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PROOF OF INSURANCE (2019) CLOSEDPage 1 of 1 DATE (MM/DDNYYY) �AoCC>R"CERTIFICATE OF LIABILITY INSURANCE I 05/30/2019 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(les) 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). CONTACT PRODUCER NAME. Willis of Greater Kansas, Inc. PHONE1-877-945-7378 mmmmmm FA)i 1-888-467- 23.78. c/o 26 Century Blvd _(A/C.No. Ext): ...................... ...m.m.m.................,,,I„jAdC Poll EMAIL...... P.O. Box 305191 ADDRESS° oertifacetasRwillis ...............................,..cm�.................... ., Nashville, TN 372305191 USA INSURR )AFPORDINGCO RAG.._E. ” ,"."..'....." .....................................ryNAIC# INSURERA: Safety National Casualty Corporation 15105 INSURED INSURER B: United site Services of California Inc. 118 Flanders Road INSURER C : II Westborough, MA 01581 INSURER SURER E : �...IN INSURER F: COVERAGES CERTIFICATE NUMBER: W11396702 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 'OLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE LIMITS N ......................... A�`i'tb�L''(I� POLICY NUMBER tMM DD EFF'.... POLICY EXP ... NSD NW /YVtlYI MMdDD�!'1 ., X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE PSJaEMISES(Eapgq� 9!�. .)...................�.............................0,000 X1 OCCUR PREMISES 1,000,000 .I A MED EXP (Any one person) $ 10, 000 .............:................ 00 Y GL40577B7 11/03/2018 11/03/2019 PERSONAL &ADV INJURY $ 1,000,000 G..... .,,......._.._ ....... AGGREGATE ....................$................... 2,000,000 ,,,_ N OTHER AGGREGATE❑PRO- APPLIES PER: PRODUCTSCOMP OPmAGG,,,, $2,000,000 GELIMIT NI AUTOMOBILE LIABILITY AvaCO BI ED�SINGL E.. LIM.11°.......n .$........ 3,000,000 X ANY AUTO BODILY INJURY (Per person) $ OWNED ASUTHOSULED CAS A AUTOS UTOS ONLY AU ONLY NOS ONL-OWNEIRED NODY 4047379 11/03/2018 11/03/2019PROTE AMAdFINJURY aocdent) ­­'­­$ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED � R................ ............... ETENTION $ $ WORKERS COMPENSAT10N YIN I ER OTH- OFYPROIRIETO REXCLUDEE X A HUTS ER 1,000..0 A ANYPROPRIETOR/PAAND ARTBNER/EXECUTIVE I ��,ACCIDENT $ 1,000,000 0 ,000 No N/A Y LDS4047370 11/03/2018 11/03/2019 p. 0 00 (Mandatory m NH) ❑ i E.L DISEASE - EA EMPLOYEE' $ If yes, describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) RE: Covered CA Operations Performed By Or On Behalf of the Named Insured..,1' The City of E1 Segundo, its officers, officials, employees, agents, and volunteers are ra d additional insured as respects general liability and this insurance is primary and noncontributory with any other insurance of the additional insured; and waiver of subrogation applies as respects workers compensation as required by written contract, per endorsements attached. CERTIFICATE HOLDER CITY OF EL SEGUNDO 350 MAIN ST EL SEGUNDO, CA 90245 ACORD 25 (2016/03) 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 ©1988-2016 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SR ID: 18030197 RATCH: 1219123 POLICY NUMBER: GL 4057787 COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 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 Name Of Additional Insured Person(s) Or Organizations) _ Location(s) Of Coveredw0 erations As required by written contract or All Locations of Insured's Operations agreement when such written contract or agreement is executed prior to an occurrence, offense or loss to which this endorsement applies, but only for the limits agreed to in such contract or the Limits of Liability provided by this policy, whichever is less. Any individually scheduled additional insureds shall not be construed to override nor negate this blanket additional insured. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section If — 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: 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. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: 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. CG 20 10 0413 © Insurance Services Office, Inc., 2012 Page 1 of 2 C. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by 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 Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. Page 2 of 2 © Insurance Services Office, Inc., 2012 CG 20 10 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED BY CONTRACT OR AGREEMENT This endorsement modifies insurance provided under the following Coverage Form: COMMERCIAL GENERAL LIABILITY PRODUCTS/COMPLETED OPERATIONS LIABILITY LIQUOR LIABILITY POLLUTION LIABILITY This endorsement changes the policy effective on the inception date of the policy unless another endorsement effective date is indicated below. SCHEDULE Name of Additional Insured Person(s) or Organization (s): As required by written contract or agreement when such agreement is executed prior to an occurrence, offense endorsement applies, but only for the limits agreed to Limits of Liability provided by this policy, whichever is scheduled additional insureds shall not be construed to blanket additional insured. Designated Project, Location, or Work of Covered Operations: As per written contract or agreement with the above organization(s). CHANGES SECTION II - WHO IS AN INSURED is amended to include: N. • written contract or loss to which this such contract or the less. Any individually override nor negate this described person(s) or 4. The person(s) or organization(s) shown in the Schedule above with whom you have agreed in a written contract to provide insurance such as is afforded under this Coverage Form, is included as an Additional Insured subject to the below: a. Insurance for such Additional Insured(s) scheduled above shall be afforded only to the extent that such Additional Insured is liable for "bodily injury", "property damage" or "personal and advertising injury" caused by your acts or omissions while actively engaged in the performance of your ongoing operations involving the project(s), locations(s), or work designated in the Schedule and as specified in the contract between you and the above scheduled Additional Insured(s). b. The insurance afforded under this Coverage Form to such Additional Insured(s) applies only: (1) If the 'occurrence" or offense takes place subsequent to the execution and effective date of such written contract: and, (2) While such written contract is in force, or until the end of the policy period, which ever occurs first. c. How Limits Apply to Additional Insured(s) The most we will pay on behalf of the Additional Insured(s) scheduled above is the lesser of: (1) The limits of insurance specified in the written contract or written agreement; or, (2) The Limits of Insurance provided by the Coverage Form. SNGL 023 1209 Safety National Casualty Corporation Page 1 of 2 The amount we will pay on behalf of such Additional Insured(s) shall be a part of, and not in addition to, the Limits of Insurance shown in the Coverage Form Declarations and described in this section. Such amount will thus not increase the Limits of Insurance shown for the Coverage Form. d. Obligations at the Additional Insured's Own Cost No Additional Insured will, except at their own cost, voluntarily make a payment, assume any obligation, or incur any expense, other than for first aid, without our consent. SECTION IV — CONDITIONS is amended by deleting item a. Primary Insurance under 4. Other Insurance and replacing such item by the following, only with respect to insurance provided to the Additional Insured(s) shown in the above Schedule: a. Primary Insurance and/or Primary and Non -Contributory Insurance This insurance is primary if you have agreed in a written contract that this insurance is to be primary. If you have agreed in a written contract that this insurance is primary and non-contributory with the Additional Insured(s) own insurance, this insurance is primary and we will not seek contribution from that other insurance. The Additional Insured(s) scheduled above shall be subject to all other conditions set forth in the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. 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 11/03/2018 Policy No. GL 4057787 Endorsement No. Named Insured UNITED SITE SERVICES, INC. Premium $ Included Insurance Company Safety National Casualty Corporation Countersigned By Page 2 of 2 Safety National Casualty Corporation SNGL 023 1209 POLICY NUMBER: GL 4057787 COMMERCIAL GENERAL LIABILITY CG 20 37 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) As required by written contract or agreement when such written contract or agreement is executed prior to an occurrence, offense or loss to which this endorsement applies, but only for the limits agreed to in such contract or the Limits of Liability provided by this policy, whichever is less. Any individually scheduled additional insureds shall not be construed to override nor negate this blanket additional insured. Location And Description Of Completed Operations All Locations of Insured's Operations 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" 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". However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by 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 Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 37 04 13 ©insurance Services Office, Inc., 2012 Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. SPECIAL NOTICE: OF: CANCELLATION SERVICE PROVIDED TO IDENTIFIED THIRD PARTIES This endorsement modifies insurance provided under the following: COMMERCIAL AUTOMOBILE COVERAGE PART CHANGE The following new provision is added to A. Cancellation of the COMMON POLICY CONDITIONS or such other applicable state cancellation endorsement: As a special service to you, if we cancel this policy for any reason other than non-payment of premium, within thirty (30) days priorto the effective date of cancellation, we will mail a copy of such written notice of cancellation to all third persons whose name and address have, during the applicable policy period, been placed on file with us through your broker of record due to third party contractual requirements relating to such notice. As a special service to you, if we cancel this policy for non-payment of premium, within ten (10) days prior to the effective date of cancellation, we will mail a copy of such written notice of cancellation to all third persons whose name and address have, during the applicable policy period, been placed on file with us through your broker of record due to third party contractual requirements relating to such notice. If we have been provided with an electronic address of such third parties, at our election we may send notice of cancellation to such third parties by electronic mail. Notice of cancellation of coverage provided to a certificate holder is a courtesy only. Failure to provide such notice will not extend the policy cancellation date, negate the cancellation of the policy, nor confer any rights nor expectations upon the certificate holder nor subject us, our agents nor representatives to liability for failure to provide notice. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherw isestated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 11/03/2018 Policy No. CAS4047379 Named Insured UNITED SITE SERVICES, INC. Insurance Company Safety National Casualty Corporation Countersigned By Endorsement No. Premium $ Included SNCA 03910 13 Safety National Casualty Corporation Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. SPECIAL NOTICE OF CANCELLATION SERVICE PROVIDED TO IDENTIFIED THIRD PARTIES This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART CHANGE The following new provision is added to A. Cancellation of the COMMON POLICY CONDITIONS or such other applicable state cancellation endorsement: As a special service to you, if we cancel this policy for any reason other than non-payment of premium, within thirty (30) days prior to the effective date of cancellation, we will mail a copy of such written notice of cancellation to all third persons whose name and address have, during the applicable policy period, been placed on file with us through your broker of record due to third party contractual requirements relating to such notice. As a special service to you, if we cancel this policy for non-payment of premium, within ten (10) days prior to the effective date of cancellation, we will mail a copy of such written notice of cancellation to all third persons whose name and address have, during the applicable policy period, been placed on file with us through your broker of record due to third party contractual requirements relating to such notice. If we have been provided with an electronic address of such third parties, at our election we may send notice of cancellation to such third parties by electronic mail. Notice of cancellation of coverage provided to a certificate holder is a courtesy only. Failure to provide such notice will not extend the policy cancellation date, negate the cancellation of the policy, nor confer any rights nor expectations upon the certificate holder nor subject us, our agents nor representatives to liability for failure to provide notice. 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 11/03/2018 Policy No. GL 4057787 Endorsement No. Named Insured UNITED SITE SERVICES, INC. Premium $ Included Insurance Company Safety National Casualty Corporation Countersigned By (Countersignature by the Broker or Agent shall only occur in the mailing states that require countersignature) SNGL 047 0614 Safety National Casualty Corporation Page 1 of 1 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 99 35 SPECIAL NOTICE OF CANCELLATION SERVICE PROVIDED TO IDENTIFIED THIRD PARTIES ENDORSEMENT As a special service to you, if we cancel this policy for any reason other than non-payment of premium, within thirty (30) days prior to the effective date of cancellation, we will mail a copy of such written notice of cancellation to all third persons whose name and address have, during the applicable policy period, been placed on file with us through your broker of record due to third party contractual requirements relating to such notice. As a special service to you, if we cancel this policy for non-payment of premium, within ten (10) days prior to the effective date of cancellation, we will mail a copy of such written notice of cancellation to all third persons whose name and address have, during the applicable policy period, been placed on file with us through your broker of record due to third party contractual requirements relating to such notice. If we have been provided with an electronic address of such third parties, at our election we may send notice of cancellation to such third parties by electronic mail. Notice of cancellation of coverage provided to a certificate holder is a courtesy only. Failure to provide such notice will not extend the policy cancellation date, negate the cancellation of the policy, nor confer any rights nor expectations upon the certificate holder nor subject us, our agents nor representatives to liability for failure to provide notice. 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 11/03/2018 Policy No. LDS4047370 Endorsement No. Insured UNITED SITE SERVICES, INC. Premium $ Included Insurance Company Safety National Casualty Corporation Countersigned By WC 99 99 35 (07 12)