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PROOF OF INSURANCE (2023 - 2023) CLOSEDCC CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD ) E.09/27/2022 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 pohcy(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 C`ON'AC Lisa Peacock NAME: Landscape Contractors Insurance Services PH NEI (559) 650-3555 _ FAX (559) 650-3558 AK", Nu5E-xt )AJC, Nal. Insurance Services, Inc. E-MAIL I eacock Icisinc.com AOORESS: p @ 1 835 N. Fine Avenue INSURER(S) AFFORDING COVERAGE NAIC p Fresno CA 93727 INSURERA: Greenwich Ins Co 22322 INSURED INSURER B : Infinity Select Ins Co 20260 INSURER C : XL Insurance America Inc 24554 Oliver Holt Landscape 8611 Amestoy Avenue INSURER D INSURER E Sherwood Forest CA 91325 ............................................................ INSURER F :� + COVERAGES CERTIFICATE NUMBER: 22/23 Pkg &Auto & IM 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, rsR ...... .......................... LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MMMMVMM _ (MMIDD/YYYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1 000,000 ® "7iAtGE"�=iC:)"1C"I""L!irn ._ .. ....................... _.. 100000 CLAIMS -MADE OCCUR PR EMISI=S I'�M.,,2urp,nre -._..._.._..._......-)....................._........... S MED EXP (Any one person) s 5,000 X $5,000PDDed �......._.. PERSONAL & ADV INJURY ..... s 1000,000 A Y NPC-1006229-00 07/16/2022 07/16/2023 GEN'LAGGREGATE LIMITAPPLIES PER: GENERALAGGREGATE S 2,000,000 X'. POLICY ❑ PET LOC PRODUCTS-COMP/OPAGG s 2A00,000 Employee Benefits s 1,000,000 OTHER: '...AUTOMOBILE LIABILITY.. .I�'AMBIC�irD SINGLE LIMIT Era gcrcidoenr ,...9,I.l P.7U,C100 ANYAUTO BODILY INJURY (Per person) S g OWNED SCHEDULED 504-61017-71117-001 07/16/2022 07/16/2023 BODILY INJURY (Per accident) S AUTOS ONLY AUTOS PROPERTYDAUAGEl S HIRED NON -OWNED ^. AUTOS ONLY AUTOS ONLY ,'n'er aecirSe�xt. Medical payments _ s 5,000 UMBRELLA LIAB OCCUR EACH OCCURRENCE S AGGREGATE S EXCESS LIAB CLAIMS -MADE DI::,C:7 I I RETENTION $ S WORKERS COMPENSATION F F.R OTH- AND EMPLOYERS' LIABILITY YIN CN; C1J PE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E1 EACH ACCIDENT 5 OFFICER/MEMBER EXCLUDE NIA (Mandatory in NH) ELDISEASE EA EMPLOYEE . $ If yes, describe under DESCRIPTION OF OPERATIONS below E..I.., DISEASE- POLICY I..IMIT $ Inland Marine C TNIM-1 006222-00 07/16/2022 07/16/2023 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) .- ....................... RE: All landscape operations performed by or on behalf of the named insured. (See attached CG20101219) City of El Segundo and its officers, elected officials, and employees (Excluding Professional Liability) are named as additional insured per attached endorsement. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of El Segundo, City Clerk ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street Room 5 AUTHORIZED REPRESENTATIVE /f ElSegundo CA 90245-3813 , / 1/� @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: NPC-1006229-00 COMMERCIAL GENERAL LIABILITY CG 20 10 12 19 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) Location(s) Of Covered Operations 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 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) designated above. 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, 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 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 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. CG 20 10 12 19 © Insurance Services Office, Inc., 2018 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 insurance; whichever is less. This endorsement shall applicable limits of insurance applicable limits of not increase the Page 2 of 2 O Insurance Services Office, Inc., 2018 CG 20 10 12 19 �� 0 A.Mw..