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PROOF OF INSURANCE (2018) CLOSED Client#:48349 WESTE23 ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 7/18/2017 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 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 CONFACT NAME: License#OK0756gaN.Ext):310 828-9662 (AJC No): 310-453-7971 9 Insurance E-MAIL A,DDRE§S� 2001 Wilshire Blvd.,#101 INSURER(S)AFFORDING COVERAGE NAIC# Santa Monica,CA 90403 INSURER A:Mesa Underwriters Specialty Ins INSURED INSURER B:Nationwide Insurance Co. Western Indoor Environmental Services StarStone National Insurance C INSURER C: o 2345 Highbury Ave. INSURER D Ste 19 INSURER E: Los Angeles, CA 90032 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 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 BEEJ REDUCED BY PAID CLAIMS. INSTYPE OF INSURANCE ADDL SUBIR j POLICY EFF PO�ICY t":XP LIMIT- Km ynp, P LICY N MBER Y O U MMIDD VY M Y /V M DOZY YY A �GENERAL LIABILITY X MP0004016002768 02/06/2017 02/06/2018 EACH N ,000,000 X COMMERCIAL GENERAL LIABILITY ACL �CCU REPNC $1T E eI $50,00 rp O urrrena:' CLAIMS-MADE � OCCUR MED EXP(Any one person) $5,000 ... .PERSONAL..&.AD,VI.N.J.U.RY............$..�..1.�.�.�.T..�.�.�............................. GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS COMP/OPG AG P -,-, $2,000,000 .. LOC $ B AUTOMOBILE LIABILITY X ACP3008130234 ,03/02/2017 03/02/2018 c0'MBINr0 gINGLE WAIT 1 000 000 ---... _IEr�nccv,:lr:rr01 ss _X_ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ _ AUTOS AUTOS X PROPERTY DAMAGE $ HIRED AUTOS X t) ...._........ ............... AUTOSNON-O OPE(P t„accident) X Drive Oth Car $ C UMBRELLA LIAB � I OCCUR X 83148R171ALI 02/06/2017 02/06/2018 EACH OCCURRENCE $1,000,000 X EXCESS LIAB X CLAIMS-MADE AGGREGATE $1,000,000 ` DED I I RETENTION$ $ WORKERS COMPENSATION WC STATU- I IOTH- AND EMPLOYERS'LIABILITY Y/N ............�.TG?R.Y.L,IMITS,� ....EU.................................................................................... (Mandatory in NH) ELL,DISEASE-EDA EMPLOYEE $ OFFICER/MEMBER EXCLUDED? D N/A .. .. ....................................................................................... Mandato If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space is required) City of EI Segundo is named additional insured as respects to the liability arising out of the named insureds operations. Blanket Additional Insureds & Waiver of Subrogation apply when required by contract. CERTIFICATE HOLDER CANCELLATION Cit of EI Segundo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City gUnTHE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 350 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. EI Segundo CA 90245 AUTHORIZED REPRESENTATIVE fl ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S77129/M75332 TDI POLICY NUMBER: MP0004016002768 COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 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 City of El Segundo,Its Officers , Officials, Employees,Agents and Volunteers 350 Main Street El Segundo, CA 90245-3813 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 B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following additional organization(s) shown in the Schedule, but only exclusions apply: with respect to liability for "bodily injury", "property This insurance does not apply to "bodily injury" or damage" or "personal and advertising injury" "property damage" occurring after: caused, in whole or in part, by: 1. All work, including materials, parts or 1. Your acts or omissions; or equipment furnished in connection with such 2. The acts or omissions of those acting on your work, on the project (other than service, behalf; maintenance or repairs) to be performed by or in the performance of your ongoing operations for on behalf of the additional insured(s) at the the additional insured(s) at the location(s) location of the covered operations has been designated above. completed; or However: 2. That portion of "your work" out of which the injury or damage arises has been put to its 1. The insurance afforded to such additional intended use by any person or organization insured only applies to the extent permitted by other than another contractor or subcontractor law; and engaged in performing operations for a 2. If coverage provided to the additional insured is principal as a part of the same project. 