PROOF OF INSURANCE (2021 - 2022) CLOSEDACC CERTIFICATE OF LIABILITY INSURANCE ��3/24/2023.
I1 ,r 3/24 J2021.
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 IN URER('S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED„ the polbcy(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 endorsementIs).
PRODUCER NA.M9E:. Julie Rybak
Har: ._(.9.eal792-2030OI9091792'-55akS Nogg & Foreland Agency, Inc. LFA P
Arroyo, Insurance Services E-MAIL Ss: julier@arroyoins.com
ODRE
........
1E54 Plum lane INSURERS AF'FORI,ING COVERAGE NAIIC y
Redlands CA 92374-45532 INSURERA: Berkley A;asurance Company 39462
INSURED INSURERB.United Financial Casualty Co 11770
California Street Lighting, A California Cora IN'SUIRERC.]Insurance CoTpany of the Guest 27947
32010 Guasti Road #100 INrURER0
Ontario CA 91161
COVERAGES CERTIFICATE NUMBER:
1 INSURER F:
REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO'THIE INSURED NAMED ABOVE FOR THE ffOLICY"PERIOD
INDICATED NOTWITHSTANDING ANY REQUIREMENT TERM OR CONDITION OF ANY
CONTRACT OR OTHER (DOCUMENT WITH RESPECT TO WHICHTHIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSUIIRANCEAF'FORDED BY
THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE: BEEN REDUCED BY PARD CLAIMS,
--
INSR
LTR TYPE OF INSUiRANC[ POLICY NUMBER,
ZWL
POLICY EFF POLICYE%P
MM1IDWYYYY MMMOISPYYYY LIMITS
X COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE $
1,000,000
�
100,000
A CLAIMS -MADE OCCURPRIP�ISES
Ea or,�tilrre e $ ..
L>r71RB01. �62533�
�7,2/1../2020 12/1./202.1 MIED EXP vF r)y ane� p3 rsonJ '... $
Excluded '.
- ....... _
PERSONAL & ADV (INJURY S
1,000,000
G'EN L AGGREGATE LIMIT APPLIES PER:
CE-N.,,,AI ACaCaRI^4':;YMTk ¢
2,000,000
X PRO-Ela
PR(7ri.1UCTS - OJC>fwll'91GI ACu S�...
r
2,000,00�0
POLICY I,IIECT LOC
$
CTI HER
AUTOMOBILE LIABILITY '
0l0RtsINCI1 SINGLE LIMIT $
f a„ac drnk
1, 000 , 000
ANY AUTO
BODILY`Ter Iaersen� $
ALL OWNED SCHEOIA'FI1:r 06588638-3
..
2/23/2021. 2/23/2022 BODILY INJURY (Per iIwdenC1 '$
AUTO$ A,ITO$
NGN-C'',NNEO
- �m-
P�S"YCI'ERT1'ILiAMAGA••-. ,S
.
X HIREDAUTOS NJT0S
Ix
Peracgid nl
i $
UMBRELLA LIAB 7C OCCUR
EACH OCCURRENCE $
2 000,000
A X EXCESS LIAB tAMS MADE
AGGREGATE $
2,000,000
QEO I.... RETERPON $ vU1,n30152553
12/1/2.020 12/1/2..021 $
WORKERS COMPENSATION
."PT+1 -LL' E6e -
.AND EMPLOYERS" LIABILITY
AN 1PEXEC�U1IVE
E L. EACH ACCIDENT $
1,000,000
ICLF0MEFTQRAC.LUt EI MIA
C (Mandatory InNH) wVz 5058158 0C
12/1/2020 1.2/3/2021 EI, DrSEASL..EAEMPLOYE.0 $
1 000,000
IS yes desArdlne Iander
DESC RIPI ION OF OPERATIONS Rtelwv
E L D] SEASE -POI ICY I If.,1IT S
11000,000
DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES IA.COR.O 101 Additional Remarks Schedule, nnay he attached if morer. space is required)
CERTIFICATE HOLDER
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of El. Segundo
ACCORDANCE WITH THE POLICY PROVISIONS.
350 Main. Street
l Segundo, CA 90245
AUTHORIZED REPRESENTATIVE
Julie Id'p^L a kr /,JULiF;
19888-2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014101) The ACORD name and logo,
are registered marks of ACORD
IN:S025 (2cn401j
COMMERCIAL GENERAL LIABILITY
CG 20 10 12 19
ADDITIONAL INSURED - OWNERS, LESSEES OR
i
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 .p n 0 r �10o9
Location (s)O,CR)ere'. 0�jatjons
As required by written contract executed prior i As designated in written contract with the Named
to the date of occurrence but only to the extent Insured,
permitted by law. 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,
Information required to, complete this Schedule, of not shown above, will be shown in the Declarations.
A. Section 11 -- Who Is An Insured is amended to 2.
If coverage provided to the additional insured is
include as an additional insured the person(s) or
required by a contract or agreement, the
organization(s) shown in the Schedule, but only
insurance afforded to such additional insured
with respect to fiabilRy for "bodily injury", "property
will not be broader than that which you are
damage"' or "personal and advertising injury"
required by the contract or agreement to
caused, in whole or in part, by:
provide for such additional insured,
1. Your acts or omissions; or
2. 1'he 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
CMG 20 10 121 Oc Insurance Services Office, Inc.,, 2010 page 1 of"3
B V\Ath 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 insure,d(s), at the
iocation 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,
Page 2 of 3 0 insurance Services Office, Inc., 2018 CG 20 10 12 19
C. With respect to! the insurance afforded to the"
additional insureds, the following is added
Section III — Uttlits0finsuraice:
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 lirnis of
insurance;
whichever is less.
This endorsement shall not increase the
applicable I,ifats of insiurance.
CG 20 10 12 19 t insurance Services Office, Inc., 2018 Page 3 of 3
POUCYNUMBER: VU14B0162533
'111tf "MM;Rri
Kq$]k
This endorsement modifies Insurance provided under the following.
VX-M*-"4 ffiffAMNAM
CG 20 3,7 12 12
0
SCHEDULE
Name Of Additional Insured Ferson(s)
Or OrganLzatiop
dO
Location And Descr .--R!q2---Perations
As designated in written contract with the Narned
As required by written contract executed prior
Insured,
to the date of occurrence but only to the extent
permitted by law and 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,
. ... .. . .....
i Informationj �red to commaNete t�his. Schedule, if not shown abovewill be shown in the Declarations,
A. Section 11 — Who Is An Insured is amended to
Z If coverage provided to the additional insured is
include as an additional In,sured the persons) or
required by a contract or agreement, the
organization(s) shown in the Schedule, but only
insurance afforded:, to such additional insured
with respect to liability for "bodily injury" or
by
will not be broader than that which you are
required by the contract or agreement to
"property damage" caused, in whole or in part,
"your work" at the location designated and
provide for such additional Insured,
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
CG 20 37 12 19 C Insurance Services Office, tnc., 2018 Page I of 2
I. With respect to the insurance afforded to these
additional iinsureds, 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,
arnount of insurance:
1, Required by the contract or agreement; or
2. Available under the applicable limits of
insurance;
whichever is less.
This endorsement shall not increase the
applicable limits of insurance.
Page 2 of 2 @ Insurance Services Office, Inc., 2018 CG 20 37 12 19
This endorsement modifies insurance provided under the following:
I W 24101111111191 molt] kh I UM a I M WIN a U.11 I M v 1.2 M 1.
Wth respect to coverage provided to an additional insured via attachment of an AdditionaI Insured endorsement to
this policy, such coverage is primary insurance and we will not seek contribution from any other insurance available
to that additional insured!.
qp;11
i
VCAS2035 11 10 Page 1 of 1
"OLICY NUMBER!: VUMB0162533 COMMERCIAL GENERAL LIABILIT',�
CG 24 04 12 19
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
WAIVER OF TRANSFER, OF RIGHTS OF RECOVERY
AGAINST OTHERS TO US (WAIVER OF SUBROGATION)
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
ELECTRONIC DATA LIABILITY COVERAGE PART
LIQUOR LIABILITY COVERAGE PART
POLLUTION LIABILITY COVERAGE PART DESIGNATED SITES
POLLUTION LIABILITY LIMITED COVERAGE PART DESIGNATED SITES
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
RAILROAD PROTECTIVE LIABILITY COVERAGE PART
UNDERGROUND STORAGE TANK POLICY DESIGNATED TANKS
Name Of Person(s) Or Organ ization (s)'
Any person or organization to whom or to which you are obligated by virtue of a written contract to waiver your
right of recovery.
Information rectuired to complete this Schedule, if not shqw�i_above_,v tit be shown in-t e,
The following is added to Paragraph 8. Transfer Of
Rights Of Recovery Against Others To Us of
Section IV-- Conditions:
We waive any right of recovery against the person(s)
or organization(s) shown in the Schedule above
because of payments we make under this Coverage
Part, Such waiver by us applies only to the extent that
the insured has waived its right of recovery against
such person(s) or organization(s) prior to loss. This
endorsement applies only to the person(s) or
organization(s) shown In the Schedule above
CG 24 04 12 19 0 Insurance Services Office, Inc,, 2018 Page, 1 of 1
13
We have the right to recover our payments from anyone liable for an injury covered by this policy. We will riot 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 agreen-Lent from us).
The additional) premium for this endorsement shall be
otherwi:se due.
2 % of the total California Workers' Compensation premium
job Description
ALL CA OPERATIONN
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 endorsermnt Is issued subsequent to preparation of the trcy.)
Endorsement Effective 12/1/20 Policy No. WVE 50581,58 00 Endorsement No,
Insured CALIFORNIA STRF= LIGHTING Premium$ INCL.
Insurance Company INSURANCE COMPANY OF THE WEST
Countersigned By