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PROOF OF INSURANCE (2018 - 2018) CLOSED F CERTIFICATE OF LIABILITY INSURANCE g °A05/19°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(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 Ws certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER CONTACT Rich Higgins 6: Associates Insurance Agency PHDNE ,AM CA License #0691071 �T, (714) 536-6086 ( 1 FIX FAlf".Not(714) 536-4054 305 17th Street "MAUL Huntington Beach CA 92648 .60nRESS: richobai-ine.com INSURER(S)AFFORDING COVERAGE MAIC Y INSURFR A:Houston Specialty Insuraance Co 12936 INSURED 4310) 618-2600 INSURERS:Nationwide Mutual insurance Co 23787 Carter Services, Inc. INSURER C:Mercer IIISuranCe Co 114478 2807 Oregon Court, P3 INSURER D:Security National Insurance Co J19879 Torrance CA 90503 INSURER E: Q INSURER F: N COVERAGES CERTIFICATE NUMBER:Cert ID 796 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, NOTWI'THSTANDIN'G ANY REOUIREMEIgTi',TERM OR CON0111ON 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, EXCLU'S'IONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I� TYPE OF INSURANCE A0OL,5UBRd POLICY EFF POLICY EIIP IN9Q MD0A POLtCYNUMBER (MMd000YYY1!1 'q LIMBS A g 11 COMMERCIAL GENERAL LIABILrrY EACHOCCURRENCE S 11000,000 VAMAG)m TO MEN]kO CLAIMS•MADE X OCCUR Y TEN-19532 06/15/2017 06/15/2018 PREMBSFS4Es ommagaaL S 100.000 MED EXP(Any oneperson) $ 51000 PERSONAL&ADV INJURY $ 11000,000 GE NIL AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE S 2,000,000 POLICY�X JECT LOC PRODUCTS-COMPIOPAGO S 2,000,000 OTHER: .Bapl Benefits Liab $ 1,000,000 AUTOMOBILE LIABILITY OMBdNED SINGLE LIMIT entl $ 1,000,000 B X ANYAUTO ACP 3047747466 06/15/2017 06/15/20186 BODILY INJURY(Per person) S OWNED SCHEDULED BODILY INJURY Par accident) S AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ - AUTOS ONLY AUTOS ONLY dPa(arc(dantl -v $ C UMBRELLALIAB N OCCUR 27305208 06/15/2017 06/15/2018 EACH OCCURRENCE S 5,000,000 X IEXCESSLUIB CLAIMS-MADE AGGREGATE S 51 000,000 DED I X IRIFTENTION$ NIL $ WORKERS COMPENSATION PER OTH• D AND EMPLOYERS'LIABILITY YIN Y SWC1148594 04/01/2017 04/01/2016 X I STATUTE ER ANYPROPRETORIPARTNER/EXECUTIVEE.L.EACH ACCIDENT $ 1,000,000 OFFICERIMEMBEREXCLUDED7 F-1 NIA (Mandatory In NH) E.L.DISEASE•EA EMPLOYEE S 1,000,000 Ifyyas dasafbe under DF,SRUPTUON OF OPERATIONS below ^ E.L DISEASE-POLICY LIMIT S 1,000,000 S S DESCRIPTIONOF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101.Additional Remarks Schedule,may be attached If more space Is required) The City of El Segundo, its officials and employees are named as additional insureds with respects general liability policy limits. Primary and non-contributory wording applies with respectsIgeneral liability policy limits. Waiver of subrogation applies with respects workers compensation policy limits. CERTIFICATEHOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of El Segundo ACCORDANCE WITH THE POLICY PROVISIONS. City Clerk 350 Main Street, AUTHORIZED REPRESENTATIVE Room 5 �` 1 Bl Segundo CA 90245 _fV' ©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#TEN-19532 COMMERCIAL GENERAL LIABILITY CG 2010 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES 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 Organization(s): Location(s)Of Covered Operations Only those parties required to be named as an Addi- ALL tional Insured in a written contract with the Named Insured under this policy,entered into prior to loss or "occurrence". 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 exclu- organization(s) shown in the Schedule, but only sions 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: i. Your acts or omissions;or 1. All work, including materials, parts or equip- ment furnished In connection with such work, 2. The acts or omissions of those acting on your on the project(other than service, maintenance behalf; or repairs) to be performed by or on behalf of in the performance of your ongoing operations for the additional i'nsured(s� at the location of the the additional Insured(s) at the location(s) desig- covered operations has been completed;or nated above. 2. That portion of "your �rork"" out of which the injury or damage arises) has been put to its in- tended use by any person or organization other than another contractor or subcontractor en- gaged in performing operations for a principal as a part of the same project. CG 2010 07 04 0 ISO Properties, Inc.,2004 Page 1 of 1 p WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed.01-84) 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 2%of the California workers'compensation premium otherwise due on such remuneration. Schedule Person or Organization Job Description Any person or organization as required by written contract, $2,796.00 ; u.. This endorsement changes the policy to which it Is attached and is effective on the date issued unless otherwise stated. (The Information below Is required only when this endorsement Is Issued subsequent to preparation of the policy.) Endorsement Effective 4/1/2017 Policy No. SWC1148594 Endorsement No. 0 Insured Carter Services,Inc. Premium$ 88012 Insurance Company Security National Insurance Company Countersigned by WC 04 03 06 (Ed.01-84)