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PROOF OF INSURANCE (2019 - 2019) CLOSED �V G DATE(MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 5/8/2018 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 pollcy(los)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 endomement(s). PRODUCER N�ACT Nyea Gallegos Rnight Insurance Services PHONE eats (818)662-4200 FAX No):(816)662-9312 535 North Brand Boulevard AD"DRRESS,NyeaGOKnightIns.net Suite 1000 INSURER(8)AFFORDING COVERAGE NAICN Glendale CA 91203 INSURERA:Liberty Surplus Insurance Company 10725 INSURED INSURER a Naticnwide Mutual / Allied 23787 All City Management Services Inc INSURER C:HOuston Casualty Company 42374 10440 Pioneer Blvd # 5 INSURERD:Endurance American Specialty 41718 INSURER E: Santa Fe Springs CA 90670 INSURER F: COVERAGES CERTIFICATE NUMBER:I8/19 Master REVIS'I'ON N'UM'BER, 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: ADDL SUBR POLICY EFF POUCY EXP LTR! TYPE OF INSURANCE IN n POLICY NUMBER IMMIDD/YYYYI IMMIODr1IYYY1 LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 RFNTrD A CLAIMS-MADE OCCUR PREMSESO(Ea occuronce) $ 50,D00 X 1DO02DD643-03 5/1/2018 5/1/2019 MED EXP(Any one person) S Excluded PERSONAL 8 ADV INJURY $ 1,000,000 GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000 X POLICY O. JJERCT LDC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER $ AUTOMOBILE LIABILITY C+.YI'AW�Ifl;�O*a'IrIS,�4E A,I,911' y, 1,000,000 (N,=4010 B X ANY AUTO BODILY INJURY(Per person) S ALL OWNED SCHEDULEDX ACP3066769436 5/1/2018 5/1/2019 BODILY INJURY(Per accident) S AUTO X HIR DSAUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS (Pal`a2e'.Idamrl) S UMBRELLA LIAB OCCUR let Layer (Primary) EACH OCCURRENCE 5 3,000,000 C X ,EXCESS UAB CLAIMS-MADF AGGREGATE S 3,000,000 C5E'd X F,TTC;WTION'$ a H16XC50744-01 5/1/2016 5/1/2019 91 WORKERS COMPENSATION p4R 0111' AND EMPLOYERS'LIABILITY STATUTE ER aa+:n'InItC7R'pP141L";'O'RST+ASY,TNUIaiq '!;q,;Y,ll'pv'E YIN Not Applicable EL EACH ACCIDENT S OFFIC'LRAIVAR513 EXCLUDED? NIA ' flArindc3ory In fol) EL DISEASE-EA EMPLOYEE S If tram,downs un dor D'cS01dIPfK)Ntip'OPERA rPONS tlo'OA EL US'EASE-POLICY LIMIT S D Excess Liability 2nd Layer (Secondary) 5/1/2018 5/1/2019 Each Occurrence In Excess of $5,00D,000 Occ $0 Retention ELD30000649700 $3M Primary Limit $5,0DO,000 Agg DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space le required) As respects General Liability and required by written contract; Certificate Holder is named as additional insured. Insurance is Primary & Non-Contributory. Waiver of Subrogation applicable. Auto Liability Additional Insured included as rquired by written contract. CERT'I'FICATE H'O'LDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE H1 El Segundo;Finance Director T .. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN SE] fi""�,.Lw� ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street El Segundo, CA 90245 AUTHORIZED REPRESENTATIVE Manny Mashhoud/NYSGAL ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401) ' ;.% Liberty Surplus Insurint v Commercial General Liability Corporal ion . LIBERTY SURPLUS INSURANCE CORPORATION (A Nmv Ilampshire Siock Insurance Company,hcieinafrer the"Cutnpanl") ENDORSEMENT NO. Effective Date: 05/01/18-05/01/19 Policy Number: 1000200843-03 Issued To: All City Management Services,Inc„ _..__ ............................................m, ........_........_...............................................mm......„ ....................................... ..................m.................................................... 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 fnlhlwing: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location(s) Of Covered Operations Any person or organization for whom you are .-11 locations of covered operations. performing operations when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy; Any other person or organization you are required to add as an additional insured under the contract or agreement described in the paragraph above. (Information required to complete Ilvs Schedule,if not shown above,will be shown in the Declarations) A. Section II—Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule,but only with respect to liability for"bodily injury","properq-damage"or"personal and advertising injury"caused,in whole or in part,by: 1. Your acts or omissions;or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insureds)at the location(s)designated above. B. N-ith respect to the insurance afforded to these additional insureds,the following additional exclusions apply: This insurance does not apply to"bodily iniury"or"property damage"occurring after: 1. .111 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 location of the covered operations has been completed;or 2 CG 20 10 07 04 Q ISO Properties,Inc.,2004 ., Liberty Surplus hisurancr Commercial General Liability C'orporation. 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 organi2ation other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. CG 20 10 07 04 ®ISO Properties,Inc.,2004 I ,I Liberty �i11r1�1t!w Mrtiriurant•e Commercial General Liability (or', crralic3n LIBERTY SURPLUS INSURANCE CORPORATION (_\New Hampshire Stock Insurance Co3npany,hereinafter the"Compan3'") ENDORSEMENT NO. Effective Date: 05/01/18-05/01/19 Policy Number: 1000200843-03 Issued To: All City Management Services,Inc. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY INSURANCE CLAUSE ENDORSEMENT To the extent that this insurance is afforded to any additional insured under the policy,such insurance shall apply as primary and not contributing with any insurance carried by such additional insured,as required by written contract. Nothing herein contained shall be held to waive,vary,alter or extend any condition or provision of the policy other than as above stated. NU-1—j CGL 10 31 04 03 Liberty Surhlu%Insurance Commercial General Liability Corlmral ion LIBERTY SURPLUS INSURANCE CORPORATION (A Nmj Hampshire Stuck Insurance Company,hereinafter the"Company") ENDORSEl'v'IEN T NO. Effective Date: 05/01/18-05/01/19 Policy Number: 1000200843.03 Issued To: All City Management Services,Inc. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: As required by written contract signed by both parties prior to any"occurrence"in which coverage is sought under this policy. Information required to complete this Schedule,if not shown above,will he sho%vn in the Declarations. The following is added to Paragraph S.Transfer Of Rights Of Recovery Against Others To Us of Section IV— Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or"your work"done under a contract with that person or organization and included in the"products-cotnpleted operations hazard". This waiver applies only to the person or organization shown in die Schedule above. ML 1 CG 24 D4 05 09 ©Insurance Services Office,Inc.,2008 Named Insured: All City Management, Inc. Policy#ACP 3068769436 Effective 05/01/18-05/01/2019 COMMERCIAL AUTO CA 00 0110 13 BUSINESS AUTO COVERAGE FOR Various provisions in this policy restrict coverage. SECTION I—COVERED AUTOS Read the entire policy carefully to determine rights, Item Two of the Declarations shows the "autos" that duties and what is and is not covered. are covered "autos"for each of your coverages. The Throughout this policy the words "you" and "your" following numerical symbols describe the "autos"that refer to the Named Insured shown in the Declarations. may be covered "autos".The symbols entered next to The words "we", "us" and "our" refer to the company a coverage on the Declarations designate the only providing this insurance. "autos"that are covered"autos". Other words and phrases that appear in quotation A. Description Of Covered Auto Designation marks have special meaning. Refer to Section V — Symbols Definitions. Symbol Description Of Covered Auto Designation Symbols 1 Any"Auto" 2 Owned"Autos" Only those"autos"you own(and for Covered Autos Liability Coverage any Only "trailers"you don't own while attached to power units you own).This includes those"autos"you acquire ownership of after the policy begins. 3 Owned Private Only the private passenger"autos"you own.This includes those private Passenger passenger"autos"you acquire ownership of after the policy begins. "Autos"Only 4 Owned Only those"autos"you own that are not of the private passengertype(and for "Autos"Other Covered Autos Liability Coverage any"trailers"you don't own while attached to Than Private power units you own). This includes those"autos"not of the private passenger Passenger type you acquire ownership of after the policy begins. "Autos"Only 5 Owned"Autos" Only those"autos"you own that are required to have no-fault benefits in the state Subject To where they are licensed or principally garaged.This includes those"autos"you No-fault acquire ownership of after the policy begins provided they are required to have no- fault benefits in the state where they are licensed or principally garaged. 6 Owned"Autos" Only those"autos"you own that because of the law in the state where they are Subject To A licensed or principally garaged are required to have and cannot reject Uninsured Compulsory Motorists Coverage.This includes those"autos"you acquire ownership of after the Uninsured policy begins provided they are subject to the same state uninsured motorists _............. 7. ..—.... Motorists Law requirement. Specifically Only those"autos"described in Item Three of the Declarationsfor which a Described premium charge is shown (and for Covered Autos Liability Coverage any"trailers" "Autos" you don't own while attached to any power unit described in Item Three). 8 Hired"Autos" Only those"autos"you lease, hire, rent or borrow. This does not include any"auto" Only you lease, hire, rent or borrow from any of your"employees",partners (if you are a partnership), members(if you are a limited liability company)or members of their households. 9 Non-owned Only those"autos"you do not own, lease, hire, rent or borrow that are used in "Autos"Only connection with your business.This includes"autos"owned by your"employees", partners(if you are a partnership),members(if you are a limited liability company) or members of their households but only while used in your business or your personal affairs. CA 00 01 10 13 ©Insurance Services Office, Inc.,2011 Page 1 of 12 ACP BAPD78-5-5954504 LIB3 17086 INSURED COPY CA0001101300 0001 47 0034413 19 Mobile Only those"autos"that are land vehicles and that would qualify under the definition Equipment of"mobile equipment"under this policy if they were not subject to a compulsory or Subject To financial responsibility law or other motor vehicle insurance law where they are Compulsory Or licensed or principally garaged. Financial Responsibility Or Other Motor Vehicle Insurance Law Only B. Owned Autos You Acquire After The Policy SECTION II—COVERED AUTOS LIABILITY Begins COVERAGE 1. If Symbols 1, 2, 3, 4, 5, 6 or 19 are entered A. Coverage next to a coverage in Item Two of the We will pay all sums an "insured"legally must pay Declarations, then you have coverage for as damages because of"bodily injury"or"property "autos"that you acquire of the type described damage" to which this insurance applies, caused for the remainder of the policy period. by an"accident"and resulting from the ownership, 2. But, if Symbol 7 is entered next to a coverage maintenance or use of a covered"auto", in Item Two of the Declarations, an "auto" you We will also pay all sums an"insured"legally must acquire will be a covered "auto" for that pay as a "covered pollution cost or expense" to coverage only if: which this insurance applies, caused by an a. We already cover all "autos" that you own "accident" and resulting from the ownership, for that coverage or it replaces an "auto" maintenance or use of covered "autos". However, you previously owned that had that we will only pay for the "covered pollution cost or coverage;and expense" if there is either "bodily injury" or b. You tell us within 30 days after you acquire "property damage"to which this insurance applies it that you want us to cover it for that that is caused by the same"accident". coverage. We have the right and duty to defend any C. Certain Trailers, Mobile Equipment And "insured"against a "suit" asking for such damages Temporary Substitute Autos or a"covered pollution cost or expense". However, wsuite have no duty to defend any"insured"against a If Covered Autos Liability Coverage is provided by this Coverage Form, the following types of ' seeking damages for 'bodily injury" or v "property damage" ora "covered pollution cost vehicles are also covered "autos" for Covered expense"to which this insurance does not apply. Autos Liability Coverage: We may investigate and settle any claim or"suit" 1. "Trailers"with a load capacity of 2,000 pounds as we consider appropriate. Our duty to defend or or less designed primarily for travel on public settle ends when the Covered Autos Liability roads. Coverage Limit of Insurance has been exhausted 2. "Mobile equipment" while being carried or by payment of judgments or settlements, towed by a covered"auto". 