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PROOF OF INSURANCE (2019 - 2019) CLOSED OP ID:EF �" " ' '` CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) 10/25/2018 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 Elizabeth Ferguson 1 & 925-966-7723 V 925-956-7777 01ga Valley Rd, 200 11A �� -_ 1 Walnut Creek,CA 4 ADDRESS. Michael H.Crist i*k6'du. k IGNIT-1 PgATQ .E.R:lp..N_ INSURER(S)AFFORDING COVERAGE NAIC# INSURED Ignited,LLC .............. .................... INSURER A:Hanover Insurance Group,,,,,,,,,,,,.............,................. 22.2.92......,,....... WhitneyStephenson INSURER B: Hiscox Insurance Company Inc. 10200 2150 Park Place,Ste.100 INSURER c: EI Segundo,CA 90245 IN I .... ....................................... ........,..,.................. d INSUR RE: INSURER F: N 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 AD LTR TYPE OF INSURANCE ' Di.'9MIA ....... 106U ��1'09... .It1,�LIC'h'`lk LIMITS.. .... CE �(.� POLICY NUMBER (IMMfD01YY'YY1 IMWDD/Y'Y'YY9 GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A F'AMA'G TURETVEu bra„ ,cuq,eu,n,,,ce9 $ ^00,000 CLAIMS-MADE 1 X1 OCCUR MED EXP(Any one person) $ 10,000 LIABILITY Y ZZF-D288432-00 06/1812018 06/18/2019 X COMMERCIAL GENERAL L PERSONAL&ADV INJURY $ EXC L GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 u POLICY PRIf Emp Ben. $ .................................1...... -- IF ,r Loc p ,000,000 SINGLE LIMIT 0 A BODILY I ' ZZF-D288432-00 06/1812018 06118/2019 ,..5..... 000,00 AUTOMOBILE LIABILITY COMBINEDN R A ANY AUTO INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accide ) nt $ SCHEDULED AUTOS ................................................�. PROPERTY X HIREDAUTOS (PER ACCIDENT) $ X NON-OWNED AUTOS $ X ABX �OCCUR - EACH OCCURRENCE ". .. �$ 5,000,000 EXCESSLABUHF-D288434-00 06118/2018 06/18/2019 AGGREGATE $ 5,000,000 A DEDUCTIBLE $ ....................�...S.................... WORKERS COMPENSATION WC STATU OTH AND EMPLOYERS'LIABILITY .._d TQf?Y 4,.I, - I ..V FR ANY PROPRIETOR/PARTNER/EXECUTIVE Y� NIA A EL EACH ACCIDENT „$ OFFICERIMEMBER EXCLUDED? N """^ (Mandatory In NH) E L DISEASE-EA EMPLOYE)$ If yes,describe under —J DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ B Tech E&O USUUA2731982 07/22/2018 07122/2019 Limit 5,000,000 Retention 25,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) EI Seundo Pol'ic Department,the CiU,its officlais and employees are additional insure,coverage prima v hen requir d by Written contract. Cancellation notification is in accordance With poicy provisions" tv CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE EI Segundo Police Department THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN g p ACCORDANCE WITH THE POLICY PROVISIONS. 348 Main St EI un Se do CA 90245 Segundo, V AUTHORIZED REPRESENTATIVE ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD ZZF D288432 00 5701695 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. COMMERCIAL GENERAL LIABILITY BROADENING ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SUMMARY OF COVERAGES 11. Additional Insured by Contract, Agreement or Permit I� Included! 2. Additional Insured—Primary and Non-Contributory 4 Included! 3. Blanket Waiver of Subrogation Included 4. Bodily Injury Redefined Included 5. Broad Form Property Damage—Borrowed Equipment, Customers Goods& Use of Elevators.! Included 6. Knowledge of Occurrence Included 7. Liberalization Clause Included I8. Medical Payments—Extended Reporting Period I Included 19. Newly Acquired or Formed Organizations-Covered until end of policy period Included) 110. Non-owned Watercraft 51 ft.l 11. Supplementary Payments Increased Limits - Bail Bonds V $2,5001 Loss of Earnings C $1000 12. Unintentional Failure to Disclose Hazards Included 13. (Unintentional Failure to Notify Included This endorsement amends coverages provided under the Commercial General Liability Coverage Part through new coverages, higher limits and broader coverage grants. 1. Additional Insured by Contract, Agreement or (1) "Your work" for the additional insured(s) Permit designated in the contract, agreement or The following is added to SECTION II — WHO IS permit; AN INSURED: (2) Premises you own, rent, lease or occupy; Additional Insured by Contract, Agreement or or Permit (3) Your maintenance, operation or use of a. Any person or organization with whom you equipment leased to you. agreed in a written contract, written agreement b. The insurance afforded to such additional or permit that such person or organization to insured described above: add an additional insured on your policy is an (1) Only applies to the extent permitted by additional insured only with respect to liability law; and for "bodily injury", "property damage", or "personal and advertising injury" caused, in (2) Will not be broader than the insurance whole or in part, by your acts or omissions, or which you are required by the contract, the acts or omissions of those acting on your agreement or permit to provide for such behalf, but only with respect to: additional insured. 