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PROOF OF INSURANCE (2021 - 2021) CLOSEDTURFT-1 OF ID: EC ACORO DATE (MMIDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 06/23/2020 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 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 CONTACT Campbell Ins. Agency NAME: Elaine Croxton, CRIS John L. Cam P 9 y PHONE 949-497-1008 FAX 949-497-9830 PO Box 4497 (Alc,, No, Ext): INC. Nol; Laguna Beach, CA 92652 E-MAIL i lane John L. Campbell Ins. Agency ADDRESS: elaine@jlcinsurance.com INSURER(S) AFFORDING COVERAGE NAIC q INSURER A: Security National Insurance 19879 INSURED Turf Time West, Inc. INSURER B: California Automobile Ins Co 38342 24312 Barbados Dr. INSURER c:National Union Fire Insurance 19445 Dana Point, CA 92629 AUTOS INSURER D: Great American Insurance Group 116691 INSURER E: HIREDAUTOS INSURER F: 03/0111920 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 INSRAoD8"8ubk POLICYEFF POLICY FXP L rR TYPE OF INSURANCE PNRR__Wn POLICY NUMBER IMIMOWYYYYV ImWoo YYYYl LIMITS GENERAL LIABILITY EACH OCCURRENCE S 1,000000 A X COMMERCIAL GENERAL LIABILITY X X NA107506805 02/01/1920 02/01/2021�,@�;Nfh"ka.'r', t:;P�r�7 'a�a'f:�7v''iVc'nMal 100,000 CLAIMS -MADE X OCCUR MED EXP (Any one pe scn7, '.S 5,000 GEN'L AGGREGATE LIMIT APPLIES PER: F,RO- X POLICY IY."r."N LOC AUTOMOBILE LIABILITY DED R'E7t N°NON S 0 B X ANY AUTO BA040000012479 ALL OWNED SCHEDULED AUTOS AUTOS X S'WC127730 NON -OWNED HIREDAUTOS AUTOS X UMBRELLA LIAB X OCCUR EACH OCCURRENCE C EXCESS LAB CLAIMS -MADE ESU15852903 DED R'E7t N°NON S 0 S WORKERS COMPENSATION Prod/Comp AND EMPLOYERS' LIABILITY Y / N ANY PROPRIFTCRtPARTNE, +ExEr'uibWl_'' X S'WC127730 "'^EbI::�ERMrP.r,EN,n63Esr„ EX„CL4J'�CIEI,d'�" +� N I A 7nRr,Y,LI%r11T;S „&:P (Mandatory in NH) ".""_•.•.•., 03/0111920 IMye,s describe trnde+ 5 DACRIP"TIONOF OPERAT!SFNS below E L DISEASE - EA EM?'^"LWEl: D Equipment IMP202427006 02/01/1920 02/01/2021 PERSONAL& ADV INJURY '.5 1,000,000 GENERAL AGGREGATE 5 2,000„000 PRODUCTS-COMP/OPAGG 5 2,000,000 S u'*MBNED SINGLE OMIT' BODILY INJURY (Per person) S BODILY INJURY (Per accident) $ Oi-p6'wNPrin6,"',7'Y$ uPER ACODENTy S DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) "The City of E1 Segundo, its officers, officials, employees, agents, and volunteers". are "additional insured as their interest may appear, the above coverage is prmamry and non contributory, waiver of subrogation applies. 30 Days Notice of Cancellation CERTIFICATE HOLDER City of EI Segundo 350 Main Street EI Segundo, CA 90245 ACORD 25 (2010/05) CANCELLATION 7\_ 1,000000 2,000,000 2„000,000 2,000„000 1,000,,000 1,000,000 1,000,000 241,500 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 41 © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD EACH OCCURRENCE S 02/01/1920 02/01/2021 AGGREGATE S Prod/Comp 5 '�4rt, ST,17U, i0T'H• X 7nRr,Y,LI%r11T;S „&:P 03/0111920 03/01/2021 E L EACH ACCIDENT 5 E L DISEASE - EA EM?'^"LWEl: 5 E L DISEASE - POLICY LIMIT S 02/01/1920 02/01/2021 Limit DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) "The City of E1 Segundo, its officers, officials, employees, agents, and volunteers". are "additional insured as their interest may appear, the above coverage is prmamry and non contributory, waiver of subrogation applies. 30 Days Notice of Cancellation CERTIFICATE HOLDER City of EI Segundo 350 Main Street EI Segundo, CA 90245 ACORD 25 (2010/05) CANCELLATION 7\_ 1,000000 2,000,000 2„000,000 2,000„000 1,000,,000 1,000,000 1,000,000 241,500 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 41 © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY BLANKET ADDITIONAL IINSUREDS - OWNERS, LESSEES OR CONTRACTORS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Policy Number: NA107506805 Endorsement Effective: 2/5/2020 12:01 a.m. Named Insured Countersigned Py. TURF TIME WEST INC TURF TIME WEST INC ' .. ... , SCHEDULE Name of Person or Organization: Any person or organization that the named insured is obligated by virtue of a written contract or agreement to provide insurance such as is afforded by this policy. Location: (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) A. Section II — Who Is An Insured is amended to include as an insured the person or organization shown in the Schedule, but only to the extent that the person or organization shown in the Schedule is held liable for your acts or omissions arising out of your ongoing operations performed for that insured. B. With respect to the insurance afforded to these additional insureds, the following exclusion is added: 2. Exclusions 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 site 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. C. The words "you" and "your" refer to the Named Insured shown in the Declarations. D. "Your work" means work or operations performed by you or on your behalf; and materials, parts or equipment furnished in connection with such work or operations. Primary Wordinq If required by written contract or agreement: Such insurance as is afforded by this policy shall be primary insurance, and any insurance or self-insurance maintained by the above additional insured(s) shall be excess of the insurance afforded to the named insured and shall not contribute to it. Waiver of Subro aq tion If required by written contract or agreement: We waive any right of recovery we may have against an entity that is an additional insured per the terms of this endorsement because of payments we make for injury or damage arising out of "your work" done under a contract with that person or organization. 49-0108 07 11 May Include Copyrighted Material of Insurance Services Offices, Inc. Page 1 of 1 Used with perm'iss'ion WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 04-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA 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 as required by written contract. 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 3/1/2020 Policy No. SWC1277380 Endorsement No. 0 Insured Turf Time West, Inc Premium $ 9,661 Insurance Company Security National Insurance Company Countersigned by. WC 04 03 06 (Ed. 04-84)