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. CG 20 10 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 2 C. With respect to the insurance afforded to theme 2. Available under the applicable Limits of additional insureds, the following is added to Insurance shown inthe Declarations; Section III Linmk�0�|n�unan��' — ' whichever imless. If coverage provided to the additional insured is This endorsement mhe|| not increase the required by a contract oragreement, the most we applicable Limits of Insurance shown in the will pay on behalf of the additional insured is the Declarations. amount ofinsurance: 1. Required bythe coniract^oragreement; or Page 2of2 0Insurance Services Office, |nc.. 2O12 CG 20100413 POLICY NUMBER: MP0004016002768 COMMERCIAL GENERAL LIABILITY CG 20 37 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSENS O CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(sy Location And Description Of Completed Operations City of El Segundo,Its Officers, Officials, Employees,Agents and Volunteers 350 Main Street El Segundo, CA 90245-3813 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section 11 — 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 dam- age" caused, in whole or in part, by "your work" at the location designated and described in the sched- ule of this endorsement performed for that additional insured and included in the "products-completed operations hazard". CG 20 37 07 04 ©ISO Properties, Inc., 2004 Page 1 of 1 0 MESA UNDERWRITERS SPECIALTY INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Al - PRIMARY NON-CONTRIBUTORY - WAIVER OF SUBROGATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM Blanket Additional Insureds -As Required By Contract A. Subject to the Primary and Non-Contributory provision set forth in this endorsement, SECTION II -WHO IS AN INSURED is amended to include as an additional insured any person or organization whom you have agreed in a written contract,written agreement or written permit that such person or organization be added as an additional insured on your policy. Such person or organization is an additional insured only with respect to liability for"bodily injury"or"property damage"or, to the extent applicable under the Coverage Part to which this endorsement applies, "personal and advertising injury"caused, in whole or in part, by: 1. Your ongoing operations, "your product", or premises owned or used by you; 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, to the extent applicable under the Coverage Part to which this endorsement applies, "personal and advertising injury"arising out of the rendering of, or the failure to render, any professional architectural, engineering or surveying services by or for you, including: a„ The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; and b. Supervisory, inspection, architectural or engineering activities. This exclusion applies even if the claims against any insured allege negligence or other wrong-doing in the supervision, hiring, employment, training or monitoring of others by that insured, if the"occurrence"which caused the"bodily injury"or"property damage", or, to the extent applicable under the Coverage Part to which this endorsement applies,the offense which caused the"personal and advertising injury", involved the rendering of, or failure to render, any professional architectural, engineering or surveying services. 2. Your maintenance, operation or use of equipment, other than aircraft, "auto"or watercraft, rented or leased to you by such person or organization. A person or organization's status as an additional insured under this endorsement ends when their contract, or agreement with you for such rented or leased equipment ends. With respect to the insurance afforded to these additional insureds, this insurance does not apply to any"occurrence"which takes place after the rental agreement or equipment lease expires. The provisions of this coverage extension do not apply unless the written contract or written agreement has been executed (executed means signed by the named insured)or written permit issued prior to the"bodily injury"or"property damage"or, to the extent applicable under the Coverage Part to which this endorsement applies, "personal and advertising injury". MUS 01 0120128 0316 INSURED Page 1 of 2 Primary and Non-Contributory Provision The following is added to Paragraph 4. Other Insurance, b. Excess Insurance under SECTION IV- COMMERCIAL GENERAL LIABILITY CONDITIONS: This insurance shall be excess with respect to any person or organization included as an additional insured under this policy, any other insurance that person or organization has shall be primary with respect to this insurance, unless: 1) The additional insured is a Named Insured under such other insurance; 2) You have agreed in a written contract, written agreement or written permit to include that additional insured on your General Liability policy on a primary and/or non-contributory basis; and 3) The written contract or written agreement has been executed (executed means signed by the named insured)or written permit issued prior to the "bodily injury"or"property damage"or, to the extent applicable under the Coverage Part to which this endorsement applies, "personal and advertising injury". Waiver Of Transfer Of Rights Of Recovery The following is added to Paragraph 8. Transfer of Rights Of Recovery Against Others To Us under SECTION IV-COMMERCIAL GENERAL LIABILITY CONDITIONS: We will waive any right of recovery we may have against a person or organization because of payments we make for"bodily injury" or"property damage" arising out of your ongoing operations or"your work"done under a written contract or written agreement and included in the "products-completed operations hazard", if: 1. You have agreed to waive any right of recovery against that person or organization in a written contract or written agreement; 2. Such person or organization is an additional insured on your policy; or 3. You have assumed the liability of that person or organization in that same contract, and it is an "insured contract'. The section above only applies to that person or organization identified above, and only if the "bodily injury"or "property damage"occurs subsequent to the execution of the written contract or written agreement. All other terms and conditions of this policy remain unchanged. MUS 01 01 20128 0316 Page 2 of 2 POLICYHOLDER COPY SC STATE QQMPFN5AT1QN P.O. BOX 8192, PLEASANTON, CA 94588 FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 07-19-2017 GROUP: POLICY NUMBER: 9126780-2017 CERTIFICATE ID: 72 CERTIFICATE EXPIRES: 03-07-2018 03-07-2017/03-07-2018 CITY OF EL SEGUNDO SC 350 MAIN ST EL SEGUNDO CA 90245-3813 This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 30 days advance written notice to the employer, We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirement, term or condwtion of any contract or other document with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy. Authorized Representative President and CEO EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT #0015 ENTITLED ADDITIONAL INSURED EMPLOYER EFFECTIVE 2017-07-19 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. NAME OF ADDITIONAL INSURED: CITY OF EL SEGUNDO ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 03-07-2016 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. ENDORSEMENT #2572 ENTITLED BLANKET WAIVER OF SUBROGATION EFFECTIVE 2017-03-07 IS ATTACHED TO AND FORMS A PART OF THIS POLICY EMPLOYER WESTERN INDOOR ENVIRONMENTAL SVCS SC 249 E HAMMEL ST MONTEREY PARK CA 91755 [P13,HO] (REV.7-2014) PRINTED : 07-19-2017 ENDORSEMENT AGREEMENT WAIVER OF SUBROGATION 9126780-17 TATERENEWAL COM_ INGURANCrz SC FUND PAGE 1 HOME OFFICE SAN FRANCISCO EFFECTIVE JULY 19, 2017 AT 12 . 01 A.M. ALL EFFECTIVE DATES ARE AND EXPIRING MARCH 7, 2018 AT 12 .01 A.M. AT 12:01 AM PACIFIC STANDARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME WESTERN INDOOR ENVIRONMENTAL SVC 249 E HAMNIEL ST z MONTEREY PARK, CA 91755 ANYTHING IN THIS POLICY TO THE CONTRARY NOTWITHSTANDING, IT IS AGREED THAT THE STATE COMPENSATION INSURANCE FUND WAIVES ANY RIGHT OF SUBROGATION AGAINST, CITY OF EL SEGUNDO WHICH MIGHT ARISE BY REASON OF ANY PAYMENT UNDER THIS POLICY IN CONNECTION WITH WORK PERFORMED BY, WESTERN INDOOR ENVIRONMENTAL SVC IT IS FURTHER AGREED THAT THE INSURED SHALL MAINTAIN PAYROLL RECORDS ACCURATELY SEGREGATING THE REMUNERATION OF EMPLOYEES WHILE ENGAGED IN WORK FOR THE ABOVE EMPLOYER. IT IS FURTHER AGREED THAT PREMIUM ON THE EARNINGS OF SUCH EMPLOYEES SHALL BE INCREASED BY 03%. 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: JULY 21 , 2017 2570 AlD"f)tl DF112ED REPR'E'SENT IVE PRESIDENT AND CEO SCIF FORM 10217 (REV.7-2014) OLD DP 217