1/2014 EACH OCCURRENCE $$5,000,000
EXCESS LIAB
]CLAIMS-MADE AGGREGAT.E............................................... $
DED X COMPENSATION Y 3011086712 7/1/2013 7/1/2014 X l R $GAEL-below
A WORKERS COMPENSATION WC STATU- OTH-
D ANY PROIETO PARTNERIEXECUTIVE Y❑ 3011086788 CA 7N/2013 ,7/1/2014 E L ,AEA C�-!2 EMPLOYEE Ali
L.D $500,000
AND EMPLOYERS'LIABILITY .......�........�.............................................
OFFICER/MEMBER EXCLUDED? NIA
C A C N
(Mandatory In NH DISEASE LOYEE $500,000
If yes,describe under ..
DESCRIPTION OF OPERATIONS below E L,DISEASE-POLICY LIMIT $500,000
F Professional Liability(E&O) 105638880 7/1/2013 7/1/2014 Per Claim 2,000,000
Claims-Made Form Aggregate 3,000,000
7/5/95 Retro Date;A-XIV
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required)
Umbrella: A-XV Rating.All Other Workers'Comp and CA Workers'Comp: A-XV Rating. California Employers Liability Limits: $1,000,000
Each Accident/$1,000,000 Disease Policy Limit/$1,000,000 Disease Each Employee.
CERTIFICATE HOLDER CANCELLATION
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.
350 Main Street
El Segundo CA 902 AUTHORIZED REPRESENTATIVE
©1988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD
POLICY NUMBER: 2093390918 COMMERCIAL GENERAL LIABILITY
CG 24 04 05 09
WAIVER OF TRANSFER OF SIGHTS OF RECOVERY
AGAINST OTHERS TO CIS
This endorsement modifies Insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
PRODUCTSICOMPLETED OPERATIONS LIABILITY COVERAGE PART
SCHEDULE
Name Of Person Or Organization:
Refer to SCHEDULE CG2404
I
Information requlre
d to cornolete 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
S 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.
i=
CG 24 04 06 09 Copyright, Insurance Services Office, Inc.,2008 Page 1 of 7
MGT of America, Inc Policy$011086788 CA
CAM (Ed.1 g,97)
WORKERV COMPENSATION AND EMPLOYERS`LIABILITY INSURANCE POLICY
BLANKET WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS
This endorsement changes the policy to which it Is attached.
It Is agreed that PaTt One If V"orkars'Compansetion,Insurance G.Recovery'From Others and part Two EmpioyaW
Liability Insurance H.Recovery From OU*rs are amended by adding the following:
We will not enforce our right to recover against parsons or organizations, ("This,agreement applies only to the extant that
you perform worm under a^ rittsrr contract that requires you to obtain this a reemoot Isom us.)
PREIVINM CHARGE-
The charge will be are amount to which you and we agrao that Is a percentage of the total standard premium for OnIffomia
exposure.The amount Is
Maim
I
i
I�
o
G-191fi0-B Page 1 of i
(Ed 11197)
MGT of America, Inc. Policy#2093390918
,�r G-17857-G
a1r3M (Ed.01101)
IMPORTANT; THIS ENDORSEMENT CONTAINS DUTIES THAT APPLY TO THE ADDITIONAL
INSURED IN THE EVENT OF OCCURRENCE, OFFENSE, CLAIM OR SUIT. SEE PARAGRAPH
C.I.OF THIS ENDORSEMENT FOR THESE DUTIES.
ALSO, THIS ENDORSEMENT CHANGES THE CONTRACTUAL UASILITY COVERAGE I IM
RESPECTS TO THE "BODILY INJURY" OR "PROPERT'Y DAMAGE" ARISING OUT OF THE
"PRODUCTS-COMPLETED OPERATIONS HIAZARD". SEE PARAGRAPH 13.3. OF THIS
ENDORSEMENT FOR THIS COVERAGE CHANGE.
THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY.
CONTRACTOR'S SCHEDULED AND BLANKET ADDITIONAL INSURED
ENDORSEMENT WITH LIMITED PRODUCTS-COMPLETED OPERATIONS
COVERAGE
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name of Person or Organization: Designated Project:
(Coverage under this endorsement is not affected by an entry or lack of entry in the Schedula above.)
A. WHO 13 AN INSURED (Section II) is amended to 2. The Limits, of insurance applicable to flue additional insured are those specirled In the
including any Person or a organization n u o orn you Declarationcontract�of this po ,agreement
hlchhovero Is lam.
a
include
e rfu a ) y
am:....� to
wdd lrpsu,��..p ih �.�.. These Urnits of Insurance are Incursive of,and riot
-_ tract or written ggraer tons °° In addition to,the Limits of lasuranoo shown In the
but the wn 0 era greemerat must be: Declarations.