1. Who Is An Insured 3. Any "auto" you do not own while used with the The following are"insureds": permission of its owner as a temporary substitute for a covered "auto" you own that is a. You for any covered"auto". out of service because of its: b. Anyone else while using with your a. Breakdown; permission a covered "auto" you own„ hire or borrow except: b. Repair; (1) The owner or anyone else from whom c. Servicing; you hire or borrow a covered"auto". d. "Loss';or This exception does not apply if the e. Destruction. covered"auto" is a"trailer" connected to a covered"auto"you own. Page 2 of 12 ©Insurance Services Office, Inc., 2011 CA 00 01 10 13 ACP BAPD78-5-5954504 LIB3 17086 INSURED COPY CA0001101300 0001 47 0034414 (2) Your "employee"if the covered"auto" is These payments will not reduce the Limit of owned by that "employee"or a member Insurance. of his or her household. b. Out-of-state Coverage Extensions (3) Someone using a covered "auto" while While a covered "auto" is away from the he or she is working in a business of state where it is licensed,we will: selling, servicing, repairing, parking or (1) Increase the Limit of Insurance for ytoursg "autos" unless that business is Covered Autos Liabllily Coverage to (4) Anyone other than your "employees", meet the limits specified by a compulsory or financial responsibility partners (if you are a partnership), taw of the jurisdiction where the covered members (if you are a limited liability "auto" is being used. This extension company) or a lessee or borrower or does not apply to the limit or limits any of their "employees", while moving specified by any law governing motor property to or from a covered"auto". carriers of passengers or properly. (5) A partner(if you are a partnership) or a (2) Provide the minimum amounts and member (if you are a limited liability types of other coverages, such as no- company)for a covered"auto"owned by fault, required of out-of-state vehicles by him or her or a member of his or her the jurisdiction where the covered"auto" household. is being used. c. Anyone liable for the conduct of an We will not pay anyone more than once for insured" described above but only to the the same elements of loss because of extent of that liability. these extensions. 2. Coverage Extensions B. Exclusions a. Supplementary Payments This insurance does not apply to any of the We will pay for the"insured": following: (1) All expenseswe incur. 1. Expected Or Intended Injury (2) Up to $2,000 for cost of bail bonds "Bodily injury" or "property damage" expected (including bonds for related traffic law or intended from the standpoint of the violations) required because of an "insured". "accident"we cover. We do not have to 2. Contractual furnish these bonds. Liability assumed under any contract or (3) The cost of bonds to release agreement. attachments in any "suit" against the But this exclusion does not I to liability for insured" we defend, but only for bond apply Y amounts within our Limit of Insurance. damages: (4) All reasonable expenses incurred by the a. Assumed in a contract or agreement that is "insured"at our request, including actual an "insured contract", provided the "bodily loss of ea'rnrngs up to $250 a day injury" or "property damage" occurs because of flnie off from work. subsequent to the execution of the contract or agreement;or (5) All court costs taxed against the b. That the "insured" would have in the insured" in any "suit" against the insured" we defend. However, these absence of the contract or agreement. payments do not include attorneys'fees 3. Workers'Compensation or attorneys'expenses taxed against the Any obligation for which the "insured" or the "insured". "insured's" insurer may be held liable under (6) All interest on the full amount of any any workers' compensation, disability benefits judgment that accrues after entry of the or unemployment compensation law or any judgment in any "suit" against the similar law. "insured"we defend, but our duty to pay interest ends when we have paid, offered to pay or deposited in court the part of the judgment that is within our Limit of Insurance. CA 00 01 10 13 ©Insurance Services Office, Inc., 2011 Page 3 of 12 ACP BAPD78.5.5954504 U83 17086 INSURED COPY CA0001101300 0001 47 0034415 4. Employee Indemnification And Employer's b. After it is moved from the covered"auto"to Liability the place where it is finally delivered by the "Bodily injury"to: "insured". a. An "employee" of the "insured" arising out 6. Movement Of Property By Mechanical of and in the course of: Device (1) Employment by the"insured"; or "Bodily injury" or "property damage" resulting (2) Performing the duties related to the from the movement of property by a conduct of the"insured's"business;or mechanical device (other than a hand truck) spouse, child unless the device is attached to the covered b. The s p , parent, brother or sister "auto". of that "employee" as a consequence of g, Operations Paragraph a.above. "Bodily injury" or"property damage"arising out This exclusion applies: of the operation of: (1) Whether the "insured" may be liable as a. Any equipment listed in Paragraphs 6.b. an employer or in any other capacity; and 6.c. of the definition of "mobile and equipment";or (2) To any obligation to share damages with or repay someone else who must pay b. Machinery or equipment that on,attached damages because of the injury. to or part of a land vehicle that at would qualify under the definition of "mobile But this exclusion does not apply to "bodily equipment" if it were not subject to a injury" to domestic "employees" not entitled to compulsory or financial responsibility law or workers' compensation benefits or to liability other motor vehicle insurance law where it assumed by the "insured" under an "insured is licensed or principally garaged. contract". For the purposes of the Coverage 10. Completed Operations Form, a domestic "employee" is a person engaged in household or domestic work "Bodily injury" or"property damage"arising out performed principally in connection with a of your work after that work has been residence premises. completed or abandoned. 5. Fellow Employee In this exclusion,your work means: "Bodily injury"to: a. Work or operations performed by you or on a. Any fellow "employee" of the "insured" your behalf;and arising out of and in the course of the fellow b. Materials, parts or equipment furnished in "employee's" employment or while connection with such work or operations. performing duties related to the conduct of Your work includes warranties or your business; or representations made at any time with respect b. The spouse, child, parent, brother or sister to the fitness, quality, durability or performance of that fellow"employee"as a consequence of any of the items included in Paragraph a, or of Paragraph a. above. b.above. 