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PROOF OF INSURANCE (2018) CLOSED 08--08:'17 14-11 FROM.— ?-5F2-8OR-5�?0 T-635 P0001/0005 F-862 6/1/2018 =E(MrouoorvrY} CERTIFICATE OF LIABILITY INSURANCE 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($), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the cortifivate holder is an ADDITIONAL INSURED,the poll'cy(Ics)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions Of the policy, certain Pol'Icies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in liou of such ondorsement(s), PRODUCER Lockton Insurance Brokers,LLC NAE'cr 725 S,Figueroa Street,35th FL PHONE I ra�.�....._�. .......................m_.�........-. CA License#OF15767 ....... Los Angeles CA 90017k1Dg�tt18 * M........ INsuRER s nFFoeawc coveRAce . ....r...,....... NAI.......... (213)689-0065 INSURt tA:Liberty Mutual Fire Insurance Com>Lany 23035 m INSURE° , INSURER B:EmploVeTS J=LIJaACe COMDany Of Wausau 21458 1047663 Joe's Sweeping,Inc. C, INSURER D: � 1C...D.gg_f�?1 L 15?JT __.......-....... P $, dba:Nationwide Environmental Services wsuRER e:Li e t 4404 ,K and JNL,BuildingServices 11914 Front St, Norwalk CA 90650 I INSURER E, .. : u I(INSURER F: u COVERAGES .JOESWO'l CERTIFICATE NUMBER; 1/876365 REVISION NU'MUIER, ''I x_X) THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSION$AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS- 7i LAIMS_ INSR p ... —....�. LTR ,.,. 'TYPE OP INSURANCE INJI I;UeR (POLICY EFF POLICY EXP ....•,�,.•,......__,�.,, IN$,Q,,,,,} ,U, POLICY NUMBER (MMdDrtrklCk'Y)�(MMIrYpMYYY) LIMITS A _MmERcwLOENEtz°r LI^elLlrr Y• Y TS2-Z91-449322-117 6/1/2017 6/1/2018 w I p COMMERCIAL CLAIMB-MADE X OCCUR ,..PRkM1fulEa4trurmen;,A, .._ S 1 00.000........................ O I Or;M�t�FT -Rr�r�ta �.$ MED EXP(Any one Person) 10.000 PERSON CON'LAGGREGATE LIMIT APPLIES PER, GF RALA cnr_GoA IJERv......_)s 2,000.000 ......_ iV 0 FyOr,FE'L'T LOC 12p' PRODUCTS-COMPIOPAGG �$ 2.000.000 I.,PK'M .._... OT}ICiR, 0—S II� $ AUTOMOBILE LIABILITY N 1,1m ASC.-Z91-449522-037 6/1/2017 6/1/2018 .�� ,SIR; Mf7 S3 1,000,000 _ ANY AUTO BODILY INJURYworperson) t XXy�XXX _ AHIRED NON-OWNED UTOS ONLY .,. ,.,. AUTOS ONLY .d PROPERTY DAr�'n.�;C accident)AUTOSONLY AUTOS . ........... .—,ISI er ........ QW0&Coll Ded S 1,000 C UMSRELLAUAB d OCCUR N N TH7-7,91449522-067 61IY2017 6/1/2018 EACHOCGURRENdE S 5.0M00 EXCI S LlA6 CLAIMS-MADE AGGREGATE $ 5,000.0Q0 _ DEA �RETENTION$ �'s X X XXX„ A AND EM OYE LIAaLITY � NIA Y WC2-Z91.449522.137 6/1/2017 6/l/2018 �..E IEAATkrTr JE AX PER N-».w..m............. WVORKFItS COMP WPARTNEVCXECLITIVE YIN t 1.000.000 I(Mvrs`idatury in N rn In E ,DISEASE-sA EMPLOYEE g 1 000 000 Po0FnCrPJ,tC"F�FBr'rkEkC'"�!tFDE�"t „....... .............w....�.wr.....,.,.,.,.,....s _ �DE'S61t 1PfiO H Or'OPFR,ATIONS I:afow EL.DISEASE-PouoY LIMIT S ..DESOR1PTION OF OPERA-TIONS i LOCATIONS/VEHICLES AC°RB r ...................................... ( 1Q1,AtltllYiewal Ftam®rNa ach®dula,m®y ba®gpehaq i9 mon apew is roquleea} City ut' 1,Srgtsndo,its off ccur cffi61h,etraploy"s,:agents and Voluntcors arc it clU drtd ssAdditiOrtFl IrasIFmd to the extem provided by the policy laiiVnge or ratal=trtnctnt as Mated or Fappr(^-od by dko:iTasw-,tncc r;%nivT'. Coverage VrPF-i cd is p rinnd%n,aIt.ay', Waiver of Snubra„ati on applk*per attadiad evdomement(s)or policy language. CERTIFICATE HOLDER CANCELLATION SrecrAlt' hr&,nts 1876365 _... ._.__._-- ..._. . . City of El Segundo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Q ttn:Eloriza ltzve>a PW Dept- THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN p ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main St, El Segundo CA 90245 AUT4Oa21ZEb REr1ORF71,818-1201 1 AC D CORPORATION. All rights reserved, ACORD 2S(2016103) The ACORD name and logo are registered marks of ACORD 11 11" `�1'11111iji T_r_%0A Dn,(Y)e)1Ar)r)Q I V_ UQ e_u I VQ I V V_/V'J'J,) I VJV Policy Number:T132291-449622-1117 Item 10. Blanket Additional Insured Where Required By Written Contract Paragraph 2. of Section 11-Who Is An Insured is amended to add the following: e.Additional Insured by Written Contract or Written Agreement The following are insureds under the policy when you have agreed in a written contract or written agreement to provide them coverage as additional insureds under your policy: (1) Lessors of Leased Equipment:The person(s) or organization(s)from whom you lease equipment.,but only with respect to liability for"bodily injury", "property damage"or"personal and advertising injury"caused, in whole or in part,by your maintenance, operation or use of equipment leased to you by such person($)or organization(s). (2)Managers or Lessors of Promises:Any manager or lessor of promises leased to you in which the written leas,-agreement obligates you to procure additional insured coverage. The coverage afforded to the additional insured is limited to liability in connection with the ownership, maintenance or use of the premises leased to you and caused, in whole or in part, by some negligent acts or omissions of you,your employees, your agents or your subcontractors.There is no coverage for the additional insured for liability arising out of the sole negligence of the additional insured or those acting on behalf of the additional insured, except as provided below. 4 If the written agreement obligates you to procure additional insured coverage for the additional insured's sole negligence,then the coverage for the additional insured shall conform to the agreement, but only if the applicable law would allow you to indemnify the additional insured for liability arising out the additional insured's sole negligence. This insurance does not apply to: (a)Any"occurrence"which takes place after you cease to be a tenant in that premises or to lease that land: or (b)Any premises for which coverage is excluded by endorsement. (3) Mortgagees,Assignees or Receivers:Any person(s) or organization(s)with respect to their liability as mortgagee,assignee or receiver and arising out of the ownership, maintenance or use of your premises. This insurance does not apply to structural alterations, new construction and demolition operations performed by or for that person or organization. (4)Any Person or Organization Other Than a Joint Venture:Any person or organization (other than a joint venture of which you are a member)for whom you are obligated by a written agreement to procure additional insured coverage, but only with respect to liability for"bodily injury", "prop"damage"or"personal and advertising injury"caused,in whole or in pat by your acts or omissions or the acts or omissions of those acting on your behalf. (a) In the performance of your ongoing operations-,or (b) in connection with premises owned by you. This insurance does not apply to: 1.Any construction, renovation, demolition or installation operations performed by or on behalf of you,or those operating on your behalf; 2.Any person or organization whose profession, business or occupation is that of an architect, surveyor or engineerwith respect to liability arising out of the preparation or approval of maps, drawings, opinions,reports, Attaclu-nent Code:D508870 Certificate ID : 1876365 n0_00 5 1-7 1 A D)a 1,_F.00 008-U77110 _ ror7 nnnno Yonor- coc�n V0 Q_ I ? I It:11 11 FRV I I- �JU6_ VV 1�(ILU T UUJ I VVVJJJU J I uue-_ surveys,change orders,designs, specification or the performance of any other professional services by such person or organization:or 3.Any person or organization more specifically covered in Paragraphs e.(1)through (4)above. The insurance afforded to any person or organization as an insured under this Paragraph 2.0,; (1)Applies only to coverage and minimurn Umits of insurance required by the writtan agreernent OF written contract, but in no event exceeds either the scope of-coverage or the limits of insurance provided by this policy; (2) Does not apply to any person or organization for any"bodily injury', 'property damage"or"personal and advertising injury"if any other additional insured endorsement attached to this policy applies to that person or organization with regard to the"bodily injury","property damage"or"personal and advertising injury'; (3)Applies only if the"bodily injury"or'propeAy darna�)e"occurs, or offense giving rise to"personal and advertising injury"is committed, subsequent to the exrecution of the written agreement;and (4)Applies only if the written agreement is in effect at the time the"bodily injury"or"property damage"occurs, or at the time the offense giving rise to the"personal and advertising injury"is committed, Item 11. Blanket Additional Insured-Grantors Of Permits Paragraph 2.of Section 11-Who Is An Insured is amended to add the following: Any state, municipality or political subdivision with respect to any operations performed by you or on your behalf, or in connection with premises you own, rent or control and to which this insurance applies,for which the state,municipality or political subdivision has issued a permit. However,this insurance does not apply to: 1."Bodily injury"."property damage"or"personal and advertising injury"arising out of operations performed for the state, municipality or political subdivision; 2-Any"bodily injury"or"property damage"included within the"products-completed operations hazard",except when required by written contract or agreement initiated prior to loss;or 3. "Bodily injury", "property damage"or"personal and advertising injury", unless negligently caused, in whole or in part, by you or those acting on your behalf LC 04 44 04 12 Amcbmeat Code,D508870 Certificate ID: 18763 65 08-08-`17 �_ 1_�� rnnh� r-nn_.n n =nn -r nnr nnnnr_ /nnnr_ r nnn 14: 1 1 HUM-I" I-JOG_o60`J tGo I-DJJ r'UUUJ/WU:) r`OOC T92-Z91-449522-117 Waiver Of Right Of Recovery By Written Contract Or Agreement The following i8 added to Paragraph 8.Transfer Of Rights Of Recovery Against Others To Us of Section IV-Commercial General Liability Conditions: We waive any right of recovery because of payments we make under this policy for injury or damage arising out of your ongoing operations or"your work"included in the"products-completed operations hazard"that we may have against any person or organization with whom you have agreed in a wrltten contract or agreement to waive your rights of recovery but only if the"bodily injury"or"property damage"occurs,or offense giving rise to"personal and advertising injury" is committed subsequent to the execution of the written contract or agreement_ Knowledge Of Occurrence Or Offense Knowledge of an"occurrence"or offense by your agent,servant or"employee"will not in itself constitute knowledge by you unless your"eXooUtive officer"or"employee"designated by you to notify us of an"occurrence"or offense has knowledge of the "occurrence"or offense. LC 0444 01 17 0 201 I.ibotty Mut.4 Insvpnm page 5 of 6 Attachment Code,D536520 Certificate ID: 1876365 f1R—O�—'1 _11 GDnM— 1_F ?_RFS2_F�7� T—PqF pono r AnnF, F-pw) WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 Ed.4-84 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALiFORNIA 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.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 2% of the California workers'compensation premium otherwise due on such remuneration. Schedule "Additional premium is a percent of the California Manual Workers COmpensation premium. Subject to a minimum premium charge of$250 per policy, Person or O_Lq�qization Job Description Were required by contract or written agreement prior to loss and allowed by few 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 6/1/2017 Policy No. WC2-Z91- Endorsement No, 12 449522-137 Insured Joe's Sweeping, inc. Policy Effective 6/1/2017 Date Insurance Company Liberty Mutual Fire Insurance Company WC 04 03 06 (Ed.4-84) 1998 by the Workers' Compensation Insurance Rating Bureau of California.All rights reserved. A.ttac�imept Code=D448503 Certificate TIS: 1.876365