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PROOF OF INSURANCE (2013) CLOSEDDATE JUMMIOff ) 1, 1 CERTIFICATE OF LIABILITY INSURANCE 7/12/2012 _..,, ._......... ._......_ ......_. aw,.,,, �.�. 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 endorsements). ,�m �.�. -_.. PRODUCER tION TAL.I' Victoria Anderson Landscape Contractors (Lic#0 55906) (559) 65���._....� � L. 1354165 - .._wMi. ,,,..... u° PFiQNE Q -3555 FA% � 0- 3558.. Insurance ,Se ices, Inc. AbnktL vanderson @lcisine.com 383' N. Fine Avenue SURERIS,)AFFORDING COVERAGE NAICa__ t'reenc CA 93727 INSURERA:ARCH Insurance Co as 11150 INSURED .... INSURER 6: Oliver Holt INSURER C B Oliver Holt Landscape INSURER D: .................. —v.. .- ,.,,......,., ....... 861 es t oy Avenue INSURER E 1I0r90hr.i!. CA 91325 INSURER E COVERAGES CERTIFICATE NUMBM12 /13 PKG REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW IlAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICAIFD NOTWITHSTANDING ANY REQUIREMENT TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT 10 WHICH 1HIS 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 - ....._..w.�..__ ... _. �. LTdY TYPE OF INSURANCE POLICY NUMBER .... ,�.- ....m..... ._. .. ...,.�.. �..,.....�.�.. �......,.� ................. _�,..�....�,,.�,�,,..�n...,�. PM U "YY 4 1PC E %P LIMITS GENERAL LIABILITY I,i. f. I sRA&qF "µI1d�4td .r]NI6I �° .. ry 100, 00 _... Fa CLAIMS -MADE X OCCUR LCPK00056304 ... ....�....� D ,N .., , fr612Q12 7/16/2013 MLD Any�� eaarsnnl S _ _A mm..ITmm..1�100,000, 5, 000 PERSONAL 4 ADV INJURY s 1, 000, 000 X $500 PD DEDD GENERAL AGGREGATE ''. 5 2, 000, 000 'AI Nt, AC( ;Nt ,AIC, LIMIT AP b ! FS PER PR�OOUCTS - COIi1PDP AGG Se..� 2, 000,000 16rw.mR I.JMItI AUTOMOBILE UABILITµ� Y nv I ?�.0 1 AQO O,Q e ANY A,FTO BODILY INJURY {Per person) S AUI.. OWNED SCHEDULED j{ CPK00056304 /16/201.2 /16/2013 BODILY INJURY (per 0ecicie. $ •. AUTOS X " AUTOS ( NON -OWNED ,.,� 4'kUF FI~ &1' ^r 6"7PnM,A.P $ _ HIRED AUTOS - AUTOS _ ......,.._......,.�.www.. _$ 51000 UMBRELLA LIAB OCC R I E61L GCUFFB F2CNCE ffi E %CESS LIAB GL/1iM$ F,IADE � RPM D D IRETFNTION 5 i .._. .._._.......... WORKERS COMPENSATION �..__..._.. 'w SIAIU 01H AND EMPLOYERS' LIABILITY Y I N a&t -'R ' °— - -' - ANY PROFR`FTORFPARTNERIEXECUT)Vc 1 N! A E I EACH ACCIDENT S OFFICE"EMBER EXCLUDED% Y.. ..F IMandatory In NH) E DISEASE EA EMPLOYE S H yes descrlce urvle, DESCRIPTION OF OPERATIONS ix'or P OL9CY LIMIT 5 EL DISEASE -K n..... .......w,......, I I I DESCPJPTRON OF; OPERATIONS f LOCATOONS t VEDOCLES IAnach ACORD 901, Addi9nranal Remarks Schedule, If mom space Is veq uhredy RE. All landscape operations performed by or on behalf of the named insured,. Blanket Addi.tional Insured per attached OOGLO434000108 City of E3 Segundo axarned as additional Insured per attached ea dornemen t. ............ ..... CERTWFICATE HOLDER CANCELLATION THIS ENDORSEMENT CHANGES THE POLICY. PLEASE REzDIT CAREFULLY. 