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PROOF OF INSURANCE (2017 - 2018) CLOSED
AC , CERTIFICATE OF LIABILITY INSURANCE V UATE,MM/D°""'"' V 1/31/2017 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 O'O'NTACT License s rance S1 YAdO NE._... 760-304-7161 ._.r... .....6 Alliant Insurance Services, Inc.-San Marcos PHONE �.- on AX 570 Rancheros Dr., Ste. 100 AIMAI Kelsey oaks n°""°W' �i ..d�a1:760-304-7362 w Kelsey Theakston N'E E Keisey Theakstoa'Iliant.com l INS,gMRtSI AFFORDING COV MAGE _..m,. ......,NAIC I U 'San Marcos CA 92069 I _. w. _INSURERA ITWestAmerican Insurance C.gmPanY-....... .._.....,44393 INSURED HADRINC-01 INSURER B:Ohio Security Insurance Comoanv 24082 Hadronex, Inc. INSURER C I ..D.,.... ...... .......................... ......... _., a: Smartcover Systems 2067 Wineridge Place,Ste E NSURER_...-............. .................... ... Escondido CA 92029 INSURER E: y INSURER F: COVERAGES CERTIFICATE NUMBER:,'12/9637376 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 SDOCUMENT WITH RESPECT TO WHICH THIS SUBJECT TO ALL THE TERMS, REDUCED B AIDC IMS. pNSERXCLUSICONS ANATE D NOTWBE ITHSTANDING OF SUCH SUED OR MAY PPOLICIES LIMITS IN, THE SSHOWN MAY HAVE BEEN URANCE AFFORDED YRE E POLICIES O R OTHER r"OLICY crF POV DESCRIBED HEREIN IS.................. Y �LNLIABILITY Y Y BKW 57741748 2/212017 �I° tY Lid r E -LTR' TYPE OF INSURANCE INSO i MND POLICY NUMBER I'MNVDDIYYYYI t'M�MODN'YYY1, LIMITS A COMMERCIAL GENERA OOD 2J2/2018 EACH OCCU I CLAIMS-MADE , OCCUR �,_T,-- _:..) $300,000100 Pr�r;pA1Lr_5 km ,wrreorwe.........'.... ................... —___. ...._..................................................... w MED_EXP(Any one person) $1b,000 .� I PERSONAL&ADV INJURY N ............._,........... _ __�.... ........................'...$1,000,000 P J GGE""N'L AGGREGATE LIMIT APPLIES PER: AGGREGATE COMP/OPAGG I$2„000,000 POLICY PECTRO F—]LOC PRODUCTS - 000 000 OTHER: is B AUTOMOBILE LIABILITY WY BAS 57741748 _ 2/2/2017 2/2/2018 LO'MSINLU9MI1 $ - 1,000,ODO BODILY INJURY X....ANY AUTO nL k, (Per person) $ ALL OWNBED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS UTOS HIRED AUTOS NON-OWNED �`"$I"b"p" :A)dR$ .L $ ... �OCCUR ( EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE DEDRETE $ UMBRELLA7 J .. ,...... ...................................................... WORKERS COMPENSATION _.J,.,STATU,T,E,,,�,,,,,,,,,,w,�,_�_R_ry___ AND EMPLOYERS'LIABILITY Y/N .............................. R I ETOR/PARTNER/EXEC UTI VE V FF E IDENT $ IN"langlyt® t•.�M<"9E%I EXCLUDED? NIA ..— E L EACH ACC.... .�._—.—. _..........................m. ..........�..... VI trs,awry In Ni DISEASE EA EMPLOYEE S a. ! y describe under E�.... DESCMPTION OF OPERA"u'14',W,Ia00°,w' E L DISEASE-POLICY I.IMIT $ ............. DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES_ (ACORD 101,Additional Remarks Schedule,maybe attached If more space is required) Certificate holder is named as additional insured as respects to General Liability when required by written contract or agreement,for services provided by the named insured for the certificate holder per the attached endorsement. I CERTIFICATE HOLDER __....... CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of EI Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 350 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. EI Segundo CA 90245 AUTHORIZED REPRESENTATIVE I ©1588-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Policy 57741748 COMMERCIALLIABILITY CG 88 10 04 1 THIS T CHANGES THE POLICY, PLEASE WAD IT CAREFULLY, COMMERCIALI IIEXTENSION This endorsement modifies insurance Ovid under the following: COMMERCIAL N L LIABILITY V E PART WATERCRAFTlum PROPERTY DAMAGE LIABILITY—ELEVATORS EXTENDED DAMAGE TO PROPERTY RENTED TO Y (Tenant's Property ) MEDICAL PAYMENTSI 3 EXTENSIONF SUPPLEMENTARY PAYMENTS vC ADDITIONAL I CONTRACT, AGREEMENT OR PERM173 PRIMARY AND NON-CONTRIBUTORYADDITIONAL INSURED EXTENSION ADDITIONAL I PROTECTION Y "LIMITS F INSURANCE" WHO IS AN INSURED—INCIDENTAL MEDIC TIC IS AN INSURED FELLOWL Y I T EMPLOYEES NEWLY FORMED OR ADDITIONALLY ACQUIRED ENTITIES7 FAjLURE TO DISCLOSEIOCCURRENCES 7 KNOWLEDGEF OCCURRENCE, OFFENSE, IT 7 ILIBERALIZATION CLAUSE 7 BODILY INJURY FI 7 EXTENDED PROPERTY DAMAGE 8 WAIVER OF TRANSFER F RIGHTS OF RECOVERY AGAINST OTHERS TO tl — WHEN REQUIRED IN CONTRACT T WITH YOU 0.201311"MtauM Insurance CG 88 10 04 13 Indudes copyNghted mateft I of fimrance Serwices Office, Iirpe;..vAth Dts pemmssIonu. Page 1 of 8 Policy 5774 7. With respect to coverage afforded by this endorsement,the provisions of the policy apply uHeso modified by the endorsement. NO"WNED AJRCRAFT Under Paragraph I Exclusions of Section I—Covera -Bodily Injury d Property Damage Liability, exclusion 9.Aircraft,Auto Or Watercraft does not apply to an aircraft provided 1a It is not awned by any insured; 2, it is hired„chartered or loaned with a trained paid crrw . 'The pilot In command holds a currently effective certfficate, issued by the duly constituted authority of the United States of America or Canada,designating her or him a commercial or airline pilot„ and . It Is not • ing used to carry persons or properly for a charge. However,the Insurance afforded by this proAslon does not apply Df there is availaUe to the insured other valid Brod DlecbNe Insurance,whether primary, excess(other than irnsu.rran wr(tteua to appy spas offically in excess of this polloy), rotingent tarn any other basis, that uUd also apply to tiros Uoss covered 4,,under tU°uUs provislo n, NON-OWNEDT T Under Paragraph Z Exclusions of Section D—Coverage A- Bodily Injury d Property Dammam Liability, Subparagraph (2)of exclusion 9.Aircraft,Auto Or WatercraftIs replaced by the foil nga This exclusion does not apply to: (2) A watercraft voua do not own that is: (a) Less than 52 feat long; and (b) Not berg used to carry persons or property for a charge. PROPERTY LIABILITY—ELEVATORS T I. Under Paragraph I Exclusionsof Section I—Coverage A—Bodily Injury And Property Damage Liability,Subparagraphs( ), ( )and( )o1 exclusion I Darnage To Property do not apply if such "property damage"results from the use of elevators. For the purpose of this provision, elevators do not include vehicle mss. Vetiide lifts are lifts or hoists used in automobile service or repair operations. 