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PROOF OF INSURANCE (2021) CLOSED
AC 08/20/2020/CERTIFICATE OF LIABILITY INSURANCE I °ATE(MY' 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 hol'de'r 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 s endorsement ',). ( Ferguson DennisCONTACT PRODUCER NA,M'�E: KesslerAlair Insurance Services, Inc PHONE (909) 931-1500 I No} FAX (909) 932-2133 O N :rt1. FAX License # OAD A 91387 DRESS, dferguson@kessleralaircom 12487 N. Mainstreet, Ste. 240 INSURER(S) AFFORDING COVERAGE Rancho Cucamonga CA 91739 INSURERA: AXIS Surplus INSURED Titan Environmental Solutions, Inc. 1521 E Orangethorpe Ave, Ste B INSURERS: Infinity Insurance (15778) INSURER C: State Compensation Ins Fund (#00815068) INSURER D: NAIC # 26620 22268 35076 INSURER E Fullerton CA 92831 INSURER F : COVERAGES CERTIFICATE NUMBER: 20/21 GL,Auto,WC 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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' AU'UL SUUK POLICY EFF - POLICY EXP ILIMITS LTR TYPE OF INSURANCE Ifs WVD POLICY NUMBER (MM/DD/YYYY) IMMIDDIYYYYI— X COMMERCIAL GENERAL LIABILITY � EACH OCCURRENCE $ 2,000,000 DAMAGE TO RFN I ED 300,000 CLAIMS -MADE � OCCUR 8 PREMISES (Ea occurrence) $ I MED EXP (Any one person) $ 5,000 Y Y SP002760-04-2020 08/27/2020 08/27/2021I 2,000,000q PERSONALBADVINJUR GENII'LAGGRF,(.1ATELIMIT APPLIES PER: IGENERAL AGGREGATE 21000,000 19 JPRO-ECT PRODUCTS $ 2,000,000 POLICYJECr LOC - OTHER Per Project Aggregate $ 2,000,000 AUTOMOBILE LIABILITY COMMNEDSINGLE'LIWT $ 1,000,000 IE a arca Beni b ANY AUTO BODILY INJURY (Per person) $ B OWNED %,,#I SCHEDULED 504610069411001 08/27/2020 08/27/2021 BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS HIRED NON -OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY aper ancideni) Uninsured motorist $ 1,000,000 UMBRELLA LIABOCCUR I EACH OCCI,IRRENCE ,.,. $ EXCESS LIAB �, CLAIMS -MADE AGGREGATE $ �1 DED JJ RETENTION $ 0 $ WORKERS COMPENSATION PER iAND EMPLOYERS' LIABILITY xI STATUTE EERH YIN 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E L EACH ACCIDENT $ C OFFICER/MEMBER EXCLUDED? Y NIA Y 9282285-20 08/27/2020 08/27/2021 (Mandatory in NH) I EL DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under 1,000,000 DESCRIPTION OF OPERATIONS below 1 E L DISEASE - POLICY LIMIT $ Each Claim $2,000,000 Professional Liability A Retro Date: 10/20/2006 SP002760-04-2020 08/27/2020 08/27/2021 Aggregate $2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of EI Segundo, it's City Council, officers, officials, employees, agents, and volunteers are named as additional insured when required by written contract per the attached blanket additional insured endorsement, Waiver of subrogation applies to the General Liability and Workers Compensaion per the attached forms CERTIFICATE HOLDER City of EI Segundo 350 Main Street EI Segundo ACORD 25 (2016/03) 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. AUTHORIZED REPRESENTATIVE CA 90245 j „. .- < ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Endorsement No. 4 Effective Date: X27 2020 @12:01 a.m. Standard Time at the address of the Named Insured Policy Number: SP002760.04®2020 Insured Name: Titan Environmental Solutions, Inc. Issuing Company: mmAXiSps Insurance Company Additional (Return) Premium: $0 If the Endorsement Effective Date is blank, then the effective date of this Endorsement is the Inception Date of the Policy. ADDITIONAL INSURED/PRIMARY COVERAGE INCLUDING COMPLETED OPERATIONS (CGL & CONTRACTORS POLLUTION COVERAGE) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies the Specialty Package Policy. In consideration of the premium charged, it is agreed that: SECTION III — WHO IS AN INSURED is amended to include as an Additional Insured the person or organization shown in the schedule below as respects Coverages A, B and D, but only for liability arising out of Your Work or Covered Operations performed by you or on your behalf for that Additional Insured and not due to any actual or alleged independent liability of said Additional Insured. This endorsement does not apply to Bodily Injury. Property Damage or Loss arising out of the sole negligence or willful conduct of, or for defects in design furnished by the Additional Insured. As respects the coverage afforded the Additional Insured, this insurance is primary and non-contributory where a written contract or written agreement in effect prior to any related Claim requires you to provide such coverage. When this insurance is primary and non-contributory, our obligations are not affected by any other insurance carried directly by such additional insured whether it is primary or excess coverage. However, regardless of the provisions above: We will not extend any insurance coverage to the additional Insured person or organization: (1) That is not provided to you in this Policy; or (2) That is broader coverage than you are required to provide to the additional Insured person or organization in the written contract or written agreement. This endorsement does not increase the Company's Limits of Insurance as specified in the Declarations of the Policy. SCHEDULE OF ADDITIONAL INSUREDS As required by written contract prior to any related Claim SPP 0024 (Ed. 06 12) Page 1 of 1 Endorsement No. 10 Effective Date:�Q�20%0 @12:01 a.m. Standard Time at the address of the Named insured Policy Number: SP002760-04-2020 Insured Name: Maffl-T—nv�ronmental Solutions, Inc. Issuing Company: AXIS Surplus Insurance Company Additional (Return) Premium: $0 If the Endorsement Effective Date is blank, then the effective date of this Endorsement is the Inception Date of the Policy. A 'W1'ft%IVEr`%'OF TRANSFER OF RIGHTS OF RECOVERY A A AGMINST OTHERS TO US This endorsement modifies insurance provided under the following: SPECIALTY PACKAGE POLICY Name Of Person Or Organization: As required by written contract In effect prior to any related Claim Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 12. Subrogation of Section VII — Common 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. Includes copyrighted material of Insurance Services Office, Inc with its permission CG 24 04 05 09 SPP 2404 09 (04 14) Page 1 of 1 ENDORSEMENT AGREEMENT WAIVER OF SUBROGATION BLANKET BASIS REP D1 9282285-20 NEW SP HOME OFFICE SAN FRANCISCO EFFECTIVE AUGUST 27, 2020 AT 12.01 A.M. PAGE 1 OF ALL EFFECTIVE DATES ARE AND EXPIRING AUGUST 27, 2021 AT 12.01 A.M. AT 12:01 AM PACIFIC STANDARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME TITAN ENVIRONMENTAL SOLUTIONS, INC 1521 E ORANGETHORPE AVE STE B FULLERTON, CA 92831 WE HAVE THE RIGHT TO RECOVER OUR PAYMENTS FROM ANYONE LIABLE FOR AN INJURY COVERED BY THTS POLTCY. WE WILL NOT ENFORCE OUR RIGHT AGAINST THE PERSON OR ORGANIZATION NAMED TN 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. THE ADDITIONAL PREMIUM FOR THIS ENDORSEMENT SHALL BE 2.00% OF THE TOTAL POLICY PREMIUM. SCHEDULE PERSON OR ORGANIZATION ANY PERSON OR ORGANIZATION _ FOR WHOM THE NAMED INSURED HAS AGREED BY WRITTEN CONTRACT TO FURNISH THIS WAIVER JOB DESCRIPTION BLANKET WAIVER OF SUBROGATION NOTHING IN THIS ENDORSEMENT CONTAINED SHALL BE HELD TO VARY, ALTER, WAIVE OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS POLICY OTHER THAN AS STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR LIMITATIONS OF THIS ENDORSEMENT. COUNTERSIGNED AND ISSUED AT SAN FRANCISCO: AUTHORIZED REPRESENT IVE SCIF FORM 10217 (REV.7-2014) AUGUST 26, 2020 PRESIDENT AND CEO 1 2572 OLD DP 217