PROOF OF INSURANCE (2013) CLOSEDCERTIFICATE OF LIABILITY INSURANCE DATEIMMIDDIYYYY)
12/1/2013 11/27/2012
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 Lockton Insurance Brokers, LLC NA T
725 S. Figueroa Street, 35th Fl. PHONE
CA License #OF15767 ,,E �. -� 1?� Nom_ ... .._w-
Los Angeles CA 90017 ADDDIIE.g
(213) 689 -0065 INSURER S AFFORDING COVERAGE NAIL!{
INSURER A: Zurich American Insurance
INSURED Best Contracting Services, Inc. INSURER B: AMCri CU QUafantep,
1314202 19027 S. Hamilton Ave INSURER C: American Zurich Insurance
Gardena CA 90248
COVERAGES BESR001 N3 CERTIFICATE NUMBER: 12083653 REVISION NUMBER XXXXXXX
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
.LM
TYPE OF INSURANCE
AUDL
INSR
SUER
WVD
POLICY NUMBER
POLICY EFF
MM /DDPYMYYJ
POLICY EXP
MM/DD/YYYY
LIMITS
A
6ENERALLIABILITY
Y
N
GL0980519701
12/1/2012
12/1/2013
y MMER IALGENERAL BILITY
DAMAGE TO
PRE ISE merenca
PREMISES tNCC4ARpAI�Ce
(Ea
$ 1,000,000
�� 0.00
.._ ....... CLAIMS -MADE OCCUR
PERSONAL & ADV INJURY
$ 1,000,000
X XCU Covers a
X Contractual Liab.
GENERAL AGGREGATE
$
EN'L AGGREGATE LIMIT APPLIES PER:
POLICY I X M FIX] LOC
PRODUCTS - COMP/OP AGG
1 2,000,900
$
A
AUTOMOBILE
LIABILITY
N
N
BAP980519601
12/1/2012
12/1/2013
COMBINED S
To acddeno
n�
$ 00
t person)
X
XX� XX,
IT
..
AUTOrED SCHEDULED
AUTOS
BODILY INJURY (Par accident)
W$,.
;
PROPERTY DAMAGE
$ X XXX
Xm
NON-OWNED
HIRED AUTOS X
Comp /Coll Ded
$ 1,000
B
X
UMBRELLA LIAB
_X ^
OCCUR
N
N
AUC594415704
12/1/2012
12/1/2013
EACH OCCURRENCE
$ 5 000 00
EXCESS LIAB
CLAIMS- MADE
AGGREGATE
$ 5
DED RETENTION $
$
C
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANY PROPRIETOR /PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
N/A
Y
WC980519801
12/1/2012
12/1/2013
X
TORY LIMIT -
-
ER
E.L. EACH ACCIDENT
$ �00. 0
_
$ 1,000000
,
0
E-L DISEASE - POLICY LIIMITE
.,. .
DESCRIPTION OF OPERATIONS below
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required)
Re: Project Name: WO #2681 Police Station El Segundo Roof Repair. El Segundo Police Department is an Additional Insured to the extent provided by the
policy language or endorsement issued or approved by the insurance carrier. Waiver of Subrogation applies per attached endorsement(s) or policy language.
Lw/:1L"I
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
12083653
El Segundo Police Department � a`
348 Main Street - N
El Segundo, CA 90245
The ACORD name and logo are registered marks of ACORD
Additional Insured - Automatic - Owners,Lessees Or ZURICH
Contractors
Policy No Eff. Date of Exp. Date of Eff. Date of End. Producer AddT. Prem Return
Pol Pol No. Prem
G LO980519701 112/11/20112 12/11/20113 12/11/2012
THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY.
Named Insured: Best Contracting Services,
Inc.
Address: 19027 S. Hamilton Ave.
Gardena, CA 90248
This endorsement modifies insurance provided under the:
Commercial General Liability Coverage Part
A. Section II - Who Is An Insured is amended to include as an insured any person or organization who you are
required to add as an additional insured on this policy under a written contract or written agreement.
However, if you have entered into a construction contract or construction agreement with an additional insured
person or organization, the insurance afforded to such additional insured only applies to the extent permitted
by law.
