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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