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PROOF OF INSURANCE (2019 - 2019) CLOSED DATE(MMIDDIYYYY) AC"REO CERTIFICATE OF LIABILITY INSURANCE 1 05/02/2018 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 CONTACT Eric Lanzillotta NAME: CBIA Insurance Agency PI'1oNE 81/ 900-2242 I FAX (866y 518-4627 8001 CANOGA AVE,SUITE A certs@cbiamember.com COVERAGE NAIC# CANOGA PARK CA 91304 INSURER A: AMTRUST INTERNATIONAL UNDERWRITERS LTI AA3190383 INSURED INSURER B: UNITED FINANCIAL CASUALTY CO. 11770 Cinbad Industry,Inc, INSURER C: NATIONAL UNION FIRE INS CO OF PITTS 19445 21417 Germaine St INSURER D: STATE COMPENSATION INSURANCE FUND(SCI 35076 INSURER E: Chatsworth CA 91311 INSURER F: COVERAGES CERTIFICATE NUMBER: REV'ISIO'N 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 ILICY EXP__ 1Tp TYPE OF INSURANCE AN DBr- POLICY'NUMBER IPOLICYWYY Y') IMMI DIIYYYYI LIMITS ... X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 .... ---�CLAIMS-MADE X OCCUR DAMAGE 1'0 PrdLMISrc,,,5 L aiiyarr ...$ 100,Q.... 00 _ MED EXP(Any one person) $ 5,0�� A X X XN104599903 02/28/2018 02/28/2019 PERSONAL&ADV INJURv $ 1,000,000 GEN'LAGGREGATELIMIT APPLIES PER: GENERALAGGREGATE $ 2,000,000 Xq )OLIC S COMP/OP AGG $ 2,000,000 X POLICY PRCO- LOC PRODUCT „$,,,,,, TH AUTOMOBILE LIABILITY ..t[O(aMBINED a„ im9 .SINGLE.LIMIT.............$ 1,000,000 " ANY AUTO BODILY INJURY(Per person) $ B OWNED SCHEDULED 05928838-1 02/17/2018 02/17/2019 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNE AUTOS ONLY AUTOS ONLDY Pgf O6akRr^Y DAMAGE rrr) $ 1,000,000 $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 1,000,000 C X EXCESS LIAB 1--dCLAIMS-MADE BE064527509 04/26/2018 02/28/2019 AGGREGATE.................... $ 1,000,000 DED I 1 RETENTION$ PR/COMP OPS AGG $ 1,000,000 WORKERS COMPENSATION �- X1L'�,',�T,w_I_r, I r'OOTTH- AND EMPLOYERS'LIABILITYER ANY PROPRIETOR/PARTNER/EXECUTIVE Y N E L EACH ACCIDENT s 1,000,000 D OFFICER/MEMBER EXCLUDED? FY N/A X 9044882-2018 02/09/2018 02/09/2019 (Mandatory in NH) """"""" E L DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CITY OF EL SEGUNDO,its officers,officials,employees and volunteers are listed as Additional Insured with respects to General Liability per endorsements NX GL 189 05 11 and CG 20 37 07 04 attached. Waiver of Subrogation applies to General Liability per endorsement NX GL 189 05 11 and Workers Compensation per endorsement 2572 attached. Re;PW 18-02 Police Department Floor Replacement Project,348 MAIN STREET EL SEGUNDO CA 90245 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CITY OF EL SEGUNDO ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 348 MAIN STREET EL SEGUNDO CA 90245 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: XN104599903 COMMERCIAL GENERAL LIABILITY NX GL 189 05 11 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSUREDS - OWNERS, LESSEES OR CONTRACTORS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Policy Number:XN104599903 Endorsement Effective: 3/26/2018 12:01 a.m. Named Insured: CINBAD INDUSTRY INC Counter Signed By: SCHEDULE Name of Person or Organization: CITY OF EL SEGUNDO 348 MAIN STREET, EL SEGUNDO CA 90245 Location: 348 MAIN STREET, EL SEGUNDO CA 90245 (If no entry appears above, information required to complete this endorsementwill be shown in the Declarations as applicable to this endorsement) A. Section II—Who Is An Insured is amended to include as an insured the person or organization shown in the Schedule, but only to the extent that the person or organization shown in the Schedule is held liable for your acts or omissions arising out of your ongoing operations performed for that insured. B. With respect to the insurance afforded to these additional insureds, the following exclusion is added: 2. Exclusions 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 services, maintenance or repairs)to be performed by or on behalf of the additional insured(s)at the site 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. C. The words"you" and"your" refer to the Named Insured shown in the Declarations NX GL 189 05 11 Page 1 of 2 Includes copyrighted material of Insurance Services Office, Inc., with its permission COMMERICAL GENERAL LIABILITY CG 20 37 07 04 Policy##: XN104599903 Insured Name: CINBAD INDUSTRY INC 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: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE .. Name of Additional................................. _ ... Insured Person(s)or ......................... ........ Location and Description of Completed Orcoanization(s): Operations CITY OF EL SEGUNDO THEY WILL BE REPLACING THE FLOORING 348 MAIN STREET, EL SEGUNDO CA 90245 STREET,348 MAIN EL SEGUNDO CA 90245 -- Information�...req......u.i.... red to complete this Schedule, if not shown above, will be shown in t he 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 Copyright Iso Properties, Inc.,2004 Page 1 of 1 Insured D. The following are added to SECTION V—DEFINITIONS: "Your work" means work or operations performed by you or on your behalf; and materials, parts or equipment furnished in connection with such work or operations. E. The following additional provisions apply to any entity that is an insured by the terms of this endorsement: 1. Primary Wordine With respect to the Third Party shown above, this insurance is primary and non-contributing.Any and all other valid and collectable insurance available to such Third Party in respect of work performed by you underwritten contractual agreements with said Third Party for loss covered by this policy,shall in no instance be considered as primary, co-insurance, or contributing insurance Rather, any such other insurance shall be considered excess over and above the insurance provided by this policy. 2. Waiver of Subrocaabon If required by written contract or agreement:We waive any right of recovery we may have against an entity that is an additional insured per the terms of this endorsement because of payments we make for injury or damage arising out of"your work"done under a contract with that person or organization. NX GL 189 05 11 Page 2 of 2 Includes copyrighted material of Insurance Services Office, Inc.,with its permission ENDORSEMENT AGREEMENT STATE WAIVER OF SUBROGATION BLANKET BASIS 9044882-18 FUND RENEWAL SC HOME OFFICE 6-85-73-14 SAN FRANCISCO EFFECTIVE FEBRUARY 9, 2018 AT 12 .01 A.M. PAGE 1 OF 1 AND EXPIRING FEBRUARY 9, 2019 AT 12 .01 A.M. ALL EFFECTIVE DATES ARE AT 12:01 AM PACIFIC STANDARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME CINBAD INDUSTRY, INC. 21417 GERMAIN ST CHATSWORTH, CA 91311 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. THE ADDITIONAL PREMIUM FOR THIS ENDORSEMENT SHALL BE 2.00% OF THE TOTAL POLICY PREMIUM. SCHEDULE PERSON OR ORGANIZATION JOB DESCRIPTION ANY PERSON OR ORGANIZATION BLANKET WAIVER OF FOR WHOM THE NAMED INSURED SUBROGATION HAS AGREED BY WRITTEN CONTRACT TO FURNISH THIS WAIVER 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: JANUARY 25, 2018 A THORa EO REPRESENT TWE PRESIDENT AND CEO 2572 SCIF FORM 10217 (REV.7.20141 OLD DP 217