2, The fobowing is added to Section I —Commercial General Liability Conditions, Condition 4, Other Imurance, Paragraph ba Excess Insurance., The insurance affordedby this provision of this endorsement is excess over any property insurance, whether primary,excess, contingent or on any other basis. D. EXTENDED DAMAGE TO PROPERTY RENTEDTO (Tenant's Property Damage) e) Dt Damage To Premises Rented To You is not otherwise excluded from this Coverage Dart: I Under paragraph I Exclusions of Section I -Coverage A-Bodily Im utry and pita, rty Damage e Liability: a. 'The fourth from the last paragraph of exclusion J. Damage To Property is replaced by the foil `nim Paragraphs(1),( )a ( )of this exclusion do not apply to"'property damage"(other Dian damage by firs„lightning„ exploslon,smoke,or leakage from an autornatic fire protection system) to, (1) Premises rented to you for a periost of'T or fewer consecutive days; or (11) Contents that you rent or iease as part of a premises rental or lease agreement for a period of more than 7 days, Paragraphs(1),(3)and( )of this exclusion deo not apply to"property damage"to contents of promises rented to you for a period of 7 or fewer consecutive days., separate limit of insurance applies to this coverage as described in Section IID—Limits o Insurance. 02013 Ube"Wual insurance CG 86 10 04 13 includes copydgWed mu derisl og insurance , Mc.,Wth Its peumladon. page 2 of _Yolicy 77477 49 b. The last paragraph of subsection 2.Exclusions Is replaced by the following: Exclusions c.through n.do not apply to damage by fire, lightning, explosion, smoke or leakage from automatic fire protection systems to premises while rented to you or temporarily occupied by you with permission of the owner.A separate limit of insurance applies to Damage To Premises Rented To You as described in Section III—Llmita Of Insurance. 2. Paragraph 6. under Section III—Limits Of Insurance is replaced by the following: 6. Subject to Paragraph 5. above,the Damage To Premises Rented To You Limit is the most we will pay under Coverage A for damages because of"property damage"to: 0. Any one premise: (1) While rented to you; or (2) While rented to you or temporarily occupied by you with permission of the owner for damage by fire, lightning, explosion,smoke or leakage from automatic protection systems; or b. Contents that you rent or lease as part of a premises rental or lease agreement. 3, As regards coverage provided by this provision D.EXTENDED DAMAGE TO PROPERTY RENTED TO YOU(Tenant's Property Damage)-Paragraph 9.a.of Definitions is replaced with the following: 9.a. A contract for a lease of premises.However,that portion of the contract for a lease of premises that indemnifies any person or organization for damage by fire,lightning, explosion, smoke, or leakage from automatic fire protection systems to premises while rented to you or temporarily occupied by you with the permission of the owner, or for damage to contents of such premises that are included In your premises rental or lease agreement, is not an "insured contract'. E. MEDICAL PAYMENTS EXTENSION If Coverage C Medical Payments is not otherwise excluded, the Medical Payments provided by this policy are amended as follows: Under Paragraph 1. Insuring Agreetment of Section I—Coverage C—Medical Payments, Subparagraph (b)of Paragraph a.is replaced by the following: (b) The expenses are incurred and reported within three years of the date of the accident;and EXTENSION OF SUPPLEMENTARY PAYMENTS—COVERAGES AAND B 1. Under Supplementary Payments—Cove es A and 8,Paragraph 1.b.is replaced by the following; b. Up to$3,000 for cost of bail bonds required because of accidents or traffic law violations arising out of the use of any vehicle to which the Bodily Injury Liability Coverage applies.We do not have to furnish these bonds. 2. Paragraph 1.d.is replaced by the following: d. All reasonable expenses incurred by the insured at our request to assist us in the investigation or defense of the claim or'suit", including actual loss of earnings up to$500 a day because of time off from work. G. ITI INSUREDS Y CONTRACT, AGREEMENT OR PERMIT IT 1. Paragraph I —Who Is An Insured is amended to include an Insured any person or organization av to add as an additional insin s written contract written agreement or permit. or organization is an additional isu ly with respectto liability for"bodly injury", r a s 'or' I and advertisingjury' caused In i y: a. Your acts or omissions, the acts or omissions of those actingon your behalf, in the performanceo r on goingoperations for the additional° sur that are the subjecte written contract or written agreementat the"bodily injury'or o w occurs. or e"personal and advertisinginjury" , subsequent to the signingof such written contract or written agreement; r 13 Liberty Mutual Insurance CG 8810 04 13 Includes copyrighted material of Insurance SerAces Ofte,Inc., Its peffnission. Page 3 of d Promises or facilities r you or used by you; or e The maintenance,operation or use by you of equipmentrented leased to you by such person or organization- or ® Operations performed by you or on yourI for which the statepolitical su n has issued a permit subject to the following °inl provisions: This insurance does not apply to" i Injury"," r ",or"pamnal and advertising injury"arising out of the operationspolitical subdivision; This insurance not apply t I or o Included °thin the "completed rati n hazard". Insurance applies to premises you own,rent, or control but onlyi to the following existence,0) The maintenance, repair, construction. erection, or removal o advertising signs, awnings, canopies, cellar entrances,coal holes,driveways, manholes, u s, hoist away openings,sidewalk ults, street banners, or decorations and similar exposures; or ( ) The n ru n, erection, or removal of elevators; ) The awn hip, maintenance, or use of any elevators covered by this insurance. However: 'I. The insurance affordedsuch additional insured only applies to the extent permitted by I n ° If coverageadditional i re is required a contract or agreemerd,the insurance afforded to such additional insured `ll not be broader than that which you are required y the contract agreement to provide for such additional insured. With resped to Paragraph I.