421-2915 06 15 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Page 1 of 4 ZZF D288432 00 5701695 (3) Applies on a primary basis if that is advertising injury" involved the rendering required by the written contract, written of or failure to render any professional agreement or permit. services by or for you. (4) Will not be broader than coverage d. With respect to the insurance afforded to provided to any other insured, these additional insureds, the following is (5) Does not apply if the "bodily injury", added to SECTION III — LIMITS OF "property damage" or "personal and INSURANCE: advertising injury" is otherwise excluded The most we will pay on behalf of the from coverage under this Coverage Part, additional insured for a covered claim is the including any endorsements thereto. lesser of the amount of insurance: c. This provision does not apply: 1. Required by the contract, agreement or (1) Unless the written contract or written permit described in Paragraph a.; or agreement was executed or permit was 2. Available under the applicable Limits of issued prior to the"bodily injury", "property Insurance shown in the Declarations. damage", or "personal injury and This endorsement shall not increase the advertising injury". applicable Limits of Insurance shown in the (2) To any person or organization included as Declarations. an insured by another endorsement 2. Additional Insured — Primary and Non- issued by us and made part of this Contributory Coverage Part. The following is added to SECTION IV — (3) To any lessor of equipment: COMMERCIAL GENERAL LIABILITY (a) After the equipment lease expires; or CONDITIONS, Paragraph 4.Other insurance: (b) If the "bodily injury", "property Additional Insured — Primary and Non- damage", "personal and advertising Contributory injury" arises out of sole negligence of If you agree in a written contract, written the lessor agreement or permit that the insurance provided to (4) To any: any person or organization included as an (a) Owners or other interests from. whom Additional Insured under SECTION II — WHO IS land has been leased which takes AN INSURED, is primary and non-contributory, place after the lease for the land ex- the following applies: pires; or If other valid and collectible insurance is available (b) Managers or lessors of premises if: to the Additional Insured for a loss covered under Coverages A or B of this Coverage Part, our (i) The occurrence takes place after obligations are limited as follows: you cease to be a tenant in that a. Primary Insurance premises; or (ii) The "bodily injury", "property This insurance is primary to other insurance damage", "personal injury" or that is available to the Additional Insured "advertising injury" arises out of which covers the structural alterations, new con- Additional Insured as a Named Insured. We struction or demolition operations will not seek contribution from any other performed by or on behalf of the insurance available to the Additional Insured manager or lessor. except: (5) To "bodily injury", "property damage" or (1) For the sole negligence of the Additional "personal and advertising injury" arising Insured; out of the rendering of or the failure to (2) When the Additional Insured is an render any professional services. Additional Insured under another primary This exclusion applies even if the claims liability policy; or against any insured allege negligence or (3) when b. below applies. other wrongdoing in the supervision, hiring, employment, training or monitoring If this insurance is primary, our obligations are of others by that insured, if the not affected unless any of the other insurance "occurrence" which caused the "bodily is also primary. Then, we will share with all injury" or"property damage" or the offense that other insurance by the method described which caused the "personal and in c. below. 421-2915 06 15 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Page 2 of 4 ZZF D288432 00 5701695 b. Excess Insurance insurer contributes equal amounts until it has (1) This insurance is excess over any of the paid its applicable limit of insurance or none of other insurance, whether primary, excess, the loss remains, whichever comes first. If any contingent or on any other basis: of the other insurance does not permit contribution by equal shares, we will contribute (a) That is Fire, Extended Coverage, by limits. Under this method, each insurer's Builder's Risk, Installation Risk or share is based on the ratio of its applicable similar coverage for"your work"; limit of insurance to the total applicable limits (b) That is Fire insurance for premises of insurance of all insurers rented to the Additional Insured or 3. Blanket Waiver of Subrogation temporarily occupied by the Additional ; The following is added to SECTION IV — Insured with permission of the ownerCOMMERCIAL GENERAL LIABILITY (c) That is insurance purchased by the CONDITIONS, Paragraph 8. Transfer Of Rights Additional Insured to cover the Of Recovery Against Others To Us: Additional Insured's liability as a tenant for "property damage" to We waive any right of recovery we may have premises rented to the Additional against any person or organization with whom you Insured or temporarily occupied by the have a written contract that requires such waiver Additional with permission of the because of payments we make for damage under owner; or this coverage form. The damage must arise out of your activities under a written contract with that (d) If the loss arises out of the person or organization. This waiver applies only to maintenance or use of aircraft, "autos" the extent that subrogation is waived under a or watercraft to the extent not subject written contract executed prior to the "occurrence" to Exclusion g. of SECTION I — or offense giving rise to such payments. COVERAGE A — BODILY INURY AND PROPERTY DAMAGE 4. Bodily Injury Redefined LIABILITY. SECTION V — DEFINITIONS, Definition 3. "bodily (2) When this insurance is excess, we will injury" is replaced by the following: have no duty under Coverages A or B to 3. "Bodily injury" means bodily injury, sickness or defend the insured against any"suit" if any disease sustained by a person including death other insurer has a duty to defend the resulting from any of these at any time. "Bodily insured against that "suit". If no other injury" includes mental anguish or other insurer defends, we will undertake to do mental injury resulting from"bodily injury". so, but we will be entitled to the insured's 5. Broad Form Property Damage — Borrowed rights against all those other insurers. Equipment, Customers Goods, Use of (3) When this insurance is excess over other Elevators Insurance, we will pay only our share of a. SECTION I—COVERAGES, COVERAGE A— the amount of the loss, if any, that BODILIY INJURY AND PROPERTY exceeds the sum of: DAMAGE LIABILITY, Paragraph 2. (a) The total amount that all such other Exclusions subparagraph j. is amended as insurance would pay for the loss in the follows: absence of this insurance; and Paragraph (4) does not apply to "property (b) The total of all deductible and self damage" to borrowed equipment while at a insured amounts under all that other jobsite and not being used to perform insurance. operations. We will share the remaining loss, if any, Paragraphs (3), (4) and (6) do not apply to with any other insurance that is not "property damage" to "customers goods"while described in this Excess Insurance on your premises nor do they apply to the use provision and was not bought specifically of elevators at premises you own, rent, lease to apply in excess of the Limits of or occupy. Insurance shown in the Declarations of b. The following is added to SECTION V — this Coverage Part. DEFINTIONS: c. Method Of Sharing 24. "Customers goods" means property of If all of the other insurance permits your customer on your premises for the contribution by equal shares, we will follow this purpose of being: method also. Under this approach each 421-2915 06 15 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Page 3 of 4 ZZF D288432 00 5701695 a. worked on; or 10. Non-Owned Watercraft b. used in your manufacturing process. SECTION I — COVERAGES, COVERAGE A c. The insurance afforded under this provision is BODILY INJURY AND PROPERTY DAMAGE excess over any other valid and collectible LIABILITY, Paragraph 2. Exclusions, property insurance (including deductible) subparagraph g.(2) is replaced by the following: available to the insured whether primary, g. Aircraft,Auto Or Watercraft excess, contingent (2) A watercraft you do not own that is: 6. Knowledge of Occurrence (a) Less than 51 feet long; and The following is added to SECTION IV — (b) Not being used to carry persons or COMMERCIAL GENERAL LIABILITY property for a charge; CONDITIONS, Paragraph 2. Duties in the Event of Occurrence,Offense, Claim or Suit: This provision applies to any person who, with your consent, either uses or is e. Notice of an 'occurrence", offense, claim or responsible for the use of a watercraft. "suit" will be considered knowledge of the insured if reported to an individual named 11. Supplementary Payments Increased Limits insured, partner, executive officer or an SECTION I — SUPPLEMENTARY PAYMENTS "employee" designated by you to give us such COVERAGES A AND B, Paragraphs 1.b. and a notice. 1.d. are replaced by the following: 7. Liberalization Clause 1.b.Up to $2,500 for cost of bail bonds required The following is added to SECTION IV — because of accidents or traffic law violations COMMERCIAL GENERAL LIABILITY arising out of the use of any vehicle to which CONDITIONS: the Bodily Injury Liability Coverage applies. We do not have to furnish these bonds. Liberalization Clause 1.d.All reasonable expenses incurred by the If we adopt any revision that would broaden the insured at our request to assist us in the coverage under this Coverage Form without investigation or defense of the claim or "suit", additional premium, within 45 days prior to or including actual loss of earnings up to$1000 a during the policy period, the broadened coverage day because of time off from work. will immediately apply to this Coverage Part. 12. Unintentional Failure to Disclose Hazards 8. Medical Payments — Extended Reporting Period The following is added to SECTION IV — COMMERCIAL GENERAL LIABILITY a. SECTION I—COVERAGES, COVERAGE C— CONDITIONS, Paragraph 6. Representations: MEDICAL PAYMENTS, Paragraph 1. Insuring Agreement, subparagraph a.(3)(b) We will not disclaim coverage under this Coverage is replaced by the following: Part if you fail to disclose all hazards existing as of the inception date of the policy provided such (b) The expenses are incurred and reported failure is not intentional. to us within three years of the date of the accident; and 13. Unintentional Failure to Notify b. This coverage does not apply if COVERAGE The following is added to SECTION IV — C — MEDICAL PAYMENTS is excluded either COMMERCIAL GENERAL LIABILITY by the provisions of the Coverage Part or by CONDITIONS, Paragraph 2. Duties in the Event endorsement. of Occurrence, Offense, Claim or Suit: 9. Newly Acquired Or Formed Organizations Your rights afforded under this policy shall not be SECTION II —WHO IS AN INSURED, Paragraph prejudiced if you fail to give us notice of an SE SEis replaced by the following: 'occurrence", offense, claim or"suit", solely due to your reasonable and documented belief that the a. Coverage under this provision is afforded until "bodily injury" or"property damage" is not covered the end of the policy period. under this policy. ALL OTHER TERMS, CONDITIONS,AND EXCLUSIONS REMAIN UNCHANGED, 421-2915 06 15 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Page 4 of 4 AAAABEN "� + y DATE(MMIDDIYYYY) AC"R" CERTIFICATE OF LIABILITY INSURANCE I 10/25/2018 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(les)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 Jim Wa� 'ner 8 ....... _. Commercial Lines-(248)353-5800 SHONE II CONTACT lA1248.621.9828 JAAc N®1 610m537.2371 ... USI Insurance Services National,Inc. E-MAIL Im.wagner@usi.com gD,t�r�ftss: lim.wagner@usi.com 4000 Town Center,Suite 800 INSURER(S)AFFORDING COVERAGE NAIC# Southfield,MI 48075 INSURERA: XL S.......ci......... ......................... It Insurance Company . .......... 37885 INSURED INSURER B: Ignited,LLC INSURER 2150 Park Place,Suite#100 C: unINSUR ... EI Segundo,CA 90245 ,INSURER E n.............. — g E, INSURER F: COVERAGES CERTIFICATE NUMBER: 13607746 REVISION NUMBER: See below 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 RAID CLAIMS. INSR................... ................', b, ..,I UBRI .. ...,.........R fMOLIC YEFf iNPq d.i..................., LIMITS LTR TYPE OF INSURANCE INSO Wvo POLICY NUMBE L CM E'XP G DDIYY'YY'1 I COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS-MADE I_)OCCUR PBEMI,S.qs S (Any one MEDXP .......... ................................... PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GE,NERAL AGGREGATE $ II T COMP/OP AGG U$ .........� POLICY E]PROJEC- .........�LOC ..P.R. . .. .T.S;,,,,,,,,,, _-- OTHER $ „ AUTOMOBILE LIABILITY 'COMBINED SINGLE.LIMIT $ .9 r 14.P1qU........_...,...._.,.,... ...................... ANY AUTO BODILY INJURY(Per person) $ .............................---.... OWNED SCHEDULEDBODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ „ AUTOS ONLY AUTOS ONLY L,F?eX atcudetl�t1 �s UMBRELLALIAB HOCCUR EACH OCCURRENCE � S EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I RETENTION$ $ A WORKERS COMPENSATION RWC6200390 01/01/18 01/01/19 X PEAruTE IOORH AND EMPLOYERS'LIABILITY —°-----•- ANYPROPRIETORIPARTNER/EXECUTIVE YIN NIA 1,000,000 E,L EACH ACCIDENT $ OFFICERIMEMBEREXCLUDED? """"""""' ' (Mandatoryfn NH) E.L.DISEASE-EA EMPLOYEE S _ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) Waiver of Subrogation applies in favor of Certificate Holder when required by written contract and where permitted by law. CERTIFICATE HOLDER CANCELLATION EI Segundo Police Department SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 348 Main St THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. EI Segundo,CA 90245 AUTHORIZED REPRESENTATIVE I The ACORD name and logo are registered marks of ACORD ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) (This ceildicats replaces certl9cetep 13569974 issued on 102412016) WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed.04-84) 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 Where required by written agreement signed prior to loss All California Operations, 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 Policy No.RWC6200390-08 Endorsement No. Insured Insurance Company Ignited,LLC XL Specialty Insurance Company Countersigned By WC 04 03 06 Page 1 of 1 (Ed. 04-84) Copyright 1984 Workers'Compensation Insurance Rating Bureau of California.All Rights Reserved.