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PROOF OF INSURANCE (2018 - 2018) CLOSED IV CERTIFICATE OF LIABILITY INSURANCE I DATE(MMIDDIYYYY) ,. 5/2/2017 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 pollcy(les)must 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). p��I PRODUCER CONTACT qt Knight InsuranceServices Boulevard RAI,iArta�E NysaG@Rni2htIns "' ""' IN!C.NoFAX i.,lelel66z-9312 535 North Brand AM"1F$$ y g net 420.0.'...... suits INPIJ 00 CA 91203 INSURERA- ty SurplusDlInsu a c - --, -,- NAIC Glendale...... ---- .Liberty Insurance Company 10725# ° INSURED NSLI,RE,R a 0epositora, In.$uranae Company 42587 All City Management Services Inc Ido, t Iia ix p- ana,tran W"C�lal�al y OMPAtly, ...., 4.2,3,74 10440 Pioneer Blvd # 5 hawsu5aE o, a Burlin agton Insurance Ctacnpany 236,20 INSUREIR J$, Santa Fe Springs CA 90670 INSURER F; COVERAGES CERTIFICATE NUMBER.-17/28 Master 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. d TYPE OF INSURANCEI WYD ......,.. I ][ COMMERCIAL GENERAL LIABILITY A BOL''S'UaR POLICY NUMBER (M�F��F:6'F� PC�LIO'M""�,I OhlriNaC#�E�TO�RF'I"I'EI� TS .. 600'YYYI rAaMp47�]v LIMITS EACH RENCE $ 1,000,000 A II CLAIMS-MADE OCCUR I F*)4I$E$IE'n q pprn ), 50,000 :k X 100020084302 5/1/2017 5/1/2018 LAMEDE (Any one pe=n) Excluded.., LIAGGREG BURY $ 1,000,000 GENT AGGREGATE LI PERSON D LIMIT APPLIES PER I GENERA AGGREGATE $ 2,000,000 „yF,O,p 1 O LOC PRODUCTS-(,OMP/OPAGG S 2,000,000 I OTHER S AUTOMOBILELIABILITY =161-111P tNtAtL°ISII $ 1,000,000 A........, I��OI."" '1 B ANY AUTO 64 TV.111 V"I.rI,IIJYt Y'llrr n,"roam>nV S AOWNED SCHEDULED AUTOS AUTOS X ACP7855954504 4/1/2017 4/1/2018 (Pr Y x, HIRED AUTOS X AUTOS IPar P'14).wY,�ACaI. S y �, NON-OVNJED I Rear i:R'I I - ---- I... .... CLAIMS-MADE II Y ( � rk07mIU"rW".Ak. 1f ,�' 3 UMBRELLA LIAR let Layer Prima ) r,Ak I Occ '40V ,P.I^I„ 31,000,000 C X EXCESS UAB 000r000 :PO.,Iy RkTENT10N 0 X H17XC5074400 � 5/1/2017 5/1/2018 g WORKERS COMPENSATION PTA II AND EMPLOYERS'LIABILITY B$ U,rl'Iy1 N @,';a NIA App _ r4.f r E �AandakoryInNH) L ExCwoE07 YIN ,P...`.;uA5r. ;uC-h4V:'o"r. I.uwVr�I:O 5 AN"� PROPRIETOWPARTNERIEKECUTIVE Not Applicable I-I -, II yy+ea d4.9criCaari iYrpf)%P'C RM11040F OPERAT'I'ONS 00'cWk F a. d:ai::aEASI.,•("CFl,71;"!'O.INAI r, D Excess Liability 2nd Layer (Secondary) 5/1/2017 5/1/2018 1"'r acl'n:,nc.uoxnccv111[ara�rdr or $5,000,000 Oce $0 Retention EFF0004884 $3M pni'la,g I mil $5,000,000 Agg DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached If more space to required) As respects General Liability and required by written contract; Certificate Holder is named as additional insured. Insurance is Primary & Non-Contributory. Waiver of Subrogation applicable. Auto Liability Additional Insured included as rquired by written contract. I CERTIFICATE HOLDER CANCE'LLAT'ION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE El Segundo;Deborah Cullen THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Finance Director ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street El Segundo, CA 90245 AUTHORIZED REPRESENTATIVE INi�trrly° hi:i.dl',lac-tu.,lca/P�P'u„(t.'!.I, ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INS025 nm am I Liberty Commercial General Liability Corporal ion . LIBERTY SURPLUS INSURANCE CORPORATION (A Nlc\i,Hampshire ampshire Siack Tnsurance Company,hereinafter the"Company") ENDORSEMENT NO. Effective Date: 05/01/17-05/01/18 Policy Number: 100020084302 Issued To: All City Management Services,Inc. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED—OWNERS,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 Any person or organization for whore you are All locations of covered operations, performing operations when you and such person or organization have agreed in writing in a contract or -agreement that such person or organization be added as an additional insured on your policy; Any other person or organization you are required to add as an additional insured under the contract or agreement described in the paragraph above. (Information required to complete this Schedule,if not shown above,will be shown in the Declarations) A. Section 11®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: 1. Your acts or omissions;or 2, The acts or omissions of those acting on your behalf-, in the performance of your ongoing operations for the additional insured(s)at the location(s)designated above. B. With respect to the insurance afforded to these additional insureds,the following additional exclusions apply: This insurance does not apply to"bodily injury"or"property damage"occurring after: 1. All work,including materials,parrs or equipment furnished in connection with such work,on the project(other than service,maintenance or repairs)to be performed by or on behalf of the-additional insured(s)at the location of the covered operations has been completed;of M 2 CG 20 10 07 04 (0 ISO Properties,Inc.,2004 Liberty Stirphis Insurance Commercial General Liability Col-l-wral ion'. 2. That portion of"your work"out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. 2 CG 20 10 07 04 ©ISO Properties,Inc.,2004 90-%4 Liberty Surj,)his I nstirance Commercial General Liability Corporatimi LIBERTY SURPLUS INSURANCE CORPORATION (A New Hampshire Stock Insurance Company,hereinafter the"Company") ENDORSEMENTNO. Effective Date: 05/01/17-05/01/18 Policy Number: 100020084302 Issued To: All City Management Services,Inc. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, PRIMARY INSURANCE CLAUSE ENDORSEMENT To the extent that this insurance is afforded to any additional insured under the policy,such insurance shall apply as primary and not contributing with any insurance carried by such additional insured,as required by written contract. Notivng herein contained shah be held to waive,vary,alter or extend any condition or provision of the policy other than as above stated. MI-21-1 CGL 10 3104 03 Liberty Surplus,Insurance Commercial General Liability Ccarpor r'iom. LIBERTY SURPLUS INSURANCE CORPORATION (A Nc%v Hampshire Stock Insurance Company,hereinafter the"Company") ENDORSEMENT NO. Effective Date: 05/01/17-05/01/18 Policy Number: 100020084302 Issued To: All City Management Services,Inc. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, 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: As required by written contract signed by both parties prior to any"occurrence"in which coverage is sought under this policy. 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. 1 CG 24 04 05 09 (D Insurance Services Office,Inc.,2008 "1?0 CERTIFICATE OF LIABILITY INSURANCE °A�'MM'°Drfml �+e�w �I/.�r2u1� 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 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 Assurance Agency., Ltd. r HONE cFAX Nr,MFw Chris,f.�aWI'rJrr1 One Century Centre .Exit;(047),163-7,2.1..6. R Wr,1+o:( 41)440'-9'126 1750 E. G)ol(Road AD°:tares, �fa)stf I I'f�asslJralls 'agdrrocy ccni SchaumburgIL 60173- INSURER(S)AFFORDING GOVERAGE Iklr1G A IN V�RER,w.�P.rDt t(Y. .Bn� .rare ..Company INSURED INSURER B,;,,,,,,,,,, Personnel Staffing Group, LLC INSURER C: a KBS Staffing INSURER D. 1751 La'k'e Cook Road,Suite 600 INSURERS I Deerfield IL 60015 INSURER F: COVERAGES CERTIFICATE NUMBER:'1556240023 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. OLTP TYPE OF INSURANCE, „ ADU$I"SI I POLSunk' ICY EFF POLICY EXP NUMBER (MMIDDrYYVXI IMMdOed'a"'waYY1 LIMITS GENERAL LIABILITY EACH OCCURRENCE S OAMA'GE TO RtNTED k cLAIh9..,.MAGC•: �I,I�d,ABlf4.lr5" PrI,I°.!~'+nSlm�la Ic'or�rs,arggr"�W") MSM"ak'mI:RB OCCUR ,fin„Mcanspprson) S '� MEIa EXP d PERSONAL&ADV INJURY 5 ...,,...... '' GENERAL AGGREGATE I. C%CNN AGGREGATE I1 APPLIES 6*ROYL.KI$ CO? ICP AGG p Ia $S AUTOMOBILE LIABILITY xafla»1D741"oI'T"I"T MIT i (I"41rr�cltdrnrl S ANY AUTO HONLY INJURY(Po"per,an) 5 ALLOWNE6 EtPa1:31LV INJURY PeP acarieni S AUTOS AUTOS ( ) P>F&OPLR'Im'D AGE HIRED AUTOS AUTO OWNED u �,,'_�SCHEDULED AUTOS I (p,'anr,II,CroB,8,or91,I S UMBRELLA LIAR OCCUR _ EACH OCCURRENCE EXCESS LIA, 6M'S M, CLOADE AGGREGATE $ DED] $ AND EMPLOYERS'LIABILITY i TCS ai A WORKERS COMPENSATION RWO08962 11/1(2017 1/1/2D16 X V %Ernr'g1' OTI I• A ?,Ifl„rl'T5 rr Y t N WD001462 1(1(2D1'7 1/1/2D16 ANY P?OPRIERJR�PARTNERIE.XECUTIVEr���---ry��� EL EADIACCIDENT 51,000,000 OFFICE R tMEIUBE R EXCLUDED? _ (Mandatory in NH) E L DISEASE. EA ENAR OYES, $1.000,000 If yes,describe under DESCRIPTION OF OPERATIONS below, E L DISEASE-POLICY LIMIT $1.0DD,DOD DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required) mm........r_ � Proof of Insurance RE: Employees assigned by All City Management Services dba The Crossing Guard Company 10440 Pioneer Blvd Suite 5,Santa Fe Springs CA 90670 See Attached... CERTIFICATE HOLDER _. �..mm..mm.....__� CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of EI Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Cii CitMain Street ACCORDANCE WITH THE POLICY PROVISIONS. EI Segundo CA 90245 AUTHORIZED REPRESENTATIVE P ©1988.2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: , LOC#-. ADDITIONAL REMARKS SCHEDULE Page 1 of AGENCY NAMED INSURED Assurance Agency,Ltd. Personnel Staffing Group, LLC .......... diba KBS Staffing POLICYNUMBER 1751 Lake Cook Road, Suite 600 Deerfield IL 60015 CARRIER NAIC CODE EFFE"C"WE DATE, : ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE .................--l-1--1 -, ...... ....... A Waiver of Subrogation applies to the Workers Compensation policy in favor of the following entities,when required by written contract and where allowed by law City of El Segundo ACORD 101 (2008101) 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 0313 ................ WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT We have the right to recover our payments frorn anyono fiable for an injury uovered by this policy.We will not enforce our right against the person or organization narned in the Schedule. (This agreement applies only to the extel)l that you perform work under a written contract that requires you to obtain this agreement from us) This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule Where required by written contract 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.) Policy Effective 0110112017 Endorsement Effective 0110112017 Policy No.WD001482 Endorsement No. Insured PERSONNEL STAFFING GROUP,LLC DBA KBS STAFFING Premium Insurance Company Protective Insurance Company Countersigned by.— WC 00 03 13 (Ed.4.84)