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PROOF OF INSURANCE (2014) CLOSED AcIIT,.be Ladpy CERTIFICATE OF LIABILITY INSURANCE DATE , 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. _ bIMPORTANT: It IAL certificate holder is an ADDIT40NAL INSURED,the polky(Ilasj must be endorsed. If SUBROGATION tl5 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 h'ofifer In lieu of such endorsem, l'S1 !PRODUCER wCO le CI Ji Chapman MA 26800 Aliso Viejo Pk Pia MPX Insurance Services,#130 Inc. PHONE Aliso Viejo,CA 92656 a006UPFA1191'3pAFFORDING DDWERAoiE' est 20 Is ....... License#:OH49306 sunErtA- D �'a Idetl E,a INSURED Si9nvertise wsSUu.BFRB.V aGlnaildd eCtD_EaweJinsmLano- DBA Si nvertise �..ru'IeE ..Y tTtRelasatitata.lns.uLaDcx.. � ....—. g w3uREr1.9._.......... 1301 S Pacific Coast Highway An Redondo Beach,CA 90277 oAd Ul F w ... 'COVERAGES CERTIFICATE NUMBER. 000100032.373633 REVISION NUMBER, 14 _ THIS IS TO 9.ERTIFY THAI"THE POLICIES OF INSURANCE LISTED OEJOWW HAVE BEEN ISSUED TO Ili III IN;il'NAMED ABOVE FOR THE 01'OLI'CY 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 SU�CO PRS' D BY PAID CLAIMS 110i POL V XV ,6011 IOR LA aloXRAL 41AaPE OFIN3URANCE M Y sl' LIMITS 075 Ny"M.�.RVE BEt':du 80912620 I•I09/2612014_®Nawnace'7o"R pNTCo,.YuMI k _1•p�MR-0 coNoarR„IAu 'MraEIALLUAEdI,IVw IIT,,,_ 10U(1.Q_.,. CA AIMS.MAN'�occuR MED Exp fAny.2Tper— a 10.000 —100%000^ n 1iR'dY'1 AM1bIiA.EGAiP,LIMIT APPDESPER GENERA(AGGREGATE 4 �AM'.X9�M�k...,( '.-l'..pV pI .. �,w.a,... .. ..mm7, .B AUTOMOBILE LIABILITY IAeluTv� n o� y BA671897 D9ns12D13 09)2 6/2014 _E3 INJURY SINGLE'Ul ,cc $ •�ANY AUTO ................,M.k..^ ALL OWNED V y SCHEDULED 5 YI:`Y.!II`f NYd'JI,Yv`Y((rt'mr.nsn9.nYy 5���� IT ALl •—„ HIRED q^ AUTOS 'x PERTY DAMAGE 6 =jUAB NON=OWNED � ...........m.IT _ ('H OCCURREIJCE ..5,,,,,,•, 11,000,000 _ HfREDAUT06 AUTOS OWi A zLAI R Y CUB719175 09126/2013 09/2612014_EA/ E%CE93 LIAR •SIT• WORKER B�MPENSATIONN$ I�X f�vTAn^Un OFH S 1.DDG,000.. AAND NY PROPOYER Imn I �..........a................... ...., .� ••• q�FrENrrin ___ ' C 1965569-2013 10/2012013 1012012014 RWARTLITY YIN OR/PAATNDED?EC U I'VE❑ NIA I.I I..eu::lue,c:i:II,dENr 1,000,000 OFFICERIM 1.NHI EXCLUDED? IMandakery IR NHI .�u,u:M'G1:Avr.it'+d,l IAliurrwL s 1.000,000 Irym d®scrims under DESCRIPTI nN OF OPER ATI ONR l _..,,,,.. ................ m...,.........,,,, E [NSFASF„,?OIIOv I.IMIr 5 1,.000 000„,.._.......a...... .............�... ....,.,�... .,.,............ .................. DESCRIPTION OF OPERATIONS ILOCATIONS I VEHICLES IAtlach ACORD 101,Additional Remarks Scha,lulo,it more space Is mqui.d) Certificate holder is named additional insured regarding general liability CEtt'fIF$CATE HOLDER CANCELLATION'S SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City Of El Seguntt0 Ow HE EXPIRATION WALL BE DELIVERED IN WITH THE POLICY PROVISIONS. A At'tw Ted Shove 350 Main S'treDt EI Segundo,CA 90245 „P nNX' AUTHORIZED HE a NTATIV _ (JJM) PR ID 19ga-2010 A RD CORPORATION.All rights reserved. ACORD 25(2010105) The ACORD name and logo are wefed'�marks of AC D ,rA printed by JJM on June 16,2094 at 02.40PM General Liability#CBP8719075 Automobile Liability#BA8718975 Signvertise 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 � .y '.. SCHEDULE 1 Name Of Additional Insured Person(s) Or Orqanization(s): City of EI Segundo Information required to complete this Schedule, if not shown above,will be shown in the Declarations. A. Section II -Who Is An Insured is amended to include This insurance does not apply to"bodily injury"or as an additional insured the person(s) or "property damage"occurring after: organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property 1. All work, including materials, parts or equipment damage" or"personal and advertising injury"caused, furnished in connection with such work, on the in whole or in part, by: project (other than service, maintenance or 1. Your acts or omissions; or repairs) to be performed by or on behalf of the additional insured(s) at the location of the 2. The acts or omissions of those acting on your covered operations has been completed; or Behalf. 2. That portion of"your work" out of which the injury in the performance of your ongoing operations for the or damage arises has been put to its intended additional insured(s) at the location(s) designated use by any person or organization other than above. another contractor or subcontractor engaged in B. With respect to the insurance afforded to these performing operations for a principal as a part of additional insured's, the following additional exclu- the same project. sions apply: CG 20 10 07 04 ©ISO Properties, Inc., 2004 Page 1 of 1 0 General Liability#CBP8719075 Automobile Liability#BA8718975 Signvertise THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: M•,x,. " �w COMMERCIAL GENERAL LIABILITY COVERAGE PARTNO d SCHEDULE ............... ................................_.... Name Of Additional Insured Person(s) Location And Description Of Completed Operations Or Oraanization: City of EI Segundo All Locations w Information required to complete this Schedule, if not shown above,will be shown in the Declarations. Section II - Who Is An Insured is amended to include as an additional 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". CG 20 37 07 04 ©ISO Properties, Inc.,2004 Page 1 of 1 0 General Liability#CBP8719075 Automobile Liability#BA8718975 Signvertise THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, PRIMARY ENDORSEMENT This endorsement modifies insurance provided under the following: ALL COVERAGE PARTS Name Of Additional Insured Person(s) Or Organization(s): City of EI Segundo Information required to complete this Schedule, if not shown above,will be shown in the Declarations. IT IS AGREED THAT SUCH INSURANCE AS IS AFFORDED BY THIS POLICY THE BENEFIT OF THE ADDITIONAL INSURED(S)SHOWN BELOW SHALL BE PRIMARY INSURANCE, BUT ONLY AS RESPECTS CLAIMS, LOSS OF LIABILITY ARISING OUT OF THE OPERATIONS OF THE NAMED INSURED(S), HIS SUBCONTRACTORS OF HIS SUB-CONTRACTORS OF MATERIALMAN,OR SUPPLIERS,AND ANY INSURANCE MAINTAINED BY THE ADDITIONAL INSURED(S)SHALL BE NON-CONTRIBUTING. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. CG 20 10 11/85 C Insurance Services Office, Inc.,2008 Page 1 of 1 General Liability#CBP8719075 Automobile Liability#BA8718975 Signvertise WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following; GENERAL LIABILITY COVERAGE PART AUTOMOBILE LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: Location of Covered Operations: City of EI Segundo above because of payments we make for injury or The following is added to Paragraph 8. Transfer Of damage arising out of your ongoing operations or"your Rights Of Recovery Against Others To Us of Section IV work" done under a contract with that person or -Conditions: organization and included in the "products completed We waive any right of recovery we may have against operations hazard". This waiver applies only to the the person or organization shown in the Schedule person or organization shown in the Schedule above. CG 24 04 05 09 Services Office, Inc., 2008 0 Insurance Page 1 of 1 ENDORSEMENT AGREEMENT WAIVER OF SUBROGATION • 1965569-13 RENEWAL FUND SG 3-15-58-48 PAGE 1 HOME OFFICE SAN FRANCISCO EFFECTIVE JUNE 17, 2014 AT 12 . 01 A.M. ALL EFFECTIVE DATES ARE AND EXPIRING SEPTEMBER 26, 2014 AT 12 . 01 A.M. AT 12:01 AM PACIFIC STANDARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME SIGNVERTISE 1301 S PACIFIC COAST HWY ( °Y, REDONDO BEACH CA 90277 �s 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, SIGNVERTISE 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: JUNE 19, 2014 2570 4 . FA�-- AUTHORIZED REPRESENTA IVE PRESIDENT AND CEO SCIF FORM 10217 IREV.1-2012) OLD DP 217