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PROOF OF INSURANCE (2018 - 2019) CLOSED CERTIFICATE OF LIABILITY INSURANCE DnTE8/24/18 ) 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. I'MPORTANT: If the certificate holder is an ADDITIONAL INSURED,the pollcy(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 right's to the certificate holder in lieu of such ondor'sDment(s). ACT PRODUCER u Bobbi BBB900 9989.............................m......................... .T.0 1 o«HONE 6 9 16 36.................. NONT _ ....... ryWo � 9821 11V0, INC,c.iNc�I: _. _.._.. Skyles Insurance Agency bpires@skylesinsurance.com 9840 Business Park Drive INSURER(S)AFFORDING COVERAGE NAIC# Sacramento,CA 95827 INSURER A, Security National Insurance Company 19879 ............................._ INSURED INSURER B: Integon National Insurance Company 29742 Network Cabling Systems INSURER C: National Union Fire Ins Co.of Pittsburgh PA 19445 Jose Luis Marquez INSURER D 8807 Pioneer Blvd. Ste M ..INSURER E:.........................� ...�... Santa Fe Springs CA 90670 INSURER F: 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY 'AID CLAIMS. iNSIR TYPE OFINSURANCE kNS,2� 1..,.,., POLICY NUMBER IMMIOD/VYYYFF I prAIIIUDO..� „..„. POLICY 60 ..............`� LTR ryYVYI LIMITS V�X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 50 P ren 0,000 CLAIMS-MADE X OCCUR MEDEXP[Any one person) $ 1 D,„,„„,,,,, ,,,,, 00 ” A Y Y NA105708305 5/25/18 5125/19 PERSONAL&ADV wluRY $ 1,00000 ,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000 X POLICY E dECT F LOC PRODUCTS-COMP/OP AGG S 2,000,000 .............................. OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 ANY AUTO BODILY INJURY(Per person) $ BOWNED �1_ SCHEDULED 12002307 5/19118 5/19/19 BODILY INJURY Per eccldenl $ ........... AUTOS ONLY AUTOS ( )' HIRED NON-OWNED PROPERTY DAM,r13E $ AUTOS ONLY AUTOS ONLY „tt?,a„_a,,ra6dartE,) UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 C EXCESS LIA PED A B CLAIMS-MADE EBU020454346 5/25/18 5/25/19 AGGREGAIE $ 2,000,000 X W RETENTION$ PRIIIIOD/COM IIP OPS $ 2,000,000 WORKERS COMPENSATION l STATUTE U I OERH AND EMPLOYERS'LIABILITY OFF CER/MEMB REXCLUDED7 ANYPROPRIETORIPARTNERIEXECUTIVE NIA ELL.EACH ACCIDENT YIN $ (Mandatory in NH) I E .DISEASE-EA E ......................MPLOYEE. ,.,.........,.,.,. If DESCdescribe under RIPTION .L RIPTION OF OPERATIONS below ❑ E,L„DISEASE POLICY Y LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) CITY OF EL SEGUNDO,ITS OFFICERS,OFFICIALS,EMPLOYEES AND VOLUNTEERS ARE ADDED AS ADDITIONAL INSUREDS AS REQUIRED BY WRITTEN CONTRACT AND PER THE CONDITIONS OF FORM 49-0108 0711 ATTACHED AND AS THE COMPANY WILL ALLOW. RE: Multiple Locations throughout California CERTIFICATE 14OLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CITY OF EL SEGUNDO ACCORDANCE WITH THE POLICY PROVISIONS. 350 MAIN STREET EL SEGUNDO, CA 90245-3895 AUTIf01tIe° D EPRa s TATt'vE I © 88.2015 ACORD CORPORATION. Ali rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY BLANKET ADDITIONAL INSUREDS - OWNERS, LESSEES OR CONTRACTORS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Policy Number:NA105708305 Endorsement Effective:8/24/2018 12:01 a.m. . ............. .............................................. Named Insured Countersigned By: JOSE LUIS MARQUEZJ NETWORK CABLING SYSTEMS SCHEDULE ................._......... g Name of Person or organization: - CITY OF EL SEGUNDO,ITS OFFICERS,OFFICIALS AND EMPLOYEES 350 MAIN ST. EL SEGUNDO CA 90245 cation: VARIOUS LOCATIONS THROUGHOUT THE STATE OF CALIFORNIA ............................. _................................... (If no entry appears above,information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) A.Section II—Who Is An Insured is amended to include as an insured the person or organization shown in the Schedule,but only to the extent that the person or organization shown in the Schedule is held liable for your acts or omissions arising out of your ongoing operations performed for that insured. B. With respect to the insurance afforded to these additional insureds,the following exclusion is added: 2. Exclusions This insurance does not apply to"bodily injury"or"property damage"occurring after: (1) All work,including materials,parts or equipment furnished in connection with such work,on the project(other than service,maintenance or repairs)to be performed by or on behalf of the additional insured(s)at the site of the covered operations has been completed;or (2) That portion of"your work"out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. C.The words"you"and"your"refer to the Named Insured shown in the Declarations. D."Your work"means work or operations performed by you or on your behalf;and materials,parts or equipment furnished in connection with such work or operations. Primary Wordine If required by written contract or agreement:Such insurance as is afforded by this policy shall be primary insurance,and any insurance or self-insurance maintained by the above additional insured(s)shall be excess of the insurance afforded to the named insured and shall not contribute to it. Waiver of Subrokyatiun If required by written contract or agreement:We waive any right of recovery we may have against an entity that is an additional insured per the terms of this endorsement because of payments we make for injury or damage arising out of"your work"done under a contract with that person or organization. 49-0108 0711 May Include Copyrighted Material of Insurance Services Offices, Inc. Page 1 of 1 Used with permission AC"R" CERTIFICATE OF LIABILITY INSURANCE I DATE Del w... 08/24/2018 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 certif'icat'e holder Is an ADDITIONAL INSURED„the policy('les) 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 CUN'IAC"I' NAME: PHONE .... , .,., FAX ....,.. Automatic Data Processing Insurance Agency,Inc. (AI ANo,Ext): INC,No): 1 Adp Boulevard A"p KESS, Roseland,NJ 07068INSURER(S)AFFORDING COVERAGE NAIC# )NSU iRER A: Employers Compensation Insurance Company 11512 C INSURED JOSE LUIS MARQUEZ INSURER B: DBA: Network Cabling Systems wsURERC; 8807 Pioneer Blvd Ste M INSURER D: Santa Fe Springs,CA 90670 INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: 967722 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, ) ICY FXP LTR AINSD DDL SWVO POLICY NUMBER (MMIDDUBR Y/YYYY) (MMLDDfYYYY TYPE OF INSURANCE ) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ _ i-OC PRODUCTS-COMP/OP AGG $ PROR OTHER: ......... $ AUTOMOBILE LIABILITY COMBINEU SINCILE k.IIiMIT (Ea accldill $ ANY AUTO BODILY INJURY(Per person) $ ., ...., ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) S .. HIREDAUTOS . NON-OWNED Pllr�iaYi.L.�pidgei7klJw<'aA4a k`' $ ( ) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DEC) ... RETENTION$) $ WORKERS COMPENSATION x PER OTH- E ER AND EROPLOYkTOR LIABILITY 1Y I E L DISEASEACCIDENT $ 1,000,000 STATUT A O F FERrMP RFMOE EXCLUDED11` '�I)I NN N/A Y EIG110433409 09/18/2017 09/18/2018 E L EACH1,000,000 yy -EA EMPLOYEE $ VaE.SCRIPTIONbOFtOPI RA)'IONS below EL DISEASE- POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Job Reference:City of EI Segundo This certificate has a blanket Waiver of Subrogation for the following state(s):CA CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of EI Segundo ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street EI Segundo,CA 90245-3895 AUTHORIZED REPRESENTATIVE I A@ 1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 4-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT-CALIFORNIA 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 FOR WHOM ALL JOBS IN CALIFORNIA THE NAMED INSURED HAS AGREED BY WRITTEN CONTRACT TO FURNISH THIS WAIVER. This policy is subject to a minimum charge of$250 for the issuance of waivers of subrogation 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.) This endorsement, effective 09/18/2017 at 12:01 AM standard time, forms a part of Policy No. EIG 1104334 09 Of the EMPLOYERS ASSURANCE CO. Carrier Code 00919 Issued to NETWORK CABLING SYSTEMS INC Endorsement No. Premium Countersigned at on By: r/ Authorized Representative WC 04 03 06 (Ed. 4-84) ©1998 by the Workers'Compensation Insurance Rating Bureau of California.All rights reserved.