6. Care,Custody Or Control Your work will be deemed completed at the "Property damage"to or"covered pollution cost earliest of the following times: or expense" involving property owned or (1) When all of the work called for in your transported by the "insured" or in the contract has been completed; "insured's" care, custody or control. But this (2) When all of the work to be done at the exclusion does not apply to liability assumed site has been completed if your contract under a sidetrack agreement. calls for work at more than one site; or 7. Handling Of Property (3) When that part of the work done at a job "Bodily injury" or "property damage" resulting site has been put to its intended use by from the handling of property: any person or organization other than a. Before it is moved from the place where it is another contractor or subcontractor accepted by the "insured" for movement working on the same project. into or onto the covered"auto"; or Page 4 of 12 ©Insurance Services Office, Inc., 2011 CA 00 01 1013 ACP BAPD78-5.5954504 LIB3 17086 INSURED COPY CAODD1101300 0001 47 0034416 Work that may need service, maintenanoe. Paragraphs b. and c. above ofthis exclusion cnmanUon, repair or replacement, but which is do not apply to "accidents' that occur away otherwise omnpleta, will be treated as from premises owned by or rented to on completed. "insured" with respect to "pollutants" not in or 111. Pollution upon ucovered''outo'if: rna0e'arising out (a) The "pollutants" or any propertyin�=~'' ^ ~ "property damage"���n�� ��o��rge which the "pollutants" are contained °' `^^= =""�'` alleged ~' ^'^ ' are upset, uve�umedmvdan�mgedan dispersal, seepage, mhgr��ou^ release or eneouhof- thmmai�en�noec* uee�� escape of mouusnu,.�� a' That are, or that one contained in any acovered"auto';and (b) The discharge, ddispseepage:,,�|. seepage:,, �rope�y�hdischarge,m\~nah � nn release or ouoopa of the (1) Being transported or towed by. handled ^p |utant " is caused directly by orhandled for movement into, onto or such upset, overturn o,damage, from the covered''eu1o'; 12. War (2) Otherwise in the cnuseuftnans� by or "Bodily Uy ^,~, or "property damage" arisingonbeha|fofthe^inaured.`or directly orindirectly out of: (3) Being stored, disposed of, treated o/ e' Var, including undeclared mvcivil war; processed in or upon the covered ��to' b' Warlike action by a militaryforce including b � action .. hindering" " = defending against ,, =='�= "= ��a m attack, by any "'" p""~^~^~ ~'~ contained -- noved from the whowhere they�y a/ *"�=^"'~nt° ` sovereign~ or ~m�a authoritymauthority^ uomgmi|�a� peroonna|or��e/mgen��`or accepted by the "insured" for movement into oronto the covered,auto^; or c. |nounadion, rebeUion, mvdudnn, usurped c' After the "pollutants" or any property in power "' action taken ~� �~_'^' ~' tal which the "pollutants" are contained are authority in hindering cxdefending against moved from the covered''euhf'hothe place any of these." where they are finally de|ivered. disposed of 1J. Racing urobandonadbythe''insured^ Covered''autos^while used inany professional Paragraph a. above does not apply tofuels, or organized racing or demolition contest or |ubricaots, f|uida, exhaust gases or other otunUnO achv�ly, or while practicing for such similar'tmUutanta"that are needed for orresult contest or activity. This insurance also does from the normal eledhoa|, hydraulic or not apply while that covered "auto" is being mechanical functioning nfthe covered^autoor prepared for such acontest oractivity. its parts if: C. Limit Of Insurance (1) The ''poUutants'^ escape, seep, migrate Regardless of the number of covered "ou1om'', or are discharged,dispersedorneleaaeU "insureds", premiums paid, claims made or directly from on "auto"part designed by vehicles involved in the "acnidenC. the most we its manufacturer to hold, sk/rw, receive will pay for the totan of all da'na@eeand 'cc*moad ordispose pfsuch"pmUutonta'';and pollution cost or expense"nonnbinedremuhb`g/oom (2) The"bodily i ^ � prope�ydamage"nr any one "accident" �m the Limit Of Insurance for ^covenedpollution� oon\ or e" Covered Autos Liability Coverage shown in the does not arise out of the operation of Declarations. any equipment listed in Paragraphs 6.b. and 6.c. of the definition of "mobile equipment". CA00O1iQ13 @InaunanceServices Office, )nc.2O11 Page 5of12 AxpsApo/o-5'ma4004 u133 17086 INSURED COPY cx0001101300 0001 47 0034417 All "bodily injury", "property damage"and"covered 3. Glass Breakage—Hitting A Bird Or Animal— pollution cost or expense" resulting from Falling Objects Or Missiles continuous or repeated exposure to substantially If you carry Comprehensive Coverage for the the same conditions will be considered as damaged covered "auto", we will pay for the resulting from one"accident". following under Comprehensive Coverage: No one will be entitled to receive duplicate a. Glass breakage; payments for the same elements of "loss" under b. "Loss" caused by hitting a bird or animal; this Coverage Form and any Medical Payments and Coverage endorsement, Uninsured Motorists Coverage endorsement or Underinsured Motorists c. "Loss"caused by falling objects or missiles. Coverage endorsement attached to this Coverage However, you have the option of having glass Part. breakage caused by a covered "auto's" SECTION III—PHYSICAL DAMAGE COVERAGE collision or overturn considered a "loss" under A. Coverage Collision Coverage. 1. We will pay for"loss"to a covered"auto" or its 4. Coverage Extensions equipment under: a. Transportation Expenses a. Comprehensive Coverage We will pay up to $20 per day, to a From any cause except: maximum of $600, for temporary transportation expense incurred by you (1) The covered "auto's" collision with because of the total theft of a covered another object; or "auto" of the private passenger type. We (2) The covered"auto's"overturn. will pay only for those covered "autos" for b. Specified Causes Of Loss Coverage which you carry either Comprehensive or Caused by: Specified Causes Of Loss Coverage. We will pay for temporary transportation (1) Fire, lightning or explosion; expenses incurred during the period (2) Theft; beginning 48 hours after the theft and (3) Windstorm, hail or earthquake; ending,regardless of the policy's expiration, when the covered "auto" is returned to use (4) Flood; or we pay for its "loss". (5) Mischief or vandalism; or b. Loss Of Use Expenses (6) The sinking, burning, collision or For Hired Auto Physical Damage, we will derailment of any conveyance pay expenses for which an "insured" transporting the covered"auto". becomes legally responsible to pay for loss c. Collision Coverage of use of a vehicle rented or hired without a Caused by: driver under a written rental contract or (1) The covered "auto's" collision with agreement. We will pay for loss of use another object; or expenses if caused by: (2) The covered"auto's"overturn. (1) Other than collision only if the Declarations indicates that 2. Towing Comprehensive Coverage is provided We will pay up to the limit shown in the for any covered"auto"; Declarations for towing and labor costs (2) Specified Causes Of Loss only if the incurred each time a covered "auto" of the Declarations indicates that Specified private passenger type is disabled. However, Causes Of Loss Coverage is provided the labor must be performed at the place of for any covered"auto"; or disablement. Page 6 of 12 ©Insurance Services Office, Inc., 2011 CA 00 01 10 13 ACP SAPD78-5-5964504 1_11313 17086 INSURED COPY CA0001101300 0001 47 0034418 (3) Collision only if the Declarations b. Any device designed or used to detect indicates that Collision Coverage is speed-measuring equipment, such as radar provided for any covered"auto". or laser detectors, and any jamming However, the most we will pay for any apparatus intended to elude or disrupt expenses for loss of use is $20 per day, to speed-measuring equipment. a maximum of$600. c. Any electronic equipment,without regard to B. Exclusions whether this equipment is permanently 1. We will not pay for"loss"caused by or resulting installed, that reproduces, receives or from any of the following. Such "loss" is transmits audio,visual or data signals. excluded regardless of any other cause or d. Any accessories used with the electronic event that contributes concurrently or in any equipment described in Paragraph c. sequence to the"loss". above. a. Nuclear Hazard 5. Exclusions 4.c. and 4.d. do not apply to equipment designed to be operated solely by (1) The explosion of any weapon employing use of the power from the "auto's" electrical atomic fission or fusion; or system that, at the time of"loss", is: (2) Nuclear reaction or radiation, or a. Permanently installed in or upon the radioactive contamination, however covered"auto"; caused. b. War Or Military Action b. Removable from a housing unit which is permanently installed in or upon the (1) War, including undeclared or civil war; covered"auto"; (2) Warlike action by a military force, c. An integral part of the same unit housing including action in hindering or any electronic equipment described in defending against an actual or expected Paragraphs a.and b. above; or attack, by any government, sovereign or d. Necessary for the normal operation of the other authority using military personnel covered "auto" or the monitoring of the or other agents;or covered"auto's"operating system. (3) Insurrection, rebellion, revolution, 6, We will not pay for "loss" to a covered "auto" usurped power or action taken by due to"diminution in value". governmental authority in hindering or defending against any of these. C. Limits Of Insurance 2. We will not pay for"loss"to any covered"auto" 1. The most we will pay for: while used in any professional or organized a. "Loss" to any one covered "auto" is the racing or demolition contest or stunting activity, lesser of: or while practicing for such contest or activity. (1) The actual cash value of the damaged We will also not pay for "loss" to any covered or stolen property as of the time of the "auto" while that covered "auto" is being "loss";or prepared for such a contest or activity. (2) The cost of repairing or replacing the 3. We will not pay for"loss"due and confined to: damaged or stolen property with other a. Wear and tear, freezing, mechanical or property of like kind and quality. electrical breakdown. b. All electronic equipment that reproduces, b. Blowouts, punctures or other road damage receives or transmits audio, visual or data to tires. signals in any one"loss"is $1,000,if, at the This exclusion does not apply to such "loss" time of"loss",such electronic equipment is: resulting from the total theft of a covered (1) Permanently installed in or upon the "auto". covered "auto" in a housing, opening or 4. We will not pay for "loss" to any of the other location that is not normally used following: by the "auto" manufacturer for the a. Tapes, records, discs or other similar audio, installation of such equipment; visual or data electronic devices designed for use with audio, visual or data electronic equipment. CA 00 01 10 13 ©Insurance Services Office, Inc., 2011 Page 7 of 12 ACP BAPD78-5-5954504 LIB3 170136 INSURED COPY CA0001101300 0001 47 0034419 (2) Removable from a permanently installed (2) The"insured's"name and address;and housing unit as described in Paragraph (3) To the extent possible, the names and b.(1) above; or addresses of any injured persons and (3) An integral part of such equipment as witnesses. described in Paragraphs b.(1) and b.(2) b. Additionally, you and any other involved above. "insured"must: 2. An adjustment for depreciation and physical (1) Assume no obligation, make no condition will be made in determining actual payment or incur no expense without cash value in the event of a total"loss". our consent, except at the "insured's" 3. If a repair or replacement results in better than own cost. like kind or quality, we will not pay for the (2) Immediately send us copies of any amount of the betterment, request, demand, order, notice, D. Deductible summons or legal paper received For each covered "auto", our obligation to pay for, concerning the claim or"suit". repair, return or replace damaged or stolen (3) Cooperate with us in the investigation or property will be reduced by the applicable settlement of the claim or defense deductible shown in the Declarations. Any against the"suit". Comprehensive Coverage deductible shown in the (4) Authorize us to obtain medical records Declarations does not apply to "loss" caused by or other pertinent information. fire or lightning. (5) Submit to examination, at our expense, SECTION IV—BUSINESS AUTO CONDITIONS by physicians of our choice, as often as The following conditions apply in addition to the we reasonably require. Common Policy Conditions: c. If there is "loss" to a covered "auto" or its A. Loss Conditions equipment, you must also do the following: 1. Appraisal For Physical Damage Loss (1) Promptly notify the police if the covered If you and we disagree on the amount of"loss", "auto"or any of its equipment is stolen. either may demand an appraisal of the "loss". (2) Take all reasonable steps to protect the In this event, each party will select a competent covered "auto" from further damage. appraiser. The two appraisers will select a Also keep a record of your expenses for competent and impartial umpire. The consideration in the settlement of the appraisers will state separately the actual cash claim. value and amount of"loss If they fail to agree, (3) Permit us to inspect the covered "auto" they will submit their differences to the umpire. and records proving the "loss"before its A decision agreed to by any two will be repair or disposition. binding. Each party will: (4) Agree to examinations under oath at our a. Pay its chosen appraiser;and request and give us a signed statement b. Bear the other expenses of the appraisal of your answers. and umpire equally. 