PROOF OF INSURANCE (2024 - 2024)DM
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ACV CERTIFICATE OF LIABILITY INSURANCE °A /116/2023° 3
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 ADDITINAL INSURED, the pollcy(Ias) must have ADDITIONAL INSURED ( io-Visions 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 endDrsement(s).
PRODUCER NAME;, i(yfe Carrier
Heals County Insurance Canter PHONE It (2111) 427-6:il Na ; (281) 422.0554
608 Rolfingbrook «ars ate, kyle@harfisr.,ounlYinsuranc'e.com
Baytown
INSURED
Industrial Maintenance Service LLC
4515 W 166 St
TX 77521
t NAIC 0 1
INsuRER B: AmGUARD Insurance Company
INSUR'ER C
INSURER. D
Lawndale CA 90260 INSURERF:
OVERAGES CERTIFICATE NUMBER: CL23111624168
THIS IS TO CERTIFY THATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN $SSUfQ TO THE INSURED NAMEW
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS 7
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
,TIT TYPE OF INSURANCE O POLICY NUMBER. MMIO MWDq.V'YYMY
�5CLAIMS-MADE
b1ERCIAL GENERAL LIABILrry OCCUR
A
Y
0100170427-2
1111 W023
11/192024
GIEM
L AGGREGATE LIMIT APPLIES PER:
POLICY ❑ PRO-
JECT 7 LDC
OTtiE;R�.
AUTOMOBILE
LIABILITY
ANY AUTO
B
OWNED SCHEDULED
AUTOS AUTOS
ONLY
Y
INAU373700
11/19/2023
11/192D24
HIRED NON4 WNED
AUTOS ONLY -. AUTOS ONLY
UMBRELLALIAB OCCUR
EXCESS LUIB , ,,,,—
EMPLOYERS'LIABILITY YIN
PROPRMTORMARTIJERIFXECUTWE; ❑'......NrA
r EI'1P'I+IE.I;B4R EXCLUDED
DESCRIPTION OF OPERATIONS d LOCATIONS I VEHICLES (ACORD 101. Additional Remat" Schedule, may be attached If mole space Is required)
Certificate Holder is named as Additional Insured with Primary and Non -Contributory wording when required by contract.
City of El Segundo
3500 Main Street
EI Segundo
CA 90245
PFVIgI()?J NIIMRFR•
BOVE FOR THE POLICY PERIOD
WITH RESPECT TO WHICH THIS
MUBJECT TO ALL THE TERMS,
LIMITS
EAPiPCCURRENCE
S 1,000,000
PREMISE E�v�xua*anrm
S 100,000
ME D EXP dArq om Per1D1l
$ 5,000
PERSONAL Aa.M%IA.'P RS
"S, 1.000.000
OEN'ERALAGGIi-EGA'rE
5. 2,0010.000
PRODUCTS •CLOMRgEAGO
S 2,000,000
Employee Benefits
$
COMA NED St LE U1
S 1,000,000
e 1
BODILY INJURY (Per pemonl
S
BODILY INJURY (Per accident)
E
A P�erel AMAGE.
y
PlP-Basic
s 2,500
EACHOCCURRENCE
5
AGGP.EOME
"S
P � CMRIN.
EEL.. EACH ACCIDENT
S
E.L.OISEASE-CAEMPLOYEE
S
E..L,. DI'SE,A.., POLICY LIIA%'T
S
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
01988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
POLICYHOLDER COPY
SC
P.O. BOX 8192, PLEASANTON, CA 94588
CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
ISSUE DATE: 04-01-2024
CITY OF EL SEGUNDO SC
350 MAIN ST
EL SEGUNDO CA 90245-3813
GROUP:
POLICY NUMBER: 1435105-2023
CERTIFICATE ID: 235
CERTIFICATE EXPIRES: 08-01-2024
06-01-2023/06-01-2024
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 certuficats 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 06-01-2023 IS
ATTACHED TO AND FORMS A PART OF THIS POLICY.
ENDORSEMENT #1951 - JOE ELLIOT MGRMBR - EXCLUDED.
EMPLOYER
INDUSTRIAL MAINTENANCE SERVICE, LLC SC
4515 W 188TH ST
LAWNDALE CA 90280
[P1 V, HOI
(REV.7-2014) PRINTED : 04-01-2024