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PROOF OF INSURANCE (2018 - 2018) CLOSED ALC"�"'RV CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDNYYY) 1w� I 01/09/2018 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 this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER ...., .... "CONTACT Stanley McDonald Agency PHCw, lege . McDonald 1101 Main Street (608)- 788 6160 FWe A3t ___._..._...._ 788-7012 ........... Onalaska WI 54650 ADORE S: i'1'mcdonalda waz"n•c' com iNSURER(S)J'k,FFORDING COV'E'RAGE NAIC# 'INSURERA:Rockhill Insurance Company 28053 INSURED INSURER B:The Federal Insurance Co. 202V INSURE 81 A. Nissan Enterprises, Inc. dba - -�"�--°-•••• -• Servpro of Santa Monica/Venice Beach INSURER C: See Below For Named Insured INSURER D: P.O. Box 7545 - Santa Monica CA 90406 INSURERE: I-IINSURERF: COVERAGES CERTIFICATE NUMBER:Cert ID 582 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. I tL TYPE OF INSURANCE SR A P I�rnR POLICY NUMBER 4IWlMOtyDNYYYi„�„iI4PFMDoffOLICY M1 LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 CLAIMS-MADE OCCUR Y ENVP021018-00 09/30/2017 09/30/2018-DAMAGE"10 RENTED P�S, �rrega $ 50.000 MED EXPM�one person) $ 5,000 PERSONAL&ADV INJURY $ 2,,000,000 p .............ER 3,000.._. 0 XEm IPOLVCY .7 AT'E'LIMIT APPLIES PER: 3,000,000 00,000 GENERAL AGGREGATE $ PRO- _. .._._............._..m..........._...._..................w_ JECT LOC PRODUCTS-COMP/OPAGG $ ,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED'SINGLE LIMIT $ (Ea aeo dant$ ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY Peraccldent $ _ AUTOS ONLY AUTOS ( ) HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLYor0dantl $ p, UMBRELLA LIAB OCCUR ENVE021019-00 09/30/201T 09/30/2018 CLAIMS-MADE AGGREGATERRENCE $ 2,000,000 EXCFSSUA6 "w.X.."..IT.-,..,....µ.X... ....................... $ 2.000,000...........,.� X_..m......_...._..flfl......._.ryry......._ DED X RETENTION$ 10,000 $ WORKERS COMPENSATION . .... ... J.PER II"b1H AND EMPLOYERS'LIABILITY Y/N E.L.EACHACON.� ...._V_. R _............................... ANYPRTATIRE OFFICE /MEMB REXC UDED?ECIfIIVE Ng $ OFFICER/MEMBEREXCLl1DED7 � NIA ' (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ WsdescAlbe under RIP'TI'O'N OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A Pollution Liability ENVP021016-00 09/30/2017 09/30/2018 $ 2mil/3mil B Employee Dishonesty 670-65-19 09/30/2017 09/30/2018 $ 25,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Addkional Remarks Schedule,may be attached If more space is required) Named Insured: A. Nissan Enterprises, Inc., dba Servpro of Santa Monica/Venice Beach dba Servpro of Marina Del Rey/Weetchester/El Segundo. City of E1 Segundo, Its Officials And Employees Are Additional Insured Per Attached CG2010 (07/04) And CG2037 (07/04) Additional Insured Endorsement A.T.I.M.A. Policy#ENVP021018-00. Insurance Is Primary And Non-Contributory Per Attached RHIC6048 (02/12) Primary/Non-Contributory Coverage. Policy Includes 30days Notice Of Cancellation 10days For Non-Payment Of Premium. RE: 314 Main Street-Fire Department Station 1. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of S1 Segundo ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street AUTHORIZED REPRESENTATIVE Room 5 E1 Segundo CA 90245-3813 ©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 , a " POLICY NUMBER: ENVP021018-00 COMMERCIAL GENERAL LIABILITY CG 2010 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL IIS RED - OWNERS, LESSEES O 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) OrOrganization(s): Locatlon(s)Of Covered Operations Any person or organization for whom you are performing In respect to any location where the named insured is operations when you and such person or organization have performing"your work". agreed in writing in a contract or agreement,effected prior to the date your operations for that person or organization commenced,that such person or organization be added as an additional insured on your policy. Information required to complete thise Schedule,If not shown,will be shown in the Declarations. A. Section'II--Who Is An Insured Is amended to Include B. With respect to the Insurance afforded to tiiese as an additional Insured the person(s)or additional Insureds, the following additional exclu- organization(s)shown in the Schedule,but only with sions apply: respect to liability for"bodily injury","propertydamage" This insurance does not apply to"bodily injury"or or"personal and advertising injury"caused,in whole or "property darnage"occurring after in part,by: 1. All work,Including materials,parts or equip- 1. Your acts or omissions;or mentfunilshed In connection with such work, 2. The acts or omissions of those acing on your on the project(other than service,, maintenance behalf; or repairs)to be performed by or on behalf of In the performance of our on the additional insured(s)at the location of the P Y going operations for the covered'operations has been completed;or additional Insured(s)at the location(s)designated 2. That portion of"your work°"out of which fife above. injuor damage rises has been put to IIs 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 9 X POLICY NUMBER:l3NVP021018-00 COMMERCIAL GENERAL LIABILITY CG 20 37 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED ED _ OWNERS, LESSEES O CONTRACTORS S - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL UAB1 JTY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Location And Description Of Completed Operations Any person or organization for whom you are performing In respect to any location where the Named Insured is operations when you and such person or organization have performing"your work." agreed in writing in a contract or agreement,effected prior to the date your operations for that person or organization commenced,that such person or organization be added as an additional insured on your-policy. Information required to complete this Schedule,if not shown above,will be shown in the Declarations. Section 11-Who Is An Insured is amended to include as an additional insured the person(s)or organization( )shown in the Schedule, but only with respect to Ilabiliry for"bodily injury"or"property dam- age"caused,in whole or in part,by"your worm'at the location designated and described in the sched- ule of this endorsement performed for that additional insured and included in the"products-completed operations hazard". d CG 20 37 07 04 0 ISO Properties,Ina, 2004 Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. 1 'RI ARYMO -CONTRI UTORY COVERAGE This endorsement modes insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART CONTRACTORS POLLUTION LIABILITY COVERAGE PART TRANSPORTATION POLLUTION LIABILITY COVERAGE PART PRIMARYMON-CONTRIBUTORY—If required by written contract or agreement,effected prior to the date your operations for that person or organization commend and named below,such insurance as is afforded by this policy to any additional insureds under this policy shall be primary insurance,and any insurance or self-insurance maintained by such additional insured(s)shall not contribute to the insurance afforded to the named insured. All other terms and conditions remain unchanged. SCHEDULE Anyperson or organization for whom you are performing operations when you and such person or oigani7ationhave agreed in writing in a contract or agreement,effected prior to the date your operations for that person or organization connnced,that such person or organization be added as an additional insured on your policy. RHIC 6048(02/12) Includes Copyrighted Materialof Insurance Services Office,Inc. Page 1 of 1 with Its permission CI CW A02 10 11 CERTIFICATE INSURANCE This certificate is issued for informational purposes only. It certifies that the policies listed in this document have been issued to the Named Insured. It does not grant any rights to any party nor can it be used, in any way, to modify coverage provided by such policies. Alteration of this certificate does not change the terms, exclusions or conditions of such policies. Coverage is subject to the provisions of the policies, including any exclusions or conditions, regard- less of the provisions of any other contract, such as between the certificate holder and the Named Insured. The limits shown below are the limits provided at the policy inception.Subsequent paid claims may reduce these limits. .............. ...................................................._......_.............._...._......................................... -.........._......._.......................................... Certificate Holder. Named Insured; __.........................r_�_-..... w........ __...,................... .. Automobile _............. ................._ a Liability Insurer Name: Allstate Insurance Yw.ompanv w............d_...................... ..... .... .... Policy Number. 1 -Any Auto 2-_Owned Autos Only 3-Owned Priv,Pass.Autos Only PassO.Autos Onl Autos.Other Than Priv w...._- Fault Autos Subject ..t®... rrrrr .. . .,,,,,,,,....... .. ._._�._,. �_...............___.......................�..�..... wned 0 6—Owned Autos Subject to a Compulsory Ute Law — .,.�...................._....._w__ 7-Specifically Described Autos 6-Hired Autos Only 9-Non-owned Autos Only ................ - _.. Policy Effective Date: Policy Expiration Date.. Limits Of Combined Single Limit(each accident) Insurance - ----- ........ 61 Per Person 1 Per Accident PD Per Accident Description of 0 pe rationsi Locations/Ve hides/Endorsements/Special Provisions Type; Interested Part __ ... TI-IIS CERTIFICATE DOES NOT G NT ANY COVERAGE OR FLIGHTS .O^. THE CERTIFICATE HOLDER, IF THIS CERTIFICATE INDICATES THAT THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED, THE POLICY(IES) MUST EITHER BE ENDORSED OR CONTAIN SPECIFIC LANGUAGE PROVIDING THE CERTIFICATE HOLDER WITH ADDITIONAL INSURED STATUS. THE CERTIFICATE HOLDEN IS AN ADDITIONAL INSURED ONLY TO THE EXTENT INDICATED IN SUCH POLICY I AI`iGGAGE. OR ENDORSEMENT _................................................ ....._. ........._ _._w...... _ ......_ .....ww_ ,.,.,...................... Producer. Authorized Representative atrwre Date; n Includes copyrighted material of Insurance Services Office, Inc., with its permission Cl CW A02 10 11 Allstate Insurance Company Pap 1 of 1 h„44w o ..J .,our POLICYNUMBER, , COMMERCIAL AUTO CA 20 48 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED FOR COVERED AUTOS LIABILITY COVERAGE This endorsement modifies insurance provided under the following! AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverme provided by this endorsement, the provisions of the Coverage Form apply unless 9 modified by this endorserr*nt. Tll,,,3s enclarsernent tdenfifies person(s) or organization(s) who are"insureds"for(,',Qvered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement does not alter coverage prcwidecl in the Coverage Fom's This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: Endorsement Efive Date: SCHEDULE w S Information required to cornplete this Schedule, if not shown above. will be shown in the Declarations. Each person or organization shown in the Schedule is an "insured"for Covered Autos Liability Coverage, brut only tcthe extent that person or organizition qualifies as an `in,. ured" under the Who Is An Insured provisuon contained in Pafagiaph A.I. of Section If — Covered Autos Uabiihty Coverage, in Me Bu sines's Auto and Mot(jr Carrier Covetxje Forms ana Pafiagraph D.2, Of SeCjar)rj I —r Co�ierpd kolos Coverages of the Auto Dealers Coverage Form. CA 20 48 10 13 Q Insurance Services OffiGe. Inc., 2011 Page 1 of 1 Policy Number 648535371 8 lCoHEDULEOF NAMED I'll U,, ailette Instural rice Company NamdInsurad A , 12',01 AA1 , Sondard 'hme .Agent Name DAVID THOMAS r)t E !7 13lj OM CW 03 0110 Allstate kwurartu)Cornptv-y m1,wm,d iv j,A Copf ACORD ,CERTIFICATE OF LIABILITY INRANCE 1 DA01/09/ 18Y) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE JVRC Insurance Services, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 5707 Corsa Avenue, Suite 105 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Westlake Village, CA 91362 INSURERS AFFORDING COVERAGE INSURED INSURER A: Benchmark Insurance Company A.Nissan Enterprises,Inc. INSURER B, dba Servpro of Santa Monica/Venice Beach dba Servpro of Marina Del Rey/Westchester/EI Segundo INSURER C, 5252 W.111th St INSURER D, Los Angeles,CA 90045 .................................. INSURER E, COVERAGES 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 i POLICIES.AG6REGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR POLICY EFFECTIVE POLICY EXPIRATION' _„LIR TYPE OF INSURANCE POLICY NUMBER DATE WNLDDIYYi,_„ IDATE(NlWD=1 LIMITS GENERAL R OCCURRENCE $ COMMERCIAL GENERAL LIABILITY FIREDAMAGE(Any on-----e fire) $ IIII ---CLAIMS MADE OCCUR MED EXP(Any one person) $ V PERSONAL&ADV INJURY GE NERAL AGGREGATE GENT AGGREGATE $ y GATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG policy $ ........ project c..... loc ........_____................................www..... AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO ...�-E.a.-accident) .. $ ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ ....................................................................................... HIRED AUTOS BODILY INJURY NON-OWNED AUTOS ( ) $ Per accident PROPERTY DAMAGE $ (Per accident) ..._._......... GARAGE LIABILITY AUTO ONLY-EA ACCIDENT S ANY AUTO AUTO ONLY: EAAACC OTHER THAN $ G a EXCESS LIABILITY EACH OCCURRENCE $ ElOCCUR CLAIMS MADE AGGREGATE ___a_..._............................................................. DEDUCTIBLE $ RETE:NTlION a$ �+T CSI 501 0093 E .EACH ACCIDENT FR $ WORKERS 04/19/2017 04/19/2018 ���� 000,000 EMPLOYERS'COMPLIABILENSATION AND X A L 1,000,000 E L. DISEASE-EA EMPLOYEE', $ ................... E .DISEASE-POLICY LIMIT $ 1,000,000 OTHER DESCRtPTIONOFOPERATIONSfLOCAVON'SBVEH@CLESIEXCLIIS'IONS ADDED BY ENDORSE'MENTISPECIAL ORS CERTIFICATE HOLDER I ADDITIONAL INSURED:INSURER,LETTER: CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION City of EI Segundo DATE THEREOF,THE ISSUING INSURER WILL MAIL 3O DAYS WRITTEN 350 Main Street RM 5 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, EI Segundo, CA 90245 AUTHORIZED REPRESENTATIVE ACCORD 28-S(7/97) (DACORD CORPORATION 1988 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 .. .......................................................................................... . ..............wwwww..............ww...... (.E.a..:....4�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. 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 04/19/2017 Policy No. CST5010093 Endorsement No.1 Coverage Dates: 04/19/2017-04/19/2018 Premium $ Insured A Nissan Enterprises, Inc Carrier Name/ Code: Benchmark Insurance Company A WC 0 8 ) 06 dCountersigned by �. ©1998 bV the Worker's Insurance Ratinq Bureau of California. All rights reserved.