Press Alt + R to read the document text or Alt + P to download or print.
This document contains no pages.
PROOF OF INSURANCE (2024 - 2025) CLOSEDCC)RV CERTIFICATE OF LIABILITY INSURANCE 03/11DATE(MMIDO/2024 _
THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOTAFFIRMATIVELY OR NEGATIVELY AM END, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTER 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 COWACT NAME. Jhosel Crenshaw
Chesapeake Insurance Services Inc PHONrE x (818) 898-1043 C.Na; (818) 898-1643
CA License: 0799383 ADDRESS,
16654 Soledad Canyon Rd, #540 INSURER(S) AFFORDING COVERAGE NAIC #
Canyon Country CA 91387 INSURERA: Mt. Hawley Insurance Co..
INSURED INSURERB: Indian Harbor Insurance Comp
Morillo Construction Inc INSURER
227 N. Holliston Ave INSURER 1
INSURER E ;
Pasadena CA 91106 INSURER F
COVERAGES CERTIFICATE NUMBER: 211c5 KEVISIUN NU11fIt3tK:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDINGANY REQUIREMENT, TERM OR CONDITION OFANY 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 TOALL THE TERMS,
EXCLUSIONSAND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR TYPE OF INSURANCE INSD 1 WVID POLICY NUMBER (MMIDDNYYY) MM DDNYYY LIMITS
X
COMMERCIAL GENERAL LIABILITY
EACI i OCCURRENCE
$ 1,000,000
DAMAGE TO r r.i..
50,000
Is
CLAIMS -MADE Ox OCCUR
i'RL'h((ISFS(Laorcrlrrsnre7
MFD E)(P(Anv orre oers©M
$ 1,000
A
MGLO198056
10/2912023
10/29/2024
PERSONAL & ADV I NJURY
$ 1,000,000
GENERAL. AGO REGAFE
$ 2,000,000
GEV1_AGGREGrr��A--'IE11LIIVIItAPPIIISPER:
P4dODLICT"S-COMPdOPAGG
g 2,000,000
POLICY JECT LOC
0IIIL
AUTOMOBILE LIABILITY�rpylR6FkE,l'
„VE'tl'r4..E.L0I.0I
1 i n rrrwtt�lgo
$
BODILY INJURY (Per person)
$
ANY AUTO
BODII...Y INJURY (Per accident)
$
OWNED SCHEDULED
AU Fos ONI...Y AUI OS
HIRED NON-OWNEC)
I nr'1�,EFT� LryAMArm
(Rel aCrh;Nov
$
AUTOS ONLY SU.11"GSONLY
$
UMBRELLA LIAB
I2
EACH OCCURRENCE
$ 5,000,000
A
iC
EXCESS LIAB
MALE
MXL0438943
10/29/2023
10/29/2024
�LCIAIMS
AUGREGA1,
$ 5,000,000
Crl_D Rf-n:':':NTION $
$
WORKERS COMPENSATION
FA P"FI-
w.T CLfCF ER
AND EMPLOYERS LIABILITY YIN
AIVYPRO PRIETORIPARTNERfEXECUiIVE 0 NIA
'?
E L EACH ACCID N"r
$
EL DISFASE EA EMPLOYEE
$
OFFICER/MEMBER EXCLUDED'?
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
E L DISEASE - POLICY I...IMI1
$
Policy General Aggregate
$4,000,000
B
Professional Liability and
Contractors Pollution Liability
PECO05790903
10/29/2023
10/29/2024
Professional Liability
$2,000,000
Pollution Liabiility
$2,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
Project No. PW 24-02 - Urho Saari Swim Stadium
City of El Segundo, its officers, officials, employees, agents, and volunteers are named as additional insured.
See attached for Al status
Issuing insurer will endeavor to mail 30 days notice of cancellation, 10 days for non-payment of premium
Q lwK III`IUA I h HULUtK {rM1V 4CLLM 1[Will
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of El Segudo City Clerk ACCORDANCE WITH THE POLICY PROVISIONS.
350 Main Street
AUTHORIZED REPRESENTATIVE
ElSegundo CA 90245--.-
(cJ 1988-ZU10 AGUKU L;QKI'UKA I IUN. Au rlgnis reserves.
ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
Policy Number: MGL0198056 Mt. Hawley Insurance Company
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
All persons or organizations where required
All Locations
by written contract executed prior to the
commencement of your work.
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 in-
clude as an additional insured the person(s) or
organization(s) shown in the Schedule, but only with
respect to liability for "bodily injury", "property dam-
age" or "personal and advertising injury" caused by:
1. Your negligence; or
2. The negligence 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 insur-
ance 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 addi-
tional 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 re-
pairs) to be performed by or on behalf of the
additional insured(s) at the location of the covered
operations has been completed; or
CGL 20 10 08 15 Contains copyrighted material of Insurance Services Office, Inc. with its permission. Page 1 of 2
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.
C. With respect to the insurance afforded to these addi-
tional insureds, the following is added to Section III —
Limits Of Insurance:
The most we will pay on behalf of the additional
insured is:
1. The minimum amount required by any contract or
agreement you have entered into to provide
additional insured coverage; 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 OF THIS POLICY REMAIN UNCHANGED.
CGL 20 10 08 15 Contains copyrighted material of Insurance Services Office, Inc. with its permission. Page 2 of 2
Policy Number: MGL0198056
Mt. Hawley Insurance Company
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS - COMPLETED OPERATIONS
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person(s)
Or Organization(s) (Vendor)
Location And Description Of Completed Operations
All persons or organizations where required
All "Commercial Construction Projects". For
by written contract executed prior to the
the purpose of this Endorsement, "Commercial
commencement of your work.
Construction Projects" are defined as
buildings or structures constructed for
commercial use and also include apartments,
hotels, homes for the aged, dormitories or
barracks. However, "Commercial Construction
Projects" shall not include any building or
structure which, in whole or in part,contains
individual owner occupied units or dwellings.
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 in-
clude as an additional insured the person(s) or organi-
zations) shown in the Schedule, but only with respect
to liability for "bodily injury" or "property damage"
caused by your negligence 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
B. With respect to the insurance afforded to these
additional insureds, the following is added to Section
III — Limits Of Insurance:
The most we will pay on behalf of the additional in-
sured is:
1. The minimum amount required by any contract or
agreement you have entered into to provide addi-
tional insured coverage; or
2. Available under the applicable Limits of Insurance
shown in the Declarations;
2. If coverage provided to the additional insured is whichever is less,
required by a contract or agreement, the insur-
ance afforded to such additional insured will not This endorsement shall not increase the applicable
be broader than that which you are required by Limits of Insurance shown in the Declarations.
the contract or agreement to provide for such
additional insured.
ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED.
CGL 20 37 08 16 Contains copyrighted material of Insurance Services Office, Inc. with its permission. Page 1 of 1
Policy Number: MGLO198056
Mt. Hawley Insurance Company
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 Condition
and supersedes any provision to the contrary:
Primary And Noncontributory Insurance
This insurance is primary to and will not seek con-
tribution 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
(2) You have agreed in writing in a contract or agree-
ment that this insurance would be primary and
would not seek contribution from any other in-
surance available to the additional insured.
CG 20 01 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1
Policy Number: MGLO198056 Mt. Hawley Insurance Company
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
WAIVER OF TRANSFER OF RIGHTS OF RECOVERY
AGAINST OTHERS TO US (WAIVER OF SUBROGATION)
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
ELECTRONIC DATA LIABILITY COVERAGE PART
LIQUOR LIABILITY COVERAGE PART
POLLUTION LIABILITY COVERAGE PART DESIGNATED SITES
POLLUTION LIABILITY LIMITED COVERAGE PART DESIGNATED SITES
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
RAILROAD PROTECTIVE LIABILITY COVERAGE PART
UNDERGROUND STORAGE TANK POLICY DESIGNATED TANKS
SCHEDULE
Name of Person(s) or Organization(s):
All persons or organizations where required by written contract executed prior to the
commencement of your work.
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
The following is added to Paragraph 8. Transfer Of
Rights Of Recovery Against Others To Us of Section
IV — Conditions:
We waive any right of recovery against the person(s) or
organization(s) shown in the Schedule above because of
payments we make under this Coverage Part. Such
waiver by us applies only to the extent that the insured
has waived its right of recovery against such person(s) or
organization(s) prior to loss. This endorsement applies
only to the person(s) or organization(s) shown in the
Schedule above.
