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PROOF OF INSURANCE (2018 - 2018) CLOSED AIDBU-1 OP to:SO A�""rCJ►RO �� CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 09/06/2017 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 071Ma n Streettage Insurance EV0191.LL �.Iji ,Ne) 91.1.6-7.8.4.1-9799 CONT Bui ders AX AC sey Carmack 916-784-9793 Roseville CA 95678 ADDRESS;lynsey@btjitdersad!vatitagein�s.com Lynsey Carmack INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:ATAIN SPECIALTY INSURANCE COMP 17159 INSURED Aid Builders Inc. INSURERB:State Comp Ins Fund ,35076 Ed Al-Badry 14821 Ansford St. INSURER C:California Automobile Ins.Co. Haceieda,CA 91745 INSURER E:Evanston Insurance Co 35378 II ........ .. .................. 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 REDUCED BY PAID CLAIMS. ............ LIMITS. .... ........ /LTR "NOL1's'0'OR POLICY EFF' f POLICY EXP TYPE OF INSURANCE �0�. 1�. POLICY NUMBER (MM/DD•IYVYX)I(MMPDDd'r"Y'Y'Y1 A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE f X OCCUR X X CIP326104 06/01/2017 06/0112018 PREMSESD(EaolccurDunce 9 100,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY T PRO- LOC PRODUCTS $..................................2,0....0....0,0.0.0 OTHER JECT ... AUTOMOBILE LIABILITY COMBINED INGL..E...'..LIMIT ................$......................... C ANY AUTO X BA040000035108 07/2512017 0712512018 BODILY INJURY(Per person) $ 1,000,000 ALL OWNED X SCHEDULED BODILY INJURY(Per accident) $ _ AUTOS AUTOS HIRED AUTOS NON- (Pena ,5NE DA.MA.�.f 1 UMBRELLA CCUR EACH 1,000,000 D X EXCESS AB AB X CLAIMS-MADE XSMP1107317 08/30/2017 06/01/2018 AGGREGATE RRENGE $ 1,000,0„00 DED RETENTION$ $ WORKERS COMPENSATION ]STATUTE PER OTH- AND EMPLOYERS'LIABILITY B OFFICEPROPRIETOR/PARTNER/EXECUTIVE /IETO OFFICER/MEMBER R/E ECUTIVE Yj/N•'( N/A 9211820-2017 06/03/2017 06103/2018 XL EACH ACCIDENT ER „$ 1,000,0,00 (Mandatory In NH) E L DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E L D6EA$E•POI.CY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) Certificate holder is named as additional insured under the commercial general liability policy per attached endorsement. RE: 314 Main Street EI Segundo,CA 90245 u CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN The City of EI Segundo ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street EI Segundo,CA 90245 AUTHORIZED REPRESENTATIVE �" Ja61a �1 I , ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: CIP326104 COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES S OR. CONTRACTORS - SCHEDULED PERSON O 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 THE CITY OF EL SEGUNDO 314 MAIN STREET 350 MAIN STREET EL SEGUNDO, CA 90245 EL SEGUNDO, CA 90245 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 injuryVroperty 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 2010 04 13 0 Insurance Services Office, Inc., 2012 Page 1 of 2 C. With respect to the insurance afforded to these 2. Available under the applicable Limits of additional insureds, the following is added to Insurance shown in the Declarations; Section III—Limits Of Insurance: whichever is less. If coverage provided to the additional insured is This endorsement shall not increase the required by a contract or agreement, the most we applicable Limits of Insurance shown in the will pay on behalf of the additional insured is the Declarations. amount of insurance: 1. Required by the contract or agreement; or Page 2 of 2 0 Insurance Services Office, Inc., 2012 CG 2010 0413 POLICY NUMBER: CIP326104 COMMERCIAL GENERAL LIABILITY CG 20 37 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 THE CITY OF EL SEGUNDO 314 MAIN STREET 350 MAIN STREET EL SEGUNDO, CA 90245 EL SEGUNDO, CA 90245 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 is added to organization(s) shown in the Schedule, but only Section III—Limits Of Insurance: with respect to liability for "bodily injury" or If coverage provided to the additional insured is "property damage"caused, in whole or in part, by required by a contract or agreement the most we 'dour work' at the location designated and will pay on behalf of the additional insured is the described in the Schedule of this endorsement amount of insurance: performed for that additional insured and included in the "products-completed operations 1. Required by the contract or agreement; or hazard". 2. Available under the applicable Limits of However: Insurance shown in the Declarations; 1. The insurance afforded to such additional whichever is less. insured only applies to the extent permitted This endorsement shall not increase the applicable by law; and Limits of Insurance shown in the Declarations. 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. CG 20 37 04 13 0 Insurance Services Office, Inc., 2012 Page 1 of 1 COMMERCIAL GENERAL LIABILITY CG 20 33 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS -AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU This endorsement modifies insurance provided under the following COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section II - Who Is An Insured is amended to B. With respect to the insurance afforded to these ad- include as an additional insured any person or or- ditional insureds, the following additional exclu- ganization for whom you are performing opera- sions apply: tions when you and such person or organization This insurance does not apply to: have agreed in writing in a contract or agreement that such person or organization be added as an 1. "Bodily injury", "property damage"or"personal additional insured on your policy. Such person or and advertising injury" arising out of the ren- organization is an additional insured only with re- dering of, or the failure to render, any profes- spect to liability for "bodily injury", "property dam- sional architectural, engineering or surveying age"or"personal and advertising injury"caused, in services, including: whole or in part, by: a. The preparing, approving, or failing to 1. Your acts or omissions; or prepare or approve, maps, shop draw- ings, opinions, reports, surveys, field or- t. The acts or omissions of those acting on your ders, change orders or drawings and behalf; specifications; or in the performance of your ongoing operations for the additional insured. b. Supervisory, inspection, architectural or engineering activities However, the insurance afforded to such additional This exclusion applies even if the claims against insured: any insured allege negligence or other wrongdoing 1. Only applies to the extent permitted by law; in the supervision, hiring, employment, training or and monitoring of others by that insured, if the "occur- 2. Will not be broader than that which you are re- rence" which caused the "bodily injury" or "prop- quired by the contract or agreement to provide erty damage", or the offense which caused the for such additional insured. "personal and advertising injury", involved the ren- dering of or the failure to render any professional A person's or organization's status as an addi- architectural, engineering or surveying services. tional insured under this endorsement ends when your operations for that additional insured are completed. CG 20 33 04 13 Copyright, Insurance Services Office, Inc.,2012 Page 1 of 2 2. 'Bodily injury" or "property damage"occurring C. With respect to the insurance afforded to these after: additional insureds, the following is added to Sec- a. All work, including materials, parts or tion III -Limits Of Insurance: equipment furnished in connection with The most we will pay on behalf of the additional in- such work, on the project(other than serv- sured is the amount of insurance: ice, maintenance or repairs) to be per- 1. Required by the contract or agreement you formed by or on behalf of the additional have entered into with the additional insured; insured(s) at the location of the covered or operations has been completed; or 2. Available under the applicable Limits of Insur- b. That portion of "your work" out of which ance shown in the Declarations; the injury or damage arises has been put to its intended use by any person or or- whichever is less. ganization other than another contractor This endorsement shall not increase the applicable or subcontractor engaged in performing Limits of Insurance shown in the Declarations. operations for a principal as a part of the same project. Page 2 of 2 Copyright, Insurance Services Office, Inc., 2012 CG 20 33 04 13 POLICY NUMBER:CI P326104 COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COM M ERCIAL G EN ERAL LIABILITY COVERAGE PART PRODUCTS/COM PLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: ANY PERSON OR ORGANIZATION WITH WHOM THE INSURED HAS AGREED TO WAIVE RIGHTS OF RECOVERY, PROVIDED SUCH AGREEMENT IS MADE IN WRITING AND PRIOR TO THE LOSS 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. CG 24 04 05 09 Insurance Services Office, Inc.,2008 Page 1 of 1 CG 25 03 03 97 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED CONSTRUCTION PRO�JECT(S) GENERAL AGGREGATE LIMIT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designated Construction Projects: LOCATIONS AS REQUIRED BY SPECIFIC WRITTEN CONTRACT (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) A. For all sums which the insured becomes legally ob- subject to the General Aggregate Limit shown in ligated to pay as damages caused by "occurrences" the Declarations, such limits will be subject to under COVERAGE A (SECTION 1), and for all medi- the applicable Designated Construction Project cal expenses caused by accidents under COVERAGE General Aggregate Limit. C (SECTION 1), which can be attributed only to & For all sums which the insured becomes legally ob- ongoing operations at a single designated construc- ligated to pay as damages caused by "occurrences" tion project shown in the Schedule above: under COVERAGE A (SECTION 1), and for all medi- 1. A separate Designated Construction Project Gen- cal expenses caused by accidents under COV- eral Aggregate Limit applies to each designated ERAGE C (SECTION 1), which cannot be attributed construction project, and that limit is equal to only to ongoing operations at a single designated the amount of the General Aggregate Limit construction project shown in the Schedule above: shown in the Declarations. 1. Any payments made under COVERAGE A for 2. The Designated Construction Project General Ag- damages or under COVERAGE C for medical gregate Limit is the most we will pay for the sum expenses shall reduce the amount available of all damages under COVERAGE A, except dam- under the General Aggregate Limit or the ages because of "bodily injury" or "property Products-Completed Operations Aggregate Limit, damage" included in the operations hazard", and whichever is applicable; and for medical expenses under COVERAGE C re- 2. Such payments shall not reduce any Designated gardless of the number of: Construction Project General Aggregate Limit. a. Insureds; C. When coverage for liability arising out of the b. Claims made or "suits" brought; or "products-completed operations hazard" is provided, c. Persons or organizations making claims or any payments for damages because of "bodily bringing "suits". injury" or "property damage" included in the "pro- ducts-completed operations hazard" will reduce the 3. Any payments made under COVERAGE A for Products-Completed Operations Aggregate Limit, and damages or under COVERAGE C for medical not reduce the General Aggregate Limit nor the Des- expenses shall reduce the Designated Construc- ignated Construction Project General Aggregate Lim-, tion Project General Aggregate Limit for that it designated construction project. Such payments shall not reduce the General Aggregate Limit D. If the applicable designated construction project has shown in the Declarations nor shall they reduce been abandoned, delayed, or abandoned and then re- any other Designated Construction Project Gen- started, or if the authorized contracting parties dev- eral Aggregate Limit for any other designated iate from plans, blueprints, designs, specifications or construction project shown in the Schedule timetables, the project will still be deemed to be the above. same construction project. 4. The limits shown in the Declarations for Each E. The provisions of Limits Of Insurance (SECTION III) Occurrence, Fire Damage and Medical Expense not otherwise modified by this endorsement shall continue to apply. However, instead of being continue to apply as stipulated. " CG 25 03 03 97 Copyright, Insurance Services Office, Inc., 1996 �ortlerNo 14eEO44 California Automobile Insurance Company P.O. Box 10730 A/ %,I Santa Ana, CA 92711-0730 AA M1 E 0HO"C U R Y INSURANCE�C , Customer Service: (800) 503-3724 J BUSINESS AUTO 'POLICY ADDITIONAL INSURED Amended Declarations Effective Date: 08/08/2017 NAMED INSURED: AGENT: ED AL-BADRY BUILDERS ADVANTAGE INS SV 14821 Ansford St 107 MAIN STREET Hacienda Heights,CA 91745-1300 ROSEVILLE, CA 95678 (916)784-9793 SCHEDULE Insurance Company: California Automobile Insurance Company Policy Number: BA040000035108 Policy Period: From: 07/25/2017 to 07/25/2018 at 12:01 AM Standard Time at your mailing address Additional Insured: THE CITY OF EL SEGUNDO Address: 350 Main St, EI Segundo CA 90245 Endorsements Attached: CA 20 48 02 99 - Designated Insured AUTOMOBILE LIABILITY PROVIDED Covered Autos: Symbol 7 -Specifically Described "Autos" Limits of Insurance: $1,000,000 CSL MCADS910711 Page 1 of 1 Policy Number: BA040000035108 AoMERCURYI I S U R A I�C E Effective Date: 08/08/2017 Ail Amended Declarations: Add Loss Payee/Addl InsuredMaiver This policy change has resulted in an additional premium of$24.00 This declarations supersedes any previous declarations bearing the same number for this policy period BUSINESS AUTO DECLARATIONS S Issued By: Agent: California Automobile Insurance Company BUILDERS ADVANTAGE INS SV P.O. Box 10730 107 MAIN STREET Santa Ana,CA 92711-0730 ROSEVILLE,CA 95678 Billing: (888)637-2176 Agent Number:04CO16 Claims: (800)503-3724 Agent Phone: (916)784-9793 ITEM ONE GENERAL INFORMATION ' Named Insured: ED AL-BADRY Mailing Address: 14821 Ansford St, Hacienda Heights,CA 91745-1300 Policy Period: From 07/25/2017 to 07/25/2018 at 12:01 AM Standard Time at your mailing address Form of Business: Corporation Total Policy Premium: $1,519.76 This policy may be subject to final audit. In return for the payment of the premium, and subject to all the terms of this policy, we agree with you to provide the insurance as stated in this policy. ENDORSEMENTS ATTACHED TO THIS POLICY IL 00 17 1198-Common Policy Conditions IL 00 2109 08-Nuclear Energy Liability Exclusion IL 00 03 09 08-Calculation of Premium CA 00 0103 10-Business Auto Coverage Form CA 01 21 02 99-Limited Mexico Coverage CA 0143 05 07-California Changes IL 02 70 09 12-California Changes-Cancellation and CA 23 94 03 06-Silica or Silica Related Dust Exclusion U-245-Auto Body Repair Consumer Bill of Rights CA 20 48 02 99-Specified Additional Insured CA 2154 09 09-California Uninsured Motorists-Bodily CA 04 24 04 06-California Auto Medical Payments Coverage MCADS030112-CA Page 1 of 4 08/08/2017 12:01 AM PT '41AI" MERCURY Policy Number: BA040000035108 INSURANCE Effective Date: 08/08/2017 ITEM TWO SCHEDULE OF COVERAGES AND COVERED AUTOS This policy provides only those coverages where a charge is shown in the premium column below. Each of these coverages will apply only to those "autos" shown as covered "autos". "Autos" are shown as covered "autos" for a particular coverage by the entry of one or more of the symbols from the Covered Autos Section of the Business Auto Coverage Form next to the name of the coverage. Coverages Coverage Limit Premium Symbol The Most We Will Pay For Any One Accident Or Loss Liability 7 $1,000,000 CSL $1,027 Medical Payments 7 $5,000 per person $57 Uninsured Motorists Bodily 7 $1,000,000 CSL $166 Injury Uninsured Motorists Property Damage Rejected Actual Cash Value Or Cost Of Repair,Whichever Is Less, Minus Deductible Shown in ITEM THREE For Each Covered Comprehensive 7 Auto, But No Deductible Applies To Loss Caused By Fire $81 Or Lightning.See ITEM FOUR For Hired Or Borrowed Autos. Actual Cash Value Or Cost Of Repair,Whichever Is Less, Specified Causes of Loss Minus Deductible Shown in ITEM THREE For Each Covered Auto For Loss Caused By Mischief Or Vandalism.See ITEM FOUR For Hired Or Borrowed Autos. Actual Cash Value Or Cost Of Repair,Whichever Is Less, Collision 7 Minus Deductible Shown in ITEM THREE For Each Covered $162 Auto.See ITEM FOUR For Hired Or Borrowed Autos. Towing and Labor See ITEM THREE LIMIT Shown For Each Disablement of An Auto. Premium For ITEM FOUR(Hired Auto Coverage) Premium For ITEM FIVE(Non-Ownership Liability) Premium For Endorsements $25.00 Miscellaneous Fees and Expense California Consumer Services and Fraud Program Fees I $1.76 Total Policy Premium $1,519.76 MCADS030112-CA Page 2 of 4 Policy Number: BA040000035108 MERCURY .Ao"' N S U t�A I"�I C E Effective Date: 08/08/2017 Ail ITEM THREE SCHEDULE OF COVERED AUTOS YOU OWN CoveredGaraging Cost New Auto No. Description VIN City ST Zip Code-� Vehicle Equip. 1 2003 CHEVROLET SILVERADO 3500 1GBJC34UX3E136061 Glendora CA 91740 $29,260 I $2,500 I I Covered Radius Auto No. (In Miles) Usage Special Industry Class Loss Payee 1 Up to 100 Service Use I I u I I COVERAGES,PREMIUMS,LIMITS,AND DEDUCTIBLES (Absence of a deductible or limit entry in any column below means that the limit or deductible entry in the corresponding ITEM TWO column applies instead.) Covered Auto Medical UM Bodily Injury UM Property Comprehensive Liability Premium Payments Damage Auto No. Premium Premium Premium Deductible V Premium ..................... 1 $1,027 $57 $166 $500 I $81 I q � d b I Covered Specified Causes Of Loss Collision, CDW Towing&Labor Auto No. Deductible Premium Deductible Premium Premium Limit Per Premium Disablement 1 $500 $162 li I I Rental Reimbursement I I Audio Visual &Data Equipment Covered Auto Loan/Lease Total Vehicle Auto No. Maximum Payment Gap Premium Premium Each Covered Auto Premium Limit Premium 1 I $1,493.00 W I I � I I MCADS030112-CA Page 3 of 4 �MERCRY Policy Number: BA040000035108 INSURANCE Effective Date: 08/08/2017 TOTAL PREMIUMS Liability $1,027 Medical Payments $57 Uninsured Motorists Bodily Injury $166 Uninsured Motorists Property Damage Collision Deductible Waiver Comprehensive $81 Specified Causes of Loss Collision $162 Rental Reimbursement Loan/Lease Gap YAudio,Visual and Data Electronic Equipment ITEM FOUR SCHEDULE OF HIRED OR BORROWED COVERED AUTO COVERAGE AND PREMIUMS Cost of hire means the total amount you incur for the hire of"autos"you don't own (not including"autos"you borrow or rent from your partners or"employees" or their family members). Cost of hire does not include charges for services performed by motor carriers of property or passengers. Estimated Liability Coverage Physical Damage Coverage p Total ITEM Annual FOUR Cost Of Hire Premium Limit Of Insurance Premium I Premium Actual Cash Value Or Cost Of Repair, Whichever Is Less, Minus$500 Deductible For Each Covered Auto. ITEM FIVE SCHEDULE FOR NON-OWNERSHIP LIABILITY Number Of Employees(Including Volunteers) Total ITEM FIVE Premium ADDITIONAL INFORMATION Discounts • Pay in Full • Years In Business • Multi-Line Driver Information . . ........ .................... Listed Drivers Excluded Drivers ED AL-BADRY Additional Insureds THE CITY OF EL SEGUNDO --. ---------------- 350 Main St EI Segundo,California 90245-3813 MCADS030112-CA Page 4 of 4 ENDORSEMENT AGREEMENT WAIVER OF SUBROGATION 9211820-17 NEW .;URANCE NF FUND PAGE 1 HOME OFFICE SAN FRANCISCO EFFECTIVE AUGUST 8, 2017 AT 12 . 01 A.M. ALL EFFECTIVE DATES ARE AND EXPIRING JUNE 3, 2018 AT 12 .01 A.M. AT 12:01 AM PACIFIC STANDARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME AID BUILDERS INC 14821 ANSFORD ST HACIENDA HEIGHTS, CA 91745 ANYTHING IAT THIS POLICY TO THE CONTRARY NOTWITHSTANDING, IT IS AGREED THAT THE STATE COMPENSATION INSURANCE FUND WAIVES ANY RIGHT OF SUBROGATION AGAINST, THE CITY OF EL SEGUNDO WHICH MIGHT ARISE BY REASON OF ANY PAYMENT UNDER THIS POLICY IN CONNECTION WITH WORD PERFORMED BY: AID BUILDERS INC 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: AUGUST 14 , 2017 2570 AUTHORIZED REPR ' ENT IVE PRESIDENT AND CEO SCIF FORM 10217 (REV.7-2014) OLD DP 217