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PROOF OF INSURANCE (2019 - 2019) CLOSED 0p DATE(MMIDDIYYYY) ACCIM " CERTIFICATE OF LIABILITY INSURANCE II 09/11/2018 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 CONTACT Cath Service Van Wyke-Stahl Sargeant Insurance Agency,LLC. 'Tt ON'.�E' s l• (818)..5.6.1..-.26.0.0................y.....— _= LF��..nlnN;.......(8188))..436-5988........ 7740 Painter Avenue#210 AP�?.R. .L......... I �S)AFFORDING COVERAGE NAIC# NSURER WhittierCA 90602 INSURERA: Liberty Mutual Insurance 24082 INSUR .INSURED............... ............ ..,,,,, .....................„ 'ERB....................EMPLOYERS .PREFERRED INS.CO....... . .........,...—. 10346 . INSURER C: Indian Harbor Insurance Co 36940 BARTEL ASSOCIATES, LLC iNs mmm ER D 411 BOREL AVE STE 101 INSURm ,F... ......................................... SAN MATEO CA 94402-3525 INSURER .......... 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 PAID CLAIMS I INSR TYPE OF INSURANCE J AI?OL1 B7 1 POLICY NUMBER IMMIDDIYYYY) IMM J J LIMITS 4.1, U—A;--- POLICY EFF 06LICY EXP LTR IN IDDIYYYYI .. ......•..... . $ 2,000,000 OOXCO COMMERCIAL GENEOCCURRENCE .... NAM9(;E TO REIN Y CLAIMS-MADE LX.I OCCUR MED EXP(Any aneperson) 5 00 15,000.00 --- ) .O L.. DV INJURY L$ 2,000,000.00 A � Y 'I BKS(19 57 29 73 74 09/01/2018 09/01/2019 GERERALmmmITITR m �$ 4,000,000.00- -- GEN L AGGREGATE LIMIT APPLIES PER. _.AGGREGATEY .. ............... PRODUCTS-CO P/OP...........� AGG $ 4,000,000.00.......,,... POLICY JEG.'C' LOC OTHER AUTOMOBILE LIABILITY t�, @,���ggn:t)..............................N........ 1,000,000 00 f:;�"J'Iu4t3dNFD siNGLE LIN T ...,.,..... BODILYINJURY(Perpe -$ 1'................ :son S OWNED SCHEDULED BODILY INJURY Per ac $ HIRED NON-OWNED cid®) _ ANY AUTO AUTOS ( accident) A ,� AUTOS ONLY AUTOS ONLY Y BAS 19 57297374 09/01/2018 09/01/2019 PROPERTY � _, AUTOS ONLY UMBRELLA LIAB ...... OCCUREACH OCCURRENCE EXCESS LIARI, CLAIMS-MADE � DED RETENTIONS AGGREGATE � � WORKERS COMPENSATION /� STATLIT,F. ORH „••••,,,,,,,,,,, AND EMPLOYERS'LIABILITY B OFFICER/MEMBER EXCLUDED? N NIA Y EIG 2685705-00 09/01/2018 09/01/2019 E DISEASE — - 0000 AIJYPROPRIETOR/PARTNER/EXECUTIVE E L EACH ACCIDENT DA E _ IN (Mandatory in NH) $ 1 000 0 0 If yes,describe under E,L,DISEASE-POLICY MP OY E�I1,000,000 O $ 00 0 Each Ula"m YLIMIE b,UUU 0 DESCRIPTION OF OPERATIONS below � IC L • UUO.UO Professional Liability D MPP001715214 09/04/2018 09/04/2019 Annual Aggregate I 5,000,000.00 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CITY OF EL SEGUNDO, IT'S OFFICERS,DIRECTORS, EMPLOYEES,AGENTS AND VOLUNTEERS ARE HEREBY NAMED AS AN ADDITIONAL INSURED BY CONTRACT ON POLICY#BKS(19)57297374 and BAS(19)57297374 AS RESPECTS TO OPERATIONS OF THE NAMED INSURED ONLY, SEE CG2010.COVERAGE UNDER POLICY#BKS(19)57297374&BAS(19)57297374 IS PRIMARY AND NON-CONTRIBUTORY ABOVE ANY OTHER INSURANCE THE CERTIFICATE HOLDER(S)MAY CARRY,30 DAY NOTICE OF CANCELLATION. 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 AUTHORIZED REPRESENTATIVE El Segundo, CA 90245 lel* ,,,/ 4— ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: BKS (19) 57 29 73 74 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) Location(s) Of Covered Operations City of EL Segundo, it's officials, officers, employees and agents ALL LOCATIONS OF THE NAMED INSURED 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 B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following additional organization(s) shown in the Schedule, but only exclusions apply: with respect to liability for "bodily injury", "property This insurance does nota I to "bodily injury" or damage" or "personal and advertising injury" apply y ry caused, in whole or in part, by: 'property damage occurring after: 1. Your acts or omissions; or 1. All work, including materials, parts or equipment furnished in connection with such 2. The acts or omissions of those acting on your work, on the project (other than service, behalf; maintenance or repairs) to be performed by or in the performance of your ongoing operations for on behalf of the additional insured(s) at the the additional insured(s) at the location(s) location of the covered operations has been designated above. completed; or However: 2. That portion of "your work" out of which the injury or damage arises has been put to its 1. The insurance afforded to such additional intended use by any person or organization insured only applies to the extent permitted by other than another contractor or subcontractor law; and engaged in performing operations for a 2. If coverage provided to the additional insured is principal as a part of the same project. 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. CG 20 10 04 13 C Insurance Services Office, Inc., 2012 Page 1 of 2 C. With respect to the insurance afforded to these 2. Available under the applicable Limits of additional insureds, the following is added to Insurance shown in the Declarations; Section III—Limits Of Insurance: whichever is less. If coverage provided to the additional insured is This endorsement shall not increase the required by a contract or agreement, the most we applicable Limits of Insurance shown in the will pay on behalf of the additional insUred is the Declarations. amount of insurance: 1. Required by the contract or agreement; or Page 2 of 2 0 Insurance Services Office, Inc., 2012 CG 20 10 0413 COMMERCIAL GENERAL LIABILITY BARTEL ASSOCIATES, LLC. POLICY# BKS (19) 57297374 & BAS (19) 57297374 CG 20 0104 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCON''TRI UTORY - 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 This insurance is primary to and will not seek additional insured. 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 01 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 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 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 09/01/2018 at 12:01 AM standard time, forms a part of Policy No. EIG 2685705 00 Of the EMPLOYERS PREFERRED INS. CO. Carrier Code 00920 Issued to BARTEL ASSOCIATES LLC Endorsement No. Premium $5,437 Z. Countersigned at _WW___ on By: � Authorized Representative WC 04 03 06 (Ed. 4-84) ©1998 by the Workers'Compensation Insurance Rating Bureau of California.All rights reserved.