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PROOF OF INSURANCE (2021) CLOSEDB DATE(MM/DD/YYYY)
-- CERTIFICATE OF LIABILITY INSURANCE 02/26/2020
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: It the certificate holder is an ADDITIONAL INSURED, the poli y(Ies) must have ADDITIONAL INSURED provisions or be endorsed. It
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
Aon Risk Services, Inc Of Florida NAME'
1001 Bri ckel l Bay Drive SpaC No, E' {); (866) 283-7122 A , Ne 1 (800) 363-0105
Suite 1100 E MAIL
°Miami FL 33131 USA ADDRESS:
INSURER(S) AFFORDING COVERAGE NAIC tt
INSURED INSURER A: Safety National casualtyCorp 15105
,Landcare USA L.L:C. INSURER B: XL Insurance America Inc 24554
5295 Westview Drive
Suite 100 INSURER C:
Frederick MD 21703 USA
INSURER D:
' INSURER E:
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required)
RI-: All California Landscape operations. The City of E1 Segundo, its officers, employees and agents are included as
Additional Insured in accordance with the policy provisions of the General Liability policy. General Liability policy
evidenced herein is Primary and Non-contributory to other insurance available to an Additional insured, but only in accordance.._
with the policy's provisions. A waiver of Subrogation is granted in favor of The City of E1 Segundo, its officers, employees
andiagents in accordance with the policy provisions of the General Liability, Automobile Liability and Workers' compensation
CERTIFICATE HOLDER 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. 'i
City of El Segundo AUTHORIZED REPRESENTATIVE
350 Main street
E1 Segundo CA 90245 USA (yj/JiAn
01988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
I INSURER F:
I
'
COVERAGES
CERTIFICATE NUMBER: 570080654729 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, NOTWIT'HST'ANINNG ANY REQUIREMENT, 'TERM Oil CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO
WHICH THIS
CERTIFICATE MAY BE I'S'SUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL
THE 'TERMS,
IONS OF I.aCFt POLICIES. LIMITS SHOWN :SAY HAVE BEEN REDUCED Limits
PO mites shown.
CLU5�IC3NSANCiI",C±A)3,OITANCE �
are as requested
tL�� TYPE OFINSUR INSURANCE
L CIES LIcCLAIMS.
POLICY NUMBER I PtiSLCCYEFF...�� PO YE7fP 11 . LIMITS
3NS�D WVD MMiDDfYYY tMWODIYYYYi 7
A X COMMERCIAL GENERAL
GL4058322 ft%631D1/'2U21', EACHOCCURRENCE
$2,000,000
CLAIMS -MADE � OCCUR
SIR applies per policy tertas &condi-:i ons DAMAGE TO RENTED
$1,000,000
PREMISES (Ea occurrence)
X SIR $250,000
MED EXP (Any one person)
$5,000
PERSONAL&ADV INJURY
$2,000,000 N
GE»NFLAGGREGATE LIMIT APPLIES PER:
''GENERALAGGREGATE
$4,000,000 't
� PRO-
POLICY I _ X LOC
JECT
..,.._.
PRODUCTS -COMP/OPAGG
$4,000,000 0
,,,,w„
OTHER:
AUTOMOBILE LIABILITY
CA 6675529 03/01/2020 03/01/2021 COMBINED SINGLE LIMIT
"'
$5,000,000
i��r nta
X ANYAUTO
BODILY INJURY ( Per person)
G
OWNED
SCHEDULED
BODILY INJURY (Pee accident)
-•- AUTOS ONLY
HIREDAUTOS
AUTOS
NON -OWNED
PROPERTY DAMAGE
mm
.rte)
v
_....... ONLY
AUTOS ONLY
(Per accident)
e XUMBRELLA IAB X
I
US00078227LI2OA 03/01/2020 03101/2021
$5,000,000�
UA
OCCUR
�RBENCE
$5,000,000
DED X REF; NTION $10,000
A WORK�E'R
EMPLOYERS'
STATUTE' . ORH
LDC4058321 03/01/2020 03/01/20211EX
YfN
OPRIETOR / PARTNER,
EACH ACCIDENT
1,000,
000
S'BLIABILIITYpODry�DCUTIVE
ER
N/A
` Mandolory In NH)
E.L DISEASE -EA EMPLOYEE
$1,000,000
Iraq, cscrlbe ander
,.......-..--.-._._,._,
.,,....
D'ESCRIPTIONOFOPERATIO'N$bedewr
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)
RI-: All California Landscape operations. The City of E1 Segundo, its officers, employees and agents are included as
Additional Insured in accordance with the policy provisions of the General Liability policy. General Liability policy
evidenced herein is Primary and Non-contributory to other insurance available to an Additional insured, but only in accordance.._
with the policy's provisions. A waiver of Subrogation is granted in favor of The City of E1 Segundo, its officers, employees
andiagents in accordance with the policy provisions of the General Liability, Automobile Liability and Workers' compensation
CERTIFICATE HOLDER 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. 'i
City of El Segundo AUTHORIZED REPRESENTATIVE
350 Main street
E1 Segundo CA 90245 USA (yj/JiAn
01988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
POLICY NUMBER: GL 4058322
COMMERCIAL GENERAL LIABILITY
CG 20 26 0413
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
A I I ,,, 0 A, a I I A I
�
ml+"141 k -4101- 11101 z i - 0
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person(s) Or Organ ization(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.
