PROOF OF INSURANCE (2018 - 2018) CLOSED DATE(MM/DD/YYYY)
CERTIFICATE OF LIABILITY NCE: 6/16/2017 I
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.
the Oterms end conditions of tlN Policy, certainDpolicies may require
the endorsement�A sta
tement mon this SUBROGATION
d 18 WAIVED, fights t to
IMPORTANT: holder Is an be
does not confer rights to the B
ooh holder In lieu of such endorsemelnQtsl.
PRODUCER
22850 Crenshaw Blvd. ate. 203 310),.,,,,,325 ,4343
1'AX, )f314) 325-7037
Bornstein Insurance PHONE
INS REPMS AF' NG COVERA •
Torrance, Ca 90505
.. ) rFD�A P� IAAIce
'n=RA � ty Insurance Com#panM 21199
INSURED LE PROTECTION SERVICE, INC. IN uR RmB olpIany 29742 ■
on Nls'tioM ,
N R Iot�q Cala 1 ineusanoe C ,
DBA: EAGLE PROTECTION OF CALIFORNIA
PO Bos 1428 INSURER
Torrance, CA 90505
(310) 320-9100 141
SE'S CERTIFY/ITE R: REVISION NLJWFR,,
THIS E 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 BYPAID CLAIMS..
^ uwr 1 �l'r tlIIM�IYi Y'hN3CY LkP LIMITS
TYPE OF INSURANCE YYYY1
E COM09MAAL GENERAL LIABILITY _EA NOCOIRRENE 1.000.000
I u' IM�u
CLAIMS-MADE ®OCCUR I I PraF'ulgaq ^A e' d„r�� i 0 QI.O
BAPRG0002708 ovis/zox� rava3/zone MOD EXP(AM(orve ; .. 5 0 0
A y PER'SONAL&ADV INJURY s1,006,000 1
N'L AGGRE' AT LIMITAPPLI NFRA AGGREGATE F 5,000,000
PR& PRODUCTS-POMP/O!P AGG R 5,000,000
POLICY JEcc::T LOC PRO,
Y
I
N
.L...(MN'U AUTOMOBILELUBILITY '
l,UUU, JUU
3ANYAUTO 2003901412 os/oi/zoic _s/oi/zoteBODILY JURY(P� eri
AOWNED SCHEDULED ( BOpI`yINJURY(Per MWol) S
AUTOS AUTOS NED PHyPtNIY UANAa
HIRED AUTOS AUTOS r
I
s
S
UMBRELLA LIA9
EXCESS LLAB OIAIMS MADE€ I AGGREGATE RRE N F I
1
ii REaWN
P'N'4P' 1E T4H'MAI4";pN ,tl�+']Ie
WORKERSCOMPENSATION !
'R:NJTN'4PEI
�STT
LITE pH-
ANDLIABILITY
ANY
, 1
Crr'FICE IoNN)
EXCLUOeIaa NIDI I E L DISEASE-EA EM
ACCIDENT
PLOYEE i
NI p1 ,(laar�"YLSeM(!®( .,.Fa tly D45..A+ P°AL,V.Q"'Y I,IV�P1T' II
I
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101.AE6tiaW R...*.Sdis",maybe elqwhed'B more space Is regcrwre1) .,.,..
Coverage afforded by this policy is Primary and Non-contributory
Certificate Holder is named as Additional Insured with respect to Commercial General
Liability for service's' performed by the Named Insured, per Blanket Additional Insured
Endorsement Form 00 GBL486 00 07 08
30 day notice of cancellation
10 day notice of cancellation for non-payment
City of El Segundo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
its officials, and employees THE EXPIRATION DATE THEREOF, NOTICE WALL BE DELIVERED IN
City Clerk ACCORDANCE WITH THE POLICY PROVISIONS.
350 blain Street, Room 5 AUTHORIZED REPRESENTATIVE
El Segundo, CA 90245-3813 eiQ
lu yp
E
®1988-2014 ACORD CORPORATION.All rights reserved.
ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
.... uuuuwm I I mlluuuuu I IIIIIIIIIIIIIIIIII IIIA IIIIIIIIIII II III Ill�lluuuuuuoinnouuuuuuuuuluuuuuuuum�
POLICY NO. BAPKG0002708
I
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED ENDORSEMENT
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
Section II—Who Is An Insured Is amended by adding the following:
Any perem(s)or organization(s)whose liability you have assumed under a valid written contract but only for
that person(s)or orgenizatlon(s)liability arising solely out of your operations. In no event, shall coverage
afforded to any additional person(s)or organization(s)be broader than coverage for the Named Insured.
