PROOF OF INSURANCE (2025 - 2026) CLOSEDAC F`'
MM/DDNYYY)
' `R "� CERTIFICATE OF LIABILITY INSURANCE
l . 1 /6/2025
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 NAM Cr Daniel Brock
Sierra Oak Insurance Services Inc PNON
9700 Business Park Drive Suite 105 (A( ta...li 9164738f1 I'll81
__..-.
E-MAIL akinC cgm
_. F
Sacramento CA 95827 A&�EMRE,$,S ca��sterTar� .......,. _ .............. (_APC N�) .... 73....---.........
.
._ ------ ......INSURER............. ........�.....----
""S S)AFFORDINGCOVERAGE
NAIL#
......,,,.
Llcense){m.Q975��
- eOne National Ins Co. _
RA
14167
FSCONTR-01
I47
NSURED
INSURER_B Insu P Y West
29879
FS Contractors,
Security Insurance
Securi"ncNat National Insurance
..
1987s
t
14838 Bledsoe St
_IMsu�►t-a --- �- � �"��
��7�����
Sylmar CA 91342
_._ - _ A'. don Ins Co _
85202
INSURER 8y
37974
iNSURERF - Navigators Insurance Com n
.
42307
i+wvr-n.i.�c- ronvieir ATe wnuoeo-nne3cenn
RFVI_CIAN NIIMRFR-
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. ..,
--- .........
•�..... .......... 1.--.,6iJf_Y" .. �I Y E .- . ....._._.___ .......
,R _ .... .. ....
J4�DDL SUBit"�� ..""" � � POLICY EFF � � POLICY IEXP LIMITS
INS _ ....._.. ----TYPE
OF
R INSURANCE MMIDD MM1DD
POLICY NUMBER
F X COMMERCIAL LIABILITY Y
Y
LA25CGLZOD4RWIC
1/13/2025
1/13/2026
EACH OCCURRENCE
$1 000 00 0
CLAIMS -MADE �f
CLAIMSGENETX r OCCUR
DAMAGE -To ktNTFRY
PREMISES. (Eaaccunence]
— 50 000
$
(Any one person)
EXP111.,..
M..
$ ----- ----- __
. ...
L & ADV INJURY
- PERSONA.... ...
..E.....D
.,$ 1 000 00„ 0 --
GEN'L AGGREGATE LIMIT APPLIES PER:
_GENERAL AGGREGATE
$ 2,000,000PRO-
POLICY %�JE T LOC
.PRODUCTS COMP/OP AGG
$ 2 000 000
C AUTOMOBILE LIABILITY Y
Y
SPP181596601
8/26/2024
8/26/2025 4 g��".I pNGi 6 LIMIT
$ 1 000 000
X ANY AUTO
BODILY INJURY (Per person)
$
OWNED SCHEDULED
.... ............ ......__
BODILY INJURY (Per accident)
$
AUTOS ONLY AUTOS
X HIRED X NON -OWNED
Sit nE
DAMAC
$
AUTOS ONLY - AUTOS ONLY
Par"F
„g pocideaa4) .•,•,,
......,-.
F
MBRELLALIAB X OCCUR
..
u--.........
SF25EXCZ0D4QLIC
1/13/2025
1/13/2026 "AGGREGATE OCCURRENCE
EACH ...
$ 8 000,000
.$ —
X
Ex CESSLIAB CLAIMS MADE
$ 8 000,000
,0
... .... ..D.-.{{{.
DE D ( 1 RETENTION $
GL AU WC
$
B
WORKERS COMPENSATION
Y
WSA5032771 09
7/31/2024
7/31/2025
X PER OTH
STATUTE ER
_
AND EEMPPLOY LLABILITY Y / N
ANYPROPRIETOR/PARTNER/EXECUTIVE
NHS'
E L EACH ACCIDENT,
$ 1 000 000
OFFICER/MEMBEREXCLUDED? ❑ NIA A
( ry )
E L DISEASE EA EMPLOYEE
$1,000,000
If yes, describe under
DISEASE POLICY LIMIT
POLI,,
$1 00000 0
DESCRIPTION OF OPERATIONS below
E.L. -
A
Pollution Liability
ENV562012869-02
1/13/2025
1/13/2026
Poll. Each Occurrence
2,000.000
E
Installation Float
ILM0718456
8/26/2024
8/26/2025
Rented/Leased
25,000
D
Professional Liability
71
ANE5470677.24
8/13/2024
8/13/2025
Prof. Each Occurrence
2,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required)
Excess over the GL, WC, BAU
Job: On -Call Concrete Maintenance Various Locations in the City of El Segundo The City of El Segundo, its officers, officials, employees, agents,&
volunteers to be named additional insured on the general liability & auto.Primary & noncontributory applies. Waiver of subrogation applies to general liability,
auto & work comp.
GtKIIFIGAIt MULILILK 's L+-rM1"114
City of El Segundo
350 Main St
El Segundo CA 90245
USA
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
U 19BB-2015 AGUKD GUKPUKA I IUN. Au rignis reserveo.
ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
Policy Number SPP181596601
COMMERCIAL AUTO
CA990187 0715
This Endorsement Changes The Policy. Please Read It Carefully
BUSINESS LESS ,AUTO COVERAGE EXPANSION
ENDORSEMENT
This endorsement modifies insurance provided by the following:
BUSINESS AUTO COVERAGE FORM
With respect to coverage provided by this endorsement, the provisions of the COVERAGE FORM apply
unless modified by the endorsement.
A. Newly Acquired or Formed
Organizations, Employee Hired Car
Liability and Blanket Additional Insured
Status for Certain Entities,
Item 1, Who is an Insured of Paragraph A.
Coverage under SECTION II — COVERED
AUTOS LIABILITY COVERAGE is
amended to add:
d. Any organization you newly acquire or
form, other than a partnership, joint
venture or limited liability company, and
over whiclt you maintain ownership of a
majority interest (greater than 50%), will
qualify as a Named Insured; however,
(1) coverage under this provision is
afforded only until the 180`� day
after you acquire or form the
organization or the end of the policy
period, whichever is earlier;
(2) coverage does not apply to "bodily
injury", "property damage" or
"covered pollution cost or expense"
that results from an "accident" which
occurred before you acquired or
formed the organization; and
(3) coverage does not apply if there is
other similar insurance available to
that organization, or if similar
insurance would have been
available but for its termination or
the exhaustion of its limits of
insurance.
This insurance does not apply if
coverage for the newly acquired or
formed organization is excluded either
by the provisions of this coverage form
or by endorsement.
e. An "employee" of yours is an "insured"
while operating an "auto" hired or rented
under a contract or agreement in that
"employee's" name, with your
permission, while performing duties
related to the conduct of your business_
f. Any person or organization you are
required by written contract or
agreement to name as an additional
"insured", but only with respect to
liability created in whole or in part by
such agreement.
B. Increase Of Loss Earnings Payment
Subpart (4) of a. Supplementary Payments
of Item 2. Coverage Extensions of
Paragraph A. Coverage under SECTION II
— COVERED AUTOS LIABILITY
COVERAGE is amended to read:
(4) We will pay reasonable expenses
incurred by the "insured" at our
request, including actual loss of
earnings up to $1,000 per day
because of time off from work.
C. Fellow Employee Injured By Covered
Auto You Own Or Hire
Item 5. Fellow Employee of Paragraph B.
Exclusions under SECTION II — COVERED
AUTOS LIABILITY COVERAGE is
amended to add:
This exclusion does not apply if the "bodily
injury" results from the use of a covered
"auto" you own or hire. Such coverage as
is afforded by this provision is excess over
any other collectible insurance.
CA990187 0715 Includes Copyrighted Material of Insurance Services Offices, Inc. Page 1 of 5
Used with permission
[f(MM/DD1YYYY)
CERTIFICATE OF LIABILITY INSURANCE /6/2025
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 endorsements .
PRODUCER CONTACT Daniel Brock _ _
Sierra Oak Insurance Services Inc PHONE 9163647380 )Ira
9700 Business Park Drive Suite 105 ikMML / q C N1,9163647381
Sacramento CA 95827 AgwiEttss
t_ certs. .err. osk C Corn
�.. INSUREftI RDING COVERAGE
IL
NA167
.-----LiceOse#; OC�7
INSURERA:_GUIdeOne National Ins. CO.
