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PROOF OF INSURANCE (2019 - 2020) CLOSEDo ISSUE DATE (MM/DD/YY) CERTIFICATE � 10/'29/18 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND anei Insurance Services, Inc. CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE 22231 Insurance Mulholland H DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE Hwy. # 2 0 9 -A POLICIES BELOW. 2alabasas CA 91302 (818) 222-9080 INSURED 'Van Lingen Body Shop, Inc. J.ba: Van Lingen Towing 2755 Lomita Blvd. Torrance CA 90503 COMPANIES AFFORDING COVERAGE COMPANY A ... LETTER National Interstate Ins. Co. COMPANY B LETTER Insurance Company of The West COMPANY `+ LETTER COMPANY D LETTER ( 310) 370-4533 COMPANY I LETTER COVEFOft 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. CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTA DATE (MM/DD/YY) DATE (MM/DD/YY) k GENERAL LIABILITY I GENERAL AGGREGATE 0, 000, 000 COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGG. s3, 000, 000 CLAIMS MADE � OCCUR. TPC -4400004-01 11/01/18 11/01/19 PERSONAL 8 ADV. INJURY $1 , 000,000 OWNER'S & CONTRACTOR'S PROT, I EACH OCCURRENCE $1, 000, 000 _ py I FIRE DAMAGE (Any one fire) $ 100, 000 N MED.E(PENSE(Anyoneperson) $ 5, 000 k AUTOMOBILE LIABILITY COMBINED SINGLE S ANY AUTO LIMIT 1,000, 000 ALL OWNED AUTOS BODILY INJURY S X SCHEDULED AUTOS (Per person) X HIRED AUTOS TPC -4400004-01 11/01/18 yyy� 11/01/19 IBODILYINJURY X NON -OWNED AUTOS I (Per accdent) S ® GARAGE LIABILITY PROPERTY DAMAGE s EXCESS LIABILITY EACH OCCURRENCE S1,000, 000 qUMBRELLA FORM TPC -4400004-01 11/01/18 11/01/19 AGGREGATE s3,000,000 OTHER THAN UMBRELLA FORM I B STATUTORY LIMITS WORKER'S COMPENSATION WVE- 5 0 213 3 2- 0 6 04/01/18 04/01/19 EACH ACCIDENT $1,000,000 AND DISEASE --POLICY LIMIT S1, 000, 000 EMPLOYERS' LIABILITY DISEASE. -EACH EMPLOYEE 1$1, O O O, 000 k OTHER On -Hook $ 200,000 Garage Keepers TPC -4400004-01 11/01/18 11/01/19 $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONSNEHtCLES/SPECIAL ITEMS The City of E1 Segundo, its officers, officials, employees, agent an volunteers are additional insureds r,Rjld,N'41w(R ,'` NCI»ATION.' SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE :;ity Of El Segundo EXPIRATION DATE THEREOF, THE ISSUING CO NY WILL ENDEAVOR TO Public Works Dept. MAIL 10 DAYS WRITTEN NOTICE TO THE CE FICAT OLD R NAMED TO THE 350 Main S t . LEFT, BUT FAILURE TO MAIL SUCH NOTICE HALL 1' O'S O OBLIGATION OR AUTHORIZED REPRESENTATIVE " �✓_ ✓- E1 Seg undo CA 90245 LIABILITY OF ANY KIND UPON THE COM'P'A ITS A NT R EPR'E'SENTATIVES. POLICY NUMBER: TPC 4400004 01 COMMERCIAL GENERAL LIABILITY CG 20 26 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON O�R ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): CITY OF EL SEGUNDO 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 as an additional insured the 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 your acts our omissions or the acts or omis- sions of those acting on your behalf; 1. In the performance of your ongoing opera- tions; or 2. In connection with your premises owned by or rented to you. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If overage provided to the additional in- sured Is required by a contract or agree- ment, the insurance afforded to such addi- tional insured will not be broader than that which you are required by the contract or agreement to provide for such additional in- sured. B. With respect to the insurance afforded to these additional iinsureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured Is required tsy a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of In- surance shown In the Declarations; whichever is less. This endorsement shall not increase the applic- able Limits of Insurance shown in the Declara- tions. CG 20 26 0413 © Insurance Services Office, Inc., 2012 Page 1 of 1 Wolters Kluwer Financial Services I Uniform Forms TM POLICY NUMBER: TPC 4400004-01 COMMERCIAL GENERAL LIABILITY CG 20 26 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) The City of EI Segundo, its officers, officials, employees, agents & volunteers above,Saltedule, if not shown Declarations, Section 11 — Who Is An Insured is amended to in- clude as an additional insured the person(s) or organi- zations) 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 your acts or omissions or the acts or omis- sions of those acting on your behalf: A. In the performance of your ongoing operations; or B. In connection with your premises owned by or rented to you. CG 20 26 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 0 i POLICY NUMBER: TPC 4400004 01 COMMERCIAL AUTO CA 99 37 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. GARAGEKEEPERS COVERAGE This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: VAN LINGf �NGEN TOWI146INC. DBA VAN Endorsement Effective Date: SCHEDULE Location Number Address Where You Conduct Garage Operations (Main Location) i 00001 2755 LOMITA BLVD TORRANCE CA 90505 Covernaes Limit Of Insurance And Deductible Premium Comprehensive $ 500,000 Limit Of Insurance $ 473 $ 500 Deductible For Each Customer's Auto For Loss Caused By Theft Or Mischief Or Vandalism $ 2,500 Maximum Deductible For Loss Caused By Theft Or Mischief Or Vandalism In Anv One Event OR $ Limit Of Insurance $ Deductible For All Perils For Each Customer's Auto $ Maximum Deductible For All Loss In Anv One Event CA 99 3710 13 © Insurance Services Office, Inc., 2011 Page 7 of 6 Wolters Kluwer Financial Services I Uniform FormsTm Specified 1$ Causes Of Loss $ Collision Location Number 00002 Coverages Comprehensive M Specked Causes Of Loss Page 2 of 6 $ 500,000 $ 500 Limit Of Insurance $ Deductible For Each Customer's Auto For Loss Caused By Theft Or Mischief Or Vandalism Maximum Deductible For Loss Caused By Theft Or Mischief Or Vandalism In Any One Event OR Limit Of Insurance Deductible For All Perils For Each Customer's Auto Maximum Deductible For All Loss In Any One Event Limit Of Insurance $ Deductible For Each Customer's Auto Address Where You Conduct Garasie Operations 20621 EARL ST TORRANCE CA 90503 Limit Of Insurance And Deductible $ 500,000 Limit Of Insurance $ $ 500 Deductible For Each Customer's Auto For Loss Caused By Theft Or , ! Mischief Or Vandalism 's 2,500 Maximum Deductible For Loss Caused By Theft Or Mischief Or Vandalism In Any One Event OR Is Limit Of Insurance $ Deductible For All Perils For Each Customer's Auto $ Maximum Deductible For All Loss In Any One Event $ Limit Of Insurance $ $ Deductible For Each Customer's Auto For Loss Caused By Theft Or Mischief Or Vandalism $ Maximum Deductible For Loss Caused By Theft Or Mischief Or Vandalism In Any One Event OR $ Limit Of Insurance $ Deductible For All Perils For Each 6 Customer's Auto $ Maximum Deductible For All Loss In Any One Event ©insurance Services Office, Inc., 2011 708 Premium 473 CA 99 37 10 13 r P Collision $ 500.000 Limit Of Insurance $ 708 $ 500 Deductible For Each Customer's Auto Location Number Address Where You Conduct Garage Operations 00003 225 N LA BREA INGLEWOOD CA 90301 Coveraaes Limit Of Insurance And Deductible Premium Comprehensive n Limit Of Insurance $ 473 $ 500 Deductible For Each Customer's Auto For Loss Caused By Theft Or Mischief Or Vandalism $ 2,500 Maximum Deductible For Loss Caused By Theft Or Mischief Or Vandalism In Anv One Event OR V$ Limit Of Insurance $ Deductible For All Perils For Each Customers Auto $ Maximum Deductible For All Loss In Any One Event Specified $ Limit Of Insurance $ Causes Of Loss $ Deductible For Each Customers Auto For Loss Caused By Theft Or Mischief Or Vandalism $ Maximum Deductible For Loss Caused By Theft Or Mischief Or Vandalism In Any One Event OR $ Limit Of Insurance $ Deductible For All Perils For Each Customer's Auto $ Maximum Deductible For All Loss In Any One Event 'Collision $ 500,000 Limit Of Insurance $ 708 $ 500 Deductible For Each Customers Auto Total Garagekeepers Prem l Premium For All Locations � $ 4,724 Information required to cornlalete this Schedule, if not shown above, will be shown in the Declarations. CA 99 37 10 13 0 Insurance Services Office, Inc., 2011 Page 3 of 6 P Direct Coverage Options Indicate below with an "X" which, if any, Direct Coverage Option is selected. 1:1 Excess Insurance If this, box Is checked, Garagekeepers Coverage remains applicable on a legal liability basis. However, coverage also applies without regard to your or any other "insured's" legal liability for "loss" to a "customer's auto" on an excess, basis over any other collectible insurance regardless of whether the other Insurance covers your or any other "insured's" Interest or the Interest of the "customer's auto's" owner. ❑ Primary Insurance If this box is checked, Geragekeepers Coverage is changed to apply without regard to your or any other "insureds" legal liability for "loss" to a "customer's auto" and is primary insurance. A. This endorsement provides only those coverages: 1. Where a Limit Of Insurance and a premium are shown for that coverage in the Schedule; and 2. For the location shown in the Schedule. B. Coverage I. We will pay all sums the "Insured" legally must pay as damages, for "loss" to a "customers auto" or "customer's auto" equipment left in the "insured's" care while the "Insured" Is attending, servicing, repairing, parking or storing it in your "garage operations" under: a. Comprehensive Coverage From any cause except: (1) The "customer's auto's" collision with another object; or (2) The "customer's auto's" overturn. b. Specified Causes Of Loss Coverage Caused by: (1) Fire, lightning or explosion; (2) Theft; or (3) Mischief or vandalism. C. Collision Coverage Caused by: (1) The "customer's auto's" collision with another object; or (2) The "customer's auto's" overturn. 2. We will have the right and du!y to defend any "insured" against a "sulf asking for these damages. However, we have ino du, to defend any "insured" apainst a: "suit seeking damages for "l'oss' to which this insurance does not apply. We may investigate and settle any claim or "Suit' as we consider appropriate. Our duty to defend or settle ends for a coverage when the Limit of Insurance for that coverage has been exhausted' by payment of judgments or settlements. 3. Who Is An Insured The following are "insureds" for "loss" to "Customer's autos" and "customer's auto" equipment: a. You. b. Your partners and theii spouses, if you area partnership, but only with respect to the conduct of your "garage operations". c. Your members, if you are a limited liability company,, but only with respect to the conduct of your "garage oper- ations". Your managers, are also "Insureds"', but only with respect to their duties as your managers, d. Your "executive officers" and directors, if you are an organization other than a partnership or limited liability company, but only with respect to their duties as your officers or directors. Your stock- holders are also "Insureds", but only with respect to their liability as stockholders. Page 4 of 6 0 Insurance Services Office, Inc., 2011 CA 99 37 10 13 F e. Your '"employees", other than either your "executive officers" elf you are an organization other than a partnership or limited liability company or your man- agers (if you area �imlted liability company), but only for acts within the scope of employment by you or while performing their duties related to the conduct of your "garage operations". 4. Coverage Extensions The following applies as Suppplementary Payments. We will pay for the ""Ensured"- a. All expenses we incur. b. The costs of bonds to release attach- ments in any "suit" against an "insured"" we defend, but only for bond amounts within our Limit of Insurance. c. All reasonable expenses incurred by the "insured" at our request„ Including actual loss of earnings up to $250 a day because of time off from work. d. All court costs taxed against the "Insured" in any "sult" against an "insured" we defend. however, these payments do not include attorneys' fees or attorneys' expenses taxed against the "insured". e. All interest on the full amount of any judgment that accrues after entry of the judgment in any "Suit" against an 'insured" we defend; but our duty to pay interest ends when we have paid, offered to pay, or deposited in court the part of the judgment that is within our Limit of Insurance. These payments will not reduce the Limit of Insurance. C. Exclusions 1. This insurance does not apply to any of the following: a. Contractual Liability resulting from any contract or agreement by which the "insured" accepts responsibility for "loss". But this exclusion does not apply to liability for "loss" that the "insured" would have in the absence of the contract or agreement. b. Theft "Loss" due to theft or conversion caused in any way by you, your "employees" or by your stockholders. c. Defective Parts Defective parts or materials. d. Faulty Work Faulty "work you performed". 2. We will not pay for "loss" to any of the following: a. Tape decks or other sound -reproducing equipment unless permanently installed in a "customer"s auto" b. Tapes, records or other sound - reproducing devices designed for use with sound -reproducing equipment. c. Sound -receiving equipment designed for use as a citizens band radio, two-way mobile radio or telephone or scanning monitor receiver, including its antennas and other accessories, unless permanently installed in the dash or console opening normally used by the "customer's auto" manufacturer for the installation of a radio. d. Any device designed or used to detect speed -measuring equipment, such as radar or laser detectors and any jamming apparatus intended to elude or disrupt speed -measuring equipment. 3. We will not pay for "loss" caused by or resulting from the following. Such "loss" is excluded regardless of any other cause or event that contributes concurrently or in any sequence to the "loss": a. War, including undeclared or civil war; b. Warlike action by a military force, in- cluding action in hindering or defending against an actual or expeted attack, by any government, sovereign or other authority using military personnel or other agents; or c. Insurrection, rebellion, revolution, usurped power or action taken by governmental authority in hindering or defending against any of these. D. Limits Of Insurance And Deductibles 1. Regardless of the number of "customer's autos", "Insureds", premiums paid„ claims made or "suits" brought, the most we will pay for each "loss" at each location is the Caragekeepers Coverage Limit Of Insurance shown in the Schedule for that location. Prior to the application of this limit, the damages for "loss" that would otherwise be payable will be reduced by the applicable deductibles for "loss" caused by: a. Collision; or CA 99 37 10 13 0 Insurance Services Office, Inc., 2011 Page 5 of 6 ea b. With respect to Garagekeepers Cover- age Comprehensive or Specified Causes Of 'Loss Coverage: (1) Theft or mischief or vandalism; or (2) All perils. 2. The maximum deductible stated in the Schedule for Garagekespers Coverage Comprehensive or Specified Causes Of Loss Coverage is the most that will be deducted for all "loss" In any one event caused by: a. Theft or mischief or vandalism; or b. All perils. 3. To settle a claim or "suit", we may pay all or any part of the deductible. If this happens you must reimburse us for the deductible or that part of the deductible that we paid. E. Additional Definitions As used in this endorsement: "Customer's auto" means a land motor vehicle, "trailer" or semitrailer lawfully within your possession for service, repair, storage or safekeeping, with or without the vehicle owner's knowledge or consent. A "customer's auto" also includes any such vehicle left in your care by your "employees" and members of their house- holds who pay for services performed. 2. "Loss" means direct and accidental loss or damage and includes any resulting loss of use. 3. "Garage operations" means the ownership, maintenance or use of locations for the purpose of a business of selling, servicin I repairing, parking or storing i "customer s autos" and that portion of the roads or other accesses that adjoin these locations. "Garage operations" also includes all operations necessary or incidental to the performance of garage operations. 4. "Work you performed" includes: a. Work that someone performed on your behalf; and b. The providing of or failure to provide warnings or instructions. Page 6 of 6 0 Insurance Services Office, Inc., 2011 CA 99 3710 13 SSUE DATE (MM/DD/YY) A4 3 03/29/19 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND Ranen Insurance Services, Inc CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE 22231 Mulholland Hwy. #209-A POLICIES BELOW, COMPANIES AFFORDING COVERAGE Calabasas CA 91302 (818) 222-9080 COMPANY A LETTER Insurance CompAny of the West COMPANY B IINSURED LETTER Van Lingen Body Shop, Inc. COMPANY c 2755 Lomita Blvd. LETTER COMPANY D rorrance CA 90503 LETTER (310) 370-4533 COMPANY E LETTER 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 I 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. Co TYPE OF INSURANCE POUCYNUMBER LTR POLICYEFFECTIVE POLICY EXPIRATION LIMITS DATE (MWDDIYY) DATE (MM/DD/YY) _GENERAL LIABILITY GENERAL AGGREGATE S COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/013 AGO. S CLAIMS MADE a OCCUR PERSONAL & ADV. INJURY S OWNERS& CONTRACTORS PROT. EACH OCCURRENCE S FIRE DAMAGE (Any one fire) S MED.EXPENSE(Anyonoperson) $ AUTOMOBILE LIABILITY COMBINED SINGLE ANYAUTO LIMIT ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY S NON -OWNED AUTOS (Per aceldeno GARAGE LIABILITY PROPERTY DAMAGE 5 EXCESS LIABILITY EACH OCCURRENCE S UMBRELLA FORM �AGGREGATE S OTHER THAN UMBRELLA FORM STATUTORY umrrs WORKER'S COMPENSATION WVE-5021332-07 04/01/19 04/01/20 EACH ACCIDENT $1,000,000 AND DISEASE -POLICY LIMIT S1,000,000 EMPLOYE RS' UABILITY DISEASE -EACH EmpLoyr:E S1,000,000 OTHER DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES/SPECIAL ITEMS row Truck Operation Raiver of Subrogation included City Of El Segundo Public works Dept. :350 Main St. El Segundo CA 90245 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 3 0 DAYS WRITTEN NOTICE TO T TIBC TE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH ICE MPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE MP5AN, GANTS OR REPRESENTATIVES, AUTHORIZED REPRESENTATIVE WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 06 34 (Ed: 8-00) WAIVER OF OUR RIGHT TO RECOVER 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 from us). The additional premium for this endorsement shall be otherwise due. Person or Organization ANY PERSON/ORGANIZATION WHEN REQUIRED BY WRITTEN CONTRACT 3 % of the total California Workers' Compensation premum Schedule Job Description 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 04/01/2019 Policy No. WVE 5021332 07 Insured VAN LINGEN BODY SHOP INC Insurance Company INSURANCE COMPANY OF THE WEST Countersigned By WC 99 06 34 (El- 8"00) 10 IN"Eo Endorsement No. Premium $ INCL.