Loading...
PROOF OF INSURANCE (2022) CLOSEDPARKLAN-01 ACOR DATE (MMIDDIYWY) CERTIFICATE OF LIABILITY INSURANCE 2/1/2022 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 ro or be p v' endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain poticies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements) PRODUCER Churchill 8r Associates Insurance Services, Inc. 31248 Oak Crest Drive, Suite 140 Westlake Village, CA 91361 Kellie Shano to (805) 220-1174 MSURED I INSURERS Alaska National Insurance Company „38733 Parkwood' Landscape Maintenance„ Inc. INSURE_RcJeXas Insurance Company 16543 16443 Hart Street INSURERo: Van Nuys, CA 9140 tlNSLGRER E ................ ....��_. INSURER F v�... ._...... ...��. COVERAGES CERTIFICATE NUM _............ PPVVTTTM 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 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 ......... ...... .... .... A6JDL SUBR "., ... TYPE OF INSURANCE POLICY NUMBER ...,,,�................... -_„_. ..... ,�_.....�,_ � POLICY EFF POLICY EXP LIMITS ................tM(G�.,!>.(;-MS,IIYXYI!)-. ._._. .. . _ A X - COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S, 1'000 011 00 CLAIMS ADE I. X OCCUR X ! X ,NPC-1000923-02 DAMAGE �BO RENTED 7/5/2021 7/5/2022 F.'RFWsE,.t+.sr 100,000 5,000 _MED EXP (Any one person) 5......... '.. PERSONAL& ADV INJURY I S 1,000100o 2,000,000 GENT AGGNLGa ., E LIMl"I A6 PI_II_ S P R: rS ,,. d ... X , POLICY pE��� � I..00 I .,PRODUCTS, COMP/OP AGG „S 2,000,00U . OTHFR .._._........................... _..,�.�,....._,�......._A, B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 X ANY AUTO X X I21 G AS 11155 7/5/2021 7/5/2022 BODILY INJURY (Per person) S,.,. OWNED S4 IU DI,LED '.. . AUTOS ONLY Al l I6S:, ,YPODII Y,",ONJIJRY X .., HIRED X NQN�6,' TI D PR()PrRTY DAMAGE S_- AUTOS ONLY :„._ ., . AUTOS 6 P'd.:Y (,Pa[_x7 rrSetukp .. S + X�- UMBRELLALIABmmmm'i, X OCCUR EACH OCCURRENCE S 4,000,000 EXCESS LIAB CLAIMS -MADE T121XANN-01060-01 7/5/2021 7/5/2022 AGGREGATE S 4,000,000 DIED RETENTIONS S . B RKERS COMPENSATION X PER FORH ANOD:.,.. 21 D WS 11155 Y / N X 4/25/2021 4/25/2022 1,000 000 ANY OFFICEO OMBOERIEXCTNER/E ECUTIVE UDE�! N I A (Mandatory in NH) E L EACH ACCIDENT CCIDENT $ _ , L DISEASE EA EMPLOYEE, S 1,000,000 If yes, describe under .E 1,000,000 DFSMRIPTIONOOERATIONS bp.!........ ,--........... . ,--__-m_FP ... DESCRIPTION OF OPERATIONS I LOCATION'S d VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RFP# 21-03 - Landscape Maintenance Services City of El Segundo is listed as Additional Insured with respects to General Liability and Auto Liability per the attached endorsement forms. Waiver of Subrogation applies to General Liability, Auto Liability and Workers Compensation per the attached endorsement forms. 30 Day Notice of Cancellation 110 Day Notice for Non -Payment ..m ......... ...--________A• CERTIFICATE HOLDER � mm .................................................... _. CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City Of El Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Y 9 ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street El Segundo, CA 90245 AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) � 0 11988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Alaska National INSURANCE COMPANY BUSINESS AUTO COVERAGE ENHANCEMENT ENDORSEMENT THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following BUSINESS AUTO COVERAGE FORM Various provisions in this endorsement restrict subrogation against that person or coverage. Read the entire policy carefully to organization is waived prior to the "accident" determine rights, duties, and what is and is not or the "loss" under a contract with that person covered, or organization. Throughout this policy, the words "you" and "your" refer to the Named Insured shown in the Declarations. The words "we", "us", and "our" refer to the company providing this insurance. Other words and phrases that appear in quotation marks have special meaning. Refer to SECTION V — DEFINITIONS in the Business Auto Coverage Form. The coverages provided by this endorsement apply per "accident" and, unless otherwise specified, are subject to all