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PROOF OF INSURANCE (2019 - 2019) CLOSED 8, DATE(MMIDDIYYYY) AC40)? °' CERTIFICATE OF LIABILITY INSURANCE 111 9/21/2018 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 NAN6E; Joanne Cov'a'rrublas Bichlmeier Insurance Services PHONE" FAX 730 S. Pacific Coast Hw Suite#201 tdVC,No,E ctt4 310-376-8852 (AIC,No);310-540-2215 Redondo Beach CA 90277 gDDRESs :, Joanne4blsins core INSURER(S)AFFORDING COVERAGE NAIC# , INSURER A:Evanston Insurance CO. INSURED Alpha O e dow Cleaning ure, LLC AL -3 NSURER S :Berkshire Hathaway GUARD 42390 g INSURER C:WESTERN SURETY COMPANY „1,3188 dba15665 Hawthorne Blvd., Suite D INSURER„p: Lawndale CA 90260 INSURER E INSURER F: , COVERAGES CERTIFICATE NUMBER:1350944820 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 INSR TYPE O INSURANCE Q IS1M CT EFF POuCY EXP LIMITS LTR POLICY NUMBER (MDOY „( A I COMMERCIAL GENERAL LIABILITY Y Y 2DB5473 9/1812018 9/18/2019EACH OCCURRENCE $2000,000 I nAd�iAGv'E 1"�"!PEI�J1'PCa CLAIMS-MADE X,,,,, OCCUR .VREMI5,E ,)„E pa:ur.enu:�:) $100000 X Package Policy MED EXP(Any one person) $5 000 PERSONAL&ADV INJURY $2000,000 GEN'L AGGREGATE LIMIT APPLIES PER 00;000 GE,NERALAGGREGATE 3,0 PRO, X POLICY El ,rE.CT 1:1 LOC ,PRODUCTS-COMP/OP AGO $Included C17HER $ B AUTOMOBILE LIABILITY Y ALAU966673 7/1612016 7/16/2019 COMBINED S'INGfl.,:IJM'I'r' S F_a,art:idon ... ,,9"000000 ANY AUTO BODILY INJURY(Per person) :, ALL OWNED X SCHEDULED BODILY INJURY(Per accident) $ AUTOS ;AUTOS r NON-OWNED611''JY ,roT'i g X HIRED AUTOS X AUTOS (PerrcG�derlJAMA.�E $ UMBRELLA LAB I OCCUR EACH OCCURRENCE $ EXCESS LIABCLAIMSAGGREGATE $ I GED � RETENTION$ ;MADE I $ WORKERS COMPENSATION PFR OTH AND EMPLOYERS'LIABILITY YIN 1 „$TF„A',I;U'T[ _.ER , ANY PROPRIETOR/PARTNER/EXECUTIVEE L EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED N 1 A (Mandatory in NH) E L DISEASE EA EMPLOYEE$ If yes,describe under I DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT $ C BOND 63343945 9/12/2018 9/12/2019 Employee Dishonesty 50,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached it more space is required) Window Cleaning. The City of El Segundo,Its officer's,officials,employees,agents and volunteers are named.additional insured per endorsement MEGL 0009-01 05 16;Primary &Non-Contributory applies per CG20010413,Waiver of Subrogation applies,per MEGL 0241-011 05 16 for G'ene'ral Liability and Ad'dilional Insured applies for Commercial Auto Liability per endorsement BA 99 04 04 16 when required by written contract or agreement. 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 Y I ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABILITY POLICY NUMBER: 2DB5473 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: $ INCLUDED (Check box if fully earned.❑X) 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 0009-0105 16 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 1 with its permission. COMMERCIAL GENERAL LIABILITY CG 20 01104 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 0104 13 0 Insurance Services Office, Inc.,2012 Page 1 of 1 COMMERCIAL GENERAL LIABILITY POLICY NUMBER: 2DB5473 L® 1!l 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: $ INCLUDED ........_ . _.....� 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 0241-0105 16 includes copyrighted material of Insurance Services Office, Inc., Page 1 of 1 with its permission. COMMERCIAL AUTO BA 99 04 04 16 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED WHEN REQUIRED BY CONTRACT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement Additional Insured When Required by Contract (a) The limits of insurance specified in (1) Paragraph A.1. — WHO IS AN INSURED — the written contract or written of Section II — Liability Coverage is agreement; or amended to add: (b) The Limits of Insurance shown in d. When you have agreed, in a written the Declarations. contract or written agreement, that a Such amount shall be a part of and not person or organization be added as an in addition to Limits of Insurance shown additional insured on your business auto in the Declarations and described in this policy, such person or organization is an Section. "insured", but only to the extent such (3) Additional Insureds Other Insurance person or organization is liable for "bodily injury" or "property damage" If we cover a claim or "suit" under this caused by the conduct of an "insured" Coverage Part that may also be covered under paragraphs a or b. of Who Is An by other insurance available to an Insured with regard to the ownership, additional insured, such additional maintenance or use of a covered"auto." insured must submit such claim or "suit" The insurance afforded to any such to the other insurer for defense and