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PROOF OF INSURANCE (2019 - 2019) CLOSED
DATE(MM[DD_YYY) CERTIFICATE OF LIABILITY INSURANCE 03/26/18 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 be endorsed. If SUBROGATION IS WANED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate doe¬ confer rights to the cortifdcAle Irolder In lieu of such cndeaslomtcol(r,p, PRODUCER CONTACT HELEN SHERLOCK TRI WORLD INSURANCE AGENCY INC PHONE +' (949)756-1356' "" 4000 Birch Street, Ste 201B a E~�hshelio)k@tr0iworld'in ' ..{-MAtL ........-.................... ...... ......................_............................. . ADDRE s.com Newport Beach, CA 92660 .... .Rig'....A....................._.... __. NSURE AFFORDING COVERAGE MC# 800-617-8428 INSURER ARCH SPECIALTY INS CO. A+XV 21199 _�. �- usuRen.._. MARX BROS. FIRE EXTINGUISHER CO. INsuReR®: RSUII INDEMNITY CO. A+XIV 22314 &COOK FIRE EXTINGUISHER INSURER C, SECURITY NATIONAL INS CO. A XV 33120 -- 1159 S. SOTO STREET INSURER D: .-...._..........a.....m LOS ANGELES, CA 90023 INSURERE,,....•_......................_............._....... ...._... .......................,�,_ INSURER F' COVERACES (7ERIIFICAI'E NUMHER; 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. wSP. TYPE OF INSURANCE AWL nraR wvo POLICY NUMBER RIAwDDoff")...._.....Mouff ......�.......�.... LIL COY) LIMITS tl GENERAL LIM31LTTY EACH OCCURRENCE S 1,000,000 UA14Ae.L io kLNILIb X. ....OM ERCIAL GENERALILITY MEDrEXP�SL's ccavnoc') 5 50,000 COMMERCIAL CLAIMS-MADE X (Any one person) 5 5,000 A X OCP DPC102191500 03/26/18 03/26/19 PERSONAL&ADV INJURY $ 1,000,000 GEtiERAL GGREGATE , 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: Y PRODUCTS-COMPO AGO S 2,000,000 , -1 POLICY YN"-p Acc I!X-1 LOC .......,.,. 5 - - AUTOMOBILE LIABILITY C0448WED tANOLt OMOI MA ODI= N) 5 ..............._.......,.,...,. -LL4` ANYALY INJURY(Per person) S ALL OWNED SCHEDULED BODILY INJURY(Par ecckfent) 5 AUTOSAUTOS - - NON-OWNED PROPERTY DAMAGE 5 HIRED AUTOS AUTOS Mcracciden(1 dd UMBRELLA LIAS X CLAIMS-MADE 4,.000,000 NHA244559 03/26/18 03/26/19 EACH OCCURRENCE mmmmmmmmm� 00,000 B X EXCESS D •6.._ LIAi RETENTION s CLAIMS-MADEI PRODUCTS/OPS 5 4x000,0....,,.. ...,_.. ® WORKERS COMPENSATION X,•,�TAY ATUT lI,,,,ER„_, AND EMPLOYERS'UABIUTY C pgr �PRo�PR TORIPARTEA NN HcmNE DEW ( NIA Y YIN SWC1185824 02/18/18 02/18/19 1 000 000 EL EACH ACCIDENT 5 r r ®.,•.....,._..., (Mandatory in NH) M E L DISEASE-PA EMPLOYEE 5 1,000,000 DESCRIPTION OF OPERATIONS below EL.DISEASE-...POLICY LIMIT s 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS r VEHICLES(Atleca ACORD 107,Addlllonal Remarks Schedule,If more space is mqulred) 4LL OPERATIONS- SERVICE AGREEMENT =ITY OF EL SEGUNDO, ITS EMPLOYEES, REPS, OFFICERS AND AGENTS ARE ADDITIONAL INSURED ?ER ATTACHED ENDORSEMENTS. WORK COMP WAIVER OF SUBROGATION ENDORSEMENT ATTACHED. THIRTY (30) DAYS NOC APPLIES TO ALL LISTED POLICIES. CERTIFICATE HOLDER CANCELLATION CITY OF EL SEGUNDO SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ATTN CITY CLERK THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 350 MAIN STREET, ROOM 5 ACCORDANCE WITH THE POLICY PROVISIONS. EL SEGUNDO, CA 90245-3813 AUTHORIZED REPRESENTATIVE @ 1988-2010 ACORD CORPORATION.All rights reserved NCORD25(2010/05) The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABILITY CG 20 37 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, ADDITIONAL INSURED - OWNERS, LEASEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: ANY PERSON OR ORGANIZATION AS REQUIRED BY WRITTEN CONTRACT LOCATION/DESCRIPTION: ALL OPERATIONS (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) Section II - Who is An Insured is amended to include as an 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". PRIMARY INSURANCE CLAUSE: To the extent that this insurance is afforded to any additional insured under this policy,such insurance shall apply as primary and not contributing with any insurance carried by such additional insured, as required by written contract. CG 20 37 07 04 © ISO Properties, Inc., 2000 Page 1 of 1 COMMERCIAL GENERAL LIABILITY CG 20 10 07 04 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 PERSON OR ORGANIZATION: ANY PERSON OR ORGANIZATION AS REQUIRED BY WRITTEN CONTRACT LOCATION/DESCRIPTION: ALL OPERATIONS A. Section II—Who is An Insured is amended to include as an insured any person(s)or organization(s)shown in the Schedule, but only with respect to liability for "bodily injury", "property 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 insured(s)at the location(s)designated above. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions applies: This insurance does not apply to"bodily injury"or"property damage"occurring after: 1. All 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. 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 a part of the same project. PRIMARY INSURANCE CLAUSE: To the extent that this insurance is afforded to any additional insured under this policy, such insurance shall apply as primary and non contributory with any insurance carried by such additional insured, as required by written contract. CG 20 10 07 04 ©ISO Properties, Inc., 2004 Page 1 of 1 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 06 34 (Ed, 8-00) WAIVER OF OUR RIGHT TO RECOVERY FROM OTHERS ENDORSEMENT—BLANKET 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 form us), The additional premium for this endorsement shall be 3% of the total California Workers' Compensation premium otherwise due. SCHEDULE )person or Orpanization Job Description Any person or organization when required All California Operations by written contract. F e Policy Number: SWC1185824 Insured: MARX BROS. FIRE EXTINGUISHER COMPANY,INC. Coverage Provided by: SECURITY NATIONAL INSURANCE COMPANY WC 99 06 34 (Ed.8-00) 6028BU ADDITIONAL INSURED (Prior Notice of Termination) This endorsement is a part of the policy. Except for the changes this endorsement makes, all other provisions of the policy remain the same and apply to this endorsement. 1. A person or organization shown on the Declarations Page as an Additional Insured is provided Liability Coverage, but only to the extent that person or organization qualifies as an insured as defined in Liability Coverage, 2, An Additional Insured has the same right of recovery under Liability Coverage as if they had not been shown on the Declarations Page as an Additional Insured. 