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PROOF OF INSURANCE (2023 - 2023) CLOSED
0 1 �"` DATE (MMIDDIYYYY) �. CERTIFICATE OF LIABILITY INSURANCE 02/14/2022 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 UN ACT ,John Bettis PHONE _ Bettis Insurance Services, Inc (310)521-4480 FAX (3 N0)521-0111 PO Box 2816 JAJC_N' � ., Ukic_Nia) _.. E-MAIL bettisl San Pedro CA 90731-0197a�• J bettislns cocrro . � .... . �.SVURA.: p y .......���� .......�....-_ �_.�.._..���_� ..� AtainS ecialt Insurance .... � _...��..�....17159 ..�� INSURED I4198.8 ansu, uran,,ce Comp any of the West 27847 Mike Erland _ Second City Plumbing _IMSUREROre9on Mutual Insurance Co (Rated A VII) 14907 ...._. 525 W. Mariposa St. ,,,,,,,.,Scottsdale Insurance Company 41297 El Segundo CA 90245- rcoricrr ATc ldt htiair r-D. Rr-vIql()N NIMMRIPW 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.. ...,... ....... .�.�—.. _....................,....,.... e.. .�,�,., ................... .,..,. ,....._.. .. ..,. am,... ...... ,.POLICY EFF y.... INSR TYPE OF INSURANCE ADDV. SU X POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY X ,,„„ CIP412273 2/15/2022 1" CHOccuaENCE WWW WW 2/15/2023 En_Mncl= $ 1,000,000 .._..__ CLAIMS -MADE OCCUR � TO RENTED DAMAGE RFM1SES,(Ea �currence)....... 50,000 �$ .... . MED, EXP (An,J! one„ person $ 5,000 ................ ..... I PfwRSONA4 &,�AmDV INJLIRY 1,000,000 ... 00 GEN`M. IT... AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE 2000,000 $ , X ., .. pL POLICY JPRO- ECT LOC i PRQOUGTS _, COMP/OP AGG 2,000,000 .. ..... .. T I:... - C AUTOMOBILE LIABILITY _.... CMO-920869 102/24/2022 2/24/2023 COMBINED SINGLE $ 1,000,000 (Eti nsxirl2tud) �.�.. .. , ANY AUTO BODILY INJURY (Per person) $ OWNED X SCHEDULED BODILY INJURY (Per accident) $ ..... AUTOS ONLY -r AUTOS X HIRED '.. X NOWOWNEO I ����'-------•-••• �--- PROPERTY DAMAGE $ ... AUTOS ONLY W AUTOS ONLY •"'."" D UMBRELLA LIAB X OCCUR IXBSO158778 b2/15/2022 2/15/2023 EACH OCCURRENCE _$ 1.000-000 X EXCESS LIAB LAIMS CMAQE„ i 1 AGGREGATE $ 1,000,000 .:.�m ,. _ DED RETENTION $. B WORKERS COMPENSATION WPL 5054200 02 03/02/2022 3/02/2023 OTH X m RTA-uE_ ......_E1 .... _. . _. AND EMPLOYERS' LIABILITY YIN I, 1,000,000 ANY PROPMETOR/PARTNER/EXECU TIVE EXCLUDED? NIA.. E L...EACH ACCIDENT $..... 000 OFFICERlMEMBER (Mandatory in NH) , E-tg..lDl$EASE_, EA, EMPLOYEE 1 00O If yes, describe under OESCRIPTIONF P ,R, A1QH, be(0,w E.L.. DISEASE -POLICY LIMIT $ 1,000,000 C Auto Physcal Damage CMO-920869 02/24/2022 2/24/2023 Comp Ded $500 Coll Dec $1000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may, be attached If mote is ice is required) City of El Segundo is named as additional Insured as per additional insured endorsement CG2033 04 where iregwred by written contract with the named insured subject to the terms and conditions set forth in the policy. L:'EKIlt'MUAIt t'MULLJt:K x. +revc� wrwwv+ 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. 150 Illinois Street ElSegundo CA 90245- AUTHORIZED REPRESENTATIVE "^ I © 1988-ZU15 AGUKU GUKYUKA I IUN. All rlgnLs reserves. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: CIP412275 COMMERCIAL GENERAL LIABILITY CG 20 33 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -OWNERS, LESSEES OR CONTRACTORS -AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section II - Who Is An Insured is amended to include as an additional insured any person or or- ganization for whom you are performing opera- tions when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy. Such person or organization is an additional insured only with re- spect to liability for "bodily injury", "property dam- age"cr "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. However, the insurance afforded to such additional insured: 1. Only applies to the extent permitted by law; and 2. Will not be broader than that which you are re- quired by the contract or agreement to provide for such additional insured. A person's or organ'i:ztion's status as an addi- tional insured under this endorsement ends when your operations for that additional insured are completed. B. With respect to the insurance afforded to these ad- ditional Insureds, the following additional exclu- sions apply: This insurance does not apply to: 1. "Bodily injury", "property damage" or "personal and advertising injury" arising out of the ren- dering of, or the failure to render, any profes- sional architectural, engineering or surveying services, including: a. The preparing, approving, or failing to prepare or approve, maps, shop draw- ings, opinions, reports, surveys, field or- ders„ change orders or drawings and specifications; or b. Supervisory, inspection, architectural or engineering activities. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of other's by that Insured, if the "occur- rence" which caused the "bodily injury" or "prop- erty damage", or the offense which caused the ''personate and advertising injury", involved the ren- dering of or the failure to render any professional architectural, engineering or surveying services. CG 20 33 04 13 Copyright, Insurance Services Office, Inc., 2012 Page 1 of 2 POLICY NUMBER: CI P 412275 COMM ERCIAL 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: ANY PERSON OR ORGANIZATION WITH WHOM THE INSURED HAS AGREED TO WAIVE RIGHTS OF RECOVERY, PROVIDED SUCH AGREEMENT IS MADE IN WRITING AND PRIOR TO THE LOSS 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 POLICY NUMBER: CIP412275 This Endorsement Changes the Policy -Please Read it Carefully PRIMARYAND NON-CONTRIBUTING INSURANCE (Sole Negligence) This endorsement modifies coverage provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART PRODUCTS COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to Section IV -Commercial General Liability Conditions, Paragraph 4-, Section IV: Commercial General Liability Conditions 4, Other Insurance; Specifically and solely for the Third -Party shown below, notwithstanding the provisions of sub -paragraphs a, b, and c of this paragraph, it is hereby agreed that in the event of any I;uiYWhere the damages are caused by the insureds sole negligence, this insurance shall be primary and any other insurance maintained by the additional insured named as the Third Party below shall be excess and non-contributory. The Third -Party to whom this endorsement applies is: ANY PARTY FOR WHOM THE INSURED IS PERFORMING SERVICES, AT A SPECIFIED PROJECT SET FORTH IN A WRITTEN CONTRACT, THAT: (1) HAS BEEN SIGNED BY ALL PARTIES, INCLUDING THE NAMED INSURED AND THE PARTY SEEKING COVERAGE UNDER THIS ENDORSEMENT; AND (2) HAS BEEN ENTERED INTO BEFORE ANY LOSS HAS OCCURRED. Any coverage provided pursuantto this endorsement shall be subject to all other terms, conditions, exclusions and endorsements of the policy to which this form is attached. The endorsement is effective on the inception date of the policy unless otherwise stated below. Policy Number: CIP412113 Named Insured: SECOND CITY PLUMBING Endorsement Effective Date: AF001397 (09/ 16) Page 1 of 1 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 06 34 (Ed. 8-00) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT- BLANKET 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 organisation 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 otherwise due. Person or Organization ANY PERSON / ORG WHEN REQUIRED BY WRITTEN CONTRACT 2 % of the total California Workers' Compensation premium Schedule Job Description ATZ -CA OPERATIONS This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (Tine Informetlon below Is required only when this endorsement is Issued subsequent to preparation of the policy.) Endorsement Effective _ _ 2 r Policy No. WeL 5 Qa 4 2 n n Endorsement No. Insured Premium $ INCL. . Second City Plumbing Insurance Company INSURANCE COMPANY OF THE WEST WC 99 06 34 (Ed. 8-00) Countersigned By INSURED