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PROOF OF INSURANCE (2025 - 2025) CLOSEDIAC<>Ri;f DATE (MM/DD/YYYY)
4,a�,,,.,..�- CERTIFICATE OF LIABILITY INSURANCE 07/03/2024
THIS CERTIFICATE IS ISSUER AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UIPON THE CERTIFICATE MOLDER. THIS CERTIFICATE
DOES NOT AFFIRMATIVELY OR NEOATI'VELY AMEND, EXTENDOR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF
INSURANCE DOES HOT 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 corder rights to the certificate holder In lieu of such endorsement(s).
PRODUCER
FEDERATED MUTUAL INSURANCE COMPANY
HOME OFFICE: P.O. BOX 328
OWATONNA, MN 55060
INSURED
HORIZON MECHANICAL CONTRACTORS OF CALIFORNIA
PO BOX 661461
ARCADIA, CA 91066-1461
CERTIFICATE NUMBER: 211
CLIENT CONTAC
mi: 888-333-4949
_I INSURER A:FEDERATED MUTUAL INSURANCE COMPANY
315-809-4 INSUR6R B
............
INSURER C
INSURER D:
INSURER E:
REVISION NUMBER: 1
13935
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.
IN6R DL 'I
TYPE OF INSURANCE POLICY NUMBER ''�. PO 'XP
LIMITS
x COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$1,000,000
CLAIMS -MADE OX OCCUR
AMFvkiE TO 'ELATED PREMISES
$100,000
MEDEXP(Any— person)
EXCLUDED
A
Y
N
1854207
03/15/2024
03/15/2025
PERSONAL S ADV INJURY
...r..-.�.-..
_t 1 000 000
AGGREGATE .....,.,.
GENE.. At`+CdL ' CMNr APPWESPER:.
I
H 1�T.�
Q�Q.
X POLICY �I DO,
PRODUCTS S COMP/OP ADO
$2,000.000
L,eC
OTHER:
OMBI ED 9INOLE LIMIT
$1,000,000
AU"rOMORILE LIABILITY
r. A.L
X ANY AUTO
BODILY INJURY War Person)
A
OWNED AUTOS ONLY ULED
N
N
1854207
03/15/2024
03/15/2025
BODILY INJURY (Per AccldenQ
CAGE..
�
HIRE�D AUTOS ONLY ,yN,C I—x,
(
UMBRELLA LAB X OCCUR
EACH OCCURRENCE
$3.000.000
A
..
BXCEssLIAB �CLAIMS4IADE
N
N
1854209
03/15/2D24
03/15/2025
AGGREGATE
$3.000,000
DIED RETENTION
WORKERS COMPENSATION
PER STATUTE THER
AND EMPLOYERS' LIABILITYANY
PROPRIETORIPARTNERI EXECUTIVE
E.L EACH ACCIDENT
OFFICERIMEMBER EXCLUDED?
N/A
E.L DISEASE EA EMPLOYEE
(Mandatory In NH)
If yea. describe under
DESCRIPTION OF OPERATIONS below
_. ...
E.L DISEASE POLICY LIMIT
DESCRIPTION OF OPERATIONS I LOCATIONS -I VEHICLES (ACORD 101, Addieanal Remarks Schedule, may he athehed if more space is nquind)
THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED SUBJECT TO THE CONDITIONS OF THE ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS - AUTOMATIC STATUS WHEN REQUIRED IN A WRITTEN CONSTRUCTION AGREEMENT WITH YOU ENDORSEMENT FOR GENERAL
LIABILITY.
CERTIFICATE HOLDER CANCELLATION
315-609-I
CITY OF EL SEGUNDO PUBLIC WORKS
350 MAIN ST
EL SEGUNDO, CA 90245-3813
211 1 1 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 //�/ /^'—•
O 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016A73) The ACORD name and logo are registered marks of ACORD
Dear Policyholder,
Thank you for choosing Federated Insurance to handle your insurance and risk management
needs. The attached certificate document(s) have been issued or updated.
Please feel free to contact us with any additional changes, additions or deletions that may be
needed by contacting the Federated Client Contact Center at:
E-mail:
Phone: 1-888-333-4949
Fax: 507-446-4664
Thank you for your business!
Client Contact Center
Enclosed
Certificate Document(s)
MISC-0829 (03-22)
I
COMMERCIAL GENERAL LIABILITY
CG 20 33 12 19
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OIL
CONTRACTORS _ AUTOMATIC STATUS WOMEN
REQUIRED IN A WRITTEN TEN CONSTRUCTION
AGREEMENT WITH YOU
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
A. Section II - Who Is An Insured is amended to
include as an additional insured any person or
organization for whom you are performing
operations when you and such person or
organization have agreed in writing in a contract
or agreement that such person or organization be
added as an additional insured on your policy.
Such person or organization is an additional
insured only with respect to liability for "bodily
injury", "property damage" or "personal and
advertising injury" 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.
However, the insurance afforded to such
additional insured:
1. Only applies to the extent permitted by law;
and
2. Will not be broader than that which you are
required by the contract or agreement to
provide for such additional insured.
A person's or organization's status as an
additional insured under this endorsement ends
when your operations for that additional insured
are completed.
