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PROOF OF INSURANCE (2020 - 2020) CLOSEDCOMM -35 OP IID: LF ACOR CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY)02/20/2020 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 626-795-9921 CONTACT Jessica Munoz NAME: Supple -Merrill (AcNN626-795-9921 FAX. No): 626-577-6656 Insurance Agents Brokers /, Ext). (AIC Es,P. 0. BOX 2408 WDi Pasadena, CA 91102 Supple -Merrill & Driscoll Inc. INSURER(S) AFFORDING COVERAGENAIC # EZXS3013009 09118/2019 09/01/2020 AGGREGATE.,,,,,,,,, INSURERA:Arch Specialty Insurance Co 21199 re(al Transportation Sery �' p Mos. fe nor Avenue San Dimas oCA 91773 INSURERS Fund INSURER C : Evan toInsurance Company INSURER?; X PER OTH- INSURER E: :.STA,TUTF a ER, 1650779-19 09/01/2019109/01/2020 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 TYPE OF INSURANCEJ-A ND I X COMMERCIAL GENERAL LIABILITY �V POLICY NUMBER POLICY EFF POLICY EXP LIMITS INSR ADDL SUBR' EACH OCCURRENCEn 1'000,000 CLAIMS -MADE X OCCUR 1;PPAGE 10 ooc„ 100,000IjSES Ecurrncs) $ MED EXP (Any one Person)S 000 PERSo.NAL,& Arse iNJLRY $'00 .J, 1 m'4R, GREL•F TE LIMIT AGENERAL AGGREGATE ?PLIES PER , TE 5 2'000000 i , X POP ICY pFT" LOC 2,000,000 PRODUCTS _COMP/OPAGG, ,,,$,,,, Cffl-NE'R AUTOMOBILE LIABILITY ANY AUTO OWNED AUTOS ONLY AUTOS ONLY SCHEDULED AUTOS NCIva;(" V �w , D A4.ATw;.A i C�;1P�iR.Y C UMBRELLA LIAB X OCCUR X EXCESS LIAB CLAIMS -MADE DED RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y f N ANY PROPRIETOR/PARTNER/EXECUTIVE X ID'EFYGE'R�/MEMBER EXCLUDED? 'N I A ( andatory in NH) If yes, describe under I DESCRIPTION OF OPERATIONS below B $ I COMONED SWNCLE I.HAT 1'ERY , BODILY INJURY ,,, BODILY INJURY (Per accident) S,,,, PROPEFCT'Y DAMAGE ��I�er aC'A-Iderroty $ EACH OCCURRENCE S EZXS3013009 09118/2019 09/01/2020 AGGREGATE.,,,,,,,,, Follow $ X PER OTH- :.STA,TUTF a ER, 1650779-19 09/01/2019109/01/2020 E LEACH ACCIDENT $ F L DISEASE.-, EA EMPLOYEE, $ E L DISEASE -POLICY LIMIT $ I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of El Se undo is an additional insured with Iresepect the insureds operations. Vh/aiverof subrogation applies to the general liability and workers compensation CERTIFICATE HOLDER CITY OF EL SEGUNDO BLDG & SAFE 350 MAIN STREET EL SEGUNDO, CA 90245 ACORD 25 (2016/03) CITYELS CANCELLATION 2,000,000 2,000,000 form GL 1,000,000 1,000,000 1,000 ,000 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 J /1 Z' CLI i ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Policy number: PLI0000133-00 COMMERCIAL GENERAL LIABILITY CG 20 10 07 04 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 ollowing: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Location(s) Of Covered Operations All persons or organizations as required by written Various contract with the insured It is further agreed that this insurance shall be primary and non-contributory but only in the event of a named insured's sole ne fiigence P 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 B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following additional organization(s) shown in the Schedule, but only exclusions apply: with respect to liability for "bodily injury", "property This insurance does not apply to "bodily injury" or damage or "personal and advertising injury' "property damage" occurring after: caused, in whole or in part, by: 1. All work including materials parts or 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. 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 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 C3 Policy number: PLI0000133-00 COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY 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: All persons or organizations as required by written contract with the insured 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 13 �- PERUDII OtpLgE AI C 4..JRTJDATE (MM1DDNYYY) ,,,,,.�..-w CERTIFICATE OF LIABILITY INSURANCE 02/03/2020 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 ii this certificate does not confer rights to the certificate holder in lieu of such endorsementjsj�. PRODUCER Gary B. Merrill Su le•Merrill li~ Driscoll Inc. PHONE CT ) . I FAX I Insurance A.'gants grad BrDkers' 626 -?9:5.99121 ,�`,mm..^'� ^FN 626.75-'9'921 ... 