I information required to complete this Schedule, if not shown above, will be shown in the Declarations.
A. Section 11 — 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 your acts or
omissions or the acts or omissions of those acting
on your behalf-.
1. In the performance of your ongoing operations;
or
2. In connection with your premises owned by or
rented to you.
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 time insurance afforded to these
additional insureds, the following is added to
Section ill — 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 26 0413 @ Insurance Services Office, Inc., 2012 Page 1 of 1
THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY.
This endorsement modifies insurance provided under the following:
COMMERCIAL AUTOMOBILE COVERAGE PART
SCHEDULE
Additional Insured - {) ----------�
Person(s) or Organization(s) as written oontract'
lJny individually scheduled Designated Additional Insured shall not be
,.,,..construed to override nor negate this blanket Designated Additional Insured.
CHANGE
The ororgan shown inthe Schedule above with whom you have agreed ina written contract
toprovide insurance such aoiaafforded under this Coverage Form, is included aomnAdditional Insured subject
to the below:
(1) Insurance for such Additional | scheduled above shall be afforded only �tothe extent that such
Additional Insured is liable for "bodily injury' or"property damage" arising out ofyour operations and
resulting from the ownership, maintenance or use of covered "autos" by you while the covered "autos" are
on premises owned or leased by the above scheduled Additional Insured(s).
CM The insurance afforded under this Coverage Form to such Additional Insured(s) applies only:
bA If the "accident" takes place subsequent to the execution and effective date of such written contract:
and.
(b) While such written contract is in force, or until the end of the policy period, which ever occurs first.
CA 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:
(a) The limits of insurance specified in the written contract or written agreement; or,
(b) The Limits ofInsurance provided bythe Coverage Form.
The amount we will pay on behalf of such Additional Insured(s) shall be a part of, and not in addition to, the
Limits ofInsurance shown inthe Coverage Form Declarations anddesoibedinthioaeoton. Such amount
will thus not increase the Limits of Insurance shown for the Coverage Form.
(4) Exclusions
(a) This endorsement does not apply to liability of the Additional Insured which arises out of the ownership
of transportation operating rights granted to the Additional Insured by public authority.
(b) This endorsement does not apply to the liability of the owner or anyone else from whom you hire or
borrow acovered auto.
SNCA 0261013 Sohab/NoUowmu* �oauohv
' ' Corporation Page of 2
(5) 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.
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 03/01/2020 Policy No. CA 6675529
Named Insured LANDCARE USA LLC DBA: LANDCARE
Insurance Company Safety National Casualty Corporation
Countersigned By
Endorsement No.
Premium $ Included
Page 2 of 2 Safety National Casualty Corporation SNCA 02610 13
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
WAIVER OF TRANSFER OF RIGHTS OF RECOVERY
AGAINST OTHERS TO US
This endorsement modifies insurance provided under the following:
COMMERCIAL AUTOMOBILE COVERAGE PART
SCHEDULE
Name Of Person Or Organization:
Person(s) or Organization(s) as required by written contract when such written
contract is executed prior to an accident to which this endorsement applies.
Any individually scheduled Waivers shall not be construed to override nor negate
this blanket Waiver.
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
CHANGE
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 "bodily injury" or "property damage" to which this insurance applies, caused by
an "accident" and resulting from the ownership, maintenance or use of a covered "auto". This waiver applies only
to the person or organization shown in the Schedule above.
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 03/01/2020 Policy No. CA 6675529
Named Insured LANDCARE USA LLC DBA: LANDCARE
Insurance Company Safety National Casualty Corporation
Countersigned By
Endorsement No.
Premium $ Included
SNCA 027 10 13 Safety National Casualty Corporation Page 1 of 1
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13
WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT
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.)
This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule.
SCHEDULE
WHERE A WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS IS REQUIRED BY WRITTEN CONTRACT,
SUCH ADDITIONAL ENTITIES SHALL BE CONSIDERED AUTOMATICALLY SCHEDULED BY THE
COMPANY.
INDIVIDUALLY SCHEDULED WAIVERS SHALL NOT BE CONSTRUED TO OVERRIDE NOR NEGATE THIS
BLANKET WAIVER.
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 03/01/2020 Policy No. LDC4058321 Endorsement No.
Insured LANDCARE USA LLC DBA: LANDCARE Premium $ Included
Insurance Company Safety National Casualty Corporation
Countersigned By
WC 00 03 13 (04 84) Page 1 of 1
©1983 National Council on Compensation Insurance.
POLICY NUMBER: GL 4058322
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:
Person(s) or Organization(s) as required by written contract when such
written contract is executed prior to an occurrence, offense or loss to
which this endorsement applies.
Any individually scheduled Waivers shall not be construed to override nor
negate this blanket Waiver.
Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Y
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 © Insurance Services Office, Inc., 2008 Page 1 of 1