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PROOF OF INSURANCE (2018 - 2019) CLOSED CANNCOR-01 ..._................. KGARCIA
A ]►RO DATE(MM/DDNYYY)
CERTIFICATE OF LIABILITY INSURANCE 08/02/2018
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE L R^^ ...IS ww.
TE 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 holderin lieu of such endorsement(s).
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PRODUCER License#0305584 c Nrncr Kristina Pettit
Morris&Garritano Insurance Agency,Inc. PHONE c,r ,Ext),(805)543-6887 375 I F c,N�,y:(805�543-3064
PO Drawer 1189 I
San Luis Obispo,CA 93406 , 5 k„ tt t(Mmorri'scgarritano.com
INSURE $O AFFORDING NAIC#
INSURER A:American Casualty Company of Reading,Pennsylvania 20427
INSURED INSURER,s,:,Transportation„Insurance.COmpanv 20494
Cannon Corporation INSURER C:Hartford_Casualty Insurance Company29424
1050 Southwood Drive
INSURER D:Liberty Insurance Underwriters,Inc. 19917,
San Luis Obispo,CA 93401
INSURER E
INSURER F
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COVERAGES CERTIFICATE NUMBER: 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
TYPE OF INSURANCE MIT
BY PAID CLAIMS
IPOLICY EFF POLICY EXP
I, AINSD WV0 POLICY NUMBER th1.IW.. .t�.(k X )..�(If1MJ� (Y.YXI�!l LIMITS
A COMMERCIAL GENERAL LIABILITY �. ... .ww...Y, 1,000,000
yy YY EACH OCCURRENCE $
P, X X DAMAGE S LEP NT D 200,000
CLAIMS-MADE X occuR 2058094931 09/01/2017 09/01/2018 rr?me) ... $
AGE TO RE
Per Project A re at 15,000
J 99 9 MEn,E,xP(Any one,personl,......, �
PERSONAL&ADV INJURY $ 1,000,000
Of"WL A4",,6REGA"f E LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000
JECT MP/OP AGG.,., �
POLICY X� PRO- � LOC
2,000,00
PRaoucrs ca ..$ .... ..
O'p'HIER $
B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000
(Fa ifgislent)....,,,,,..
ANY Aura 2058094976 09/01/2017 09/0112018 BODILY person) $
(OWNED SCHEDULED
OPer aS ONLY
ABODILY INJURY ccident) $
HIRED NON-OWNEDLfdoo�tl GE
AUTOS ONLY AUTOS ONLY Ie Or $
er dul,Y'i
UMBRELLA LIAB OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE AGGREGATE $
DED 4 I RETENTION$ $
C WORKERS COMPENSATION X I PEATUTE OTTH
AND EMPLOYERS'LIABILITY Y,dN 51WEAA50F4 09/01/2017 09/01/2018 1,000,0001
OFFICER/MEMBER
ANY /PARTNER/EEXCLU ED?ECUTIVE �' C NIA E L EACH ACCIDENT $.
(Mandatory in NH) E L DISEASE-EA EMPLOYEE $ 1'000,000
_.. ---- ----
If yes,describe under 1,000,000
DESCRIPTION aF OPERATIONS below .. EL DISEASE-POLICY LIMIT $
D Professional Liao. � AEXNYABNDIR001 06/08/2018 06108/2019 Per Claim m 2,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required)
Re:#180607.
See form attached as triggered by written contract:
GL:AI/PNC-CNA75079XX 0115(Ongoing and Completed Operations),WOS-CNA75008XX 0115
CERTIFICATE HOLDI R ................. .. 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 9 ACCORDANCE WITH THE POLICY PROVISIONS.
Public Works
350 Main St. .....-......................._.........................__-_._.. .._....................._._.....—.11.1.1.........................
EI Segundo,CA 90245 AUTHORIZED REPRESENTATIVE
11
40-11-
ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
CNA CNA PARAMOUNT
Blanket Additional Insured - Owners, Lessees or
Contractors - with Products-Completed
Operations Coverage Endorsement
This endorsement modifies insurance provided under the following
COMMERCIAL GENERAL LIABILITY COVERAGE PART �A,,L
It is understood and agreed as follows:
I. The WHO IS AN INSURED section is amended to add as an Insured any person or organization whom the Named
Insured is required by written contract to add as an additional insured on this coverage part, including any such
person or organization, if any, specifically set forth on the Schedule attachment to this endorsement. However, such
person or organization is an Insured only with respect to such person or organization's liability for:
A. unless paragraph B. below applies,
1. bodily injury, property damage, or personal and advertising injury caused in whole or in part by the acts
or omissions by or on behalf of the Named Insured and in the performance of such Named Insured's
ongoing operations as specified in such written contract; or
2. bodily injury or property damage caused in whole or in part by your work and included in the products-
completed operations hazard, and only if
a. the written contract requires the Named Insured to provide the additional insured such coverage; and
b. this coverage part provides such coverage.
B. bodily injury, property damage, or personal and advertising injury arising out of your work described in such
written contract, but only if:
1. this coverage part provides coverage for bodily injury or property damage included within the products
completed operations hazard; and
2. the written contract specifically requires the Named Insured to provide additional insured coverage under
the 11-85 or 10-01 edition of CG2010 or the 10-01 edition of CG2037.
II. Subject always to the terms and conditions of this policy, including the limits of insurance, the Insurer will not provide
such additional insured with.-
A.
ith:A. coverage broader than required by the written contract; or
B. a higher limit of insurance than required by the written contract.
III. The insurance granted by this endorsement to the additional insured does not apply to bodily injury, property
damage, or personal and advertising injury arising out of:
A. the rendering of, or the failure to render, any professional architectural, engineering, or surveying services,
including:
1. the preparing, approving, or failing to prepare or approve maps, shop drawings, opinions, reports, surveys,
field orders, change orders or drawings and specifications; and
2. supervisory, inspection, architectural or engineering activities; or
B. any premises or work for which the additional insured is specifically listed as an additional insured on another
endorsement attached to this coverage part.
IV. Notwithstanding anything to the contrary in the section entitled COMMERCIAL GENERAL LIABILITY CONDITIONS,
the Condition entitled Other Insurance, this insurance is excess of all other insurance available to the additional
insured whether on a primary, excess, contingent or any other basis. However, if this insurance is required by written
CNA75079XX (1-15) Policy No: 2058094931
Page 1 of 2 Endorsement No: 7
AMERICAN CASUALTY CO OF RF-ADING,PA
Insured Name: CANNON CORPORATION
Copyright CNA All Rights Reserved Includes copyrighted material of Insurance Services Office,Inc,with its permission
CNA CNA PARAMOUNT
Blanket Additional Insured - Owners, Lessees or
Contractors - with Products-Completed
Operations Coverage Endorsement
contract to be primary and non-contributory, this insurance will be primary and non-contributory relative solely to
insurance on which the additional insured is a named insured.
V. Solely with respect to the insurance granted by this endorsement, the section entitled COMMERCIAL GENERAL
LIABILITY CONDITIONS is amended as follows:
The Condition entitled Duties In The Event of Occurrence, Offense, Claim or Suit is amended with the addition
of the following:
Any additional insured pursuant to this endorsement will as soon as practicable:
1. give the Insurer written notice of any claim, or any occurrence or offense which may result in a claim;
2. except as provided in Paragraph IV. of this endorsement, agree to make available any other insurance the
additional insured has for any loss covered under this coverage part;
3. send the Insurer copies of all legal papers received, and otherwise cooperate with the Insurer in the
investigation, defense, or settlement of the claim; and
4. tender the defense and indemnity of any claim to any other insurer or self insurer whose policy or program
applies to a loss that the Insurer covers under this coverage part. However, if the written contract requires
this insurance to be primary and non-contributory, this paragraph (4) does not apply to insurance on which
the additional insured is a named insured.
The Insurer has no duty to defend or indemnify an additional insured under this endorsement until the Insurer
receives written notice of a claim from the additional insured.
VI. Solely with respect to the insurance granted by this endorsement, the section entitled DEFINITIONS is amended to
add the following definition:
Written contract means a written contract or written agreement that requires the Named Insured to make a person
or organization an additional insured on this coverage part, provided the contract or agreement:
A. is currently in effect or becomes effective during the term of this policy; and
B. was executed prior to:
1. the bodily injury or property damage; or
2. the offense that caused the personal and advertising injury
for which the additional insured seeks coverage.
Any coverage granted by this endorsement shall apply solely to the extent permissible by law.
All other terms and conditions of the Policy remain unchanged.
This endorsement,which forms a part of and is for attachment to the Policy issued by the designated Insurers, takes effect
on the effective date of said Policy at the hour stated in said Policy, unless another effective date is shown below, and
expires concurrently with said Policy.
CNA75079XX (1-15) Policy No: 2058094931
Page 2 of 2 Endorsement No: 7
AMERICAN CASUALTY CO OF READING,PA
Insured Name: CANNON CORPORATION
Copyright CNA All Rights Reserved Includes copyrighted material of Insurance Services Office,Inc,with its permission
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
WAIVER OF OUR RIGHT TO RECOVER FROM
OTHERS ENDORSEMENT - CALIFORNIA
r
Policy Number: 51 WE AA50F4 Endorsement Number:
Effective Date: 09/01/17 Effective hour is the same as stated on the Information Page of the policy.
Named Insured and Address: CANNON CORPORATION
1050 SOUTHWOOD DR
SAN LUIS OBISPO CA 93401
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: 09/01/17 Policy Expiration Date: 09/01/18