3. Legal Action Against Us If we submit to an appraisal, we will still retain No one may bring a legal action against us our right to deny the claim. under this Coverage Form until: 2. Duties In The Event Of Accident,Claim, Suit a. There has been full compliance with all the Or Loss terms of this Coverage Form; and We have no duty to provide coverage under b. Under Covered Autos Liability Coverage, this policy unless there has been full we agree in writing that the"insured"has an compliance with the following duties: obligation to pay or until the amount of that a. In the event of "accident", claim, "suit" or obligation has finally been determined by "loss", you must give us or our authorized judgrnent after trial. No one has the right representative prompt notice of the under this policy to bring us into an action "accident"or"loss". Include: to determine the"insured's"liability. (1) How, when and where the "accident" or "loss"occurred; Page 8 of 12 © Insurance Services Office, Inc., 2011 CA 00 01 10 13 ACP BAPD78-5.5954504 1-1133 17086 INSURED COPY CA0001101300 0001 47 0034420 4. Loss Payment—Physical Damage S. Other Insurance Coverages a. For any covered "auto" you own, this At our option, we may: Coverage Form provides primary a. Pay for, repair or replace damaged or insurance, For any covered"auto"you don't stolen property; own, the insurance provided by this b. Return the stolen property, at our expense. Coverage Form is excess over any other We will pay for any damage that results to collectible insurance, However, while a the"auto"from the theft; or covered "auto" which is a "trailer" is connected to another vehicle, the Covered C. Take all or any part of the damaged or Autos Liability Coverage this Coverage stolen property at an agreed or appraised Form provides for the"trailer"is: value. If va pay for the "loss", our payment will (1) Excess while it is connected to a motor vehicle you do not own; or include the applicable sales tax for the (2) Primary while it is connected to a damaged or stolen property. covered"auto"you own. 5. Transfer Of Rights Of Recovery Against b. For Hired Auto Physical Damage Coverage, Others To Us any covered "auto" you lease, hire, rent or If any person or organization to or for whom we borrow is deemed to be a covered "auto" make payment under this Coverage Form has you own. However, any "auto" that is rights to recover damages from another, those leased, hired, rented or borrowed with a rights are transferred to us. That person or driver is not a covered"auto". organization must do everything necessary to c. Regardless of the provisions of Paragraph secure our rights and must do nothing after "accident"or"loss"to impair them. a, above, this Coverage Form's Covered Autos Liability Coverage is primary for any B. General Conditions liability assumed under an "insured 1. Bankruptcy contract". Bankruptcy or insolvency of the"insured"or the d. When this Coverage Form and any other "insured's" estate will not relieve us of any Coverage Form or policy covers on the obligations under this Coverage Form same basis, either excess or primary, we 2. Concealment, Misrepresentation Or Fraud will pay only our share. Our share is the This Coverage Form is void in any case of proportion that the Limit of Insurance of our Coverage Form bears to the total of the fraud by you at any time as it relates to this limits of all the Coverage Forms and Coverage Fonar. It is also void if you or any policies covering on the same basis. other "insured", at any time, intentionally 6. Premium Audit conceals or misrepresents a material fact concerning: a. The estimated premium for this Coverage a. This Coverage Form; Form is based on the exposures you told us b. The covered"auto"; you would have when this policy began.We will compute the final premium due when c. Your interest in the covered"auto";or we determine your actual exposures. The d. A claim under this Coverage Form. estimated total premium will be credited 3. Liberalization against the final premium due and the first Named Insured will be billed for the If we revise this Coverage Form to provide balance, if any. The due date for the final more coverage without additional premium premium or retrospective premium is the charge, your policy will automatically provide date shown as the due date on the bill. If the additional coverage as of the day the the estimated total premium exceeds the revision is effective in your state. final premium due, the first Named Insured 4. No Benefit To Bailee—Physical Damage will get a refund. Coverages b. If this policy is issued for more than one We will not recognize any assignment or grant year, the premium for this Coverage Form any coverage for the benefit of any person or will be computed annually based on our organization holding, storing or transporting rates or premiums in effect at the beginning property for a fee regardless of any other of each year of the policy. provision of this Coverage Form. CA 00 01 10 13 ©Insurance Services Office, Inc., 2011 Page 9 of 12 ACP BAPD78-5.5954504 LIB3 17086 INSURED COPY CA0001101300 0001 47 0034421 7. Policy Period, Coverage Territory 2. Any other land vehicle that is subject to a Under this Coverage Form, we cover compulsory or financial responsibility law or "accidents"and "losses"occurring: other motor vehicle insurance law where it is a. During the policy period shown in the licensed or principally garaged. Declarations; and However, "auto" does not include "mobile b. Within the coverage territory, equipment". The coverage territory is: C. "Bodily injury" means bodily injury, sickness or disease sustainedby a person, including death (1) The United States of America; resulting from any of these. (2) The territories and possessions of the D. "Covered pollution cost or expense" means any United States of America; cost or expense arising out of! (3) Puerto Rico; 