Sectlon I—Coverages,Coverage A Bodily Injury and Property Damage Liability,Paragraph 2.,Exclusions is
amended by adding the following:
This Insurance does not apply to:
1. Any customer or a user of your goods or services who does not have a"standard contract".
2. Person(s)or organization(s)who are contractors for whom you are a subcontractor or for
whom you are otherwise providing services unless a"standard contract"has been effected.
Services Include but are not limited to leasing,maintaining,servicing,or monitoring of alarm
systems.
3. Peraon(s)or organizations)who is a manager,owner or lessor of premises leased to you
for:
(a) "bodily injury"or"property damage"occurring after you cease to be a tenant; or
(b) "bodily Injury'or"property damage"of those acting on your behalf.
4. Person(s)or organizatlon(s)who Is an owner or lessor of leased equipment for.
(a) "bodily injury"or"property damage"occurring after the equipment lease expires;or
(b) "bodily injury"or"property damage"arising out of the sole negligence of the owner or
lessor.
5. "Bodily Injury" or"property damage" the person(s) or organization(s) has assumed from
another person(s)or organization(s)other than Nabiftly the person(s)or organizations)would
have had If It had not been assumed.
AN other terms and conditions of the Polley remain unchanged.
I
I
00 GLO486 00 07 08 Page 1 of 1
7777777777777--
Important
Information ion X,, Berkshire Hathaway
GUARD Insurance
-Companies
Agency
Eagle Protection Service, Inc. AUTOMATIC DATA PROCESSING INSURANCE AGENCY,
2700 West 182nd St 201 INC.
Torrance, CA 90504 1 ADP Boulevard
Roseland, NJ 07068
Changes to Your Workers' Compensation Policy
Policy Number EAWC812927
Policy Period
From May 1, 2017 to May 1, 2018, 12:01 AM, standard time at the insured's mailing address.
Party Requesting the Change and Type of Endorsement
The Agent- Added 0_040 effective 05/01/2017
State: CA; Code: 7605 BURG/SECURTY SYS ALARM INST,SVC,REP; Payroll: $414
The Agent- Added 0_040 effective 05/01/2017
State: CA; Code: 7605 BURG/SECURTY SYS ALARM INST,SVC,REP; Payroll: $1,104
The Agent- Added Waiver of Subrogation effective 05/01/2017
Name: Shak King Corp; Job Description: service and repair of cameras
The Agent- Added Waiver of Subrogation effective 05/01/2017
Name: City of EI Segundo; Job Description: service repair fire/burglar systems
Premium change: $ 207.00
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 See Above Policy No. EAWC812927 Endorsement No. 1
Insured Eagle Protection Service, Inc. Premium $207
Insurance Company Countersigned bym,,,_,,,,__..........,,_,
NorGUARD Insurance Company
Thank You Again for Choosing Berkshire Hathaway GUARD Insurance Companiesi
Call Customer Service at 800-673-2465 with any questions.
Endorsement
WC 99 00 13
CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) V
1110212017
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: It the certificate holder Is an ADDITIONAL INSURED,the policy(les)must be endorsed.If SUBROGATION 1S 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
cerdflcats holder In lieu of such endorsement(s).
CP N'IAt M' u -
jPRODUCER ME,:
Automatic Data Pr sing Insurance Agency,Inc. e$11"I Inc,No::
—
1 Adp Boulevard E'4;
Roseland,NJ 07068 INSURE")AW+ORDINO COVERAGE NAIC e
INSURER A: NorGUARD Insurance Company 31470
INSURED INSURER 8:
EAGLE PROTECTION SERVICE INC I...
2700 W 182ND ST STE 201 INSURER c
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06
(Ed.4-84)
WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT-CALIFORNIA
We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce
our right against the person or organization named in the Schedule. (This agreement applies only to the extent that
you perform work under a written contract that requires you to obtain this agreement from us.)
You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the
work described in the Schedule.
The additional premium for this endorsement shall be 1.05 % of the California workers' compensation premium
otherwise due on such remuneration.
i
Schedule
Penson or Organisation Job Description
Shak King Corp service and repair of cameras i
City of EI Segundo service repair fire/burglar systems
This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated.
(Thin Information below Is required only when this endorsement Is Issued subsequent to preparation of the policy.)
Endorsement Effective Policy No. EAWC812927 Endorsement No.
Insured Insurance Company
Countersigned By