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PROOF OF INSURANCE (2019 - 2019) CLOSED DATE(MM/DD/YYYY) ACOR" CERTIFICATE OF LIABILITY INSURANCE `,.� 1 11/14/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER (CONTACT NAME: Thomas Costello Insurance Agency I(A/C-PHONE.Ext) (805)520-4997 ac.No): (805)426-8802 2775 Tapo St.#101 I E-MAIL Y@ ADDRESS: tracy@costello-assoc.com INSURER(S)AFFORDING COVERAGE NAIC# Simi Valley CA 93063 I INSURER A: FIRST MERCURY INSURANCE COMPANY INSURED INSURER B: NATIONWIDE MUT INS CO 23787 Advanced Access Controls, Inc. I INSURERC: TOPA INS CO 18031 15414 Cabrito Rd Ste A I INSURER D: STATE COMPENSATION INSURANCE FUND INSURER E: SENTINEL INS CO LTD 11000 Van Nuys CA 91406 I INSURER 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 INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER (MM/DD/YYYYI (MM/DD/YYYYI X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE � OCCUR PREM SESDAMAGEO(Ea occur RETEence) $ 50,000 MED EXP(Any one person) $ 5,000 A GLO-510992 01/17/2018 01/17/20191 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY[:] PRO JECT [:] LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ B OWNED V SCHEDULED AUTOS ONLY AUTOS ACP7884593214 08/26/2018 08/26/2019 BODILY INJURY(Per accident) $ /� XHIRED V NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 5,000,000 C X EXCESS LIAB HCLAIMS-MADE XL 6602561-07 01/17/2018 01/17/2019 AGGREGATE $ 5,000,000 DED 1 1 RETENTION$ $ WORKERS COMPENSATION X1 PER STATUTE EORH AND EMPLOYERS'LIABILITY D ANY PROPRI OFFICER/MEMBER/ YE.L.EACH ACCIDENT $ 1,000,000 EXCLUDED?ECUTIVE � N/A 9128882-18 04/01/2018 04/01/2019 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 BUSINESS PERSONAL LIMIT: $260,000 E PROPERTY 72SBAAK3924 01/17/2018 01/17/2019 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) *CITY OF EL SEGUNDO, ITS OFFICIALS&EMPLOYEES ARE LISTED AS ADDITIONAL INSURED* CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CITY OF EL SEGUNDO ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Policy NunnbarGLO-51O992 COMMERCIAL GENERAL LIABILITY CG 20330704 THIS ENDORSEMENT CHANGES THE POLICY' PLEASE READ IT CAREFULLY' ADDITIONAL INSURED — OWNERS, LESSEES OR CONTRACTORS - AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section || – Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured any person or additional insurode, the fn||ovvinQ additional organization for whom you are performing exclusions apply: operations when you and such person or This insurance does not apply to� organization have agreed in writing in acontract or agreement that such person or organization be 1. "Bodily injury" ''property damaBe" or "personal added as an additional insured on your pm|ioy and advertising injuryp arising out of the Such person or organization in an additional rendering of, or the failure to nender, any insured only with respect to liability for "bodily professional arohiteotura|, engineering or injury". "property damage" or "personal and surveying services, including: advertising injur/' oauood. inwhole orin part' by: a. The pnepahng, approving, or failing to 1. Your acts oronnissionmor prepare or approve, meps, shop drawings, ' opinions, reports, surveys, field orders, �. Th� aoteoromi�mionsofthomeactin� onyour behalf; change orders or drawings and specifications-, or in the performance of your ongoing operations for b. Supervisory, inspection, architectural or the additional insured ' engineeringactivities. A person's or organization's status as an 2. "Bodily� i �un' '/' or "property damage" occurring insured under this endorsement ends ' aftec when your operations for that additional insured are completed. m. All work, including maheria|m, parts or equipment furnished in connection with such work, on the project (other than aemice, 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 b. That portion of 'your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as o port of the same project, POLICY NUMBER: GLO-510992 COMMERCIAL GENERAL LIABILITY CG 20 37 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organ ization(s): Location And Description Of Completed Operations Any person or organization you have agreed in a written Premises covered under this policy when required by contract to add as an additional insured on your policyvriften contract executed prior to the "bodily injury", provided the written contract is executed prior to the`property damage" or"personal and advertising injury". `bodily injury", "property damage" or "personal and advertising injury". lInformation required to complete this Schedule, if not shown above, will be shown in the Declarations. Section 11 — 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" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the schedule of this endorsement performed for that additional insured and included in the "products- completed operations hazard". CG 20 37 07 04 C ISO Properties, Inc., 2004 Page 1 of 1 ❑ POLICY NUMBER: GLO-510992 GENERAL LIABILITY CG 24040509 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the fo||owing� COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name OfPerson OrOrganization: A person or organization you have agreed in a written contract to waive any right of recovery against provided the written contract isexecuted prior tothe injury nrdamage. | Unformation required to complete this Sohedu|e, if not shown above, will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Seotion |V—Conditions: VVewaive any right ofrecovery wemay 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- completed operations hazord" This waiver applies only to the person or organization shown in the Schedule above. CG 24040509 CInsurance Services Office, Inc., 2008 Page of [� THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ KCAREFULLY. PRIMARY AND NONCONTRIBUTORY —OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance Condition and supersedes any provision to the contrary'. Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under this policy provided that: (1) The additional insured ismNamed Insured under such other insurance; and (2) You have agreed in writing in a contract or agreement prior to the injury or damage that this insurance would be primary and would not seek contribution from any other insurance available tothe additional insured. Hov*aver, the insurance provided under this endorsement will not apply beyond the extent required by such contract or agreement. ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED. This endorsement forms a part of the Policy to which attached, effective on the inception date of the Policy unless otherwise stated herein. (The following information is required only when this endorsement is issued subsequent to preparation of the Policy.) Endorsement effective Policy No. GLO-510992 Endorsement No. Named Insured Countersigned by CFS|C'GL-1002(10/2015) Policy#ACP 7884593214 COMMERCIAL AUTO AC 04 44B 03 16 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. The Transfer Of Rights Of Recovery Against Others To Us Condition does not apply to any person(s) or organization(s) to the extent that subrogation is waived prior to any "accident" or "loss" under a written contract with that person or organization. AC 04 44B 03 16 Includes copyrighted material of Insurance Services Office, Inc. Page 1 of 1 with its permission. re"M ENDORSEMENT AGREEMENT COMPENSATION WAIVER OF SUBROGATION . BLANKET BASIS 9128882-18 RENEWAL NA HOME OFFICE 3-30-70-99 SAN FRANCISCO EFFECTIVE APRIL 1, 2018 AT 12.01 A.M. PAGE 1 OF 1 ALL EFFECTIVE DATES ARE AND EXPIRING APRIL 1, 2019 AT 12.01 A.M. AT 12:01 AM PACIFIC STANDARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME ADVANCED ACCESS CONTROLS INC 13407 SATICOY ST NORTH HOLLYWOOD, CA 91605 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. THE ADDITIONAL PREMIUM FOR THIS ENDORSEMENT SHALL BE 2.00% OF THE TOTAL POLICY PREMIUM. 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 NOTHING IN THIS ENDORSEMENT CONTAINED SHALL BE HELD TO VARY, ALTER, WAIVE OR EXTEND ANY OF THE TERMS, 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. COUNTERSIGNED AND ISSUED AT SAN FRANCISCO: MARCH 22, 201�8 2572 AUTHORIZED REPRESENTIVE PRESIDENT AND CEO SCIF FORM 10217 (REV.7-2014) OLD DP 217