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PROOF OF INSURANCE (2019) CLOSED Policy Number: vARious Date Entered: 9/21/2018 AC/0R" DATE JMWDDNYYY) CERTIFICATE OF LIABILITY INSURANCE 9/21/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT, If the certificate holder is an ADDITIONAL INSURED, the policy(ios) 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 Diane DeSilva Mary Barnard Insurance NAME: PHONE (408)286-1334 FAX 2190 Stokes Street IAICNo.Ell: (ALC.No,: (408)286-6425 E-M ADDREAIL SS,jennie@barnardinsurance.com Suite 201 INSURER($)AFFORDING COVERAGE MAIC 4 San Jose CA 95128 CATLIN SPECIALTY INSURANCE COMPANY INSURER A INSURED Range MaintenanceALLSTATE Services, L.L.C. INSURER 8: Donna Fogglato INSURER C:STATE COMPENSATION INSURANCE FUND 301 Mary Belle Way INSURER D: Angels Camp, CA 95222 INSURER E: NSURER F: 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 li 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, iADDL SUER POLICY EFF POLICY EXP INSR TYPE OF INSURANCE LIMITS LTR INSO WVD POLICY NUMBER rMM/DDffYYYl IMMIDDIYYYY A x COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000 OCCUR 0400702136 PREMISES(Ea occurrence) CLAIMS-MADE .1/01/19 DAMAGE TO RENTED $ 100,000 MED EXP(Anyone person) $ 5,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMITAPPLIES;PER GENERAL AGGREGATE $2,000,000 POLICY[❑PRO-JECT ❑ LOC PRODUCTS-COMPIOP AGG $ INCLUDED OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1,000,000 (Ea accident) B ANYAUTO 648827264 BODILY INJURY(Per person) $ OWNED 'K71 SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTYDAMAGE $ AUTOS ONLY AUTOS ONLY I(Per accident) UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAR F CLAIMS MADE AGGREGATE $ DED I I RETENTION$ $ R WORKERS COMPENSATION PER EMPLOYERS`LIABILITY YIN STATUTE E10TH- ANDR C ANYPROPRIFTORIPARTNERIEXEWN IE 11/01/19 E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMEIER EXCLUDED? LJ NIA 1760432 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 IT yes,describe under DESCRIPTION OF OPERATIONS below EL,DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) *TEN DAYS NOTICE OF CANCELLATION APPLIES FOR NON—PAYMENT OF PREMIUM 30 DAYS FOR ALL OTHER. BE.- ALL CALIFORNIA OPERATIONS. CERTIFICATE HOLDER IS NAMED AS ADDITIONAL INSURED. CERTIFICATE HOLDER CANCELLATION CITY OF EL SEGUNDO, CITY CLERK ATTENTION: BRIAN EVANSKI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 350 MAIN STREET ACCORDANCE WITH THE POLICY PROVISIONS. EL SEGUNDO, CA 90245 AUTHORIZED REPRf§b TATIVE 1988-201C ORD CORPORATION. All rights reserved. 4 ACORD 25(2016103) The ACORD name and logo are registered marks of AD Produced using Forms Boss Plus software.www.FormsBoss.com:Impressive Publishing 800-208-1977 ii POLICY NUMBER: 0400702136 COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Orcianlzafion(s): Locationtsi Of Covered Onerations BLANKET Information required to complete this Schedule. if not shown above- will be shown in the Declarations. A. Section If — Who Is An Insured is amended to B. With respect to the insurance afforded to these Include as an additional, insured the person(s) or additional insureds, the following additional organization(s) shown in the Schedule, but only exclusions apply: with respect to liability for"bodily injury", "property This insurance does not apply to "bodily injury" or damage" or "personal and advertising injury" "property damage"occurring after: caused, in whole or in part, by: 1. Your acts or omissions; or 1. All. work, including materials, parts or equipment furnished in connection with such 2. The acts or omissions of those acting on your work, on the project (other than service, behalf, maintenance or repairs) to be performed by or in the performance of your ongoing operations for on behalf of the additional insured(s) at the the additional insured(s) at the location(s) location of the covered operations has been designated above. completed; or However: 2. That portion of "your work" out of which the injury or damage arises has been put to its 1. The insurance afforded to such additional intended use by any person or organization insured only applies to the extent permitted by other than another contractor or subcontractor law, and engaged in performing operations for a 2. If coverage provided to the additional insured is principal as a part of the same project, required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide forsuch additional insured. CG 20 10 04 13 @Insurance Services Office, Inc., 2012 Page 1 oft C. With respect to the insurance afforded to these 2. Available under the applicable Limits of additional insureds, the following is added to Insurance shown in the Declarations; Section III—Limits Of Insurance; whichever is less. If coverage provided to the additional insured is This endorsement shall not increase the required by a contract or agreement, the most we applicable Limits of Insurance shown in the will pay on behalf of the additional insured is the Declarations. amount of insurance: 1. Required by the contractor agreement; or Page 2 oft O Insurance Services Office, Inc., 2012 CG 20 10 04 13 k r t 't r COMMERCIAL GENERAL LIABILITY CG 20 0104 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. j PRIMARY AND NONCONTRIBUTORY OTHERINSURANCE CONDITION i i This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PROD UCTSJCOMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance (2) You have agreed in writing in a contract or Condition and supersedes any provision to the agreement that this insurance would be contrary: primary and would not seek contribution Primary And Noncontributory Insurance from any other Insurance available to the additional insured. This insurance is primary to and will not seep contribution from any other insurance available to an additional insured under your policy i provided that: (9) The additional Insured is a Named Insured under such other insurance; and j I I 1 i' i i i' i; CG 20 01 04 13 U Insurance Services Office, Inc., 2012 Page 1 of 1 "r f S j POLICY NUMBER: 04007021 36 COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 �g I AI TRANSFER RIGHTS F RECOVERY � AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: I COMMERCIAL GENERAL LIABILITY COVERAGE PART PROD UCTSICOMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: BLANKET Information�l;Wln-•#to nom this Sr had„ra_ if not hninrn ahovap Uill hr.Ghrmin in th flan! ami: The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV—Conditions: We waive any right of recovery we may have against i. the person or organization shown in the Scheduleis 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- completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. !.i i i„ is is is I i° i CG 24 04 05 09 U insurance Services Office, Inc., 2008 Page 4 of 1 ❑ is - is P L { � 3 i t COMMERCIAL AUTO AA CW 20 10 11 THIS ENDORSEMENT CHANCES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESS AUTO ENHANCEMENT ENDORSEMENT h Coverage provided under this policy is modified by the attachment of this endorsement if there is any conflict in coverage provisions between this form and any state specific endorsement also attached to this policy, the provislon(s) of the state specific form shall apply. j Y This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM In SECTION I w COVERED AUTOS, the following changes are made: The following is added: D. Physical Damage Coverage for Temporary d. Any organization, other than a partnership or joint Substitute and Leased Autos venture, over which you maintain ownership or in which you hold a majority interest. This provision If Physical Damage Coverage is provided by this applies only if there is no similar insurance provided policy,the following kinds of"autos"are covered to that organization. "autos"for the same coverages provided by the e. Any organization you acquire or form after policy policy: inception, other than a partnership or joint venture, 1. Any private passenger "auto", or other than over which you maintain ownership, or in which private passenger vehicle with gross vehicle you hold a majority interest. Coverage under this weight of 20,000 lbs. or less, you do not own provision does not apply; while used with the permission of the owner as (1) If there is similar insurance provided to that a temporary substitute for a covered"auto"you organization; Or own that is out of service because of its: (2) To "bodily injury" or "property damage" that Occurred before you acquired or formed the a. Breakdown; organization. b. Repair; f. Any person or organization that you are required to c.Servicing; name as an additional insured under the terms of a written job contract, or by written insurance d."Loss";or requirements executed prior to any covered 'loss" e. Destruction. or claim. This protection applies only if the person or organization is liable for the conduct of an 2. Private passenger"autos"and other than private 'insured"and only to the extent of that liability. passenger vehicles with gross vehicle weight of 10,000 lbs, or Less, leased, hired, rented, or Under A. Coverage, Coverage Extensions, borrowed for a period of 30 days or less.This Supplementary Pa 2 and 4) does not include any vehicle you lease, hire, pp ' ymems, subparagraphs ra hs p g p ( ) { rent, or borrow from any of your "employees, are replaced with the following: or partners or members of their households. (2) Up to $5,000 for cost of bail bonds (including In SECTION lI -- LIABILITY COVERAGE, the bonds for related traffic law violations) required following changes are made: because of an "accident" we cover. We do not have to furnish these bonds. Under A. Coverage, Who Is An Insured, the following is added: Includes copyrighted material of Insurance Services Office, Inc.,with its permission AA CW 20 1011 Allstate Insurance Company Page 1 of 3 Insured Full Copy j �# All reasonable incurred bythe�nsumd" N) Costs for extended warranties, Credit` ' atourqt, including of earnings up to Life Insurance, Health, Accident or $5OUoday because oftime off from work. Disability |nmunmou purchased with the loan orlease;and Under B. F�|mm �n9k&m*, �h�fb!k»vNnQ (5) Carry-over balances 0nmprevious loans Exclusions, or|oemma' pmragroph |oodded: But this exd~`i~' does not applyto "bodily injury"to Under CL Deductible' the fb|km 'ny paragraphraph is fellow � a � w "employed'"employed' caused by n whose position within the insured organization |mmLurabove When Collision Coverage iyprovided bythis the level ofmanager orsupervisor. policy, the deductible amount will not be subtracted from the loss payment in collisions Coverage afforded by this provision is excess over involving your covered 'autu''and another auto any other collectible insurance. covered by Allstate Insurance Company or any ofiVssffiUates. In SECTION III ~ PHYSICAL DAMAGE COVERAGE, the following changes are made: In SECTION |V ~ BUSINESS AUTO CONDITIONS, the following changes are made. Under A. Coverage, Glass Breukage~ Hitting A Bird OrAnimal' Falling Objects Or80esi|es� the following is added: Under ALoss Conditions, Duties |nThe Event OfAccident Claim, Suit OrLoss Condition, the If damage to glass is repaired in |(ou of being following |aadded under subpart mc replaced, uodeductible will apply for repair only. Knowledge ufan "acddmmf' or5oaa" byany of Under A Coverage, CcwnruQu Extensions, the your agemta, servants or "employees"shall not following is added: in itself oonudihub* knowledge by you, un|oam you or one of your corporate officers or c. Personal Effects Coverage managers, orany assignee, shall have received In the event of a Lobd theft ofyour covered "aubo", such ncJkm from the mgemt, servant or for which you carry either Comprehensive or 'tmp��� Spnm|had Causes of Loss coverage, we will pay up k/$SOOfor the personal effects which are: Men you � an occurrence of any 1 owned '~r~ ' ` '�codem�'or�ooa"toaWorker's Compensation 2. in your covered "auto"otthe time o[the total theft carrier or self insured plan providing the named ofsuch'amto". |neured's V&urkmru Compensation |nmummoe Nodeductible applies twPersonal Effects Coverage. which later develops into o claim submitted under this policy, failure to report such Under ACoverage, the following |yadded: 'bocdent"or'Yoam" touaedthe same time shall not be deemed a violation of this condition. 5. Lease and Loan Gap Coverage After you become aware ofsuch liability claim /n the event of ntotal '1ouu" to a covered "auto" arising from the 'taccdent" or 'loss", you must shown 1nthe Schedule urDeclarations for which m give usprompt notice. opomUic premium chargeindicates that physical damage coverage applies, we will pay any unpaid Undmr�� Lo��Coudb�oe\Tr�/��ru "°�'°~ f of amount duo on the �cmmor loan for a covered . AQm�� O�o� l� Us, the �|bmdng is added: "auto", less: '~~~~~ a �'- ---- -- u'-- the Physical Damage Coverage section oYthe poUcy` and We waive any right of /�uvv� w� may have against any person or organization because of b. Any: payments we make for injury or damage arising out (1) Overdue|aaeo/|uan payments at the time of of work you perform under a contract with such {ha"loes",- person or organization, in which you have agreed (2) Financial penalties imposed under o bow�v�you,hUhiofouohrouovm�. lease for excessive use, abnormal wear and tear orhigh mileage; (3) Security deposits not returned by the lessor; |nc|udeaoopyrightedmatedaof|nourannmServiceaOffice, |nu,withItspermisaion AACVV2O1O11 Allstate Insurance Company Page 2of3 Insured Full Copy i � 1 i Under B. General Conditions, Concealment, Misrepresentation Or Fraud, the following' is added: This condition does not apply to any omission or failure to provide material facts if the omission or failure was unintentional. i l' i i I 1 1 I f `s I. f L I I: I 1 ' I I; Includes copyrighted material of Insurance Services Office, Inc.,with its permission AA CW 2010 11 Allstate Insurance Company Page 3 of 3 Insured Full copy l ENDORSEMENT AGREEMENT x, s . WAIVER OF SUBROGATION BLANKET BASIS 1760432 RENEWAL NA HOME OFFICE 6"1.7-16'-03 SANE FRANCISCO EFFECTIVE NOVEMBER 1, 2018 AT 12.01 A.M. PAGE I OF I ALL EFFECTIVE DATES ARE AND EXPIRING NOVEMBER 1, 2019 AT 12.01 A.M. AT 12:01 AM PACIFIC STANDARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME Y RANGE MAINTENANCE SERVICES, LLC 301 .MARY BELLE WAY ANGELS CAMP, CA 95222 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. is THIS AGREEMENT APPLIES ONLY TO THE EXTENT THAT YOU PERFORM WORK TINDER A WRITTEN CONTRACT THAT REQUIRES YOU I TO OBTAIN THIS AGREEMENT FROM US. THE ADDITIONAL PREMIUM FOR THIS ENDORSEMENT SHALL BE 2.00% OF THE TOTAL POLICY PREMIUM. I' SCHEDULE PERSON OR ORGANIZATION JOB DESCRIPTION ANY PERSON OR ORGANIZATION BLANKET WAIVER OF FOR WHOM THE NAMED INSURED SUBROGATION �~ HAS AGREED BY WRITTEN CONTRACT TO FURNISH THIS WAIVER i. NOTHING IN THIS ENDORSEMENT CONTAINED SHALL BE HELD TO VARY, ALTER, WAIVE OR EXTEND ANY OF THE TEAMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS POLICY OTHER THAN AS STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR LIMITATIONS OF THIS ENDORSEMENT. i COUNTERSIGNED AND ISSUED AT SAN FRANCISCO: NOVEMBER r 2018 4 2572 AUTHORIZED REPRESENT 1VE PRESIDENT AND CEO