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PROOF OF INSURANCE (2019) CLOSED Page 1 of 1 AC L> 10/ CERTIFICATE OF LIABILITY INSURANCE I DATE(MM/DD/YY 09/20168 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 NAME: Willis of New York, Inc. ( PHONE 1-877-945-7378 FAX 1-888-467-2378 c/o 26 Century Blvd (A/C.No.Extl: (A/C,No): ( E-MAIL certificates@willis.com P.O. Box 305191 ADDRESS: Nashville, TN 372305191 USA I INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: QBE Insurance Corporation 39217 INSURED INSURER B: General Casualty Company of Wisconsin 24414 Galls, LLC 1340 Russell Cave Road IINSURERC: Praetorian Insurance Company 37257 Lexington, KY 40505 USA ( INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: W8476585 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 OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER (MM/DD/YYYYI (MM/DD/YYYYI X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGESf RENTED CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ 1,000,000 A MED EXP(Any one person) $ 10,000 Y Y CGA1331044 03/01/2018 03/01/2019 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY❑ PRO ❑ LOC JECT PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) X ANY AUTO BODILY INJURY(Per person) $ A OWNED SCHEDULED CRA1331044 03/01/2018 03/01/2019 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTYDAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) B X UMBRELLALIAB OCCUR EACH OCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS-MADE CCU1331044 03/01/2018 03/01/2019 AGGREGATE $ 5,000,000 X DED I I RETENTION$ 10,000 $ WORKERS COMPENSATION X I SPER TATUTE EORH AND EMPLOYERS'LIABILITY C ANYPROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? F—] N/A Y CWC1331044 03/01/2018 03/01/2019 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) This Voids and Replaces Previously Issued Certificate Dated 10/09/2018 WITH ID: W8475829. City of El Segundo is included as an Additional Insured as respects to General Liability. Waiver of Subrogation applies in favor of City of El Segundo with respects to General Liability and Workers Compensation as permitted by law. 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 El Segundo AUTHORIZED REPRESENTATIVE 350 Main E1 Segundo, CA 90245 ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD SR 1D: 16872214 BATCH: 902857 POLICY NUMBER: CGA 1331044 COMMERCIAL GENERAL LIABILITY CBGENERAL HOLDINGS LLC CG2010 0413 ENDORSEMENT NO. OOO EFFECTIVE 3/1/2018 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) 0r0mgenizetipn(s) Location(s) Of Covered Operations WHERE REQUIRED BY WRITTEN CONTRACT OR AGREEMENT Information required to complete this Snhodu|o, ifnot shown abovo, will be shown in the Declarations. A. Section || — Who Is An Insured in amended to B. With nonpont to the insurance afforded to these include an an additional insured the person(s) or additional innunodn, the following additional organization(s) shown in the Snhodu|o, but only exclusions apply: with nonpont toliability for "bodily injury". "property This insurance does not apply to "bodily injury" or damage" or "personal and advertising injury" "property damage"occurring after: naunod, inwhole orin part. by: 1. All work, including maboria|n, parts or 1 Your or ' ' equipment furnished in connection with such 2. The acts or omissions of those acting on your work, on the project (other than non/ino, behalf; maintenance orrepairs) 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 tothe extent permitted by other than another contractor orsubcontractor law; and engaged in performing operations for a 2. If coverage provided to the additional insured in principal an a part of the same project. required by a contract or agreement, the C. With nonp*nt to the insurance afforded to these insurance afforded to such additional insured additional innunodn, the following in added to will not be broader than that which you are Section |||—Limits Of Insurance: required by the contract or agreement to provide for such additional insured. CG 20 10 04 13 @ Insurance Sominon Office, Inc., 2012 Page 1 of If coverage provided to the additional insured is 2. Available under the applicable Limits of required by a contract or agreement, the most we Insurance shown in the Declarations; will pay on behalf of the additional insured is the amount of insurance: whichever is less. 1. Required by the contract or agreement; or This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. Page 2 of 2 © Insurance Services Office, Inc., 2012 CG 20 10 04 13 (iv) If the