+w'B!'M. DATE (MMIDD/ ) 7w,.. CERTIFICATE OF LIABILITY INSURANCE 10/03/2022 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 NOMT Rhonda Scow CISR Landscape Contractors Insurance Services PHONE (559) 650-3555 h (559) 650-3558 AIC No Ext: Nedf'....................................... Insurance Services, Inc, ADDRESS: rscaw@Icisinc.com 1835 N, Fine Avenue INSURER(S) AFFORDING COVERAGE NAIL d Fresno CA 93727 INSURERA: State Compensation Insurance Fund 35076 .................................. INSURED INSURER B Oliver Holt Landscape INSURER C r 8611 Amestoy Avenue INSURER D INSURER E ........... Sherwood Forest CA 91325 INSURER F :. COVERAGES CERTIFICATE NUMBER: 22/23 WC 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. ......... ... ...... ... ........_... .._... .At9'I"yT: 5l1tf............ ..........................................�.,.................._. POLICYEFF POLICY EXP Rw WWWWWWWWTTTTTT���.............. TYPE OF INSUYRANCE.. _. IN,SD WVD POLICY NUMBER MMIDDM'YY,) (MMIDD/YYYY) LIMITS CO� MERCIAL GENELW LIABILITY EACH OCCURRENCE s- RENT DAMAGE O R I"E CLAIMS -MADE OCCUR PREMISES (Ea occurrence) S GEN LAGGREGATE LIMITAPPLIES PER: �........ PRO- POLICY DJECT D LOC OTHERw............................... AUTOMOBILE LIABILITY ANYAUTO OWNED SCHEDULED AlJ r0 ;ONLY R IilRll) 71V (.Y\YttNl.l:.7 O NON NON -OWNED A.I I IOS ONLY AUTC)S ( 7NI.Y UMBRELLA LIAB OCCUR EXCESS LIAB 1-1 CLAIMS -MADE DED RETENTION S '..... WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I N A ANY PROPRIETOR/PARTNER/EXECUTIVE � NIA 9129706-22 OFFICER/MEMBER EXCLUDED '......(Mandatory in NH) If yes, describe under MED EXP (Any one Derson) s PERSONAL B ADV INJURY S GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGO S 5 COMBINED SINGLE. LipAin S (Ea a r,4,d wnt BODILY INJURY (Per person) s BODILY INJURY (Per accident) 5 PROPERTY DAMAGE 5... IPer accident) S EACH C:kC;CL.IRRENCI:Z S AGGREGATE s E, L. EACH ACCIDENT S 1,000,000 04/01 /2022 04/01 /2023 _.....-.-...... E.L. DISEASE-EAEMµPLOYEE' 5 1,000,000 E.L. DISEASE -POLICY LIMIT wl $W1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: All landscape operations performed by or on behalf of the named insured. ***** WC Waiver of Subrogation on Order*"" Waiver of Subrogation in favor of City of El Segundo and its officers, elected officials, and employees (Excluding Professional Liability) **This revises certificate dated 3/17/2022** ** WC WOS attached 10/6/2022** CERTIFICATE HOLDER CANCELLATION City of El Segundo City Clerk 350 Main Street Room 5 ACORD 25 (2016103) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE CA 90245-3813 ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ENDORSEMENT AGREEMENT BROKER COPY WAIVER OF SUBROGATION - 9129706-22 ® RENEWAL NE HOME OFFICE 1-53-82-86 SAN FRANCISCO PAGE 1 OF 1 ALL EFFECTIVE DATES ARE AT 12:01 AM PACIFIC EFFECTIVE OCTOBER 4, 2022 AT 12.01 A.M. STANDARD TIME OR THE TIME INDICATED AT AND EXPIRING APRIL 1, 2023 AT 12.01 A.M. PACIFIC STANDARD TIME OLIVER HOLT LANDSCAPE 8611 AMESTOY AVE SHERWOOD FOREST, CA 91325 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 CITY CLERK WHICH MIGHT ARISE BY REASON OF ANY PAYMENT UNDER THIS POLICY IN CONNECTION WITH WORK PERFORMED BY, OLIVER HOLT LANDSCAPE 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 CONTAINED SHALL BE HELD TO VARY, ALTER, WAIVE OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS POLICY OTHER THAN AS STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR LIMITATIONS OF THIS ENDORSEMENT. COUNTERSIGNED AND ISSUED AT SAN FRANCISCO: OCTOBER 5,2022 2570 AUTHORIZLD REPRESENT ZIVE PRESIDENT AND CEO SCIF FORM 10217 (REV.7-2014) OLD DP 217