& above,a person's or organi don's status as an additional insured under this endorsement ends when, I work, including mat l , parts or equipment furnished ion with such , an ft project(other thanservice,maintenancer repairs)to be performed by or on behalf f the additional insured(s) t the location of the covered operations has been complated; or ( ) That portion of"yourwork"out of which the injuryarises has been put to its intended use by anyn or organization n another contractor or subcontractor engaged in performing operations for a principal as a part of the same pr With respect to Paragraph 1.b.above,a person's or organization's status as an additional insured der this endorsement ends when their written contracten agreement wi u for such premises or facilities ends. With respects to insurance not apply toe "occurrence"which takes place after equipmentthe rental lease t has expired or you have returned such t to the lessor. The Insurance provided by t es endorsement applies only if the writtencontract a ent is signed prior tot it j or" " We have no duty to defendn additional insured under this endorsement until we receivewritten notice "suit" by the additional° required .of Condition Z Duties In the Event Of Occunrence, Offense,Claim Or Suit uCommercial General Uability Conditions. 2013 Ulsedy Mutual Insurance CG 88 10 04 13 Indudes copyrighted material of Insumnee Services 01fice,Inc., t Its perrinission. --Fd-icy#BKW5774174Tf- Z With respect to the Insurance provided by this n n ,the following ° Exclusions under s A-Bodily Injury And Property Damage Llabilw. This Insurance does not apply to: 8. 'Bodily Injury" r" y arising the solenegligence of the additional insured. b. 13odily injury"or" rprior to you commencing operationsthe location where such "bodily Injury" " C. 13odly In' , "propertyr"personal end advertisinginjury" °n rendering ®or the failure to render, ny professional architectural, engineering or surveying 1 , including; preparing, vine or failing to prepareapprove, maps,shop dreoings, opinions, reports, surveys,field , change orders or drawings andc tion d or Supervisory, inspection, architectural or engineeringactivities. This inn applies even if the claims againstn insured I negligence ro in in the supervision, hiring, employment, training or monitoring of others by that insured, if the'occurrence"which caused "bodily inju ",or the offense which 'personal and advertising injury'.. involvedrendering failuret render, anyprofessional 1,engineering or surveying services. d. a ily injury"or"property "occurring aftera I work, including matri ls, parts or equipment furnished in connection with such work, projecton the (other than service, maintenanceor repairs) to be performedy or on behalf of the additional insured( ) at the location of the coveredoperations has been completed, or portion o neo "out of which ihe injury d has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing for a principalas a part of the same project. person0. Any or organization specifically i nat I insured ongoing operations by a separate ADDITIONAL INSURED endorsement issued by us and made a part of this policy. 3. With respect to the insuranceadditional insureds,the followingis added t®Section III Insurance:Limfts Of coverageIf vi i insured is required y a contract or agreertent,the most we YAN pay on behalfthe additionalinsured is the amount of insurance: a. Required by the contract or agreement; or b. Available r the applicable Urnits of Insurance n in the Declarations; whichever is less. This t shall not increasethe applicable Limits of Insurance shown in the Declarations. NON-CONTRIBUTORYH. PRIMARY AND II INSURED EXTENSION This provisionapplies to any person or organization who qualifies as an additional insured under any form or endorsement under this oli ° Condition °Other Insurance of SECTIONiV-COMMERCIAL GENERAL LIABILITY1 is amendedfollows: a. The following is r I ° n additionalis °s policy has an Other Insurance provi ° n making its policy excess, and u have agreedin a writtenn en agreemerd to provide the additional insured primarycoverage an a basis,this policy shall . and we will not seek contribution from the additional° sur ®s policy for damages we cover. 2013 Ubedy Mutual Insurance CG 86 10 04 13 Includes copyrighted matedal of Insurance Ser ft ,Inc., it ci 'cy 7 - b. The following Is r I s a® writtenWhen a written contract or nt,other than a promiseslease,facilities n I contract or agreement, on equlpt ent rental or lease contract or agreement, or permit Issued by a state of political subdivision between you and an add"Itlorlal'f sured dues not require this Insurance to be primary or primary andn- n ' ut is insurance is excess over any other Insurance r which the additionalin Is t s a Named Insured, Regardlessof the writtent between you andadditional Insured, this Insurance Is excessover any other Insurance whether primary, ° contingent or on anyr basis for which the additional Insured been added as an additionali r on other policies. ADDITIONAL INSUREDS-EXTENDED PROTECTION OF YOUR"LIMITS OF INSURANCE" This provision applies to any person or organization who qualifiesas an additional insured under any form or endorsement under this I . ° The following is added to Condition I Duties In The Event Of Occurrence,Offense,Claim or Suit: An additional Insured under this endorsement will as soon as practicable: writtena. Gve notice o " rr n "or an offense that may result in a claimor"suit"under this insurance to us; b. Tender the fens indemnity of any claim or"auk"to all insurers om also have insurance available to the additional Insured, and C. Agree to make availableother insurance h° the additional ir s for a loss we cover under this Coverage Part, d. We have no duty to defend or Indernnlyy an additional insured under this endorsement until we receive written notice of a"suit"by the additional insured, 2. The limits of insurance applicable the additional Insured are those specified in a written contract or written agreement or the limits of insurance as stated in the Declarations of this policy nd defined in Section III—Limits of Insurance this policy, whichever are less,These limits are inclusive of and not in addition tut limits of insurance v it I under this policym 1 WHO 13 AN I -INCIDENTAL MEDICAL1 MALPRACTICE WHO IS AN INSURED-FELLOW EMPLOYEE EXTENSION Paragraph 2.a.