3. If Liability Coverage is changed or terminated as to the interest of the Additional Insured, unless another number of days notice is shown on the Declarations Page, we will provide the Additional Insured: a. 10 days notice of such change or termination if the policy is nonrenewed or the cancellation is for nonpayment of premium; and b. 20 days notice of such change or termination if the cancellation is for any reason other than nonpayment of premium. Additional Insured: 'the City,its officials,and employees' Page 1 of 1 6028BU ©,Copyright,State Farm Mutual Automobile Insurance Company,2011 ATE A C CA R tL CERTIFICATE OF LIABILITY INSURANCE ®11/27/2018 Y) 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 Bryce Mckell Insurance Agency, Inc NAMF', JRanlecEWlnlirn,'s PHONE FAX 413 E Foothill Blvd Ste 102 tkCc 'n,F.xl)l'90g`'305-1370 WC,Nz;):908r5J6 7055 stratc:'fTrtor EMAIL @. San Dimas, CA 91773 ADDREs.,,home t nT'CdCeIR.CDnM1 ,1 9T, INSURERS)AFFORDING COVERAGE N'AIC# TWj�p:g� INSURER A:State Farm Mutual Automobile Insurance Company 25178 INSURED Marx Brothers Fire Extinguisher Co Inc INSURER B,; 1159 S Soto St INSURER C Los Angeles, CA 90023-2198 INSURER p INSURER E 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 AOOL SUER 'POLICY EFF POLICY EXP LIMITS LTR lS^ A I,t ._,....„„„„ POLICY NUMBER iMW0D'NY"Y'Y'I 9MPAMIDlYY'YYy GENERAL LIABILITY ^.,...,X.1 L............... ,.. EACH OCCURRENCE $ „ L....�.....1............... r AC.1Ad.,r'TC:.t.RVNY'I'O a . . COMMERCIALCOMMERCIALGFNFRAI..LIABILITY PREMISES"(Ea nrr'aa n'rnce,,f, CLAIMSMADE OCCUR MJ n FXP(Pray ono nrv.on) 4. PERSONAL'L ADV INJURY !h GENERAL.AGGREGATE $ GENT..AGGREGATE 1.111AIr APPLIES PER. PRODUCTS-C.OMP10P AGG :6 POLICY PRO, LOC $ � Y ' d _...... AAUTOMOBILE LIABILITY Y SINGLE 4r MIT Ea11:rMMIJ ANY AUTO 041 1832-B22-7510812212018 02122/2019 BODILY ...... INJURY(Per person) q; 1,000,000 AIA.OWNED X SCHEDULED BODILY INJURY/Per accident) � 1,000,000 AUTOS AUTOS 404 5720-D19-75W 10/19/2018 04119/2019 NON-OWNED FRCY6HFH,Y'^r t"Td4CJ1Ad:;E HIRED AUTOS AUTOS 454 0524-E08-75D 11108/2018 05108/2019 $ .'0()Q,U00 IPcr ar.;y.�;rn.r?i, UMBRELLA LIAB OCCUR II II EACH OCCURRENCE $ EXCESS LIAB CI..AIMS-MAIDF.Y_I ll��"II AGGREGATE DED RETENTION'$, $ .._ WORKERS COMPENSATION WC STATU- UTH- AND EMPLOYERS'LIABILITY 7QRY LIMI,];,�j,„,,,,,, FIR , Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE❑ ^ E,L_EACH ACCIDENT $ OFFICE/MEMBER EXCLUDED? N A (Mandatory in NH) ..... I::,l.. DISEASE-EA EMPLOYEE, $ If yes,describe under E.L.DISEASE-POLICY 1.11111 Y S DEc B1?L OP_E.B:?:LQ.NaL��w _ W A EMPLOYERS NON OWNED/HIRED AUTO i[Y"I[-1 BODILY INJURY(E'er person) /1,n(tp,llt}(f LIABILITY I Y 567 0896-BO6-75 0810612018 0210612019 BODILY INJURY(Per accidernl) $t,tTOl),41uu PROPERTY DAMAGE(Per accident) I{-I,ttlT(l,CUI�C! .�........... _.......................... DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Automobile Liability Section:State Farm provides certification for Scheduled Autos only,described as all vehicles insured by State Farm,under the Producer named above. Additional Scheduled Auto:Policy No 474 1500-F21-75D(Eff 06/21/2018 to 12/21/2018), This insurance is primary and non-contributory with respects to claims arising out of the operation of the described vehicle. Additional Insured to be named on all policies:'the City,its officials,and employees'. Cancellation Clause to include 30 days written notice to the Certificate Holder listed below. (Certificate Holder contact:jallen@elsegundo.org) CERTIFICATE HOLDER CANCELLATION City f EI Segundo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE y ogunTHE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Attn: City Clerk ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street AUTHORIZED REPRESENTATIVE EI Segundo, CA 90245-0989 Digitally signed by Janiece Williams - LSA5 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 1001486 132849.8 01-23-2013