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PROOF OF INSURANCE (2018 - 2019) CLOSED ACORa DATE(VOUDDlYYYYi
CERTIFICATE OF LIABILITY INSURANCE
01124120113 I
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 pollcy(les)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
certlfdcate holder In lieu o1such endorsements.
PRODUCER Costanza Ins.Agency,Ino CONTACT
9101 LSJ FreewayPHONE ALL (97 )9 91-6084 tl� I N'o1��7Z�g1 2139
E,...
PHONE FAX ). ._ _.._.
Suite 150 EMAIL
Dallas TX 75243-
w__......._.
. ................ I'NWRBR.AdSte - '' Insurance.. ..__.- .._. 26387
INSURED
Lawles Enterprises,Inc. _IN'.SVRER,c_ _... __
752 Bungalow Drive
EI Segundo CA 90245-
I Pr
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,
Btr45w X CDMIAERY -„.... —Pt9.6CYS%P
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CIALGENERALLIABILITYAAa,CidIGt _ddIC.w?;,, 2,000000
.....
A ___.. _.�cLAIMs-MADE occuR O1. 322518-11 0£1190d2017 0€3J1'012018 DsOEai I s 100,000.
8,030 �I
RS AND OUISSIt7N5 Pt 4asaN�P r aPaelfprarq�y._ s ..... 000
G Ni P+GGR�. PRo _L _ I .._ . 2 000,`.. . .
ERRORS
POLICY .m_
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A WA AANOYBAU70ABILf7Y ... HE LED E(]L9322518-1101/23/2018 118110/2018 eoDILv NJURY(Pe,rlvr,slil)�p S _ _ ...X...�..
""....._. AUTOS .. AUTOSAUTOS G. _� a,ctc A sURAW,AIaFe. )I s __LL.-....— ..
x HIRED AUTOS rYri n'P 5
L-OS SC D L......... _.....
UMBRELLA LIAR OCCUR U4 9� P L(., S
EXCESSLIAB
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WORKERSCOMPENSATIONC.91 PER O-r
AA DBMPLOYERS' �._ .... �.�,�.•.�..�. I PER ! �O"C'�•
LIABILnY ,. Y
A1YWP0-, F'MletI'.uNe'fi�^ARN NkG�r.YFXr..CUT11Vm I CW{A�CC'@TlEE�P"p" Sf
F.G IYI'
L.I.;
CffiFIGERaSRCt.Itfw�rt EXCk.Ut5Ind37 N to
Ilrlrndat"In NN)
If yes,describe c nd'er SE AS,E'-r+l'AL1C'Y LUP,IC"N
I
DESCRIP'nON dr O�y��NRA'nONS d LOCAnOPpS I VEH CIES ACORD III,Additlonkl lgomarke sehodute,MN
a Aa alttaahod Ar marsragr'E
CE.RTIF'IL,A E P1OLDER IS INCLUDED�5 AI�ADDITIONAL INSURE'D'UNDER G NEITL i lA6PL9TPV 4Vl TI I RE 1'i=:.G°R 0,TO THE OPERATIONS OF THE
NAMED INSURED AS REQUIRED BY VAS"ITEN CONTRACTOR WRITTEN AGREEMENT'.
CERTIFICATE HOLDER CANCELLATION AI014458
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
City of EI Segundo ACCORDANCE WITH THE POLICY PROVIS1ONS.
350 Main Street
EL Segundo CA 90245- AUTHORZEDREPRESENTAme
_.
©1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 2S(2014101) The ACORD name and logo are registered marks of ACORI7
Additional Insured — Owners Lessees Or
Contractors Scheduled Person_ _'- -~ - Organization
ZURICH
n� ��2 ,�mrvorxpu� pfsnu / pmUuo ,w �
EC)L9322518 / /�4/2O1B 08/1U/2018
_~_ ________-
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
Named Insured:
Address(including ZIP Cede):
Laxv|aoEnterprises, Inc.
7G2Bungalow Drive
E| Segundo CA9O245
This endorsement modifies insurance provided under the: ^�
Commercial General Liability Coverage Part
SCHEDULE
Name 0fAdditional Insured Person(m)
Or0rgamizmtiap(s) Location And Description Of Covered Operations
��� ������ ��
CITY OFELSEGUNDO
350 MAIN STREET ELSE6}UNOOCA_00245
A. Section N–Who VsAnInsured is amended toinclude mumnadditional insured the person u,organization
shown in the Schedule above, whom you are required to add as an additional insured on this policy under a
written contract or written agreement. Such person or organization is an additional insured only with respect to
liability for"bodily injury", "property damage" or"personal and advertising injury"caused, in whole or in part, by:
1. Your acts or omissions; or
2' The acts uromissions ofthose acting onyour behalf,
in the performance of your ongoing operations or"your work" as included in the"prod ucts-com pleted
operations hazard", which is the subject of the written contract or written agreement at the Location designated
and described inthe Schedule above.
However, the insurance afforded to such additional insured:
1' Only applies bothe extent permitted by |avv� and
2. Will not be broader than that which you are required by the written contract or written agreement to provide
for such additional insured.
B. With respect to the insurance afforded to these additional insureds, the following additional exclusion applies:
This insurance does not apply to:
u-eL1177'FovV(04113)
Page 1w2
Includes copyrighted material o/Insurance Services office,Inc.with itspermission-
"Bodily injury", "property damage"or"personal and advertising in] ry" - out n[the rendering Crfailure
to render any professional architectural, engineering or surveying services including:
a' The pnapahng, approving or failing to prepare mrapprove maps, shop dnawinQa, op)nionn, neportm,
nVmeyo, field ordero, change orders or drawings and specifications; or
b. Supervimory, inspection, architectural orengineering activities.
This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the
supervision, hiring, employment, training or monitoring of others by that insured, if the"occurrence" which
caused the"bodily injury"or"property dannoQe", or the offense which caused the"personal and advertising
in|ur/', invokmd, the rendering oforthe failure to render any professional arch)tertuna|, engineering or
surveying services.
C. The following is added to Paragraph 2. Duties in The Event Of Ooounenoe, Offenne, Claim Or Suit of Section
|V—Conmmnerc|ml General Liability Conditions:
The additional insured must sea to it that.,
1. We are notified as soon as practicable of an"occurrence"or offense that may result in a claim:
2. We receive vvh(han notice of claim or"suit"as noon as practicable; and
3. A request for defense and indemnity of the claim or"suit"will promptly be brought against any policy issued
by another Insurer under which the additional insured may be an insured in any capacity. This provision
does not apply to insurance on which the additional insured in a Narned |Msured, if the written contract or
written agreement requires that thl�,s coverage beprimary and non-noohibmtmry
D. For the purpose ofthe coverage provided bythis endoroement.-
1. The following is added to the Other Insurance Condition of Section IV—Commercial General Liability
Conditions-,
Primary and Noncontributory insurance
This Insurance is primary huand will not seek contribution from any other insurance available toan
additional insured provided that:
a'The additional insured iaeNamed Insured under such other insurance;and
b^ You are required by written contract mrwritten agreement that this insurance be primary and not seek
contribution from any other insurance available to the additional insured.
2' The following paragraph is added to Paragraph 4-b. of the Other Insurance Condition of Section IV—
Commercial General Liability Conditions:
This insurance ioexcess over:
Any of the other ineuramce, whether primary, excena, contingent or on any other basis, available to an
additional insured, in which the additional insured onour policy is also covered as an additional insured on
another poHcyproviding coverage for the smrne~mcournance~. offense, claim or'^so|f''This provision does
not apply taany policy inwhich the additional insured ioa Named Insured nnSuch other policy and where
our policy is required by written contract or written agreement to provide coverage to the additional insured
on aprimary and non-contributory basis.
E.With respect to the insurance afforded to the additional insureds under this endnrsemont, the following is added
to Section YO—Limits Of Insurance:
The most we will pay on behalf of the additional insured is the amount of insurance:
1. Required by the contract or agreement referenced in Paragraph A. of this endorsement; or
2.Available under the applicable Limits of Insurance shown in the Declarations,
whichever is less.
This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations
All other terms and conditions ofthis policy remain unchanged.
u'G L-11rr'Fcv«(«*/1»)
Page avf2
Includes copyrighted material of Insurance Services Office,Inc.,with its permission.
Hired and Nonowned Auto Liability Declarations ZURIC,%, ,
Policy Number: EOL9322518-11 Renewal of Number: EOL9322618-10
Insurance Company Name Producer Name
Steadfast Insurance Company Costanza Insurance Agency of Texas
Dover, Delaware 9101 LBJ Freeway Suite 150
Administrative Offices- 1299 Zurich Way Dallas TX 75243
Schaumburg, Illinois 60196-1056
Named Insured
Lawles Enterprises, Inc,
Form Of Business:
FRI Corporation 0 Limited Liability Company 11 Individual 0 Partnership 0 Other
Schedule OfCoverages
Limit
Coverages The Most We Will Pay For Any Premium
One Accident Or Loss
Liability 1,000,000, 275.00
Uninsured Motorists (IL and LA only)
Underinsured Motorists (IL only)
Premium For Endorsements:
Total Premium: 275.00
Schedule Of Hired 0 1 r 8 1 orrowed Covered Auto and Non-Ownership Liability Coverage And Premiums
Liability Coverage—Rating Basis, Cost Of Hire
Number of Employees Premium
3 275.00
Total Premium 275.00
Forms and Endorsements Attached to this policy: See attached Forms and Endorsement Schedule
U-CA-ID-604-A CW (07/06)
Page 1 of 1
THUS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY'
POLICY ���� �� ��������
�-�.���&�� 0 n�.�������������
Policy Change
Wu�����--__'_
- l
POLICY NUMBER POLICY CHANGES COMPANY
EOL9322518-11 EFFECTIVE 01/24/2018 Steadfast Insurance Company
Policy Effective U0102017
__-. _______ .L�o/]8/ 0V2} 8
N��ED |NSU���� AUTHORIZEE0REPREGENTATK/E �
� C0ST8NZAINSURANCE AGENCY 0FTEXAS �
L8VVLE8ENTERPR|8ES. INC, 8101 LBJFREEVV8Y SUITE 150
752BUNGALOW DRIVE DALLAS,TX75243 |
EL8EGUNDO. C890245 �
—
COVERAGE
--PARTS AFFECTED - - -- - — -'- ----' INFORMATION - '- '-
General Liability Premium: $525.00
Surplus Lines Tax $ 1E75
Stamping Fee $ 1.05 |
---- ------'- -- --- -- - J
CHANGES
This endorsement is subject to the declarations, oonditions, and other terms of the policy wh�ch are consistent '
�
harevvith, and when countersigned by on authorized representative of the company forms o part of the policy
described herein, All other terms and conditions ofthe policy remain unchanged, �
-the following item(s): --' ----- _ ------- -- --- _ _ - -- __ - -- ---�
-�--'--- - -�---- --- - ��- |
O |naund'oNmne O |nnured's Mailing Address �
O Policy Number O Effeo8vo/Expiration Date
�
O Business Description CI |nsued'aLegal Status
191 Additional Interested Parties X Coverage Forms and Endorsements '
O Umhs]Exposures O Deductibles �
O Covered Location Description O Class Codes �
�
O Rates o. Cancd\e1ion,of{PoHcY_
i� Aam�_�ohanqe�to read:
_ �_ ' -_ ~^-
1INCONG|QENA[ION OFTHE PREMIUM CHARGED ABOVE; iT |SHFREBYUNDERSTOOD AND AGREED i
/ THAT THE ATTACHED FORM (S) U-GL,144G-ACVV(D5/10) NOTIFICATION TOOTHERS(JFCANCELLATION
AND U-GL-1177'FCVV(04/13)ADDITIONAL INSURED-SCHEDULED, iNFAVOR OF, SOUTH BAY REGIONAL
PUBLIC COMMUNICATIONS AUTHORITY(RCC)AND CITY OF EL SEGUNDO IS MADE PART OF THE POLICY
LISTED ABOVE �
|
IT IS ALSO UNDERSTOOD AND AGREED THAT THE ATTACHED FORMS U-CA-D-604-A CW(07/06) HIRED
AND NON0VVNEOAUTO LIABILITY DECLARATIONS & U-CA,543-ACVV(O70G) HIRED AND N{}NOVVNED
AUTO LIABILITY COVERAGE |8ADDED TOTHE POLICY LISTED ABOVE,
Th�abmvo�r��nc,��ntsnmmu� imLacna��� xl �n*rnivma�foUuvva� _
-� -�- - / |
[] NoChanges L � O ToboAdp�edabAudit Additional: ^_�etonm: $
Tax and Surcharge Changes
Additional: $ 1G-80 _ _ _ $___
|L12O1 1188 Copyright, Insurance Services Office, Inc., 1983 Page 1mf 2 O
Copyright, (SD Commercial Risk Services, Inc., 1983
_
THE FOLLOWING CLASS CODE INFORMATION I$: Added
916
Code No. Premium Basis Premises/Operations
36
Location Exposure Rate Annual Premium Pro Rata Premium
1 FLAT $275.00
Class ffication*
ts/Co
HIRED & NON-OWNED AUTO d 9perations
Rate-- Prado Annuamp!eb�Premium ' Oro Rata Premium
$ 1$
THE F6LL6Wii�b'dLA§�§'C-OD[f'INFORMAT"IbN" IS. Added
91636
Code No. Premium Basis Premises/Operations
Location Exposure Rate Annual Premium
Pro Rata Premium
1 $250.00 $
_bia,s-s' if i-c-adi—o n- FLAT
2 Additional Insured Prod�µAnn�
cts/Completed Operations
Rate al Premium Pro Rata Premium
Cancellation Type
Cancellation Reason
Cancellation Description Date Processed: 01/30/2018
Authorized Repre rztative Signature
Page 2 of 2 Copyright, Insurance Services Office, Inc., 1983 IL 12 01 11 85 El
Copyright, ISO Commercial Risk Services, Inc., 1983
Hired And Nonowned Auto Liability Coverage ZURICH '
Throughout this policy the words"you"and"your" refer to the Named Insured shown in the Declarations. The words
'wry"" "us" and 'our" refer to the company providing this insurance Other words and phrases that appear in
quotation marks have special meaning Refer to Section H. DEFINITIONS
A. COVERAGE
We will pay all sums an "insured" legally must pay as damages because of"bodily injury" or"property damage"
to which this insurance applies, caused by an "accident" and resulting frown the ownership, maintenance or use
of:
1. An "auto" you lease, hire, rent or borrow. This does not include any "auto" you lease, hire, rent, or borrow
frorn any of your "employees", partners (if you are a partnership), members (if you are a limited liability
company) or members of their households.
2. An "'auto"' you do not own, lease, hire, rent or borrow that is used in connection with your business, This
includes "autos" owned by your "employee,;" partners (if You are a partnership), members (if you are a
limited liability cornpany), or members of their households but only while used in your business or your
personal affairs.
We will also pay ail sums an "insured" legally must, pay as a "'covered pollution cost or expense" to which this
insurance applies, caused by an "accident' and resulting from the ownership, maintenance or use of covered
autos"'. However, we will only pay for the"covered pollution cost or expense" if there is either "bodily injury" or
"property damage"to which this insurance applies that is caused by the same"accident".
We have the right and duty to defend any ""insured"" against a "suit" asking for Such damages or a "covered
POOLItion cost or expense". However, we have no duty to, defend any "in$Ured" against a "suit" seeking
damages for "bodily injury" or "property damage" or a "covered pollution cost or expense" to which this
insurance does riot apply. We may investigate and settle any claim or "'suit" as we consider appropriate. Our
duty to defend or settle ends when the Hired and Nonowned Auto Liability Coverage Limit of Insurance has
been exhausted by payment of judgments or settlements.
B. WHO IS AN INSURED
The following are"insureds":
1. You for any covered "auto"
2. Anyone else while using with your permission an "auto" you hire except:
a. The owner or anyone else from whom you hire or borrow 8 CUVeM'(J "auto", This exception does not
apply if the covered"auto" is a"trailer"connected to a covered"auto" YOU OWn,
b. Your"employee" if the"auto"is owned by that"employee""or a member of his or her household.
c. Someone using an "auto" while he or she is working in a business of selling, servicing, repairing,
parking or storing "autos" unless that business is yours.
d, Anyone other than your"employees", partners (if you are a partnership), members (if you are a limited
liability company), or 2 lessee or borrower or any of their"employees", while moving property to or from
an"auto".
e. A partner (if you are a partnership) or 2 member (if you are a limited liability company) for a covered
"auto" owned by him or her or a rnember of his or her household.
3. Anyone liable for the conduct of an "insured" described above but only to the extent of that liability.
U-CA-543-5 CW(03/10)
Page I of 9
Includes copyrighted material of insurance Services Office, Inc,,with its permission.
C. COVERAGE EXTENSIONS
1. Supplementary Payments
VVewill pay for the"in$urecy':
a. All expenses vweincur.
b' Up to $2,000 for cost of bail bonds (including bonds for related traffic law violations) required because
ofan "mcoidonf'vvecover. VVedonot have tofurnish these bonds.
c' The cost of bonds to release attachments in any "suit" against the "insured" we defand. but only for
bond amounts within our Limit ufInsurance.
d. All reasonable expenses incurred bythe ^innunad" at our requeot, including actual loss ofearnings up
to$25Oaday because cdtime off from work.
m. All court costs taxed against the "insured" in any "suit" against the "insured" we defend. However,
these payments do not include attorneys' fees or attorneys' expenses taxed against the"insured"-
f. All interest on the full amount ofany judgment that accrues after entry of the judgment in any "suit"
against the"insured"we defend, but our duty to pay interest ends when we have paid, offered to pay or
deposited in court the part of the judgment that is within our Limit of Insurance
These payments will not reduce the Limit ofInsurance,
D. EXCLUSIONS
This insurance does not apply toany ofthe following:
1' Expected OrIntended Injury
"Bodily injury"or"property damage"expected or intended from the standpoint of the"insured".
2' Contractual
Liability assumed under any contract oragreement.
But this exclusion does not apply toliability for damages:
a. Assumed in a contract or agreement that is an "insured comtroct" provided the "bodily injury" or
"property damage" occurs Subsequent to the execution of the contract or agreement; or
b. That the"inoured"would have inthe absence ofthe contract oragreement,
3. Workers' Compensation
Any obligation for which the "insured" or the ''inaured's^ insurer may be held liable under any workers'
compensation, disability benefits or unemployment compensation law or any similar law.
4' Employee Indemnification And Employer's Liability
"Bodily injury"toi
a' An''emp|oyaa" ofthe"inouned" arising out ofand inthe course of:
(1) Employment bythe^iooured'; or
(2) Perfonningthedudeore|atedtoLhecondo(tofthe'^inauvad's^ buoineye� or
b. The opouea, ohi|d, parent, brother Or sister nfthat ^ernpioyeo" as a consequence of Paragraph a.
above.
This exclusion applies:
(1) VVhether|ha"insured'' maybe |iab|easanemp|oyerorinanyotheroapeody� ond
(%) To any obligation to share damages with or repay someone else who must pay damages because
of the injury.
U-C�543-80V(03/10
Page 2ofS
Includes copyrighted material of Insurance Services Office, Inc,,with its permission.
But thision does not apply to "bodily, injury" to domestic "employees" entitled to workers'
compensation benefits or to liability assuMied by the "insured" under an "insured contract'. For the
purposes of the coverage form, adomestic"employee" isaperson engaged mhousehold or domestic work
performed; p/incipaAyin connection with al residence premises.
5. Fellow Employee
"Bodily injury" to:
m. Any fellow "employee" of the ^ioeured" arising out of and in the course of the feUnvv "employee's"
employment orwhile performing duties related buthe conduct ofyour Iousineoo� ur
b. The spouse, ohi|d, parent, brother orsister ofthat fellow'^e»np|oyee" as a consequence of Paragraph a.
above.
6' Care,Custody OrControl
"Property damage"toor"covered pollution cost urexpense" involving property owned ortransported bythe
"imso/ed''nrmthe"insuned'o' care, custody o,control. But this exclusion does not apply tmliability assumed
under asidetrack agreement
7. Handling Of Property
"Bodily injury"or"property damage" resulting from the handling of property:
w. Before it is moved from the place where it is accepted by the "insured" for movement into or onto the
covered ^outo"; or
b. After it is moved from the covered"auto" to the place where it is finally delivered by the "insured".
8. Movement OfProperty ByMechanical Device
"Bodily injury" or"property damage" resulting from the movement ofproperty byamechanical device (other
than ahand truck) unless the device iaattached hothe covered "auto'
9. Operations
"Bodily injury"or"property damage" arising out ofthe operation of:
m' Any equipment listed in Paragraphs f.(2)and f.(3) of the definition of"mobile equipment"; or
b' Machinery or equipment that is on, attached to or part ofa land vehicle that would qualify under the
definition of "mobile, equipment" if it were not subject to a compulsory or financial responsibility law or
other motor vehicle insurance law whef e it is licensed or principally garaged,
10. Completed Operations
"Bodily injury" or "property damage" arising out of your work after that work has been completed or
abandoned
In this exo|uaion, your work means:
a. Work oroperations performed byyou oronyour behalf; and
b. Materials, parts or equipment furnished in connection with such work or operations.
Your work includes warranties or representations made at any time with respect to the fitnnnm, quality,
durability or performance of any of the iterns included in Paragraph a. or b. above,
Your work will be deemed completed at the earliest of the following firnes.-
(1) When all ofthe work called for inyour contract has been completed,
(2) When all of the work to be done at the site has been completed if your contract oa||o for work at
more than one site.
(3) When that part of the work done at a job site has been put to its intended use by any person or
organization other than another contractor or subcontractor working on the same project.
Work that may need semioe, nnainbenance, norrantion, repair or replacement, but which is otherwise
complete, will betreated ascomp|eted.
U'CA-543-BCYV(03110)
Page 3o/S
Includes copyrighted material of Insurance Services Office, Inc,,with its permission.
__
11. Pollution
"Bodily injury" or "property dannage' arising out of the actual, alleged or threatened diochapge, dispersal,
seepage, migration, release orescape of"pn||utanh/',
m. That are, nrthat are contained in any property that is:
(1) Being transported or towed by, handled or handled for movement into, onto or from the covered
"auto";
(3) Otherwise inthe course nf transit hyoronbehalf ofthe "insured"; or
(3) Being stared, disposed of, treated or processed in or upon the covered"auto";
b, Before the''pn||utante"orany property in which the"pollutants"are contained are moved from the place
where they are accepted by the"insured"for movement into or onto the covered "auto"; or
c. After the "pollutants" or any property in which the "pollutants" are contained are moved from the
covered"auto^'hnthe place where they are finally delivered, disposed oforabandoned bythe''innured"
Paragraph a. above does not apply to fuels, |vbhnawtm' fluids, exhaust gases or other similar "po||utants`
that are needed for or result from the nunna| e|autnma/' hydraulic or mechanical functioning of the covered
"outo^ orits parts, if-,
(1) The "poUubanhs" enoape, smep, migrate or are dianhargad, dispersed or released directly from an
"auto" part designed by its manufacturer to hold, store, receive or dispose of such "pollutants"; and
(2) The "bodily injury", "property damage" or"covered pollution cost or expense" does not arise out of
the operation of any equipment, listed in Paragraphs f.(2) and t<3) of the definition of "mobile
equipment"
Paragraphs b. and o. above of this exclusion do not a�pi|y to "accidents" that occur away from premises
owned by or rented to an"insured"with reSpect to"pollutants" not in or upon a covered "auto" if:
(a) The °po||utants" or any property in which the "pollutants" are contained are upnet, overturned or
damaged as aresult ufthe maintenance oruse ofacovered"ou$z"; and
(b) The discharge, dispenso|, seepage, m|gnation, release or escape of the "pollutants" is caused
directly bysuch upset, overturn ordamage.
12. War
"Bodily injury"or"property damage" `arising directly orindirectly out ot
a. War, including undeclared orcivil war;
b. Warlike action by o military fonoe, including action in hindering or defending against on actual or
expected aMaok, by any government, sovereign orother authority using military personnel or other
agents; or
c' Insurrection, rebellion, revolution, usurped power or action taken by governmental authority in hindering
ordefending against any ofthese
13. Racing
Covered °auk»a" while used in aimy professional or organized racing or dmrno/ition contest or stunting
acbvity, or while practicing for such contest or activity. This insurance also does not apply while that
covered"aVto'' imbeing prepared for such acontest ocactivity.
E. LIMIT OF INSURANCE
Regardless of the number of covered "autos", `insumado'", premiums paid, olainms made or vehicles involved! in
the '^accideut'^, the most we will pay for the total of all damages and "'covered pollution coat or expense"
combined ramu)t}m0 from any one "accident" is the Limlr of Insurance for Hired and Nonowmed L`mbiUty
Coverage.
All "'bodily injury", "property damage" and "covered pollution cost or expense'* resulting from continuous or
repeated expQSUre to substantially the same conditions will be considered as resulting from one"accident".
No one will be entitled to receive dup4cate payments for the same elements of"loss" under this coverage form
and any Medical Payments Coverage endorsement, Uninsured W4ok»rieta Coverage endoraernemt or
Underinsured Motorists Coverage endorsement attached tothis Coverage Part.
U-CA-542DCVV(03/10)
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F. CONDITIONS
1. Duties In The Event Of Accident, Claim, Suit Or Loss
We have no duty to provide coverage under this policy un|oou there has been full compliance with the
following duties:
a' In the event of "acoidenC'. claim, ''auiy' or "loss"' you must give us or our authorized representative
prompt notice ofthe"aocident'or"\oas" Include:
(1) How, when and where the "accident' nr''|oss'' occurred;
(2) The"insunad's" name and addreso� and
(3) To the extent possible, the names and addresses of any injured persons and witnesses.
b' Additionally, you and any other involved "msured^ must:
(1) Assume no obligation, make no payment or incur no expense without our consent, except at the
"inuured'o'' own cost.
(2) Immediately !send um copies of any request, demand, order, notioe, summons or legal paper
received concerning the c|aimnor"ouit'
(3) Cooperate with us in the investigation or settlement of the claim or defense against the"suit',
(4) Authorize us to obtain medical records orother pertinent information.
(5) Submit to emamination, atour expense, by physicians ofour choice, as often as we reasonably
reqv\na.
�.
If there is"loss"to a covered"auto"or its equipment you must also do the following:
(1) Promptly notify the police if the covered"auto"or any of its equipment is stolen. .
(2) Take all reasonable steps to protect the covered "auto" from further damage. Also keep a record of
ynmrexpenses for consideration |nthe settlement ufthe claim.
(3) Permit os to inspect the covered "auto" and records proving the "|000^ before its repair or
disposition.
(4) Agree to examinations under oath at our request and give us a signed statement of your answers
2' Legal Action Against Us
Noone may bring alegal action against uounder this coverage form unU|�
m' There has been full compliance with all the terms ofthis coverage form� and
b. UnderLiabiNy Coverage` we agree in m//h/ng that the 'insuned^ has an obligation to pay or until the
amount ufthat obligation has finally been determined by judgment after trial. No one has the right
under this pmhcy to bring us into an action to determine the"inmured'm" liability.
3. Transfer Of Rights Of Recovery Against Others Tn Us
If any person or organization to or for whom vou nnahe psyment umder, this uoxeraqk4 forni has rights to
recover damages from another, those rights are transferred to ma. That person ororganization must do
everything necessary tnsecure our rights and must do nothing after^aucident' m/'^losa~toimpair thern
G. GENERAL CONDITIONS
1. Bankruptcy
Bankruptcy or insolvency of the ''inmured" or the "inaured'm" estate will not relieve us of any obligations
under this coverage form
2. Concealment, yNNsmwpnesmm8atien Or Fraud
This coverage funn is void in any came of fraud by you at any time an it naiotmo to this coverage form It is
also void if you or any other "insured". at any time, intentionally conceal or misrepresent a material fact
oonuerninyi
a. This coverage form;
b. The covered "auto'';
U'CA-543-BCW03110
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Includes copyrighted material of insurance Services Office, Inc.,with its permission.
c. Your interest in the covered"auto"; or
d. A claim under this coverage form.
3. Liberalization
If we revise this coverage form to provide more coverage without additional premium charge, your policy
will automatically provide the additional coverage as of the day the revision is effective in your state,
4. Other Insurance
The insurance provided by this coverage form is excess over any other collectible insurance.
a. This coverage form's Liability Coverage is primary for any liability assumed under an "insured contract'.
b. When this coverage form and any other coverage forrn or policy covers on the same basis, either
excess or primary, we will pay only out,share. Our share is the proportion that the Limit of:Insurance of
our coverage form bears to the total of the Itrnits of all the coverage forms and policies covering on the
same basis.
5. Premium Audit
a. The estimated premium for this coverage forma is based or) the exposures you told US You would have
when this policy began, We will compute the final premium due when we determine your actual
exposures. The estimated total premium will be credited against the final premium due and the first
Named Insured will be billed for the balance, if any. The due date for the final premium or retrospective
premium is the date shown as the due date on the bill If the estimated total premmm exceeds, the final,
premium due, the first Named Insured will get a refund,
b. If this policy is issued for more than one year, the premium for this covet-age form will be computed
annually based on our rates or premiums in effect at the beginning of each year of the policy.
6. Policy Period,Coverage Territory
Under this coverage form,we cover"accidents" and "losses"occurring:
a. During the policy period shown in the Declarations; and
b. Within the coverage territory.
The coverage territory is:
(1) The United States of America;
(2) The territories and possessions of the United States of America-,
(3) Puerto Rico-,
(4) Canada; and
(5) Anywhere in the world it:
(a) A covered "auto"of the private passenger type is leased, hired, rented or borrowed without a driver
for a period of 30 days or less-, and
(b) The "insured's" responsibility to pay damages is determined in a "suit"' on the merits, in the United
States of America, the territories and possessions of the United States of America, Puerto Rico. or
Canada or in a settlement we agree to.
We also cover"loss" to, or"accidents" involving, a covered "auto" while being transported between any of
these places
7. Two Or More Coverage Forms Or Policies Issued By Us
If this coverage form and any other coverage form orpolicy issued to you by us or any company affiliated
with us apply to the same "accident", the aggregate maximurn Limit of Insurance under all the coverage
forms or policies shall not exceed the highest applicable Limit of Insurance under any one coverage forrn or
policy. This condition does not apply to any coverage form or policy issued by us or an affiliated company
specifically to apply as excess insurance over this coverage form,
U-CA-543-B CW(03110)
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Includes copyrighted material of Insurance Services Office, Inc.,with its permission.
Hi DEFINITIONS
1. "Accident" includes continuous or repeated exposure hothe same conditions resulting in "bodily injury" or
"property damage`',
2. "Auto" means:
m. Aland motor vehicle, "trai|er'orsemitrailer designed for travel onpublic roads; or
b. Any other land vehicle that in Subject to a compulsory or financial responsibility law or other motor
vehicle insurance law where itinlicensed orprincipally garaged.
However, "auhn''does not include"mobile equiprnen/'
3. "Bodily injury" means bodily injury, aiuknoao or disease sustained by a person including death resulting
from any ofthese.
4. "Covered pollution cost or expense" means any cost or expense arising out of:
a. Any request, demand, order or statutory or regulatory requirement that any "insured" or others test for,
monitnr, clean up, rernove, onnhain, troet, detoxify or neutna|ize, or in any way respond to, orassess the
effects of, "pollutants-, or
b' Any claim or "suit' by or on behalf of o ymvennnpenbs| authority 0mr danmages because of tes#ng for,
monitoring, cleaning up, removing, oontoinimg, treating, detoxifying or neutnsBzm0' or in any way
responding to, orassessing the effects of, ''p(N|utmmkm,
"Covered pollution cost or expense" does not include any cost or expense arising out of the actual, alleged
or threatened discharge, dispersal, seepage, migration, release or escape of"pollutants",
(1) That are, orthat are contained inany property that is:
(o) Being transported or towed by, handled or handled for movement into, onto orfrom the covered
"auto""
(b) Otherwise inthe course oftransit byoronbehalf ofthe"\nsured"; or
(c) Beinystored. diopoaedottnaatedorpmoesaedinoruponthenovermd"auky;
(2) Before the "pollutants" or any property in which the"pollutants"are contained are moved from the place
where they are accepted bythe"inourod"for mmvennentinto oronto the covered ^euio~. or
(3) After the "pollutants" or any property in which the "pollutants" are contained are moved from the
covered"auto"to the place where they are finally delivered, disposed of or abandoned by the"insured".
Paragraph (1) above does not apply to fue|a. Umbdoantu, f|uids, exhaust gases or other similar''poUwtanis"
that are needed for or result from the normal e|acthca\, hydraulic or mechanical functioning of the covered'
~auto" or its parts, it
(a) The "Pollutants" escspe, seep, migrate orare discharged, dispersed or released directly from an
"auto" part designed by its manufacturer to hold, stmna, receive or dispose of such, "pollutants"; and
(b) The "'bodily injury", "property damage" or"covered pollution cost or expense" does not arise out of
the operation of any equipment listed in Paragraph f.(2) or t(]) of the definition of "mobile
equipment'.
Paragraphs (2) and (3) above do not apply to '`aocideutm^^ that occur away from premises owned by or
rented to an"insured"with respect to"pollutants" not in or,upon a covered "auto" it:
(U The ''poAwbanto" or any property in which the '`poNuha:bs~ are oonbmmned are upset, overturned or
damaged asaresult ofthe maintenance oruse ofmcovered '^auto'; and
(|i) The d\ooharge, dispersal, aeopage, mkJraton, release or escape of the "pollutants" is caused
directly bysuch upset, overturn$rdamage.
5' ''Emp\oyee^ includes a"leased worker' "Emp|oyee'' does not include a"temporary worker'
6. "Insured" means any person mrorganization qUakfymgasaninsured inthe Who Is AnInsured provision o(
this coverage form, Except with respect tothe Limit of |nauronoa, the coverage afforded applies separately
to each insured who is seeking cove,age or against whom a claim or"suit" is brought.
U'CA+543-BCVV(03M0
Page 7nf8
7. "Insured contract"means:
o. Alease ofpremises;
b. Asidetrack agreement;
c' Any easement orlicense agreement, except in connection with onnetwudon or demolition operations
onnrwithin 5Ofeet cfara/lroad�
d. An obligation, as required by ordinance, to indemnify a municipality, except in connection with work for
a municipality;
e' That part of any other contract cxagreement pertaining to your business (mclud�ng an indemnification
u[emunicipality /mconnection with work performed for amunicipality) under which you assume the tort
liability of another to pay for "bodily iinjury'^ or "property damage" to e th'rd party or organization, Tort
liability means,aliability that would be imposed byYav* |nthe absence¢f any contract or agreement
f. That part of any contract mragreement entered into, aspart ufyour business, pertaining tothe rental or
lease, by YOU Orany ofyour"ennplmyees''. uf any"auto". However, such contract nragreement shall not
be considered an"insured contract" to the extent that it obligates you or any of your"employees"to pay
for"property damage"to any"auto" rented or leased by you or any of your"employees".
An"insured contract'does not include that part of any contract or agreement:
(f) That (mdemmhfiea o railroad for "bodily injury" or "property damage/' arising out of construction or
demolition operations, within 50 feet ofany railroad property and affecting any railroad bridge or
trestle, tracks, roadbeds, tunnel, underpass orcrossing;
(2) That pertains to the lman. Vease or rental of an ^nuho" to you or any of your "employees", if the
^auLo'' |sloaned, leased orrented with adriver; or
(3) That holds e person or organization engaged in the business of transporting property by ,auto""for
hire harmless for your use ofacovered ''an1o"over a route orterritory that person ororganization iu
authorized hoserve by public authority.
8. "Leased worker' meanna person leased toyou byalabor leasing firm under anagreement between you
and the labor leasing firm toperform duties related tothe conduct cfyour business. "Leased worker' does
not include a"temporary workar'
9. ^Lnss" means direct and accidental loss ordamage
10. "Mobile equipmenf' means any of the following types of land vehicles, including any attached machinery or
equipment
a. Bulldozers, farm machinery, forklifts and other vehicles designed for use principally off public roads-,
b. Vehicles maintained for use solely unornext topremises you own orrent;
c. Vehicles that travel oncrawler treads:
d. Vehic|es, whether self-propelled or not, maintained primarily to provide mobility to permanently
mounted:
(1) Power cranes, shovels, |oadmro, diggers ordrills; or
(2) Road construction or resurfacing equipment such as graders, scrapers or rollers;
e. Vehicles not described in Paragraph a., b., c. or d. above that are not self-propelled and are
maintained primarily to provide mobility to permanently attached equipment of the following types:
(f) Air cmrnpvessors, pumps and gonensbors, including wpnsying, we\ding, building cleaning.
geophysical exploration, fighting and well-servicing equipment; or
(2) Cherry pickers and similar devices used toraise orlower workorn� or
f. Vehicles not described in Paragraph a , b , c. or d. above maintained primarily for purposes other than
the transportation of persons or cargo. However, self-propelled vehicles with the following types of
porcoanendyattached equipment are not"mobile equipment" but will be cWn$idered'`amlos"�
(11) Equipment designed primarily for:
U'CA-543'BCVV(03h0
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Includes copyrighted material of Insurance Services Office, Inc.,with its permission
___ __
(a) Snow removal;
(b) Road maintenance, but not construction orresurfacing; or
(c) Street cleaning',
(2) Cherry pickers and similar devices mounted on automobile or truck chassis and used to raise or
lower workers; and
QW Air nomproosonn, pumps and generaboro, including spraying, wolding, building cleaning,
geophysical exploration, lighting orwell-servicing equipment,
However, "mobile equipment" does not include, land vmNo)es that are. subject to a compulsory or
financial responsibility law or other nnotm, vehicle insurance law where it is licensed or principally
garaged. Land vehicles sUbjeot to a compulsory or financial responsibility |am/ or other mVtorvehAc|e
insurance law are considered "autos".
11. "Pollutants" means any solid, |iqu|d, gaseous or thermal irritant orcontaminant, including sRooke, vopur,
soo\, fumee, adds, o|ko|io, chemicals and waste. Waste includes materials tohe re:yo/ed, reconditioned o/
reclaimed.
12. "Property damage" means damage hoorloss ofuse oftangible property.
13, ''Suit" means ocivil proceeding in which:
a' Damages because of"bodily injury" nr"property clarnage^; or
b. A"covered pollution cost oraxpenae''�
to which this insurance app|ies, are alleged,
"Suit' includes:
(1) An arbitration proceeding in which such damages or"covered pollution costs or expenses" are claimed
and bzwhich the"imsunad" must submit ordoes submit with our consent; or
(2) Any other alternative dispute resolution proceeding inwhich such danna0es or"covered pollution costs
or expenses"are claimed and to which the; insured submits with our consent.
14. ''Temporary worker" means a person who is furnished to you to substitute for a permanent"employee" on
leave ortomeet seasonal orshort-term workload ulonditi0nm.
15. ''Trai|er' includes semitrailer.
U'CA-543-BCVV(03/10)
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Includes copyrighted material of insurance Services Office, Inc.,with its permission,
DATE(MM/DD/YYYY)
CC>R" CERTIFICATE OF LIABILITY INSURANCE
�• 02/27/2018
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 MANE cT Don Kiger, CSR
Strategic Alliance Insurance PHONE, FAX License 0764210
(AFC,No.Flat), (Arc,No),
1714 Louise Lane E-MAIL
donkiger67@yahoo.com
Nipomo, CA 93444 1NSURE,RIS)AFFORM NGCOVE RAGE NAIL#
INSURER A: State Compensation Insurance Fund
INSURED
INSURER B
Lawles Enterprises inc INSURERC:
400 Continental Blvd, 6th Floor
INSURER D
EI Segundo CA 90245 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
INSR ADDL SUBI't POLICY EFF POLICY EXP
LTR TYPE OF INSURANCE INSQ_WD POLICY NUMBER (MMIDD/YYY'YI_ (MMIDDIYYYY) LIMITS
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE , $
DAMAVE'10 REN'Pl�D
CLAIMS-MADE J OCCUR PREMISES(Ea occurrence) $
MED EXP(Any one person) $
PERSONAL&ADV INJURY $
GEN1 AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $
P01,ICY( I (R O. 1'.0c PRODUCTS COMP/OP AGG $
OTHER $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $
Ep aro,J;ept,l
ANY AUTO BODILY INJURY(Per person) $
OWNED SCHEDULED BODILY INJURY(Per accident) $
AUTOS ONLY AUTOS
HIRED NON-OWNED PROPERTY DAMAGE
AUTOS ONLY AUTOS ONLY (Per accident)
$
UMBRELLA LAB � OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE AGGREGATE $
DED RETENTION$
A WORKERS COMPENSATION SF A 0312018-00 3-1-2018 3-1-2019 N
X PER ERH
AND EMPLOYERS'LIABILITY Y F STATUTE ER
ANYPROPRIETOR/PARTNER/EXECUTIVE L""" � N/A EL EACH ACCIDENT $ 1,000,000
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH) .°".° E L Dlol rA"aE.EA EMPLQ)YE�L $ 1,000,000
yes,describe under
DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT $ 1,000,000
DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
Certificate holder is named as an additional insured
CERTIFICATE HOLDER CANCELLATION
City of EI Segundo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City Clerk TMs Office THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
350 Main St. ACCORDANCE WITH THE POLICY PROVISIONS.
EI Segundo, CA 90245
AUTHORIZED REPRESENTATIVE
R-sk�� Ill S1.
©1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
ENDORSEMENT AGREEMENT
WAIVER OF SUBROGATION
9227676-18
STATE NEW
NA
FUND PAGE 1
HOME OFFICE
SAN FRANCISCO EFFECTIVE MARCH 22 , 2018 AT 12 . 01 A.M.
ALL EFFECTIVE DATES ARE AND EXPIRING MARCH 9, 2019 AT 12 . 01 A.M.
AT 12:01 AM PACIFIC
STANDARD TIME OR THE
TIME INDICATED AT
PACIFIC STANDARD TIME
LAWLES ENTERPRISES INC
400 CONTINENTAL BLVD, 6TH FLOOR
EL SEGUNDO, CA 90245
ANYTHING IN THIS POLICY TO THE CONTRARY NOTWITHSTANDING,
IT IS AGREED THAT THE STATE COMPENSATION INSURANCE FUND
WAIVES ANY RIGHT OF SUBROGATION AGAINST,
CITY OF EL SEGUNDO
WHICH MIGHT ARISE BY REASON OF ANY PAYMENT UNDER THIS
POLICY IN CONNECTION WITH WORK PERFORMED BY,
LAWLES ENTERPRISES INC
IT IS FURTHER AGREED THAT THE INSURED SHALL MAINTAIN
PAYROLL RECORDS ACCURATELY SEGREGATING THE REMUNERATION
OF EMPLOYEES WHILE ENGAGED IN WORK FOR THE ABOVE
EMPLOYER.
IT IS FURTHER AGREED THAT PREMIUM ON THE EARNINGS OF SUCH
EMPLOYEES SHALL BE INCREASED BY 03%.
NOTHING IN THIS ENDORSEMENT CONTAINED SHALL BE HELD TO VARY, ALTER, WAIVE
OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS
POLICY OTHER THAN AS STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE
HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR
LIMITATIONS OF THIS ENDORSEMENT.
COUNTERSIGNED AND ISSUED AT SAN FRANCISCO: MARCH 26, 2018 2570
AUTHO!E !RF aE9rppt IV'E PRESIDENT AND CEO
SCIF FORM 10217 (REV.7-2014) OLD DP 217