..4m—
INSURED FSCONTR-01
INSURERS: Insurance Compy 2f�hq t
C
INSURER C Security t onaal Insurance CO
19879
1FS 838 Bledsoe'St
"N"
_
Sylmar CA 91342
lNsuRR D : Llo d s of Insurance
_y..... ranee Co _
85202
INSURERE: Mt. Hawley Insurance Company
37974
^nv=ewr_cc d%coTicid`ATC kiniu=o-i iaaananan RPVISIAN NIIMRFR!
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. __.
.---- TM���...•. _ ��_ .. .. ............ .-.,.. __ ._ _.....
.R.. ASDL Sub POLIOY EFF POLICY EXP
S PE OF INSURANCE POLICY NUMBER MMIDD D LIMITS
R
F
X
COMMERCIAL GENERAL LIABILITY
Y
Y
LA25CGLZOD4RWIC
1/13/2025
1/13/2026
EACH OCCURRENCE
$1,000,000
X
CLAIMS MADE OCCUR
b1ihD ICY
(Eao a on¢)
$50, 000
MEDEXP (Any one person
$
--------------
PERSONAL JURY
$1 000 000
_
GEN-L..
TE LIMIT APPLIES PER:
AGGREGATE
ATE
GENERALAGGREGATE
$ 2,000,000
X
POLICY jE O- LOC
PRODUCTS COMP"�
/OP AGG
k $ 2 000 000
F$
C
UTOMOBILELIABILITY
AUTOMOBILE
OTHER
Y
Y
SPP181596601
2 2024
8/ 6/
8/26/2025
COMBINED SNNGLE LIIWII"r'
I..(Ea accldgrart) ..
$1,000,000
.. .
ANY
er
BODILY INJURY
person)OWNED
$
X
AUTOS ONLY AUTOS
HIREDUTO NON -OWNED
X
INJURY (Per
m
TY DAMAGLaccident)
PROPINJU mm.
$
...__
AUTOS ONLY AUTOS ONLY
',.. (PeC a IiY'.41?.kt ...�_ --- .....-$
... _ _ ..,.,r .............-
ry f
i
$
F
I UMBRELLALIAB
SF25EXCZOD4QLIC
1/13/2025
1/13/2026
EACH OCCURRENCE
$8,000,000OCCUR " a
X
L CLAIMS- MADE
_AGGREGATE r
$ 8,000,000
�
DEDEXCESS
RETENTION $
GL AU W C
$
B
WORKERS COMPENSATION
Y
WSA503277109
7/31/2024
7/31/2025
'''-X $TATUTEw OTH
ER
AND EMPLOYERS' LUU3ILITY y
E L EACH $ 1 000 000
ANYPROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED�
N / A
1111111111111ACCIDENT
(Mandatory in NH)
$1,000,000
E.L. DISEASELIMIT
If es, describe
— pp
$1,000,000
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY MIT ;
A
Pollution Liability
ENV562012869-02
1/13/2025
1/13/2026
Poll. Each Occurrence
2,000,000
E
Installation Float
ILM0718456
8/26/2024
8/26/2025
Rented/Leased
25,000
D
Professional Liability
ANE5470677.24
8/13/2024
8/13/2025
Prof. Each Occurrence
2,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required)
Excess over the GL, WC, BAU
Job: Concrete Improvements PW 21-10 Various Locations in the City of El Segundo, The City of El Segundo, its officers, officials, employees, agents,&
volunteers to be named additional insured on the general liability & auto.Primary & noncontributory applies. Waiver or subrogation applies to general liability,
auto & work comp.
CERT'IFI
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of El Segundo iACCORDANCE WITH THE POLICY PROVISIONS.
350 Main St
El Segundo CA 90245 AUTHORIZED E'PRESEN'TATI'VE
USA Aw 11604
9)1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
Policy Number SPP181596601
COMMERCIAL AUTO
CA990187 0715
This Endorsement Changes The Policy. Please Read It Carefully
BUSINESS AUTO COVERAGE EXPANSION
ENDORSEMENT
This endorsement modifies insurance provided by the following:
BUSINESS AUTO COVERAGE FORM
With respect to coverage provided by this endorsement, the provisions of the COVERAGE FORM apply
unless modified by the endorsement.
A. Newly Acquired or Formed
Organizations, Employee Hired Car
Liability and Blanket Additional Insured
Status for Certain Entities.
Item 1, Who is an Insured of Paragraph A.
