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PROOF OF INSURANCE (2018) CLOSED BRYON-1 OP ID: LB DATE(MMIOD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 09/25/2017 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 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 thi's certificate does not confer rights to the c'ertifica'te holder In lieu of such end'Orsernent(s). PHO T a 3401 Centre lake Drive St'Inc NR fa Aaron " 9 - 3401HomC elt a lakence Serv, r ) 11 .emeWelkirN .com -I�c 7-3027 PRODUCER o Eaaa (7 I'Io Afa7 NoN:.,, Ontario,CA 91761 al Ste 410 IAfC�I 09 25 Aaron Brewart ass, INStJRER,(S,)„AFFOltDING COVERAGE _NAIC# „INSURE.R.A:--. I Insurance Co. 41343 Byron E HDI Unionl ...... .RED Y Epp,Inc. ----- INSURER C,Security National 9445 wsuFire In 879 26062 Merit Circle Suite 107 Laguna Hills,CA 92653 INSURER Insurance Co 19 INSURER D: INSURER E 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 DOLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS /NSR TYPE OF INSURANCE ADDL$ UBR POLICY EFF POLICY EXP POLICY NUMBER .LW d D ( 1 LIMIT A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS—MADE X . OCCUR X X rAMAGt 70 Yda',I'^♦I'da:7 .... --,00. GK20X00067102 10/01/2017 10/01/2018 If�EMISFS(FstPa�,Ruf�an(I�,,,,, � 100,000 MED EX 5,000 EXE(Any one person) I$ .... .,,, PERSON AL„BADVINJURY1,000,000 �s IF LIMIT APPLIES PER. PRODUCTS 2,000,000 (X r�l P(7Li4'"ti AGGR4 d A p � I LOC _GENERAL AGGR P,(o AGG 00,000 p ? $_ 1 0. e�all�N Em Ben I� 00,000 A AUTOMOBILE LIABILITY COMNNEa :SINOLE/.IMI"& 1,000,000 X_ ANY AUTO GK20X00067102 10/01/2017 10/01/2018 BODILY _$ OWNED SCHEDULED ,BODILY INJURY(Pe,r,personl $ X AUTOS ONLY X AUTOS 1 F0LY IINIi7tRy I' aoclde;_nlp_$ A A M"AO AUTOS ONLY AUUTOS ONL� al�iar anti IRs/ B UMBRELLA LIAB X___]OCCUR EACH OCCURRENCE $ 4,000,000 CLAIMS-MADE GK20X00067102 10/01/2017 10/01/2018 X EXCESS LI�B C 4,000,000 _AGGREGATE $ D ED X RETENTION$ 0 $ C WORKERS COMPENSATION X P(_R')'Itl)k C()IH ___ _ AND EMPLOYERS'LIABILITY I I f'1,1AI An E” ,IC'^P F Ft ANY PROPRIETOR/PARTNER/EXECUTIVE YIN X S 1,000,000 n NIA SWC1167998 10/01/2017 10!01/2018 „I u uMt,. ( EMI L('4i11 r.in NHI $ 000,000 nbe under DESCRIPTION PSTION OF OPERATIONS below Ea MSEASE,R'CKICYLIIMI"p $ 1,000,000 A Contractors 10/01/2017 10/01/2018 Equipment 106,000 Equipment DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) *Cancellation provision reverts to 30 days 10 days for non-payment of promium. RE: City of EI Segundo-PW15-23B Fire Station#1 Apparatus Bay Door Replacernent. **SEE HOLDER NOTES FOR ADDITIONAL INSURED" CE'R'TIFICATE HOLDER CANCELLATION' CITYOEL SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Ci of EI Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City g ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street EI Segundo,CA 90245 AUTHORIZED REPRESENTATIVE I ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD HOLDER CODE CITYOEL BRYON-1 PAGE 2 NOTEPAD. INSURED'S NAME Byron Epp, Inc. OP ID: LB Date 09/25/2017 The City of El Segundo, its office officials employee and volunteer are to be included as additional insurl"7dl'with respects to the General Liability per form attached. Waiver of Subrogation applies on the General Liability and Workers Compensation per form attached. .................11.1............................................... POLICY NUMBER: GK20X000671 02 00 CA COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 (Blkt) WAIVER OFTRANSFER OF FIGHTS 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 and effective during the policy period as stated on the policy declarations. 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 organ- ization shown in the Schedule above. CG 24 04 05 09 (Blkt) © Insurance Services Office, Inc., 2008 Page 1 of 1 POLICY NUMBER: GK20X000671 02 00 CA COMMERCIAL GENERAL LIABILITY CG 20 37 04 13 (Blkt) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES O CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations Blanket as required by written contract and effective Primary Insurance applies: It is agreed that such during the policy period as stated on the policy insurance as is afforded by this policy for the benefit declarations. of the additional insured shown shall be primary insurance, and any other insurance maintained by the additional insured(s) shall be excess and noncontributory as respects any claim, loss or liability allegedly arising out of the operations of the named insured or its subcontractors, provided however that this insurance will not apply to any claim loss or liability which is determined to be solely the result of the additional insured's negligence or solely the additional insured's responsibility. This insurance also does not apply to any structure intended to be occupied as a private residence, not including apartments. 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 Section III organization(s) shown in the Schedule, but only with —Limits Of Insurance: respect to liability for "bodily injury" or "property If coverage provided to the additional insured is damage" caused, in whole or in part, by "your work" required by a contract or agreement, the most we will at the location designated and described in the pay on behalf of the additional insured is the amount of Schedule of this endorsement performed for that insurance: additional insured and included in the "products- completed operations hazard". 1. Required by the contract or agreement; or However: 2. Available under the applicable Limits of Insurance 1. The insurance afforded to such additional insured shown in the Declarations; only applies to the extent permitted by law; and whichever is less. 2. If coverage provided to the additional insured is This endorsement shall not increase the applicable required by a contract or agreement, the Limits of Insurance shown in the Declarations. 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 37 04 13 (Blkt) 0 Insurance Services Office, Inc., 2012 Page 1 of 1 C. With respect to the insurance afforded to these 2. Available under the applicable Limits of Insurance additional insureds, the following is added to Section shown in the Declarations; III—Limits Of Insurance: whichever is less. If coverage provided to the additional insured is This endorsement shall not increase the applicable required by a contract or agreement, the most we will Limits of insurance shown in the Declarations. pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or Page 2 of 2 © Insurance Services Office, Inc., 2012 CG 20 10 04 13 (Blkt) POLICY NUMBER: GK20X000671 02 00 CA COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 (Blkt) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES O CONTRACTORS - SCHEDULED PERSON O ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Orqanization(s) Location(s) Of Covered Operations Blanket as required by written contract and effective Primary Insurance applies: It is agreed that such during the policy period as stated on the policy insurance as is afforded by this policy for the declarations. benefit of the additional insured shown shall be primary insurance, and any other insurance maintained by the additional insured(s) shall be excess and noncontributory as respects any claim, loss or liability allegedly arising out of the operations of the named insured or its subcontractors, provided however that this insurance will not apply to any claim loss or liability which is determined to be solely the result of the additional insured's negligence or solely the additional insured's responsibility. 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 additional exclusions organization(s) shown in the Schedule, but only with apply: respect to liability for"bodily injury", "property damage" This insurance does not apply to "bodily injury" or or "personal and advertising injury" caused, in whole "property damage"occurring after: or in part, by: 1. All work, including materials, parts or equipment 1. Your acts or omissions; or furnished in connection with such work, on the 2. The acts or omissions of those acting on your project (other than service, maintenance or repairs) behalf; to be performed by or on behalf of the additional in the performance of your ongoing operations for the insured(s) at the location of the covered operations additional insured(s) at the location(s) designated has been completed; or above. 2. That portion of "your work" out of which the injury However: or damage arises has been put to its intended use by any person or organization other than another 1. The insurance afforded to such additional insured contractor or subcontractor engaged in performing only applies to the extent permitted by law; and operations for a principal as a part of the same 2. If coverage provided to the additional insured is project. 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 10 04 13 (Blkt) © Insurance Services Office, Inc., 2012 Page 1 of 2 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 06 37 (Ed. 5-02) 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 2% of the California Workers' Compensation premium otherwise due on such remuneration, subject to a minimum premium of$50.00. Schedule Person or Organization Job Description Blanket,As required by contract. Policy Number: SWC1167998 Insured: Byron Epp Inc. Endorsement Effective: 10/01/2017 Coverage Provided by: Security National Insurnace Company WC 99 06 37 (Ed. 5-02)