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PROOF OF INSURANCE (2019 - 2020) CLOSEDADATE(MMIDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 5/29/2019 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 s ich endorsement(s). PRODUCER CONTACT Arthur J. Gallagher & Co. Insurance Brokers of CA. PHONE n ax License No. 0726293 AIP'N , Exj) 805-520-4997 r N.I: 805-426-8802 AME; roc enn L T 2775 Tapo Street, Suite 101 4gg9r §! ....... Y_ ern .):).� �.,Ixa ......-.................................................. Simi Valley CA 93063 INSURER(S) AFFORDING COVERAGE NAIC# INSURER Crum & Forster Specialty Insurance Co 44520 .... .. ....— INSURED ADVAACC-01 INSURER B; Nationwide Mutual Insurance Company (USE 23787 Advanced Access Controls, Inc. INSURER 9-: TPPR Insurance Company.18031 5414 Cabritto Rd Ste A INSURER.D..........PP..............."-...................... ..................................... ...... _ ............. Van Nuys C 9 06 INSURER Company E: Sentinel Insurance Company � m,.. 11000,,, INSURER F: COVERAGES CERTIFICATE NUMBER: 1111782927 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 3ERTAIN, 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. ILTR TYPE OF INSURANCE INSDwVD POLICY NUMBER IPOLICY EFF POLICY EXP MM/Dp/YYYY1 IMM/pp/YYYYI LIMITS � A X COMMERCIAL GENERAL LIABILITY GL0581789 1/17/2019 1/17/2020 EACH OCCURRENCE $1,000,000 CLAIMS -MADE p OCCUR S)Atw%lkd E'"iU I r t3 X 14715 Ea occurre $ 50,000 ... ... ..........r PRE .. _.. S..IG ........IT........:.:i.).. .. 5, 000 MED EX (Any ..............$.........,... PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $2,000,000 XPRO- POLICY F tlECT LOC PRODUCTS -COMP/OP AGG $ 2,0001,00011111111111111-1.1 —II OTHER, B AUTOMOBILE LIABILITY ACP7884593214 ANY AUTO $1,000,000 OWNED X " SCHEDULED INJURY person ) AUTOS ONLY _ AUTOS HIREDX NON -OWNED X„ $ AUTOS ONLY AUTOS ONLY PROPERTYDAMAGE PE..mm.N..AGE p C UMBRELLALIAB X �i OCCUR XL0020149301 X EXCESS LIAB CLAIMS -MADE DED ( RETENTION$ D WORKERS COMPENSATION WVE504721400 AND EMPLOYERS' LIABILITY Y I N . ...0. ANYPROPRI ETOR/PARTNER/EXECUTI VE OFFICER/MEMBER EXCLUDED? L9 NIA AGGREGATE (Mandatory in NH) If yes, describe under $ DESCRIPTION OF OPERATIONS below PER ORH- X STATUTE LLAER E BUS PERSONAL PROPERTY 72SBAAK3924 A PROFESSIONAL LIABILITY GL0581789 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CITY OF EL SEGUNDO, ITS OFFICIALS & EMPLOYEES ARE LISTED AS ADDITIONAL INSURED" CERTIFICATEHOLDER City of EI Segundo 350 Main Street EI Segundo CA 90245 Eammanam 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 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD $ 8/26/2018 8/26/2019 COMBINED SINGLE LIMIT Via, aoc�dacat) ... $1,000,000 INJURY person ) $ ..BODILY.. ..(Per ............................ .... BODILY INJURY (Per accident) $ PROPERTYDAMAGE PE..mm.N..AGE p ....................... 1/17/2019 1/17/2020 OCCURRENCE . ...0. AGGREGATE $55.000,000 000, 000 $ 4/1/2019 4/1/2020 PER ORH- X STATUTE LLAER EACH ACCIDENT $1,000,000 L DISEASE -EA EMPLOYEE': $1,000,000 E,LDISEASE- POLICY LIMIT $1,000,000 1/17/2019 1/17/2020 LIMIT: $260,400 1/17/2019 1/17/2020 LIMIT: $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CITY OF EL SEGUNDO, ITS OFFICIALS & EMPLOYEES ARE LISTED AS ADDITIONAL INSURED" CERTIFICATEHOLDER City of EI Segundo 350 Main Street EI Segundo CA 90245 Eammanam 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 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Policy Number: GLO-581789 COMMERCIAL GENERAL LIABILITY CG 20 33 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSPIRED - OWNERS, LESSEES OR CONTRACTORS -AUT'OMAT'IC STATUS WHEN REQUIRED IN CONSTRUCTION AGREEMENT NT" WITH YOU This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section II — Who Is An Insured is amended to include as an additional insured any person or organization for whom you are performing operations when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy. Such person or organization is an additional insured 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. A person's or organization's status as an additional insured under this endorsement ends when your operations for that additional insured are completed. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to: 1. "Bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of, or the failure to render, any professional architectural, engineering or surveying services, including: a. The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or b. Supervisory, inspection, architectural or engineering activities. 2. "Bodily injury" or "property damage" occurring after: a. 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 b. 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 33 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 0 POLICY NUMBER: GLo-561789 COMMERCIAL GENERAL LIABILITY CG 20 37 07 04 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 SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Location And Description Of Completed Operations Any person or organization you have agreed in a written Premises covered under this policy when required by contract to add as an additional insured on your policy written contract executed prior to the "bodily injury", provided the written contract is executed prior to the"property damage" or "personal and advertising injury 'bodily injury", "property damage" or "personal and advertising injury". 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 designated and described in the schedule of this endorsement performed for that additional insured and included in the "products - completed operations hazard". CG 20 37 07 04 - 001 C ISO Properties, Inc., 2004 Page 1 of 1 0 POLICY NUMBER: GLo-581789 COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVER" AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: A person or organization you have agreed in a written contract to waive any right of recovery against provided the written contract is executed prior to the injury or damage. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV —Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products - completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 05 09 0 © Insurance Services Office, Inc., 2008 Page 1 of 1 0 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance Condition and supersedes any provision to the contrary: Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under this policy provided that: (1) The additional insured is a Named Insured under such other insurance; and (2) You have agreed in writing in a contract or agreement prior to the injury or damage that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. However, the insurance provided under this endorsement will not apply beyond the extent required by such contract or agreement ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED. This endorsement forms a part of the Policy to which attached, effective on the inception date of the Policy unless otherwise stated herein. (The following information is required only when this endorsement is issued subsequent to preparation of the Policy.) Endorsement effective Policy No.GLO-581789 Endorsement No. Named Insured Countersigned by CFSI C -G L-1002(10/2015) Policy # ACP 7884593214 COMMERCIAL AUTO AC 04 44B 03 16 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. -0 61 11 =1:191A This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. The Transfer Of Rights Of Recovery Against Others To Us Condition does not apply to any person(s) or organization(s) to the extent that subrogation is waived prior to any "accident" or "loss" under a written contract with that person or organization. AC 04 4413 03 16 Includes copyrighted material of Insurance Services Office, Inc. Page 1 of 1 with its permission. 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 / ORG WHEN REQUIRED BY WRITTEN CONTRACT 3 % of the total California Workers' Compensation premium Schedule Job Description ALL CA 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 5047214 00 Endorsement No. Insured ADVANCED ACCESS CONTROLS INC Premium $ INCL. Insurance Company INSURANCE COMPANY OF THE WEST Countersigned By WC 99 06 34 (Ed. &00) INSURED