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PROOF OF INSURANCE (2020 - 2020) CLOSEDARCPLUM-01 PPEREZ a ww CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) pI 9/26/2019 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 License # OC368911 CONTACT pati Perez NAME: Lyddy Martin Company 20300 Ventura Blvd. Suite 340 PHONE AIC: Na, Ext): (310) 548-1959 (A/C, No):(310) 548-1346 n Woodland Hills, CA 91364 ApAaY'Ess: Pati@lyddymartin.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Nationwide Mutual_InSu_rance_ Company----- - 23767 INSURED INSURERS: AMCO Insurance Company_ _ 19100 Ruben Chavarin, DBA, ARC Plumbing INSURER C: Hartford Underwriters Insurance_ Company _ 3010.4_ 3124 Rosecrans Avenue, Suite B INSURER D: Hawthorne, CA 90250 INSURER E INSURER F: COVERAGES_ ....................._. CERTIFICATE NUMBER:' 5 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 INSR ADDL SUSIR POLICY EFF POLICY EXP AJBTYPE OF INSURANCE IINRD rpyVO POLICY NUMBER IMM1DD/YYYYY IN.MI, YI LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,00'0,000 CLAIMS -MADE X OCCUR ACPGL03028333597 7/18/2019 7/18/2020 DAMAGE TO RENTED 100,000 X X _PREMISES (Ea ocrurrenoe)_- $_ MED EXP (Any one_pefsonl $ 5,000, PERSONAL & ADV INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 2,000'000 POLICY % T LOC PRODUCTS - COMP/OP AGG $ 2,000,000 JE DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Sa'hsdule, may be attached If more space is required) The City of EI Segundo, its officials„ officers, agents and employees are named as additional insureds as may be required by written contract as pertains to general liability and workers compensation per the attached autotomatic endorsements CG 73 23 12 16 and WC 04 03 06 endorsement. RE: Engineering Plan Check Svcs, City of EI Segundo CERTIFICATE MOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE The Cit of EI Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Y 9 ACCORDANCE WITH THE POLICY PROVISIONS. Public Words Dept. 350 Main Street, EI Segundo, CA 90245 `AUTHORIZED REPRESENTATIVE r- 4 P --Z ............. ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD N G H 1, IR:... ... _ A __ COMBINED SINGLE LIMIT 1,000,000 AUTOMOBILE LIABILITY {Ea acchdanlJ $ I ANY AUTO ACPBA3028333597 7/18/2019 7/18/2020 BODILY INJURY (Per person)__$__ SCHEDULED?" "X AUTOS ONLY UTLOS BODILY INJURY n mh il,l X HIE) �"��y A, NON•Ya��'V�+�Y D &D PPRO.PP �Rd nl AMAGE q, AU(EC7S ONLY AUTOS S B X UMBRELLA LIAB OCCUR _._Wvv...........v EACH OCCURRENCE $ 1,000,000 EXCESS LIAB CLAIMS -MADE ACPCAA3028333597 7/18/2019 7/18/2020 AGGREGATE $ 1,000,00o DED RETENTION $ S C WORKERS COMPENSATION X PER OTrB STATUTE ER AND EMPLOYERS' LIABILITY Y / N X 72WECZ19068 4/1/2019 4/1/2020 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE Y N / A EL EACH ACCIDENT $ (PFICER/MEMBER EXCLUDED? 1,000,000 Mandatory in NH) EL DISEASE - EA EMPLOYEE $ If yes, describe under 1,000,000 DESCMPTION OF OPERATIONS below EL DISEASE' • POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Sa'hsdule, may be attached If more space is required) The City of EI Segundo, its officials„ officers, agents and employees are named as additional insureds as may be required by written contract as pertains to general liability and workers compensation per the attached autotomatic endorsements CG 73 23 12 16 and WC 04 03 06 endorsement. RE: Engineering Plan Check Svcs, City of EI Segundo CERTIFICATE MOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE The Cit of EI Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Y 9 ACCORDANCE WITH THE POLICY PROVISIONS. Public Words Dept. 350 Main Street, EI Segundo, CA 90245 `AUTHORIZED REPRESENTATIVE r- 4 P --Z ............. ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABILITY CG 73 23 12 16 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTRACTORS ENHANCEMENT PLUS ENDORSEMENT INCLUDING MEDICAL PAYMENTS This endorsement modifies insurance provided under the following, COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Lost Key Coverage D. Expanded Property Damage Coverage 1. Under Section I — Coverages, Coverage A 1. For the purposes of this endorsement only: Bodily Injury And Property Damage Section I — Coverages, Coverage A Liability, coverage is extended to include Bodily Injury And Property Damage the following: Liability, 2. Exclusions, Exclusion j. If a customer's master or grand key, Damage To Property is amended as follows: excluding electronic key card, is lost, a. Paragraphs (3), (5), and (6) are deleted damaged or stolen while in your care, in their entirety. custody or control we will pay the cost of b. Paragraph (4) is deleted in its entirety replacing the keys, including the master lock and replaced with: and all keys used in the same lock, the cost (4) Personal property in the care, of adjusting locks to accept the new keys, or custody, or control of the insured: the cost to replace the locks, whichever is less. (a) for storage or sale at premises 2. Limit of Insurance — For the purpose of this you own, rent or occupy; or coverage the most we will pay is $ 10,000 (b) while being transported by any per "occurrence". aircraft, "auto" or watercraft B. Voluntary Property Damage owned or operated by or rented to or loaned to any insured. 