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PROOF OF INSURANCE (2022 - 2023) CLOSED
DATE (MMIDD/YYYY) C "�"� CERTIFICATE OF LIABILITY INSURANCE 9/22/2021 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 NAME; CT Chanell Jones Bichlmeier Insurance Services PHONE FAX 730 S. Pacific Coast Hwy Suite #201 310-376-8852 /arc No °, 310-540-2215 Redondo Beach CA 90277 ADbRLESsa chariellj@bisins.com INSURED Alpha Omega Fish Venture, LLC dba Fish Window Cleaning P.O. Box 1174 Lawndale CA 90260 INSURERS AFFORDING COVERAGE NAIC # INSURER A: Evanston Insurance Co. 35378 ALPHOME-02 INSURER B : CALIFORNIA AUTOMOBILE INS CO 38342 INSURER C : WESTERN SURETY COMPANY 13188 COVERAGES CERTIFICATE NUMBER' 217197392979 REVISION NUMRER- 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 SUS POLICY NUMBER �._ MM/pp� . _ .. _ _. MMIDD/YYXY .... �..............................................._.� .. LIMITS A COMMERCIAL GENERAL LIABILITY Y Y 2AA351113 9/18/2021 9/18/2022 EACH OCCURRENCE $2,000,000 —. ......... . -......, CLAIMS -MADE L_ !i OCCUR PREMISES Ea or"I rr scats $ 1 00,000 MED EXP (Any one person) $ 5,000 X. Da se,Policy................. PERSONAL & ADV INJURY $ 2,000,000 X Blanket At GENERAL AGGREGATE $3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER, X PRCA- POLICY � J9:i;•,T71 LOC '. PRODUCTS - COMP/OP AGG $Included $ OTHER: B AUTOMOBILE LIABILITY BA040000053804 7/16/2021 7/16/2022 '�OMBIhdETrSNNOLELIMIr $1000,000 ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED AUTOS ONLYAUTOSX BODILYINJURY (Peraccident) $ I HIRED NON -OWNED LA AUTOS ONLY AUTOS ONLY PROPERTY DAMAGH (Parr at.liicrt,),_ ,,,,,,, ,,,_,,,,,,,,,,,,,,,, $ UMBRELLALIAB OCCUR EACH OCCURRENCE $ Id EXCESS LIAB CLAIMS -MADE AGGREGATE $ DED RETENTION $ _.. $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN PER OTH- STATUTE ''� ER E.L. EACH ACCIDENT $ ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ NIA E.L. DISEASE - EA EMPLOYEE. $ '.. (Mandatory in NH) If yes, describe under ''.... DESCRIPTION OF OPERATIONS below E,L. DISEASE - POLICY LIMIT $ C Bond 63343945 9/12/2021 9/12/2022 Employee Dishonesty 50,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may attached if more space is required) Window Cleaning The City of El Segundo per endorsement MEGL 0009-01 09 18 is named additional insured, Primary & Non -Contributory CG 20 01 04 13 Waiver of Subrogation per MEGL 0241-01 05 16 apply for General Liability when required by written contract or agreement. The City of El Segundo, its officers, officials, employees, agents and volunteers are named additional insured. 30 day notice of cancel applies or 10 day notice for non-payment. 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 350 Main Street AUTHORIZED REPRESENTATIVE El Segundo CA 90245 ` ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABILITY III POLICY NUMBER: IRKEV EVANSTON INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM LIQUOR LIABILITY COVERAGE FORM OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE FORM PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE FORM SCHEDULE Additional Premium: $ INCLUDED (Check box if fully earned �X ) Please refer to each Coverage Form to determine which terms are defined. Words shown in quotations on this endorsement may or may not be defined in all Coverage Forms. A. Who Is An Insured is amended to include as an additional insured any person or entity to whom you are required by valid written contract or agreement to provide such coverage, but only with respect to "bodily injury", "property damage" (including "bodily injury" and "property damage" included in the "products -completed operations hazard"), and "personal and advertising injury" caused, in whole or in part, by the negligent acts or omissions of the Named Insured and only with respect to any coverage not otherwise excluded in the policy. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. The insurance afforded to such additional insured will not be broader than that which you are required by the valid written contract or agreement to provide for such additional insured. Our agreement to accept an additional insured provision in a valid written contract or agreement is not an acceptance of any other provisions of such contract or agreement or the contract or agreement in total. When coverage does not apply for the Named Insured, no coverage or defense will apply for the additional insured. No coverage applies to such additional insured for injury or damage of any type to any "employee" of the Named Insured or to any obligation of the additional insured to indemnify another because of damages arising out of such injury or damage. B. With respect to the insurance afforded to these additional insured, the following is added to limits of insurance: The most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the valid written 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. All other terms and conditions remain unchanged. MEGL 0009-01 