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PROOF OF INSURANCE (2019 - 2019) CLOSED RAMEROO-01 LELROM ASC ISR DATE(MM/DDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 3/7/2019 .............................�.... ..._........ _............................_® 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 License#OE63493 CONTACT NAME- Orr&Associates Insurance Services PHONE Ezt: 9,1 28780 Single Oak Dr ) ( )506-5859 IA NR).(800)474-3003 5 or'randassoclates . Ste 255 F ° , s setvice� com Temecula,CA 92590 INSUR,ER(S),AFFOR4ING,CpVERAGE NAICtI INSURERa Company 38920 wsuREo .... MNsuwzEl�M3, State le Insurance ..,,.. Cam ensa Insurance Fund 35076 Ramey Roofing Inc. INSURER P..; 221 1/2 Arena St. INSURER D: El Segundo,CA 90245 ItiSURE RIq: INSURER...... .... ..........�.�.. F: ._ .......................�..�... ........................................................................................._............,.................... COVERAGE$ CERTIFICATE NUMBER: REVISION I)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, MAY HAVE BEEN REDUCED BY PAID CLAIMS, CONDITIONS OF SUCH fPOLICIES sLIMITS,S,HP WC Y Y NUMBER POLICY EFF POLICY EXP i LIMITS IMMIDDIYYYY! IM MIDDIYYYYI I A X COMMERCIAL GENERAL LIABILITY „EACH CC,CURRENCE $ 1,000,000 CLAIMS-MADE X I,OCCUR 01000680740 6/7/2018 6/7/2019 DAMAGE TO RENTED r 100,000 ..---------------_ I I X X .PRImMII$E,S�L��,�SK.G6dFTQP�a � $ MED EXP(Anyane,pe,Gson)..........,.$ PERSONAL 8 ADV INJURY $ 1,000,000 _.. RODucTsn COMP/OP 2,000,000 GENN'L AG�GREG A E TE APPLIES PER G $ 2,000,000 POINTER E LST E ERA _ JE � . .. is COMBINED SINGLE LIMITTGG $ P AUTOMOBILE LIABILITY IE dgodgBI�,) $ ANY AUTO BODILY INJURY(Perperson $ _ AUTOS ONLY AUED TOSULNEDr BODILY INJURY(PeraccidenL) $ AUTOS ONLY ....., ..I A C3G Ooh L`Y „('Petr gCLcRft�C�r�9`Py ACa"iAP`E $ UMBRELLA � CCUR EACH EXCESSLIABAB �. _ _. _.-- CLAIMS-MADE GATRRENCE 1$ ............-ANDS MPL DYERS'L ABTLIITrN$ YIN _ .X ,T_ATI TE--I .SRH,,,,,,,.$.....................................................- B WORKERS COMP CNYANY PROPRI O EXCLUDED? N 1A 9162512 2018 6128/2016 6/2812019 _. ._.. LOYEB�, 1,000,000i, ,FOIA PROPRIETOR/PARTNER/EXECUTIVE R R/F�(ECUTIVE X es,descdbe under E L D SEASEC A EMP $ 1,000,000If ' DESCRIPTION OF OPERATIONS below .. E L DISEASE POLICY I.IMIT �$ 1,000 000 DESLOCATIONS CRIPTION VEHICLES a1dtSchedule, be aftched leapace Is required) City of EI Segundo Its Officials&Employees are nmedasaddiional insured per aached endorsement form(s). ...............�... CERTIFICATE HOLDER CANCELLATION ............... SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cit of EI Segundo,Its Officials&Employees THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Y 9ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street EI Segundo,CA 90245 .......................................... AUTHORIZED REPRESENTATIVE rVl"VvMc � r. ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS SCHEDULED PERSON OR ORGANIZATION Attached To and Forming Part of Policy Effective Date of Endorsement Named Insured 0100068074-0 06/07/2018 12:01AM at the Named Insured Ramey Roofing address shown on the Declarations Additional Premium: Return Premium: $0 $0 This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART ............................................................................................ ....................................... SCHEDULE Name of Additional Insured Person(s)or Organization(s): Location(s)of Covered Operations _,_. Blanket, as required by written contract. Information required to complete this Schedule, if not shown above,will be shown in the Declarations. A. Section II —Who Is An Insured is amended to include B. With respect to the insurance afforded to these as an additional insured the person(s) or additional insureds,the following additional exclusions organization(s) shown in the Schedule, but only with apply: respect to liability for "bodily injury", "property This insurance does nota I " damage" or "personal and advertising injury" caused, Y to "bodily injury" or " in whole or in part,by: property damage"occurringg after: 1. All work, including materials, parts or equipment 1. Your acts or omissions;or furnished in connection with such work, on the 2. The acts or omissions of those acting on your project (other than service, maintenance or behalf; repairs) to be performed by or on behalf of the in the performance of your ongoing operations for the additional insured(s) at the location of the covered additional insured(s) at the location(s) designated operations has been completed;or above. 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. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. CG 20 10 07 04 © ISO Properties,Inc.,2004 Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS Attached To and Forming Part o Policy E.................................... ._.__._.._.._-___________. � g f y ffective Date of Endorsement Named Insured 0100068074-0 06/07/2018 12:01AM at the Named Insured Ramey Roofing address shown on the Declarations Additional Premium: Return Premium: SO $0 This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Additional Insured Person(s)or Organization(s) Location and Description of Completed Operations _�. _... _...-......................__....... Blanket,as required by written contract. EXCLUDES ALL NEW RESIDENTIAL CONSTRUCTION Your work"does not include"new residential construction",which means any building or structure not previously occupied,and designed or intended for occupancy in whole or in part as a residence by any person or persons. "New residential construction"does not include apartments or apartment buildings or assisted living facilities. Information required to complete this Schedule, if not shown above,will be shown in the Declarations, 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" or "property damage" caused, in whole or in part, by "your work" at the location desig- nated and described in the schedule of this endorse- ment performed for that additional insured and in- cluded in the"products-completed operations hazard". ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED, CG 20 37 07 04 C ISO Properties,Inc.,2004 Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - PRIMARY AND NON-CONTRIBUTORY ENDORSEMENT Attached To and Forming Part of Policy Effective Date of Endorsement Named Insured 0100068074-0 06/07/2018 12:01AM at the Named Insured Ramey Roofing address shown on the Declarations Additional Premium: Return Premium: This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE ENVIRONMENTAL CONTRACTING AND PROFESSIONAL SERVICES LIABILITY COVERAGE PRODUCTS POLLUTION LIABILITY COVERAGE PREMISES ENVIRONMENTAL LIABILITY INSURANCE COVERAGE The insurance provided to Additional Insureds shall be excess with respect to any other valid and collectible insurance available to the Additional Insured unless the written contract specifically requires that this insurance apply on a primary and non-contributory basis,in which case this insurance shall be primary and non-contributory. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. CAS5003 0717 Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US-BLANKET __.....�­'W� ,.,,,.........................................................................................----------,-,- , Attached To and Forming Part of Policy Effective Date of Endorsement med Insured 0100068074-0 06/07/2018 12:01AM at the Named Insured Ramey Roofing _ address shown on the Declarations ` Additional Premium: Return Premium: ,.$0 1 $0 This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE SECTION IV—CONDITIONS,8.Transfer of Rights of Recovery against Others to Us is amended by the addition of the following: We waive any right of recovery we may have against persons or organizations because of payments we make for injury or damage arising out of"your work"done under a written contract with that person or organization wherein you have agreed to provide this waiver. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. CAS4002 0110 Page 1 of 1 , .!^lr 0 DATE(MM/DDIYYYY) ACCO CERTIFICATE OF LIABILITY INSURANCE 10/15/2018 114�1THIS 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 CONTAc1 Remon Wasfi NAME, REMON WASFI RAPER15SS; CNNo Evtl'310-322-1132 Ij Nd,3106401057 5taterarm 3737 TORRANCE BLVD STE 201 remon.wasfi.kOw3@statefarm.com TORRANCE, CA 90503 INSURER(S)AFFORDING COVERAGE NAIC 9 JED IV .................. INSURER INSURER A State Farm Fire and Casualty Company 25143 INSUR JON A RAMEY INSURER a State Farm Mutual Automobile Insurance Company 25778 142 SHELDON ST INSURER C! EL SEGUNDO, CA 90245-3915 INSURER D: INSURER E: ---------- ---- IIII INSURER F: P 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 I .�..p ... ................. pp. CLAIMS"- .. ...., Wt........ ...... . ........ ..._... POTkUT9FP LYExPRTYPE OF INSURANCE IN IDiVDPOLICY NUMBER pMM1D0IYYYY -IMMDDIYYYYp LIMITS A COMMERCIAL GENERAL LIABILITY Y Y EACH OCCURRENCE s .yQC:(AIMS-MADE ..... OCCUR � , ' Rr:MIdaP,;';SP;°noarceur+e�aenl S MCD EXP ++ra one miony S .. I I� 'Y P .. PERSONAL 8 ADV INJURY 3 GEN I.AGGREGATE .. -_.._. ...�.......,,,, . .. . u.«cIMC'1IT APPI.FS PER: N GENERAL E.RAL jGp.M GATE �S POIKNtl. .00 PRODUCTSCPIOP AGG 3 PRIM. AUTOMOBILE r.� fi,q . d,_............. CrCCidr`,VE." dW tb.E I.il&I1T B MOBILE LIABILITY Y Y 600 4325-D13-75 10113/2018 04113/2019 x ALLANY lvVNE X SCHEDULED 629 4146-D05-75 10!05/2018 04/05/2019 'B OILY INJURY(per accidenb s 1'000.000 INJURY(Per P a rson) S 1 000 AMA0h ALL O'4VNED SCHEDULED ,BODILY INJURY AUTOS AUTOS ERSY L X HIRED AUTOS X AUTOS I I VLpR�l�a�rl'.a_.,_, d...,_ I ~ EXCESS LIAR „CLA:MS-MADC AGGREGATE TE 5 1,...` OCCUR ° M DED E ED- RETENTION 5 � HGGR,aA OCCURRENCE....,.� UMBRELLA Ll PER AND ANY PROPRIETOR,''`AR VER/EXECUTIVE E.L.EACH ACCIDENTu OIH c WORKERS COMPENSATION (ABILITY YIN II, TE ER OFFICEtory in NH)RrMEMBER EXCLUDED? NIA (MandaE.L.DISEASE-EA EMPLOY if yes,describe under E DISEASE•POLICY LI DESCRIPTION OF OPERATIONS below d L MIT + V p i DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) 1.Policy#600 4325-D13-75 ;1992 ISUZU P°UP:VIN#JALC4B1 KXN7010870 . 2 Policy#629 4146-DO5-75;2008 FORD F150;VIN#1 FTPX04548KP12475. 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. AUTHORIZED REPRESENTATIVE ed.Jm ACORD 25(2014/01) The ACORD name and logo are registered marks OfA CORD©1988-2014 RCD' 'D CORPORATION.All rights 0 10094816 1321949.9 02-04-2014 ENDORSEMENT AGREEMENT WAIVER OF SUBROGATION REP 04 9162512-18 STATE RENEWAL SP FUND 4-47-88-58 PAGE 1 HOME OFFICE SAN FRANCISCO EFFECTIVE MARCH 7, 2019 AT 12. 01 A.M. AND EXPIRING MARCH 18, 2019 AT 12. 01 A.M. ALL EFFECTIVE DATES ARE AT 12:01 AM PACIFIC STANDARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME RAMEY ROOFING 221 1/2 ARENA ST �� EL SEGUNDO, CA 90245 ANYTHING IN THIS POLICY TO THE CONTRARY NOTWITHSTANDING, IT IS AGREED THAT THE STATE COMPENSATION INSURANCE FUND WAIVES ANY RIGHT OF SUBROGATION AGAINST, CITY OF EL SEGUNDO WHICH MIGHT ARISE BY REASON OF ANY PAYMENT UNDER THIS POLICY IN CONNECTION WITH WORK PERFORMED BY, RAMEY ROOFING IT IS FURTHER AGREED THAT THE INSURED SHALL MAINTAIN PAYROLL RECORDS ACCURATELY SEGREGATING THE REMUNERATION OF EMPLOYEES WHILE ENGAGED IN WORK FOR THE ABOVE EMPLOYER. IT IS FURTHER AGREED THAT PREMIUM ON THE EARNINGS OF SUCH EMPLOYEES SHALL BE INCREASED BY 03%. NOTHING IN THIS ENDORSEMENT SHALL BE HELD TO VARY, ALTER, WAIVE OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS POLICY OTHER THAN AS ABOVE STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR LIMITATIONS IN THIS ENDORSEMENT. COUNTERSIGNED AND ISSUED AT SAN FRANCISCO: MARCH 8, 2019 2570 A17�N HONIED fEP111 SENT' NVE PRESIDENT AND CEO SCIF FORM 10217 (REV.4-2018) OLD DP 217