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PROOF OF INSURANCE (2019) CLOSED DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 02/22/2018 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. 2 IMPORTANT.If the certificateholder is an ADDITIONAL INSURED,the pol'icy(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 5? certificate does not confer rights to the certificate holder in lieu of such endD'rsement('s), c m PRODUCER CON PACT � Chicago IL office IAMc, Aon Risk Services Central, Inc. (ypy 'E RFAX •°°•......--- ac.No.Ext): (866) 283-7122 II (nml: Ny) 800-363-0105 200 East Randolph EaJIAILWWWWWW w p Chicago IL 60601 USA ADDRESS: _ INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURERA: QBE Insurance CorporationITITITITIT•mm•mm•ITITITIT•mmITIT •••,39217� ............................................................_.._.._w..______w..__________....... Shelter Clean Services Inc. INSURER B: Praetorian Insurance Company 37257 11065 Penrose Street sun valley CA 91352 USA INSURER c Starr Indemnity & Liability Company 38318 INSURER D: ,.INSURER.E ,.,.,.,._..............._r.,.,.,.,.,.,.,., ., INSURER F: COVERAGES CERTIFICATE NUMBER: 570070264416 REVISION NUMBER: T'H'IiS IS TO CE'R'TIFY 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. Limits shown are as requested IINSR AOD&'"SUU14 PULICY bFF PO'i.14;Y R:xG" LIR TYPE OF INSURANCE IN'SD WVO POLICY NUMBER {MMIDDNYYYI,�LM��MPDD N 'YI LIMITS A X COMMERCIAL GENERAL LIABILITY CGA0913299 UL'%C8/'CUi90 019 EACH OCCURRENCE $1,000,000' T971IvYYt T(EIVT'ED CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $500,000' X Contractual Liability _ I MED EXP(Any one person) PERSONAL&ADV INJURY i1,000,000 fO GE Np' EGT LI IT AP PLIES PER: (GENERAL AGGREGATE $3,000,000, POLICYPLOC PRODUCTS-COMP/OPAGG $3,000,000JECT X OTHER: J A AUTOMOBILE LIABILITY CBA0913299 02/28/201802/28/2019 COMBINED SINGLE LIMIT $1,000,000' N A _ CBA0926211 02/28/2018 02/28/2019-(ia,acizidenl) X ANYAUTO BODILYINJURY(Perperson) Z OWNED SCHEDULED BODILY INJURY(Per accident) y AUTOS ONLY AUTOS •---•--- "" HIREDAUTOS NON-OWNED PROPERTY DAMAGE ONLY AUTOS ONLY •(Per accident) I� X Cor,,164Cmkl;$1,000 G UMBRELLA LIAB OCCUR 1000589602181 02/'28/2018 02/'28/2019IEACH OCCURRENCE $10,000,000 V X EXCESS p LIAR CLAIMS-MADE (AGGREGATE $10,000,000 DED I ((RETENTION KERS B OWOROYERSFFICER/ME BEREXC COMPENSATION RI EXECUTIVE NIA AOS Except 02/2$/201$02/ I IEP,...1 NY PR PRIE NIH I PART I,E L„,_STA76.ITE 28/2019 PER OTH-i Y7N AC4!a Except NY ,EACH ACCIDENT $1,000,000, N ( ry ) DISEASE-EA EMPLOYEE $1,000,000 IF yes,describe under DESCRIPTION OF OPERATIONS below E,L,DISEASE-POLICY LIMIT $1,000,000- DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) RE: City of El Segundo. City of El Segundo, its officials, officers, agents and employees are included as Additional Insured in accordance with the policy provisions of the General Liability policy. A Waiver of Subrogation is granted in favor of Certificate Holder in accordance with the policy provisions of the workers' Compensation policy. ru w CERTIFICATE HOLDER CANCELLATION ” SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of El Segundo AUTHORIZED REPRESENTATIVE Attn: Pw Dept. 350 Main Street "I El Segundo CA 90245 USA clan LiQ�c c./ dt�aG e./ �� ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 570000003447 LOC#: ADDITIONAL REMARKS SCHEDULE Page _ of _ AGENCY NAMEDINSURED Aon Risk services central, Inc, shelter clean Services Inc. POLICY NUMBER see certificate Number: 570070264416 CARRIER NAIC CODE see certificate Number: 570070264416 EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance Excess Liability Policy Excess Liability - 2nd Layer Policy # ccu3977337 Term: 2/28/2018 to 2/28/2019 Carrier: QBE Insurance corporation Limits: $15,000,000 occurrence / $15,000,000 Aggregate ACORD 101(2008601) Q 2008 ACORD CORPORATION,Alll fdghls reservocr, The ACORD name and logo are registered marks of ACORD POLICY NUMBER: CGA0913299 COMMERCIAL GENERAL LIABILITY EFFECTIVE DATE: 02/28/2018 CG 20 10 04 13 NAMED INSURED: Triangle Services Inc. 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 Additional Insured Person(s) Or Organization(s) Location(s) Of Covered Operations As Required by Written Contract or Agreement 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 B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following additional organization(s) shown in the Schedule, but only exclusions apply: with respect to liability for"bodily injury", "property This insurance does nota I to "bodily injury" or damage" or "personal and advertising injury" apply y caused, in whole or in part, by: "property damage occurring after: 1. All work, including materials, parts or 1. Your acts or omissions; or equipment furnished in connection with such 2. The acts or omissions of those acting on your work, on the project (other than service, behalf; maintenance or repairs) to be performed by or in the performance of your ongoing operations for on behalf of the additional insured(s) at the the additional insured(s) at the location(s) location of the covered operations has been designated above. completed; or However: 2. That portion of "your work" out of which the injury or damage arises has been put to its 1. The insurance afforded to such additional intended use by any person or organization insured only applies to the extent permitted by other than another contractor or subcontractor law; and engaged in performing operations for a 2. If coverage provided to the additional insured is principal as a part of the same project. 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. CG 20 10 04 13 0 Insurance Services Office, Inc., 2012 Page 1 of 2 C. With respect to the insurance afforded to these 2. Available under the applicable Limits of additional insureds, the following is added to Insurance shown in the Declarations; Section III—Limits Of Insurance: whichever is less. If coverage provided to the additional insured is This endorsement shall not increase the required by a contract or agreement, the most we applicable Limits of Insurance shown in the will pay on behalf of the additional insured is the Declarations. amount of insurance: 1. Required by the contract or agreement; or Page 2 of 2 © Insurance Services Office, Inc., 2012 CG 2010 0413 POLICY NUMBER: CGA0913299 COMMERCIAL GENERAL LIABILITY EFFECTIVE DATE: 02/28/2018 CG 20 37 04 13 NAMES INSURED: Triangle Services Inc. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSU ED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations As Required by Written Contract or Agreement 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 2. If coverage provided to the additional insured is include as an additional insured the person(s) or required by a contract or agreement, the organization(s) shown in the Schedule, but only insurance afforded to such additional insured will with respect to liability for "bodily injury" or not be broader than that which you are required "property damage"caused, in whole or in part, by by the contract or agreement to provide for such "your work" at the location designated and additional insured. described in the Schedule of this endorsement performed for that additional insured and included in the "products-completed operations hazard". However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and CG 20 37 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 2 B. With respect to the insurance afforded to these additional insureds, the following is added to Section III—Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; 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. Page 2 of 2 ©ISO Properties, Inc., 2004 CG 20 37 07 04 POLICY NUMBER: CGA 0913299 COMMERCIAL GENERAL LIABILITY EFFECTIVE DATE: 02/28/2018 NAMED INSURED: Triangle Services Inc. CG 24 04 05 09 WAIVER OF TRANSFER, OF RIGHTS OF RECOVERY AGAINST OTHERS TO SIS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: As Required by Written Contract or Agreement Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV—Conditions: We waive an right of recover we may have against sel, the person or organization shown in the Schedule YgY Y Y 9 above because of a ments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products- completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 05 09 C Insurance Services Office, Inc., 2008 Page 1 of 1 ❑ POLICY NUMBER: CGA 0913299 COMMERCIAL GENERAL LIABILITY EFFECTIVE DATE: 02/28/2018 NAMED INSURED: Triangle Services Inc CG 20 26 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PARTY„., Y SCHEDULE _. . .___.._............................ .......................... Name Of Additional Insured Person(s) Or Organization(s): As Required by Written Contract or Agreement 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 B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following is added to organization(s) shown in the Schedule, but only Section III—Limits Of Insurance: with respect to liability for "bodily injury”, "property If coverage provided to the additional insured is damage" or "personal and advertising injury" required by a contract or agreement, the most we caused, in whole or in part, by your acts or will pay on behalf of the additional insured is the omissions or the acts or omissions of those acting amount of insurance: on your behalf: 1. In the performance of your ongoing operations; 1. Required by the contract or agreement; or or 2. Available under the applicable Limits of 2. In connection with your premises owned by or Insurance shown in the Declarations; rented to you. whichever is less. However: This endorsement shall not increase the 1. The insurance afforded to such additional applicable Limits of Insurance shown in theDeclarations. insured only applies to the extent permitted by law; and 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. CG 20 26 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13 (Ed. 4-84) _.................. _ _.............. WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT 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.) This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule Any person or organization for which you have agreed to waive your rights of recovery in a written contract, provided such contract was executed prior to date of loss. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 02/28/2018 Policy No. CWC0913300 Endorsement No. Insured Triangle Services Inc. Premium Incl Insurance Company: Stonington Ins Co Countersigned by WC 00 03 13 (Ed. 4-84) 0 1983 National Council on Compensation Insurance.