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PROOF OF INSURANCE (2021) CLOSEDAC OG1222020 CERTIFICATE OF LIABILITY INSURANCE DATEIMMDDYYYYI 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 terns and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer riohts to the certificate holder in lieu of such endorsement(s). PRODU -CONTAC FEDERATED ER AfOt+ll'goTExn- 888-333- 949 CT CENTER «.«.«.«...W..F�rs N, f 507-a4 FEDERATED MUTUAL INSURANCE COMPANY _ HOME OFFICE: P.O BOX 328 AMF w 888- CO...., ..... W t_...-._.."?.":, 6-4„ OWATONNA, MN 55060 E'rdAll. ooREss: ENTCONTACTCENTER,(gIFE,O,I COM INSURER(S) AFFORDING COVERAGE NAIC d INSURER A: FEDERATED SERVICE INSURANCE COMPANY 28304 INSURED171-235-5 INSURER B: , �............__....................... MARIPOSA LANDSCAPES INC INSURER C: 6232 SANTOS DIAZ ST �.. IRWINDALE, CA 91702-3267 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 288 REVISION NUMBER: 1 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 IN$R ADDL SIUBR POLICY EFF POLICY EXP I,10 TYPE OF INSURANCE INSP lY+,ryy POLICY NUMBER lmmmOlyvyyl (MMInDlYVW1 LIMITS X COMMERCIAL GENERAL LIABILITYEACH OCCURRENCE $1,000,000 CLAIMS -MADE X OCCUR $100,000 EXCLUDED $1,000,000 $2,000,000 $2,000,000 A Y N EWL AOOREOA E UNIT APPLIES PER: X I o' 1C "M' PRO• LOC 1ECT OTHER: .,..., ., ALMTOMODtLE LIABILITY X ANY AUTO SCHEDULED A OWNED AUTOS ONLY AUTOS N N LL` -,......' NON -OWNED HIRED AUTOS ONLY AUTOS ONLY X UMBRELLA LIAR X OCCUR A - EXCESS LIAB CLAIMS -MADE N N 'DED I uRETENTION WORKERS COMPE AND EMPLOYERS' LIABILITY N ANY PROPRIETORIPARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? NIA (Mandatory in NH) 11 yes, describe under DESCRIPTION OF OPERATIONS below PRFMASFS IFA flrnllrrrnpC1 DAMAGE TO RENTED MED EXP (Any one person) 6D69499 04/01/2020 04/01/2021 PRSONAL d A.".""....-.._"."..... E ... '.DW 104J.UI1'y GENERAL AGGREGATE PRODUCTS COMPIOP AGO CablBllaEDEiIP4GLn, .Iphl $1,000,000 «.t9.m..t£3LtlauvCT BODILY INJURY (Per person) 6069499 04/01/2020 04/01/2021 BODILY INJURY(Peraccidenl) PROPERTY DAMAGE ..VPPL:HSefi! L'S.".'.9I.................... ............... ................ ................. ............... ...._. EACH OCCURRENCE 510,000,000 6069500 04/01/2020 04/01/2021 AGGREGATE ...........................« " $10,000,000" PER STATUTE TE ER E.L. EACH ACCIDENT E L DISEASE EA EMPLOYEE E L DISEASE POLICY LIMIT DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may he attached i1 more space is required) PROJECT: TURF RENOVATION AT RICHMOND STREET FIELD THE CITY OF EL SEGUNDO, ITS OFFICERS, OFFICIALS, EMPLOYEES, AGENTS AND VOLUNTEERS ARE INCLUDED AS ADDITIONAL INSURED WITH RESPECT TO THE COMMERCIAL GENERAL LIABILITY POLICY. CERTIFICATE HOLDER CANCELLATION 171-235-5 288 1 CITY OF EL SEGUNDO SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE O� 350 MAIN ST THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN EL SEGUNDO, CA 90245-3813 ACCORDANCE WITH THE POLICY PROVISIONS. f+ AUTHORIZED REPRESENTATIVE _ O 1988-2015 ACORD CORPORATION All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: 6069499 COMMERCIAL GENERAL LIARILITY CG 20 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED (PERSON OR ORGANIZATION This endorsement modifies insurance prcvided tinder the. following- COMMERCIAL ollowing:CO1 ME RCIAL GENERAL :.IAB€LITY COVERAGE PART SCHEf3131.k "w Name Of Additional Insurer) Person(s) .................... Y..................................................................... Or Organizations: Locat on(s) Of Covered Operations ANY COVERAGE PROVIDED BY THIS FgDOR1',EA1ENT CITY OF EL SEGUA'I>O " APPLIES ONLY TO'lTIIE COI ENIERC:LU TURP 350 NIA TN ST RENOVATION n I RICHMUND Sl KEL'I PILLD F.I. SFCUNUO, C.4 90245-3813 ADDITIONAL INSURFDS ALS(-! TNCLUI)E. THE CITY OF ; E. SEGUNDO, ITS OFFICERS. OFFICIALS, EMPLOYEES, Al ENT6 AND VOLUNTEERS i —_...._..LLrLL_._.....W......���57..�.:fYi$lkC!.e 4 �.�`..flW.`..._t..........._,..y.... Infnrmatlion r¢ pui, d a -his ;Schcduie, It not Ml w�ln above, will be shown . ' • w .... . ...........n he Declarations. � A. Se on 11 - Who Is An Insured is amended to include as an additional insured the person(s) or org:afiization(s) shown in the Schedule, but only with respect to liability for "Bodily injury", ^propet#y Carnage" or "persona; and advertising injury" caused, in whole or in part, by: 1. Your acts or oinissions; Or 2. The acts or omissions o1 those acting on your behalf'; in the performance of your ongoing operations, for the additional insured(s) at the location(s) designated above. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by lav; and 2. If coverage provided to the additional insured iS required by a rontract or agreernent, the in;-uraricee 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, -'1ARIPOSA LAND6GAPES INC 6232 SAN TOS f)ir1Z ST IRWINDALE, CA 917112-3267 B. With respect to the insurance afforded to these additional insureds, the following additional exciusions apply: This insuranne does not Apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or ealuipment furnished in connection with such worts, on the project (other than service, maintenance or repairs) to be performed by or cn behalf Of th(: Udditional 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 $Ubcontr actor engaged in performing operations for a principal as a pail of the same project. ,Ze) Insurance Services OtTce, Inc.. 2012 page 1 of 2 CG 20 1004 13 Policy Number: 5069499 Transaction Effective Gate: 0612i=, C, With respect to the insurance afforded to these additional insureds, the following is added to Sect! w;ll pay on behalf of the additionW insured is the amount of insurance: T. HEMMM 2. Available under ffie applicable Limits of �nsurance shown in the Declarations-, whichever Is less. This endorsement shall not increase the appkable Limits of Insurance shown in the 0eclarations. Page 2 of 2 @ Insurance Services Office, Inc., 2012 CG 20 10 04 13 Policy Numbei-, 60£9499 Transaction Effective Date: C61221202-3 0 DATE(MMIDDIYYYY) ACC>R " CERTIFICATE OF LIABILITY INSURANCE III ,,,.- 06/15/2020 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(les) 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 CONTACT NA Global Risk, LLC METami Mason N 800 Wilshire Blvd., Second Floor (A+C,N o,,Ext);, (213) 550-2253 �WC,No: (213) 550-2258 E-MAIL Los Angeles CA 90017 ADDRESS; „tmas'on@q;obalriekcap.com INSURER(S) AFFORDING COVERAGE NAIC N INSURER A: Sentry Casualty Company 28460 INSURED INSURER B Mariposa Landscapes, Inc. INSURER C: 6232 Santos Diaz St. INSURER D: Irwindale CA 91702 INSURER E; INSURER F: COVERAGES CERTIFICATE NUMBER: Cert ID 308 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 ADDL SUSR POLICY EFF POLICY EXP LIMITS LTR INCn WVn POLICY NUMBER (MMIDDIYYYY) fmmdODJYYYY'I� COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S CLAIMS -MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER 'PRO, POLICY J'S u':'( O'TI-ER AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY UMBRELLA LIAB OCCUR EXCESS LIAB CLAIMS -MADE DED RETENTIONS WORKERS COMPENSATION A AND EMPLOYERS' LIABILITY Y I N ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED� Y NIA (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below DAMAGE TO REN TLD PREMISES (Ea occurrence) S MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP/OPAGG S S e Ofwt8lNE.D SI,TTOSiLE"..Wl T' S (,En acca:ten't) BODILY INJURY (Per person) S BODILY INJURY (Per accident)' S RRbPER'T4, T;AlOACE". „ $ , S EACH OCCURRENCE S AGGREGATE S PERS % 90-20720-01 00 191 04/01/2020 04/01/2021, STATUTE EERH , E L EACH ACCIDENT S 11000,000 E L DISEASE- EA EMPLOYEE S 1,000,000 EL DISEASE -POLICY LIMIT S 1,000,000 S S DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Project: Turf Renovation at Richmond Street Field NIx CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of El Segundo ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main St. AUTHORIZED REPRESENTATIVE E1 Segundo CA 90245 �"- I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 26 (2016/03) The ACORD name and logo are registered marks of ACORD Page 1 of 1 SENTRY CASUALTY COMPANY Carrier Code No. 37877 WORKERS' COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY POLICY NUMBER: 90'20720'01 UO 191 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT We have the right to recover our � s from an one liable for an injury covered by this policy . limy. �e will not en�orce our right against the person or organization named in the Schedule. (Thio agreement applies only to the extent thatyou p�rform work under a written contract that requires you to m��aim this agreement frmn LIS. ) This agreement shall not operate directly or indirectly to benefit any one not named in the Schedule. Schedule "ALL WRITTEN CONTRACTS PROVIDED SUCH ODNTRACT'WA8 MADE PRIOR TO LOSS" WC 00 03 13 (Ed. 04'84) Copyright 1083 National Council on Compensation Insurance. MAR 90'20720'01 00 191 MARIPOSA LANDSCAPES INC O3'27'1G PAGE 001