CG 24 04 12 19 0 Insurance Services Office, Inc., 2018 Page 1 of 1
�� DATE (MM/DD/YYYY)
AC"tea 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 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, SHAHIN HOOSHMAND
(!#!c Nf .. zcti 8188844451 (AA/c No)., .._. _
_. .......
SHAHIN HOOSHMAND PHONE I 8188844122
19730 VENTURA BLVD
E-MAIL SHAH INL7a ALLSTATE.COM
ADoNES
SUITE ONE INSURER
WOODLAND HILLS CA 91364 INSURER A: CONTRACTORS BONDING AND INSURANCENAIc#
—.,
CO--
LSTATE
INSURED--- INSURANCE CO
INSURER B . ........
MORILLO CONSTRUCTION, INC.
_ _ER C
INSURER
_ _..E....�..............------....... ......... .......w____
227 N HOLLISTON AVE.
--- ...�...._... .. -- ............... .._ ...
PASADENA CA 91106
INSURER
rroTICIf1ATlc KIIIRARICG• RFVISInN NTIMRFR:
INSURER
INSURER
D:
F;
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. .,..,�.,...__ ......... ......
.....� ....... --
.,._.... _ .......... ......... �._ -. .._ ..
..... ,. POLICY NUMBER MM DD 1 YYV MM/DO/VVYX LIMITS..
ILTR AODL SLi�... — jj + yy
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
� $
CLAIMS -MADE lm a OCCUR
t ITE�p
- —
...............__
MEDEIXPSIEawgccrrPrevelk...!
(Any one person
$
PERSONAL & ADV INJURY
� $
GEN'LAGC.^rFIEG,..... ......,.._.___ _.
ATE LIMIT APPLIES PER:
....
,GENERAL AGGREGATE
� ......, .....
$
{ PRO I LOC
�$
j POLICY
-°
- _
V'DTl1EFt..
AUTOMOBILE LIABILITY
C4�MeI�EC3SINOME/�Mn'GG.
11E'a,,y,i a erwl,),,, _, --
$ 2,000,000 .......... .
ANY AUTO
BODILY INJURY (Per pers?,n
$
B
AUTOS SCHEDULED
X
X
648239431
06/03/2023
06/03/2024
BODILY INJURY (Per accident)
$
AUTOS NON -OWNED
PROPLIITY OAMAr,E
IF.ea•rrarfnt)...
$ _.
HIRED AUTOS AUTOS
UMBRELLA IAB OCCUR
URRENCE Is
.
EXCESS L AB CLAIMS MADE
AGGROGATE $
....,
DED 1 RETENTION $
$
WORKERS COMPENSATION
TATUTE : ER PE'R OTH
AND EMPLOYERS' LIABILITY Y/N
ANYPROPRI TOR/PARTNER EXECUTIVE
E L EACH
OFFICER/MEMBER EXCLUDED �'..
(Mandatory in NH)
N / A
E L, DISEASECEA EMPLOYEE $
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L„ DISEASE - POLICY LIMIT $
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
Additional Insureds are as followlin,g:' City of EI Segundo, Its Officers„ officials, employees, agents, and volunteers will be covered as insureds as respects:
liability arusing out of activities performed by or on behalf of the Contractor; products and completed operations of the Contractor; premise owned„ occupied or
used by the Contractor; or automobiles owned, teased, hired or borrowed by the Contractor. The coverage will contain no speciial'� limitations on the scope or
protection afforded to the City, its officers„ officials, employees„ agents, or volunteers.
We agree in writing to waive all rights of subrogation against the City, its officers, officials, employees and volunteers for losses arising from work performed by
the Contractor for the City.
TE HOLDEH
CITY CLERK
City of El Segundo
350 Main Street
El Segundo, CA 90245
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
SHAHIN HOOSHMAND
U 1988-21)14 AGOHU GUMYUHA I IUIV. All rlgniS reSerVeO..
ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
Firefox
about:blank
Cl CW A02 10 11
CERTIFICATE OF INSURANCE
This certificate is issued for informational purposes only. It certifies that the policies listed in this document have
been issued to the Named Insured. It does not grant any rights to any party nor can it be used, In anyway, to modify
coverage provided by such policies. Alteration of this certificate does not change the terms, exclusions or conditions
of such policies. Coverage is subject to the provisions of the policies, including any exclusions or conditions, regard-
less of the provisions of any other contract, such as between the certificate holder and the Named Insured. The limits
shown below are the limits provided at the policy inception. Subsequent paid claims may reduce these limits.
Cortf"nicate HoMen"
C P TY 01 !Io lio :11CYIl:JCS
in 11, eEc1.1lI)0', Cv t,')24 8.1.3
Insurer Name: Allstate Insurance Compan
Nlarned Inquired:
rC)R "L l.,-) Cw 71 1:;C1'6 I'�i.C)i,5!', :[CC;,
22'1 N IiO.'.,ul 11�1.'C)! 11V'1E
Automobile
Pofi.a.Nurnbeir 648239431 s`L
1 -Any Auto 2 - Owned Autos Only 3 - Owned Priv. Pass. Autos Only
4 - Owned Autos Other Than Priv. 5 - Owned Autos Subject to No 6 - Owned Autos Subject to a Compulsory UM Law
Pass. Autos Only Fault
7 S ecificall Described Autos fir_ 8 - Hired Autos Onlym mmmmm 9 Non-oned. Autos Onlyw.w
Poli Effective Date: 06-03-20 W0 ..............w.........._ 23 Pdi Expiration 06-03-202r
Lim its Of S 2„ 07 )O, 000 Combined Single Limit (each accident)
Insurance: BI Per Person BI Per Accident PD Per Accident
Description of Operations/ Locations/Vehicles/Endorsements/Special Provisions
CIE'] ' .)F ::.'L SEC""(J'NJIi.'7,, ][. :.CEllC:l.`=, C",.!C'
AS .l.l` r.lC� [ 0:)I'ii A5"' 1:1.1:, ui'i.("!'3. q.,4.1`.5" VcLt:''aJlgC,. ')'1-CII:'
! :V.! l.aRMEWU i31' 0P ON i::EHA i..,1•'
C) i':i'lP: AT T.01f!::
irl ire, dIPaft'1 CE•:p,1'1.Ell Cr1'.[]^: [i)113E:R
THIS CERTIFICATE DOES NOT GRANTANY COVERAGE OR RIGHTS TO THE CERTIFICATE HOLDER
IF TH IS CERTIFICATE INDICATES THAT THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED, THE POLICY(IES)
MUST EITHER BE ENDORSED OR CONTAIN SPECIFIC LANGUAGE PROVIDING THE CERTIFICATE HOLDER WITH
ADDITIONAL INSURED STATUS. THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED ONLY TO THE EXTENT
INDICATED IN SUCH POLICY' LANGUAGE OR ENDORSEMENT.
Producer
SHllHIN _K EOCSIiPIAND
Authorized Representative:
Date: C -1 s< _ 2 c
Cl CW A021011
Includes copyrighted material of Insurance Services Office, Inc., with its permission
Allstate Insurance Company
Page 1 of 1
Insured Full Copy
I of 2 3/13/2024, 4:10 PM
Firefox
about:blank
POLICY NUMBER: 648239431 COMMERCIAL AUTO
AA CW 40 10 11
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
WAIVER OFTHE
TRANSFER OF RECOVERY AGAINST OTHERS TO US
This endorsement modifies insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
GARAGE COVERAGE FORM
MOTOR CARRIER COVERAGE FORM
TRUCKERS COVERAGE FORM
SCHEDULE
Designated Person or Organization:
CITY CLERK
CITY OF EL SEGUNDO
Contract Number: PW 24-02
Description of Project:
URHO SAARI SWIM STADIUM / PLUNGE RENOVATION PROJECT
Location of Project:
The following is added to the Transfer of Rights of Recovery Against Others To Us Condition:
We waive any right of recovery we may have against the person or organization designated in the above
Schedule because of payments we make for injury or damage arising out of work you perform under a
contract with the above designated person or organization. The waiver applies only to the above
designated person or organization and the work you perform must be under the contract, and for the
project and location designated in the above Schedule.
AA CW 40 10 11 Allstate Insurance Company Page 1 of 1
Insured Full Copy
1 of 1 3/13/2024, 4:10 PM
MORICON-Cl AB.
