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PROOF OF INSURANCE (2020 - 2020) CLOSEDy.�-. 0 p DATE (MMIDD/YYYY) +" CERTIFICATE OF LIABILITY INSURANCE �-- ul 06/13/2019 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 CONTACT AIan h...2....is NAME: AVOCOINSURANCE PHONE FAX _1 , -910.O)84-399.5........... (888) 552-3562................ ance hotma'I,00m 655 N CENTRAL AVE FL 17 �"aD��ss: avocoins„u.r.............( ............"............. .. ..... IN,SURE„R,IS,l,AFFORDING COVERAGE NAIC #,,,,,,,,,,,,mmmm_ GLENDALE CA 91203 INSURER A: NATIONAL FIRE & MARINE INS CO 20079 ............................................. INSURED INSURER B: FIVE STAR TRANSPORTATION, INC INSURER C 1800 Imperial HWY #j! URERD: INSURER E Los Angeles CA 90057 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. ILTR TYPE OF INSURANCE ADD� � POLICY NUMBER ................. ......._�� PdiOCY EFF POLICY 'EXP Y _ �MMID0ryYYY'1 IMMJ0DIYYYY1 LIMITS ._ X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 .....0..^......,...,,, -- 10 0 0 CLAIMS -MADE .V OCCURAil$LacS Winced ................. MED EXP (Any one person) $ 5,000 A 73APS083033 10/30/2019 10/30/2020 Y ..........$.......2:.....0,0 0 GEN' L AGGREGATE LIMIT APPLIES PER: ^^^^^^ GENERAL AGGREGATE ,000 X POLICY � ❑LOC JECT 000,000 PRODUCTS $.......20 PRODU OTHER, $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT-'. ^ $ 1,0,00,000 2EJar4dvp.4) ANY AUTO BODILY INJURY (Per person) $ A OWNED SCHEDULED 73APS083033 10/30/2019 10/30/2020 BODILY INJURY (Per accident) $R AUTOS ONLY HIRED X AUTOS OPER'rY' D A,MA P,GE $ AUTOS ONLY AUTOS ONLY mm LAABp OCCUR EA H OCCURRENCE $ 4,000,0..00 ........................ A ExESSB�CLAIMS-MADE 73APS083033 10/30/2019 10/30/2020 ,A, GR GATE $ k DED R RETENTION $ �. 'WORKERS COMPENSATION $TATuT II ETH AND EMPLOYERS' LIABILITY Y / N __ ............-mm ........................ „ ANY PROPRIETOR/PARTNER/EXECUTIVE E L, EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? NIA ...E .............."'.,.".".". (Mandatory in NH) L. DISEASE - EA EMPLOYEE' $ If yes, describe under 1 DESCRIPTION OF OPERATIONS below E.L DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Public Transportation. Certificate holder is named as additional insired. CERTIFICATE HOLDER City of EI Segundo 350 Main St, , EI Segundo , ACORD 25 (2016/03) r r 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 CA 90245 ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: 73APS083033 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 t., SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) City of El Segundo 350 Main St , , E1 Segundo , CA 90245 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 in- clude as an additional insured the person(s) or or- ganization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property dam- age" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions 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 0 ISO Properties, Inc., 2004 Page 1 of 1 13 ACCORL> CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) ^" 1 6/12/2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON' 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 TIB Transportation Ins Brokers 425 West Broadway, Suite 400 Glendale CA 91204 INSURED FIVES3 13 Anderson i) Jack B - TCP20874 DBA: Five Star Transportation P.O. Box 470323 Los Angeles CA 90047 818µ245,28O0 CONTACT Nb#M��hCn AtaneS'�an PHONE FA7I EDDRss �OaG;aree3 ars itbin$urs µal 818-246-4690 — MAIL ��jkc ' _ nce,con1 .., INSURIaR SS1 AFFORDING COVERAGE NAIC q _....._...... _. rt?'sCrafB_a : CA Sate CgTpensatlon Ins Fund 35075 INSURER8: _INSURER D: INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: 209518750 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, ANDLIMITS SHOWN CONDITIONS OF SUCH POLICIES HAVE BEEN REDUCED BY PAID D IMS. SR Y E..._ NUMBER MD -..^— ........ LTIEXCLUSIONSAN OF INSURANCE .. ...�..rALwS�UIs MIDDrYYYYI CN9M/D dYYYY1 LIMITS I COMMERCIAL GENERAL LIABILITY I I' ........................ ...__ CLAIMS � EACH OCCURRENCE NCE LAftak'"I(..T'G $ __ ,._....,.�.—. -MADE OCCUR I .............. �. ,MED EXP (Any one Rper'?�1_......S....� ..son _.-_—.—.,_,,,. ADV INJURY 5 GEN' IT APPLIES PER: � ATELIM ELATE $ ..............._......— _PEPRODU..LAGG.RM ..........—.._.. .�.�.�............ RO POLICY �G ml JET LOC TS ti..,...mm, CO P/t3P AGS OTHER m$ $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ _ ss,�c,�a,ents _ ANY AUTO �. BODILYINJURY (Par person) $ ALL II _..- AUTOS AUTOS AUTOS AUTOS BODILY INJURY (Par accident) $ I HIR NON -OWNED AUTOS - - — UMBRELLA LIAB I !OCCUR EACH OE REN $ EXCESS LIAB 1 , CLAIMS=MADE __ AGGREGATE �.,.= . ....._........_ OED,...I RETENTION 5, $ S A WORKERS COMPENSATION 915351919 AORKERSCOMPEMPLOYERSCOMPENSATION2/24/2019 2124/2020 X hER CuTbi TA7U ERE...`. YIN ANY P'ER/MEMSERFEXCLUD�L'E+BCLI F'aVE �I m� Od'd'VCERJMEMBLREXCLUDED? Y NIA ....L.. ...L..._.....^.. ..... ........ EL. . (Mandato m NH rY ) tlI as„ describe under O c€ON rvE L DYSEASECuC�E EALiY,,,,,, .....0. P ...YEE $ 1,000,00II.... _.000 .............. ....... EC LI SCRe Cad OPERATI h3S ba v O for E. i.... DSEASE - AO IT LIMIT $1 000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) CERTIFICATE HOLDER CANCELLATION r�- SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of E1 Segundo ACCORDANCE WITH THE POLICY PROVISIONS. Recreation and Park Department 401 Sheldon St AUTHORIZED REPRESENTATIVE EI Segundo CA 90245 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD ENDORSEMENT AGREEMENT BROKER COPY WAIVER OF SUBROGATION 9153519-19 RENEWAL SP HOME OFFICE SAN FRANCISCO PAGE 1 OF 1 ALL EFFECTIVE DATES ARE AT 12:01 AM PACIFIC EFFECTIVE JUNE 15, 2019 AT 12.01 A.M. STANDARD TIME OR THE TIME INDICATED AT AND EXPIRING FEBRUARY 24, 2020 AT 12.01 A.M. PACIFIC STANDARD TIME FIVE STAR TRANSPORTATION PO BOX 470323 LOS ANGELES, CA 90047 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, FIVE STAR TRANSPORTATION 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 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: JUNE 18, 2019 AUTHORYZED REPRESENT IVE PRESIDENT AND CEO SCIF FORM 10217 (REV.7-2014) 2570 OLD DP 217