1, Currently In effect or becoming effective during the S. The coverage provided to the additional insured
facer ofthie policy,and by ffils endorsement and paragraph f. of the
law definition of "insured contract" under
2. Executed prior s the "bodily injury,i "property DEFINITION'S(Section V)do not apply to"bodily
damage,'or"personal and advertising injury", In)u ^ or "property damage* arising out of the
B. The Insurance provided to the additional insured Is 'products-completed operations ha.ard" unless
- — limited asfbliowwa: required by the written contraact or written
agreement,When coverage does apply to""bodily
1. That person or organQation is an additional Injury" or 'property damage" arising out of the
insured solely for IlablIty Niue to your negligence 'A products-completed operations hou:rd" such
specllically resulting 'from ""your work" for the coverage will not apply beyond:
^— additional Insured which Is the subject of the
written contract or written agreement No a. The period of lime required by the written
coverage applies to[lability resulting from the sole contractor wrifien agreemer(c or
negligence of the additional Insured.
0-17957-G Page 1 of 2
(Ed.01101)
G-17957-G
(Ed.01101)
b, 5 years from the completion of'your worIC on (1) Give written notice of an occurrence or an
the project which is the subject of the written offense to us which may result In a claim
contract or written agreement, or'suit""under this insurance;
whichever is less. (2) Tender the defense and Indemnify of any
clairn or"suit" to any other inswer which
4. The insurance pmvided to ttie additional insured also has Insurance for a loss we cover
does not apply to "bodily Injury," 'property under this Coverage Pat,and
damage," or 'personal and advertising injury""
arising out of an arcHtects, engineer's, or (2) Agree to make available any other
surveyor's rendering of or faliure to render any Insurance: which the additional Insured
professional services including: has for a loss we cover under this
a. The preparing,approving,or failing to prepare Coverage ParL
or approve maps, shop drawings, opinions, f. We have no duty to defend or indemnify an
reports, surveys, field orders, cliange orders additional Insured under this endorsement
or drawings and specifications;and until we receive written notice of a claim or
b. Supervisory,or inspection activities performed vsuir from the additional Insured,
as part of any related architectural or 2. Paragraph 4,h,.of the other insurance Condition is
engineering activities. deleted and replaced With ti v follovdng;
G. As resp m� %, the coverage provided under this 4. Other Insurance
endorsement SECTION IV — COMMERCIAL b. Excess Insurance
GENERAL LIABILITY CONDITIONS arse amended as
follows: This insurance is excess over any other
1. The following is added in the Dufles,In The Event insurance naming the additional insured
of Occurrence,Offense,Claim or Suit Condition: as an insured whether primary, excess,
contingent or an any other basis unless a
0. An additional insured under this endorsement written contract or written, agreement
will as soon as practicable: specifically sequires,that this insurance be
either primary or primary and
nonconlributing.
G-1 7957-G Page 2 of 2
(Ed.011101)
MGT of America, Inc. Policy 3011086712 All Other
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC OD 03 13
(Ed.4-84)
WAIVER OF OUR RIGHT TO R15COVER FROM OTHERS ENDORSEMENT l
We have the right to recover our payments from artyona llelale for an Injury covered by this policy.We 0 not enforce our
light aga[nst the person or organlr.ation named In the Schedule, ("l"tile ag,resment applies only to the extant that you
perform work under a written contract that requires you to obtain this agreement from us,)
This agreement shall not operate directly or IncGrectly to benefit anyone not named In the Schedule.
I
l
Schedule a
z
ANY PERSON OR ORGANUATION ON WHOSE BEHALF YOU ARE REQUIPM TO OBTAIN l
THIS WAIVER OF OUR RIGHT TO RECOVER FROM 13NDER A 4 RTTTNN CONTR;LCT r`
OR AGREE+lENT. l
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This endorsement changes the policy to whlch fl Is attached and Is elfeollvo on the date iaauard unless olherwtae atatea. s
_ (The lnformalloh below Is required only when this endorsement Is Issued subsequent to preparation of the polloy.l 1
_ Endommerd Elteclivo Pc%w No. EndoroemeMNo.
Insured PMm[unr$ t
EMM
Inaura noe Carnpsny Counters Igned by
i
WC 00 0813
(Ed,4-84) Copyright 19as National Counoil on Componeaifon Insuranoe.
AUTOMOBILE ADDITIONAL INSUREDS & WAIVER OF SUBROGATION
1.Who Is An Insured
The following are"insureds":
a. You for any covered"auto".
b.Anyone else while using with your permission a covered"auto"you own,hire or borrow except:
(1)The owner or anyone else from whom you hire or borrow a covered"auto".This exception does
not apply if the covered"auto"is a"trailer"connected to a covered"auto,you own.
(2)Your"employee'if the covered"auto"is owned by that"employee"or a member of his or her
household.
(d)Someone using a covered"auto"while he or she is working in a business of selling,servicing,
repairing,parking or storing"autos"unless that business is yours.
(4)Anyone other than your"employees",partners(if you are a partnership),members(if you are a
limited liability company),or a lessee or borrower or any of their"employe ",while proving property
to or from a covered"auto".
(5)A partner(if you are a partnership),or a member(if you are a limited liability company)for a
covered"auto"owned by him or her or a member of his or her household.
e.Anyone liable for the conduct of an"insured"described above but only to the extent of that liability.
Providea"additional
insured"status
5.Transfer Of Rights Of Recovery Against Others To Us
If any person or organization to or for whom we make payment under this Coverage Form has rights to
recover damages from another,those rights are transferred to us.That person or organization must do
everything necessary to secure our rights and must do nothing after"accident"or"loss"to impair them.
Policy automatically permits
"waiver of subroaatiorr
i
Business Auto Policy
MGT of America, Inc. Policy 2093563501
S. Owned Autos You Acquire After This policy .covered pollution cost or expense,' However, we
009itts have no duty to defend any'Insured' against a 'suit'
seeking damages for 'frodify Injury' or 'property
1. If Symbols 1,2,3,4,5,6 or 19 are entered next damage'or a*covered pollution cost or expense:'to
to a coverage in Itarn Two of the Declarations, which this insurance does not apply. We may
then you have coverage for *autos' that you investigate and settle any claim or 'suit' as we
acquire of the type described tot the remainder considot appropriate. Our, duty to defend or sefile
of ilia policy period. ends when the Liability Coverage Limit of Insurance
2. But,if Symbol 7 is entered next to a coverage in has been exhausted by payment of judgments or
Item Two of the Declarations, an 'auto' you sattlqmerits.
acquire will be a covered 'auto' for that 1. Who Is An Insured
coverage only if. The following are'insureds":
a. We already cover all 'autos" that you own
for that coverage or It replaces an *auto' a. You for any covered'auto.'
you previously owned that had that b. Anyone e6a while using with your
coverage;and permission a covered 'auto' you own, hire
b. You tell us within 30 days after you acquire or borrow except
it that you want use to cover it for that (1) The owner or anyone also from whom
coverage. you h1ra or borrow a covered 'auto,*
C. Certain Trallars, Mobile Equipment And This exception does not apply If the
Temporary Substitute Autas covered "auto' Is a 'trailer" connected
It Liability Coverage is provided by this Coverage to a covered'auto'you own.
Form, the following typos of vehicles are also (2) Your*employee,if the covered'auto'Is
covered`autos"for Liability Coverage- owned by that'employee*or a member
1. "Trailers'with a load capacity of 2,000 pounds of his or her household!,
or less designed primarily for travel on public (3) Someone using a covered*auto' while
roads he or she is working in a business of
selling, servicing, repairing, parking or
2. 'Mobile equipment'while being carded or towed stodng "autos' unless that business Is
by a covered'auto.' yours.
3. Any "auto'you do not own,while used,with the (4) Anyone other than your *employees,"
permission of its owner as a temporary partners (it you are a partnership),
substitute for a covered 'auto'you own that is members (If you are a Ilmiled liability
out of service because of its: company), or a lessee or borrower or
a. Breakdown; any Of their*6Mp1,0y86S,* w1hila moving
b. Repair; property to or from a covered'auto.'
a. Servicing; (6) A partner(it you are a partnership),or a
member Vf you are a limited liability
iL "Loss';or company) for a covered 'auto' owned
e. Destruction. by h:im or hot or a member of his or her
SECTION N—LIABILITY COVERAGE householcl"
A. Coverage a. Anyone liable for the conduct of an
'insured' desofted above but only to the
We will pay all sums an 'insured' legally must pay extent of that liability.
as damages because of 'bodily Injury'or *proporly 2. Coverage Extensions
damage*to which this insurance applies,caused by
an 'accident' and resulting from the ownership, a- Supplementary 13"Mefft
maintenance or use of a covered"auto! We will pay for the'Insured':
We will also pay all sums an "insured' legally must (1) All expenses we incur.
pay as a 'covered pollution cost or expense" to (2) up to $2,000 for cost of bail bonds
which this insurance applies, caused by an (including bonds for related traffic law
*accident' and resulting from the ownership, violations) required because of an
maintenance or use of covered *autos.` However, "acciderno we cover.We do not have to
we Will only pay for the 'Covered pollution cost or furnish these bonds.
expense'It there Is either*bodily Injury*or'property
damage* to which flits insurance applies that Is (3) The cost of borKis to release
caused try the same*accident' attachments in any 'suit" against the
We have the right and duty to defend any"Insured' 'insured*'we defend, but only for bond
against a 'suit' asking for such damages or a amounts within out Limit of Insurance,
Page of 11 Copyright,ISO properties.Inc.,2005 CA 00 0103 06
Business Auto Policy
MGT of America, Inc. Policy 2093563501
SECTION IV—BUSINESS AUTO CONDITIONS (1) Promptly notify the police if the covered
The following conditions apply in addition to the 'auto`or any of its equipment is stolen.
Common Policy Conditions: (2) Take all reasonable steps to protect the
A. Lose Conditions covered 'auto' from 'lutther damage.
1. Appraisal For physical Damage Loss Also keep a record of your expenses for
consideration In the settlement of the
If you and we disagree on the amount of'loss,' claim.
either may demand an appraisal of the'loss.' In (3) Permit us to inspect the covered 'auto'
this event, each party will select a competent and records proving the'loss'before its
appraiser. The two appraisers will select a repair or disposition,
competent and Impartial umpire.The appraisers
will state separately the actual cash value and (4) Agree to examinations under oath at
amount of 'loss.' If they fail to agree, they will our request and give us a signed
submit their differences to the umpire. A statement of your answers.
decision agreed to by any two will be binding. S. Legal Action Against Us
Each party will: No one may bring a legal action against us
a. Pay Its chosen appraiser;and under this Coverage Form until:
b. Bear the other expenses of the appraisal a. There has boon full compliance with all the
and umpire equally. terms of this Coverage Form;acid
If we submit to an appraisal, we will still retain b. Under liability Coverage, we agree in
our right to deny the claim. writing that the 'insured' has an obligation
2. buttes In The Event Of Aceldent,Claim,Suit to pay or until the amount of that obligation
Or Loss has finally been determined by Judgment
We have no du "to provide coverage under this after trial. No one has the right under this
p g policy to ,bring us Into an action to
policy unless there has been full compliance determine the'Insured's'liability.
with the following duties: 4. Loss Payment—Physical Damage Coverages
a. In the event of 'accident,' cialrn, "suit' or At our option we ma
'loss,' you must give us or our authortzed p y:
representative prompt notice of the a. Pay for,repair or replace damaged or stolen
'accldant'or'los .*Include: property;
(1) Now,when and where the'aocldenr or b. Return the stolen property, at our expense.
'lass'occurred; We will pay for any darnage that results to
(2) The'insuted's'name and address;and the'auto*from the theft;or
(3) To the extent possible, the names and c. Take all or any part of the damaged or
addresses of any injured persons and stolen property at an agreed or appraised
witnesse& value.
b. Additionally, you and any other involved if we pay for the'loss,'our payment will include
'insured'must: the applicable sales tax for the damaged or
(1) Assume no obligation, make no stolen property.
S payment or incur no expense without S. Traaosfer Of Rights Of Reeovary Agairtist
our consent, except at the 'Insured's' tethers To Us
own cost. It any person or organization to or for whom we
MM (2) Immediately send us copies of any make payment under this Coverage Form has
request, demand, order, notice, rights to recover damages from another, those
summons or legal ,paper received rights are transferred to us. That person or
concerning the claim or"suit.' organization must do everything necessary to
secure our tights and must do, nothing after
(3) Coopetate with us In the investigation "accident'or"loss'to impair thorn,
i� or settlement of 1he claim or defense B. General Conditions
against the*suit,"
(4) Authorize us to obtain medical records 1• Bankruptcy
or other pertinent information. Bankruptcy or insolvency of the"insured'or the
(S) Submit to examinatlon,a�t Our expense, 'lnsured'as' estate will not ral'leve us of any
by physicians of our choice,as often as obligations under this Coverage Form,
we reasonably requfra. 2. Concealment,Misrepresentation Or Fraud
C. tl there is 'loss' to a covered 'auto' or Its This Coverage Form is void In any case of fraud
equipment you must also do the following: by you at any time as It relates to this Coverage
CA 00 8103 06 Copyright,ISO Properties, Inc.,2005 Page 7 of 11