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PROOF OF INSURANCE (2019 - 2019) CLOSED ARCPLUM-01 PPEREZ CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) �.... 07/20/2018 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 License#OC36891 CONTACT pati Perez 1 NAME: Lyddy Martin Company PHONE FAX 20300 Ventura Blvd.Suite 340 (A/C,No,Ext): (310) 548-1959 (A/C,No):(310) 548-1346 Woodland Hills,CA 91364 E-MAIL pati@lyddymartin.com INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:Nationwide Mutual Insurance Company 23787 INSURED INSURERB:AMCO Insurance Company 19100 Ruben Chavarin, DBA, ARC Plumbing INSURERC:Twin City Fire Insurance Company 29459 3124 Rosecrans Avenue INSURER D: Hawthorne,CA 90250 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: 1 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 CONTRA,T OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLIC ES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH 'OLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY 'AID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD (MM/DD/YYYYI IMM/DD/YYYYI A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,0001 CLAIMS-MADE Fir] OCCURX X ACPGL03018333597 07/18/2018 07/18/2019 PREMI ES( RENTED 100,0001 PREMISES R occurrence) $ MED EXP(Any one person) $ 5,0001 PERSONAL&ADV INJURY $ 1,000,0001 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,0001 POLICY jECLOC 2,000,0001JT OTHER: $ 1 A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,0001 (Ea accident) $ ANY AUTO X X ACPBA3018333597 07/18/2018 07/18/2019 BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY X AUTOS BODILY INJURY(Per accident) $ X US XTSOLPROPERTY ONLY NON-OWNED ONLY (Per accident) $ $ B X UMBRELLA LIAB OCCUR1,000,0001 EACH OCCURRENCE $ EXCESS LAB CLAIMS-MADE ACPCAA3018333597 07/18/2018 07/18/2019 AGGREGATE $ 1 DED I I RETENTION$ $ 1,000,0001 C WORKERS COMPENSATION PER STATUTE OERH AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y❑ X 72WECZ19068 04/01/2018 04/01/2019 E.L.EACH ACCIDENT $ 1,000,0001 OFFICER/MEMBER EXCLUDED N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,0001 If yes,describe under 1,000,0001 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) The City Of EI Segundo,a general law city and municipal corporation("City")are named as additional insured(s)as pertains to general liability per the attached blanket additional insured endorsements CG 73 23 12 16. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Ci Of EI Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City g ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street EI Segundo,CA 90245 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABILITY CG 73 23 12 16 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTRACTORS ENHANCEMENT PLUS ENDORSEMENT INCLUDING MEDICAL PAYMENTS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Lost Key Coverage D. Expanded Property Damage Coverage 1. Under Section I — Coverages, Coverage A 1. For the purposes of this endorsement only: Bodily Injury And Property Damage Section I — Coverages, Coverage A Liability, coverage is extended to include Bodily Injury And Property Damage the following: Liability, 2. Exclusions, Exclusion j. If a customer's master or grand key, Damage To Property is amended as follows: excluding electronic key card, is lost, a. Paragraphs (3), (5), and (6) are deleted damaged or stolen while in your care, in their entirety. custody or control we will pay the cost of b. Paragraph (4) is deleted in its entirety replacing the keys, including the master lock and replaced with: and all keys used in the same lock, the cost (4) Personal property in the care, of adjusting locks to accept the new keys, or custody, or control of the insured: the cost to replace the locks, whichever is less. (a) for storage or sale at premises 2. Limit of Insurance— For the purpose of this you own, rent or occupy; or coverage the most we will pay is $ 10,000 (b) while being transported by any per"occurrence". aircraft, "auto" or watercraft B. Voluntary Property Damage owned or operated by or rented 1. Section I — Coverages, Coverage A Bodily to or loaned to any insured. Injury And Property Damage Liability, c. The coverage provided by this coverage is extended to include the following: endorsement does not apply to "property damage": At your request, we will pay for "property (1) Arising out of the disappearance or damage" to property of others caused by you and while in your possession, arising out of your loss of use of personal property; or business operations and occurring during the (2) Included in the "products-completed policy period. operations hazard". 2. Limit of Insurance— For the purpose of this 2. Limit of Insurance - The most we will pay coverage the most we will pay is $1,500 per for loss arising out of any one "occurrence" "occurrence". is $5,000. C. Non-Owned Watercraft 3. Deductible - Our obligation to pay for a Under Section I — Coverages, Coverage A covered loss applies only to the amount of Bodily Injury And Property Damage Liability, loss in excess of$250. 2. Exclusions, Exclusion g. Aircraft, Auto Or We will pay the deductible amount to effect Watercraft Paragraph (2) (a) is replaced with: settlement of any claim or "suit" and, upon (a) Less than 51 feet long; and notification of this action having been taken, you shall promptly reimburse us for the deductible as has been paid by us. CG 73 23 12 16 Includes copyrighted material of Insurance Services Office, Inc., Pagel of 5 with its permission. CG 73 23 12 16 This insurance is primary to any expanded d. All reasonable expenses incurred by the property damage coverage provided by a insured at our request to assist us in the separate endorsement attached to this investigation or defense of the claim or policy, and it will supplant any deductible in "suit", including actual loss of earnings up to said endorsement $500 a day because of time off from work. E. Damage To Premises Rented To You G. Newly Formed And Acquired Organizations 1. Under Section I — Coverages, Coverage A Under SECTION II — WHO IS AN INSURED Bodily Injury And Property Damage Paragraph 3.a. is replaced with: Liability, the last paragraph of 2. a. Coverage under this provision is afforded Exclusions is replaced with: only until the 180th day after you acquire or If Damage To Premises Rented To You is form the organization or the end of the policy not otherwise excluded, Exclusions c. period, whichever is earlier; through n. do not apply to damage by fire, H. Additional Insured — Automatic Status When lightning, explosion, smoke, or sprinkler Required In An Agreement Or Contract With leakage to premises while rented to you or You temporarily occupied by you with permission Section II — Who Is An Insured is amended to of the owner. include: 2. Under Section III — Limits Of Insurance, 1. Any person(s)or organization(s)described Paragraph 6 is replaced with: in Paragraph a.—d. below with whom you 6. Subject to 5. above, the Damage To have agreed in writing in a contract or Premises Rented To You Limit is the written agreement that such person or most we will pay under Coverage A for organization be added as an additional damages because of"property damage" insured on your policy during the policy to any one premises, while rented to period shown in the Declarations. you, or in the case of damage by fire, 2. Any other person or organization you are lightning, explosion, smoke or sprinkler required to add as an additional insured leakage, while rented to you or under the contract or agreement described temporarily occupied by you with in Paragraph 1. above. permission of the owner. The limit is The person or organization added as an increased to $1,000,000. insured by this endorsement is an insured 3. Under Section IV — Commercial General only for liability due to: Liability Conditions, 4. Other Insurance, b. a. Lessors of Leased Equipment — with Excess Insurance (1) (a) (ii) is replaced respect to their liability for"bodily injury", with: "property damage", or "personal and (ii) That is Fire, Lightning, Explosion, Smoke advertisinginjury", or Sprinkler leakage insurance for j ry", caused in whole or in p g part by your maintenance, operation, or premises rented to you or temporarily use of equipment leased to you by such occupied by you with permission of the person(s) or organization(s). This owner. insurance does not apply to any F. Supplementary Payments "occurrence" which takes place after the Under Section I — Coverages, Supplementary equipment lease expires. Payments — Coverages A and B Paragraphs However, their status as additional 1.b and 1.d. are replaced with: insured under this policy ends when b. Up to $2,500 for cost of bail bonds required their lease, contract, or agreement with because of accidents or traffic law violations you for such leased equipment expires. arising out of the use of any vehicle to which b. Managers or Lessors of Premises — the Bodily Injury Liability Coverage applies. with respect to liability arising out of the We do not have to furnish these bonds. ownership, maintenance, or use of that part of the premises you own, rent, lease, or occupy. Page 2 of 5 Includes copyrighted material of Insurance Services Office, Inc., CG 73 23 12 16 with its permission. CG 73 23 12 16 This insurance does not apply to: (1) Your acts or omissions; or (1) Any "occurrence" which takes place (2) The acts or omissions of those after you cease to be a tenant in acting on your behalf; in the that premises. performance of your ongoing (2) Structural alterations, new con- operations performed for that struction, or demolition operations additional insured, whether the work performed by or on behalf of the is performed by you or on your person or organization. behalf. However, their status as additional The insurance does not apply to: insured under this policy ends when you (1) "Bodily injury", "property damage", cease to be a tenant of such premises. or "personal and advertising injury" c. State or Political Subdivision — arising out of the rendering of or the Permits Relating to Premises — with failure to render any professional respect to the following hazards for architectural, engineering, or survey which the state or political subdivision services, including: has issued a permit or authorization in (a) The preparing, approving, or connection with premises you own, rent, failing to prepare or approve or control and to which this insurance maps, shop drawings, opinions, applies. reports, survey, field orders, (1) The existence, maintenance, repair, change orders, or drawings and construction, erection, or removal of specifications; or advertising signs, awnings, (b) Supervisory, inspection, archi- canopies, cellar entrances, coal tectural or engineering activities. holes, driveways, manholes, This exclusion applies even if marquees, hoist away openings, the claims against any insured sidewalk vaults, street banners, or allege negligence or other decorations and similar exposures; wrongdoing in the supervision, or hiring, employment, training or (2) The construction, erection, or monitoring of others by that removal of elevators; or insured, if the "occurrence" (3) The ownership maintenance or use which caused the "bodily injury" of any elevators covered by this or "property damage", or the insurance. offense which caused the "personal and advertising This insurance does not apply to: injury", involved the rendering (1) "Bodily injury" or "property damage" of, or failure to render, any or "personal or advertising injury" professional, architectural, arising out of operations performed engineering, or surveying for the state or municipality; or services. (2) "Bodily injury" or "property damage" (2) "Bodily injury" or "property damage" included within the "products- occurring after: completed operations hazard". (a) All work, including materials, However, such state or political parts, or equipment furnished in subdivision's status as additional connection with such work, on insured under this policy ends when the the project (other than service, permit ends. maintenance, or repairs) to be d. Owners, Lessees, or Contractors — performed by or on behalf of the with respect to liability for"bodily injury", additional insured(s) at the location of the covered "property damage", or "personal and operations has been completed; advertising injury" caused in whole or in or part, by: CG 73 23 12 16 Includes copyrighted material of Insurance Services Office, Inc., Page 3 of 5 with its permission. CG 73 23 12 16 (b) That portion of "your work" out b. You have agreed in writing in a contract of which the injury or damage or agreement that this insurance would arises has been put to its be primary and would not seek intended use by any person or contribution from any other insurance organization other than another available to the additional insured. contractor or subcontractor I. Employee Bodily Injury To Another Employee engaged in performing Under Section II — Who Is An Insured The operations for a principal as a part of the same project. following is added to Paragraph 2.a.(1): However, a person or organization's Paragraphs 2.a.(1) (a), (b) and (c) do not apply status as additional insured under to "bodily injury" to a co-"employee" in the this policy ends when your course of the co-"employee's" employment by operations for that additional insured you, or to "bodily injury" to a co-"volunteer are completed. worker" while performing duties related to the With respect to the insurance afforded to conduct of your business. such additional insureds a. — d. described J. Broad Form Named Insured above, the following is added to Section III Under Section II — Who Is An Insured The —Limits Of Insurance: following is added to Paragraph 2.: If coverage provided to the additional e. Any business entity incorporated or insured is required by a contract or organized under the laws of the United State agreement, the most we will pay on behalf of of America (including any State thereof), its the additional insured is the amount of territories or possessions, or Canada insurance: (including any Province thereof) in which the 1. Required by the contract or agreement; Named Insured shown in the Declarations or owns, during the policy period, an interest of 2. Available under the applicable Limits of more than fifty percent. If other valid Insurance shown in the Declarations: collectible insurance is available to any whichever is less. business entity covered by this solely by This endorsement shall not increase the reason of ownership by the Named Insured applicable Limits of Insurance shown in the shown in the Declarations in excess of fifty Declarations. percent, this insurance is excess over the However, the insurance afforded to such other insurance, whether primary, excess, additional insureds a.—d. described above: contingent, or on any other basis. 1. Only applies to the extent permitted by K. Aggregate Limit Per Location law; and Under Section III — Limits Of Insurance the 2. Will not be broader than that which you following is added to Paragraph 2: are required by the contract or The General Aggregate Limit under Section III agreement to provide for such additional Limits Of Insurance applies separately to each insured. of your locations owned by or rented to you or 3. Primary and Noncontributory — Other temporarily occupied by you with the permission Insurance Conditions of the owner. For the purposes of this provision, The following is added to the Other location means premises involving the same or Insurance Condition and supersedes any connecting lots, or premises whose connection provisions to the contrary: is interrupted only by a public street, roadway, Primary and Noncontributory Insurance waterway or railroad right-of-way. This insurance is primary to and will not L. Aggregate Limit Per Project seek contribution from any other insurance Under Section III — Limits Of Insurance The available to an additional insured under your following paragraph is added to Paragraph 2: policy provided that: The General Aggregate Limit under Section III a. The additional insured is a Named Limits Of Insurance applies separately to each Insured under such other insurance; and of your construction projects away from premises owned by or rented to you. Page 4 of 5 Includes copyrighted material of Insurance Services Office, Inc., CG 73 23 12 16 with its permission. CG 73 23 12 16 M. Medical Payments inception date of the policy shall not Under Section III — Limits Of Insurance, prejudice the coverage afforded by this Paragraph 7. is replaced with: policy provided such failure to disclose all 7. Subject to 5. above, the higher of: hazards or prior"occurrences" or offenses is not intentional. This provision does not a. $10,000; or affect our right to collect additional premium b. The amount shown in the Declarations or exercise our right of cancellation or non- for Medical Expense Limit is the most renewal. we will pay under Coverage C for all P. Waiver Of Subrogation medical expenses because of "bodily Under Section IV — Commercial General injury"sustained by one person. Liability Conditions, 8. Transfer Of Rights Of This coverage does not apply if Coverage C Recovery Against Others To Us the following — Medical Payments is excluded either by paragraph is added: the provisions of any coverage forms If required by a written contract executed prior to attached to the policy or by endorsement. loss, we waive any right of subrogation we may N. Knowledge Of An Occurrence have against the contracting person or Under Section IV — Commercial General organization because of payments we make for Liability Conditions, the following is added to injury or damage arising out of your ongoing 2. Duties In The Event Of Occurrence, operations or "your work" done under a contract Offense, Claim Or Suit: with that person or organization and included in e. Knowledge of an occurrence, offense, claim the "products-completed operations hazard". or suit by an agent or employee of any Q. Liberalization insured shall not in itself constitute Under Section IV — Commercial General knowledge of the insured unless you, a Liability Conditions, the following paragraph is partner, if you are a partnership; or an added: executive officer or insurance manager, if 10. Liberalization you are a corporation receives such notice of an occurrence, offense, claim or suit from If we revise this coverage form to provide more the agent or employee. coverage without additional premium charge, f. The requirements in Paragraph b. will not your policy will automatically provide the be considered breached unless there is additional coverage as of the day the revision is knowledge of occurrence as outlined in effective in your state. Paragraph e. above. R. Broadened Bodily Injury Definition (Mental O. Unintentional Failure To Disclose Hazard Anguish) Under Section IV — Commercial General Under Section V — Definitions Definition 3. Liability Conditions, Condition 6. "Bodily Injury" is replaced with: Representations the following paragraph is 3. "Bodily injury' means physical injury, added: sickness, or disease to a person and if d. Your failure to disclose all hazards or prior arising out of the foregoing, mental anguish, "occurrences"or offenses existing as of the mental injury, shock, or humiliation, including death at any time resulting therefrom. All terms and conditions of this policy apply unless modified by this endorsement. CG 73 23 12 16 Includes copyrighted material of Insurance Services Office, Inc., Page 5 of 5 with its permission. .4, ;-(W20 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA Policy Number: 72 WEC Z19068 Endorsement Number: Effective Date: 04/01/18 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address: RUBEN CHAVARIN 3124 W ROSECRANS AVE STE B HAWTHORNE CA 90250 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.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 2 % of the California workers' compensation premium otherwise due on such remuneration. SCHEDULE Person or Organization Job Description Any person or organization from whom you are required by written contract or agreement to obtain this waiver of rights from us Countersigned by Authorized Representative Form WC 04 03 06 (1) Printed in U.S.A. Process Date: 02/20/18 Policy Expiration Date: 04/01/19