1. Any request, demand, order or statutory or (4) Canada;and regulatory requirement that any "insured" or (5) Anywhere in the world if a covered others test for, monitor, clean up„ remove, "auto" of the private passenger type is contain, treat, detoxify or neutralize, or in any, leased, hired, rented or borrowed way respond to, or assess the effects of Without a driver for a period of 30 days "pollutants";or or less, 2. Any claim or "suit" by or on behalf of a provided that the "insured's" responsibility to governmental authority for damages (be'caus'e pay damages is determined in a "suit" on the of testing for, monitoring, cleaning up merits, in the United States of America, the removing, con'tain'ing, treating, detoxifying or territories and possessions of the United States neutralizing, or in any way responding to, or of America, Puerto Rico or Canada, or in a assessing the effects of, "poliutatits"° settlement we agree to. "Covered pollution cost or expense" does not We also cover "loss" to, or "accidents" include any cost or expense arising out of the involving, a covered "auto" while being actual', alleged or threatened discharge, dispersal, transported between any of these places. seepage, migration, release or escape of pollutants": 8 Two Issued y rB More UsCoverage Forms Or Policies a. That are, or that are contained in any If this Coverage Form and any other Coverage property that is: Form or policy issued to you by us or any (1) Being transported or to'+r+^ed by, handled company affiliated with us applies to the same or handled for movement into, onto or "accident", the aggregate maximum Limit of from the covered"auto"; Insurance under all the Coverage Forms or (2) Otherwise in the course of transit by or policies shall not exceed the highest applicable on behalf of the"insured";or Limit of Insurance under any one Coverage (3) Being stored, disposed of, treated or Form or policy.This condition does not apply to processed in or upon the covered any Coverage Form or poky issued by us or "auto"; an affiliated company spe6fically to apply as b. Before the "pollutants" or any property in excess insurance over this Coverage Form. which the "pollutants" are contained are SECTION V—DEFINITIONS moved from the place where they are A. "Accident" includes continuous or repeated accepted by the "insured" for movement exposure to the same conditions resulting in into or onto the covered"auto'; or "bodily injury"or"property damage". c. After the "pollutants" or any property in B. "Auto"means: which the "pollutants" are contained are 1. A land motor vehicle, "trailer" or semitrailer moved f'rorn the covered"auto"to the place designed for travel on public roads; or where they are finally delivered,disposed of or abandoned by the"insured". Page 10 of 12 ©Insurance Services Office, Inc,, 2011 CA 00 01 1013 ACP BAPD78.5-5954504 LIB3 17086 INSURED COPY CA0001101300 0001 47 0034422 Paragraph a, above does not apply to fuels, 5. That part of any other contract or wagreer°nent lubricants, fluids, exhaust gases or other pertaining to your business (including an similar"pollutants"that are needed for or result ind'en°rnification of a 1111.niMpalr'ty in connection from the normal electrical, hydraulic or with work performed for a municipality) under mechanical functioning of the covered"auto"or which you assume the tort liability of another to its parts, if: pay for°"bod'ily injury"or"property damage"to a (1) The "pollutants" escape, seep, migrate third party or organization. Tort liability nr:eans or are discharged, dispersed or released a l'ia'bility that would be imposed by law in time directly from an "auto" part designed by absence of any contract or agreerrrent,Or its manufacturer to hold, store, receive 6. That part of any contract or agreement entered or dispose of such"pollutants";and into, as part of your business, pertaining to the (2) The"bodily injury", "property damage"or rental or lease, by you or any of your "covered pollution cost or expense" "employees of any "auto". However, such does not arise out of the operation of contract or agreement shall not be considered any equipment listed in Paragraph 6.b. an "insured contract" to the extent that it or 6.c. of the definition of "mobile obligates you or any of your "employees" to equipment". pay for"property damage"to any"auto"rented Paragraphs b. and c. above do not apply to or leased by you or any of your"employees". ""accidents" that occur away from premises An "insured contract" does not include that part of owned by or rented to an"insured"with respect any contract or agreement: to "pollutants" not in or upon a covered "auto" a. That indemnifies a railroad for"bodily injury" if: or "property damage" arising out of (a) The "pollutants" or any property in construction or demolition operations,within which the "pollutants" are contained 50 feet of any railroad property and are upset,overturned or damaged as affecting any railroad bridge or trestle, a result of the maintenance or use of tracks, roadbeds, tunnel, underpass or a covered"auto";and crossing; (b) The discharge, dispersal, seepage, b. That pertains to the loan, lease or rental of migration, release or escape of the an "auto" to you or any of your "pollutants" is caused directly by "employees", if the "auto" is loaned, leased' such upset, overturn or damage. or rented with a driver; or E. "Diminution in value" means the actual or c. That holds a person or organization perceived loss in market value or resale value engaged in the business of transporting which results from a direct and accidental"loss". properly by "auto"for hire harmless for your use of a covered "auto'" over a route or F. "Employee" includes a leased worker". territory that person or organization is "Employee" does not include a "temporary authorized to serve b public authority. worker". Y p Y• G. "Insured" means any person or organization 1. "Leased worker"means a person leased to you by a labor leasing firm under an agreement between qualifying as an insured in the Who Is An Insured you and the labor leasing firm to perform duties provision of the applicable coverage. Except with related to the conduct of your business. "Leased afforded applies separately to each insured who is respect to the Limit Insurance, the coverage worker"does not include a"temporary worker". seeking coverage or against whom a claim or J. "Loss" means direct and accidental loss or "suit" is brought. damage. H. "Insured contract"means: K. "MtoWe equ'ipmenl" rneans any of the following 1. A pease of premises; types of land vehicles„ including any attached machinefy or equipment 2. A sidetrack