'4 CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDNYYY)
3/11 /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 _ .._
--
Bolton Insurance Services LLC Aec No Ert 62 000 W Ne 626 441 3233
PHONE
3475 E. Foothill Boulevard 6 799 7— ) ) ._-
(
Suite 100I _......
Pasadena, CA 91107
ICompSURER �s1�AF ion Insurance Fund,,- California
(rasuREr� A 'State Compensation
COVERAGE
NA
.........rr,_-_ ....-.........- .............. __..... ...... ....... ....----'---. ....._.. ,
INSURED ,..INSURER B ....... ..... __ --... ,..
Morillo Construction Inc #.so€ c .... ----
227 N Holliston Ave INSURER D
Pasadena, CA 91106 -. INSUR.ER_E .. .........._.
INSURER F .
COVERAGES _ CERTIFICATE UMBER: REVISION UMBER _._....
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,
E D BY PAID CLAIMS.
INSR TYPE OF INSURANCE OF SUCH ADDL R POLICY N '^ AVE BEEN REDUCED .---_ ..__—. .. LIMITS
EXCLUSIONS AND CONDITIONS LIMITS SHOWN MAY H�
....... a,,,....... --...,._ UMBER EFF � POLICY EXP .....,�...,_.. _— ..._ ..... •_,,.
COMMERCIAL GENERAL LIABILITY I UB (YYYY! � /D EACH OCCURRENCE „ ,� . ,,,
.� CLAIMS -MADE OCCUR DAMAGE TO RENTED
PBF�M!..GF��s�afr�no€) .. .. ..... .._. .........
_ .... - ......_..- ... .L ADV NJURY �$ ...,,_ ,.,...,.
An one erson
GEN'L AGGREGATE LIMIT APPLIES PER: AGGREGATE $
..GENERAL.-...- .. ._-......__ ... .. ..._
- PC H'L.t .� JEO LOC ._PRODUCT„3-COMP/OPAGG $ ..... ... _
M BODILY I ... S
D SINGLE LIMIT
ANY AUTO [ COMBINEDSINGLE�
AUT ANY AU LIABILITY SCHEDULED f .,BODILY INN ( P )m)
�f,�Fi �
URY Per erson �
AUTOS ONLY AUTOS Per I TJURY (_Per accident
HIRED NON -OWNED CkAi�RAG£.
..... AUTOS ONLY .. AUTOS ONLY ......._ ..�...... ........ ............. �....{ ROI'ITITITITIT.,np).,.. _. --- .,,_ ......
..
E 1 ,._EACH OCCURRENCE �
UMBRELLA LIAB OCCUR
EXCESS LIAB CLAIMS -MADE AGGREGATE ,„„„,`SIG, ,,,,,,_ ,,,m,,,,,
A WORKERS COMPENSATION -.........� .,_DED RETENTION $ �... ......_. _ $
AND EMPLOYERS' LIABILITY Y B N .. ..._.-. . X.. aaTAT�dT)m F.RH..... ..- --- 1,000,000
(HB dER/M in BER EXCLUDE[
E L DISEASE IDENT ' ,000
ANY 9206372 1/1/2024 1/1/2025 ncc
a4 ER/MEMNH) EXCLUDED? N / A
r s Y 1 000.. .
"' A, EA EMPLOYES•, $µ
If yes, describe under 1,000,000
_DESCR.IPTION OF OPERATIONS below ............
,..,............
... EA
E.L, DISSE - POLICY LIMIT
DESCRIPTION OF OPERATIONS / LOCATGONS I VEHICLES ACORD 101, w........-..
( Additional Remarks Schedule, may be attached if more space is required)
Re: Urho Saari SWiim Satdium, Project # PW-24-02
_ ............... . ............... __. .... _....... _
CERTIFICATE HOLDER .... _ ......_.,_ _.. CANCELLATION _.
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE City Clerk ACCORDANCE WITH THE POLICY PROVISIONS.
CE WILL BE DELIVERED IN
City of El Segundo
350 Main Street _ ....
El Segundo, CA 90245 AUTHORIZED REPRESENTATIVE
(r
l_..._. ........................
_._. ......_ _.
ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD