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PROOF OF INSURANCE (2021 - 2021) CLOSED
Client#: 1291580 04CORRACON DATE (MM/DD/YYYV) ACORD,. CERTIFICATE OF LIABILITY INSURANCE 112/15/2020 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. ----------------- IMPORTANIf 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME. McGriff Insurance Services PHONe 888 743-2217 - ' LAt( mj �,� No) 8888279861 7701 Airport Center Dr E I $Ulte18OO INSURER A: ColonylnlsuranceCompanyG.coV'ERAtE 39993NAIC#.... Greensboro' NC 27409 INSURED.....�__--__..-.--- ...................-.. .. ��w................--------......................... ............ a ................ INSURER B: State Compensation Ins. Fund of A 076 Corral Construction & Development Inc INSURER O: Ohio Security Insurance Company �25062 5211 E. Washington Blvd. #2-122 ...R........_ .............. ......... __.....__ ......... Commerce, CA 90040 INSURER D ............ ......_............ INSURER E INSURER F 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.. INSFi, AC7DLSUF3R NUMBER LA TYPE OF INSURANCE _IN$9 WV POLICY ........... .. MMNDYI) (MNWDYV).i... LIMITS .. ..,, L 4 m.......a ...- ..- .................... COMMERCIALGENERAL LIABILITY 41300 1O1GLO19O 2/08/2020 12/08/2021 L-..,, 2�000, 00 �.... .... OCCUR CLAIMS -MADE X �EACH ,.,.... ._ ��OCCURRENCE � E 5 11 I .. MS k .curR rtiw.. $ 100r000 X BI/PD Ded 500 .„, n person) $5'O0001 _ . ........ v INJURY 0 C PERSGNA(LaAD$ 2 OO OO ENLAGGREGATE APPLIES PER NE GERALAGGREGATE ,$3,000000 ILLIMIT POLICY [7 JECT El LOC PRODUCTS -COMP/OP AGG $3,000,000 OTHER: C .. BAS5 ......7 AUTOMOBILE LIABILITY 746683 _ $ j 2/OS/2020 j 2/O$/2O2j COMdINi=D SINGLE tl.Wkat9i 1 "OOO,OOO ..... ANY AUTO BODILYINJURYPer person)",, WNED SCHEDULED -_ .. BODILY INJ INJURY (Per accident) ( $ AUTOS AUTOS ONLY AUTOS X HIRED X NON -OWNED J - , ROF imRTY f '.1. AOUTOS ONLY AUTOS ONLY Pe toa.+denlGbAMAGi _;... �...._ f$ ,_............. ---� - .... AB UMBRELLA �..,,.., ,.. ._.-......-.... ... ..,, ._ ___ EACHOCCURRENCE.. EXCESS L AL �� ........ OCCUR MADE AGGRE". ATE � $ DED RETENTION $ .... --t. 1--- . .....- ........ „ .. ...------ X,,. 903611819 WORKERS COMPENSATION B $ 1............. .... ......... .2 — ... -.......- OTH PER 2/O1/2020 12/O1/2O21ImE. UT AND EMPLOYERS' LIABILITY V / N.� Y ITT OFFICER/MEMBER/EXRLUDRD ECUTIVE '- N/A -�FP, $1,OODa000 � LEACH A "-` 1 (Mandatory in NH) $ccIDENT E,L DISEASE EA EMPLOYEE S1,000,000 If yes describe under DESCRIPTION OF OPERATIONS below �. _ �..� .......�....._...... LIMIT ! $1 OOO,OOO E L DISEASE POLICY ...J. DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) ** Workers Comp Information ** Proprietors/Partners/Executive Officers/Members Excluded: Ernesto Corral, President Renee Soto, Vice -President (See Attached Descriptions) CERTIFICATE HOLDER CANCELLATION City of El Segundo 350 Main Street El Segundo, CA 90245 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 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) 1 of 2 The ACORD name and logo are registered marks of ACORD #S26950065/M26950061 LRN SAGITTA 25.3 (2016103) 2 Of 2 #S26950065/M26950061 101 GL 0003161-06 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 Oroanization(s1 I Location(s) Of Covered Operations AS DESIGNATED IN WRITTEN CONTRACT WITH THE I All Commercial and/or Residential-Remodel/Repair NAMED INSURED work as required by written contract with the insured 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. C. With respect to the insurance afforded to these 2. Available under the applicable Limits of CG 20 10 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 2 101 GL 0003161-06 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 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 04 13 101 GL 0003161-06 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 Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV — Conditions: We waive any rights of recovery we may have against any person or organization because of payments we make for injury or damage resulting from your ongoing operations or "your work" done under a contract with that person or organization and included in the "products -completed operations hazard" if: a. you agreed to such waiver; b. the waiver is included as part of a written contract or lease; and c. such written contract or lease was executed prior to any loss to which this insurance applies. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. U047-0310 Includes copyrighted material of ISO Properties, Inc., Page 1 of 1 with its permission. ENDORSEMENT AGREEMENT WAIVER OF SUBROGATION 9036118-20 RENEWAL SP 2-83-35-91 PAGE 1 HOME OFFICE SAN FRANCISCO EFFECTIVE DECEMBER 1, 2020 AT 12.01 A.M. ALL EFFECTIVE DATES ARE AND EXPIRING DECEMBER 1, 2021 AT 12.01 A.M. AT 12:01 AM PACIFIC STANDARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME CORRAL CONSTRUCTION & 5211 E WASHINGTON BLVD STE 2 COMMERCE, CA 90040 ANYTHING IN THIS POLICY TO THE CONTRARY NOTWITHSTANDING, IT IS AGREED THAT THE STATE COMPENSATION INSURANCE FUND WAIVES ANY RIGHT OF SUBROGATION AGAINST, CITY OF EL SEGUNDO WHICH MIGHT ARISE BY REASON OF ANY PAYMENT UNDER THIS POLICY IN CONNECTION WITH WORK PERFORMED BY, CORRAL CONSTRUCTION & IT IS FURTHER AGREED THAT THE INSURED SHALL MAINTAIN PAYROLL RECORDS ACCURATELY SEGREGATING THE REMUNERATION OF EMPLOYEES WHILE ENGAGED IN WORK FOR THE ABOVE EMPLOYER. IT IS FURTHER AGREED THAT PREMIUM ON THE EARNINGS OF SUCH EMPLOYEES SHALL BE INCREASED BY 03%. NOTHING IN THIS ENDORSEMENT SHALL BE HELD TO VARY, ALTER, WAIVE OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS POLICY OTHER THAN AS ABOVE STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR LIMITATIONS IN THIS ENDORSEMENT. COUNTERSIGNED AND ISSUED AT SAN FRANCISCO: AUTHORIZED REPRESENT p'V"E SCIF FORM 10217 (REV.4-2018) DECEMBER 28, 2020 PRESIDENT AND CEO 2570 OLD DP 217