PROOF OF INSURANCE (2021 - 2021) CLOSED'& I DATE (MMIDD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE
12/01/2020
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 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 NAME: f SILVI CRA
INSURANCE L !NSURANCE SERVICES PHONE Fax _71
(A/O,.Mo, Extb:, ,.,(ArCp Nol:,,,,,,,,
213-388-5505 -48
4032 WILSHIRE BLVD E-MAIL
ADDRESS: INSUR CEL IL. CO
SUITE 309 INSURER($) AFFORDING COVERAGE NAIL #
LOS ANGELES CA 90010 INSURERA: EVANSTON INSURANCE COMPANY 35378
INSURED INSURER B: STATE FARM
VALLEY MAINTENANCE CORPORATION INSURER C: UNI TED STATES LIABILITY INS. CO. 25895
INSURER D:ICW GROUP 27847
11759 TELEGRAPH ROAD INSURER EITRAVELERS CASUALTY AND SURETY CO. 19038
SANTA FE SPRINGS CA 90670 INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POJ_ICIES 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.
I'INSR ADDT SU'BR POLICY EFF POLICY EXP
IN ., Cb."6 ..�.„�... POLICY NUMBER (MM/DD/YY Y) : (MM/DD/YYYY),..,.-... _
I..TR TYPE OF INSURANCE LIMITS
II COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE_ 1 $ 1,000,0001
3 414169 08/13/2020 OB/13/2021 DAMgG RENTED-
CLAIMS -MADE 1z OCCUR PRI7'MJS,F,,,„(Fa,gCcuranga) $ 100,000
PRIMARY NON-CONTRIBUTORY MED EXP (Any one person) $ 51000
A XPERSONAL & ADVINJURY $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
POLICY I'0
�L.0PRODUCTS $ INCLUDED
OTHER: 11
� T $25000
AUTOMOBILE LIABILITY H
II COMBINED SINGLE LIMIT $ 2,000,000
Ea accident
6838202C12-75 09/15/2020 03/15/2021"( )
ANY AUTOperson) $
BODILY INJURY (Per
B ALL OWNED SCHEDULED X BODILY INJURY (Per accident) $
AUTOS AUTOS
NON -OWNED PROPERTY DAMAGE
HIRED AUTOS AUTOS (Per acMtdentl $
AGGREGATE $ 1,000,000
UMBRELLA LIAB OCCUR XL1578400C 05/02/2020 05/02/2021 EACH OCCURRENCE $ 5,000,000
C EXCESS LIAB CLAIMS -MADE AGGREGATE $ 5,000,000
DED.I.. I RETENTIONS... ,..
PRODUCTS-COM/OP AcG $ 1,000,000
WORKERS
N PER 01
AND
ANY PR®FRIEEOR/PAR®N®REXECUTIVE YIN W3 5037498 03 08/13 /2020 06/13/2021 ELISTATUTE EACHACCI� 'ER,
H 1®000®000
ED?
D OFFICER/MEMBER
TION under
OPERA® ONS halnv Y� NIA X E L DISEASE -POLICY LIMIT $ 11000,00 ®®®®®®®
If yes, describe unN
(mandatory in NH)
ELDisEASE- EAEMPLo $ 1,000,000
E CRIME 105620659 05/24/2020'1105/24/2021 THIRD PARTY $1,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached If more space is required)
HOLDER: CERTIFICATE 1 •
CERTIFICATE HOLDER- CANCELLATION
THE CITY OF EL SEG DO SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
350 MAIN ST
AUTHORIZED REPRESENTATIVE
L SEGUNDO CA 90245
@1988-2014ACO DCORPORATION. All rights reserved.
ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
POLICY NUMBER: 3AA353541
COMMERCIAL GENERAL LIABILITY
CG 20100413
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
Name Of Additional Insured Person(s)
Or Organization(s)
The City of El Segundo
350 Main St
El Segundo, CA 90245
SCHEDULE
Various
Location(s) Of Covered Operations
Information reouired to comolete 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 lextent permitted by
law; and 1
Z If coverage provided to the additional insured is
required by a contract or agreement, the
insurance afforded to such additional insured
wilt not be broader than that which you are
required by the contract or agreement to
provide for such additional insured,
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.
CG 20 10 0413 0 Insurance Services Office, Inc., 2012 Page 1 of 2
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 0 Insurance Services Office, Inc., 2012 CG 20 10 04 13
COMMERCIAL GENERAL LIABILITY
CG 20 0104 13
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
PRIMARY AND NONCONTRIBUTORY -
OTHER INSURANCE CONDITION
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 0104 13 @Insurance Services Office, Inc., 2012 Page 1 of 1
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE FORM
SCHEDULE
Name Of Person Or Organization,
The City of El Segundo, 350 Main St, El Segundo, CA 90245
The following is added to Condition 8, Transfer Of Rights Of Recovery Against Others To Us under Section IV —
Commercial General Liability Conditions:
We waive any right of recovery we may have against the person or organization shown in the Schedule of this
endorsement with respect to written contracts that exist between you and such person or organization, provided you have
agreed in writing to furnish this waiver, This waiver applies only to the person or organization shown in the Schedule of
this endorsement.
All other terms and conditions remain unchanged.
MEGL 0241 05 16 Includes copyrighted material of Insurance Services Office, Inc., Page I of I
with its permission.
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 06 34
(Ed. 8-00)
WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - BLANKET
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 wdrk under a written contract that requires you to obtain this agreement from us).
The additional premium for this endorsement shall be 2 % of the total California Workers' Compensation premium
otherwise due.
Schedule
Person or Organization Job Description
ANY PERSON / ORG ALL CA OPERATIONS
WHEN 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 08/13/2020 policy No. WSA 5037498 03 Endorsement No,
Insured VALLEY MAINTENANCE CORPORATION Premium $ INCL.
Insurance Company INSURANCE COMPANY OF THE WEST
Countersigned By
WC 99 06 34
(Ed. 8-00)
WSURE)