1. Section I — Coverages, Coverage A Bodily c. The coverage provided by this Injury And Property Damage Liability, endorsement does not apply to coverage is extended to include the following: property damage": At your request, we will pay for "property (1) Arising out of the disappearance or damage" to property of others caused by you loss of use of personal property; or and while in your possession, arising out of your business operations and occurring during the (2) Included in the "products -completed policy period. operations hazard". 2. Limit of Insurance — For the purpose of this 2. Limit of Insurance - The most we will pay coverage the most we will pay is $1,500 per for loss arising out of any one "occurrence" "occurrence". is $5,000. C. Non -Owned Watercraft 3. Deductible - Our obligation to pay for a Under Section I — Coverages, Coverage A covered loss applies only to the amount of Bodily Injury And Property Damage Liability, loss in excess of $250. 2. Exclusions, Exclusion g. Aircraft, Auto Or We will pay the deductible amount to effect Watercraft Paragraph (2) (a) is replaced with: settlement of any claim or "suit" and, upon (a) Less than 51 feet long; and notification of this action having been taken, you shall promptly reimburse us for the deductible as has been paid by us. CG 73 23 1216 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 5 with its permission. CG 73 23 12 16 This insurance is primary to any expanded property damage coverage provided by a separate endorsement attached to this policy, and it will supplant any deductible in said endorsement E. Damage To Premises Rented To You 1. Under Section I — Coverages, Coverage A Bodily Injury And Property Damage Liability, the last paragraph of 2. Exclusions is replaced with: If Damage To Premises Rented To You is not otherwise excluded, Exclusions c. through n. do not apply to damage by fire, lightning, explosion, smoke, or sprinkler leakage to premises while rented to you or temporarily occupied by you with permission of the owner. 2. Under Section III — Limits Of Insurance, Paragraph 6 is replaced with: 6. Subject to 5. above, the Damage To Premises Rented To You Limit is the most we will pay under Coverage A for damages because of "property damage" to any one premises, while rented to you, or in the case of damage by fire, lightning, explosion, smoke or sprinkler leakage, while rented to you or temporarily occupied by you with permission of the owner. The limit is increased to $1,000,000. 3. Under Section IV — Commercial General Liability Conditions, 4. Other Insurance, b. Excess Insurance (1) (a) (ii) is replaced with: (ii) That is Fire, Lightning, Explosion, Smoke or Sprinkler leakage insurance for premises rented to you or temporarily occupied by you with permission of the owner. F. Supplementary Payments Under Section I — Coverages, Supplementary Payments — Coverages A and B Paragraphs 1.b and 1.d. are replaced with: b. Up to $2,500 for cost of bail bonds required because of accidents or traffic law violations arising out of the use of any vehicle to which the Bodily Injury Liability Coverage applies. We do not have to furnish these bonds. d. All reasonable expenses incurred by the insured at our request to assist us in the investigation or defense of the claim or "suit", including actual loss of earnings up to $500 a day because of time off from work. G. Newly Formed And Acquired Organizations Under SECTION II — WHO IS AN INSURED Paragraph 3.a. is replaced with: a. Coverage under this provision is afforded only until the 180th day after you acquire or form the organization or the end of the policy period, whichever is earlier; H. Additional Insured — Automatic Status When Required In An Agreement Or Contract With You Section II — Who Is An Insured is amended to include: 1. Any person(s) or organization(s) described in Paragraph a. — d. below with whom you have agreed in writing in a contract or written agreement that such person or organization be added as an additional insured on your policy during the policy period shown in the Declarations. 2. Any other person or organization you are required to add as an additional insured under the contract or agreement described in Paragraph 1. above. The person or organization added as an insured by this endorsement is an insured only for liability due to: a. Lessors of Leased Equipment — with respect to their liability for "bodily injury", "property damage", or "personal and advertising injury", caused in whole or in part by your maintenance, operation, or use of equipment leased to you by such person(s) or organization(s). This insurance does not apply to any "occurrence" which takes place after the equipment lease expires. However, their status as additional insured under this policy ends when their lease, contract, or agreement with you for such leased equipment expires. b. Managers or Lessors of Premises — with respect to liability arising out of the ownership, maintenance, or use of that part of the premises you own, rent, lease, or occupy. Page 2 of 5 Includes copyrighted material of Insurance Services Office, Inc., CG 73 23 12 16 with its permission. N d CG 73 23 12 16 This insurance does not apply to: (1) Your acts or omissions; or (1) Any "occurrence" which takes place (2) The acts or omissions of those after you cease to be a tenant in acting on your behalf; in the that premises. performance of your ongoing (2) Structural alterations, new con- operations performed for that struction, or demolition operations additional insured, whether the work performed by or on behalf of the is performed by you or on your person or organization. behalf. However, their status as additional The insurance does not apply to: insured under this policy ends when you (1) "Bodily injury", "property damage", cease to be a tenant of such premises. or "personal and advertising injury" State or Political Subdivision — arising out of the rendering of or the Permits Relating to Premises — with failure to render any professional respect to the following hazards for architectural, engineering, or survey which the state or political subdivision services, including: has issued a permit or authorization in (a) The preparing, approving, or connection with premises you own, rent, failing to prepare or approve or control and to which this insurance maps, shop drawings, opinions, applies. reports, survey, field orders, (1) The existence, maintenance, repair, change orders, or drawings and construction, erection, or removal of specifications; or advertising signs, awnings, (b) Supervisory, inspection, archi- canopies, cellar entrances, coal tectural or engineering activities. holes, driveways, manholes, This exclusion applies even if marquees, hoist away openings, the claims against any insured sidewalk vaults, street banners, or allege negligence or other decorations and similar exposures; wrongdoing in the supervision, or hiring, employment, training or (2) The construction, erection, or monitoring of others by that removal of elevators; or insured, if the "occurrence" (3) The ownership maintenance or use which caused the "bodily injury" "property of any elevators covered by this or damage", or the offense which caused the insurance. "personal and advertising This insurance does not apply to: injury", involved the rendering (1) "Bodily injury" or "property damage" of, or failure to render, any or "personal or advertising injury" professional, architectural, arising out of operations performed engineering, or surveying for the state or municipality; or services. (2) "Bodily injury" or "property damage" (2) "Bodily injury" or "property damage" included within the "products- occurring after: completed operations hazard". (a) All work, including materials, However, such state or political parts, or equipment furnished in subdivision's status as additional connection with such work, on insured under this policy ends when the the project (other than service, permit ends. maintenance, or repairs) to be performed by or on behalf of the Owners, Lessees, or Contractors — additional insured(s) at the with respect to liability for "bodily injury", location of the covered "property damage", or "personal and operations has been completed; advertising injury" caused in whole or in or part, by: CG 73 23 12 16 Includes copyrighted material of Insurance Services Office, Inc., Page 3 of 5 with its permission. CG 73 23 12 16 3 (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. However, a person or organization's status as additional insured under this policy ends when your operations for that additional insured are completed. With respect to the insurance afforded to such additional insureds a. — d. described above, 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. However, the insurance afforded to such additional insureds a. — d. described above: 1. Only applies to the extent permitted by law; and 2. Will not be broader than that which you are required by the contract or agreement to provide for such additional insured. Primary and Noncontributory — Other Insurance Conditions The following is added to the Other Insurance Condition and supersedes any provisions 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 your policy provided that: a. The additional insured is a Named Insured under such other insurance; and b. You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. I. Employee Bodily Injury To Another Employee Under Section II — Who Is An Insured The following is added to Paragraph 2.a.(1): Paragraphs 2.a.