Coverage under SECTION II — COVERED
AUTOS LIABILITY COVERAGE is
amended to add:
d. Any organization you newly acquire or
form, other than a partnership, joint
venture or limited liability company, and
over which you maintain ownership of a
majority interest (greater than 50%), will
qualify as a Named Insured; however,
(1) coverage under this provision is
afforded only until the 180`' day
after you acquire or form the
organization or the end of the policy
period, whichever is earlier;
(2) coverage does not apply to "bodily
injury", "property damage" or
"covered pollution cost or expense"
that results from an "accident" which
occurred before you acquired or
formed the organization; and
(3) coverage does not apply if there is
other similar insurance available to
that organization, or if similar
insurance would have been
available but for its termination or
the exhaustion of its limits of
insurance.
This insurance does not apply if
coverage for the newly acquired or
formed organization is excluded either
by the provisions of this coverage form
or by endorsement.
e. An "employee" of yours is an "insured"
while operating an "auto" hired or rented
under a contract or agreement in that
"employee's" name, with your
permission, while performing duties
related to the conduct of your business_
f. Any person or organization you are
required by written contractor
agreement to name as an additional
"insured", but only with respect to
liability created in whole or in part by
such agreement.
B. Increase Of Loss Earnings Payment
Subpart (4) of a. Supplementary Payments
of Item 2. Coverage Extensions of
Paragraph A. Coverage sunder SECTION II
— COVERED AUTOS LIABILITY
COVERAGE is amended to read:
(4) We will pay reasonable expenses
incurred by the "insured" at our
request, including actual loss of
earnings up to $1,000 per day
because oftimeoff from work.
C. Fellow Employee Injured By Covered
Auto You Own Or Hire
Item 5. Fellow Employee of Paragraph B.
Exclusions under SECTION II — COVERED
AUTOS LIABILITY COVERAGE is
amended to add:
This exclusion does not apply if the "bodily
injury" results from the use of a covered
"auto" you own or hire. Such coverage as
is afforded by this provision is excess over
any other collectible insurance.
CA990187 0715 Includes Copyrighted Material of Insurance Services Offices, Inc. Page 1 of 5
Used with permission
D. Limited Automatic Towing Coverage
Item 2. Towing, of Paragraph A. Coverage,
under SECTION III — PHYSICAL DAMAGE
COVERAGE is amended to read:
2. Towing
We will pay for towing and labor costs
each time that a covered "auto" is
disabled. All labor must be performed at
the place of disablement of the covered
"auto".
a. The limit for towing and labor for
each disablement is $500;
b. No deductible applies to this cover-
age.
E. Item 3. Glass Breakage — Hitting A Bird
Or Animal — Falling Objects or Missiles of
Paragraph A. Coverage under SECTION III
— PHYSICAL DAMAGE COVERAGE, is
amended to add:
Glass Repair Coverage
We will waive the Comprehensive
deductible for Glass, if one is indicated on
your covered "auto", for glass repairs. We
will repair at no cost to you, any glass that
can be repaired without replacement,
provided the "loss" arises from a covered
Comprehensive "loss" to your "auto".
F. Increase Of Transportation Expense
Coverage
Subpart a. Transportation Expenses of
Item 4. Coverage Extensions of Paragraph
A. Coverage under SECTION III —
PHYSICAL DAMAGE COVERAGE is
amended to read:
a. Transportation Expenses
We will pay up to $50 per day to a
maximum of $1,000 for temporary
transportation expense incurred by you
because of the total theft of a covered
"auto" of the private passenger type.
We will pay only for those covered
"autos" for which you carry either
Comprehensive or Specified Causes of
Loss Coverage or Theft Coverage. We
will pay for temporary transportation
expenses incurred during the period
beginning 48 hours after the theft and
ending, regardless of the policy's
expiration, when the covered "auto" is
returned to use or we pay for its "loss".
G. "Personal Effects" Coverage
Item 4. Coverage Extensions of Paragraph
A. Coverage, under SECTION III -
PHYSICAL DAMAGE COVERAGE, is
amended to add:
"Personal Effects" Coverage
We will pay actual cash value for "loss" to
"personal effects" of the "insured" while in
a covered "auto" subject to a maximum
limit of $2,500 per "loss", for that covered
"auto" caused by the same "accident". No
deductible will apply to this coverage.