of the terms, conditions, exclusions and deductible provisions of the policy, to which it is attached. SECTION II — COVERED AUTO LIABILITY COVERAGE, Paragraph A.I. Who Is An Insured is amended to include: d. Any "employee" of yours while operating an "auto" hired or rented under a contract or agreement in an "employee's" name, with your permission, while performing duties related to the conduct of your business. e. Any person or organization for whom you have agreed in writing to provide insurance such as is afforded by this Coverage Form, but only with respect to liability arising out of the ownership, maintenance or use of "autos" covered by this policy. If such person or organization has other insurance then this insurance is primary to and we will not seek contribution from the other insurance. SECTION IV — Business Auto Conditions, Paragraph A. 5. — Transfer of Rights of Recovery Against Others To Us is amended to include: 5. Transfer of Rights of Recovery Against Others to Us This condition does not apply to any person(s) or organization(s) to the extent that SECTION II — COVERED AUTO LIABILITY COVERAGE, Paragraph A.2.a. (2) — Supplementary Payments is replaced by the following: (2) Up to $10,000 for cost of bail bonds (including bonds for related traffic law violations) required because of an "accident" we cover. We do not have to furnish these bonds. SECTION II — COVERED AUTO LIABILITY COVERAGE, Paragraph A.2.a. (4) — Supplementary Payments is replaced by the following: (4) All reasonable expenses incurred by the "insured" at our request, including actual loss of earnings up to $500 a day because of time off from work. SECTION II — COVERED AUTO LIABILITY COVERAGE, Paragraph A.2.c. —Voluntary Property Damage is added as follows: c. Voluntary Property Damage At your written request, we may make a voluntary payment for Property Damage caused by an "insured", but without liability to a third party, up to $25,000. We will not make a Voluntary Property Damage payment to anyone who is an "insured" under this policy. SECTION III — PHYSICAL DAMAGE COVERAGE, Paragraph A.2. —Towing is replaced by the following: Towing We will pay up to $500 for towing and labor costs incurred each time a covered "auto" that is a: a. Private passenger; Parkwood Landscape Maintenance, Inc. 21 G AS 11155 07/05/21 - 07/05/22 ANIC CA 1150 10 13 Page 1 of 4 b. Truck; c. Pick-up truck; d. Panel ; or e. Van type vehicle under 20,000 lbs. of Gross Vehicle Weight is disabled. However, the labor must be performed at place of disablement. SECTION III — PHYSICAL DAMAGE COVERAGE, Paragraph A.3. — Glass Breakage — Hitting a Bird or Animal — Falling Objects or Missiles is replaced by the following: Glass Breakage — Hitting a Bird or Animal — Falling Objects or Missiles If you carry Comprehensive Coverage for the damaged covered "auto", we will pay the following under Comprehensive Coverage: a. Glass Breakage; b. "Loss" caused by hitting a bird or animal; and c. "Loss" caused by falling objects or missiles. However, you have the option of having glass breakage caused by a covered "auto's" collision or overturn considered a "loss" under Collision Coverage. Glass Repair —Waiver of Deductible No deductible applies to glass breakage, if the glass is repaired rather than replaced. SECTION III — PHYSICAL DAMAGE COVERAGE, Paragraph A.4.a, — Transportation Expenses is replaced by the following: a. Transportation Expenses We will pay up to $200 per day to a maximum of $1,500 for temporary transportation expense incurred by you because of the total theft of a covered "auto" that is a: (1) Private passenger; (2) Truck; Parkwood Landscape Maintenance, Inc. (3) Pick-up truck; (4) Panel; or (5) Van type vehicle under 20,000 lbs. of Gross Vehicle Weight. We will pay only for those covered "autos" for which you carry either Comprehensive or Specified Causes of Loss Coverage. We will pay for temporary transportation expenses incurred during the period beginning 48 hours after the theft and ending, regardless of the policy's expiration, when the covered "auto" is returned to use or we pay for its "loss". SECTION III — PHYSICAL DAMAGE COVERAGE, Paragraph