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PROOF OF INSURANCE (2019 - 2020) CLOSEDaI DATE (MM/DDIYYYY) �='�'" ARV CERTIFICATE OF LIABILITY INSURANCE 06/25/2019 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 Alan Gharibian AVOCO INSURANCE NAEXt)®(800)_ ...4-39 PONE 3 95 FAY (888) 552-3562 655 N CENTRAL AVE FL 17 ADDRESS: avocoinsurance@hotmaii.com INSURER(S) AFFORDING COVERAGE NAIC # GLENDALE CA 91203 I INSURERA: NATIONAL FIRE & MARINE INS CO 20079 INSURED INSURER ,NSUR R B : FIVE STAR TRANSPORTATION, INC INSURER cIT 1800 Imperial HWY INSURE.R.D: DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Public Transportation. Certificate holder is named 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 EI Segundo ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main St_ , AUTHORIZEDPRESENTATIVE EI Segundo , CA 90245 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 26 (2016/03) The ACORD name and logo are registered marks of ACORD INSURER E : _... Las 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, .YNSR ...INSURANCE ADDS n ............................. ......,....Jid' d.._ ----- POLICY.....,..... Y EFF POLICY EXP ............. ............,,,,,,,,,,.,..... ........ ................................— LIMITS LTR TYPE OF UR POUCXNUMBER 17/YYYY1 /NYM/OD(IYYYI X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 —h/� 1 CLAIMS -MADE OCCUR Imi QIU YO' V l , IEa ire 9qL. $ .. 00 ..... ... ............. MED EXP (Ani one person) $ 5,000 A _ 73APS083033 10/30/2018 10/30/2019 PERSONAL &ADV INJURY $ 1.000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 P ❑ POLICY LOC JEST 2,000, - COMP/ OPAGG $ ..............................000 OTHER $ AUTOMOBILE E LIABILITY,a'cc(aYgnYh IT(PP .DUCTS COMBINED . NEDSING�LELIMIT ,000,000 ......................................... ANY AUTO BODILY INJURY (Per person) $ A OWNED SCHEDULED 73APS083033 BOP 10/30/2018 10/30/2019 D INJURY (Per accident) $ AUTOS ONLY HIRED NON -OWNED ................ ERTY OgwMAGE PF�eOr,,ccdeM2 AUTOS ONLY AUTOS ONLY ( w.....$.... UMBRELLA LIAR OCCUR EACH OCCURRENCE $ 4,000,000 A,,,,. X EXCESS LIAR V CLAIMS -MADE 73APS083033 10/30/2018 10/30/2019 AGGREGATE _ DED RETENTION $ $WORK ERS COMPENSATION PES � 0TH -' AND EMPLO YERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE —]NIA CH ACCIDENT,PLOY $ I'll OFFICERIMEM ER EXCLUDED (Mandatory in NH) E,L, pIDI EASE A, ,,,,E,, .........O, EE S If yes, describe under DESCRIPTION OF OPERATIONS below E L, DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Public Transportation. Certificate holder is named 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 EI Segundo ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main St_ , AUTHORIZEDPRESENTATIVE EI Segundo , CA 90245 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 26 (2016/03) 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 a.. � SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) City of El Segundo 350 Main St , , El 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- ganizations) 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 m ISO Properties, Inc., 2004 Page 1 of 1 0 A47 8 CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) ,, • ' I 6/12/2019 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(les) 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 TIB Transportation Ins Brokers PHON Or)hen Atardesyan FAX 425 West Broadway, Suite 400 IAJC,No. EMth 818-246-2800 IAIc,Nel:818-246-4690 Glendale CA 91204 ADDRESS: Datanesyan@tibinsurance.com INSURERS) AFFORDING COVERAGE NAIC # INSURER A: CA State Compensation Ins Fund 35076 INSURED FIVES13 INSURERS: Anderson II Jack B-TCP20874 DBA: Five Star Transportation INSURER C P.O. Box 470323 INSURER D: .................................................................................................................................................................................................................................................................................... Los Angeles CA 90047 INSURER E : I 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, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ......m....................�.....................................................................................................................................................'AdUL'9isCOR.,_...................................................................................................................._..,......,....m......................-.,....._,..................................................................................................... .......................................................................... INSR TYPE OF INSURANCE POLICY EFF POLbCY EXP LIMITS . L7R IN�n wVn POLICY NUMBER IMMIDDNYYYI dMM10DlYYYY1� COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR GE IN'L AGGREGATE LIMIT APPLIES PER: 1p PRO- LOC m...,.,..II POLICY F PRO OTHER: AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED „.,.......... AUTOS ........ AUTOS HIRED AUTOS NON-OWNED AUTOS UMBRELLA LIAR OCCUR EXCESS LIAB HCLAIMS-MADEj DED I I RETENTION $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y d N ANY PROPRIETOR/PARTNER/EXECUTIVE ��� OFFICER/MEMBER EXCLUDED? y I� N / A (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of EI Segundo ACCORDANCE WITH THE POLICY PROVISIONS. Recreation and Paris 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 EACH OCCURRENCE $ . PRAM E` Ixa orrA..,ce)..............$.................................................... ..M.E..EX,FC�A�.Y..one ..person) .............$....................................................................... PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS OP AGG $ $ SINGLECOMBINED BBcODILY t .$,,,,,,,,,,,,, INJJURY(Pe�rperso�n)..., BODILY INJURY (Per accident) $ 0��bptk4fY DAM 'At, E $ _.Lp r ar,� qo� EACH OCCURRENCE $ AGGREGATE $ 915351919 2/24/2019 2/24/2020 X PER OT H_ ....$T;AT.LTF - JR ........ ..,......... E, L, EACH ACCIDENT $ 1,00D,000 E L, DISEASE - EA EMPLOYEE $1,000,000 E L DISEASE - POLICY LIMIT $ 1,000„000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of EI Segundo ACCORDANCE WITH THE POLICY PROVISIONS. Recreation and Paris 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 0 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 AND EXPIRING FEBRUARY 24 2020 AT 12.01 A.M. TIME INDICATED AT r 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 AUTHORIZED REPRESENT IV[ PRESIDENT AND CEO SCIF FORM 10217 (REV.7-2014) 2570 OLD DP 217