Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
PROOF OF INSURANCE (2023 - 2024) CLOSED
.✓ KRAUACT-01 LORALEEBARLOWBOYES A CERTIFICATE OF LIABILITY INSURANCE DATE(MM/D2�) ...........�._............._-2 ......._ 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; NFP Prope & Casualty Services, Inc. PHONE N5550 fiF 714 975-8966 1551 Nort,h7ustln Avenue (.• .,-q Ext:.�4� 505-N°I-...,. ac 1.... .... Suite 500 AE IkMAI PR s Santa Ana, CA 92705 INStIRER(S�AFFORDING COVERAGE _ � �NAIC # INS,URERA COI Insurance Company 39993 INSURED Krause ACT, Inc. DBA Air CleaningTechnology � INsuRER c C ress Insurance Com�an� __ 10855 9Y___-__ - ----- ----- 411 Rowland Ave ..INSURER ps........................................................................................................... � ,,,,,,,_, � ,,,_,_,_,.. Santa Ana, CA 92707 INSURER E ........ ...... INSURER F r COVERAGE CERTIFICATE 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. .._ .� m....m.............. — .. "."."....... IN5R ADDL-SUBR".. POLICY EFF POLICY EXP T TYPE OF INSURANCE IN • IA POLICY NUMBER LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X occuR xPACE4245133114 3/7/2023 3/7/2024 DAMAGE TO RENTED 100,000 MED EXP Any one perspn.. $...-,,.-.-.. m__ 50,000 PERSONALBADVINJURY $ 1,000,000 Gr,N'IL AGGREGATE LIMIT APPLIES PER: $ GENERAL AGGREGAT_ E 2,000,000 �� ,actor � LOC PRODUCTS COMP/O,PAGG 8 2 000,000 OTF9EI�' ...._ $ COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY ANY AUTO L OWNED SCHEDULED AUTOS ONLY AUTOS AUTOS ONLY NON-OWNED SPROPFRTY DA'Ia4AGlr•'.: -- PercirlYnk,� ---- -------------- $ .._. ._." ..__._.._.._.�._._ $ A UMBRELLA LIAB X OCCUR AGGREGATERRENCE$ 10 000 00 X DEDEETENTION $mm CLAIMS - MADE EXC424513R4 3/7/2023 3/7/2024 10,000,000 B WORKERAND EMPSO ERSELIA ILIITYSATION X PER ,ST TI-ITE ----..... .. O ANY PROPRIETOR/PARTNERIEXECUTIVE ("""" X KRWC422876 1/1I2023 1/112024 EACH ACCIDENT OTH $ OOO OOO `YIN OFFICER/MEMBER EXCLUDED? NIA $ 1 (Mandatory ) E L DISEASE EA EMPLOYEE ' Mandato m N If yes, describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY OLICY LIMIT $............. ' A Pollution Prof Liab PACE4245133114 317/2023 3/712024 Limit 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: El Segundo Fire Department, 314 Main Street, El Segundo, CA 90245. The City of El Segundo is included as Additional Insured with regard to General Liability per attached forms EPACE100-0814 & EPACE101-0814. Waiver of Subrogation applies to Workers' Compensation per attached form WC990410C. 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 RI�jREPRESENTATIVE ........ I __. _. ---....................................................................................... V"`• ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: PACE4245133R4 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. 0 E -*J*; I s 0 1 Wa- This endorsement modifies insurance provided under the following: EnviroPACE Insurance Policy SCHEDULE Name Of Additional Insured Person(s) Or Oraanization(s) I Location(s) Of Covered Operations Where Required By Written Contract I Where Required By Written Contract A. Section XX. WHO IS AN INSURED, Coverage Part 1 and Part 2 is amended to include as an additional insured the person(s) or organization(s) shown in the SCHEDULE above, but only with respect to liability for bodily injury, property damage, personal and advertising injury, environmental damage, or cleanup costs 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. EPACE101-0814 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 2 with its permission. C. With respect to the insurance afforded to these additional insureds, the following is added to section XXI. LIMITS OF LIABILITY AND DEDUCTIBLE: 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 Liability shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Liability shown in the Declarations. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. EPACE101-0814 Includes copyrighted material of Insurance Services Office, Inc., Page 2 of 2 with its permission. POLICY NUMBER: PACE4245133R4 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. K*J 9 1 go, Y.A I tri" Lei 4901 J, I :J 4 =1 9 =1 is 1101 :J =1 0 This endorsement modifies insurance provided under the following: EnviroPACF Insurance Policy SCHEDULE Name Of Additional Insured Person(s) Location And Description Of Completed Or Organization(s) Operations Where Required By Written Contract Where Required By Written Contract A. Section XX. WHO IS AN INSURED, Coverage Part 1 and Part 2 is amended to include as an additional insured the person(s) or organization(s) shown in the SCHEDULE above, but only with respect to liability for bodily injury, property damage, environmental damage, or cleanup costs 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. 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 is added to section XXI. LIMITS OF LIABILITY AND DEDUCTIBLE: 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 Liability shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Liability shown in the Declarations. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. EPACE100-0814 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 1 with its permission. ` 0 DATE (MM/DD/YYYY) ACCOR" CERTIFICATE OF LIABILITY INSURANCE 03/20/2023 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 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 I P!qACTKathyPerry Dan Rickabus Stat0brm State Farm Insurance 30131 Town Center Drive, Suite 275 Laguna Niguel, CA 92677 INSURED Krause A C T DBA Air Cleaning Technology 411 Rowland Ave Santa Ana, CA 927073445 949-363-7100 ................... .a , No) 949 363 1836 i tetarm corn katherine perry.Ntffsts State Farm Mutual Automobile _ INSURER(S) AFFORDING COVERAGE _NAIC p obile Insurance Co _ k: Company 25178 rn%1C0An-1=¢ r1=0TIVI1 ATl= Kill IMRt=R• RFVISIAN NIIMRFR- 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. .. ............... ;SU`9k..._.._._ ..."........ ItNTNt IN DL pCb N �"Y' E�FF POLICY EXfA TYPE OF INSURANCE........... WVD POLICY NUMBER fMM1DD1YYYY1 IMMIDOM`Y"LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE � $ _.... .,, .. . .-.. CLAIMS -MADE ..J OCCUR _,PREM SE$-jEa ou ... .... r ..... MED EX . PERSONAL & ADV INJURY ..........'. $ GEN L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ _ (vPRO FOk8sY IECT IC PRODUCTS.. COMP/OPAGG $ .......,_ OTHER t$ A AUTOMOBILE LIABILITY Y 545 8874-001-75 03/01/2023 09/01/2023 COMBINED SINGLE LIMq _(a�ccidaatr� ... $ 1,000,000 X ANY AUTO BODILY INJURY (Per person) $ X ALL OWNED �SCHEDULED BODILY INJURY (Per accident) $ AUTOS , AUTOS 545 1763-001-75 03/01/2023 09/01/2023 — - „ _ X .HIRED AUTOS NON -OWNED _ Auros 497 1093-001-75 03/01/2023 09/01/2023 PP&�0PER `�k M'AG'E ._C� __ $ .. $ '.. UMBRELLA LIAB ........... a ...,.. OCCUR EACH OCCURRENCE ..$...... _. ...,. '.. EXCESS LIAB CLAIMS -MADE --- ,... ....,._.rr_,,. .__ AGGREGATE ....... ......... .. ... $ DED 'RETENTION $ $........... WORKERS COMPENSATION PER OTH UTE„ �,,, FAR ANY PROPRIETOR/PARTNER/EXECUTIVE AND ABILITY Y / N N I A ,w,,,,,, E L EACH ACCIDENT „-,- r $ OFFICERIMEMBER EXCLUDED? (Mandatory in NH) PLOYEEj EmmL. DISEASE - EA EM m $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT A BNOL Y 507 2152-001-75 , 03/01/2023 09/01/2023 $250 Physical Damage deductible DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of EI Segundo, its officials and employees are named additional insured Location: El Segundo Fire Department Illillw,, •; twaI.Nroi:fmw�lbdT*T El Segundo Fire Department SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 350 Main St THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN El Segundo, CA 90245 ACCORDANCE WITH THE POLICY PROVISIONS. f AUTHORIZED REPRESENTATIVE U 1988-2014 AGORD GORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD 1001486 132849.9 02-04-2014 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 04 10 C (Ed. 01-19) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT-CALIFORNIA BLANKET BASIS 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.) The additional premium for this endorsement shall be calculated by applying a factor of 2% to the total manual premium, with a minimum initial charge of $350, then applying all other pricing factors for the policy to this calculated charge to derive the final cost of this endorsement. This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule Blanket Waiver Person/Organization Blanket Waiver — Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. Job Description Waiver Premium (prior to adjustments) All CA Operations 2036.00 This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective: 01/01/2023 PolicyNo.: KRWC422876 Endorsement No. Insured: Premium $ Insurance Company: Cypress Insurance Company Countersigned by WC 99 04 10 C (Ed. 01-19)