H. "Downtime Loss" Coverage
Item 4. Coverage Extensions, of
Paragraph A. Coverage, under SECTION
III. PHYSICAL DAMAGE COVERAGE, is
amended to add:
"Downtime Loss" Coverage
We will pay any resulting "downtime loss'
expenses you sustain as a result of a
covered physical damage "loss" to a
covered "auto" up to a maximum of $100
per day, for a maximum of 30 days for the
same physical damage "loss", subject to
the following conditions:
a. We will provide "downtime loss" beginning
on the 5"' day after we have given you
our agreement to pay for repairs to a
covered "auto" and you have given the
repair facility your authorization to make
repairs;
b. Coverage for "downtime loss' expenses
will end when any of the following occur:
(1) You have a spare or reserve "auto"
available to you to continue your
operations.
(2) You purchase a replacement "auto".
(3) Repairs to your covered "auto" have
been completed by the repair facility
and they determine the covered
"auto" is road -worthy.
(4) You reach the 30 day maximum
coverage.
CA990187 0715 Includes Copyrighted Material of Insurance Services Offices, Inc. Page 2 of 5
Used with permission
I. Item 4. Coverage Extensions, of
Paragraph A. Coverage, under SECTION
III. PHYSICAL DAMAGE COVERAGE, is
amended to add. -
We will pay any resulting rental
reimbursement expenses incurred by you for
a rental of an "auto" because of "loss' to a
covered "auto' up to a maximum of $100 per
day, for a maximum of 30 days for the same
physical damage "loss", subject to the
following conditions:
a. We will provide rental reimbursement
incurred during the policy period
beginning 24 hours after the "loss" and
ending, regardless of the policy
expiration, with the number of days
reasonably required to repair or replace
the covered "auto". If the "loss' is
caused by theft, this number of days is
the number of days it takes to locate the
covered "auto" and return it to you or the
number of days it takes for the claim to
be settled, whichever comes first.
b. Our payment is limited to necessary and
actual expenses incurred.
c. This coverage does not apply while
there are spare or reserve "autos"
available to you for your operations.
d. Contraband or property in the course
of illegal transportation or trade.
e. "Loss' caused by theft, unless there is
evidence of forced entry into the
covered "auto" and a police report is
filed.
K. Accidental Airbag Discharge Coverage
Item 3.a. of Paragraph B. Exclusions under
SECTION III — PHYSICAL DAMAGE
COVERAGE is amended to read:
a. Wear and tear, freezing, mechanical
or electrical breakdown. The
exclusion relating to mechanical
break -down does not apply to the
accidental discharge of an air bag.
L. Loan or Lease Gap Coverage
Paragraph C. Limit Of Insurance under
SECTION Ill — PHYSICAL DAMAGE
COVERAGE is amended to add:
If a covered "auto" is owned or leased and
if we provide Physical Damage Coverage
on it, we will pay, in the event of a covered
total "loss", any unpaid amount due on the
lease or loan for a covered "auto", less:
a. The amount paid under the Physical
Damage Coverage Section of the
policy; and
d. If a "loss" results from the total theft of a
"auto"
b. Any:
covered of the private passenger
type, we will pay under this coverage
(1)
Overdue lease or loan
only that amount of your rental
payments including penalties,
reimbursement expenses which is not
interest or other charges
already provided for under the Physical
resulting from overdue
Damage Coverage Extension.
payments at the time of the
J. "Personal Effects" Exclusion
"loss';
Paragraph B. Exclusions under SECTION
(2)
Financial penalties imposed
III — PHYSICAL DAMAGE COVERAGE, is
under a lease for excessive use,
iv
amended to add:
abnormal wear and tear high
mileage;
"Personal Effects" Exclusion
(3)
Costs for extended warranties;
We will not pay for "loss' to "personal
Credit Life Insurance, Health,
effects" of any of the following:
Accident or Disability Insurance
a. Accounts, bills, currency, deeds,
purchased with the loan or
evidence of debt, money, notes,
lease;
securities or commercial paper or
(4)
Security deposits not refunded
other documents of value.
by the lessor; and
b. Bullion, gold, silver, platinum, or other
(5)
Carry-over balances from
precious alloys or metals; furs or fur
previous loans or leases
garments; jewelry; watches; precious
or semi-precious stones.
c. Paintings, statuary and other works of
art.