11,911,11110FT, ;,1MffMnffME13= COMMERCIAL GENERAL LIABILITY COVERAGE FORM 1. SECTION 11 - WHO IS AN INSURE* © amended to include as an insured amy organization or person required to be named as an additional insured pursuant to a written contract or agreement. e. With respects to the additional insured, this insurance does not apply "Property Damage" to "your product" arising out of it or any part d< 2. "Property Damage" to "your work" arising o< ©< © any part of it and included in the prod ucts-com pleted 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, 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 »»«©; in the "products completed operations hazard". Endorsement Numbers k Poiicy Number, LCPKG0056304 Named insure± Oliver Hoft Landscape T endorsement is effecfive on th.e inception date of this poi cy un%ss otherwise stated herein, Endorsement Effecfive DatE 0216/2012 00 G10434 00 01 08 includes copyrighted material of insuranr.;e Services Office, inc Page 1 of! witt, its oermisgon ACR 16�O DATE (MMIDDIYYYY) "' CERTIFICATE OF LIABILITY INSURANCE 3/30/2012 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 endorsements PRODUCER NAMEr Victoria Anderson Landscape Contractors (Lic #0755906) PHONE (559) 650 -3555 d INS; (559) 650-3558 Insurance Services, Inc. EmMAIL vanderson @lcisinc.com 1835 N. Fine Avenue INSURER(SLALEFORDING COVERAGE NAIC f Fresno CA 93727 INSURERA:Tower Select Ins Co/ 44300 INSURED INSURERB:Tower Group CqTganies Oliver Holt INSURER C: DBA Oliver Holt Landscape INSURER D : 8611 Amestoy Avenue INSURER E: . . . . . . . . . . . . . . . . . . . . . . Northrid a CA 91325 INSURER F: COVERAGES CERTIFICATE NUMBER -12/13 WC RF \lICIf1Al IJIIMRFR• 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 TYPE OF INSURANCE POLICY EFF POLICY EXP LTR POLICY NUMBER MMIO INYYY MMIDDIYYYY LIMITS GENERAL LIABILITY P ACI -I OCCURRENCE $ "OM A FL4A GFV 6'1 LIADILFY 1 t P2h N✓il L, -0 0 - ��,ff a t�rrudie�rucfi.•" CLAIM , NIADF F-1 OCCUR MC 17 FXP IC'viy onp person) $.... PERi:wChV`dAL. 8, ADV ilNJORY G [..- NERAL.A,.- ,GRE.GAIE $ GEN'L AGGRE SAIE 1. i- 11 APPLIES PR. iS - r0Mp OP AGG $ POLICy 0C " I 1� AUTOMOBILE LIABILITY . 7777777 Pd 7 ' ..::. CJrrl V 4 RCq'pfV49N1 BODILY INJURY (Pear f1H sop) $ ANY AUIIQL Ai.i..O'VJNIfY SCflPii:DLHF-D -. l 111 OS AS.fo s BO[Dili.'V INJURY (Peracmderfl $ Pd CON -0 NYVED -fO5' IRO 11 Ri y DANiAG1E (ecQ,,,,Id,e .. 3 HIREDAU AU.f0S UMBRELLA LIAB '',.00CUR E-:ACI- IOCCIJfiRENCE $ AGGREGATE $. EXCESS LIAB CL..F�111A YhF,R:YE` ::I=T TON $...... A WORKERS COMPENSATION VVC STATU- I 10TH- T RY IMIT,. AND EMPLOYERS' LIABILITY Y! N f II O'CIH d C.i Vf71 �U.I $ 1 000 000 ANY PRO PRIETORIPARTNER /EXECUTIVE OFFICERIMEMBER EXCLUDED? N/A C 0012625 02 /1/2012 /1/2013 _ cr If yes, describe under t4. &E' $ 1 000,000 DESCRIPTION OF OPERATIONS below - E L IJII E,rk F E 0111 ICY 1...01miT $ ,1 000,000 DESCRIPTION OF OPERATIONS/ LOCATIONS [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. -.arc nrl1.ral a nVI_veR City of E1 Segundo City Clerk 350 Main Street Roam 5 El Segundo, CA 90245 -3813 i -11ft 44wi71I 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 Anderson /RBUSTO AGUKU 25 (ZU1U/U5) © 1988 -2010 ACORD CORPORATION. All rights reserved. INS025 (201005) 01 The ACORD name and logo are registered marks of ACORD