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PROOF OF INSURANCE (2018) CLOSED _ Page 1 of 3 A�® 11/08/2017 CERTIFICATE OF LIABILITY INSURANCE I DATE(MM/ 2017Y) 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 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 endorsement(s). PRODUCER (CONTACT NAME: Willis of Massachusetts, Inc. PHONE 1-877-945-7378 ( FAX1-888-467-2378 c/o 26 Century Blvd (A/C,No.Ext): (A/C,No): IE-MAIL cm P.O. Box 305191 ADDRESS: ertificates@willis.co Nashville, TN 372305191 USA I INSURER(S)AFFORDING COVERAGE NAIC# INSURERA: ACE American Insurance Company 22667 INSURED INSURER B: Indemnity Insurance Company of North Ameri 43575 UniFirst Corporation and its Subsidiaries 68 Jonspin Road IINSURERC: Agri General Insurance Company 42757 Wilmington, MA 018871086 INSURER D: ACE Fire Underwriters Insurance Company 20702 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:W4301609 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE � OCCUR PREMISES ES(TO RENTED 1,000,000 PREMISES(Ea occurrence) $ A MED EXP(Any one person) $ 5,000 y y HDOG2787146A 10/01/2017 10/01/2018 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 POLICY❑ PRO JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 2,000,000 (Ea accident) X ANY AUTO BODILY INJURY(Per person) $ A OWNED SCHEDULED y y ISAH09063675 10/01/2017 10/01/2018 BODILY INJURY Per accident $ AUTOS ONLY AUTOS ( ) HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident) $ UMBRELLALIAB OCCUR EACH OCCURRENCE $ EXCESS LAB HCLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION x PER STATUTE OERH AND EMPLOYERS'LIABILITY Y/N EL EACH ACCIDENT $ 1,000,000 B ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED� No N/A y WLRC64619329 (AOS) 10/01/2017 10/01/2018 (Mandatory in NH) IEL DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ A Workers Compensation and y WLRC64619317 (AZ, CA) 10/01/2017 10/01/2018 EL Each Accident $1,000,000 Employers Liability EL Disease - Limit $1,000,000 Per Statute EL Disease - Each Emp$1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) This Voids and Replaces Previously Issued Certificate Dated 09/29/2017 WITH ID: W3847909. Division/Location: 324 Certificate Holder is an Additional Insured for General Liability and Auto Liability as their interest may appear if SEE ATTACHED 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 Attn: City Clerk City Clerk's Office, 350 Main Street Room 5 q L,.mpov _ El Segundo, CA 90245-3813 (V ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD SR ID: 15295656 BATCH: 506874 AGENCY CUSTOMER ID: LOC#: A�0 ADDITIONAL REMARKS SCHEDULE Page 2 of 3 (AGENCY NAMED INSURED Willis of Massachusetts, Inc. UniFirst Corporation and its Subsidiaries 68 Jonspin Road ( POLICY NUMBER Wilmington, MA 018871086 See Page 1 CARRIER NAIC CODE See Page 1 See Page 1 EFFECTIVE DATE: See Page 1 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance required by written contract but only with respect to liability arising out of operations of the Named Insured. It is understood and agreed that the Company waives its right of subrogation against the Additional Insured which may arise by reason of a payment of claim under all the policies, if required by written contract and as permitted by law. Additional Insured's: City of E1 Segundo, its officials, and employees. General Liability policy shall be Primary and Non-contributory with any other insurance in force for or which may be purchased by Additional Insured's. INSURER AFFORDING COVERAGE: ACE American Insurance Company NAIC#: 22667 POLICY NUMBER: WCUC64619354 (MA, ME, OH) EFF DATE: 10/01/2017 EXP DATE: 10/01/2018 SUBROGATION WAIVED: Y TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT: Workers Compensation and EL Each Accident $1,000,000 Employers Liability EL Disease - Limit $1,000,000 Per Statute EL Disease - Each Emp $1,000,000 INSURER AFFORDING COVERAGE: Agri General Insurance Company NAIC#: 42757 POLICY NUMBER: WLRC64619330 (TN) EFF DATE: 10/01/2017 EXP DATE: 10/01/2018 SUBROGATION WAIVED: Y TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT: Workers Compensation and EL Each Accident $1,000,000 Employers Liability EL Disease - Limit $1,000,000 Per Statute EL Disease - Each Emp $1,000,000 ACORD 101 (2008101) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SR ID: 15295656 BATCH: 5(Y6874 CERT: W4301609 AGENCY CUSTOMER ID: LOC#: A�0 ADDITIONAL REMARKS SCHEDULE Page 3 of 3 (AGENCY NAMED INSURED Willis of Massachusetts, Inc. UniFirst Corporation and its Subsidiaries 68 Jonspin Road ( POLICY NUMBER Wilmington, MA 018871086 See Page 1 CARRIER NAIC CODE See Page 1 See Page 1 EFFECTIVE DATE: See Page 1 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance INSURER AFFORDING COVERAGE: ACE Fire Underwriters Insurance Company NAIC#: 20702 POLICY NUMBER: SCFC64619342 (WI) EFF DATE: 10/01/2017 EXP DATE: 10/01/2018 SUBROGATION WAIVED: Y TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT: Workers Compensation and EL Each Accident $1,000,000 Employers Liability EL Disease - Limit $1,000,000 Per Statute EL Disease - Each Emp $1,000,000 ACORD 101 (2008101) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SR ID: 15295656 BATCH: 5(Y6874 CERT: W4301609 1 POLICY NUMBER: HDO G2787146A Endorsement Number: 49 COMMERCIAL GENERAL LIABILITY CG 20 26 04 13 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): Any person or organization whom you have agreed to include as an additional insured under a written contract, provided such contract was executed prior to the date of loss. 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", "property If coverage provided to the additional insured is damage" or "personal and advertising injury" required by a contract or agreement, the most we caused, in whole or in part, by your acts or will pay on behalf of the additional insured is the omissions or the acts or omissions of those acting amount of insurance: on your behalf: 1. In the performance of your ongoing operations; 1. Required by the contract or agreement; or or 2. Available under the applicable Limits of 2. In connection with your premises owned by or Insurance shown in the Declarations; rented to you. whichever is less. However: This endorsement shall not increase the 1. The insurance afforded to such additional applicable Limits of Insurance shown in the insured only applies to the extent permitted by Declarations. law; and 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 26 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 Workers' Compensation and Employers' Liability Policy Named Insured Endorsement Number UNIFIRST CORPORATION 68 JONSPIN RD Policy Number WILMINGTON MA 01887 Symbol: WLR Number: C64619317 Policy Period Effective Date of Endorsement 10-01-2017 TO 10-01-2018 10-01-2017 Issued By(Name of Insurance Company) ACE AMERICAN INSURANCE COMPANY Insert the policy number.The remainder of the information is to be completed only when than r:sndon,,ernent 6�Is%ued Cry I110 psA°a.+p+:rmrutr+;rrr r„ror the p: !ir,y, CALIFORNIA WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement applies only to the insurance provided by the policy because California is shown in Item 3.A. of the Information Page. 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, but this waiver applies only with respect to bodily injury arising out of the operations described in the Schedule, where you are required by a written contract to obtain this waiver from us. You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. Schedule 1. ( ) Specific Waiver Name of person or organization: ( X ) Blanket Waiver Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. 2. Operations: ALL OPERATIONS CONDUCTED BY AN INSURED PURSUANT TO SUCH WRITTEN CONTRACT 3. Premium: The premium charge for this endorsement shall be 2 . 0 percent of the California premium developed on payroll in connection with work performed for the above person(s) or organization(s) arising out of the operations described. 4. Minimum Premium : $0 A iiihorized A peril WC 99 03 22