09 18 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 1 with its permission. COMMERCIAL GENERAL LIABILITY oil POLICY NUMBER: 2AA351113 MARKEr EVANSTON INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM SCHEDULE Name Of Person Or Organization: Additional Premium: $ The following is added to Condition 8. Transfer Of Rights Of Recovery Against Others To Us under Section IV — Commercial General Liability Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule of this endorsement with respect to written contracts that exist between you and such person or organization, provided you have agreed in writing to furnish this waiver. This waiver applies only to the person or organization shown in the Schedule of this endorsement. All other terms and conditions remain unchanged. MEGL 0241 05 16 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 1 with its permission. COMMERCIAL GENERAL LIABILITY CG 20 01 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance (2) You have agreed in writing in a contract or Condition and supersedes any provision to the agreement that this insurance would be contrary: primary and would not seek contribution Primary And Noncontributory Insurance from any other insurance available to the additional insured. This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and CG 20 01 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 DATE(MMIDDIYYYY) A � CERTIFICATE OF LIABILITY INSURANCE Acct#: 2741131 7/ 15/2022 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 CONTACT NAME Lockton Companies PHONE��" 844-2904908 INC. 444 W 47th Street, Suite 900 z s5: ggSlcerts@locktonaffinity.com Na) Kansas City, MO 64112 1906 ....................... INSURED Barrett Business Services, Inc. LIC/F ALPHA OMEGA FISH VENTURE, LLC DBA: FISH WINDOW CLEANING 15665 HAWTHORNE BLVD, STE D LAWNDALE, CA 90260 INSURERS AFFORDING COVERAGE NAIC # INSURER A Ace "American Insurance Co. 22667 INSURER B : COVERAGES CERTIFICATE NUMRER- 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 �._..... AOD SU I1' POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MMIpD/YYYY '� MM/DDM'YY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE Is CLAIMS -MADE 1:1 OCCUR PREM SSE _ Ea Occurrence,)""""" .$..............._•._...... ,,„ MED EXP (Any one person) $ PERSONAL &ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY1:1 2RCO-T LOC ,wEC PRODUCTS - COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE'. LIMIT Ea aoccidan $ ANY AUTO BODILY INJURY (Per person) $, $ OWNED SCHEDULED BODILY INJURY (Per accident) $ •.._ AUTOS ONLY AUTOS HIRED NON -OWNED PROPERTY DAMAGE War accdent $ •-•• AUTOS ONLY AUTOS ONLY UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ .. EXCESS LIAB CLAIMS -MADE _............................................_......_ ....._..__..._....,.�..___. $ DED RETENTION $ WORKERS COMPENSATION X PER O'TH- AND EMPLOYERS' LIABILITY Y / N ."""",,.STATUTE " _ER.," ,_•,,,,,,,,,,,,,,,,, ••,",............... ANY PROPRIETOR/PARTNER/EXECUTIVE E,L EACH ACCIDENT $ 2,000,000 A '..OFFICER/MEMBER EXCLUDED? ❑ N / A C51245039 7/1/2022 7/1/2023 -- """""""""" . in NH) E,L. DISEASE - EA EMPLOYE $ 2,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below EL, DISEASE - POLICY LIMIT '�""•"•• •'•'•'• •'•'•'•'• $ 2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Policy State = CA (:tK I I City Of El Segundo 350 Main Street El Segundo, CA 90245 GANGtLLA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. i rights reserved- ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Workers' Compensation and Employers' Liability Policy i Named Insured Endorsement Number Barrett Business Services, Inc. Policy Number L/C/F ALPHA OMEGA FISH VENTURE, LLC DBA: FISH WINDOW CLEAN 15665 HAWTHORNE BLVD, STE D Symbol: Number: C51245039 LAWNDALE, CA 90260 Policy Period Effective Date of Endorsement 7/1 /2022 TO 7/1 /2023 7/21 /2022 Issued By (Name of the Insurance Company) Ace American Insurance Co. Insert the policy number, The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the poky. CALIFORNIA WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement applies only to the insurance provided by the policy because California is shown in Item 3.A. of the Information Page. 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, but this waiver applies only with respect to bodily injury arising out of the operations described in the Schedule, where you are required by a written contract to obtain this waiver from us. You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. Schedule 1. ( ) Specific Waiver Name of person or organization: (X) Blanket Waiver Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. 2. Operations: 3. Premium: The premium charge for this endorsement shall be INCLUDED percent of the California premium developed on payroll in connection with work performed for the above person(s) or organization(s) arising out of the operations described. 4. Minimum Premium: INCLUDED Authorized Agent WC 99 03 22