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PROOF OF INSURANCE (2019) CLOSED 272545 AC � CERTIFICATE OF LIABILITY INSURANCE DA 7/9/ops Y' 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 Gary Nerger 855-491-0974 PHONE602-666-4817 FA'X' 610-537-2283 INC,No,EmP I IAIc„No,); USI Insurance Services National, Inc. E•MML a r16r 'i.com ADDRESS: erusg 8331 Norman Center Dr,Ste 500 INSURER(S)AFFORDING COVERAGE NAIC# Bloomington,MN,55437 INSURER A: Nationwide Mutual Insurance Company 23787 INSURED INSURER B: State Compensation Insurance Fund 35076 THE GLASS MIRROR&STOREFRONT COMPANY INC INSURER C; DBA THE GLASS PROFESSIONALS INSURER D: 239 S.La Brea Avenue INSURER E a Inglewood,CA 90301 INSURER F COVERAGES CERTIFICATE NUMBER: 13305849 REVISION NUMBER: See below 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 RAID CLAIMS. INSR TYPE OF INSURANCE NSO V R POLICY EFF POLICY EXP RO POLICY NUMBER (MMIIDDIYYYY) (MM/DDIYY Y) LIMITS A X COMMERCIAL GENERAL LIABILITY ACP7812143045 3/1/2018 3/1/2019 EACH OCCURRENCE S 1,000,000 CLAIMS-MADE OCCUR PREMISCS( uMED EXP(Anp $ 100,000 oyne�rwvacrcra' .,on) $ 5,000 PERSONAL&ADV INJURY S 1,000,000 GENT AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGAI E $ 2,000,000 II X POLICYu PRO JFC1 Li LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHFR $ A AUTOMOBILE LIABILITY ACP7812143045 3/1/2018 3/1/2019 COMF3INEDSirJGLELIMITS 1,000,000 ........... ANY ...mX.. TO _... BODILY SCHEDULED ®e..f a INJURY.".IT....P..IT er acdent.}. �OWNESDONLY ........... HIRED NON-OWNED PROPERTY UAkd»E ....................... -. ._• AUTOS ONLY _ ...�. AUTOS ONLY ..................G.........•..... 5 A „X... UMBRELLA LIAB ............. OCCUR ACP7812143045 3/1/2018 3/1/2019 EACH OCCURRENCE ..5...................................,z,'-0,00,1.®.00......... X EXCESS LIAB CLAIMS MADE AGGREGATE $ 2,000,000 DED RETENTI N$ R T_ B WORKERS COMPENSATION YIN X 9100673-2018 06/08/2018 06/08/2019 X I STATUTE I I FRH 000 0 O FFIICdER MEMBE EXCLUDED?EMPLOYERS'LIABILIANYPROPRIETORIPARTNEECUTIVE C NIA ...E..L....DISEASE�C�EAEEMPLOYEE....�....................................1..v�000,.00®.......III (Man atory in NH) If yes,describe under 9,000,000 DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) 10217,CG 20 10 04 03,CA 20 48 10 13 CITY OF EL SEGUNDO-CITY CLERK ITS OFFICIALS,AND EMPLOYEES are named as additional insured as it relates to general&auto liability in accordance with the terms and conditions of the policies.Umbrella follows form as it relates to additional insureds. CERTIFICATE HOLDER CANCELLATION CITY OF EL SEGUNDO-CITY CLERK SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ITS OFFICIALS,AND EMPLOYEES THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 350 MAIN STREET,ROOM 5 EL SEGUNDO,CA 90245-3813 AUTHORIZED REPRESENTATIVE I ge-4,,I, The ACORD name and logo are registered marks of ACORD ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) �ru,:=.rorni,.•,i,>�ol,i.u�•+.r_�or�r,:,mr i a r;:•Rin a r;,,,ra�,��nnuao ury POLICY NUMBER° COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 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) CITY OF EL SEGUNDO - CITY CLERK ITS OFFICIALS AND EMPLOYEES 350 MAIN STREET, ROOM 5 EL SEGUNDO, CA 90245-3813 Location(s) Of Covered Operations ALL CALIFORNIA LOCATIONS 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 with respect to liability for "bodily injury", "property will not be broader than that which you are damage" or "personal and advertising injury" required by the contract or agreement to caused, in whole or in part, by: provide for such additional insured. 1. Your acts or omissions; or B. With respect to the insurance afforded to these 2. The acts or omissions of those acting on your additional insureds, the following additional behalf; exclusions apply: in the performance of your ongoing operations for This insurance does not apply to "bodily injury" or the additional insured(s) at the location(s) "property damage" occurring after: designated above. 1. All work, including materials, parts or However: equipment furnished in connection with such 1. The insurance afforded to such additional work, on the project (other than service, insured only applies to the extent permitted by maintenance or repairs) to be performed by or law;and on behalf of the additional insured(s) at the location of the covered operations has been completed; or CG 20 10 04 13 ©Insurance Services Office, Inc., 2012 Pagel of 2 ACP GLO 7822143045 MACH 18004 AGENT COPY 43 0011440 CG 20 10 04 13 2. That portion of "your work" out of which the 1. Required by the contractor agreement;or injury or damage arises has been put to its 2. Available under the applicable Limits of intended use by any person or organization Insurance shown in the Declarations; other than another contractor or subcontractor whichever is less. engaged in performing operations for a principal as a part of the same project. This endorsement shall not increase the C. With respect to the insurance afforded to these applicable Limits of Insurance shown in the additional insureds, the following is added to Declarations. 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: All terms and conditions apply unless modified by this endorsement. Page 2 of 2 © Insurance Services Office, Inc., 2012 CG 20 10 04 13 ACP GLO 7822143045 MACH 18004 AGENT COPY 43 0011441 COMMERCIAL AUTO CA 20 48 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED FOR COVERED AUTOS LIABILITY COVERAGE This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds"for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. SCHEDULE Name Of Person(s)Or Organization(s): CITY OF EL SEGUNDO - CITY CLERK ITS OFFICIALS, AND EMPLOYEES ...................... Information required to complete this Schedule„if not shown above,will be shown in the Declarations. Each person or organization shown in the Schedule is an "insured"for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Paragraph A.1. of Section II — Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms and Paragraph D.2. of Section I — Covered Autos Coverages of the Auto Dealers Coverage Form. CA 20 48 10 13 © Insurance Services Office, Inc., 2011 Page 1 of 1 ACP BA 78-2-2143045 L542 18002 AGENT COPY CA2048101300 0100 43 0011486 ENDORSEMENT AGREEMENT STATE WAIVER OF SUBROGATION BLANKET BASIS 9100673-18 FUND RENEWAL NA HOME OFFICE 3-28-99-93 SAN FRANCISCO EFFECTIVE JUNE 8, 2018 AT 12 . 01 A.M. PAGE 1 OF 1 ALL EFFECTIVE DATES ARE AND EXPIRING JUNE 8, 2019 AT 12 .01 A.M. AT 12:01 AM PACIFIC STANDARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME THE GLASS PROFESSIONALS 239 S LA BREA AVE INGLEWOOD, CA 90301 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: MAY 14, 2018 AUTHORIZED REPRESENT IVFPRESIDENT ANO CEO 2572 SCIF FORM 10217 IREV.7.2014! OLD OP 217