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PROOF OF INSURANCE (2021 - 2021) CLOSEDJEFFTRA-01 BC,AMPSELL CERTIFICATE OF LIABILITY INSURANCE 1 D11�0/2203Y0 .. 1 ... _ 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 License#CT 71 Orlon Risk k MManagment Insurance Services, An Alera Group Insurance 10. N mExl m: (n 49) 263-8860 „Chic. nla):(949) 263-8860 A enc , ,E t, 1 0 Quail Street„ Suite 110D�ESS. .. _..... . - -w,,,.. .. Newport Beach, CA 92660 y 60RE ,ts1 ArFQnOi . 'GCOVERAGE NAICp giles x.Insurance Cormp;kPYL. .................... 23434 INeIaOw�q,n, Vii'.4 INSURED INSURI'R a :, y,pre'ss lgsq aarr,iewe CpaMpaf>;y (PA) 10856 Land Forms Landscape Construction, Inc. INSURER C 75 Barranca Parkway Suite A-110 INSURER D: Irvine, CA 92618 INSURER E: _.. .... _ .... ... ......... ..... .. _ _ _ tlN'SURER'F . VWRAr_..... REV'ISIO'N 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.TYPE „ ADOIL'6'UII POLICYE'I-"F POILI'CYE'XP NA X COMMERCIAL AOFGINSURANCE F,LOO,mD POLICY NUMBER _ A.1?1 #1 LL.121YY'V aJ. iMNt1;OIY EACH OCCURRENCE OC LIMITS _ ..., ., .� 00 pp ENERA'LLIABILJTY CURRENCE S m. _. 1,06,OOaO AVAS-WADE I X I CCCUR A0131960004 6/3012020 6/3012021 DAMAGE TO RENTED $ 00 000 CL u X PREMISES_(Ea occurrence) DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarlts Schedule, may be attached If more space is required) RE; Acacia Park. City of EL Segundo Is Included as Additional Insured par the terms of the attached CG2010 04131CG2037 0413 Endorsements. Waiver of Subrogation applies per the terms of the attached WC 990410B Endorsement. Digitally signed by Joseph Llllio DN: cn=Joseph Lillio, o=City of EI Joseph L i l l i o Segundo, ou=Director of Finance, email=jllllio@efsegundo,org, c=US Date: 2020,12.2022.24 :fp ,09'00" CERTI'FICATI Hpl,,(rd. ............._.. _ CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION ATE City of EL Segundo ACCORDANCE WITH THE POLICY PR THEREOF, SCE WILL BE DELIVERED IN 360 Main Street El Segundo, CA 90246 - - _,_...................................... AUTHORIZED REPRESENTATIVE 1Ld ACORD 26 (2016103) 11988-2016 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD MED EXPJAny or!o,pdflxn,y 5...,, 10,000 1,000@000 PE94PNAL S AGV INJURY s , 3„000,'000 AGGREGATE LIMIT APP LIES PER GENERAL AGGREGATE S ... .., .0TEN-IES JE I I_-. 1 IDL+CM X„ � _� LOC - "ROOUCTS - C'$7M P+.hCi.Ya. I �.. 2,000,000 CITY ....................... A AUTOMOBILE LIABILITY �fL0BINCID SINGLE WAIT b ,00 1000"0, My ;1,l.l'I'h, A0131960001 6/30/2020 6/30/2021 SOMILY INJD RY1F?®,rp miIn)---- OWNED SCHEDULED AUTOS n11,41 i, AUTOS SOCIL'Y INJUHY iPc�n' Jc� edimli S Y SSE'•, N t� .Mid . ;}� „�y� 109� 111I,m 1 AIdTi7SCIF 5 OPi Y WAGE n Par a.ci, a�rvQ'f ,'S OMPICOLL DED $ 500 UM................................................................... ., A BRELLA LIAR X OCCUR ., ., ......, .,.., .,, EACH OCCURRENCE $ 6,000,000 X EXCE'S'S LIAR CLAIMS•MADEA0131960006 6/3012020 6130/2021 AGGREGATE'I ;8�� '5,000,000 OED X F RET'EtI71CrNS 0 B WORKERS COMPENSATION BgE m _ CR E.. F IY I"N X LAW0117476 �p ICY� N1 NIA 12/112020 12/112021 ACHACCIDENTC1TYd- EACH H $ �M `nUA rjr on NHS EXCLUDED? ::,I,,,. DISEASE III A EPOPLOd .I°° I; 1,000,0010" yy,Lta under Ok9 RIPTION d?'` OPERATIONS, rere6a!w....._. ... , E L 01ALA5E POLIOV' LIMIT 5 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarlts Schedule, may be attached If more space is required) RE; Acacia Park. City of EL Segundo Is Included as Additional Insured par the terms of the attached CG2010 04131CG2037 0413 Endorsements. Waiver of Subrogation applies per the terms of the attached WC 990410B Endorsement. Digitally signed by Joseph Llllio DN: cn=Joseph Lillio, o=City of EI Joseph L i l l i o Segundo, ou=Director of Finance, email=jllllio@efsegundo,org, c=US Date: 2020,12.2022.24 :fp ,09'00" CERTI'FICATI Hpl,,(rd. ............._.. _ CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION ATE City of EL Segundo ACCORDANCE WITH THE POLICY PR THEREOF, SCE WILL BE DELIVERED IN 360 Main Street El Segundo, CA 90246 - - _,_...................................... AUTHORIZED REPRESENTATIVE 1Ld ACORD 26 (2016103) 11988-2016 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: A0131960004 COMMERCIAL GENERAL LIABILITY 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 provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE .....� Name Of Additional Insured Person(s) Or Organization(s) Location(s) Of Covered Operations as required by written contract. as required by written contract. ....................... 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. 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. JZ_ CG 20 10 04 13 ©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 2010 0413 POLICY NUMBER: A0131960004 COMMERCIAL GENERAL LIABILITY CG 20 37 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES 0 CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Persons) Location And Description Of Completed Or Organization(s) Operations as required by written contract. as required by written contract. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. o 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. B. With respect to the insurance afforded to these additional insureds, the following is added to Section Ill - 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. �7L CG 20 37 0413 ©insurance Services Office, Inc., 2012 Page 1 of 1 L7L WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 0410 C (Ed. 01-19) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT -CALIFORNIA BLANKET BASIS 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.) The ,:additional premium for this endorsement shall be calculated by applying a factor of 2% to the total manual piernium, wath a minimum initial charge of $350, then applying all other pricing factors for the policy to this calculated charge to derive the final cost of this endorsement. This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule, Schedule Blanket Waiver Person/Organization Blanket Waiver — Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. Job Description Waiver Premium (prior to adjustments) All CA Operations 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- 12/01/2020 PoficYNo, LAWC117475 Endorsement No.: Insured; Land Forms Landscape Construction, Inc. Premium S Insurance Company: Cypress insurance Company Countersigned by WC990410C (Ed. 01-19)