B. The insurance provided to the additional insured person or organization applies only to "bodily injury",
"property damage" or "personal and advertising injury" covered under Section I - Coverage A - Bodily Injury
And Property Damage Liability and Section I - Coverage B - Personal And Advertising Injury Liability, 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,
and resulting directly from your ongoing operations or "your work" as included in the "products- completed
C operations hazard ", which is the subject of the written contract or written agreement.
However, regardless of the provisions of Paragraphs A. and B. above:
1. We will not extend any insurance coverage to any additional insured person or organization:
a. That is not provided to you in this policy; or
b. That is any broader coverage than you are required to provide to the additional insured person or
organization in the written contract or written agreement; and
2. We will not provide Limits of Insurance to any additional insured person or organization that exceed the
lower of:
a. The Limits of Insurance provided to you in this policy; or
b. The Limits of Insurance you are required to provide in the written contract or written agreement.
U -GL- 1175 -E CW (04112)
Page 1 of 2
Includes copyrighted material of Insurance Services Office, Inc., with its permission
Attachment Code: D460740
Certificate ID: 12083653
D. The insurance provided to the additional insured person or organization does not apply to
"Bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering or failure
to render any professional architectural, engineering or surveying services including:
1. The preparing, approving or failing to prepare or approve maps, shop drawings, opinions, reports,
surveys, field orders, change orders or drawings and specifications; and
2. Supervisory, inspection, architectural or engineering activities.
E. The following is added to Paragraph 2. Duties In The Event Of Occurrence, Offense, Claim Or Suit of
Section IV - Commercial General Liability Conditions:
The additional insured must see to it that:
1. We are notified as soon as practicable of an 'occurrence" or offense that may result in a claim;
2. We receive written notice of a claim or "suit' as soon as practicable; and
3. A request for defense and indemnity of the claim or "suit' will promptly be brought against any policy
issued by another insurer under which the additional insured may be an insured in any capacity. This
provision does not apply to insurance on which the additional insured is a Named Insured, if the written
contract or written agreement requires that this coverage be primary and non - contributory.
F. For the coverage provided by this endorsement:
1. The following paragraph is added to Paragraph 4.a. of the Other Insurance Condition of Section IV -
Commercial General Liability Conditions:
This insurance is primary insurance as respects our coverage to the additional insured person or
organization, where the written contract or written agreement requires that this insurance be primary and
non - contributory with respect to any other policy upon which the additional insured is a Named Insured. In
that event, we will not seek contribution from any other such insurance policy available to the additional
insured on which the additional insured person or organization is a Named Insured.
2. The following paragraph is added to'Paragraph 4.b. of the Other Insurance Condition of Section IV -
Commercial General Liability Conditions:
This insurance is excess over:
Any of the other insurance, whether primary, excess, contingent or on any other basis, available to an
additional insured, in which the additional insured on our policy is also covered as an additional insured on
another policy providing coverage for the same 'occurrence ", offense, claim or "suit'. This provision does
not apply to any policy in which the additional insured is a Named Insured on such other policy and where
our policy is required by written contract or written agreement to provide coverage to the additional insured
G. on a primary and non - contributory basis.
This endorsement does not apply to an additional insured which has been added to this policy by an
endorsement showing the additional insured in a Schedule of additional insureds, and which endorsement
applies specifically to that identified additional insured.
All other terms and conditions of this policy remain unchanged
Attachment Code: D460740
Certificate ID: 12063653
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY
WC 04 03 06 (Ed. 4 -84)
WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT -
CALIFORNIA
This endorsement changes the policy to which it is attached effective on the inception date of the policy
unless a different date is indicated below.
(The following "attaching clause" need be completed only when this endorsement is issued subsequent to preparation
of the policy.)
This endorsement, effective on 12/1/2012
at 12:01 AM. standard time, forms a part
of
Policy No. WC980519801 Endorsement No.
of the American Zurich Insurance Company
Issued to BEST CONTRACTING SERVICES, INC.
Premium (if any) $
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 % of the California workers' compensation
premium otherwise due on such remuneration.
Person or Organization
El Segundo Police Depart
WC 252 (4 -84)
WC 04 03 06 (Ed. 4 -84)
Attachment Code: D464669
CertifiicateID: 12083653
SCHEDULE
Job Description
See Description of Operations on Certificate
attached
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