Loading...
PROOF OF INSURANCE (2025 - 2025)IAC<>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)