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PROOF OF INSURANCE (2020 - 2021) CLOSEDClient#: 1255108 305A1 ENT ACORD,. CERTIFICATE OF LIABILITY IINSURANCEDATEIMMMDNYYY) 9/10/2020 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 any rights to such endorsement(s). PRODUCERMcGriff Insurance Servicesthe certificate holder in lieu of INTACT NAME, Arlie Mosier P'AoR Ext): 714 941-2800G,Noll 877-297-1116 2400 E Katella Ave Suite 1100 E-iM1AML gme amosler riffinsurance.com DDREs Anaheim, 92806 As: INSURER(S) AFFORDING COVERAGE I NAIC # II 714 941-280000 INSURER A: Indian Harbor Insurance Company u36940 II INSURED INSURER B :Preferred ssional Insurance Co 136234 0 A-1 Enterprises Inc. Travelers Indemnity u INSURER C : mnity Co of CT .............................-10948_............. dba A-1 Fence Company INSURER D: 25662 II 2831 E. La Cresta Ave. INSURER E: 4 Anaheim, CA 92806 -- mm...mm. ..�.,.. .._.....m......_...._. INSURER F: r 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 CONTRACTOR 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 ADDLI$UaR PO IC ErF a POLICy EXP ............. L R TYPE OF INSURANCE POLICY NUMBER IiMM/DD — IN3.f? 4 . ...... ......,,,,,, ¢MM ! fM h Y YO LIMITS A X COMMERCIAL GENERAL LIABILITY ESG0055503 12/01/2019 12/01/202 I gE��AACH��OCCURRENCE $1,000,000 CLAIMS -MADE OCCUR IAAISESEeI Ieundncsl $100,000 X BI/PD Ded:5,000 I MED EXP (Any one person) 45,000 ,,,,,-,,,,„ ....... _,,,,,,,,......... I PERSONAL & ADV INJURY $1,000,000 GENI. AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY � J CT LOCI PRODUCTS - COMP/OP AGG I $2,000,000 OTHER: I $ C AUTOMOBILE LIABILITY 810211665871 08129/2020 01/01/2021kBOD1Y �$1,000,000 ANY AUTO INJURY (Per person) I $ AUTOS AUTOS SCHEDULED a BODILY INJURY (Per accident) I $ XyI HIRED NON -OWNED PROPERTY DAMAGE AUTOS ONLY X AUTOS ONLY V IPor arcidenll $ $ UMBRELLA LIAR OCCUR EACH OCCURRENCE_J $ EXCESS LIAR CLAIMS -MADE I AGGREGATE $ I DED. V I RETENTION 5 _ B WORKERS COMPENSATION _ ON0872702 01/01/2020 01/01/2021 X PER' mm' OTH- $ ANO' EMPLOYERS" LIAaI'LtTY YIN 7 FR ANY PROPRIETORIPARTNERIE.XECUTIVE E.L. EACH ACCIDENT $1,000,000 OFFICERlMEMBER EXCLUDED? F7 N I A (Mandatory In NH) IE.LDISEASE - EA EMPLOYEE $1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE-PpUGYLIMIT $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 101. Additional Remarks Schedule, may be attached If more space Is required) RE: On Call Fence Repair Services on City -Owned Facilities (All Operations) City of EI Segundo, its officials, officers, agents and employees are named as additional insured as respects general and auto liability, this insurance is primary and noncontributory with any other insurance of the additional insured; waiver of subrogation applies as respects workers compensation as required by written contract, per endorsements attached. CERTIFICATE HOLDER City of EI Segundo I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Public Works Department ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street EI Segundo, CA 90245 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) 1 of 1 The ACORD name and logo are registered marks of ACORD #S26462862/M26386824 ACMOS POLICY NUMBER: ESGO055503 COMMERCIAL GENERAL LIABILITY CG 2010 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 GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): AS REQUIRED BY WRITTEN CONTRACT SIGNED BY BOTH PARTIES PRIOR TO LOSS Location(s) Of Covered Operations ALL LOCATIONS 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 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: 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) desig- nated above. B. With respect to the insurance afforded to these additional insureds, the following additional exclu- sions apply: This insurance does not apply to "bodily injury' or "property damage" occurring after: 1. All work, including materials, parts or equip- ment 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 in- tended use by any person or organization other than another contractor or subcontractor en- gaged 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 ❑ COMMERCIAL GENERAL LIABILITY CG 20 01 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance Condition and supersedes any provision to the contrary: Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and (2) You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. CG 20 01 0413 © Insurance Services Office, Inc., 2012 Page 1 of 1 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC ON 04 WS A (Ed. 01-19) 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. Blanket Waiver: The additional premium for this endorsement shall be 2% of the California workers' compensation premium otherwise due on such remuneration. Specific Waiver: The additional premium for this endorsement shall be 5% of the California workers' compensation premium otherwise due on such remuneration. Schedule Person or Organization Job Description Blanket Waiver of Subrogation As respects to all CA jobs performed by the named insured during the policy period where by written contract a waiver of subrogation is required prior to the commencement of work. 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: 01/01/2020 Insured A-1 Enterprises, Inc. dba A-1 Fence Company Print Date: 12/23/2019 Policy No.: ON08727 - 02 Endorsement No.: Insurance Company Preferred Professional Insurance Company Zrova �1 C Countersigned By