PROOF OF INSURANCE (2022) CLOSEDIIITY INSURANCE DATE(MM,DD,YYYY)
CERTIFICATE OF LIA D6,D7,2D21
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 O
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED m
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,. it
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 N M iSCT (D
Aon Risk Insurance services West, Inc. (g66) 283-7122 FAX <800) 363-0105
Los Anggeles CA office
707 wilshire Boulevard ADDRESS: _
Suite 2600
LOS Angeles CA 90017-0460 USA INSURER(S) AFFORDING COVERAGE NAIC #
INSURED INSURER A: Starr Indemnity & Liability Company 38318
West Coast Arborists, Inc. INSURERB: Starr specialty Insurance Company 16109
2200 E Via Burton
INSURERC:
Anaheim CA 92806 USA
INSURER D:
INSURER E:
INSURER F:
r" "
COVERAGES CERTIFICATE NUMBER: 570067661032 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, Limits shown are as re uested
POLIO
L,TR' NSD WVADOL Y NUMBER MMIDD�YYi"V MYDDIYYYY LIMITS
X COMMERCIAL GENER�A-L EACH OCCURRENCE $2 , 000, 000
LLgIABILITY
$1,000,000
CLAIMS -MADE p x (OCCUR PREMISES gzoccurrence
u IVIED EXP (Any one person) $ 5 , 000
PERSONAL& ADV INJURY �$2,000,000
M
GEN'LAGGREGATELIMITAPPLIESPER; GENERAL AGGREGATE $410001000
co co
PRO -
POLICY E]JECT LOC PRODUCTS - COMP/OPAGG $4,000,000OD
0
OTHER:
0
A AUTOMOBILE LIABILITY 1000198198211 07/01/2021 07/61/2022 COMBINED SINGLE LIMIT $2 , 000 , 000
fCn snnidanl\
BODILY INJURY ( Per person)
O
ANYAUTO
Z
BODILY INJURY (Par accident)
SCHEDULED
rd„
OWNED
AUTOS ONLY AUTOS
E
.PROPERTY DAMAGE
v
HIRED AUTOS NON -OWNED
(Per accident)
ONLY AUTOS ONLY
1:
UMBRELLA LIAB OCCUR
EACH OCCURRENCE
AGGREGATE'
EXCESS LIAR CLAIMS -MADE
A
WORKERS COMPENSATION AND
1000004229
0710112021''0
71011202Z
X PER STATUTE OTRH.
EMPLOYERS' LIABILITY YtN
.. ANY PROPRIETOR / PARTNER / EXECUTIVE
'workers Comp AZ
1000004228
07/01/2021
07/01/2022
E.L. EACH ACCIDENT
$1.000,
-,
B
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
N/A
Workers Comp CA
E.L. -EA EMPLOYEE
DISEASE
$1,000
If yyes, describe under
nFRCRIPTION OF OPERATIONS below
E.L. DISEASE -POLICY LIMIT
$1, 000,
DESCRIPTION' OF OPERATION „.# I LOCATIONS P VEHICLES (ACORD 101, Additional Rornarks Schad:u�le, maybe attached if more apace Is required)
The City of El Segundo, its officials, and employees are included as Additional insured in accordance with the policy
provisions of the General Liability policy and Automobile Liability policies. General Liability policy evidenced herein are
Primary and Non -Contributory to other insurance available to an Additional insured, but only in accordance with the policy's
provisions. A waiver of Subrogation is granted in favor of Additional insured in accordance with the policy provisions of the
Workers Compensation policy.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE .-.,
EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE
POLICY PROVISIONS.
City of El Segundo AUTHORIZED REPRESENTATIVE
350 Main street
E1 Segundo CA 90245 USA IQ
70
aI� �Gf� �Gfit�iC>?O /lY�! ✓ eta �
01988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
POLICY NUMBER: 1000100141211
Effective: 07/01 /2021
COMMERCIAL GENERAL LIABILITY
CG20100413
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
NDDITIONALOWNERS, • ,
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
Where Required By Written Contract Where Required By Written Contract
Information required to complete this Schedule, 4f 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
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
applicable Limits of
Declarations.
shall not increase the
Insurance shown in the
CG 20 10 04 13 0 Insurance Services Office, Inc., 2012 Page 1 of 1
POLICY NUMBER: 1000100141211
Effective: 07/01 /2021
COMMERCIAL GENERAL LIABILITY
CG 20 37 04 13
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
SCHEDULE
Name Of Additional Insured Person(s) Or Location And Description Of Completed
Organizations ; Operations
Where Required By Written Contract Where 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" 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 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.
CG 20 37 04 13 0 Insurance Services Office, Inc., 2012 Page 1 of 1
r tiW . Starr Indemnity & Liability Company
Dallas, TX 1-866-519-2522
Primary and Non -Contributory Condition
Policy Number: 1000100141211
Named Insured: West Coast Arborists, Inc.
This endorsement modifies insurance provided under the:
Effective Date: July 1, 2021 at 12:01 A.M.
Commercial General Liability Coverage Part
A. SECTION IV — CONDITIONS, condition 4. Other Insurance is amended as follows:
1. The following is added to paragraph 4.a. of the Other Insurance condition:
This insurance is primary insurance as respects our coverage to the additional insured, where the written
contract or written agreement requires that this insurance be primary and non-contributory. In that
event, we will not seek contribution from any other insurance policy available to the additional insured
on which the additional insured is a Named Insured.
ALL OTHER TERMS AND CONDITIONS REMAIN UNCHANGED,
Signed for STARR INDEMNITY & LIABILITY COMPANY
Steve Blakey, President
Nehemiah E. Ginsburg, General Fouinsel
OG 107 (04/11) Page 1 of 1
Copyright ® C. V. Starr & Company and Starr Indemnity & Liability Company. All rights reserved.
Includes copyrighted material of ISO Properties, Inc., used with its permission.
POLICY NUMBER: 1000198198211 COMMERCIAL AUTO
CA20481013
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
This endorsement modifies insurance provided under the following:
AUTO DEALERS COVERAGE FORM
BUSINESS AUTO COVERAGE FORM
MOTOR CARRIER COVERAGE FORM
With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless
modified by this endorsement.
This endorsement identifies person(s) or organization(s) who are "insureds" for Covered Autos Liability Coverage
under the Who Is An Insured provision of the Coverage Form. This endorsement does not alter coverage
provided in the Coverage Form.
This endorsement changes the policy effective on the inception date of the policy unless another date is indicated
below.
Named Insured: West Coast Arborists, Inc.
Endorsement Effective Date: 07/01/2021
SCHEDULE
Name Of Person(s) Or Organization(s):
Where required by written contract
Information required to complete this Schedule, if not shown
Each person or organization shown in the Schedule is
an "insured" for Covered Autos Liability Coverage, but
only to the extent that person or organization qualifies
as an "insured" under the Who Is An Insured
provision contained in Paragraph A.I. of Section II —
Covered Autos Liability Coverage in the Business
Auto and Motor Carrier Coverage Forms and
Paragraph D.2. of Section I — Covered Autos
Coverages of the Auto Dealers Coverage Form.
will be shown in the Declarations.
CA 20 48 10 13 0 Insurance Services Office, Inc., 2011 Page 1 of 1
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY
WC 04 03 06
(Ed. 04-84)
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.
The additional premium for this endorsement shall be 2 . o 0 of the California workers' compensation premium
otherwise due on such remuneration.
Schedule
Person or Organization Job Description
Any person or organization to whom you become obligated to waive Where required by contract
your rights of recovery against, under any contract or agreement you
enter into prior to the occurrence of loss.
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: 07/01/2021 Policy No.: 100 0004228 Endorsement No.:
Insured: West Coast Arborists, Inc. Premium:
Insurance Company: Starr Specialty & Liability Company Y Countersigned by,
WC 04 03 06
(Ed. 04-84) Page 1 of 1