agreement; 1. Bulldozers, farm machinery, forklifts and other 3. Any easement or license agreement, except in vehicles designed for use principally off public connection with construction or demolition roads; operations on or within 50 feet of a railroad; 2. Vehicles maintained for use solely on or next to 4. An obligation, as required by ordinance, to premises you own or rent; indemnify a municipality, except in connection 3. Vehicles that travel on crawler treads; with work for a municipality; CA 00 01 10 13 ©Insurance Services Office, Inc., 2011 Page 11 of 12 ACP BAP078-5.5954504 LIB3 17086 INSURED COPY CA0001101300 0001 47 0034423 4. Vehicles, whether self-propelled or not, However, "mobile equipment" does not include maintained primarily to provide mobility to land vehicles that are subject to a compulsory or permanently mounted: financial responsibility law or other motor vehicle a. Power cranes, shovels, loaders, diggers or insurance law where it is licensed or principally drills; or garaged. 'Lard vehicles subject to a compulsory or b. Road construction or resurfacing equipment financ'i'al responsibility law or other motor vehicle such as graders, scrapers or rollers; insurance law are considered"autos". 5. Vehicles not described in Paragraph 1., 2., 3. L. "Pollutants" means any solid, liquid, gaseous or or 4. above that are not self-propelled and are therrnal irritant or contaminant, including smoke, maintained primarily to vapor, soot, fumes, acids, alkalis, chemicals and p y provide mobility to waste Waste includes materials to be recycled, permanently attached equipment of the Following types: reconditioned or reclaimed. a. Air compressors, pumps and generators, M. "Property damage" means damage to or loss of including spraying, welding, building use of tangible property. cleaning, geophysical exploration, lighting N. "Suit"means a civil proceeding in which; and well-servicing equipment;or 1. Damages because of "bodily injury" or b. Cherry pickers and similar devices used to "property damage";or raise or lower workers; or 2. A"covered pollution cost or expense"; 6. Vehicles not described in Paragraph 1., 2., 3, to which this insurance applies, are alleged. or 4, above maintained primarily for purposes "Suit"includes: other than the transportation of persons or cargo. However, self-propelled vehicles with a. An aTbitratlon proceeding in which such the following types of permanently attached damages or "covered) pollution costs or be considered id ered 'autos': expenses" are claimed and to which the are not "mobile equipment' but will "insured" must submit or does submit with be con a. Equipment designed primarily for. our consent;or (1) Snow removal; b. Any other alternative dispute resolution proceeding in which such damages or (2) Road maintenance, but not construction "covered pollution costs or expenses" are or resurfacing; or claimed and to which the insured submits (3) Street cleaning; with our consent. b. Cherry pickers and similar devices mounted 0. "Temporary worker" means a person who is on automobile or truck chassis and used to furnished to you to substitute for a permanent raise or lower workers; and "employee"on leave or to meet seasonal or short- c. Air compressors, pumps and generators, term workload conditions. including spraying, welding, building P. "Trailer"includes semitrailer. cleaning, geophysical exploration, lighting or well-servicing equipment. Page 12 of 12 ©Insurance Services Office, Inc.,2011 CA 00 01 1013 ACP BAPD78-5-5954504 LIB3 17086 INSURED COPY CA0001101300 0001 47 0034424 0 � DATE(MM/DDIYYYY) CERTIFICATE OF LIABILITY INSURANCE �,,,,•• 712/2018 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 certificate holder in lieu of such endo t(s). y require an en the terms and conditions of the policy,,certain policies may endorsement. A statement on this certificate does not confer rights to the PRODUCER coNTACTNAME. Chris Dalstrom Assurance Agency, Ltd, PHONE 847 463-7218 FAX Not:-(847 440-912 Century E-MAIL 6 4Arc Mas: c(. ) agealcy_com 50 E.One Golf Road IarDt s�; pdaYtlrq assurance Schaumburg IL 60173- INSURER(S)AIFFORDING COVERAGE NAac# . INSURER A:XL Specialty 37885,. Persona l SINSURE Staffing Group, LLC INs(IReInsurance America,Inc 4'554' INSURED dba KBS B: ' Staffing FC; 1751 Lake Cook Road, Suite 600 INSURER D; Deerfield IL 60015 INSURER E INSURER F' COVERAGES CERTIFICATE NUMBER:322550500 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. ILTSRv TYPE OF INSURANCE IAS�DLi ",)I,I'd� . POLICY NUMBER tfwP41a0RtL' MYCYYY11 p�MepxnoYnlmY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LiA,MLIT'C' e $ iCLAIMS•MAOE 1 OCCUR 1 MED EXP(Any one person) $ PERSONAL 8 ADV INJURY $ GENERAL AGGREGA.,,.,,,,._ ...............ATE $ G'EN'POLLIMIT LIES PER:AGGREGATE APP, I L PRODUCTS COMP/ P AGG G O PRO LOC :$ ANY AUTO V, BODILYr INJURY(Per person) $ AUTOMOBILE LIABILITY BODILY INJURY(Per accident) ALL OWNED SCHEDULED AUTOS NUTOS ON-OWNED iTe.SAiMIAGE HIRED AUTOS I AUTOS I i I V Is �.... EXCESS UMBRELLA LIA6 EACH OCCURRENCE OCCUR � .,. AGGREGATE DED R $ ESS LIAB I RETENTION CLAIMS-MADE( A ................. WC STATU- r,.�TIrN.. pYIN i Y „f OFFICE NIA 7 II N� NIA 6/30)2018 6130(2019 X )OR^�"IMIID NT �' 000,000 ® ANY PROPRIETOR/PARAND BTINER/EXECUTIVE """",'.'"""' RWD3001422 6/3012098 6/30/2099 E L DISEASE EA EMPLOYEEi $1,, -- - _- WORKERS COMPENSATION Mandato m NH EL EACH ACCIDENT 0.000 (Mandatory } I I $1,000,00 If yes,describe under DESCRIPTION OF OPERATIONS below ° EL DISEASE-POLICY LIMIT $1, 0 wDESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space is required) Proof of Insurance i RE:Employees assigned by All City Management Services dba The Crossing Guard Company 10440 Pioneer Blvd Suite 5,Santa Fe Springs CA 90670 A Waiver of Subrogation in favor of the Certificate Holder applies to the Worker's Compensation policy only,when required by written contract and where allowed by law. CERTIFICATE(HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of EI Segundo 350 Main Street AUTHORIZED REPRESENTATIVE EI Segundo CA 90245 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 0313 (Ed. 484) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule Where required by written contract This endorsement changes the policy to which It is attached and Is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Policy Effective 06/30/2018 Endorsement Effective 06/30/2018 Policy No, RWD3001422 Endorsement No. Insured PERSONNEL STAFFING GROUP, LLC DBA KBS STAFFING Premium$ Insurance Company XL Insurance America, Inc. Countersigned By WC 00 03 13 (Ed. 4-84) Copyright 1983 National Council on Compensation Insurance