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PROOF OF INSURANCE (2018 - 2018) CLOSED CERTIFICATE OF LIABILITY INSURANCE I DATE(N20/2YY017 11/20/27 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 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 .. ....... Radius Insurance Services ( NAME Nick Roumi 135 S State College Blvd., #200 IAA , 800 400-7283 IJAIC,No):(888) 908 0704 NAME: Brea CA 92821 SS ) nick®radiusins.com !NSU„ .. # RER(S)AFFORDING COVERAGE NAIC INSURERA:Arch Insurance Company 11150 INSURED (310) 669-8949 RERB:Bvanaton Insurance Company 35376 Alfaro Communications Construction Inc. INSU dba ACCI ,INSURER C, 620 S. Bradfield Ave. INSURER D: Compton CA 90221 INSYREINSURERE ...., .. .,,.., RF: COVERAGES CERTIFICATE NUMBER:Cert ID 2458 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. ILIP A TYPE OF INSURANCE IINSD W D POLICY NUMBER (IMMIDDIYYYY) (MMIDDIYYYV LIMITS B XII COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE XII OCCUR Y Y 3C21407 10/9/2017 10/9/2018 PREMISES(Ea occurence)AMAGE 10 RENTEb $ 100,000 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEMLAGGREGATE LIMIT APPLIES PER GENERALAGGREGATE $ 2,000,000 POLICY[ X PE® I LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OT a•I E:R $ AUTOMOBILE LIABILITY COMMNEDSINGLE 1.IMI f $ „ (Ea amdent) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PRC7P9°°WY DAMAGE AUTOS ONLY AUTOS ONLY (Por aQCtiid ontf $ $ B X UMBRELLA LIAR gL ,0 EXCESS LIAB ®IMS-MADE AGGREGATE RENCE $ 5,000,000 000 00 DED I I,RETENTION$ $ WORKERS COMPENSATIONPER 101H- A AND EMPLOYERS°LIABILITY YIN Y ZAWC12540400 11/26/2017 11/26/2018 X STATUTE ER (OFFICEMs daa/Mryl�m NEjEXCLUDED?ECUTIVEmm"^� NIA EL DISEASE CEAEMPLOYEE $ 1,000 000 If yes.describe under """ "'......"........' DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ 1,000,000 $ $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) *30 day notice of cancellation, 10 day notice of cancellation in the event of nonpayment of premium City of E1 Segundo, its officers, its officials, and employees are named as Additional Insured regarding the General Liability policy per form CG 20 10 04 13 and CG 20 37 04 13. Waiver of Subrogation applies regarding the General Liability policy per form CG 24 04 05 09 and the Workers Compensation policy per form WC 04 03 06. Primary and Non-Contributory wording applies in regards to the General Liability per form CG 20 01 04 13. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of E1 Segundo ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street AUTHORIZEDREPRESENTATIVE E1 Segundo CA 90245 1 vta Witt, I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Page 1 of 1 POLICY NUMBER: COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL, INSURED, - OWNERS,S, LESSEES OR CONTRACTORS - SCHEDULED 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) Location(s)Of Covered Operations 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 organization(s) shown in the Schedule, but only exclusions apply: with respect to liability for"bodily injury", "property This insurance does not apply to "bodily injury" or damage or personal and advertising injury "property damage"occurring after: caused, in whole or in part, by: 1. All work, including materials, parts or 1. Your acts or omissions; or equipment furnished in connection with such 2. The acts or omissions of those acting on your work, on the project (other than service, behalf; maintenance or repairs) to be performed by or in the performance of your ongoing operations for on behalf of the additional insured(s) at the the additional insured(s) at the location(s) location of the covered operations has been designated above. completed; or However: 2. That portion of "your work" out of which the injury or damage arises has been put to its 1. The insurance afforded to such additional intended use by any person or organization insured only applies to the extent permitted by other than another contractor or subcontractor law; and engaged in performing operations for a 2. If coverage provided to the additional insured is principal as a part of the same 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 0413 0 Insurance Services Office, Inc., 2012 Page 1 of 2 C. With respect to the insurance afforded to these 2. Available under the applicable Limits of additional insureds, the following is added to Insurance shown in the Declarations; Section III—Limits Of Insurance: whichever is less. If coverage provided to the additional insured is This endorsement shall not increase the required by a contract or agreement, the most we applicable Limits of Insurance shown in the will pay on behalf of the additional insured is the Declarations. amount of insurance: 1. Required by the contract or agreement; or Page 2 of 2 0 Insurance Services Office, Inc., 2012 CG 2010 0413 COMMERCIAL GENERAL LIABILITY CG 20 0104 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONT TORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance (2) You have agreed in writing in a contract or Condition and supersedes any provision to the agreement that this insurance would be contrary: primary and would not seek contribution Primary And Noncontributory Insurance from any other insurance available to the This insurance is primary to and will not seek additional insured, contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and CG 20 0110413 0 Insurance Services Office, Inc., 2012 Page 1 of 1 POLICY NUMBER: COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER OF TRANSFER OF IRIGHTS OF RECOVERY AGAINST OTHERS TO S 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: Information required to complete this Schedule, if not shown above, will be shown in the Declarations, The following is added to Paragraph S. 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. CG 24 04 05 09 0 Insurance Services Office, Inc., 2008 Page 1 of 1 C3 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 04-84) POLICY NUMBER: ZAWCI2540400 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. SCHEDULE PERSON OR ORGANIZATION JOB DESCRIPTION ANY PERSON OR ORGANIZATION WHERE ALL JOBS UNDER CONTRACT WAIVER OF OUR RIGHT TO RECOVER IS PERMITTED BY LAW AND IS REQUIRED BY WRITTEN CONTRACT PROVIDED SUCH CONTRACT WAS EXECUTED PRIOR TO DATE OF 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 1126® 7 Policy No. ZAWC12540400 Endorsement No. Insured ALFARO COMMUNICATIONS Premium $ INCL. Insurance CompanyARCH INSURANCE COMPANY Countersigned By [SATE OF ISSUE: 1®2 ®17 ©1998 by the Workers'Compensation Insurance Rating Bureau of California. All rights reserved. From the WCIRB's Califomia Workers'Compensation Insurance Forms Manual © 1999. � ........_....................... . # � RH DA CERTIFICATE OF LIABILITY INSURANCE 12101 /2017 THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLYAND 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 endorsement(s). ._............_..w...._......._...._e_e_e_...e_e_e__....._e__e._-........... _._................._ .. _ w..._.............._..... ..........caw ... ......................www............_ PRODUCER CONTACT NAME: Aymme Mejia FARMERSINSURANCE �...._.._.__................__..._......_. �.........._�w _ _................_.__.........__.......................--_........ _ ._....... PHONE LORENA GUTIERREZ (A/C,NO,EXT):(562)445-4690 (n c,No):(562) 4096 8141 2nd ST STE 215 E-MAIL DOWNEY,CA 90241 ADDRESS: IguGerrezl@farmersagent corn INSURER(S)AFFORDING COVERAGE NAIC N INSURED INSURERA: Farmers Insurance Exchange 21652 . ............................... .......... . ......_—_------- INSURERS: .m_ Alfaro Communications Construction Inc ••� 15614 S.Atlantic Ave INSURER C: lrlsuRERD: Compton,CA 90221 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 NAME 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 THETERMS.EXCLUSIONSANDCONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CW MS. ... INSD1 wvD LILY EFF MM/DD/YYYY) ( ... .......... ........................................._.LIMITS INSRL SUER (MM POLICY EXP ... LTR TYPEOFINSURANCE POLICY NUMBER L COMMERCIAL GENERALLIABILITYEACH OCCURRENCE �f CLAIMS-MADE ti OCCUR DAMAGE s f I PREMISES(Ea Occurrence) PMED EXP(Anyone person) IS PERSONAL&ADV INJURY I f . GEN'L AGGREGATE LIMITAPPLIES PER: I GENERAL AGGREGATE $ POLICY [� PROJECT [] LOC PRODUCTS-COMP%OPAGG S OTHER: 5 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) f 1,000,000, ANYAUTO I BODILY INJURY(Per person) 'S A OWNEDAUTOS SCHEDULED BODILYINJURY(Peraccident)g ONLY AUTOS Y Y 606684088 09/06/2017 09/06/2018 . HIRED AUTOS NON-OWNED PROPERTY DAMAGE f ONLY AUTOSONLY (Peraccident) S UMBRELLALUIB OCCUR EACH OCCURRENCE f EXCESS LIAR CLAIMS-MADE I AGGREGATE f DED N RETENTION f f WORKERS COMPENSATION PER V N OTHER f AND EMPLOYERS'LIABILITY STATUTE u u ANY PROPRIETOR/PARTNER/ Y/N N/A E.L.EACH ACCIDENT f EXECUTIVE OFFICER/MEMBER EXCLUDED?(Mandatory In NH) E L.DISEASE-EA EMPLOYEE If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE POLICY LIMIT $ I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) This policy shall not be canceled except by written notice to the Risk Manager at:City Clerk City of EI Segundo,CA 90245.at least thirty(30)days prior to the date of such cancellation.With respect to such insurance as is afforded by this policy,the city of EI Segundo and its officers,employees,elected officials, volunteers,and members of broads and commissions shall be named as additional insured.This additional insured coverage only applies With respect to liability of the named insured or other parties acting on their behalf arising out of the activities of the undertaking specified in paragraph No.5(Indemnification Clause) ................................................................... .... .......................................... ,........... .......................".. ....... ,, �._...... _. CERTIFICATE HOLDER CANCELLATIONr" GityClerk SHOULD ANY OF THE ABOVE DESCRIB 0 ES BE CAN ELL EDB'EFORETHE EXPIRATION City of EI Segundo DATE THEREOF,NOTICE WILL BE DELI b CCORCE WITH THE POLNC'Y'PROVISIONS. 350 Main Street AUTHORIZED REPRESENTATIVE FI.SeguOdD_CA Qn*pdS / ACORD 25(2016/03) C1988-10 O DC RPORATION.All Rights Reserved 31-1769 11-15 The ACORD name and logo are registered marks of ACORD� POLICY NUMBER, 50563-4.0-88 COMMERCIAL AUTO CA 20 48 02 99 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" under the Who Is An Insured Provision of the Coverage Form. This e ndorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below Endorsement Effective, Countersigned By: 09/06/2017 � J � Named Insured: ALFARO COMMUNICATIONS rv_•;,4uthorized Representative) SCHEDULE n " Name of Person(s) or Organization(s): City of EI Segundo (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to the endorsement.) Each person or organization shown in the Schedule is an "insured" for Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured Provision contained in Section If of the Coverage Form. CA 20 48 02 99 Copyright, Insurance Services Office, Inc , 1998 Page 1 of 1