additional insured applies only if the indemnity. "bodily injury" or "property damage" However, this provision does not apply occurs: to the extent that you have agreed in a (1) During the policy period, and written contract or written agreement that the insurance is primary and non- (2) Subsequent to the execution of such contributory with the additional insured's written contract, and own insurance (3) Prior to the expiration of the period (4) Duties in The Event Of Accident, Claim, of time that the written contract Suit or Loss requires such insurance be provided If you have agreed in a written contract to the additional insured. or written agreement that another (2) How Limits Apply person or organization be added as an If you have agreed in a written contract additional insured on your policy, the or written agreement that another additional insured shall be required to person or organization be added as an comply with the provisions in A. Loss additional insured on your policy, the Conditions 2. — Duties In The Event most we will pay on behalf of such Of Accident, Claim, Suit Or Loss — of additional insured is the lesser of: SECTION IV — BUSINESS AUTO CONDITIONS, in the same manner as the Named Insured. BA 99 04 04 16 Includes copyrighted material of Insurance Services Office,Inc,with its permission Page 1 of 1 YYYY) MMIDD/ ^' 5MMIDDI CERTIFICATE OF LIABILITY COVERAGE DATE( 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 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-ErnpI'oyerJoint Man Sponsors NAME: William Flores Ome a'Con�ITULInity Labor ASSociation PHONE FAX 126 r IliiS St Suite 200 INC,,No,Ext). (833)427.4568 ,INC.No): (800)673-0183 Redding, CA 96001 EMAIL info@corT')passpilot.00rTI ISSUER(S)AFFORDING COVERAGE COVERED ISSUER A: COMPASSPILOT Diamond PEO, LLC ERISA-based member benefit program of 19800 MacArthur Blvd, Suite 300 Irvine CA 92612 OMEGA COMMUNITY LABOR ASSOCIATION ISSUER B: 41803272 ISSUER C: 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 CONDITIONSOF SUCH POLICIES.LIMITSSHOWN MAY HAVEBEEN REDUCED BYPAID CLAIMS TYPE OF A•OOL SUB!R dElVMrDIPl�,YN..,t'"!" POLICY EXP LTR ^4 ovo wvo7 I�ad;211...II`,:'dt•YtllllA1BFF'R? ' 111 IMMdDW'YYYYI LIMITS T COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS MADE OCCUR PREMISES(Ea occurrence) $ MED EXP(Anyone person) $ PERSONAL 8 ADV INJURY $ GEN'L AGGREGATE LIMIT PER: GENERAL AGGREGATE $ POLICY PRO LOC PRODUCTS-COMPIOPAGG 1$ JECT $ OTHFR r. AUTOMOBILE UAB'ILITY i,;(}BASINEUSIN(•`Rll I0:04 � Ta hcc rr'onlr AN'M',AI,lTO fjouiI.Y INJURY(Il:n:.,f porreny AL I OWNED SCHEDULED AUTOS AUTOS BODILY 1N„IURY q;Pec'alt.;r otloeuep `B NON OWNED PRON:'r("LY DAMAGI HIRED AUTOS AUTOS ('!°tilt 0,;v 1-vit) 1 I (T• UMBRELLALIAB OCCUR EACH OCCURRENCE $ EXCESSLIAB CLAIMS-MADE AGGREGATE $ DED 1 RETENTION$ $ A IIWORKERS COMPENSATION / WB2018-1001-43 3/1/2018 3/1/2019V ST'ATI.PES OTw'!• ANDEMPLOYERS'LIABILITY ' E L EACH ACCIDENT ER $ 1,000,000 ANYPROPRI'FTO'RWARTNEWEXLCUTIVE FA DISEASE EAFFIPI,CYPE 'S 1,000,000 f;FFtCFNM'EM8ER EXCLUDED (Y/N) EL DISEASE IPOLICYLIM'R"I" $ 1 000,000 DESCRIPTION OF OPERATIONS!LOCATIONS I 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. Fiis un dow Cleaning-Lawndale 350 Street A .. El Segundo CA 90245 AUTHORIZED REPRESENTATIVE WIVO, William Flores 41803272 11010 1 Diamond PEO, LLC (1001-43) ` TUWana Ware 15/10/2018 11:11:47 AM (EDT) i Page 1 of 2 AGENCY CUSTOMER ID: 1010 LOC ACCOR" ADDITIONAL REMARKS SCHEDULE Page of �1 AGENCY NAMED INSURED nd PEO, OMNIS Benefit Plan Administrators lil9iw81101100 MacAMLLC iur Blvd,Suite 300 POLICY NUMBER ...... Irvine CA 92612 . ... ........ . ...... NAIC CODE CARRIER EFFECTIVE DATE: ADDITIONAL REMARK$ 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 Cleaning-Lawndale ADDRESS:350 Main Street El Segundo CA 90245 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 1101 (2008101) C 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ADDENDUM/DO( 43.803272 1 1010 1 Diamond PEO, LLC (1001-43) Tuwana Ware i 5/10/2016 11:11:47 AM (EDT) I Page 2 of 2 011 �y WORKER'S COMPENSA' |ONBEWEF|T ENDORSEMENT AGREEMENT WAIVER OF SUBROGATION Diamond PEO,LLC 19800 MacArthur Blvd.8u�mm \ Irvine CA 92612 � POLICY #^ xva2018'1001-43 POLICY PERIOD: 3/1/2018 3/1m019 ANYTHING IN THIS POLICY TO THE CONTRARY NOTWITHSTANDING, IT IS AGREED THAT COMPASS PILOT WAIVES ANY RIGHT OFSUBROGATION AGAINST FIS Wndov�Cleaning-La°nua|o �350 Main Street El Segundo CA 90245 ITS SUBSIDIARIES,OWNERS,OFFICERS, DIRECTORS, PROPERTY OWNERS AND EMPLOYEES ARE HEREBY NAMED ASADDITIONAL COVERED. 5m3/2018 ENDORSED AUTHORIZED REPRESENTATIVE William Flores-PRESIDENT . 8077Florence Ave, Downey[a9O24O \nfo@yconnpasspUokwcmomPh033\427-456Q (55S)573-Q214Fax (8OO) 673-0183Billing(559) S73'QO7S