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PROOF OF INSURANCE (2018) CLOSED EXCEELE-02 CWHOOLERY CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 03/24/2017 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(ies)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 rl tS tot a cert/Icate holder in lieu of such endorsement(s). PRODUCER C A J" C'r Certificate'Department Preferred Insurance Services,Inc PHONE F.xt 703 667-5940 FAX 4035 Ridge Top Road,Suite 150 I )� ) /ABC,No):(703)991-4838 Fairfax,VA 22030 ADDRESS,certs ,preferins.COm INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Great American Insurance Company 16691 INSURED INSURER B:National Union Fire Ins Co 19445 Excelsior Elevator Corporation INSURER C:Preferred Employers Insurance Company 10900 1961 Blair Avenue INSURER D Santa Ana,CA 92705 INSURER E INSURER F: _ COVERAGE'S 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. INSR ADOL SUBR POLpCY EFF POLICY EXP LTR TYPE OF INSURANCE IN.a .,W. .iT POLICY NUMBER LIMITS _IMMIU91Y,.Y.Y.,Y1....(M .Q1Y�fy.y,1.................................. .......... A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMACLAIMS-MADE X OCCUR GLP123442600 04/01/2017 04/01/2016 PREIO�$ d"0EapoIREN rfr $ 300,000 X X P°FtEh"iSES 4k',a r„ar�iaffr7fl�e1 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 C'eEN1 AGGREGAIE.LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 POLICY X JECT LOC PRODUCT'S•COMPA)F AGG,,$ 4,000,000 OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE I IMIIT (EA acadenl,p $ ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOpS�VN BODILY INJURY(Per accident) $ AUTOS ONLY AUOTOS ONLY PROPERTY accident!TY CJ'AWNAk;�E� Per PERT rid $ $ BUMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5'000,000 X EXCESS LIAB CLAIMS-MADE X X ;EBU 033341708 04/01/2017 04/01/2018 AGGREGATE $ 5,000,000 DED RETENTION$ $ WORKERS COMP C '.............._........._. .m AND EMPLOYERS'LIABILITY X X ITY PER UTi” EO�F�I� YBN: WKN1464026 04/01/2017 04/01/2018 1,000,000 ANY PROPRIETORIPARTNERIEXECUTIVE E L FACH ACCIDENT $ �FFICER/MEMBER EXCLUDED? N I A (Mandatory in NH) E1 DISEASE-EA EMPLOYEL $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below (U 1, OU!i2:ASE-i}"C11.IIC'Y'k.I1ahU'I 5 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached it more space is required Re:City,its officials,and employees are Additional Insured with respect to General Liability for ongoing and competed operations,regarding all work performed by the named insured. A Waiver of Subrogation applies in favor of the Additional Insured with regard to General Liability and Worker's Compensation. Excess Liability Follows form. Primary&non-contributory wording applies to General Liability as required by written contract. 30 Days Cancellation. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Ci of EI Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City 9 ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street EI Segundo,CA 90245-3813 AUTHORIZED REPRESENTATIVE ,A.l�� ACORD 25(2016/03) ©1988- 2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD CG 20 10 (Ed. 04 13) GLP123442600 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 Organization(s) Location(s) of Covered Operations Any person or organization that you are required and agreed to name as Any location within the"coverage territory" an additional insured on your policy under: 1.A written contract or agreement that is in effect during the term of this policy and such contract is entered into prior to the"occurrence"of any"bodily injury","property damage","personal injury",or"advertising injury'; or, 2.An oral contract or oral agreement with a person or organization when a certifiicate of insurance showing that person or organization as an Additional Insured has been issued;and such oral contract or oral agreement is in effect during the term of this policy and is entered into prior to the "occurrence"of any"bodily injury","property damage","personal injury",or "advertising injury" 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. However; 1. the insurance afforded to such additional insured only applies to the extent permitted by law; and 2. if coverage provided to the Additional Insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. 