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PROOF OF INSURANCE (2018 - 2019) CLOSED DATE(MMIDDIYYYY) ,4►>R0 CERTIFICATE OF LIABILITY INSURANCE 6/5/2018 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 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 NAME: Joanne Covarrubias Blchlmeler Insurance Services PHONE FAX ) ...2215 730 S. Pacific Coast Hwy Suite#201 ('M IL NP, 310-376-8852 tn/c,.M. 310-540- Redondo Beach CA 90277 ADDREss: tloGronnes bisins,corol7 INSURER(S) AFFORDING NAIC# INSURERA:Evanston Insurance Co. INSURED ALPHA-3 INSURER B:WESTERN SURETY COMPANY 13188 Alpha Omega Fish Venture, LLC INSURER C, dba Fish WINSU Window Cleaning ................. .... .... .... .... .... .... .... .... .... 15665 Hawthorne Blvd. Suite D INSURER D: Lawndale CA 90260 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 1189857842 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. INTRR TYPE OF INSURANCE Aum wVP POLICY NUMBER (MMPOLICY )_' DI Y „ l POLICY EXP LIMITS MMIpD MIDp/VYYYI A COMMERCIAL GENERAL LIABILITY Y Y 2DA0456 9/18/2017 9/18/2018 EACH OCCURRENCE $2,000,000 — LAMA(G 1 OkENTEty �1 IFVEMI :F4(t•,eVVaP,oru at ... $100.000 CLAIMS-MADE X OCCUR a „. �„ . . X Package Policy ...M.E.D..EX„P,,(An,y one person)..............$..5...0.0.0...................................................... X Blanket At PERSONAL&ADV INJURY $2,.000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $3.000,000 X POLICY —1 J CT LOC PRODUCTS-COMP/OP AGG $Included PRO- OTHER $ a AUTOMOBILE LIABILITY COMRNED SINGLE LNMIT V^ enn $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ ­AUTOS AUTOS NON-OWNED ...........O...... ........ .. ,................................................................................................................ DAMAGE $ HIREDAUTOS AUTOS cdent).....................................,,. .......,,................................................................ UMBRELLA OCCUR ACH OCCURRENCE GGREGATE $ EXCESS LIAB CLAIMS-MADE AA DED I I RETENTION$ $...................................................................... WORKERS COMPENSATION J STATUTE I,,,,,, �ORH AND EMPLOYERS'LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE N I A E L EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E DISEASE-EA EMPLOYEE $ If yy�cs,describe under 11,SC`.RIPTIC N OF OPE: COMMERCIAL GENERAL LIABILITY III POLICY NUMBER: 2DA0456 PAARK r EVANSTON INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, BLANKET ADDITIONAL INSURED This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM LIQUOR LIABILITY COVERAGE FORM OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE FORM PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE FORM SCHEDULE Additional Premium: $ (Check box if fully earned.® A. Who Is An Insured is amended to include as an additional insured any person or entity to whom you are obligated by valid written contract to provide such coverage, but only with respect to negligent acts or omissions of the Named Insured and only with respect to any coverage not otherwise excluded in the policy. However: 1. The insurance afforded to such additional 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. Our agreement to accept an additional insured provision in a contract is not an acceptance of any other provisions of the contract or the contract in total When coverage does not apply for the Named Insured, no coverage or defense will apply for the additional insured. No coverage applies to the additional insured shown in the Schedule of this endorsement for injury or damage of any type to any "employee" of the Named Insured or to any obligation of the additional insured to indemnify another because of damages arising out of such injury or damage B. With respect to the insurance afforded to these additional insured, the following is added to 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, All other terms and conditions remain unchanged. MEGL 0009-01 05 16 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 1 with its permission COMMERCIAL GENERAL LIABILITY CG 20 0104 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance (2) You have agreed in writing in a contract or Condition and supersedes any provision to the agreement that this insurance would be contrary: primary and would not seek contribution Primary And Noncontributory Insurance from any other insurance available to the additional insured. This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance;and CG 20 01 0413 0 Insurance Services Office, Inc., 2012 Page 1 of 1 COMMERCIAL GENERAL LIABILITY oil POLICY NUMBER: 2DA0456 MARKS V EVANSTON INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM SCHEDULE Name Of Person Or Organization: Any person(s) or organization(s)with whom the Named Insured agrees, in a written contract executed prior to the'occurrence", to waive rights of recovery Additional Premium: $ The following is added to Condition 8. Transfer Of Rights Of Recovery Against Others To Us under Section IV — Commercial General Liability Conditions: We waive any right of recovery we may have against any person or organization shown in the Schedule of this endorsement. This waiver applies only to the person or organization shown in the Schedule of this endorsement. All other terms and conditions remain unchanged MEGL 0241-01 05 16 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 1 with its permission. DATE(MMIDD/YYYY) ACCORV CERTIFICATE OF LIABILITY INSURANCE 6/5/2018 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 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 NAME! Joanne Covarrubias Bichlmeier Insurance Services PHO1.NE FAX 730 S. Pacific Coast Hwy Suite#201 310-376-8852 IMC,Noy 310-540-2215 EMAIL Redondo Beach CA 90277 -ADE)RE_ss:__joal'lnec_@bisins.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:CALIFORNIA AUTOMBILE INS CO 38342 INSURED JULIA-1 INSURER B Julian Gran, LLC dba: Fish Window Cleaning INSURERC: 15665 Hawthorne Blvd., Suite D INSURERD: Lawndale CA 90260 INSURER E: I INSURER F: COVERAGES CERTIFICATE NUMBER:648744580 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. iNSRLTR'.........................................TYPE..O...................,,��,,,,,,,,,,,,,,,,,,,... . F INSURANCE I NSnDbE WV'i"t POLICY EI�F PMZW EXP LIMITS INSn wVD POLICY NUMBER IMMIDD/YYYY! IM'MPfiZDdYYYYO COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE CURRENCE AMA $ . CLAIMS-MADE 4 OCCUR rN '� Qr J PRE N CA.a Fa ar ) engq $ MED EXP(Any one person) I$ PERSONAL&ADV INJURY GEN'L AGGREGATE LIMIT APPLIES..P.......................... I$ ER: �GENERAL AGGREGATE I$ POLICY J�JyCG/fi LOC PRODUCTS-COMP/OP AGG I$ OTHER $ .... ............. _.. A AUTOMOBILE LIABILITY Y BA040000010738 11/16/2017 11/16/2018 (EMrBINED,SINGLFLIMIT' $ ccidon1N __1.000,Q00 BODILY e X ANY AUTO INJURY(Per person) $ .............. ALL OWNED ............ SCHEDULED '', AUTOS AUTOS BODILY INJURY(Per accident) "u NON-OWNED PFkOPER11Y DAMAGE1y HIRED AUTOSAUTOS Parr a ............ ( _oC1_40'.44 X Blanket At _ $ UMBRELLA LAB........... I OCCUR EACH OCCURRENCE n ...... �............ $ EXCESS L ABI CLAIMS-MADE AGGREGATE DED I RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITYYIN ,.STATUTE,�,,, „�„ER,,,,,,,,, ANY PROP'FdOF,,,TOR,PARTNIER,+B:XEP,'1,JTIVEC NIA E EACH ACCIDENT $ OFF�CEWME.MIJEREX�C'LUD'F';C,F�? El . (Mandatary in N)1) E DISEASE-EA EMPLOYEE'' $ If d_S Df:R9AI”�rlO�smilse hkCbFunoot �CDPERIa'Itl�OPVSbelow EL DISEASE . POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Window Cleaning The City of EI Segundo,its officers,officials,employees,agents and volunteers are named additional insured per endorsement MCA85100711 for commercial auto. 30 day notice of cancel or 10 day notice for non-payment applies. 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 EI Segundo 350 Main Street AUTHORIZED REPRESENTATIVE EI Segundo CA 90245 it ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Mercury Business Auto Broadening Endorsement This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM I. NEWLY ACQUIRED OR FORMED ENTITY (BROAD FORM NAMED INSURED) II, EMPLOYEES AS INSUREDS III. AUTOMATIC ADDITIONAL INSURED IV. EMPLOYEE HIRED AUTO V. SUPPLEMENTARY PAYMENTS VI. FELLOW EMPLOYEE COVERAGE VII. ADDITIONAL TRANSPORTATION EXPENSE VIII. HIRED AUTO PHYSICAL DAMAGE COVERAGE IX. ACCIDENTAL AIRRBAG DEPLOYMENT COVERAGE X. LOAN/LEASE GAP COVERAGE XI. GLASS REPAIR—DEDUCTIBLE WAIVER XII. TWO OR MORE DEDUCTIBLES XIII. AMENDED DUTIES IN EVENT OF ACCIDENT, CLAIM, SUIT OR LOSS XIV. WAIVER OF SUBROGATION XV. UNINTENTIONAL ERROR,OMISSION, OR FAILURE TO DISCLOSE HAZARDS XVI. EMPLOYEE HIRED AUTO XVII. HIRED AUTO—COVERAGE TERRITORY XVIII, BODILY INJURY REDEFINED TO INCLUDE RESULTANT MENTAL ANGUISH Copyright 2011 Mercury Insurance Services,LLC. All rights reserved. MCA85100711 Includes copyrighted material of Insurance Services Office,Inc.,with its Permission Page 1 of 6 BUSINESS AUTO COVERAGE FORM II. NEWLY ACQUIRED OR FORMED ENTITY(Broad Form Named Insured) SECTION II -LIABILITY COVERAGE, A. Coverage, 1.Who Is An Insured,the following is added: d. Any business entity newly acquired or formed by you during the policy period provided you own 50%or more of the business entity and the business entity is not separately insured for Business Auto Coverage. Coverage is extended up to a maximum of 180 days following acquisition or formation of the business entity. Coverage under this provision is afforded only until the end of the policy period. Coverage does not apply to an "accident" which occurred before you acquired or formed the organization. II. EMPLOYEES AS INSUREDS SECTION II - LIABILITY COVERAGE, A. Coverage, 1.Who Is An Insured,the following is added: e. Any"employee"of yours is an "insured" while using a covered "auto"you don't own, hire or borrow in your business or your personal affairs. III. AUTOMATIC ADDITIONAL INSURED SECTION II-LIABILITY COVERAGE,A. Coverage, 1.Who Is An Insured,the following is added: f. Any person or organization that you are required to include as additional insured on the Coverage Form in a written contract or agreement that is signed and executed by you before the"bodily injury"or "property damage" occurs and that is in effect during the policy period is an "insured"for Liability Coverage, but only for damages to which this insurance applies and only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Section II. IV. EMPLOYEE HIRED AUTO SECTION II-LIABILITY COVERAGE, A. Coverage, 1.Who Is An Insured,the following is added: g. An "employee" of yours is an "insured" while operating an "auto" hired or rented under a contract or agreement in that "employee's" name, with your permission, while performing duties related to the conduct of your business. V. SUPPLEMENTARY PAYMENTS SECTION II—LIABILITY COVERAGE, A.Coverage,2.Coverage Extensions, a. Supplementary Payments,Subparagraphs(2) and (4)are replaced by the following: (2) Up to $3,000 for cost of bail bonds(including bonds for related traffic law violations) required because of an "accident" we cover. We are not obligated to furnish these bonds. (4) All reasonable expenses incurred by the "insured" at our request, including actual loss of earnings up to$500 a day because of time off from work. VI. FELLOW EMPLOYEE COVERAGE: SECTION II—LIABILITY COVERAGE, B. Exclusions, 5. Fellow Employee This exclusion does not apply. Copyright 2011 Mercury Insurance Services,LLC. All rights reserved. MCA85100711 Includes copyrighted material of Insurance Services Office,Inc.,with its Permission Page 2 of 6 VII. ADDITIONAL TRANSPORTATION EXPENSE SECTION III- PHYSICAL DAMAGE COVERAGE,A. Coverage, 4.Coverage Extensions, a.Transportation Expenses, is replaced with the following: We will pay up to$50 per day to a maximum of$1000 for temporary transportation expense incurred by you because of the total theft of a covered "auto"of the private passenger type. We will pay only for those covered "autos"for which you carry either Comprehensive or Specified Causes of Loss Coverage. We will pay for temporary transportation expenses incurred during the period beginning 48 hours after the theft and ending, regardless of the policy's expiration, when the covered "auto" is returned to use or we pay for its "loss". If your business shown in the Declarations is other than an auto dealership, we will also pay up to $1,000 for reasonable and necessary costs incurred by you to return a stolen covered auto from the place where it is recovered to its usual garaging location. VIII. HIRED AUTO PHYSICAL DAMAGE COVERAGE SECTION III— PHYSICAL DAMAGE COVERAGE,A. Coverage, 4. Coverage Extensions,the following is added: C. If hired "autos" are covered "autos"for Liability Coverage in this policy and Comprehensive, Specified Causes of Loss, or Collision coverages are provided under this coverage form for any"auto"you own,then the Physical Damage Coverages provided are extended to "autos"you hire,subject to the following limit: (1) The most we will pay for"loss"to any hired "auto" is$50,000 or Actual Cash Value or Cost of Repair, whichever is less (2) $500 deductible will apply to any loss under this coverage extension, except that no deductible shall apply to "loss" caused by fire or lightning Subject to the above limit and deductible we will provide coverage equal to the broadest coverage applicable to any covered "auto" you own of similar size and type. This coverage extension is excess coverage over any other collectible insurance. IX. ACCIDENTAL AIRBAG DEPLOYMENT COVERAGE SECTION III - PHYSICAL DAMAGE COVERAGE, B. Exclusions, 3.a., is amended to add the following: This exclusion does not apply to the accidental discharge of an airbag. Copyright 2011 Mercury Insurance Services,LLC. All rights reserved. MCA85100711 Includes copyrighted material of Insurance Services Office,Inc.,with its Permission Page 3 of 6 X. LOAN/LEASE GAP COVERAGE SECTION III- PHYSICAL DAMAGE COVERAGE C. Limit of Insurance,the following is added: 4. In the event of a "total loss"to a covered "auto"shown in the schedule or declarations for which Collision and Comprehensive Coverage apply, we will pay any unpaid amount due on the lease or loan for that covered "auto," less: a. The amount paid under the Physical Damage Coverage Section of the policy;and b. Any: (1) Overdue lease/loan payments at the time of the"loss"; (2) Financial penalties imposed under a lease for excessive use, abnormal wear and tear or high mileage. (3) Security deposits not returned by the lessor; (4) Costs for extended warranties, Credit Life Insurance, Health,Accident or Disability Insurance purchased with the loan or lease; and (5) Carry-over balances from previous loans or leases. XI. GLASS REPAIR—DEDUCTIBLE WAIVER SECTION III- PHYSICAL DAMAGE COVERAGE, D. Deductible, the following is added: No deductible applies to glass damage if the glass is repaired rather than replaced. XII. TWO OR MORE DEDUCTIBLES SECTION III -PHYSICAL DAMAGE COVERAGE, D. Deductible,the following is added: If two or more"company" policies or coverage forms apply to the same accident: 1. if the applicable Business Auto deductible is the smallest, it will be waived;or 2. If the applicable Business Auto deductible is not the smallest, it will be reduced by the amount of the smallest deductible;or 3. If the loss involves two or more Business Auto coverage forms or policies the smallest deductible will be waived. For the purpose of this endorsement"company" means the company providing this insurance and any of the affiliated members of the Mercury Insurance Group of companies. XIII. AMENDED DUTIES IN EVENT OF ACCIDENT,CLAIM,SUIT OR LOSS The requirement in SECTION IV, BUSINESS AUTO CONDITIONS,A. Loss Conditions, 2. Duties In The Event Of Accident,Claim,Suit, Or Loss,a., In the event of"accident", you must notify us of an "accident" applies only when the "accident" is known to: (1) You, if you are an individual; (2) A partner, if you are a partnership; (3) A member, if you are a limited liability company; or (4) An executive officer or insurance manager, if you are a corporation. Copyright 2011 Mercury Insurance Services,LLC. All rights reserved. MCA85100711 Includes copyrighted material of Insurance Services Office,Inc.,with its Permission Page 4 of 6 XIV. WAIVER OF SUBROGATION SECTION IV-BUSINESS AUTO CONDITIONS, A. Loss Conditions, 5.Transfer of Rights Of Recovery Against Others To Us,section is replaced by the following: 5. Transfer Of Rights Of Recovery Against Others To Us We waive any right of recovery we may have against any person or organization to the extent required of you by a written contract executed prior to any "accident" or "loss",provided that the "accident"or"loss" arises out of the operations contemplated by such contract.The waiver applies only to the person or organization designated in such contract. XV. UNINTENTIONAL ERROR,OMISSION,OR FAILURE TO DISCLOSE HAZARDS SECTION IV-BUSINESS AUTO CONDITIONS, B. General Conditions, 2. Concealment, Misrepresentation, or Fraud,the following is added: Any unintentional omission of or error in information given by you,or unintentional failure to disclose all exposures or hazards existing as of the effective date or at anytime during the policy period shall not invalidate or adversely affect the coverage for such exposure or hazard or prejudice your rights under this insurance. However, you must report the undisclosed exposure or hazard to us as soon as reasonably possible after its discovery. This provision does not affect our right to collect additional premium or exercise our right of cancellation or non-renewal. XVI. EMPLOYEE HIRED AUTO SECTION IV—BUSINESS AUTO CONDITIONS, B.General Conditions, 5. Other Insurance, b. For Hired Auto Physical Damage Coverage, is replaced by the following: b. For Hired Auto Physical Damage Coverage,the following are deemed to be covered "autos"you own: 1. Any covered "auto" you lease, hire,rent or borrow;and 2. Any covered "auto" hired or rented by your"employee" under a contract in that individual"employee's" name,with your permission,while performing duties related to the conduct of your business. However, any"auto"that is leased, hired, rented or borrowed with a driver is not a covered "auto". XVII. HIRED AUTO-COVERAGE TERRITORY SECTION IV-BUSINESS AUTO CONDITIONS, B. General Conditions, 7. Policy Period, Coverage Territory, e. Anywhere in the world if:, is replaced by the following: e. Anywhere in the world if: (1) A covered "auto" is leased, hired, rented or borrowed without a driver for a period of 30 days or less;and (2) 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. Copyright 2011 Mercury Insurance Services,LLC. All rights reserved. MCA85100711 Includes copyrighted material of Insurance Services Office,Inc.,with its Permission Page 5 of 6 III. BODILY INJURY REDEFINED TO INCLUDE RESULTANT MENTAL ANGUISH SECTION V—DEFINITIONS,C. "Bodily Injury" is amended by adding the following: "Bodily injury"also includes mental anguish but only when the mental anguish arises from other bodily injury,sickness,or disease. Copyright 2011 Mercury Insurance Services,ILC. All rights reserved. MCA85100711 Includes copyrighted material of Insurance Services Office,Inc.,with its Permission Page 6 of 6 CERTIFICATE OF LIABILITY COVERAGE DATE(MMIDD/YYYY) 5/1012018 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 LIABILITY COVERAGE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL.COVERED the policy(ies)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 Union-Ernployer Joint Nolan Sponsors NAME: William Flores Ome a Comml.Init Labor Association PHONE 126�" Villis St, Sure 200 TAX Redding, CA 96001 I(A/c,No,Ext): (833)427-4568 I'AdC Not: (800)673-0183 9, EMA4L 'We", info@compasspilo'I.corn ISSUER(S)AFFORDING COVERAGE COVERED Diamond PEO, LLC ISSUER A: COMPASSPILOT li 19800 MacArthur Blvd, Suite 300 ERISA-based member benefit program of Irvine CA 92612 OMEGA COMMUNITY LABOR ASSOCIATION ISSUER B: 41803272 ISSUERC: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF COVERAGE LISTED BELOW HAVE BEEN ISSUED TO THE COVERED 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 COVERAGE 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. TYPE OF ADI7L S'UBR POLICY EPP POLICY EXP LTR I �OVDI wVD POLICYNUMBER (MMIDD/YYYY► (MMIDD/YYYY) LIMITS J COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS MADE OCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENT AGGREGATE LIMIT PER: GENERAL AGGREGATE Is POLICY PRO LOC PRODUCTS-COMP/OP AGG I$ JECT $ AUTOMOBILE LIABILITY COMBINED SINGLE LINl1I II $ (Fa a�ccddonl). ANYAUTO BODILY INJURY(Per person) $ ALL OWNED SCeraccen TOS ( ) HEDULED AUTOS AUBODILY INJURY Pidt $ I NON OWNED P'P'OPPwP`YY I~1AMAOE $ HIRED AUTOS AUTOS (Per accident) UMBRELLALIAB OCCUR EACH OCCURRENCE $ EXCESSLIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ A 'WORKERS COMPENSATION / WB2018-1001-43 3/1/2018 3/1/2019 V/ STATUTE I I ORTH- ANDEMPLOYERS'LIABILITY EL EACH ACCIDENT $ 1,000,000 ANY PROP RIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED (Y/N) E L,DISEASE EA EMPLOYEE $ 1,000,000 EL DISEASE POLICYLIMIT $ 1,000„000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES: Alternate Employer Esmar Management Group is provided coverage only for employees properly enrolled and assigned to Diamond PEO LLC pursuant to the client service agreement between Esmar Management Group and Diamond PEO LLC Services Rendered by:Alpha Omega Fish Venture, LLC DBA: Fish Window Cleaning --See Attached Remarks Schedule-- CERTIFICATE HOLDER CANCELLATION' SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN C%of El Segundo ACCORDANCE WITH THE POLICY PROVISIONS. Fish Window Clean ing-Lawndale 350 Main Street AUTHORIZED REPRESENTATIVE EI Segundo CA 90245 William Flores 41803272 1 1010 1 Diamond PEO, LLC (1001-43) Tuwana Ware 1 5/10/2018 11:11:47 AM (EDT) 1 Page 1 of 2 AGENCY CUSTOMER ID: 1010 LOC#: ................... ............. ADDITIONAL REMARKS SCHEDULE Page of AGENCY NAMED INSURED OMNIS Benefit Plan Administrators Diamond PEO, LLC 19800 MacArthur Blvd,Suite 300 POLICY NUMBER Irvine CA 92612 ............... ....................................................................... CARRIER NAIC CODE ....EFFECTIVE DATE ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: CL FORM TITLE:CLC(06/17) HOLDER: City of El Segundo Fish Window Clean ing-Lawndale ADDRESS:350 Main Street El Segundo CA 90245 ......—11-11-11............................... There is a 10-day notice to contractor before cancellation due to nonpayment and a 30-Day written notice to contractor prior to the cancellation or non-renewal of any benefit coverage herein from covered subcontractor. Omega Community Labor Association offers employer liability coverage up to state required coverage limits as an erisa-protected member benefit program(Compass Pilot) . All liability protection and member benefit policies issued per collective bargaining agreement only. U.S. Dept of Labor Form M-1 Multiple employer welfare arrangement filing code: ECE. ACORD 101 (2008/01) CU 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ADDENDUM/DO( 41803272 1 1010 1 Diamond PEO, LLC (1001-43) 1 Tuwana Ware 15/10/2018 11:11:47 AM (EDT) I Page 2 of 2 awh �p Imiiuuum��� l ,u�a;��;m'mmrl Illuumuul P�Nm' I......¢u,, VllluylW� uw!!! �a wu� I� im ,III � � IIIGAu�,��uVumuu � �� d �h" muuu�OI ��������IIIIIIIIIIIIN� °1 umNIN 4�N 4011p 1� 1 III �IlulmilR"�� I ��m uuuww "uw." u Iluuumu h.�„ IIII �pIIIIIIO M, WORKER'S COMPENSA' ION BENEFIT ENDORSEMENT AGREEMENT WAIVER OF SUBROGATION Diamond PEO, LLC 19800 MacArthur Blvd,Suite 300 Irvine CA 92612 ✓ POLICY #: WB2018-1001-43 POLICY PERIOD: 3/1/2018 3/1/2019 ANYTHING IN THIS POLICYTO THE CONTRARY NOTWITHSTANDING, IT IS AGREED THAT COMPASS PILOT WAIVES ANY RIGHT OF SUBROGATION AGAINST City of"EP Segundo Fish y ,nd'ow Cleaning-Lawndale 350 Mals Street EI Segundo CA 90245 ITS SUBSIDIARIES, OWNERS, OFFICERS, DIRECTORS, PROPERTY OWNERS AND EMPLOYEES ARE HEREBY NAMED AS ADDITIONAL COVERED. 5/23/2018 ENDORSED AUTHORIZED REPRESENTATIVE William Flores-PRESIDE VT 8077 Florence Ave, Downey Ca 90240 Ph (833)427-4568 (559)573-8214 Fax (800) 673-0183 Billing (559) 573-8075 42058073 1010 1 Diamond PEO, LLC (1001-43) 1 Tuwana Ware 1 5/23/2018 6:21:13 PM (EDT) i Page 3 of 3