B. With respect to the insurance afforded to these
additional insureds, the following additional
exclusions apply:
This insurance does not apply to:
1. "Bodily injury", "property damage" or
"personal and advertising injury" arising out of
the rendering of, or the failure to render, any
professional architectural, engineering or
surveying services, including:
a. The preparing, approving, or failing to
prepare or approve, maps, shop drawings,
opinions, reports, surveys, field orders,
change orders or drawings and
specifications; or
b. Supervisory, inspection, architectural or
engineering activities.
This exclusion applies even if the claims
against any insured allege negligence or other
wrongdoing in the supervision, hiring,
employment, training or monitoring of others
by that insured, if the "occurrence" which
caused the "bodily injury" or "property
damage", or the offense which caused the
"personal and advertising injury", involved the
rendering of or the failure to render any
professional architectural, engineering or
surveying services.
© Insurance Services Office, Inc., 2018 Page 1 of 2
CG 20 33 12 19 Policy Number: 1854207 Transaction Effective Date: 03/15/2024
2. "Bodily injury" or "property damage"
occurring after:
a. 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
b. 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
additional insureds, the following is added to
Section III - Limits Of Insurance:
The most we will pay on behalf of the additional
insured is the amount of insurance:
1. Required by the contract or agreement you
have entered into with the additional insured;
or
2. Available under the applicable limits of
insurance;
whichever is less.
This endorsement shall not increase the
applicable limits of insurance.
Page 2 of 2 © Insurance Services Office, Inc., 2018
CG 20 33 12 19 Policy Number: 1854207 Transaction Effective Date: 03/15/2024
IS
0 CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDmY
07/10/2024)
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
CONTACT
PRODUCER (+UAfAE.,- Gabriel Hill
Insurance & Surety Services, LLC PHONE e....�
4195 Chino Hills Pkwy. #403 ( „," .Exrt1,- 09 703 939m6mmm ..... _ VC 1-.-......-._,
Lic. 0I67797 E-MAIL abriel8isscllc.com
Ag ORAP� �w__..9....
Chino Hills CA 91709 rn,xrrnr_c NAtC 9t
+IG
INSURED
Horizon Mechanical Contractors of California,
Inc
P.O. Box 661461
Arcadia CA 91066
(626) 574-0900
. .1NSUI1ER(5I APFORDIf
ritV National It
A Sic...0.........
B: ............
C:
D: •.............�
E:
-- ����._.... � ,•... _-� �., „ no r+a�t 191w5/1Y.'"ff'1Ix9 MI IMRFR•
THIS S TO CERTIFY THAT THE POLICIES ,OF INSURANCE LISTEDBELOW 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 BEENN REDUCED BY PAID CLAIMS.
_ "_... ....... _ _
UNSR: AODLSUBR POLfCYoff POLICYEXP LIMITS
T"R TYPE OF INSURANCE POLICY NUMBER MMt NYYY M. 1D YYY ''.....
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE.
....
„5 „„„.•","""
...... ....
CLAIMS -MADE El OCCUR
•OAS TM�`l RR'
MED EXP QAny one.p+rason)
$
PERSONAL S ADV' UNJURY
S
GEN'L. AGGREGATE LIMIT APPLIES � PER.
GENERALAGGREGATE
$
PRO -
POLICY D JECT LOC
F1
PRODUCTS (K7MPi0I" AGG
-----
S -....... ..........
OTHER
COMBINED SINGLELIMIT
$
AUTOMOBILE LIABILITY
( sarskdm! ......""",
ANY AUTO
BODILY INJURY (Per person)
$
OWNED ... SCHEDULED
BODILY INJURY (Per accident)
$
AUTOS ONLY ...... AUTOS
HIRED NON -OWNED
PROiERTY DAf+11ACroE
$
AUTOS ONLY • AUTOS ONLY-Pp'renN
-----
UMBRELLALIHB OCCUR
EACH OCCURRENCE
5_w,,,„"_,. ,,,,,„„.•
EXCESS LIHB CLAIIwflS�MAO'E.,
_
AGGREGATE
$ IT"„"._. ...._.
DED RE'TENT'UON$
P_
$
WORKERS COMPENSATION
y
SWC1480756
03/01/2024
03i01/2025.
X $'rATUJTF ERH
" „„
A
AND EMPLOYERS' LIABILI TY YJ'N
E L E �Ctj COCIOENT
$ 1,000,000
ANYPROPRIETOR/PARTNER/EXECUTIVE ��y�y
OFFICERIMEMBEREXCLUDED? 1
NIA'
..A ..
1,000,000�
1
iMandatoryinNH)
EL DISEASE-6.�4.E...YEE
$ -
Ues, describe undee
E.L. DISEASE • POLICY LIMCT
S, 1,000,000
SCRIPT [ON OF OPERATIONS Wows
L
$
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
Waiver of Subrogation applies per attached WC 040306 04/84 endorsement.
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
AUTHORIZED REPRESENTATIVE
350 Main St„
El Segundo CA 90245-3813
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
Page 1 of 1
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06
(Ed. 04-84)
WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA
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.)
You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work
described in the Schedule.
The additional premium for this endorsement shall be 2% of the California workers' compensation premium otherwise due on such
remuneration.
Schedule
Person or Organization Job Description
Any person or organization as required by written contract.
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 3/1/2024 Policy No. SWC1480756 Endorsement No. 0
Insured Horizon Mechanical Contractors of California (A Corp) Premium $ 18,779
Insurance Company Security National Insurance Company
Countersigned by
WC 04 03 06
(Ed. 04-84)