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 Copyright, ISO Properties, Inc., 2012 CG 20 10 (Ed. 04/13) (Page 1 of 2) 2. that portion of "your work" 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. C. With respect to the insurance afforded to these Additional Insureds, the following is added to SECTION III - LIMITS Of INSURANCE: If coverage provided to the Additional Insured is required by a contract or agreement, the most we will pay on behalf of the Additional Insured is the amount of insurance: 1. required by the contract or agreement; or 2. available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. Copyright, ISO Properties, Inc., 2012 CG 20 10 (Ed. 04/13) (Page 2 of 2) CG 20 37 (Ed. 04 13) 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 PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART Schedule Name of Additional Insured Person(s) or Organization(s) Location and Description of Completed Operations Any person or organizationthat you are required and agreed to name as An location within the"coverage territory",as an additional insured on your policy under: Y g and for all completed operations 1. A written contract or agreement that is in effect during the term of this policy and such contract is entered into prior to the"occurrence"of any "bodily injury","property damage","personal injury",or"advertising injury'; Or, 2.An oral contract or an oral agreement with a person or organization where a certificate of insurance showing that person or organization as an Additional Insured has been issued;and such oral contract or oral agreement is in effect during the term of this policy and such contract is entered into prior to the"occurrence"of any"bodily injury","property damage","personal injury",or"advertising injury' 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" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the Schedule of this endorsement performed for that Additional Insured and included in the "products-completed operations hazard." However: 1. the insurance afforded to such additional insured only applies to the extent permitted by law; and 2. if coverage provided to the Additional Insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these Additional Insureds, the following is added to SECTION III - LIMITS OF INSURANCE: If coverage provided to the Additional Insured is required by a contract or agreement, the most we will pay on behalf of the Additional Insured is the amount of insurance: 1. required by the contract or agreement; or Copyright, ISO Properties, Inc., 2012 CG 20 37 (Ed. 04/13) (Page 1 of 2) 2. available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. Copyright, ISO Properties, Inc., 2012 CG 20 37 (Ed. 04/13) (Page 2 of 2) (',1Lr"'I'::.i,p j,,)o0 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ELEVATOR CONTRACTOR PLUS ENDORSEMENT Primary and Non-Contributory Additional Insured Extension This endorsement modifies insurance provided under the following: COMMON POLICY CONDITIONS COMMERCIAL GENERAL LIABILITY COVERAGE PART Section Extracted from Endorsement CG 90 53 (Ed. 04/161 K. Primary and Non-Contributory Additional Insured Extension This provision applies to any person or organization who qualifies as an Additional Insured under any form or endorsement under this Policy. Condition 4.Other Insurance of SECTION IV-COMMERCIAL GENERAL LIABILITY CONDITIONS is amended as follows: a.The following is added to Paragraph a. Primary Insurance: This insurance is primary to and will not seek contribution from any other insurance available to an Additional Insured under your policy provided that: (1)the Additional Insured is a Named Insured under such other insurance; and (2)you have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the Additional Insured. GM11 23442600 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ELEVATOR CONTRACTOR PLUS ENDORSEMENT Blanket Waiver of Subrogation This endorsement modifies insurance provided under the following: COMMON POLICY CONDITIONS COMMERCIAL GENERAL LIABILITY COVERAGE PART Section Extracted from Endorsement CG 90 53 (Ed. 04d16) T. In SECTION IV-COMMERCIAL GENERAL LIABILITY CONDITIONS, the following is added at the end of Condition 8.Transfer of Rights of Recovery Against Others to Us: We waive any right of recovery we may have against a person or organization because of payments we make for injury or damage arising out of: a. your ongoing operations; or b. "your work"pursuant to a written contract between you and that person or organization and included in the"products-completed operations hazard"; but only if: c. you and that person or organization have agreed, in a written contract or agreement,that you waive such rights against that person or organization; and d. the injury or damage occurs only after you and that person or organization have signed the written contract or agreement described in c. ......_.....— Prefeffed Employers 1 N S U It A N C li C 0 M P A N Y WC 99 07 00 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT—BLANKET 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 for which you perform work under a written contract that requires you to obtain this agreement for us. The premium charge for this endorsement shall be 3%of the Worker's Compensation premium,subject to a minimum charge of$500.00 i This endorsement changes the policy to which it is attached effective on the date issued unless otherwise stated. (The information below Is required only when this endorsement Is Issued subsequent to preparetlon of the policy.) Endorsement Effective 4/01/17 Policy No. VWN1464026 Endorsement No. 2 Insured EXCELSIOR ELEVATOR CORPORATION e Insurance Company PREFERRED EMPLOYERS INSURANCE COMPANY /l i Countersigned By Aidlearixed apreseraAare DATE(MM/DO/YYYY) '-"Ra CERTIFICATE OF LIABILITY INSURANCE 1166.� 08/09/2017 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(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 NANtE,; IW Insurance Center PHONE q6-447-8m�A 8 4115 E LIVE OAK AVENUE I� F ...FX11aAri, �� 068 626-447-606 E-MAIL-M ADDRESS. 1n1�,R(S)AFFORDING COVERAGE NAIC 0 SUITE INSUR'ERm Inf. _., ...,-,,.-.w-.... to -y Select Insurance CoaxaparL 20260 ARCADIA.... ....,,,,,, ..............w-, „ CA 91,006... .. ., _ ....,, INSURED INSURERS: a Excelsior Elevator Corp. INSURER C. INSURER D 1961 Blair Avenue INSURER.E......... ............,,.. ..,. .........................wW....... Santa Ana CA 92705 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 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 ff „� . ............ .._._." �"�__....._.................. REDUCE-D-.----B---Y.-._P.-..,A. ID..C..L_.A.I.M..S . INSR � iyY_ TYPE OF — gQE-01F LICY EXP LtlR L.,��IM.Y. .I.T..S COMMERCIAL GENERAL LIABILITY r1YG'NpyyYEACH OCCURRENCE CLAIMS-MADEOCCUR GR -_ §$.. MED ,....,, - i EXP( m su ab 5 ERNA Ads ADV INJURY ....... ' , ' . ''SUL 'N 4JR'A $ GE{N' GATE LIMITAPPLIES PER: _GENERAL S. 1 OTHER:E J Ic�RO DR a r5 `.. _ CR _.�.. POLICY LOC c Ft" MP+OF AGG $ AUTOMOBILE LIABILITY o6/ii/2018 VNFr,1) OGLE LIMIT 000,000 504-59867-2275-001 o6/li/2oi� 1r m ANY AUTO BODILY INJURY(Per person) S ......... ....�._.._, ALL l AUTOS OWNED NO GOWNED x BODILY L,'INJURYPry (oPer accident)Y 5 . ... SCHEDULED A p✓1 Auras !F')I;,Ed,�s,a,;,.Ir �E HIRED AUTOS +iI $ UMBRELLA LAB OCCUR EACH OCCURRENCE $ -,EXCESS LIABAGGREGATE DEC t+°L''T"e'deTll„1rk'$ N I WORKERSI AND EMPL OYERS' LIABILIITY YIN ST.A."q,P_F' M. EF,ri.......^...g.. .__ -— .......... ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? ❑ N/A " ,(Mandatory in NH) � E,L DISEASE,CAEM6Rt.O IYN_Fx ,,.......-.-,....,. _ . . , I/ySCd1;Pr'ONa,n;ter .. E DISEASE-RNJI;.YLRAIT �DE;,GRIP'"uG7'd'd:eF GPE,R,ATII(r>ls 14elrrH DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) City of E1 Segundo - Public Works Department is named as an Additional ]Insured per Form 50461AIS011. 30 days notice of cancellation. All terms and conditions are based upon the actual policy form. .............. .... - - CERTIFIC'AT'E HOLDER CANCELLATION City of E1 Segundo - Public Works Department SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street AUTHORIZED REPRESENTATIVE E1 Segundo CA 90245 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD