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PROOF OF INSURANCE (2018 - 2018) CLOSED OATE(MM9DDIYy'YY') CERTIFICATE OF LIABILITY INSURANCE 1212(,r�tll7 THIS CERTIFICATE is Nt4SUITD AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE BOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOYIN, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER, IMPO TA T, 1(16 carli t aka Ntold r N an Cd PI IkCti A NfJ N D,tyre laoNl N y r r NMS ha aw�, �Dre � Nf SUBROGATION IS AN subject t� the tome and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the lieu of such endorsetnant(s rPR certificate balder in...... .. . _,,...»,�......_.�___.�._...�,.... ..ItR A �"�c�,,. .. , . . ce I, eras Republic Insulnnce Scrvices W 914,336.0300 4c,Noy; oouc E West p � a Bal$: ,-- 19900 Beach Blvd it Suite F l INSURERIA)APFORMG COVERAGE NAIL M Huntington Beach CA 92648 INSURER A: NORGUARD INS CO INSURED INsuRER B: KINSALE INS CO 38920 Manuel Alba Moreno dba Golden Meters Service INSURER C: CALIFORNIA AUTOMOBILE INS CO 14812 Hunter Lane INSURER D: NATIONAL UNION FIRE INS CO OF PITT,PA INSURER E Midway City CA 92655 i INSURER F: COVERAGES CERTIFICATE NUMBER, 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. INSH "NASJu�,.,�ubft' YULILY 101. PULIL "P LTR TYPE OF INSURANCE I(NSD WVD POLICY NUMBER (MMIDDIYYYY) (MWODIYYYY) LIMrrS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 �iUAA�nwc e!rsca^AILu CLAIMS-MADE X OCCUR PREMISES Ea occurrence) $ 100,000 _ I MED EXP(Any one person) $ 5,000 B Y Y 01000320092 09/09/2017 09/09/2018 PERSONAL s ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY ❑PEP LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: CGL $ AUTOMOBILE UABIUTY � WM81NLU SINGLE"LI'Miil $ 1,000,000 Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOSSCHEDULED C AUTOS Y Y BA040000002873 11/02/2017 11/02/2018 BODILY INJURY(Per accident $ NON-O_ X AUTOS X HIRED AUTOS X AUTOSWNED (Per accident) $ '_:;('UMBRELLA WAS X OCCUR EACH OCCURRENCE $ 2,000,000 D EXCESS LIAS CLAIMS-MADE EBU 13207526 09/09/2017 09/09/2018 AGGREGATE $ 2,000,000 - DED��RETENTION$ $ -_PIG tri COMPEN9ATIOtn XISTATUTE I �ERn AND EMPLOYERS'LIABILITY ANY PROPRIETOPJPARTNERk EXE'CU'TIiVE' Y/N E.L.EACH ACCIDENT 1$ 1,000,000 A OFFICERIMEMBEREXCLUDED? NIA Y MAWC891579 03/07/2017 03/07/2018 ;Mandatory In NH) E.L.DISEASE-EA EMPLOYEE N S 1,000,000 ;q yq9 dosalba undor CFS RIFTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT V.S 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHIC_ES (,-,CORD 101,Additional Remarks Schedule,maybe attached It more space is oe"h*Q Those usual to the insured's operations.A blanket additional insured and blanket waiver of subrogation are included with the general liability and commercial auto policies.Additional insured status is automatically granted where required by written contract.A Waiver of Subrogation applies in favor of Owners Parties for Workers Compensation,General Liability,Auto and Umbrella policies where required by writteD contract.The certificate holder is named as additional insured where required by written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN City of EN Segundo ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main St. AUTHORIZED REPRESENTATIVE EI Segundo,CA 90245 e Pi � r ................................... .......................................... ©19$8-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD THIS ENDORSEMENT CHANGES ICY.PLEASE READ IT CAREFULLY. ADDITIONAL INSURED AS REQUIRED BY WRITTEN CONTRACT AttachedN„To and Form. .., µ, b ” . .. .. .Mµ.m. s w w . wn w w mow„ , !ng Port o/Pollry Effective nate of Endorsement Named insured 0100032009-2 09/09/2017 12:01AM at the Named Insured Manuel Alba Moreno address shown on the Declarations Additional Premium; Return Premium: $0Mw. u , This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE A. SECTION II-WHO IS AN INSURED is amended to include any person or organization you are required to include as an additional insured on this policy by written contract in effect during the policy period and executed prior to the "occurrence"of the"bodily injury"or"property damage", but only for the vicarious liability imposed on the Additional Insured provided that such liability is caused by the sole negligent conduct of the Named Insured and is proximately caused by"your work"or"your product"for the Additional Insured. B. The insurance provided to the Additional Insured under this endorsement is limited as follows: 1. In the event the written contract requires limits of insurance in excess of the Limits of Insurance provided by this policy,the Limits of Insurance provided by this policy shall apply and not the limits required by the written contract.This endorsement shall not increase the Limits of Insurance stated in the Declarations of this policy. 2. This insurance does not apply to"bodily injury"or"property damage"arising out of"your work"or"your product'included in the"products-completed operations hazard"unless you are required to provide such coverage by written contract. If such insurance is required by written contract, the insurance provided to the Additional Insured is limited to the alleged or actual vicarious liability imposed on the Additional Insured as a result of the alleged or actual negligent conduct of the Named Insured as a result of liability solely caused by "your work"or"your product"for the Additional Insured. 3. Any insurance provided by this endorsement to an Additional Insured shall be excess with respect to any other valid and collectible insurance available to the Additional Insured unless the written contract specifically requires that this insurance apply on a primary and non-contributory basis, in which case this insurance shall be primary and non-contributory. 4. Where there is no duty to defend the Named Insured,there is no duty to defend the Additional Insured. Where there is no duty to indemnify the Named Insured,there is no duty to Indemnify the Additional Insured. 5. This insurance does not apply to"bodily injury"or"property damage,"arising out of the sole negligence of the Additional Insured or any employees of the Additional Insured, C. Duties of the Additional Insured in the event of"occurrence",claim or"suit": 1. The Additional Insured must promptly give notice of an "occurrence",a claim which is made or a"suit',to any other insurer which has insurance for a loss to which this insurance may apply. 2. The Additional Insured must promptly tender the defense of any claim made or"suit'to any other insurer which also issued insurance to the Additional Insured as a Named Insured or to which the Additional Insured may qualify as an Additional Insured for a loss to which this insurance may apply. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. CAS5010 0717 Page 1 of 1 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed."4) 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 thls 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 of the California workers' compensation premium otherwise due on such remuneration. Schedule Person or Organization Job Description Blanket Waiver-Any person ororganization forwhornthe All CA Operations Nand Insured has agreed by written contract to furnish this waiver. 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 Policy No MAWC891579 Endorsement No. Insured Insurance Company Countersigned By 01998 by the Workers'Compensation Insurance Rating Bureau of California.All rights reserved.