(1)of SectionII®Who Is Insured is replaced with the it in (1) "Bodily inju °or"personal and advertisinginjury": ( ) To you,to your partners or m (if you am a partnershipor joint venture), to your members (if you are a limited liability ), to a co-"employeem whilethe courseor her employment or performingrelated to the conductyour business, to your other "vol ars"while performingduties related to the conductyour business; ( ) To the spouse, child,parent, brother or sister of that -"e e"or"volunteerworker"as consequence of Paragraph(1) ( ) ° ) For whichis any obligation to share damages with or repay someone else who must pay damages because of the injury described in Paragraphs( ) or )above;or ( ) Arising out of his or her providingfailing to provide professional heafth careHowever, if you are not in the businessproviding nal health care services or providing professional h I re personnel to others, or If coverage for providing professional health r services is noto ise excluded by separate endorsement,this provWon(Paragraph( ))does not apply. 2013 Uberty MutualInsurance CG 88 10 04 13 Includes oopyrighted material of Insurance ices Otece,Int,vAth Its pemnisslon. Paragraphs a)and(b)above do not apply to'bodily i r"personal and advertising Injury" d by an " "who is actingIn i for you,Supervisory capacity as used herein moons the 'employee's"joflities assigned by y , Includes I supervision f other "of yours. However, none of these "employees" are Insureds for"'bodily Injury or"personal and advertising injury" arising out of their willful conduct, whlch is defined as tt°o purposeful or wfliful intent to cause"bodily injury"or"personal and 4rtvertising itIjriry"% or cAusrrd in whole or in part by their 6toxicatitin by liquor or controlled substances, coverageThe ro °ded by provision J.is excess over any r valid I Insurance o f i to your 'employee". K. NEWLY FORMED OR ADDITIONALLY ACQUIRED Paragraph .of Section II Is Insured replaced by the fbilowing: 3. Any organization you newly acquire or form and over maintain ownership or majority interest, will qualify as a Namedre there Is no other similar insurance av it I o that organization. However: Coverage r this provision is d only until the expiration of the policy °o in which entity was acquired or formed by you; b. Coverage s not apply to injury"or"property "that occurred of acquiredr formed the organization; Coverage s not apply to"personal and advertisingInjury" out of an offense committed before you acquired formed the organization. d. Records a s of operations must be maintainedy the first Namedd° No person or organization is an insured respect tate conduct of any current or pastpartnership,joint venture or limited I i y that is not shown as a Named Insuredin the Declarations or qualities as an insured under this provision. L FAILURE TO DISCLOSEPRIOR Under Section i Commercial Gorreral Liability Conciftions, e foilowing is added to Condition . Representations: Your failure to disclose r or prior"occurrences"existing as of the Inception date of the policy shall not prejudicethe coverage affordedthis policy providedsuch fallure to discloseall hazards or prior'occurrences"is not intentional. M. KNOWLEDGE OF OCCURRENCE,OFFENSE, CLAIM OR SUIT Under ! 4 Commercial General Liability Conditions, following is added o Condition Z DutiesI The Event of Occurrence, Offense,ClaimSuit: Knowledge of an"occurrence",offense, claim or"suit" ageervant or'employee"of any insured shall not in itself constitute knowledge of the insured l an insured listed under Paragraph Section II Insured or a person who has been designatedthem to receive reports of .occurrences", offenses,clairris or"suits"shall have received notice from the agent, servant or "e le ". N. LIBERALIZATION If we revise this Commercial GeneralLiability n a o provide more coverage without additional premiumea your policy willautomatically o ' the coverage as of the dayrevision is effective in your state. ° BODILY Under Section V—Definitions,Definition °is replacedthe following: 3. 'Bodily j s physical Injury. sior disease sustained y a person, This includes mental anguish, l injury, shock,fright or deathresults from suchI injury, sickness or disease. 2013 Liberty Mutual Insurance IncludesCG 88 10 04 13 copyfttted matedal of Insurarme Serviceas„Inc.,vwiih its perrniBeian, Policy 0KW57141748 P. EXTENDED PROPERTY DAMAGE Exclusion 1 1 1 replaosd by the following: ® Expected Or Intended Injury In® r Intended from the standpointof the insured, i exclusion does not apply to"bodily injury'or'property "resulting the use of reasonable force to protect persons or property. a WAIVER OF TRANSFER OF RIGHTS 1 IN CONTRACT OR AGREEMENT WITH YOU Under Section 14 Commercial General Liability Conditions, t following is added to Condition 8. Transfer Of Rights inst Others T We waive any right of recoveryhave i st a person or organization s for injury arising our ongoing operations or'your under a contract with n or organization and Included in the"products-completed operations vi 1, You andr or organization haver in °tin in a contractres that you waive such rights that person or organization: and 2. The injury or damage occurs subsequent tot e execution oft as written contract or written agreement, 13 LIberty MulualInsurance CG 88 10 04 13 Includes copydghtedmetertal of Insurance rAces Office,Inc., th Its is on. Page 8 of 8 Palicy#BASS7741748 COMMERCIAL CA 88 10 1 THIS ENDORSEMENT CHANGES THE POUCY. PLEASE READ IT CAREFULLY, BUSINESS AUTO COVERAGE ENHANCEMENT ENDORSEMENT This I Insurance provided under the following: BUSINESS AUTO COVERAGE FORM With respect to coverage afforded by this endorsement, the provisions of the policyy unless modified by theet. COVERAGEINDEX AUALUm ADDITIONAL INSURED Y CONTRACT, A REEF ENT OR PERMIT ACCIDENTAL AIRBAG DEPLOYMENT 1 AMENDED DUTIES IN THE EVENT OF ACCIDENT, CLAIM, SUIT OR LOSS 1 ENDED FELLOW EMPLOYEE EXCLUSION AUDIO, VISUAL AND DATA ELECTRONIC EQUIPMENT COVE E 1 BROAD FORM INSURED 1 BODILY INJURY REDEFINED 22 EMPLOYEES AS INSUREDS (Inauding employee hired auto) 2 EXTENDED CANCELLATION CONDITION EXTRA EXPENSE_BROADENED COVERAGE 10 GLASS REPAIR WAIVER OF DEDUCTIBLE 1 HIRED AUTO PHYSICAL DAtd'A+ E• (Including employee hired auto and loss of use) 6 HIRED AUTO COVERAGE VERA 'P" 'I'FR I"ORY 20 LOAN I LEASE GAP 14 PARKED AU"I"f)f","0111 I ('OVLRA E(WAIVER OF DEDUCTIBLE) 1 PERSONAL EF EC""rS COVFFAGE 11 PIAL DAMAGE-•-ADDITIONAL TRANSPORTATION EXPENSE COVERAGE 6 RENTAL REIMBURSEMENT SUPPLEMENTARY PAYMENTS 4 TOWING AND LABOR 7 TWO OR MORE DEDUCTIBLES 17 UNINTENTIONAL FAILURE T L E HAZARDS PSS 16 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO LIS 2 SECTION11—LIABIUTY COVERAGE is amended as follows: 1. BROAD FORM INSURED SECTION 11 — LIABILITY COVERAGE, paragraph A.I. —WHO IS AN INSURED is amended to Include the following s an insured, d. Any legally incorporated entity of which you own morethan 50 percent of the voting stock during the policyperiod. However,'insured"doss not include any organization that: (1) Is a partnership or joint venture:or (2) Is an insured under any other automobile Idoy;or (3) Has exhausted its Limit of Insurance Lander any other automobile policy. Paragraph d" (2)of this provision does not apply to s policy written to apply specifically in excess of this policy. 0. Any organization you newly acquire or form, other than s partnership or Joint varriure, of which you n more than 50 percent of the voting stock This automatic coverage is afforded only for 160 days from the date of acquisition or formation. However,coverage under this provision doss not apply. (1) If there is similar insurance or a self-insuredretention plan available to that ani tion,- 2013 Liberty MLAW Irsumce CA 88 10 0113 Indudes rneteriai of Insurance se h its permission. Page 1 of 7 un cy#BAS57741748 ( ) Ilf the Cloths of Insurance any other insurance policy have been exhaustedo or ( ) To 'bodily lrjueryo or 'property damage" that occurred before you acquired or formed the organization, ° EMPLOYEES INSUREDS SECTON IA - LIABILaY COVERAGE, paragraph A.I. .-WHO IS ABS INSURED is amended to om cluede the following as an In red.- E Any"employee"of yours wNle,using a covered "auto"you do not own, hire or borrow, but only for acts wlthlmn the scope of their employrrient by you, Insurance vided by t s doir t As excess over any outer insurance datale to any"alrrtpnloyee". ° An "e loy " of yours while operating an 'auto" hired or borrowed kinder s v4itten contract or agreement In that "employee's' name, with your permission, while performing duties related to the conduct of your business and wAthI n the scope of their employment, Insurance provided by this endorsement Is excess over any other Insurance available to the"employee", SECTiON AA - LIABILITY COVERAGE, paragraph A.I. -WHO IIS AN INSURED W amended to Include the following as an insured, K Any person or organization with respect to the operation,°on, mmtainte rn or use of a covered "auto", provided that you and such person or ou ani7atAorn have agreed to a written contract, agreement, or permit issued to you by govemmental or public authority, to add such person, or organization, or governmental or public authority to this policy as an"Insured". However„ such person organization As an"Iunsuured". Q'tOnly with respect to the operation, maintenance or use of a covered 'auto"a ( ) Only for "bodily Arjutry" or 'property damage' caused by an 'accidenim which takes place after you executed the written contract or agreement, or dna permit has been issued to you;and ( Only for the duration of that contract,agreement or permit a SUPPLEMENTARY PAYMENTS SECTION All - LIABILITY ILITY COVE E„ Coverage Extensions, 2.a. Supplementary Payments, paragraphs hs ( ) and (4)are replaced by the following: ( ) Up to $3,000 for st of bah bonds (including bonds fuer related traffic vidatAouns) required because of aro"a `d t'"vie cover.. We due not have to furnish these bonds. ( ) All reasonable expenses incdrred by the insured at our request,including actual loss of earrifts up to $500 a day because of time off from work. AMENDED5. FELLOW EMPLOYEEEXCLUSION In those jurisdictions where, by law, fellow empioyees are not ent4led to the protection afforded to the employer by the workers compensation exudes➢vlty rule,or simmflar protection,the following provision is added. SECTION ➢l-LIA ILA , exclusion MS.FELI...O MPL Y does not aprp iy of the"'tnodfily in.Iury. results from the use of a covered "auto"you own or hire.. SECTION III-PHYSICAL DAMAGE IEE;w is amended as follows: 6. HIRED AUTO PHYSICAL DAMAGE Paragraph h ° Coverage Extensions of SECTION AAA - PHYSICAL DAMAGE COVERAGE, is amended by adding the following., If hired "autos" are covered"autos"for LIaIbAIuty Coverage,e, amnd 6 Comprehensive, Speed Causes of Loss or Collision coverage are provided under the Buslness Auto Coverage Ido r any 'auto' you own,, then the Physicai Damage coverages pnro ed are extended to'autos": a„ your hire,rent or ow;or 13 UbWy MuWW Insurmce CA 88 10 0113hdudes copydghWd nud&,W of warmce Semen omes,o,,with nus mm e Policy*BAS 5774 t 74 b„ Your'emeph " hires s om rents under a written oontiract or age em mrd 0n twat'employee's" name, but only Off the dernage occurs while the vehicle is be0ng u •d 0mu the conduct ofyour business, subject to the following hOmtoht and deductlbl1e., rhe most we will pay for"loss"in any one "accident"or` oss"is the