Loading...
PROOF OF INSURANCE (2021 - 2022) CLOSEDACCORD® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 8/24/2021 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 Orr & Associates Insurance Services 28780 Single Oak Dr 255 CONTACT NAME: Certificates PHONE FAX A/C No Ext : 800-311-3081 A/c, No): 800-474-3003 E-MSte ADDRESS: certs@orrandassociates.com INSURER(S) AFFORDING COVERAGE NAIC# Temecula CA 92590 INSURERA: James River Insurance Company 12203 License#: OE63493 INSURED RAMEROO-01 Ramey Roofing Inc 1411 11th Street INSURERB: State Compensation Ins Fund 35076 INSURERC: INSURERD: Santa Monica CA 90401 INSURER E INSURER F : COVERAGES CERTIFICATE NUMBER: 1805411464 REVISION NUMBER: 2 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. INSR LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF MM/DD POLICY EXP MM/DD LIMITS A X COMMERCIAL GENERAL LIABILITY Y Y 000925902 6/7/2021 6/7/2022 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ 50,000 MED EXP (Any one person) $ 5,000 PERSONAL &ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY � PE� LOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY UMBRELLALIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LAB CLAIMS -MADE DED RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N Y 9162512-2021 6/28/2021 6/28/2022 X PER OTH- STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 1,000,000 OFFICE R/M EMBER EXCLUDED? ❑ N/A E.L. DISEASE - EA EMPLOYEE $ 1,000,000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) Certificate is subject to policy limits, conditions and exclusions. City of El Segundo, Its Officials & Employees are named as Additional Insured as per policy endorsement form(s). CG2404-0509 Waiver of Subrogation - Where required by Written Contract AP5031 US-0410 Primary and Non Contributory CG2010-0704 Additional Insured - Owners, Lessees or Contractors Where required by written contract or written agreement. All operations of the Named Insured 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. Its Officials & Employees AUTHORIZED REPRESENT WE 350 Main Street El Segundo CA 90245��,, @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD ACAORV DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 02/05/2021 THIS CERTIFICATE IS ISSUED ASA 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 t confer rights to the certificate holder in lieu of such endarsement(s). PRODUCER es may require an endorsement Astatementonthlscertlficae�doMeco,® - _ conditions of thepdicy.certalnpoltl � CONTACT Jodi Bush Jodi Bush PHONE FAX 43545 17th St W Ste 503 (A/C, NO, E)CT1: 661-942-6685 (A/C, No): 661-729-2142 E-MAIL ADDRESS: jbushl@farmersagent.com Lancaster CA 93534-5858 INSURER(S)AFFORDINGCOVERAGE NAIC# INSURED INSURERA Truck Insurance Exchange 21709 INSURERS: Farmers Insurance Exchange 21652 RAMEY ROOFING INC INSURERC: Mid Century Insurance Company 21687 221 1 /2 ARENA ST INSURER O INSURER E EL SEGUNDO CA 90245 IN SURERF: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: I F-IIS IS 10 CER I FY THAI T HL POLICIES OF INSURANCE LIS I EU BELOW HAVE BEEN ISSUED TO I HE INSURED NAME ABOVE FOR I HE POLICY PERIOD INDICAI ED, NOI WI T HSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT -TO WHICH THIS CERTIFICA'rF MAY BE NSUED OR MAY PERTAIN. THE IN.SURAN'CF AFFORDED BY THE POIJICIESDEiSC:RIBED IIEREINISSJf3JEC1 TOALL 'THETERMS, EXCLUSIONS AND CONDITIONS OFSUCl/POLICIES LIMITS SIIOWN MAY IIAVEBEEN REDUCED BYPAID CLAWS , INSR ......... - ... INSD WVD (MM LICYEFYY) POUCYEXP LIMITS ADOTL SUER POLICY NUMBER LTR TYPEOFINSURANCE __ ... (MM/DD/YYYY) , ,,,,.. ..._.. ... .._. __ ,....,..,, ._..�,,,a _ ,., ,,, _ COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE DAMAGE TORE:N'TED ,S '.... CLAIMS -MADE OCCUR PREMISES (Ea Occurrencv) MFD FXP (Anyone jrsrson) PERSONAL lkRtDVINJURY C. CN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE ,S T,RorvU+"TS•COMP/OPAGG S POLICY '�i PROJECT" LOC OTHER....... .... ..... ....... ., ...... CC:}I�M1F31NEC7 ExINCiLE I..IMIi` I AUTOMOBILE LIABILITY (Ea accident) ANYAUTa J Per pet 1 1 000 000 BODILVIIV INJURY (r ... . _- q, a. OWNEDAUTOS SCHEDULED BODILY II'dJURY (Per acelderrl) f A` 0NLY X AUTOS, 606767923 10/26/2020 10/26/2021 HIRFn AUTOS NON""OWNFr1 WtT('kTxF R1`Y r7AXef.Au;�I'- 1S X''... ONLY AU'TOSONLY [Prrrlcccdcnlp._.. .__ 100„000, i M 1 UMBRELLALIAB OCCUR FACH OCCURRENCE 1 EXCESS UAB ChAIMS-MADE At,C-RF CxAY'F DED RETENTIONS �_ S WORKERS COMPENSATION PEE "1 i AND EMPLOYERS' LIABILITY STATUTE' OTHER _ .... ANY PROPRIETOR/PARTNER/ YYN F I FACHACCFDFNT FXECUTIVEOFFICER/MEMBER ..._ ". N/A .... ,,....,,,, A11 E.L., DISEA SE-EFMPLOYE: E EXCLUDCD-f (Mandatory InNH) 6._. .... -- !... If yes, describe under DESCRIP110N OF EJ_. DISEASE- P01_ICY I IM11 !$ OPFRATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD I D 1, Additional Remarks Schedule, maybe attached if more space is required) Additional Insured City of El Segundo its Officials & Employees CERTIFICATE HOLDER CANCELLATION " City of El Segundo " SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Its Officials & Employees POLICY PROVISIONS. WILL BE DELIVERED IN ACCORDANCE WITH THE PO 350 Main Street w mm ... ,,.(.:A ..,.''�.��"� ,..,,,,,� ,,,.. DATE THEREOF, ,�'.L...�"^rF' .. .. ............,,,, AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) C� '69 B -2.015 ACORD CORPORATION. All Rights Reserved 31-1769 11-15 The ACORD name and logo are registered marks of ACORD POLICY NUMBER: 00092590-2 COMMERCIAL GENERAL LIABILITY CG 20 10 07 04 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 Organ izations : Locations Of Covered Operations Where required by written contract All operations of the Named Insured. or written agreement. 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) desig- nated above. B. With respect to the insurance afforded to these additional insureds, the following additional exclu- sions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equip- ment 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 in- tended use by any person or organization oth- er than another contractor or subcontractor engaged in performing operations for a princi- pal as a part of the same project. CG 20 10 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 0 POLICY NUMBER: COMMERCIAL GENERAL LIABILITY CG 20 28 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - LESSOR OF LEASED EQUIPMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Where required by written contract or written agreement. 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 your maintenance, operation or use of equipment leased to you by such person(s) or organization(s). 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, this insurance does not apply to any 'occurrence" which takes place after the equipment lease expires. 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. CG 20 28 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 POLICY NUMBER: 00092590-2 COMMERCIAL GENERAL LIABILITY CG 20 37 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Or anization s : Location And Description Of Completed Opera - tions Where required by written contract All operations of the Named Insured. or written agreement. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. 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". CG 20 37 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 0 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NON CONTRIBUTORY ENDORSEMENT This endorsement modifies insurance provided under the following: ALL COVERAGE PARTS Name Of Additional Insured Person(s) Or Organization(s): If no entry appears above, this endorsement applies to all Additional Insureds covered under this policy. Any coverage provided to an Additional Insured under this policy shall be excess over any other valid and collectible insurance available to such Additional Insured whether primary, excess, contingent or on any other basis unless a written contract or written agreement specifically requires that this insurance apply on a primary and noncontributory basis. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. AP5031 US O4-10 Page 1 of 1 POLICY NUMBER: 00092590-2 COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: Where required by written contract or written agreement. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. 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 we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products - completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 1 0 ENDORSEMENT AGREEMENT WAIVER OF SUBROGATION REP 04 9162512-21 RENEWAL SP 4-47-88-58 PAGE 1 HOME OFFICE SAN FRANCISCO ALL EFFECTIVE DATES ARE AT 12:01 AM PACIFIC STANDARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME RAMEY ROOFING EFFECTIVE JULY 15, 2021 AT 12.01 A.M. AND EXPIRING JUNE 28, 2022 AT 12.01 A.M. 1411 11TH ST SANTA MONICA, CA 90401 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, RAMEY ROOFING 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: JULY 22, 2021 2570 AUTHORIZED REPRESENT /IVE PRESIDENT AND CEO SCIF FORM 10217 (REV.4-2018)