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PROOF OF INSURANCE (2021 - 2021) CLOSED
I I OF LIABILITY INSURANCE I DATE (MM/DD/YYYY) CERT08/05/2020 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 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 rnnru'aI^� Cerlificale Department NAME: Tutton Insurance Services PF40tJ FAX (949) 261-5335 ).T Nau E�1; P�AI�',wNo.,. (949) 261-1911 2913 S Pullman St Al ONE MAI LEBrenadette Reza or Caitlin Ortiz SS: License #0889376 INSURER(S) AFFORDING COVERAGE MAIC # Santa Ana CA 92705 INSURERA: Middlesex Insurance Company 23434 ...-.. ................._.........._,,.......................................... INSURED ............. INSURER B: Sentry Ins ....................... ................................... ,............ ............ ....... 24988 .w..... ........................ ._ Mako Overhead Door U INSURER C: Michael McCall INSURER D ; 5618 E La Palma AveINSURER E,, Anaheim CA 92807 INSURER F COVERAGES CERTIFICATE NUMBER: 20-21 GL WC XS 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 .......- ...............m INSR TYPE OF INSURANCE AD0.AL SUli l,l POLICY NUMBER LTR INSD IM/D......._........................ LICY EFF POLICY EXP (MMI DIYYYY) (MM/DD/YYYYI _ .__..... LIMITS ......w........... . ........................ X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1'000'000 CLAIMS -MADE 19 OCCUR D,r4wl AOE. 10REN ,IEO PREM 6$ V Eo 6cccarenc9'I $ 500,000 ._.......-................ _ MED EXP (Anv one person} $ 15,000 A A0153044002 08/01/2020 08/01/2021 PERSONAL &ADV INJURY $ 1,000,000 I 3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: V GENERAL AGGREGATE S POLICY,LOC PRODUCTS COMP(OP AGG 2,000,000 $ .mW...........w THER: $ AUTOMOBILE LIABILITY ..-... W01.1E9+LO SINGLE LIR7f crtcL..................... $WEa ANYAUTO BODILY INJURY (Per person) $ OWNED, SCHEDULED BODILY INJURY (Per accident) $ AUTOS ONLY HIRED AUTOS NON -OWNED 1 PR'OFF.RIY DAMAGE _.m...._.,.,.,,-.. S .............. AUTOS ONLY AUTOS ONLY (Per arcldlenll ............................. $ X UMBRELLALIAB (' `{ OCCUR I EACH OCCURRENCE S 3,000,000 A EXCESS LAB CLAIMS-MADE A0153044004 08/01/2020 08/01/2021 AGGREGATE $ 3,000,000 DE p RETENTION $ _._._........... .....�.............................. ............. r_...AND f OTH- R Q ER ER EMPLOYERS„' LIABILITY Y YIN X�EAGHIAGCIDENT E, ,,,,,,,,,,, $ 1,000,000 ANY PROPRIETORIPARTNER/EXECUTIVE B , Y NIA A0153044003 OOFCER/MEMBER EXCLUDED? 08/01/2020 08/01/2021 (Mandatory in . 1-. DISEASE - EA, EMPLOYEE S 1'000'000 If es, describe under 1,000,000 I DESCRIPTION OF OPERATIONS below ._..... .........�...._....,...,......................,.,..�.�..n...,� F I. DISEASE .,.. ,. .Y LIMIT S ..-......._........ ...... DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: All Locations City of EI Segundo, its officials, and employees are named as additional insured per attached CG2010.0413 and CG2037.0413, WC Blanket WOS per W0000313 0484 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of EI Segundo ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main St Rm 5 AUTHORIZED REPRESENTATIVE El Segundo CA 90245-3813 G 7 off/ �rz_ ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD ■ �WAh7!A1W= may W—M ELI I +• ' 0 CG f 10 04 13 This endorsement modifies insurance provided under the following. COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location(s) Of Covered Operations Any person or organization you are required to add as All locations per written contract, agreement or an permit. additional insured under a written contract or Description: agreement All jobs performed that have a written contract, in effect prior to any accident, injury, loss or damage, agreement, or permit. (,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) designated above. 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. CG 20 10 04 13 A0153044 Middlesex Insurance Company 1 00001 0000000000 20212 0 N B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: 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 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 subcontractor engaged in performing operations for a principal as a part of the same project. © Insurance Services Office, Inc., 2012 71 a175e8-7632 4d46-a7d6-3fb717bc4fb0 Page 1 of 2 07/30/2020 C. With respect to the insurance afforded to these additional insureds, the following is added to Section III - 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. Page 2 of 2 © Insurance Services Office, Inc., 2012 CG 20 10 0413 A0 153044 07/30/2020 Middlesex Insurance Company POLICY NUMBER: A0153044002 COMMERCIAL GENERAII... II...IIABIILITY CG 20 37 0413 °T1 111S ENIDOIRSIBIMEIN"T CH I ° "THE: P011 ICY. P11...,EASE I READ 1"T CAIREFUll...JL.Y. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations _............ .......... .............................. ...„................................................................... .....-...�...............,......., Any person or organization you are required to add as All locations and jobs performed that have a written an contract, agreement, or permit. additional insured under a written contract or agreement in effect prior to any accident, injury, loss or damage. 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" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the Schedule of this endorsement performed for that additional insured and included in the "products -completed operations hazard". 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. CG 20 37 0413 A0153044 Middlesex Insurance Company 1 00001 0000000000 20212 0 N B. With respect to the insurance afforded to these additional insureds, the following is added to Section III - 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. © Insurance Services Office, Inc., 2012 ddea3833-3896 4 53-b3s3-ne27b3baeec0 Page 1 of 1 07/30/2020 CERTIFICATE OF LIABILITY INSURANCE PRODUCER: INSURED: Employers Insurance Admin. Corp. 1240 N. Lakeview Ave., Ste. 130 Anaheim, CA 92807-1831 Tel: (714) 970-6500 Lic # 0296134 MAKO OVERHEAD DOOR 561 BE. LA PALMA AVENUE ANAHEIM,CALIFORNIA 92807 FAX# 714-970-2107 Date: 10/05/2020 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND, OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. COMPANIES AFFORDING COVERAGE Company A: CALIFORNIA AUTOMOBILE INS. COMPANT Company B: Company C: Company D: COVERAGES THIS IS TO CERTIFY THAT 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 ITEMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO POLICY POLICY LTR TYPE OF INSURANCE POLICY NUMBER EFFECTIVE DATE EXP.DATE LIMITS GENERAL LIABILITY GEN. AGGREGATE: [X] COMMERCIAL LIAB. PRODUCTS-COMP/OP AGG: [ ] CLAIMS MADE PERSONAL & ADV INJURY: [X] OCCUR EACH OCCURANCE: [ ]OWNERS & FIRE DAMAGE: CONTRACTORS'S PROT (any one fire) [ ] MED EXP: [ ] (any one person) AUTOMOBILE LIABILITY A [X ] ANY AUTO COMBINED SINGLE LIMIT: $1,000,000 [ ] ALL OWNED AUTOS BODILY INJURY: $ [ ] SCHEDULED AUTOS BA040000047308 10/13/2020 10/13/2021 (Per Person) [ X ] HIRED AUTOS BODILY INJURY: $ [X ] NON -OWNED (Per Accident) AUTOS PROPERTY DAMAGE: $ EXCESS LIABILTY [ ] UMBRELLA FORM EACH OCCURANCE: [ ] OTHER THAN UMBRELLA FORM WORKER'S COMP & WC STATUATORY LIMITS EMPLOYER'S LIABILITY THE PROPRIETER'/ EACH ACCIDENT $ PARTNERS/EXECUTIVE DISEASE POL LIMIT $ OFFICERS ARE: EACH EMPLOYEE $ []INCLUDED [ ] EXCL DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/oPECIAL ITEMS Renewal certificate The Certificate holder listed below is named as additional insured CERTIFICATE HOLDER CANCELLATION City of EI Segundo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 350 Main Street BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY EI Segundo, Ca. 90245 WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE g CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILTY OF ANY KIND UPON THE COMPANY, IT'S AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACCORD 25-5 (1-95) &VWA99 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13 (Ed. 4-84) 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 Name: Any person or organization from whom you are required to waiver your right to recover under a written contract or agreement in effect prior to any loss or damage. Address: 5618 E La Palma Ave Anaheim, CA 92807-2110 Description of Waiver: Any person or organization from whom you are required to waive your right to recover under a written contract or agreement in effect prior to any loss or damage. JobID: 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 08/01/2020 Insured Mako Overhead Door Insurance Company WC 00 03 13 (Ed. 4-84) ©1983 National Council on Compensation Insurance. Policy No. A0153044003 Countersigned bi Endorsement No. Premium Page 1 of 1 A0153044003 07/30/2020 Sentry Insurance a Mutual Company 1 00001 0000000000 20212 0 N 1c9d2a73-026c-4f6c-bBcf-O45c86fO66bf