PROOF OF INSURANCE (2024) CLOSED0 DATE (MMIDDIYYYY)
ACC" CERTIFICATE OF LIABILITY INSURANCE
a .. 12115/2022
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 Rebecca Zannetti
NAHIE:
STERLING INSURANCE GROUP PHONE
E t : (586) 685-0152 a No : (586) 323-5703
13900 Lakeside Circle E-MAJL rzannetti@sterlingagency.com
ADDRESS:
INSURER(S) AFFORDING COVERAGE NAIC #
Sterling Heights MI 48313-1318 INSURERA: Amerisure Insurance Company 19488
INSURED INSURER B :
Fire-Catt LLC INSURER C
3250 W Big Beaver INSURER D:
INSURER E :
Troy
MI 48084 1INSURER F A
COVERAGES CERTIFICATE NUMBER: CL22121530015 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAYBE 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.
NSR
LTR
TYPE OF INSURANCE
ADDLSUBR
INSD
WVD
POLICY NUMBER
PODUf E'fF
MMYDDIYYYV
POLICY EXP
MMIDDM'YY
LIMITS
X COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,000
1,000,000
CLAIMS -MADE ❑X OCCUR
PR MMES Egocsunamcu
$
MED EXP (Any one person)
$ 10,000
A
CPP21110210302 01/11/2023 01/11/2024 PERSONALBADV INJURY
$ 1,000,000
''. GEN'LAGGREGATE LIMITAPPLIES PER:
GENERAL AGGREGATE
$ 2,000,000
POLICY JET LOC
PRODUCTS-COMPIOPAGG
$ 2,000,000
Employee Benefits
$ 1,000,000
OTHER.
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMA
C� arCc�deel
S 1,000,000
" ANYAUTO
BODILY INJURY (Per person)
$
A OWNED SCHEDULED
CA21110200302 01/11/2023 1 01/11/2024 BODILY INJURY (Per accident)
$
AUTOS ONLY AUTOS
HIRED NON -OWNED
P_
PROPERTY DAMAGE
$
AUTOS ONLY AUTOS ONLY
P'e.r acckr nl.
UMBRELLALIAB OCCUR
EACH OCCURRENCE
$ 5,000,000
A EXCESS LIAR CLAIMS -MADE
'.. CU21110220302 01/11/2023 01/11/2024 AGGREGATE
$ 5,000,000
DED X1 RETENTIONS 10,000
$ 0
WORKERS COMPENSATION
STATUTE ERH
AND EMPLOYERS' LIABILITY�
YIN
1,000,000
ANY PROPRIETOR/PARTNER/EXECUTIVE
A
E.L. EACH ACCIDENT
NIA WC211101103 01/11/2023 01/11/2024
$
OFFICER/MEMBEREXCLUDED?
1,000,000
(Mandatory in NH)
E.L. DISEASE - EA EMPLOYEE
$
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
1,000,000
$
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
City of El Segundo, its officials and employees are
named as additional inusred with respect to general liability as required by written contract. Coverage is
primary and non-contributory.
CERTIFICATE HOLDER
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of El Segundo
ACCORDANCE WITH THE POLICY PROVISIONS.
350 Main Street, Room 5
AUTHORIZED REPRESENTATIVE
EI Segundo
CA 90245
@ 198 8-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016103)
The ACORD name and logo are registered marks of ACORD
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CONTRACTOR'S BLANKET ADDITIONAL INSURED ENDORSEMENT ---
FORM A
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY
COVERAGE PART
Policy Number
Agency Number
Policy Effective Date
CPP21110210402
0115254
01/11/2023
Policy Date Expiration Exmmm ..........
p
_....
Date
Account Number
01/11/2024
01/2G/2023
20074208
Named Insured
Agency
Issuing Company
FIRE -GATT LLC
STERLING INSURANCE GROUP
AMERISURE MUTUAL INSURANCE
COMPANY
1. a. SECTION it - WHO IS AN INSURED is amended to add as an additional insured any person or
organization:
(1) Whom you are required to add as an additional insured on this policy under a written contract or
written agreement relating to your business; or
(2) Who is named as an additional insured under this policy on a certificate of insurance,
b. The written contract, written agreement, or certificate of insurance must:
(1) Require additional insured status for a time period during the term of this policy; and
(2) Be executed prior to the "bodily injury", "property damage", or "personal and advertising injury"
leading to a claim under this policy.
c. If, however:
(1) "Your work" began under a letter of intent or work order; and
(2) The letter of intent or work order led to a written contract or written agreement within 30 days of
beginning such work; and
(3) Your customer's customary contracts require persons or organizations to be named as additional
insureds;
we will provide additional insured status as specified in this endorsement.
2. The insurance provided under this endorsement is limited as follows:
a. That person or organization is an additional insured only with respect to liability caused, in whole or in
part, by:
(1) Premises you:
(a) Own;
(b) Rent;
(c) Lease; or
(d) Occupy;
(2) Ongoing operations performed by you or on your behalf. Ongoing operations does not apply to
"bodily injury" or "property damage" occurring after:
includes copyrighted material of Insurance Services Office, Inc.
CG 70 48 10 15 Pages 1 of 4
(a) All work to be performed by you or on your behalf for the additional insured(s) at the site of the
covered operations is complete, including related materials, parts or equipment (other than
service, maintenance or repairs); or
(b) That portion of "your work" out of which the injury or damage arises is put to its intended use by
any person or organization other than another contractor working for a principal as a part of the
same project.
(3) Completed operations coverage, but only if:
(a) The written contract, written agreement, or certificate of insurance requires completed
operations coverage or "your work" coverage; and
(b) This coverage part provides coverage for "bodily injury" or "property damage" included within
the "products -completed operations hazard".
However, the insurance afforded to such additional insured only applies to the extent permitted by law,
b. If the written contract, written agreement, or certificate of insurance:
(1) Requires "arising out of language; or
(2) Requires you to provide additional insured coverage to that person or organization by the use of
either or both of the following:
(a) Additional Insured -- Owners, Lessees or Contractors — Scheduled Person Or Organization
endorsement CG 20 10 10 01; or
(b) Additional Insured — Owners, Lessees or Contractors — Completed Operations endorsement CG
20 37 10 01;
then the phrase "caused, in whole or in part, by' in paragraph 2.a. above is replaced by "arising out of'.
c. If the written contract, written agreement, or certificate of insurance requires you to provide additional
insured coverage to that person or organization by the use of:
(1) Additional Insured — Owners, Lessees or Contractors — Scheduled Person Or Organization
endorsement CG 20 10 07 04 or CG 20 10 04 13; or
(2) Additional Insured — Owners, Lessees or Contractors — Completed Operations endorsement CG 20
37 07 04 or CG 20 37 04 13; or
(3) Both those endorsements with either of those edition dates; or
(4) Either or both of the following:
(a) Additional Insured — Owners, Lessees or Contractors — Scheduled Person Or Organization
endorsement CG 20 10 without an edition date specified; or
(b) Additional Insured —Owners, Lessees or Contractors— Completed Operations endorsement CG
20 37 without an edition date specified;
then paragraph 2.a. above applies.
d. Premises, as respects paragraph 2.a.(1) above, include common or public areas about such premises if
so required in the written contract or written agreement.
e. Additional insured status provided under paragraphs 2.a.(1)(b) or 2.a.(1)(c) above does not extend
beyond the end of a premises lease or rental agreement.
f. The limits of insurance that apply to the additional insured are the least of those specified in the:
(1) Written contract;
(2) Written agreement;
(3) Certificate of insurance; or
(4) Declarations of this policy.
The limits of insurance are inclusive of and not in addition to the limits of insurance shown in the
Declarations.
Includes copyrighted material of Insurance Services Office, Inc.
Page 2 of 4 CG 70 48 10 15
g. The insurance provided to the additional insured does not apply to "bodily injury", "property damage", or
"personal and advertising injury" arising out of an architect's, engineer's, or surveyor's rendering of, or
failure to render, any professional services, including but not limited to:
(1) The preparing, approving, or failing to prepare or approve:
(a) Maps;
(b) Drawings;
(c) Opinions;
(d) Reports;
(e) Surveys;
(f) Change orders;
(g) Design specifications; and
(2) Supervisory, inspection, or engineering services.
h. SECTION IV— COMMERCIAL GENERAL LIABILITY CONDITIONS, paragraph 4. Other Insurance is
deleted and replaced with the following:
4. Other Insurance.
Coverage provided by this endorsement is excess over any other valid and collectible insurance
available to the additional insured whether:
a. Primary;
b. Excess;
c. Contingent; or
d. On any other basis;
but if the written contract, written agreement, or certificate of insurance requires primary and non-
contributory coverage, this insurance will be primary and non-contributory relative to other insurance
available to the additional insured which covers that person or organization as a Named Insured, and
we will not share with that other insurance.
I. If the written contract, written agreement, or certificate of insurance as outlined above requires additional
insured status by use of CG 20 10 11 85, then the coverage provided under this CG 70 48 endorsement
does not apply except for paragraph 2.h. Other Insurance. Additional insured status is limited to that
provided by CG 20 10 11 85 shown below and paragraph 2.h. Other Insurance shown above,
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS (FORM B)
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART.
SCHEDULE
Name of Person or Organization: Blanket Where Required by Written Contract, Agreement, or
Certificate of Insurance that the terms of CG 20 10 11 85 apply
(if no entry appears above, information required to complete this endorsement will be shown in the
Declarations as applicable to this endorsement.)
WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown
in the Schedule, but only with respect to liability arising out of "your work" for that insured by or for you.
CG 20 10 1185 Copyright, Insurance Services Office, Inc., 1984
Includes copyrighted material of Insurance Services Office, Inc.
CG 70 48 10 15 Pages 3 of 4
The insurance provided by this endorsement does not apply to any premises or work for which the
person or organization is specifically listed as an additional insured on another endorsement attached to
this policy.
Includes copyrighted material of Insurance Services Office, Inc.
Page 4 of 4 CG 70 4810 15