Loading...
PROOF OF INSURANCE (2025 - 2025)DATE (MMIDDNYYY) AcbRa CERTIFICATE OF LIABILITY INSURANCE M 1/23/2025 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 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 N ME,. Shannon Schmidt Leavitt Group Northwest PHONE (800)726-8771 No, tseelTze-a se E-MAIL Shannon-schmidt@leavitt.com PO Box B33 ADOREss: INSURERS AFFORDING COVERAGE NAIC # Auburn WA 98071 INSURER A: Homeland Ins Co of NY 34452 INSURED INSURER B : West American Insurance C2M2a 1 .... 44393 H2O Solutions LLC INSURERC: 9030 W Sahara Avenue # 208 INSURER D: Las Vegas Nv 89117 i. r.�irew n�c PCDTICI1%ATC KIH11e29=0•rT.9AAQAA752 REVISION NUMBER: 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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„ 'INBR 7R TYPE OF INSURANCE AODL S VD,13R POLICY NUMBER MMID.� Y EfF D2fYYYY PM/ LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE O RF_NTED PRE S 50, 000 A CLAIMS -MADE X OCCUR EXP(Any one person) . $ 5,000 X 793-00-83-87-0007 8/8/2024 8/8/2025 PERSONAL &ADV INJURY $„„ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENILAGGREGAT'E LIMITAPPLIES PER: PRODUCTS - COMP/OPAGG $ 2,000,000 POLICY LXJ PEO 0 LOC Policy Aggregate $ 2,000,000 , OTHER: 'AUTOMOBILE O�MeBINE.D INGLE Mil Sgognu $ 1,000,000 LIABILITY BODILY INJURY (Per person) $ X B ANY AUTO BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED B AW57788399 5/27/2024 5/27/2025 AUTOS '� AUTOS NON -OWNED PROF"ERTY C)AfntAICTE'� r� ,' n $ HIRED AUTOS AUTOS 0 aAtAo'F'xihowwT4E'ndw $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 4 000, 000 A EXCESS LIAB CLAIh15•freAOE AGGREGATE $ 4,000,000 DED RETENTION $ $ 793-00-83-88-0007 8/8/2024 8/8/2025 WORKERS COMPENSATION WA Stop Gap P.TRT T X. ETH E.L. EACH ACCIDENT $ 1,000 000 AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE Employer's Liability I E.L. DISEASE - EA EMPLOYEE $ 11000000 A In D? ER EXCLUDE OFFICENH) OFFICERIME (Mandatory NIA' 793-00-83-87-0007 8/8/2024 8/8/2025 E.L. DISEASE -POLICY LIMIT $ 1 000,000 If yes, de%Nba under DESCRIPTtlON. OF OPERATIONS below A Professional Liability 793-00-83-87-0007 8/8/2024 8/8/2025 Limit $1,000,000 A Pollution Liability 793-00-83-87-0007 8/8/2024 8/8/2025 Limit $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) Certificate holder is listed as additional insured per written contract and the terms and conditions of forms OBENVGE3460119 & OBENVGE3201120. Per project aggregate applies per form OBENVGL3240713. CERTIFICATE HOLDER 6AF4L CLLMI IUrt SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of E1 Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 415 Lomita St E1 Segundo, CA 90245 AUTHORIZED REPRESENTATIVE 'Rob Bush/SHSCHM QC6O 01988-2014 ACORD CORPORATION. All rights ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD INS025 (201401) Policy Number: 7 93-00-83-87-0007 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies coverage provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART CONTRACTORS ENVIRONMENTAL 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 this policy provided that: a. The additional insured is a named insured under such other insurance; and b. The Named Insured has agreed in writing in a contract or agreement that this insurance would: (1) Act primary to any other insurance available to the additional insured; and (2) Would not seek contribution from any other insurance available to the additional insured. All other terms and conditions remain the same. OBENV GE 319 (11 20) Contains copyrighted material of Insurance Services Office, Inc. with its permission. Page 1 of 1 E-INSURED Policy Number: 7 93-00-83-87-0007 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON -OR ORGANIZATION - FORM III This endorsement modifies coverage provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART CONTRACTORS ENVIRONMENTAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location(s) Of Covered Operations Any person or organization that the Any location where required by the Named Insured agreed to add as an written contract or written agreement in additional insured in a written contract which the Named Insured agreed to add or written agreement that was fully the person or organization qualifying as executed by the Named Insured prior to an additional insured under this the performance of the Named Insureds endorsement. work that is the subject of such written contract or written agreement. V Information re uired 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, environmental 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 contractor agreement, the 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. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to bodily injury, property damage or environmental 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 OBENV GE 346 (01 19) Contains copyrighted material of Insurance Services Office, Inc. with its permission. Page 1 of 2 Copyright 2019, Intact Insurance Group USA LLC E-INSURED 2. That portion of your workout 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: 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. All other terms and conditions remain the same. OBENV GE 346 (01 19) Contains copyrighted material of Insurance Services Office, Inc. with its permission. Page 2 of 2 Copyright 2019, Intact Insurance Group USA LLC I Policy Number: 7 93-00-83-87-0007 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies coverage provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART CONTRACTORS ENVIRONMENTAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person( r r i i s): Any person or organization that the Named Insured agreed to add as an additional insured in a written contract or written agreement that was fully executed by the Named Insured prior to the performance of the Named Insureds work that is the subject of such written contract or written agreement. Location And Description tod Operations: Any location, and completed operations at such location, where required by the written contract or written agreement in which the Named Insured agreed to add the person or organization qualifying as an additional insured under this endorsement. 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 environmental 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 contractor agreement, the 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. B. With respect to the insurance afforded to these additional insureds, the following is added to 1. Limits of Insurance in SECTION III - LIMITS OF INSURANCE AND DEDUCTIBLE: 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. All other terms and conditions remain the same. OBENV GE 351 (09 20) Contains copyrighted material of Insurance Services Office, Inc. with its permission. Page 1 of 1 Copyright 2020, Intact Insurance Group USA LLC E-INSURED Policy Number: 7 93-00-83-87-0007 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED CONSTRUCTIONPROJECT(S) AGGREGATE LIMIT This endorsement modifies coverage provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM SCHEDULE Designated Construction Project(s): Any projects for which the Named Insured has agreed to provide insurance prior to loss as provided by this policy but only to the scope of insurance agreed to by the Named Insured Total Designated Construction Project(s) Aggregate Limit: $ 5, 0 0 0, 0 0 0 A. For all sums which the insured becomes legally obligated to pay as damages caused by occurrences under Section I — Coverage A, and for all medical expenses caused by accidents under Section I — Coverage C, which can be attributed only to ongoing operations at a single designated construction project shown in the SCHEDULE above: 1. A separate Designated Construction Project General Aggregate Limit applies to each designated construction project, and that limit is equal to the amount of the General Aggregate Limit shown in the Declarations. 2. The Designated Construction Project General Aggregate Limit is the most we will pay for the sum of all damages under Section I - Coverage A, except damages because of bodily injury or property damage included in the products -completed operations hazard, and for medical expenses under Section I - Coverage C regardless of the number of: a. Insureds; b. Claims made or suits brought; or C. Persons or organizations making claims or bringing suits. 3. The Total Designated Construction Project(s) Aggregate Limit shown in the SCHEDULE above is the most we will pay for the sum of all damages caused by occurrences under Section I — Coverage A, except damages because of bodily injury or property damage included in the products -completed operations hazard, and for all medical expenses caused by accidents under Section I — Coverage C, which can be attributed only to ongoing operations at designated construction projects. OBENV GL 324 (07 13) Includes copyrighted material of Insurance Services Office, Inc. Page 1 of 2 Copyright 2013, Intact Insurance Group USA LLC E-INSURED 4. Any payments made under Coverage A for damages or under Coverage C for medical expenses will reduce the Designated Construction Protect General Aggregate Limit for that designated construction project. Such payments will also reduce the Total Designated Construction Project(s) Aggregate Limit shown in the SCHEDULE above. However, such payments will not reduce: a. The General Aggregate Limit or Policy Aggregate Limit shown in the Declarations; or b. Any other Designated Construction Project General Aggregate Limit for any other designated construction project shown in the SCHEDULE above. 5. The limits shown in the Declarations for Each Occurrence, Damage To Premises Rented To You and Medical Expense continue to apply. However, instead of being subject to the General Aggregate Limit or Policy Aggregate Limit shown in the Declarations, such limits will be subject to the applicable Designated Construction Project General Aggregate Limit. B. For all sums which the insured becomes legally obligated to pay as damages caused by occurrences under Section I — Coverage A., and for all medical expenses caused by accidents under Section I — Coverage C, which cannot be attributed only to ongoing operations at a single designated construction project shown in the SCHEDULE above, any payments made under Section I — Coverage A, and for all medical expenses caused by accidents under Section I —Coverage C will: 1. Reduce the amount available under the General Aggregate Limit and Policy Aggregate Limit shown in the Declarations; and 2. Not reduce any Designated Construction Projects Aggregate Limit or the Total Designated Construction Project(s) Aggregate Limit. C. If the applicable designated construction project has been abandoned, delayed or abandoned and restarted, or if the authorized contracting parties deviate from plans, blueprints, specifications or timetables, we will deem the project to be the same construction project as it was originally listed in the SCHEDULE above. All other terms and conditions remain the same. OBENV GL 324 (07 13) Includes copyrighted material of Insurance Services Office, Inc. Page 2 of 2 Copyright 2013, Intact Insurance Group USA LLC returns of premiums, receiving and accepting any endorsements issued by us forming a part of this policy, and exercising or declining to exercise any Extended Reporting Period. 3. Bankruptcy Bankruptcy or insolvency of the insured or of the insured's estate will not relieve us of our obligations. 4. Cancellation or Non -Renewal a. The Named Insured shown on the Declarations may cancel this policy by mailing or delivering to us written notice of a cancellation date no later than the Expiration Date of this policy. A request by a premium finance company to cancel this policy for non-payment of premium shall be deemed a request by the Named Insured to cancel this policy. The earned premium will be computed in accordance with standard short rate tables and procedure, and will not be less than the Minimum Earned Premium shown on the Declarations. b. We may cancel this policy by mailing or delivering to the Named Insured shown on the Declarations written notice of cancellation at least sixty (60) calendar days before the effective date of cancellation; or ten (10) calendar days in the event of cancellation for non-payment of premium. We will send the Named Insured shown on the Declarations any premium refund due. If we cancel, the refund will be computed in accordance with standard pro rata tables and procedure, and will not be less than the Minimum Earned Premium shown on the Declarations. C. We will mail or deliver our notice of cancellation stating the effective date of cancellation to the Named Insured's mailing address shown on the Declarations. The policy period will end on that date. d. If we cancel this policy due to failure of the Named Insured(s) to comply with terms and conditions under this policy, you shall have sixty (60) calendar days from the date of the notice of cancellation to comply with the terms and conditions. If the resolution is satisfactory to us, we shall rescind such notice in writing and the policy shall remain in force. e. We will not be required to renew this policy upon its expiration. If we elect not to renew this policy, we will mail or deliver to the Named Insured shown on the Declarations written notice of nonrenewal at least sixty (60) calendar days prior to the Expiration Date of this policy. Any offer of renewal on terms involving a change of retention, premium, limit of liability, or other terms and conditions shall not constitute, nor be construed as, a failure or refusal by us to renew this policy. f. If notice is mailed, proof of mailing will be sufficient proof of notice. 5. Defined Terms and Phrases Words and phrases that appear in quotation marks or in bold font have special meaning. Refer to Section VII — Definitions. 6. Headings The descriptions in the headings and sub -headings of this policy are solely for convenience, and form no part of the terms and conditions of coverage. 7. Legal Action Against Us No person or organization has a right under this policy: a. To join us as a party or otherwise bring us into a suit asking for damages from an insured; or b. To sue us on this policy unless all of its terms have been fully complied with. 28 of 43 Includes copyrighted material of Insurance Services Office, Inc. OBENV GL 101 (10 12) Copyright 2012, Intact Insurance Group USA LLC =DATE(MMIDD;TY") ' CERTIFICATE OF LIABILITY INSURANCE 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 . p o Nr DT PRODUCER ce Team The Insurance Shop, LLC NAME: Servi I Sho Online Insurance Agency, LLC PHONE 573-445-5535 FAX 833 492 5952 P�sr. I Xtl ........, t?/S No : ..._ _...._.. E-MAIL 3901 South Providence Rd Suite B service@insuranceshopllc.com Columbia, MO 65203 INSURER(S) AFFORDING COVERAGE NAIC IF INSURED H2O Solutions LLC 9030 W Sahara Ste 208 Las Vegas, NV 89117 State Compensation Ins Fund F: --A rc r.rr na AM=M, RFVICIr1N NI lI IRFIR, 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. POLNCY' EFF POIP.PEXP LIMITS INT R TYPE OF INSURANCE POLICY NUMBER MMrDDrrYYY MMd ldYYY ',.. COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE ..... ........_. ........ CLAIMS -MADE OCCUR'..PRF'AM9.%.''..1.::.c.ui'r%t�........._. DA W ," $' -f—NTEt? .... ..._..� ............. .._.... MED EXP (ITp4sw)r one prsrat ,'»' ww mm w PERSONAL & ADV INJURY $' ....m ... SPER: I GENT AGGREGATE LIMIT APPLE RALAGG............... GENEREGATE $IT ................... POLICY PRO- ❑ LOC JECT PRODUCTS - COMPIOP AGO ••••- $ ............... OTHER': OOMBtN9OSINGLELIMIT $ AUTOMOBILE LIABILITY A iFp a�pWd, nt) ................ ANY AUTO BODILY INJURY (Per person) _ mBODILY $ OWNED SCHEDULED INJURY (Per accident) $ AUTOS ONLY AUTOS HIRED NON -OWNED PROPI=RT'1" DAMP'CE� ................ $ AUTOS ONLY AUTOS ONLY . ........ ---------------•--�' UMBRELLA LIAB OCCUR ''.. EACH OCCURRENCES �.... ,�,,,.........__�_� I. EXCESS LIAB CLAIMS -MADE... AGCFREGATE .......... $„_................_.,. DED RETENTION'S @ Erd OTH- COMPENSATION /� SLEIl R LA_ A AND EMPLOYERS' LIABILITY Y'd W ANY PROPRIETOR/PARTNER/EXECUTIVE '.� NIA 9239483 10/06/2024 1 06/2025 0/ E L EACH A4C'°IOI�;Nf .............. $ 1,000,000 OFFICER/MEMBEREXCLUDED? ('Mandatory In NH) E L DISEASE EA EMPLOYE 1,000,000 .......— lv' yes, describe under DESCRIPTION OF OPERATIONS help u E I. DISEASE - POLICY LIMIT $ 1 000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) City of El Segundo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 415 Lomita St. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN El Segundo, CA 90245 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Wow C4+wk @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD