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PROOF OF INSURANCE (2018) CLOSED FELILIG-01 fW3 '09/'0' AICORO C 0 09/ 712017 DATE(MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE .......................................................................... w_............... THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOmLDER.T HIS 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 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 ...................°.t... ..........................9 . s. ..... s). this certificate 0564249 nfer ri hts to the certificate holder in lieu of such C24endorsement(s). n PRODUCER ,Jorge Aguilar Heffernan Insurance Brokers PHONEFAX 18004S Park Circle,Suite 210 LAIC,No,Extl;(213)785-6914 56914 IAIC,Noy(213)623-1388 Irvine,C.4 92614 EA°j1oAl1�5s,«Jor+geA@Iief'lims.com INSUR'ERIS)AFFORDING COVERAGE, NAIC N INSURERA:Great Divide Insurance Company 25224 INSURED INSURER B Felix Lighting INSURER C; 17116 Valley View Ave INSURER 0: La Mirada,CA 90638 INSURER E INSURER F: COVERAGES, -wwww. _ CERTIFICATE NUMBER:.......................... .N, .L ON 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. INSR ADDLISUBRI POLICY EFF POLICY EXP) LTR INSURANCE lb1LM/pp(YYYYI IMMIDD _ I,•,,,„,,,,,,,,,,,,,,,,W,�,,,,�„_„ /NSD i WVD'� POLICY NUMBER LIMITS dYXYY..n,..FACr.,�OCCURRENCE ........................ A X COMMERCIAL GENERAL LIABILITY LPRR,CIrICE g, 1,000,000 CLAIMS-MADE X OCCUR X X CPA200918114 06/30/2017 06/30/2018 DAMAGE �RENTED imr,:�t) 100'„000 MF,D EXP'(Anyone person,/ 5 5,000 PERSONAL&ADV ROURY 5 1,000,000 GE N-1.AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 5 2.,000,000 X p'k'�I.Ir.r PRO- LOC 2,000,000 JECT PRODUCTS.L�r�IrfR'k)P AGC, S ................ CTIIER' A AUTOMOBILE LIABILITY ...m„��..............................................�.�.�.�.�...�.�.�.........._ ............,..�.(OMeCWcuNi'f4;D' ' 1GLE.LWIT ., ....................�1.„000,000' ANY AUTO CAA200918214 06/30/2017 06/30/2018 BODILY IRS URY IiPer purser) 5 OWNED X SCHEDULED AUTOS ONLY AUTOS RODILY INJU'R'Y'/Per accdcanll $' X AUTOS ONLY X AUOTOS ONLYY (f �Jacc�icePE RI mq)'r'wMr"tGE 5 .. .... .... ..... ... ......... .... .... ......... ....... A X UMBRELLA LIAB X OCCUR EACH O000RRIR4CX 5 5„000,000 EXCESS LIAB CLAIMS-MADE CUA200918314 06/30/2017 06/30/2018 AGGRECA.fC 5 5"000,000 DED X RETENTIONS PER A AANORKERS COMPENSATION DOFFICEMP�LOIF M ER LIA ILITY ! NIA WCA200917014 06/30/2017 STATUTE G,yk..r..�....oR .N^......... ANY PF,(Of.rsIETOR/PARTNER/EXECUTIVE Y II N X 06/30/2018 XI EACH o+I',C'I H 1"0'00"00'0 (Mandatory In NH) — L-L DISEASE,4A L'.MI"1.2:s"a'EE 5 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS.,h.Pln•ln'.............................�...........�.. ..... ,.,.,.,.,.,.,•................................................................. Cml 1. k'.'hY:S'k(/4:;akiPC'�71,g4'.a�...t�,.),I+�.u.T� 5 DESCRIPTION OF OP'ERAT'IONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Re:As Per Contract'or Agreement on File with Insured.The City of EI Segundo,its officers,officials,employees,agents,and volunteers and the EI Segundo Unified School District are included as an additional insured on General Liability policy per the attached endorsement,if required.Waivers of Subrogation are included on General Liability and Workers Compensation policies per the attached endorsements,if required.This certificate replaces and supersedes all previously issued certificates. .............................................................................................. CERTIFICATE HOLDER CANCELLATION__ ...................................................... SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Ci of EI Se THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City Segundo ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main St. EI Segundo,CA 90245 AUTHORIZED REPRESENTATIVE ................................................................. ......................................................... .. ,m ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Insured: Felix Lighting, Inc. POLICY NUMBER: CPA200918114 Effective Dates: 06/30/2017-06/30/2018 CG 20 26 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED — DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Additional Insured Person(s) or Organization(s) Blanket as required by written contract executed prior to loss 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", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or ommissions or the acts or ommissions of those acting on your behalf: A. In the performance of your ongoing operation; or B. In connection with your premises owned by or rented to you. CG 20 26 07 04 ISO Properties, Inc, 2004 Page 1 Insured: Felix Lighting, Inc. POLICY NUMBER: CPA200918114 Effective Dates: 06/30/2017-06/30/2018 CG 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: Blanket as required by written contract executed prior to 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. J� CG 24 04 05 09 Copyright, Insurance Services Office, Inc., 2008 Page I WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 04 84 WAIVER OF OUR RIGHT TO RECOVER OM 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 0.00%of the California workers'compensation premium otherwise due on such remuneration. Schedule Person or Organization Blanket as required by written contract executed prior to loss. 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 Policy No. Endorsement No. 06/30/2017 WCA2009170 14 Insured Premium Felix Lighting Inc Insurance Company: Countersigned by Great Divide Insurance Company WC 04 03 06 04 84 1998 by the Workers'Compensation Insurance Rating Bureau of California. Page 1 of 1 All rights reserved. From the WCIRB's California Workers'Compensation Insurance Forms Manual 2001.