loss arises out of the 0. LIMITED WORLDWIDE LIABILITY COVERAGE maintenance or use of aircraft, 11 autos", or watercraft to the The following is added to SECTION IV extent not subject to Para- CONDITIONS within the COMMERCIAL GEN- graph 2. g. Aircraft, Auto Or ERAL LIABILITY COVERAGE FORM: Watercraft under COVER- Expanded Coverage Territory AGE A.BODILY INJURY 1. If a"suit" is brought in a part of the "coverage AND PROPERTY DAMAGE territory" that is outside the United States of LIABILITY of SECTION I – America (including its territories and posses- COVERAGES within the sions), Puerto Rico or Canada, and we are COMMERCIAL GENERAL prevented by law, or otherwise, from defend- LIABILITY COVERAGE ing the insured, the insured will initiate a de- FORM. fense of the "suit". We will reimburse the in- 0. UNINTENTIONAL FAILURE TO DISCLOSE sured, under Supplementary Payments, for HAZARDS any reasonable and necessary expenses in- The following is added to Paragraph curred for the defense of a "suit" seeking 6. Representations of SECTION IV — COM- damages to which this insurance applies, that MERCIAL GENERAL LIABILITY CONDITIONS we would have paid had we been able to ex- within the COMMERCIAL GENERAL LIABILITY ercise our right and duty to defend. COVERAGE FORM: If the insured becomes legally obligated to Any unintentional failure to disclose all exposures pay sums because of damages to which this or hazards existing as of the effective date of the insurance applies in a part of the "coverage Commercial General Liability Coverage Form or territory" that is outside the United States of at any time during the policy period will not invali- America (including its territories and posses- date or adversely affect the coverage for such sions), Puerto Rico or Canada, and we are exposure or hazard. However, you must report prevented by law, or otherwise, from paying the undisclosed exposure or hazard to us as soon such sums on the insured's behalf, we will re- as reasonably possible after the exposure or imburse the insured for such sums. hazard is discovered. 2. All payments or reimbursements we make for P. WAIVER OF SUBROGATION damages because of judgments or settle- ments will be made in U.S. currency at the The following is added to Paragraph 8.Transfer Of prevailing exchange rate at the time the in- Rights Of Recovery Against Others To Us of sured became legally obligated to pay such SECTION IV — COMMERCIAL GENERAL sums. All payments or reimbursements we LIABILITY CONDITIONS within the COMMER- make for expenses under Supplementary CIAL GENERAL LIABILITY COVERAGE FORM: Payments will be made in U.S. currency at This condition does not apply to any person or the prevailing exchange rate at the time the organization to which you waived this condition by expenses were incurred. written contract or agreement, but only to the 3. Any disputes between you and us as to extent that subrogation is waived prior to the whether there is coverage under this policy "bodily injury" or "Property damage" under a must be filed in the courts of the United contract with that person or organization. States of America (including its territories and possessions), Puerto Rico or Canada. 4. The insured must fully maintain any coverage required by law, regulation or other governmen- tal authority during the policy period, except for reduction of the aggregate limits due to pay- ments of claims,judgments or settlements. Failure to maintain such coverage required by law, regulation or other governmental authori- ty will not invalidate this insurance. However, this insurance will apply as it the required coverage by law, regulation or other govern- mental authority was in full effect. Includes copyrighted material of Insurance Services Office, Inc., CG 8179 01 11 with its permission. Page 5 of 6 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13 (Ed. 4-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT 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.) This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule Any person or organization for which you have agreed to waive your rights of recovery in a written contract, provided such contract was executed prior to date of loss. 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.) Endorsement Effective 03/01/2018 Policy No. CWC1331044 Endorsement No. 000 Insured CB GENERAL HOLDINGS LLC Premium $750,000.58 Insurance Company PRAETORIAN INSURANCE COMPANY Countersigned by WC 00 03 13 (Ed. 4-84) Cc)1983 National Council on Compensation Insurance. CWC1331044 20180301 000