Loading...
PROOF OF INSURANCE (2024 - 2025) CLOSED0 -DATE ACll >RL> CERTIFICATE OF LIABILITY INSURANCE 03/12/2024 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 10877 White Rock Rd (A!O No... llµ ......(949) 97 t"AX NAME:_, PJ Hawthorne Edgewood Partners Insurance Center PHONE 994 80AIC„No 1.. _ EIryIL crrc. zai .Ixawthornegewicbrokors. com Rancho Cordova CA 95670 INSURER A : INSURE......,_,. _ ......... ....... _ ..... .., ...--- �,.,......,_.. ... D INSURER B Robert's Liquid Disposal, Inc. wsuRERC: ..-.........., 14018 Carmenita Road INSURERp; Santa Fe Springs, CA 90670 INS,U„RERE: INSURER F : xe war er�wx��„�n..a•n — I ^ATC L111\AOCO. n.. Tn Sol 2n /il 'RNAFFORDINGCOVERAGE ____ ..-NAIC# NATIONAL INSURANCE CO 14167 RFVICIAN 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 CLAIMS. ......... ,,,, ..... iPAID --- .�.�........ N2''�MLjg'U'I%�i ..----... .. ,..n .... ...........m ....., ........... ..... . ....�M�MIDD EFP LNCY PYV LIMITS INSRI........ .TYPE LTR OF INSURANCE POLICY NUMBER MAA BD�DrYYYY , A ICOMMERCIAL GENERAL LIABILITY X ` 000 EACH OCCURRENCE 000 _... ( OCCUR CLAIMS -MADE X Y ENV56200933202 03/OS/2024 y$ Mlw xd I'a h REN tt0pn. $-..1, 03/05/2025g( PRFMISEs(Eanccaw �eJ 50 000 _ M .. EXP (Any one person) $ 5 000 ......... ...... ... ... .... ................. ....... INJURY $ 1 000 PERSONAL 8 ADV.. .,,,,000 GEN'LAGGREGATEPL�f�TAPPLIESPER: ENERALAGGREGATE 00 000 X POLICY LOC 4 PRODUCTS-COMP/OP . ----- 00 000 OTHER AUTOMOBILE LIABILITY COMBINED SENGLE UM[T $ ANY AUTO BODILY INJURY (Per person) $ µ OWNED SCHEDULED BODILY INJURY ident)$ AUTOS ONLY „� AUTOS HIRED NON -OWNED PROPERTY AMAOacc $ Per dent ............. AUTOS ONLY ( AUTOS ONLY L....., r acc (�- 1 I -- -.... ;.... $ p, UMBRELLALIAB 03/OS/2029 03/OS/202EACH OCCURRENCE $OCCUR 4000000,000 XEXCESS LIABCLAIMS-MADE AGGREG p$ 9000 DED RETENTION $ , WORKERS COMPENSATION PER OTH STATU ER AND EMPLOYERS' LIABILITY YIN �E ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? TIA E.L EACH A CIDENT _ $, (Mandatory In NH) """""' E EA EM.P.LOYEE. E.L DISEAS, � ..... W._.., ` If yes, describe under DESCRIPTION OF OPERATIONS below LIMIT E.L. SE POLICY L DISEASE- $ A Pollution Liability ENV56200933202 03/05/2024 03/05/2025`Each Pollution Condition Limit $ 5,000,000 Aggregate $ 5,000,000 '.. DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Pumping & Disposal per Rate Sheet-2012 Certificate holder is named as additional insured as respects the general liability, but only if required by written contract with the named insured, prior to an occurrence, per form CG 2010 07/04 & CG2037 07/04 subject to all policy terms and conditions. City of E1 Segundo, its officials, and employee as "additional insureds" with respects to general liability. CERTIFICATE HOLDER CANCkLLAI1UN 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 Public Works Department 350 Main Street AUTHORIZED REPRESENTATIVE El Segundo CA 90245 I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Page 1 of 2 AC RV0 CERTIFICATE OF LIABILITY INSURANCE DATE I03/5/20512D02/Y4 4 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 pollcy(les) 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 e'ndorsemen't s , PRODUCER g r Insurance Agency, Inc. 562-469-1000 IT _ . ._ CONTACT StateFdl7f1 Beth BetteE. _�.....ez 'FAX FORDING COVERAGE IIC. Nop562�09 9 �1251178 Ic Ir 20220 State Farm Road E� janml4bethtretitger co1T? Cerritos, CA 90703 IN uE _., _. 'INSu�RElr.A• State Farm Mutual Automobile Insurance CoTwlpany INSURED INSURER, a : Roberts Liquid Disposal Inc. INSURER C: 14018 Carmen"Ita Rd INSURER o Santa Fe Springs, CA 90670 INSURER E : INSURER. r :: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFYTHAT 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 PERTA N, THE INSURANCE AFFORDED BY THE POLICIES OESCRlBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE SEEN REDUCED BY PA ID CLAIMS.. _.. D,r ti'�'�'LIMITS LTR. TYPE OF INSURANCE INSD 1NVD POLICY NUMBER M� MMA7wym COMMERCIAL GENERAL LIABILITY EACH OCCURRENC.E'. S ...... f ENTEO CLAIMS-MADEOCCUR I$ P MED EXP (Any parsoar) f ......, , ...,...o.IT... PERSONAL I1ADV INJURY f GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE PRO. PRODUCTS - COMPlOP A POLICY ❑ JECT LOC GG f "" .. f OTHER AUTOMOBILE LIABILITY 621 9999-BOl-75B 02/01/2024 08/01/2024 .„qEUMI f 2,000^000.00 ANYAUTO 653 6343-BOl -75B 02/01/2024.08/01/2024 OWNED�/ SCHEDULED Y soDaINJU RY Rr(Parpsrsdsnl Pari AUTOSONLY 'IN AUTOS +III f HIRED NON -OWNED 603-2889-AO7-75N 01/07/2024 07/07/2024 art ( .. LL"Str.-.p.R�5349P.Ylt'..._ 'f AUTOS ONLY �. AUTOS ONLY 663-3372-FO6-751 12/06/2023 06/06/2024 UMBRELLA LIAR OCCUR EACH OCCURRENCE �f C EXCESS LIAB I.ApMS-MADE AG f WORKERS COMPENSATIIONN... .. - DED S f PER OTT1• f, AND EMPLOYERS' UABILr Y ANY PROPRIETOR/PARTNERIFXECUTNE YIN E.L. EACH ACCIDENT f OFFICERIMEMBER EXCLUDED? NIA - ftM I lorY In NH) EASE - EA EMPLOYE f I Yee, ders0rgbs under E.L. DISEASE - POLICY LIMIT f DESCR:IPTIONOF OPERATIONS baktiw DESCRIPTION OF OPERATIONS I LOCATIONS! VEHICLES (ACORD 101, Additional Remarks Schedule, may be aMached it more space Is required) 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 AUTHORSCED REPRES NTATPIE El Segundo, CA 90246 01988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD 1001488 132849.14 04-13-2072 YYYj M/ (MDD/YDD/Y CERTIFICATE COVERAGES OVERFLOW DATE 03// Certificate Coverages Overflow (11/2010) P_0. BOX 8192, PLEASANTON, CA 94588 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 01-16-2024 CITY OF EL SEGUNDO PUBLIC WORKS DEPARTMENT 350 MAIN ST EL SEGUNDO CA 90245-3813 GROUP: POLICY NUMBER: 144138E t-2023 CERTIFICATE I0: 453 CERTIFICATE EXPIRES: 12-31-2024 12-31-2023/12-31-2024 This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated_ This policy is not subject to cancellation by the Fund except upon 30 days advance written notice to the employer, We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policy listed herein, Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy. Authorized Representative President and CEO EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE, ENDORSEMENT H2O65 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 12-31-2023 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. EMPLOYER ROBERT'S LIQUID DISPOSAL, INC. SP 14018 CARMENITA RD SANTA FE SPRINGS CA 90670 (ERG,CSI