smallest.of. (1) $50,000„ or ( ) The actual cash value the damaged or stoWn property as of time lime of the'loss"„or (3) The cost of repehrOmug or replacing time damaged or stolen property with other property of like kind and quality, rn0nus a deduchUs. ,. The aeductiNe will be equal to the largest deduefinhe applicable to any owned"auto'for that coverage. C. Subject to the ONrrmh„ deductiUe and excess provisions described 0n this provision, we M0 provide coverage equal to the broadest coverage appftat4e to any covered 'auto"you own, ID. Sublect to e maximum of$1,000 per "accident', we wN00 also cover the actual Noss of use of 0-m hired "auto" of it results from an 'accident', you sirs legally liable and the lessor incurs an actual financial loss. E, ° hls coverage extermsNo n does not aptly to: (1) Any"auto"that tls tmhred, rented or borrowed with a driver cu (2) Any'auto"that 0s hired, rented or borrowed from your'employee", For the purposes of fts provWo m, SECTION V- DEFUTIONS 0s amended by adding the Uo mug: 70M loss"means a "'loss'in whch the oost of repaurs plus time salvage vaUe exceeds time actual cash value. " . TOWING AND I.ABOR SECTION h00 - PHYSICAL DAMAGE COVERA E, paragraph An2. TowNng, 0s amended tiny the addition of the foflo ng: We wflO pay tov4ng and labor costs incurred, up to time limits shown below, each time s covered 'auto' dassifled and rated as a private passenger type, 'light truucw or"irrmedhuuvm trucle is disabled. & For private passenger type vehicles,we wIfl pay up to 0 per disabilement. For 'light tru cks% we will pay up to $50 per,ftabOernemmt. "t4Ng0•mt trucks" are trucks that have a gross imide weight(GVW)of'tg, g pounds or less. C. For"medium trucks" ,we wi1ll pay up to$150 per dN Wergemut. "Medium trucks"are trucks that have a gross vehicle weight(GVW)of 10,001 -20,000 Pounds. However, the labor must be performed at the place of dhsall:Aememmt. B. PHYSICAL DAMAGE ,u ADDITIONAL TRANSPORTATION NSE COVERAGE Paragraph A. .a., Coverage Extension of SECTION III - PHYSICAL I)AMAGE COVERAGE, is amended to provide a 00mmmtt of$ g per day and a maximum limit of$1,500 0 201311.3heny Mutual fturance CA 88 10 0113Ind udes copyrighted rnaterlai of Cnsurance SeMces Office,Nmc.,vAth Its •mm issNmmmm. Pagle 3 of 7 Policy# ASS774174$ . RENTAL REIMBURSEMENT SECTION III—PHYSICAL DAMAGE COVERAGE, A.COVERAGE,Is amended by adding ft fbfiowlng� a. We will pay up to $75 per day for rental reimbursement expenses incurred by you for the rental of an "auto" because of 'sooldenr or "lose", to an 'auto" for which we also pay a °'loss°" under Comprehensive, Specified Causes of Loss or Collision Coverages. We will pay only for those expenses In rred after the first 4 hours following the"a id t°"or"Gass"to the covered"'auto." Dental Reimbursement will be based on the rental of a comparable vehicle, which In many cases araay be substantially less than $75 per day" and will only be allowed for the pefiod of flame it shoWd take to ruspair or replace the vehicle with reasonable speed and similar quality, up to a maximum of 30 da C. We will also pay up to $500 for reasonable and necessary expenses Incurred by you to remove and replace your tools and equipment from the covered 0autob d. This coverage does not apply unless you have a business necessity that other"autos' avallable for your use and operation cannot fill. C it"lose"results from the total theft of a covered 'auto""of the private passenger type"we will pay under this coverage only that amount d your rental reimbursement expenses which is not already provided under Paragraph 40 Coverage Extension, f. No deductible applies to this coverage. Fair the pug-poses of this endorsement provision, rnnateflWs and equipment do not Gnclude"personal effects" as defined in provision 11. 10EXTRA EXPENSE-BROADENED COVERAGE Under SECTION ill — PHYSICAI,.. All A COVERAGE, A. COVERAGE, we will pay fbr the expense of returning a stoleru covered"auto"to you.. The maximum amount we will pay is $1,0W '11. PERSONAL EFFECTS COVERAGE A. SECTION III PHYSICAL ®ADAGE COVERAGE, Aa COVERAGE, is amended by adding the fall ng: if you.have purclna omprelnernsive Coverage on this policy for an "auto'.you own and that'auto"is stollen, we wfll pay,without application of a deductible, up to 0 for'pe nal effects"stolen with tlhe'auto.µ The insurance provided under this provision is excess over any other collectible insurance, t . SECTION V., DEFINITIONS is amended by addiriig the foil iirn For the purposes of this provision, "personal effects" mean tangible property that is worn or carded by an insured.' 'Personal effects""does not include tools, equipment,jerwelry, money or secuedles, 12.. ACCIDENTAL AIRBAG DEPLOYMENT SECTION III .._PHYSICAL ICAL D (3fr...COVERAGE, 5.EXCLUSIONS is annended by adding the fdlowingo If you have pun sed ComprehensNe or Collision Coverage under this policy, the exclusion for"lose relating to mechanical breakdown daces not apply to the accidental discharge of an airbag. Any insurance we provilde shall be excess over any other collectible insurance or reimbursement by r nuufa irer"s warranty. However, we agree to pay any deductible applicable to the other coverage or warranty. 