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PROOF OF INSURANCE (2018 - 2019) CLOSED DATE(MM/DD/YYY1n CERTIFICATE OF LIABILITY INSURANCE 03/26/18 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), AUTHORRED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. U 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 codificato holder In heat of such ondorsoment(s). PRODUCER ACT NAME: SHERLOCK TRI WORLD INSURANCE AGENCY INC PHONE FAr( I 4000 Birch Street, Ste 2018 F-mA"- ) I ) ADDRESS: hsherlo k@triiworldins.com (`c�"°-_ 949 ; .a6-1356,,,,,,,,,,,,,,,,,,,.-,,., Newport Beach, CA 92660 �— 800-617-8428 INSUT�ER(s) AFFORDING COVERAGE Macs INSURER A: ARCH SPECIALTY INS CO. A+XV_ 21199 INSURED MARX BROS. FIRE EXTINGUISHER CO. INSURER B: RSUI INDEMNITY CO. A+XIV 22314 I, &COOK FIRE EXTINGUISHER , INSIIRERC: SECURITY NATIONAL INS CO, A XV 33120 1159 S. SOTO STREET I INSURER D: LOS ANGELES, CA 90023 INSURER E: �m INSURER F� COVERAGES C'ERTIRCATE 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. r19RTYPE OF INSURANCE AWL SIM POLICY EFF' POLICY EXp LIMITS s.Te mars AWL POLICY NUMBER (MM100"YY) (MWDDNYYY) erNER'AL 0A�BILi Y EACH OCCURRENCE S 1,000,000 DAMAGE$UkE�NIE.0 X COMMERCIAL GENERAL LIABILITY I PREMISES IEo ocourmoce) $ 50,000 CLAIMS-MADE M OCCUR I MED EXP(Any one Person) $ 5,000 p A X OCP Y DPC102191500 03/26/18 03/26/19 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 coo- Loc I......_.._PRODUCTS _/ s 2,000,000 GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGO .�POLICY M $ UCOMBINEO SINGLE LIMIT' AUTOMOBILE LIABILITY -AU i (Ea accident) S ANYAUTO BODILY INJURY(Per person) S � - ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) S NON-OWNED YY PROPERTY DAMAGE - �$ HIRED AUTOS AUTOS (Per accident) it S UMBRELLA LIARN OCCUR NHA244559 03/26/18 03/26/19 'EACH OCCURRENCE $ 4,000,000 B X EXCESS LIAR cLAIMSMADE AGGREGATE $ 4,000,000 DED RETENTION s PRODUCTS/OPS s4,000,000 WORKERS COMPENSATION -x,.,I WCSTA S I JOTH- AND EMPLOYERS'UABILJTY .,� C ANY PROPRIETORIPARTNEMEXECUTIVE YIN SWC1185824 02/18/18 �i02/18/19 E.LEACH ACCIDENT $ 1,000,000 OFFICERIMEMBER EXCLUDED? F—N-1 NIA Y (Mandatory In NH) E L DISEASE-EA EMPLOYEE S 1,000,000m If yes,describe under DESCRIPTION OF OPERATIONS below °E.L.DISEASE-POLICY LIMIT S 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Atlach ACORD 101,Additional Remarks Schedule,II more space is required) 06LL OPERATIONS - SERVICE AGREEMENT CITY OF EL SEGUNDO, ITS EMPLOYEES, REPS, OFFICERS AND AGENTS ARE ADDITIONAL INSURED ?ER ATTACHED ENDORSEMENTS. WORK COMP WAIVER OF SUBROGATION ENDORSEMENT ATTACHED. THIRTY (30) DAYS NOC APPLIES TO ALL LISTED POLICIES. I CERTIFICATE HOLDER CANCELLATION CITY OF EL SEGUNDO SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ATTN CITY CLERK THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 350 MAIN STREET, ROOM 5 ACCORDANCE WITH THE POLICY PROVISIONS. EL SEGUNDO, CA 90245-3813 AUTHORIZED REPRESENTATIVE I ®1988-2010 ACORD CORPORATION. All rights reserved. �CORD25(2010/05) The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABILITY CG 20 37 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LEASEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: ANY PERSON OR ORGANIZATION AS REQUIRED BY WRITTEN CONTRACT LOCATION/DESCRIPTION: ALL OPERATIONS (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) Section II - Who is An Insured is amended to include as an insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work"at the location designated and described in the schedule of this endorsement performed for that additional insured and included in the"products-completed operations hazard". PRIMARY INSURANCE CLAUSE: To the extent that this insurance is afforded to any additional insured under this policy,such Insurance shall apply as primary and not contributing with any insurance carried by such additional insured, as required by written contract. CG 20 37 07 04 © ISO Properties, Inc., 2000 Page 1 of 1 COMMERCIAL GENERAL LIABILITY CG 20 10 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE NAME OF PERSON OR ORGANIZATION: ANY PERSON OR ORGANIZATION AS REQUIRED BY WRITTEN CONTRACT LOCATION/DESCRIPTION: ALL OPERATIONS A. Section II—Who is An Insured is amended to include as an insured any person(s)or organization(s)shown in the Schedule, but 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 or omissions of those acting on your behalf: In the performance of your ongoing operations for the additional insured(s)at the location(s)designated above. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions applies: This insurance does not apply to"bodily injury"or"property damage"occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs)to be performed by or on behalf of the additional insured(s)at the location of the covered operations has been completed;or 2. That portion of"your work"out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. PRIMARY INSURANCE CLAUSE: To the extent that this insurance is afforded to any additional insured under this policy, such insurance shall apply as primary and non contributory with any insurance carried by such additional insured, as required by written contract. CG 20 10 07 04 ©ISO Properties, Inc., 2004 Page 1 of 1 .F CCORH IIDATE(MWDD--Y) CERTIFICATE OF LIABILITY INSURANCE N 02/22/18 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 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 certificate holder In lieu of such endorsement(s), PRODUCER CONTACT AME: HELEN SHERLOCK TRI WORLD INSURANCE AGENCY INC FPPO NE hsherlock@trlw 3 FAX -1 4000 Birch Street, Ste 201B I�o.CA), (949)756-08 - ND),•(949)756 356 IADDRESS, orldins.com Newport Beach, CA 92660 INSURER(el AFFORDING COVERAGE NAICY _ INSURERA SECURITY NATIONAL INS CO. AXV 33120 INSURED MARX BROTHERS�FIRE INSUREER 8IR - B tltl EXTINGUISHER COMPANY INC INSURER 1V 1159 SOUTH SOTO INSURER D 1 LOS ANGELES, CA 90023 a INSURER 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 IM"ONY a Nall ! TYPE OF INSURANCE ...• te_.,.. ._,._,._,......_._,._ ° POLICY EFF POLICY EXP POLICY NUMBER (MMOMITS LTFL INSsI ww /DDIW'M W�'Y) I GENERAL LL WLITY' {I FACH OCCURRENCE S DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PRE.'tlg-t(E!otcunenea S COM _ CLAIMS-MADE 0 OCCUR MED EXP(.Any one person) i PERSONAL a ADV INJURY i GENERAL AGGREGATE i GENL AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG S IPCL OY F JF a F-I Loc I i AUTOMOBILE LIABILITY COMBI'NE'D SINGLE wwt aceldenn ANYALITO SODILY INJURY(Por person) IIS m ALL WNOED SCHEDULED BODILY INJURY(Per ecpdent) $ AVTOS AUTOS = ROPER'"DAMAGE HIRED AUTOS AUTOS .._.... .., ........ N014-OWNED Por ACCIdenl) ( -.....- UMBRELLA LIABI EACH OCCURRENCE S OCCVR EXCESS LIAR CLAIMS-MADE AGGREGATE S -� �• DED I RETENTIONS w - ..... $ WORKERS COMPENSATION y I WCSTATV pp OT'n- AND EMPLOYERS'LIABILITY T,QRYLIMITSl I ER YIN SWC1185824 02/18/18 02/18119 1,000 000 A AW PROPRIETORNARTNEWEXECUI.— / E.L EACH ACCIDENT S OFFlCERNEMYER EXCLUDED' N NIA Y 1 OOO OOO (Mandatory In NH) EL DISEASE-EEA EMPLOYEE.....A PL / r - If yes,dascdDe under DESCRIPTION OF OPERATIONS below E.L.DISEASE•POLICY LIMB a 1,000,000 -...._ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is maul" .,., 'RENEWAL INSURANCE CERTIFICATE- WORKERS COMPENSATION WAIVER OF SUBROGATION ENDORSEMENT ATTACHED. THIRTY (30) DAYS NOC APPLIES. CERTIFICATE HOLDER CANCELLATION CITY OF EL SEGUNDO SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITY CLERK OFFICE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 350 MAIN STREET, ROOM 5 ACCORDANCE WITH THE POLICY PROVISIONS EL SEGUNDO, CA 90245-3813 .......- AUTHORIZED Rf:FRt ., ®1988-2010 ACORD CORPORATION.All rights reserved ACORD25(2010/05) The ACORD name and logo are registered marks of ACORD WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 06 34 (Ed. 8-00) WAIVER OF OUR RIGHT TO RECOVERY 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 form us). The additional premium for this endorsement shall be 3% of the total California Workers' Compensation premium otherwise due. SCHEDULE Person or Organization Job Descri tion Any person or organization when required All California Operations by written contract. B 1 Policy Number: SWC1185824 Insured: MARX BROS. FIRE EXTINGUISHER COMPANY,INC. Coverage Provided by: SECURITY NATIONAL INSURANCE COMPANY WC 99 06 34 (Ed.8-00) 0 ATE '"'`CCERTIFICATE OF LIABILITY INSURANCE I D03/30/2018 ) 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 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 Bryce Mckell, Agent NAME.: JanieeeW(Ifiams 413 E Foothill Blvd Ste 102 PHONE 909-305-1370 lArc„Nop 909.596.7055 .. Sl��� °rrrTl San Dimas, CA 91773 nD�Ala�ss ��or�c,@t�paackeil.corn„ INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:State Farm Mutual Automobile Insurance Company 25178 INSURED Marx Brothers Fire Extinguisher Co Inc iNsuRER„e: 1159 S Soto St INSURER C: Los Angeles, CA 90023-2198 INSURERD: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 2013-2014 RENEWAL 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 LTR TYPE OF INSURANCE VAIN �� POLICY NUMBER IMM DDfYYXY) f bucy EFF POLICY EXP LIMITS ......, MM/DDIYYYYI GENERAL LIABILITY II EACH OCCURRENCE $ W E COMMERCIAL GENERAL LIABILITY PREM7E TCS kaoccu rx ISrronce CLAIMS-MADE OCCUR MEDXP(Any one person) $ $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGO $ A LOC $ PV�frt. �........._.� POLICY a....--.., ..................... ,Y....:::::.::._..............>.................. AUTOMOBILE LIABILITY 0225740-B22-75K 02/22/2018 08/22/2018 ( accis"'IY'INt.,Lt,t.IMla (Eaaociedrrtfp $ ANY AUTO Y 041 1832-B22-751 02/22/2018 08/22/2018 BODILY INJURY(Per person) $ 1,000,000 ALL OWNED SCHEDULED BODILY INJURY(Per accident) AUTOS AUTOS 404 5720-D19-75W 11/19/2017 05/19/2018 1,000,000 NON-OWNED (Per ac ide DAMAGE HIREDAUTOS AUTOS 454 0524-E08-75D 11/08/2017 05/08/2018 {Per accident) $ 1,000,000 UMBRELLA LIAB I �I E _....._L.......................................... CCUR EXCESS LIAB ! E $ DED RETF.NTlON$ ®LAIMS-MADE AGGREACH EGATE WO.:KERS COMPENSATION WC STA f-L r_._�OTH- AND EMPLOYERS'LIABILITY Y i N TORY 1 IMIT$ ER„ ”""""""'"� �I E L EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE 7 OFCE/MEMER If yes,describe under elowt E L DISEASE-POLICY LIMITS $ ndatory nBNH)EXCLUDED� E L DISEASE-EA EMPLOYEE A WEMPLOYERS NON-OWNED/HIRED AUTO 561 0896-1306-75 02/06/2018 08/02/2018 BODILY INJURY(Per person) $1,000,000 LIABILITY I_.....I BODILY INJURY(Per accident} $9,000,000 PROPERTY DAMAGE(Per accident) $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) _., ,..,M.,..... Automobile Liability Section:State Farm provides certification for Scheduled Autos only,described as all vehicles insured by State Farm,under the Producer named above. Additional Scheduled Auto:Policy No 474 1500-F21-75D(Eff 12/21/2017 to 06/21/2018). This insurance is primary and non-contributory with respects to claims arising out of the operation of the described vehicle Additional Insured to be named on all policies:'the City,its officials,and employees'. Cancellation Clause to include 30 days written notice to the Certificate Holder listed below. (Certificate Holder contact:jallen@elsegundo.org) CERTIFICATE HOLDER CANCELLATION Cit of EI Segundo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City g THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Attn: City Clerk ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street AUTHORIZED REPRESENTATIVE EI Segundo, CA 90245-0989 Digitally signed by Janiece Williams- LSA5 @ 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 1001486 132849,8 01-23-2013 Statekinn 0by �, 6028BU ADDITIONAL INSURED (Prior Notice of Termination) This endorsement is a part of the policy. Except for the changes this endorsement makes, all other provisions of the policy remain the same and apply to this endorsement. 1. A person or organization shown on the Declarations Page as an Additional Insured is provided Liability Coverage, but only to the extent that person or organization qualifies as an insured as defined in Liability Coverage. 2. An Additional Insured has the same right of recovery under Liability Coverage as if they had not been shown on the Declarations Page as an Additional Insured. 3. If Liability Coverage is changed or terminated as to the interest of the Additional Insured, unless another number of days notice is shown on the Declarations Page, we will provide the Additional Insured: a. 10 days notice of such change or termination if the policy is nonrenewed or the cancellation is for nonpayment of premium; and b. 20 days notice of such change or termination if the cancellation is for any reason other than nonpayment of premium. Additional Insured: 'the City,its officials,and employees' Page 1 of 1 6028BU ©,Copyright, State Farm Mutual Automobile Insurance Company,2011