62'6 5??-fa6b� P, O. Bax 24ti8 E-MAtL Pasadena, CA 91102— Supple-Merrill 8 Driscoll Inc. Irl gag—lxlsl AFFORoaNG C.O.VEIi Mercu Insurance Grou 11908 ".n" D I7�Ina' erugino San Dimas,nCR 1773.3420 ...�.��������� .....,._....... INS1j,FiILRA;....InrFn............,,,,,,,............._............ #'.SL1R R D........,. 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. iNSR TYPE OF INSURANCE DL — ,... — _........ ......._,_..,................. __...., POLICY Ei ... - . .. _... ......._. j USR POLICY NUMBER q YY I I- L1CY EX�1 I LIMITS I i COMMERCIAL GENERAL LJABI1UTY I_i14,F;N„b C6,I9 ,ikF,h7GE, CLAIMS -MADE OCCUR I WDAMAGE "TORENTED .. � i'fIFl�41F 19�f ra�ron� . PERSONAL�Lt ASU 9N�) �._.... _. ,_ ...�.,.,_ ._..... URY .. . __„........., 0,...A,.,.�..EI LIMIT APPLIES PER: RAL _17.EN'I, POLICY i�� JCO7 LOC S . D 9 II OIL HER A COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY A O ,,,q,E,��Rg,�rpLpD .., .. 1140104120149615 01115/20 20 0711512020 SORiLYIN,JUR@,.GFrir,ptpSCaat OWNED X AUTOSULED AUTOS ONLY � BODILY INJURY (,PeraqldtanCS 3 300,,000 ...,.., HIRED NO N i7 FOPERTY AMAGE er a¢ adevr0 100„000' ..,� AUTOS ONLY AO LY COMPICOLL 50015'00 $ UMBRELLA IU1LB � OCCUR E=,n("(fiCiC �.�.. GLAIMS- EXCESS, 11 ,MADE I _ A9 CRAA,PR'RFNI ...,_....._.. �$ � DED � RETENTION$ � WORKERS COMPENSATION ... I fl. OtH PER O1' I AND EMPLOYERS'LIABILITY YIN ..................... .. .............. ANY CE tPfu TORI EXLLUOEDJiF','i:'U'I'I^JE NIA! FL..M� +hG {ACCIf7EIwflT_ry...,..� _.Y 3 ,) +rll ndaLory n ') R F.i_ DISEASE-EAE;M+P,pLq FCJ�_................ �... ...... If as, describe under D as,OF OPERATIONS below N E.L.. DISEASE - POLICY LIMIT p 1 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space rs required) 2001 CHEVROLE SILVERAD PKP 4 2GCEC19T911396791 2017 TOYOTA 4 RUNNER JTEZU5JR3H5149180 RTIFICATE HOLDER 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 Supple -Merrill & Driscoll inc. I ACORD 25 (2016103) O 1988.2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ENDORSEMENT AGREEMENT WAIVER OF SUBROGATION 1650779-19 RENEWAL SC 0-58-54-42 PAGE 1 HOME OFFICE SAN FRANCISCO EFFECTIVE SEPTEMBER 1, 2019 AT 12.01 A.M. ALL EFFECTIVE DATES ARE AND EXPIRING SEPTEMBER 1, 2020 AT 12.01 A.M. AT 12:01 AM PACIFIC STANDARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME COMMERCIAL TRANSPORTATION SERVICES 142 E BONITA AVE # 107 SAN DIMAS, CA 91773 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, COMMERCIAL TRANSPORTATION SERVICES 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 SHALL BE HELD TO VARY, ALTER, WAIVE OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS POLICY OTHER THAN AS ABOVE STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR LIMITATIONS IN THIS ENDORSEMENT. COUNTERSIGNED AND ISSUED AT SAN FRANCISCO: SEPTEMBER 5, 2019 2570 AUTHORIZED REPRI SENT IVE PRESIDENT AND CEO SCIF FORM 10217 IREV.4-20181 OLD DP 217 u, til'; g °0°IoIIV'i��ii�� ��II •• �'jl'i� �� �''i Commercial Transportation Services Inc. RE: PROFESSIONAL SERVICES AGREEMENT To whom it may concern, We request that you consider waiving the insurance requirements for CTS/Dino Perugino for the following reasons: C.T.S has no exposure and the insurance does not apply. C.T.S works on the city premises and does not provide any equipment other than his expertise. C.T.S. is providing a certificate of the General Liability Insurance, E. & O., again, no exposure here in regards to the services C.T.S provides. Additional Insured Endorsement: The current insurance provider does not provide this coverage because C.T.S once again has no exposure or liability in this area. Auto: C.T.S does not have a commercial auto exposure with regard to the services he provides the city. In fact C.T.S does not own a commercial vehicle. In the past C.T.S has provided a copy of his personal auto insurance policy. We have provided a copy of said insurance. In regards to Workers Compensation Insurance, we have provided a copy the State Fund Compensation insurance Certificate. Please feel free to contact Diane Stamm with any questions at Supple -Merrill & Driscoll. He can be reached at 626-795-9921 Monday — Friday 9-5. Sincerely Dino Perugino President/CEO 142 E. Bonita Ave. #107 San Dimas, CA 91773 (626) 966-1509 email: dino-cts@verizon