CA990187 0715 Includes Copyrighted Material of Insurance Services Offices, Inc. Page 3 of 5
Used with permission
M. Aggregate Deductible
Paragraph D. Deductible under SECTION
111-- PHYSICAL DAMAGE COVERAGE is
amended to add. -
Regardless of the number of covered
"autos" involved in the same "loss", only
one deductible will apply to that "loss". If
the deductible amounts vary by "autos",
then only the highest applicable deductible
will apply to that "loss".
N. Diminishing Deductible
Paragraph D. Deductible under SECTION
III — PHYSICAL DAMAGE COVERAGE is
amended to add:
Any deductible will be reduced by the
percentage indicated below on the first
"loss" reported during the corresponding
policy period:
Loss Free Policy Periods
With the Expansion
Endorsement
Deductible
Reduction on the
first "loss"
1
0%
2
25%
50%
ft
75%
5
100%
If we pay a Physical Damage "loss" during
the policy period under any BUSINESS
AUTO COVERAGE FORM you have with
US, your deductible stated in the
Declarations page of each such
COVERAGE FORM will not be reduced on
any subsequent claims during the remainder
of your policy period and your deductible
reduction will revert back to 0% for each
such COVERAGE FORM if coverage is
renewed.
O. Knowledge of Loss and Notice To Us
Subsection a. of Item 2. Duties In the Event
of Accident, Claim, Suit or Loss of
Paragraph A. Loss Conditions under
SECTION IV -- BUSINESS AUTO
CONDITIONS is amended to add:
However, prompt notice of the "accident",
claim, "suit" or "loss" to us or our
authorized representative only applies
after the "accident", claim, "suit" or "loss" is
known to:
(1) You, if you are an individual;
(2) A partner, if you are a partnership;
(3) An "executive officer" or director, if
you are a corporation;
(4) A manager or member, if you are a
limited liability company;
(5) Your insurance manager; or
(6) Your legal representative.
P. Waiver Of Subrogation For Auto Liability
Losses Assumed Under Insured Contract
Item 5. Transfer Of Rights Of Recovery
Against Others To Us of Paragraph A.
Loss Conditions under SECTION IV —
BUSINESS AUTO CONDITIONS is
amended to read:
5. Transfer of Rights of Recovery
Against Others To Us
If any person or organization to or for
whom we make payments under this
Coverage Form has rights to recover
damages from another, those rights are
transferred to us. That person or
organization must do everything
necessary to secure our rights and must
do nothing after an "accident" or "loss"
to impair them. However, if the insured
has waived those rights to recover
through a written contract, we will waive
any right to recovery we may have
under this Coverage Form-
Q. Insurance is Primary and
Noncontributory
Subpart a. of Item 5. Other Insurance of
Paragraph B. General Conditions under
SECTION IV — BUSINESS AUTO
CONDITIONS is amended to read:
a. This insurance is primary and
noncontributory, as respects any other
insurance, if required in a written
contract with you.
R. Other Insurance — Hired Auto Physical
Damage
Subpart b, of Item 5..Other Insurance of
Paragraph B. General Conditions under
SECTION IV — BUSINESS AUTO
CONDITIONS is amended to read:
b. For Hired Auto Physical Damage
Coverage, the following are deemed
to be covered "autos" you own:
(1) Any covered "auto" you lease,
hire, rent or borrow; and
CA990187 0715 Includes Copyrighted Material of Insurance Services Offices, Inc. Page 4 of 5
Used with permission
(2) Any covered "auto" hired or rented
by your "employee" under a
contract in that individual
"employee's" name, with your
permission, while performing
duties related to the conduct of
your business.
However, any "auto" that is leased, hired,
rented or borrowed with a driver is not a
covered "auto".
S. Unintentional Failure To Disclose
Hazards
Paragraph B. General Conditions under
SECTION IV —BUSINESS AUTO CONDI-
TIONS is amended to add:
9. Your failure to disclose all hazards
existing as of the inception date of this
policy shall not prejudice the coverage
afforded by this policy, provided that
such failure to disclose all hazards is not
intentional. However, you must report
such previously undisclosed hazards to
us as soon as practicable after its
discovery.
T. Additional Definition
SECTION V — DEFINITIONS is amended to
add:
"Personal effects" means personal
property owned by the "insured".
"Downtime loss" means actual loss of
"business income" for the period of time
that a covered "auto":
1. Is out of service for repair or
replacement as a result of a covered
physical damage "loss" and
2. Is in the custody of a repair facility if
not a total "loss".
"Business Income" means:
1. Net Income (Net Profit or Loss
before income taxes) that would
have been earned or incurred; and
2. Continuing normal operating
expenses incurred, including payroll.
In this endorsement, Headings and Titles
are inserted solely for the convenience and
ease of reference. They do not affect the
coverage provided by this endorsement,
nor do they constitute any part of the terms
and conditions of this endorsement. All
other policy wording not specifically
changed, modified, or replaced by this
endorsement wording remains in effect.
CA990187 0715 Includes Copyrighted Material of Insurance Services Offices, Inc. Page 5 of 5
Used with permission
Policy Number LA25CGLZOD4RWIC
COMMERCIAL GENERAL LIABILITY
CG 20 01 04 13
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
contribution 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
agreement that this insurance would be primary
and would not seek contribution from any other
insurance available to the additional insured.
CG 20 01 0413 0 Insurance Services Office, Inc., 2012 Page 1 of 1
POLICY NUMBER: LA25CGLZOD4RWIC
COMMERCIAL GENERAL LIABILITY
CG24041219
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 Or Organization„
Any person or organization when you and such person or organization have agreed in writing in a contract or
agreement that you will waive any right of recovery against such person or organization..
Information required to complete this Schedule, if not shown above, will be shown in the Declarations. u
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., 2008 Page 1 of 1
POLICY NUMBER:LA25CGLZOD4RWIC
COMMERCIAL GENERAL LIABILITY
CG 20 37 04 13
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OIL
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)
Location And Descri tion Of Com leted O erations
Any person or organization for whom you are
performing 'commercial construction" during the period
of this policy and have agreed in a contract to add as
an additional insured for products -completed
operations. "Commercial construction" does not
include any written habitational or residential
construction other than hotels or apartments
i
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
include as an additional insured the person(s) or
organization(s) shown in the Schedule, but only
with respect to liability for "bodily injury" or
"property damage" caused, in whole or in part, by
"your work" 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
2. If coverage provided to the additional insured is
required by a contract or agreement, the
insurance afforded to such additional insured
B. With respect to the insurance afforded to these
additional insureds, the following is added to
Section III - Limits Of Insurance:
If coverage provided to the additional insured is
required by a contract or agreement, the most we
will pay on behalf of the additional insured is the
amount of insurance:
1. Required by the contract or agreement; 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.
CG 20 37 04 13 0 Insurance Services Office, Inc., 2012 Page 1 of 2
will not be broader than that which you are
required by the contract or agreement to
provide for such additional insured.
CG 20 37 04 13 0 Insurance Services Office, Inc., 2012 Page 2 of 2
POLICY NUMBER:LA25CGLZOD4RWIC
COMMERCIAL GENERAL LIABILITY
CG20100413
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL ITIONAL 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) Locations Of Covered O erations
Any person or organization for whom you are
performing operations during the policy period 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
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
include as an additional insured the person(s) or
organization(s) shown in the Schedule, but 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(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
B. With respect to the insurance afforded to these
additional 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
repairs) to be performed by or on behalf of the
additional insured(s) at the location of the covered
operations has been completed; or
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.
CG 2010 04 13 0 Insurance Services Office, Inc,, 2012 Page 1 of 2
insurance 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.
C. With respect to the insurance afforded to these 2. Available under the applicable Limits of Insurance
additional insureds, the following is added to shown in the Declarations;
Section III - Limits Of Insurance: whichever is less.
If coverage provided to the additional insured is This endorsement shall not increase the applicable
required by a contract or agreement, the most we Limits of Insurance shown in the Declarations.
will pay on behalf of the additional insured is the
amount of insurance:
1.Required by the contract or agreement; or
CG 2010 0413 0 Insurance Services Office, Inc., 2012 Page 2 of 2
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY
WC 99 06 34
WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - BLANKET
(Ed. 8-00)
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).
The additional premium for this endorsement shall be 2% of the total California Workers' Compensation
premium otherwise due.
Any person or organization for whom the named
insured is required under written contract to
furnish this waiver.
Policy Number: WSA 5032771 09
Endorsement Effective: 07/31/2024
Issue Date: 07/17/2024
WC 99 06 34
(Ed. 8-00)
Schedule
California operations only.
Insured: F S Contractors Inc
Coverage Provided by: Insurance Co of the West
Countersigned by: