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PROOF OF INSURANCE (2018) CLOSED Ate"" CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) I 09/05/2017 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 NAME. Eric Lanzillotta CBIA Insurance Agency .a,tSt); (877)900 2242 „(a C Ne); (866)518 4627 PHONE FAX 8001 CANOGA AVE,SUITE A E-MAIL certs@cbiamember.com INSURERS)AFFORDING COVERAGE NAIC# CANOGA PARK CA 91304 INSURER A: AMTRUST INTERNATIONAL UNDERWRITERS LTI AA1780074 INSURED INSURER B: UNITED FINANCIAL CASUALTY CO. 11770 Cinbad Industry,Inc. INSURER c: NATIONAL UNION FIRE INS CO OF PITTS 19445 21417 Germaine St INSURER D: STATE COMPENSATION INSURANCE FUND(SCI 35076 INSURER E: Chatsworth CA 91311 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 iryTR 0.... ADbL 8UBR, .. .POLICY EFF_._ POLICY EXP TYPE F INSURANCE INSD wVD POLICY NUMBER IMMIDDIYYYY) (MMIDDIYYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR PM IDAMSI r r Pv Rr nr,r�.nrrV. .$ 100 000 MED EXP(Any one person) $ 5,000 A X XN104599902 02/28/2017 02/28/2018 PERSONAL&ADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY pjr"j I Oc PRODUCTS-COMP/OP AGG $ 2,000,000 ..................... AUTOMOBILE LIABILITY ECM�ka.O[;NED SINGLE..LIN,1l.................$.... ..1..1000,000............................. ........... (, ..qc.,...,,��..) ......................... ............................... X ANY AUTO BODILY INJURY(Per person) $ B ALL OWNED SCHEDULED AUTOS AUTOS X 05928838-0 02/17/2017 02/17/2018 BODILY INJURY(Per accident) $ , ( aciAMAGL HIRED AUTOS NON-OWNED Pord0W .$ 1,000,000 $ OCCUR EACH OCCURRENCE $ 2,000 00 UMBRELLA LIAB O C X CLAIMS-MADE EBU096059760 02/17/2017 02/28/2018 AGGREGATE $ pp ,000 DED 9 RETENTION$ PR/COMP OPS AGG $ 2,000,000 WORKERS COMPENSATION OTH- n XCLLITM Y� NIA X I STATUTE D ��NDCOUMEM ERIE CLUDED?l vµ'J'°LIVE Y X 9044882-17 02/09/2017 02/09/2018 E L EACH UTE ER $ 1,000,000 (Marulatory in NH) E L DISEASE-EA EMPLOYEE $ 1,000,000 IP yy'eS,desri ibe under r;kll,SCRIPTION OF(We"RAI IONS ImHo a E L DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) The City of EI Segundo and Fire Station#1,314 Main Street EI Segundo,CA 90245 are listed as Additional Insured with respects to General Liability per endorsements NX GL 189 05 11 and CG 20 37 07 04 and Commercial Auto per endorsement 1198(01/04)attached. Waiver of Subrogation applies to Workers Compensation per endorsement 2570 attached. Location;PW 17-33,PW 17-06 Fire Station#1,EI Segundo CA CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. The City of EI Segundo Fire Station#1 AUTHORIZED REPRESENTATIVE 314 Main Street EI Segundo CA 90245 @ 1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: XN104599902 COMMERCIAL GENERAL LIABILITY NX GL 189 05 11 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSUREDS - OWNERS, LESSEES OR CONTRACTORS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Policy Number: XN104599902 Endorsement Effective: 9/5/2017 12:01 a.m Named Insured: CINBAD INDUSTRY INC Counter Signed By: SCHEDULE Name of Person or Organization: CITY OF EL SEGUNDO FIRE STATION# 1 314 MAIN ST, EL SEGUNDO CA 90245 Location: 314 MAIN ST, EL SEGUNDO CA 90245 (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) A. Section II—Who Is An Insured is amended to include as an insured the person or organization shown in the Schedule, but only to the extent that the person or organization shown in the Schedule is held liable for your acts or omissions arising out of your ongoing operations performed for that insured. B. With respect to the insurance afforded to these additional insureds,the following exclusion is added: 2. Exclusions 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 services, maintenance or repairs)to be performed by or on behalf of the additional insured(s)at the site of the covered operations has been completed: or (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. The words"you" and"your" refer to the Named Insured shown in the Declarations. NX GL 189 05 11 Page 1 of 2 Includes copyrighted material of Insurance Services Office, Inc.,with its permission D The following are added to SECTION V—DEFINITIONS: "Your work" means work or operations performed by you or on your behalf; and materials, parts or equipment furnished in connection with such work or operations. E. The following additional provisions apply to any entity that is an insured by the terms of this endorsement: 1 Pdrnarv'Wordinq With respect to the Third Party shown above, this insurance is primary and non-contributing.Any and all other valid and collectable insurance available to such Third Party in respect of work performed by you under written contractual agreements with said Third Party for loss covered by this policy,shall in no instance be considered as primary, co-insurance, or contributing insurance. Rather, any such other insurance shall be considered excess over and above the insurance provided by this policy. 2 Waiver of Subrogation If required by written contract or agreement:We waive any right of recovery we may have against an entity that is an additional insured per the terms of this endorsement because of payments we make for injury or damage arising out of"your work'done under a contract with that person or organization. NX GL 189 05 11 Page 2 of 2 Includes copyrighted material of Insurance Services Office, Inc.,with its permission COMMERICAL GENERAL LIABILITY CG 20 37 07 04 Policy#: XN104599902 Insured Name: CINBAD INDUSTRY INC 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 SCHEDULE Name of Additional Insured P ons or Location an Person(s)O d Description of Completed Organization(s): Operations CITY OF EL SEGUNDO FIRE STATION#1 LOCATION AND DESCRIPTION OF OPERATIONS: INTERIOR PAINTING AND WALL PAPER PW 17-33 AS WELL AS KITCHEN IMPROVEMENTS 17-06 FOR FIRE STATION#1 314 MAIN....ST,.....E.......L SEGUNDO CA 90245 314 MAIN ST, EL SEGUNDO CA 9.0.24.5 _ . Information required to complete this Schedule, if not shown above, will be shown in the declarations 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". CG 20 37 07 04 Copyright Iso Properties, Inc.,2004 Page 1 of 1 Insured D. The following are added to SECTION V—DEFINITIONS" "Your work" means work or operations performed by you or on your behalf; and materials, parts or equipment furnished in connection with such work or operations. E. The following additional provisions apply to any entity that is an insured by the terms of this endorsement: 1. PrimarwWording, With respect to the Third Party shown above, this insurance is primary and non-contributing.Any and all other valid and collectable insurance available to such Third Party in respect of work performed by you under written contractual agreements with said Third Party for loss covered by this policy, shall in no instance be considered as primary, co-insurance, or contributing insurance. Rather, any such other insurance shall be considered excess over and above the insurance provided by this policy. 2 Waiver of Subrogation If required by written contract or agreement:We waive any right of recovery we may have against an entity that is an additional insured per the terms of this endorsement because of payments we make for injury or damage arising out of"you work"done under a contractwith that person or organization. NX GL 189 05 11 Page 2 of 2 Includes copyrighted material of Insurance Services Office, Inc.,with its permission Additional Insured Endorsement Name of Person or Organization CITY OF EL SEGUNDO 350 MAIN ST EL SEGUNDO CA 90245 The person or organization named above is an insured with respect to such liability coverage as is afforded by the policy but this insurance applies to said insured only as a person liable for the conduct of another insured and then only to the extent of that liability.We also agree with you that insurance provided by this endorsement will be primary for any power unit specifically described on the Declarations Page. Limit of Liability Bodily Injury each person/ each accident Property Damage each accident Combined Liability $1,000,000 each accident All other terms,limits and provisions of this policy remain unchanged, This endorsement applies to Policy Number: 059288380 Issued to(Name of Insured): CINBAD INDUSTRY, INC. Effective date of endorsement:02/21/2017 Policy expiration date: 02/21/2018 Form 1198(01/04) ENDORSEMENT AGREEMENT WAIVER OF SUBROGATION 9044882-17 RENEWAL CC) ffN5ATlQN SC FUND6-85-73-14 PAGE 1 HOME OFFICE SAN FRANCISCO EFFECTIVE FEBRUARY 18, 2017 AT 12 . 01 A.M. AND EXPIRING FEBRUARY 9, 2018 AT 12 . 01 A.M. ALL EFFECTIVE DATES ARE AT 12:01 AM PACIFIC STANDARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME CINBAD INDUSTRY, INC. 21417 GERMAIN ST CHATSWORTH, CA 91311 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, CINBAD INDUSTRY, 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: FEBRUARY 22, 2017 2570 AUTHORIZED REPIIESEN°h IVE PRESIDENT AND CEO SCIF FORM 10217 (REV.7-2014) OLD DP 217