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PROOF OF INSURANCE (2014) CLOSEDSep 09 13, 11 :548 Oliver Holt (818) 886 -0223 p.7 ��r^r DATE (MMIDOIYYYY) CC CERTIFICATE OF LIABILITY INSURANCE 7/17/2013 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 CONTACT Victoria Mitchell Landscape Contractors (Lic #0755906)rt PNDE (559) 650 -3555 FIa N, (.559)650 -3518 Insurance Services, Inc. E- MAIL` V,anderson @lcisinc.com 1835 N. Fine Avenue INSURERS AFFORDING COVERAGE NAIC0 Fresno CA 93727 INSURERA:ARCH Insurance Compan 11150mm�- INSURED INSURER B m Oliver Holt Landscape INSURERC: dba Oliver Holt Landscape INSURERD: 8611 Amestoy Avenue INSURER E: Northrid a CA 91325 1 INSURER F: rnvFRAr;FS r^FRTIFICATF NIIMRFR•13 /14 Pkcr 6 Auto RFVMtON NIIMRF'R^ 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. iNSR �A POLICY EFP POLICY yY LTR TYPE OF INSURANCE POLICY NUMBER a Y. Al / -. iYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE S 1. 0 0 0, 0 0 0 i► X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE a� OCCUR LCPKGD056305 /16/2013 7 /16/2014 � � S 100, 0 001 - ME EXP (AmE one person) $ 5, 000 PERSONAL SADVINJURY S 1, 000, 000, GENERAL AGGREGATE $ 2,000,0001 X $500 Pd Ded GEN'LAGGREGATE LIMITAPPUES PER. PRODUCTS - COMPIOPAGG S 2,000,000 S X POLICY 0 L01C AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT- a accideni 110-0-01 00 0 BODILY INJURY (Par person) -t __ S A ANY AUTO ALL OWNED X SCHEDULED AUTOS AUTOS CPKG0056305 /16/2013 /16/2014 890ILY INJURY (Per accident) S X X NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE P r cde S Medimatl AvMtn13 5 5 000 UMBRELLA LWB OCCUR HCLAIMS-MADF EACH OCCURRENCE $ AGGREGATE 5 EXCESS UAIR S DED I I RETENTIONS WORKERS COMPENSATION OR STATU- O R AND EMPLOYERS' LIABILITY YIN"'"` ANY PROPRIETORIPARTNERIEXECUTIVE E.L EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? ❑ NIA (Mandatory in NH) E L DISEASE - EA EMPLOYE S M yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS t VEHICLES (Attach ACORD 101, Additional Remarks Schedule, H more space Is required) RE: All landscape operations performed by or on behalf of the named insured - Blanket Ad4liLtional insured per attached OOGL0434000108 City of E1 Segundo named as additional insured per attached endorsement. City of El Segundo City Clerk 350 Main Street Room 5 E1 Segundo, CA 90245 -3813 Lw. :Ia ZLRW.LelLW 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 V Mitchell /ACOMBB ACORD 25 (2010105) © 1988 -2010 ACORD CORPORATION. All rights reserved. INS025 (201005) 01 The ACORD name and logo are registered marks of ACORD Sep 09 13 11:54a Oliver Holt (818) 886 -0223 p.8 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED PROTECTION ENDORSEMENT This endorsement modifies insurance provided under.•the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM 1. SECTION II - W_ HO 1S AN INSURED is amended to include as an insured, any organization or person required to be named as an additional insured pursuant to a written contract or agreement. The insurance provided by this endorsement is subject to the following: a. This insurance does not apply to any person or organization not specifically approved by us as an additional insured. b. Any insurance afforded an additional insured under this endorsement shall not begin before the date that the person or organization is approved by us as an additional insured. c. The Limits of Insurance under this insurance, which are listed in the Declarations of this policy, shall not be increased, regardless of the number of additional insureds, or the limits specified in the,contract or agreement. d. Any coverage that is not provided under an additional insured's liability insurance policy for your acts, errors, or omissions is also not provided under this insurance. e. With respects to the additional insured, this insurance does not apply to: 1. "Property Damage" to "your product' arising out of it or any part of it 2. "Property Damage" to "your work' arising out of it or any part of it and included in the "products- completed operations hazard ". 3. Liability for "Property Damage" or "Bodily Injury" for acts, errors, omissions of an additional insured. f. If required under written contract, this insurance will apply to an additional insured as primary insurance and other insurance which may be available to such additional insured shall apply on an excess basis. g. If required by a written contract, we waive our right to recovery against any additional insured because of payments we make for injury or damage arising out of :your ongoing operations, or "your work" done under a contract with that additional insured and included in the "products completed operations hazard ". All other terms and conditions of this Policy remain unchanged. ,4 Endorsement Number: N/A Policy Number: LCPKGO056305 Named Insured: Oliver Holt Landsc This endorsement is effective on the inc i date of this policy unless otherwise stated herein. Endorsement Effective Date. 07/16/2013 00 GL0434 00 01 08 Includes copyrighted material of Insurance Services Office, Inc Page 1 of 1 .with its permission Sep 09 13 11:53a Oliver Holt (818) 886 -0223 p.5 "- -1 DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 4/4/2013 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 policigs may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). cDRTACT PRODUCER victoria Anderson NAMit%a Landscape Contractors (Lic#0755906), PH"?H'E (559) 650 -3555 FAX 1.(559)G50-3556 II No Insurance Services, Inc. EjML :v.zLndersoxx@lcisinc.com 1835 N. Fine Avenue INSURER s AFFORDING COVERAGE NAtc a Fresno CA 93727 1 INSURER A:F'reserver Insurance Corer an 15586 INSURED IN9k1RER e: Oliver Holt aNSURERC: DBA Oliver Holt Landscape $NSURER0 8 611 Ames toy Avenue INSIIaER E Northridge CA 91325 INSURER F: CO'V=oAOaES CERTIFICATE NUMBER'1 -1/ 14 wU rcc11101VIN I4UIV10 CIR. 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. • POLICY EFF POLICY EXP I TR TYPE OF INSURANCE A POLICY NUMBER M �. MMIDO YWk^I° .. LIMITS GENERAL LIABILITY E.AyxH OCOURra.ENCE S T PA � win x�.o S COMMERC'tAL GENERAL L"IL}TY MED EXP Arr one ae30nk $_ CLAIMS -MADE [:J OCCUR PERSONAL & ADV INJURY OENERALAOGREGATE Is .' GEN 'L AGGREGATE LIMIT APPLIES PER: PRODUCTS „COMPIOPAGO S COMBINED StlNGLE UMiT S POLICY PRO. LOC JECT AUTOMOBILE LIABILITY BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED BODILY INJURY (Per accident) S AUTOS NON -01IMED PROP R E Per 6 6deral S HIRED AUTOS ,AUTOS $ - UMBRELLA LIAQ OCCUR EACH OCCURRENCE S EXCESS LIAR CLAIMS -MADE AGGREGATE $.. S DED '.. J R ""C'E.71gTVON'S A WORKERS C'OMPEN'SATION' D EMPLOYERS' LIABILITY YIN IE.A 0 0° ANY �PROPMETOMPARTNERIEX .E.'CUT'IVE. ❑....NIA C 7015629 00 '/ IW,L lyl•••.ICCASI= OFnCF,RIMEMBER EXCLUDED? C 71/2013 /1/2014 EMPLOYE( OO Q DD S eM11A S 000 (Mandatary in ON) '.yo cnftoN uOrF doOr C L DISEASE POLICY LMdT S l D SeCRdIePu PERAT6DN5 tetlw3 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) RE: All landscape operations performed by or on behalf of the named insured. i City of E1 Segundo City Clerk 350 Main Street Room 5 El Segundo, CA 90245 -3813 CA 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 V Anderson /ACOMBE ACORD 25 (2010/05) uTyoo- cu'IUH%.vr%a,....r.�....,.• ...•• . ••••7••- • - - -• IN S025 (201005) 01 The ACORD name and logo are registered marks of ACORD Sep 09 13 11:51a Oliver Holt (818) 886 -0223 p•1 OLIVER I -IOLT LANDSCAPE & CHRIST -MAS TREES 8611 NIESTOY AVENUE, NORTHRIDGE, CA 91325 (8 18) 886 -2203 FACSIMILE TRANSMITTAL SHEET TO: FROM: Vina Ramos Oli er Holt COMPANY, uATEi City of El Segundo 9/9/2013 FAX NUMBER: 'rtrrAl. NO. OF PAGFS INCLUDING COt'I.It, 310 -647 -4223 8 PHONL N UNIULK: 310 -524 -2882 Semites Agreement ❑ U1tGFN'1' ❑ UOR RE\'IE•W ❑ P1J-'ASh: ❑ f'].1:.1tiF. REPLY ❑ PLEASL IMiCYCLI-. Hello, The following is the signed service agreement from Oliver Holt Christmas Trees. The originals will be mailed. Please look over the insurance documents. Nothing has changed for us since last year, so I am confident these are what you need. However, if I missed something, please let me know. As with last year and all the years previous, we are declining flee Waiver of Subrogation Endorsement. If you have an), questions or need to discuss this matter further, please call us at (818) 886 -2203 to speak to Oliver Holt or Nancy Maya. Thank you! Nancy