AA.b. — Loss of Use Expenses is replaced by the following: b. Loss of Use Expenses — Hired, Rented, or Borrowed Automobiles We will pay expenses for which an "insured" becomes legally responsible to pay for loss of use of a vehicle hired, rented or borrowed without a driver under a written rental contract or agreement. We will pay for loss of use expenses, if caused by: (1) Other than Collision, only if the Declarations indicate that Comprehensive Coverage is provided for the vehicle withdrawn from service. (2) Specified Causes of Loss only if the Declarations indicate that Specified Causes of Loss Coverage is provided for the vehicle withdrawn from service. (3) Collision only if the Declarations indicate that Collision Coverage is provided for the vehicle withdrawn from service. 21 G AS 11155 07/05/21 - 07/05/22 ANIC CA 1150 10 13 Page 2 of 4 JU Alaska Natfonal INSURANCE COMPANY However, the most we will pay for any expenses for loss of use is $200 per day, to a maximum of $1,500. SECTION III — PHYSICAL DAMAGE COVERAGE, Paragraph A.4.c. — Non -Transportation Loss of Use Expenses is added as follows: c. Non -Transportation Loss of Use Expenses We will pay up to $2,000 for non - transportation expense incurred by you, because of "loss" to a covered "auto", if caused by.- (1) Other than Collision, only if the Declarations indicate that Comprehensive Coverage is provided for the "auto" withdrawn from service; (2) Specified Causes of Loss only if the Declarations indicate that Specified Causes of Loss Coverage is provided for the "auto" withdrawn from service; or (3) Collision only if the Declarations indicate that Collision Coverage is provided for the "auto" withdrawn from service. SECTION III — PHYSICAL DAMAGE COVERAGE, Paragraph AAA. — Airbag Coverage is added as follows: d. Airbag Coverage We will pay for the cost to repair, replace, or reset an airbag that inflates for any reason other than as a result of a collision, if the Declarations indicate that the covered "auto" has Comprehensive Coverage or Specified Causes of Loss Coverage, SECTION III — PHYSICAL DAMAGE COVERAGE, Paragraph AA.e. — Rental Reimbursement Coverage is added as follows: e. Rental Reimbursement Coverage We will pay up to $75 per day for rental reimbursement expenses incurred by you for the rental of an "auto" because of "loss" to a covered "auto" that is a: (1) Private Passenger; (2) Truck; (3) Pick-up truck; (4) Panel; or (5) Van type vehicle under 20,000 lbs, of Gross Vehicle Weight. Payment applies in addition to the otherwise applicable amount of each coverage you have on a covered "auto". No deductibles apply to this coverage. (1) We will pay only for those expenses incurred during the policy period beginning 24 hours after the "loss" and ending, regardless of the policy's expiration, with the lesser of the following number of days: (a) The number of days reasonably required to repair or replace the covered "auto". (b) 30 days. (2) This coverage does not apply while there are spare or reserve "autos" available to you for your operations. (3) The Rental Reimbursement Cov- erage described above does not apply to a covered "auto" that is described or designated as a covered "auto" on Rental Reimbursement Coverage Form CA 99 23. SECTION IV — BUSINESS AUTO CONDITIONS — Paragraph 6.2. — Concealment, Misrepresentation Or Fraud is amended by adding Unintentional Failure to Disclose Hazards at the end of Paragraph B.2. as follows: Unintentional Failure to Disclose Hazards If you unintentionally fail to disclose any hazards existing at the inception date of your policy, we will not deny coverage under this Coverage Form because of such failure. However, this provision does not affect our right to collect additional premium or exercise our right of cancellation or non -renewal. Parkwood Landscape Maintenance, Inc. 21 G AS 11155 07/05/21 - 07/05/22 ANIC CA 1150 10 13 Page 3 of 4 JW Alaska Aft3fional INSURANCE COMPANY SECTION IV — BUSINESS AUTO CONDITIONS — Paragraph B.5.b. — Other Insurance is replaced by the following: b. For Hired Auto Physical Damage Coverage, the following are deemed to be covered "autos" you own: (1) Any covered "auto" you lease, hire, rent, or borrow; and (2) Any covered "auto"" hired or rented by your "employee" under a contract in that individual "employee's" name, with your permission, while performing duties related to the conduct of your business. However, any "auto" that is leased, hired, rented or borrowed with a driver is not a covered "auto". SECTION V — DEFINITIONS — Paragraph C. — "Bodily injury" is replaced by the following: C. "Bodily injury" means bodily injury, sickness or disease sustained by a person including death or mental anguish resulting from any of these. Mental anguish means any type of mental or emotional illness or disease Parkwood Landscape Maintenance, Inc. 21 GAS 11155 07/05/21 - 07/05/22 ANIC CA 1150 10 13 © Insurance Services Office, Inc., 2009 Page 4 of 4 PARKWOOD LANDSCAPE MAINTENANCE, INC. POLICY NUMBER: NPC-1000923-02 N. BLANKET WAIVER OF SUBROGATION The following is added to Section IV -Commercial General Liability Conditions: Waiver of Subrogation We waive any right of recovery we may have against any person or organization because of payments we make for injury or damage arising out of premises owned or occupied or rented or loaned to you; ongoing operations performed by you or on your behalf, done under a contract with that person or organization; "your work"; or "your products". We waive this right where you have agreed to do so as part of a written contract, executed by you prior to loss. O. INCIDENTAL MEDICAL MALPRACTICE INJURY 1. For insurance applicable to this Article O, the definition of "bodily injury" in Section V - Definitions is amended to include, "Incidental Medical Malpractice Injury". 2. The following definition is added to Section V- Definitions: "Incidental medical malpractice injury" means "bodily injury", mental anguish, sickness or disease sustained by a person, including death resulting from any of these at any time, arising out of the rendering of, or failure to render, the following services: a. Medical, surgical, dental, laboratory, x-ray or nursing service or treatment, advice or instruction, or the related furnishing of food or beverages; b. The furnishing or dispensing of drugs or medical, dental or surgical supplies or appliances; c. First aid; or d. "Good Samaritan Services". As used in this Article O., "Good Samaritan Services" are those medical services rendered or provided in an emergency and for which no remuneration is demanded or received. 3. Paragraph 2.a.(1)(d) of Section II -Who Is An Insured does not apply to any registered nurse, licensed practical nurse, emergency medical technician or paramedic employed by you, but only while performing the services described in Paragraph 2. above and while acting within the scope of their employment by you. Any "employees" rendering "Good Samaritan Services" will be deemed to be acting within the scope of their employment by you. 4. The following exclusion is added to Paragraph 2. Exclusions of Coverage A. — Bodily Injury And Property Damage Liability of Section I — Coverages: [This insurance does not apply to:) Willful Violation of Penal Statute Liability arising out of the willful violation of a penal statute or ordinance relating to the sale of pharmaceuticals by or with the knowledge or consent of the insured. 5. For the purposes of determining the applicable Limits of Insurance, any act or omission, together with all related acts or omissions in the furnishing of services described in Paragraph 2.a. through 2.d. above to any one person, will be considered one "occurrence". 6. This Article O. does not apply if you are in the business or occupation of providing any of the services described in Paragraph 2. above. Form XIL 436 1208 © 2008, XL America, Inc. Page 7 of 8 Includes copyrighted material of Insurance Services Office, Inc., with its permission. POLICY NUMBER: NpC-1000923-02 COMMERCIAL GENERAL LIABILITY CG20 371219 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDIT���|���U����U INSURED ����������� LESSEES ���� IONAL om���������� — °������/�w�v ���������� '�n� CONTRACTORS COMPLETED OPERATIONS following - COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Opperatio s Blanket as required by written contract, Blanket as required by written contract. Information required to complete this Schedule, if not shown above, will be shown in the Declarations, A. Section U—VVhm Is An Insured is amended to B. With respect to the insurance these include aunn additional insured the peraon(o)or additional inounodo, the following is added to organization(s) shown in the Sohadu|a, but only Section III Limits OfInsurance: with respect to liability for "bodily injury" or If coverage provided to the additional insured is property damage" cauoed, in whole or in pnrt, by required by contract oragreement, the most we ^your work" at the location designated and will pay on behalf of the additional insured is the described in the Schedule of this endorsement amount ofinsurance: performed for that additional insured and included 1. Required by the contract oragraament� or inthe "prod uuto'nomp|etedoperations hozond^ 2. Available under the applicable limits of However |nuunonna� . 1 The insurance afforded to such additional ' whichever inless. insured only applies tothe extent permitted by |ew;ond This endorsement shall not increase the applicable limits of insurance. 3. |fcoverage provided hothe additional insured io required by a contract or agpeement, 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. CO|2O37 12 19 @ Insurance Services Office, Inc., 2018 Page 1 of � POLICY NUMBER: PC-1000923-02 COMMERCIAL GENERAL LIABILITY CG20100413 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 Organization(s) Locations Of Covered Operations Blanket as required by written contract Blanket as :required by wr:i.tten. con.t:r.a.ct Information re uired to complete this Schedule, ifITnot shown above, will be shown in the Declarations, A. Section II — Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following additional organization(s) shown in the Schedule, but only exclusions apply: with respect to liability for "bodily injury", "property This insurance does not apply to "bodily injury" or damage" or "personal and advertising injury" "property damage" occurring after: caused, in whole or in part, by: 1. All work, including materials, parts or 1. Your acts or omissions; or equipment furnished in connection with such 2. The acts or omissions of those acting on your work, on the project (other than service, behalf; maintenance or repairs) to be performed by or in the performance of your ongoing operations for on behalf of the additional insured(s) at the the additional insured(s) at the location(s) location of the covered operations has been designated above. completed; or However: 2. That portion of "your work" out of which the injury or damage arises has been put to its 1. The insurance afforded to such additional intended use by any person or organization insured only applies to the extent permitted by other than another contractor or subcontractor law; and engaged in performing operations for a 2. If coverage provided to the additional insured is principal as a part of the same project. 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. CG 20 10 04 13 ©Insurance Services Office, Inc., 2012 Page 1 of 2 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. Page 2 of 2 ©Insurance Services Office, Inc., 2012 CG 20 10 04 13 r— a It, ! +r , �T/Z�, . a l ■ 1Y °Y 1. W. 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.) Person or Organization Blanket Waiver: Any person or organization for whom the insured, has agreed by written contract, to furnish this waiver. 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 % of the California workers' compensation premium otherwise due on such remuneration. SCHEDULE Job Description This endorsement changes the policy to which it is attached and, unless otherwise stated, is effective on the date issued at 12:01 A.M. standard time at your mailing address shown in the policy. The information below is required only when this endorsement is issued subsequent to commencement of the policy. Endorsement Effective 04/24/2021 — 04/25/2022 Insured Parkwood Landscape Maintenance, Inc. Countersigned By Policy No. 21 D WS 11155 Endorsement No. 3 WC 04 03 06 (04 84)