(1) (a), (b) and (c) do not apply to "bodily injury" to a co -"employee" in the course of the co -"employee's" employment by you, or to "bodily injury" to a co2volunteer worker" while performing duties related to the conduct of your business. J. Broad Form Named Insured Under Section II — Who Is An Insured The following is added to Paragraph 2.: e. Any business entity incorporated or organized under the laws of the United State of America (including any State thereof), its territories or possessions, or Canada (including any Province thereof) in which the Named Insured shown in the Declarations owns, during the policy period, an interest of more than fifty percent. If other valid collectible insurance is available to any business entity covered by this solely by reason of ownership by the Named Insured shown in the Declarations in excess of fifty percent, this insurance is excess over the other insurance, whether primary, excess, contingent, or on any other basis. K. Aggregate Limit Per Location Under Section III — Limits Of Insurance the following is added to Paragraph 2: The General Aggregate Limit under Section III Limits Of Insurance applies separately to each of your locations owned by or rented to you or temporarily occupied by you with the permission of the owner. For the purposes of this provision, location means premises involving the same or connecting lots, or premises whose connection is interrupted only by a public street, roadway, waterway or railroad right-of-way. L. Aggregate Limit Per Project Under Section III — Limits Of Insurance The following paragraph is added to Paragraph 2: The General Aggregate Limit under Section III Limits Of Insurance applies separately to each of your construction projects away from premises owned by or rented to you. Page 4 of 5 Includes copyrighted material of Insurance Services Office, Inc., CG 73 23 12 16 with its permission. M. Medical Payments Under Section III - Limits Of Insurance, Paragraph 7. is replaced with: 7. Subject to 5. above, the higher of: a. $10,000; or b. The amount shown in the Declarations for Medical Expense Limit is the most we will pay under Coverage C for all medical expenses because of "bodily injury" sustained by one person. This coverage does not apply if Coverage C - Medical Payments is excluded either by the provisions of any coverage forms attached to the policy or by endorsement. N. Knowledge Of An Occurrence Under Section IV - Commercial General Liability Conditions, the following is added to 2. Duties In The Event Of Occurrence, Offense, Claim Or Suit: e. Knowledge of an occurrence, offense, claim or suit by an agent or employee of any insured shall not in itself constitute knowledge of the insured unless you, a partner, if you are a partnership; or an executive officer or insurance manager, if you are a corporation receives such notice of an occurrence, offense, claim or suit from the agent or employee. f. The requirements in Paragraph b. will not be considered breached unless there is knowledge of occurrence as outlined in Paragraph e. above. O. Unintentional Failure To Disclose Hazard Under Section IV - Commercial General Liability Conditions, Condition 6. Representations the following paragraph is added: d. Your failure to disclose all hazards or prior "occurrences" or offenses existing as of the CG 73 23 12 16 inception date of the policy shall not prejudice the coverage afforded by this policy provided such failure to disclose all hazards or prior `occurrences" or offenses is not intentional. This provision does not affect our right to collect additional premium or exercise our right of cancellation or non- renewal. P. Waiver Of Subrogation Under Section IV - Commercial General Liability Conditions, 8. Transfer Of Rights Of Recovery Against Others To Us the following paragraph is added: If required by a written contract executed prior to loss, we waive any right of subrogation we may have against the contracting person or organization 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". Q. Liberalization Under Section IV Liability Conditions, added: 10. Liberalization - Commercial General the following paragraph is If we revise this coverage form to provide more coverage without additional premium charge, your policy will automatically provide the additional coverage as of the day the revision is effective in your state. R. Broadened Bodily Injury Definition (Mental Anguish) Under Section V - Definitions Definition 3. "Bodily Injury" is replaced with: 3. "Bodily injury" means physical injury, sickness, or disease to a person and if arising out of the foregoing, mental anguish, mental injury, shock, or humiliation, including death at any time resulting therefrom. All terms and conditions of this policy apply unless modified by this endorsement. CG 73 23 12 16 Includes copyrighted material of Insurance Services Office, Inc., Page 5 of 5 with its permission. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA Policy Number: 72 WEC Z19068 Endorsement Number: Effective Date: 04/01/19 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address: RUBEN CHAVARIN 3124 W ROSECRANS AVE STE B HAWTHORNE CA 90250 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.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 2 % of the California workers' compensation premium otherwise due on such remuneration. SCHEDULE Person or Organization Job Description Any person or organization from whom you are required by written contract or agreement to obtain this waiver of rights from us Countersigned by Authorized Representative Form WC 04 03 06 (1) Printed in U.S.A Process Date: 02/20/19 Policy Expiration Date: 04/01/20