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PROOF OF INSURANCE (2018 - 2019) CLOSED ' "�'""�' Y DATE(MMIDD/YYYY) V CERTIFICATE OF LIABILITY INSURANCE I 7 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 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: N1CIC1e Einertson Hatter, Williams & Purdy Insurance HONE Ext), (760)795-2002 FAX(AIC N.):"(760)929-0534 2230 Faraday Ave AIL ADDRESS:neinertson@hwpinsurance.com INSURER(S)AFFORDING COVERAGE NAIC# Carlsbad CA 92008 INSURERA:West American Insurance Co 44393 INSURED INSURIERBAmerican ,Fire and CasualtyCo 24066, Ace Electric, Inc. INSURER C:ICW 27847 P.O. BOX 601071 INSURER D: INSURER E: San Diego CA 92160 INSURER F: COVERAGES CERTIFICATE NUMBER:17-18 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. /NSR AN 2_W POLICY NUMBER N IMI POLICY DIYYYYI (MMI D/YYYYI LTR TYPE OF INSURANCE LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE 1 X OCCUR EgEM.I.SES(Paa wairr i;c(�p $ 100,000 X BKW56459617 3/25/2017 3/25/2018 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY J X PRO- JECT [_1 LOC PRODUCTS-COMP/OP AGG $ 0,000 OTHER No Deductible $ UTOMOBILELIABILITYCOMBINLU SWGLE LIM11 $ 1,000,000 X ANY AUTO BODILY INJURY(Per person) $ B ALL OWNED SCHEDULED AUTOS ............. AUTOS BAA56459617 3/25/2017 3/25/2016 BODILY INJURY(Per accident) $ NON-OWNED P HIRED AUTOS AUTOS (Per Y)AMAZE $ PER�Tenh Medical payments $ 5,000 X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 6,000,000 B EXCESS LIAB CLAIMS-MADE AGGREGATE $ 6,000,000 ( X DED 1 I RETENTION$ 0 ESA56459617 3/25/2017 3/25/2018 $ WORKERS COMPENSATION X AND EMPLOYERS'LABILIITY Y/N ���STATUTE„,L.........�..E?.RHANY ... (Mandatory I NH)/PARTNER/EXECUTIVE ”""""""I EL EACH ACCIDENT $ 1,000,000 OFFICER/MC (Mandatory in ER EXCLUDED? Y N/A WSD502855203 1/1/2018 1/1/2019 EL DISEASE-EA $ 1,000,000 Ifas,describe under DI,SCRIP'110N OF OPE RA"I"IONS below EL DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Certificate holder is named as Additional Insured as required by written contract. CERTIFICATE HOLDEN CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of E1 Segundo-Public Works THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Attention: Arianne Bola ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street El Segundo, CA 90245 AUTHORIZED REPRESENTATIVE Nickie Einertson/NRE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401) DATE(MM/DD/YYYY) '"CC>RV CERTIFICATE OF LIABILITY INSURANCE 3/23/2017 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 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 cenorsemen (s). PRODUCER ooucERate holder in lieu o such dt . .... ... ...... Cthha'fAcT ....... .... NAME. Nickie Einertson Hatter, Williams & Purdy Insurance PHONE� �t). (760)795-2002 (AMaNp), (760)929-0534 2230 Faraday Ave E-MAIL ADORE$St neinertson@hwpinsurance.com INSURER(S)AFFORDING COVERAGE NAIC# Carlsbad CA 92008 INSURERA:West American Insurance Co 44393 INSURED INSURER B American Fire and Casual„ty„Co 24066 INSU ., Ace Electric, Inc. INSURERC:ICW 27847 P.O. BOX 601071 INSURER D: INSURER E: San Diego CA 92160 INSURER F: COVERAGES CERTIFICATE NUMBER:17-18 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 30LICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IN AODL'S�UP3'R' POLICY EFF POLICY EX I LTR I TYPE OF INSURANCE IN211;l_jW„ POLICY NUMBER IMM/DD/YYYY) (NIM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE X I OCCUR 1P�9EMISI' I�O.fB�;N')("(') i $ 100,000 .. � F(E9JiISE'� L�rarcorwrrenoq X BKW56459617 3/25/2017 3/25/2018 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 2,000,000 JE� POLICY LOC COM II P/OP AGG $ 2,000,000 .%.I V PRODUCTS OTHER No Deductible $ AUTOMOBILE LIABILITY COMINNED"SINGLE IJIAIT $ 1 000 000 ( deo�A9, , , X ANY AUTO BODILY INJURY(Per person) $ B ALL OWNED SCHEDULED AUTOS AUTOS HAA56459617 3/25/2017 3/25/2016 BODILY INJURY(Per accident) $ ( DAMAGE $ AUTOS Par aacgidon'), HIRED AUTOS (Par Medical Pavments $ 5,000 A OCCURRENCE $ 6,000,000 EXCESS AMS-MADE A B GGREGATE $ 6000,000 B X.. .DF.D I .RETENTION..$ ..LAIUR.............0.. ESA56459617 3/25/2017 3/25/2018 $ WORKERS Y/N X,,, TA{TUTE,,,-IERH AND EMPLOYERS'LIABILITY COMPENSATION I �SER OT ANY PROPRIETOR/PARTNER/EXECUTIVE �' ( E L,EACH ACCIDENT $ 11000,000 (Mandatory NH)/ iMBER EXCLUDED? YN/A C ,,, WSD502855203 1/1/2018 1/1/2019 EL DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ 11000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) Certificate holder is named as additional insured re: Recreation Park Phase 4 Lighting Project No. PW 16-26 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of E1 Segundo-Public Works THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Attn• John Gilmour ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street El Segundo, CA 90245 AUTHORIZED REPRESENTATIVE Nickie Einertson/NRE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401) WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 06 34 (Ed. 8-00) ... WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT-BLANKET 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). The additional premium for this endorsement shall be 3% of the total California Workers' Compensation premium otherwise due. Schedule Person or Organization Job Descriction ANY PERSON OR ORGANIZATION FOR RE: ALL CALIFORNIA OPERATIONS WHOM THIS WAIVER IS REQUIRED. Policy Number: WSD 5028552 03 Insured: Ace Electric Inc Endorsement Effective: 1/1/18 Coverage Provided by: Insurance Company of the West Issue Date: 12/26/17 Countersigned by: WC 99 06 34 (Ed. 8-00)