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PROOF OF INSURANCE (2018 - 2018) CLOSED ELITEWA OP ID:EK ACORO' CERTIFICATE OF LIABILITY INSURANCE DATE IM8/20 ozio /2o8 18 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). PODUCER rakke-SchafnitzIns.Brokers pHCE64C BIIAR License#OK07568 ) °NxE.949 365 5128 ardr.949-365-5161 �A+,,t� 28202 Cabot Road,Suite 600 E-MAIL. ADDr¢( "a sa.4tuehltsig.uS Laguna Niguel,CA 92677-1251 h „ ..... Richard Kuehn INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:Ohio Security...Insurance Co........................ ............................ ........ ........, 2 4082 INSURED _. Bayshore Water Conditioning, 2 . gr INSURER B Inc.Elite Water Systems 10611 Calle Lee Suite 113 INSURER c: Los Alamitos,CA 90720 INSURER D: INSURER E: INSURER F: COVERAGE'S CE'RTIFiCATE 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. INS ' At7DC". �_ . ....... ... .... ....i...'PdQCY F.�.- .,...... .. ... .. ... LIMITS,,,,,, TYPE OF INSURANCE r POLIO L'XP LTR IN POLICY NUMBER pMMJDDd"MY) C(dbMM00YY"XY1 A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 CLAIMS-MADE 01 X„ occuR BK856288512 12/30/2017 12/30/2018 ( a cnJ.. s 500,000 MED EXP(Any one person) s 5,000 ..... ................... ................. ....... PERSONAL& ..000,000 ADV INJURY S GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000 JECOT LOC P, GG S 2,000 ,0. 00 0 .. POLICY PRODUCTS-COMP/OPA OTR°HER: AUTOMOBILE LIABILITY B COMBINED SINGLE LIMI I S (%_o n"dura ......................... ANY AUTO BODILY INJURY(Per person) S ALL OWNED SCHEDULED AUTOS AUTOS UT BODILY INJURY(Per accident) $ ..._.. .. „ ON HIRED AUTOS AUTOS (�pOP I?dph9DA 1AQE S $ Y UMBRELLA LIAB ---" EACH OCCURRENCE CLAIMSEXCESS LIAB MADE ................................................................................................ 5 AGGREGATE S DED RETENTIONS.. -.................. - ._� II S WORKERS COMPENSATION STATUTE V EORH AND ER YPN' -- ---- --- ----- -,---- ANY PROPRIETOR/PARTNER/EXECUTIVE E L.EACH ACCIDENT S OFFICER/MEMBER EXCLUDED? N/A (Mandatory In NH) E L-DISEASE-EA EMPLOYEE S UIF yyes,describe under DESCRIPTION OF OPERATIONS below E DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) It is agreed Certificate Holder is additional insured as required by written contract per attached End.#CG88620413. CERTIFICATE HOLDER CANCELLATION CITYSEG SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CI t of EI Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN y g ACCORDANCE WITH THE POLICY PROVISIONS. Fire Deptartment 314 Main Street EI Segundo,CA 90245 AUTHORIZED REPRESENTATIVE II ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABILITY CG 88 62 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, ADDITIONAL INSURED - BLANKET VENDORS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART ^� PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART A. Section II -Who Is An Insured is amended to include as an additional insured any person(s) or organiza- tion(s) (referred to throughout this endorsement as vendor) whom you have agreed to add as an additional insured in a written contract or written agreement, but only with respect to "bodily injury" or "property damage" arising out of "your products" which are distributed or sold in the regular course of the vendor's business. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and x 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these vendors, the following exclusions apply: 1. The insurance afforded the vendor does not apply to: a. "Bodily injury" or "property damage" for which the vendor is obligated to pay damages by reason of the assumption of liability in a contract or agreement. This exclusion does not apply to liability for damages that the vendor would have in the absence of the contract or agree- ment; b. Any express warranty unauthorized by you; c. Any physical or chemical change in the product made intentionally by the vendor; d. Repackaging, except when unpacked solely for the purpose of inspection, demonstration, test- ing or the substitution of parts under instructions from the manufacturer, and then repackaged in the original container; e. Any failure to make such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products; f. Demonstration, installation, servicing or repair operations, except such operations performed at the vendor's premises in connection with the sale of the product; g. Products which, after distribution or sale by you, have been labeled or relabeled or used as a container, part or ingredient of any other thing or substance by or for the vendor; or In. "Bodily injury" or "property damage" arising out of the sole negligence of the vendor for its own acts or omissions or those of its employees or anyone else acting on its behalf. However, this exclusion does not apply to: (1) The exceptions contained in Subparagraphs d. or f.; or (2) Such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products. C. This insurance does not apply to any insured person or organization, from whom you have acquired such products, or any ingredient, part or container, entering into, accompanying or containing such products. © 2013 Liberty Mutual Insurance CG 88 62 04 13 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Page 1 of 1 Cl CW A0210 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. Automobile LiaWity Insurer Name; Al9state Insurance Couiroisy Policy t+IVlul,ru'hu' I An, Auto ( s Only 3--Owned Priv.Vass.Autos Only d-Owned .Than Priv, 5-Owned Autos Other , s Subject to No � 16_Owned Autos Subject to a Compulsory UM Law Pass,Autgs Only Fault ffNon-owned.. "Iv 17_ 'or.!r pti,ally C)tscribed Au or; �-Hired Autos OraVy° p':i 19- . Autos fir" Policy Effective Date. (' i 2 01 Policy Expiration Date,. 8-.1 s-2 t;;,K Limits Of Combined Smgie Limit iear h aC ad(anl) nsurance. BI Per Person BI Per Accident PD Per Accident ._ _..,,,..... _ mm . .........,. __. Description of operations$LocationslVehicleslEndors,ements/Special Provisions Interested Party Typo: , THIS CERTIFICATE DOES NOT GRANTANY COVERAGE OR RIGHTS TO THE CERTIFICATE HOLDER. IF THIS CERTIFICATE INDICATES THAT TH E CERTIFICATE HOLDER IS AN ADDITIONAL INSURED,THE POLICY(IES) MUST EITHER BE ENDORSED OR CONTAIN SPECIFIC LANGUAGE PROVIDING THE CERTGFICATE HOLDER WITH ADDITIONAL INSURED STATUS THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED ONLY TO THE EXTENT INDICATED IN SLJCNd POLICY LANGUAGE OR ENDORSEMENT. Authorized R'e' esen time-" Date: ;! Includes copyrighted material of Insurance Services Office, Inc.,with its permission Cl CW A02 10 11 Allstate Insurance Company Page 1 of 1 C' rk'air Corr A0948-82-84 ACO CERTIFICATE OF LIABILITY INSURANCE UATE,MMI°DIYYYY) � I W 02/09/2018 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(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 this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAMECONTACT FIAMF: Rebecca Huddle Becky Huddle Insurance Agency PHONE 916-789-7500 FAX916-789-2545 (AIG.Np.Eft);729 729 Sunrise Ave Ste 504 E-MAIL staff.rhuddle farmeirsa erlc com Roseville CA 95661 ADDRF.36, g `}" INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:MID CENTURY INSURANCE 21687 INSURED INSURER B: Bayshore Water Conditioning DBA Elite Water Systems INSURERC: 10611 CALLE LEE SUITE 113 INSURER D: LOS ALAMITOS,CA 90720 INSURER E 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. UIAR EFF EXP IL7R TYPE OF INSURANCE COMMERCIAL G NERAL LIABILITY AI ��6 �WVD POLIGYNUMBER (MMIDDY dMPM�DGL%fiYYYYffi EACHOCTb('2�YJ'��b L �CURRENCE $ I®J LIMITS MAGE CLAIMS-MADE 0I OCCUR PREMISE,(Fa occurrence) $,,,,,,,,,,,, MED EXP(Any one person) $ �- PERSONAL&ADV INJURY $ GEI.1°LAGGRIGA1ELIMIT APPLIES PER: GENERAL AGGREGATE $ JECT LOC PRODUCTS COMPI PAG„G POtL4' O OTHER $ AUTOMOBILE LIABILITY �'� OMBN I ��acaNEO SINGLE UWr $ .� F rl',yro)�) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY IN AUTOS ONLY AUTOS JURY(Per accident) $ ...... DAMAGE AHIRED UTOS ONLY NON-OAUTOSWNED P'RI�PtR'I' DAMAGE $ UMBRELLALIAB OCCURMADE EACH OCCURRENCE $ EXCESS LIABId ATE $ DED FIRETENTION$ $ WORKERS COMPENSATIONV I PER OTH- AND EMPLOYERS'LIABILITY Li STATUTE FIR A (Mandea IM in NH)EXCLUDED F—]F—] NIA A0948-82-84 01/01/2018 07/07/2019 EL"EL DSEASECEDA $ 1,000,000 ENT EMPLOYEEI $ 1'000'000 describe under DIf ESCRIPTION PTION OF OPERATIONS below E L D, .....,, SEASC!•POLICY LIMIT' $ 1,000,000 �I® DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) CERTIFICATE HOLDER CANCELLATION City of EI Segundo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Fire Dept. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 314 Main St. ACCORDANCE WITH THE POLICY PROVISIONS. El Segundo, 45 Aa)FO �tDN�REPRESENTATIVE � �) Rebecca Huddle ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Produced using Forms Boss Web Software.www.FonnsBoss.com(c)Impressive Publishing 800-208-1977 tv"N , FARMERS uNS III RAiN¢",uE WC 99 06 20 WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY INSURANCE POLICY Named Insured 0 Bayshore Water Conditioning DBA Elite Water Systems • 10611 CALLE LEE SUITE 113 i LOS ALAMITOS, CA 90720 Effective Agent A0948-82-84 2018 Date 01/01/2018 95-39-R6A Policy Number Policy of the Company Year WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - SPECIFIC 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 3 % of the Workers' Compensation premium otherwise due for the state(s) listed below on such remuneration, subject to a minimum charge of 250 . Schedule Person or Organization Job Description City of EI Segundo Install three reverse osmosis systems at Fire Dept. 314 Main St. EI Segundo and 2261 E. Mariposa 314 Main St. Ave., EI Segundo EI Segundo, CA 90245 This endorsement is part of your policy. It supersedes and controls anything to the contrary. It is otherwise subject to all the terms of the policy. Countersigned Authorized Representative 93-6369 1ST EDITION 9-07 WC990619A J6369111 PAGE 1 OF 1