11 AUDIO,VISUAL,AND DATA ELECTRONIC EQUIPMENT COVERAGE SECTION III PHY ICAI,,. DAMAGE COVERAGE,, B.. EXCLUSIONS, exception paragraph a. to exclusions 4.c.and 4ed.W deleted and replaced with the following-, 20,13 Libeirly MMN Insurance CA 88 10 0113 includes copyrighW matedW of insurance 6 Office,Inc.,with its pairmu"wi, Page 4 of 7 Poky#BASS7741748 Exclusion ° °and 4 „do not apply tm . Elecitcinic equipment that reoeives or transmits audio, visual or date signals, whether at,nut designed U Vy for time reproduction f sound, Vf the equipment Is 1p rroa n rntUy in staINed irn the r v urrud '° uutcn" at the time of ft 'U a o and such n q uip meet Is designed to be solely operated by use of the power from the "auto's" electrics.fl sy t lrn, in or upon the covered 'auto" and physicaI damage ver g are provided faro UV„re covered"auto”;or 0 the "loss" occurs solely to audio, visual or date electronic equipment or accessories used with this equipment,ftn our olWilg t m to pay for, repair, return or reosoe damaged r stolen propel will be reduced by 100 d duuctibp ° ° LOANr LEASE . Paragraph °, LIMIT OF INSURANCE ECT11ON III _ PHYSICAL DAMAGE COVERAGE Vs amended by adcling the following. The most we ill pay for a '"totaV Voss' to a covered '° uat " owned by or leased to you In any one "accident-Is the r t rr of then °t. Balance due under terms of the loan or Ilease to which the darnaged darncovered `auto" is subject at the time of the"loss"pees the amount of: . Overdue payments and financial penalties associated witty those payments as of the to of the"loss", ° Financial penalties imposed under a lease due to high mile , excessive use of abnormal wear and tear, Costs for wdended warranties, Credit Life haurance, Health, Accident or Disablfty Insurance purchased th the loan or lease, d.. Transfer or raiUlover balances from previous Voans or leases, . Final payment duce under a"Balloon Le rno, .f, The dollar amount of any unrepaired damage whiia occurred prior to the"total loss"of red'a uteo, 9• Security deposits not refunded by a lessor, pro. Ail refunds payable or pard to you as a result of the early ten-ninaborii of a lease ree rnt or as a result of the early tenytination of any warranty or extended service FQ! reament on a covered'auuto", L Any amount represeriting taxes, t Loan or lease termination fees;or 2. The U cash value of the damage or stolen property as of the time of the"oss". An a0jusiment for dWecition and physicall condition mvill be made In deterrnining the arlual cash value at the time of the "loss"., This ac$ustment is not applicaMe in Texas, This coverage applies ly to the original loan for which the covered "auto' that incurred the loss serves as collateral,or lease writtenan the vered`auto*that incurred the Vela, C. SECTION V—DERINTIONS is changed by adding the folllowiang., As used in time endorsement provision,the following definitionsapply; 'Tot ll loss"means a 'loss"In which the cost of rqpsim Dins tin selvage value exceeds the actual!cash value. "ball " is one with periodic payments that are insufficient to repay the balance over the term of the loan, thereby requiring a large final payment.. 0 2013 Llbo y. pnavmice CA 88 10 0113lndudes c pyre gu~kid mateda of Insurance eo Office,lne.,mdth its permnsson. Page 5 of 7 Policy#BAS57741748 15. GLASS REPAJR-WAIVER OF DEDUCTIBLE Pansgraph M M. dualible of SECTION III PHYSICAL DAMAGE COVERAGE is amended by the addition of the fWowlng� No deductible applies to gWes damage If the glass Is repaired rather than replaced, Is. PARKED AUTO COLLISION COVERAGE(WAIVER OF DEDUCTIBI E) Paragraph D. Deductible of SECTION III ---- PHYSICAL DAMAGE COVE RAGE is amended by ft addition of ft fofiovAng: D)G dedUc0ble: (Joes not appiy to ""Noss" caused by collision to suot� covered '&UM"' 0 type of 1u0h( weight tru(.k with a gross vehicle weight of 10,000 lbs. or toss as defined Uy 1he rnanufacturar as fyAxin"orn kmded weight 1I,m'amu tD`is designed to carry whiW R 1w a. In the charge of an "'insured", ib. L0 parked„ and C, Unoccupied. The 'loss'must,be reported to the poiloe authodbes within 24 hours of known damage. The total amount of the dernage to the covered'auto"rnust exceed the deductible she in the Declarations. This provision does not apply to any"loss"N the covered 'auto'is in the charge of any person or organization engaged In the automobile business, 17. TWO OR MORE DEDUCTIBI ES Under SECTION III PHYSICAL DAMAGE COVERAGE, if two or more company policies or coverage forms appiy to the same acdderd, the following applies to paragraph D.DeductiNe: a. N the applicable Business Auto deductible is the smaller(or smallest)deductiNeit will be waived;or If the applicable Business Auto deductible is not the smaller(or sma0est)deductible it wfll be reduced by the amount of U)s srnalier(or smallest)deductible; or If the to Involves two or more Business Auto coverage forms or policies the smMer (or smallest) deductlNe wiUl be waived,, For the purpose of this endorsement company means any company that is part of the Liberty IMutuM Group. SECTION IV-BUSINESS AUTO CONDITIONS Is amended as follows: 18., UNINTENTIONAL FAILURE TO DISCLOSE WkZARDS SECTION IV.- BUSINESS AUTO CONDITIONS, Paragraph B.Z.is amended by adding the Wa owing.- Iff you uhint entionaily fail to disclose any hazards,exposures or material facts eyisting as of the in Non date or renewei date of the Business Auto Coverage Form, the coverage afforded by this policy will not be prejudiced. However, you must report the undisclosed hazard of exposure as soon as practicable after'its discovery, and we have the rigil'it to coflect additional premium for any such hazard ore su.ure. 19. AMENDED DUTIES IN THE EVENT OF ACCIDENT,CLAIM, SUIT,OII R LOSS SECTION IV BUSINESS AUTO CONDRIONS, paragraph A2.a. is replaced in its entirety by thefo0owlng: 8. In the event of'accident", claim, "suit"or"loss",you must promptly notify us when it is known to* I You, if you are an individual, 2.. A partner,if you are a partnership; 3. Member,if you are a limited lishifity company,- 4. An executive officer or the 'employee"designated by the Named Insured to give such notice, if you area corporation, 0 20,13 U"— Wdual Inswanco CA 88 10 0113 Indudes coWrIghted makrAM of insurm-me SeMces Office,Inc-Mai os pernvisson, Page 6 of 7 Policy#BAS5'7741748 'To the extent.IreoisscMe, notice to us should cnclcud er (1) low,whein send where the"'accident,"or"loss"took place, (2) Pie"insureds narne and address,and (3p Pie narriie%and addresses of any injured 1persons and witnesses. 20. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US SEC UfUN IV — BUSINESS, M311"o CONDITIONS, paragraph AS., Transfer of Rights of Ifs very AgMnsi (Xhentn to Us, is annended by the addition of the fb0owlngr If the perswn or oirganizabon has waived those right It for an ';scddent"or loss", our rights are wacve d Wso. 21. III-ORED AUTO COVERAGE TERRITORY SECTION IV — BUSINESS AUTO CONDI`!`ONS, paragraph 137., Policy Period, Coverage 1"errilory, is amended by the addition of the fohawinlg„ t. For"'autos' hired 30 dV a, or Poov ess, the erage territmy ian s yh weff-i in the world, provided that the _q insupod's responsilb0ity to pay for damages is deterrtirwed iin a "suif', on the nwrits, fi,i the Un tied SlAmes,the territories and pkurus of the United States or America,, Puerto Rico or Canada Or oi ii a settlement.we agree to, Ttils extension of coverage does not apjpUy to an"'auto"hired,ieased,rented or borrowed with a driver. SFCTION V— DEFINITIONS is amended as follows: 22. SM..ILY INJURY REDEFINED Under SE:CTION V Ir.)EFINTIONS, deflidtion C.is replaced by the'fool owingl- F:k.:d1y injurV' rnearwsphys�caf in,iury, siduiess or disease sustacned by a person, incJuding irnentai anguish, vnental iniury, shock, fright or dieattt res0fing frown any of thieseatairsy finw, COMM MON FIOLICY CON13111 rIONS ,7 3. EXTENDED CANCELLATION comInnON COMMON POLICY CONDITIONS, panagraph A CANCELI ATION awdflion appfies except as f6flows" It we cancel for,any reasoru other than nonpayment of premium,we will M80 t1D tt*first INamed Unsured wrIften nofice of cancdiation at least 60 days, be-fore the effective date of canceflatrim, Thi Iprwri. icxi does not apply In ftse states which require more than 60 days prior notice of carpceltabon. 0 2013 Uberly MAW Urmrwce CA 88 10 0113 ades cxWo-ghMM inalviN of Msufanc*Services Moe,,lm-_w0h Its U.xmWskxt Page 7 of 7 COMMERCIAL AUTO CA 88 60 05 13 THIS ENDORSEMENT CHANGES THE POLICY. PILEASEREAD IT CMEFULLY. DESIGNATED INSURED - NONCONTRIBUTING This endorsement modifies Insuranoe provided under the following: K.)SINESS AUTO COVI:RAGE FORIM GARAGE COVERAG.E FORM MOTOR CA R- RIER COVERAGE FORM TRUCKERS COVERAGE FORM With respecttD coverage provided by this endorsemonL lie provlsions of the Coverage Form apply uldless moa Mad by this endoirsenient. Ttils endorsement ldentifies piwson(s) or organization(s) who are ""insureds" under the Who Is An Insured ProAslon of Me Coverage Form. 'This andorsernent does not Wter coverage provided M the Coverage Form, Schedule Nanwo of Perwm(s)or Organizadon(s): Kankp�... Adk'JiLiona.1, irisuxea ajreed a —ne grec nr, pempir C!!jjjtj',�:1qj Be j!1:jjj!111J;V-.;c� hie u P11 .waw 11 g 11 "11 1, 1m MH 11 ,R lEach person or organization shawn inthe SrtW.ule, of this endomement is an "Insured" for LiabNity Cov- erage, but only to the extent that person or organization quallfies as an insured under, the Who Is An Insured Provision contained it) Section ll of the Coverage, Form., The follfmNing is added to the Other Insurance Conditiom If you have agreed in a written agreement that this policy aro dl be primary andl wfthout right of oontribu- flon from any insurance in force for an AdftoinalI Insured 'for 4abilfty arising mit of your operabons, arW Thor* ere wnent was executed prior to 'I' %x3dfly injurr, or "'Foopeily damage", them this insurance wilt be primary and we will not seelk contributlon torn such Insurance. 2013 Liberty Mutual Insuranre-AJI is reserved CA 88 66 05 13 Includes copyrighted material of Insurance Services Office,Inc.,with its permission Page I of I SAB DATE(MM/DD/YYYS� CERTIFICATE OF LIABILITY INSURANCE R022 6/26/2017 THIS CERTIFICATEIS 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 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 rights to the certificate holder in lieu of such enm dorseent(s� - ' RODUc'ER cONr�ax NAME PAYCHEX INSURANCE AGENCY INC/PHS PHONE FA — (AIC,No,EYt): ac,Na): ( ) ._.,.. 8 8 8 443-6112 ...... .... ...,.,.,w..._.................... ._..._ ......._...._._ 210756 P: F: (888) 443-6112 ESA" ADDRESS: PO BOX 33015 INSURER(S)AFFORDING COVERAGE NAIC* 'SAN ANTONIO TX 78265 I INSURERA: Hartford—Fire & Its P&C Affiliates 0091 .............. _— INSURED IIpII INSURER B M INSURER- MMMM ....................ww....... ....""....... ..�......,.,. ...-........-.._,....,.,.,.,.,.,.,.,.,.,...,..,.,..,.,.,.,.,.,.,.,� HADRONEX INC DBA SMART COVER SYSTEMS INSURER D: 2067 WINERIDGE PL ST E INSURER E: ESCONDIDO CA 92029 INSURER - 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. �Sk1 SUB Pof. - d'- 1 I dnL- LrerrTs fN.S'R TypE OFIA'SURANCE A�XdJAd.•BURR lCYNUMRER IMJf.It')4, PoLrcY II r _COMMERCIAL GENERAL LIABILITY EACH OCCURRENCEYY CLAIMS-MADE DAMAGE TO RENTED II I I'Ja':,1"df'. PREMISES(Ea occurrence) P MED EXP(Any one person) PERSONAL&ADV INJURY �Fp C V'L. GR AGEGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ PRO- .,P.RO... ROLMGw p JECT PRO-F-] PRDUCTS-COMP/OP AGG E] a OTHER: COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY (Ea accident) ANYAUTO P 9 BODILY INJURY(Per person) ' OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) "1 ........_.............. ........_ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per actident) UMBRELLA UA13 OCCUR DED EACH OCCURRENCE CLAIMS-MADE EXCESS LIAR N -� AGGREGATE 11.. I11i ETENTIONS, .,... _..�.._.._., .�T.—"., ... WOR%£R.a'COMPENSATION PER I IOTH- AND£MPLOYERS"LIABILITY STATUTE ER ANY PROPRIETOR/PARTNERIEXECUTIVE YIN E.L.EACH ACCIDENT 1, 000, 000 OFFICERIMEMBER EXCLUDED? WA •""•-"--'-' A (Mandatory in NH) ❑ �— 76 WEG GH3220 10/01/2016 1 10/01/2017 E.L.DISEASE.EA EMPLOYEE 51, 000, 000 If yes describe under EL.DISEASE-POLICY LIMIT Sl 000, 000 DESCRIPTION OF OPERATIONS below J ....... ..."_.. .......... ..-... DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES ACOR)101,Additional Remarks Schedule,may be attached N more space is required) Those usual to the Insured' s Operations. Blanket Waiver of Subrogation applies in favor of the Certificate Holder per the Waiver of Our Right to Recover from Others Endorsement WC040306, attached to this policy. ..,.,.,.,_.,..�...w.w.w......_............w......_.,. ............ 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. .. .�.._"..........................................._.....__.. City of El Segundo AUTHORIZED REPRESENTATIVE 150 ILLINOIS ST EL SEGUNDO, CA 90245 001980.2015 ACORD CORPORATION.All R ht g s reserved., ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD