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PROOF OF INSURANCE (2015) CLOSEDBESTCON -01 LHETHERINGTON
^ DATE (MnvDDmYYj
CERTIFICATE OF LIABILITY INSURANCE 1zMMIDDI4
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 tort if sate holder Is an ADDITIONAL INSURED, the pollcy(lea) 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
cortl'0cate holder in lieu of such endorsement(a).
PRODUCER
Orion Risk Management insurance Services, Inc.
1800 quail Street Suite 110
Newport Beach, 6A 92660
INSURED
A
B
co
Best Contracting Services, Inc. 1N*UKtW V :.
19027 S. Hamilton Avenue rHSURER D:
Gardena, CA 90248 INSURER E
263 -8850
merican Insurance Company 16535
Guarantee and Liability Insurance Company 26247
n Zurich Insurance Comoanv 140142
UV1zKAU Uftf(lIN AIICr+1UIVIbU : KIZV1 *IUNPriURItICKt
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 SHOVMI MAY HAVE BEEN REDUCED BY PAID CLAIMS.
IR TYPE OF INSURANCE POLICY NUMBER (MMMONYYVI IM P i UNITS
X I COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 3 1,000,0
CLAIMS -MADE 0 OCCUR X X GL0980519703 12/0112014 12101/2015 S 1,000,0
I, I I I I I PERSONAL 6 ADV INJURY $ 1
GEN"L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
S 2
POLICY WT LOC
PRODUCTS - COMPA)P AGG
S
-.T
$ ?
Emp Benefits
s 1
AUTOMOBILE LIABILITY
C a E
S 1
X
X
X
BAP980519603
12/01/2014
1210112016
perso)Q
ALL001SIMtED A OESULED
BODILYINJURY(Per n
S
-OWNED
X HIRED AUTOS X AUTOS
E
Ps
S
$
X UMBRELLA LIAB 1-xi OCCUR
EACH OCCURRENCE
$ 1
AGGREGATE
s 1
EXCESS LIAS CLAIMS -MADE
U
12/01/2014
1210112015
EMPLOYERS' LIABILITY
PROPRiETORIPARTNERIEXECUTIVE Y 'i N 1 A X
CFRAWCrAAArR rXr"I1if Fn')
121011201411210112016 I E.L. EACH ACCIDENT
E.L.
s
s
DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 101, AdOtIonal Remarks Schedule, may be aUached If more space Is required)
Project: REPAIR OF PUMP STATION 18 ROOF. The City, Its officers, officials, employees, agents, and volunteers are an Additional Insured to the
extent provided by the policy language or endorsement Issued or approved by the Insurance carrier. Insurance provided to Additional Insured(s) Is primary
land
non- conWbutory as per the attached endorsements or policy language. Waiver of Subrogation applies per attached endorsements) or policy language.
x 4'e SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of El Segundo �) of 4 ACCORDANCE WITH THE POLICY PROVISIONS.
360 Main Street"
El Segundo, CA 90246 °
g v
..�" AUTHORIZED REPRESENTATIVE
0 1988 -2014 ACORD CORPORATION. All rights reserved.
ACORD 26 (2014101) The ACORD name and logo are registered marks of ACORD
POLICY NUMBER:GLO 9805197 -03
CX14VEF40A- �P+1..LIABI1-17Y ,
CG24040509 Ord
WAIVER OF TRANSFER OF RIGHTS OF RECOVERY
AGAINST OTHERS TO US
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
PRODUCTS /COMPLETED OPERATIONS LIABILITY COVERAGE PART
SCHEDULE
'� ao
e VITT
IV itions:
;r• r •' r r, r rr r rr: r �
r r rr r rm r
r r -r rr w r rir
zr all ,i
CG 24040509 © Insurance Services Office, Inc., 2008 Pagel o fl D
X
Additional insured - Automatic - Owners, Lessees Or'
Contractors
PZ; No. Eff. Dato d Pol. I Exp. Date d Pd. Eff. Dated End. I Producer No. Add'1. Rem 1, Rstum Rem.
THIS ENDOFISEWEW CHANGES THE POLICY. PLEASE HEAD IT CAREIRILLY.
Named Insured: BEST CONTRACTING SERVICES, INC
Address (imluding ZIP Code):
19027 S HAMILTON AVE
GARDENA, CA 90248
This endorsement modifies Insurance provided under the:
Commercial Ganemi Liability Coverage Part
A. Section 11 —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 pens fitted by law.
E. 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 1 — Coverage A — Bodly Injury And Properly
Damage Liability and Section I — Coverage B — Personal And Advertising injury Liabliity, 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 %jour work" as included in the °products -completed operations
hazard ", which Is the subject of the written contract or written agreement.
C. 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.
D. The insurance provided to the additional Insured person or organization does not apply to:
°Sadliy 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.
U- GL -1175-E CW (04/ 12)
Page 1 d 2
Includes copyrighted materfaf of Insurance Services Office. inc., with its permission.
E. The following is added to Paragraph 2 Duties In The Event Of Occurrence, Offense, Claim Or Suit of Section IV —
Commerclal General Lability 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— Conmwc d
General Llabl ty Conditioner
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 4.6. of the Other Insurance Condition of Section IV —Commercial
General Liability Conditioner
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 UV, 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 on a primary and non-
contributory basis.
G. 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.
U-GL- 1176E CW (04/12)
Page 2 of 2
Includes copyrighted material of insurance Services Ogice, Me., with Its permission.
�µ
,'ZURICH
Other Insurance Amendment — Primary And
Non - Contributory
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
Named Insured:
Address (including ZIP Code):
This endorsement modifies insurance provided under the:
Commensal General Liablllly Coverage Part
SECTION M COMMERCIAL GENERAL LI MUW CONDITIONS, 4. Other Innuance, is amended per the
following:
1. The following paragraph is added under a. Primary Insmance:
This insurance is primary insurance as respects ourt:o^terage to an additional insured person or organi.
xation, where the written contract or written agreement t0quires that this insurance be primary and
non - contributory. In that MA we will not seek contribution frown arty other insurance policy available
to rite additional insured on which the additional insured person or organization Is a Named Insured,
2. The following paragraph Is added under b. Excess imtnance:
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 in-
sured by attacbment of an endorsement to another policy providing coverage for the same °occurren ,
claim or "'rude'. 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 on a primary and non - contributory basis.
Any provisions in this Coverage Part not changed by the term and conditions of this endorsement continue to apply
as written.
U- 0L-W --A CW (3/2007)
Peke t of t
POLICY NUMBER: BAP 9805196 -03
0CN%1EFQALA1JT0
CA04440310
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
WAIVER OF TRANSFER OF RIGHTS OF RECOVERY
AGAINST OTHERS TO US {WAIVER OF SUBROGATION)
This endorsement modHies insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
BUSINESS AUTO PHYSICAL DAMAGE COVERAGE FORM
GARAGE COVERAGE FORM
MOTOR CARRIER COVERAGE FORM
TRUCKERS COVERAGE FORM
Wrth respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modi-
fied by the endorsement.
This endorsement changes the policy effective on the inception date of the policy unless another date is Indicated
below.
Tamed Insured
ndorsement Effective Date:
SCHEDULE
Name(s) Of Persons) Or Organization(s):
ALL PERSONS AND /OR ORGANIZATIONS THAT ARE REQUIRED BY WRITTEN
CONTRACT OR AGREEMENT WITH THE INSURED, EXECUTED PRIOR TO THE
ACCIDENT OR LOSS, THAT WAIVER OF SUBROGATION BE PROVIDED UNDER
THIS POLICY.
The Transfer Of Rights Of Recovery Against Others
To Us Condition does not apply to the person(s) or
organization(s) shown in the Schedule, but only to
the extent that subrogation is waived prior to the ac-
cidenr' or the IllosW under a contract with that person
or organization.
CA04440310 0 Insurance Services Office, Inc., 2009 Page 1 of 1 D
>
WORI(ERS COMPENSATION AND EMPLOYERS UAIEUTY INSURANCE POLICY 000313
0313
WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT ,I�` 01 `
We have the right to recover our payments from an one !able for an In ury red' by this policy. We will not enforce
our right against the person or organization the Schedule, (�h a agreement applies only to the extent that you
perform work under a written contract that requires you to obtain thli agreement from us.)
This agreement shall not operate directly or indirectly to benefit anyone not named In the Schedule.
Schedule
ALL PERSONS AND /OR ORGANIZATIONS THAT ARE REQUIRED BY WRITTEN
CONTRACT OR AGREEMENT WITH THE INSURED, EXECUTED PRIOR TO THE
ACCIDENT OR LOSS, THAT WAIVER OF SUBROGATION BE PROVIDED UNDER THIS
POLICY FOR WORK PERFORMED BY YOU FOR THAT PERSON AND /OR ORGANIZATION
Thla er dwswwa ctanges the pok7 W vrhloh It Is stf8 *A and is eftecBve on Use date Woued unless oftwm a sued.
(The Infonnatlon below Is ompred only when this endorsement Is Issued subsequent to preparatlon of ft poNW.)
Endowment EffeeUve Polley No.
Insuranoe Company
WC 00 0313
(Ed. 4-84)
• CMdSM 1sa3 NeMnel Caution on C=P0naattoa lawn 'P 11
Cozad nWned By
PMTAM $
WORIMW COMPENSATION AND EMPLOYOW U40UTY INSURANCE POLICY WC 04 03 06
Ed.
WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT- -
CALIFORNIA
M have the right to recover our payments from anyone fable for an Injury covered by this policy. V6 will not
enforce our right against the person or organization named In the Schedule. (This agreement apples 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 white engaged in
the work described in the Schedule.
The additional premium for this endorsement shall be 0.00 % of the California workers' compensation pre-
mium otherwise due on such remuneration.
Person or Organization
ALL PERSONS AND /OR
ORGANIZATIONS THAT
ARE REQUIRED BY
WRITTEN CONTRACT OR
AGREEMM WITH THE
INSURED, EXECUTED
PRIOR TO THE
ACCIDENT OR LOSS,
THAT WAIVER OF
SUBROGATION BE
PROVIDED UNDER THIS
POLICY FOR WORK
PERFORMED BY YOU FOR
THAT PERSON AND /OR
ORGANIZATION.
WC 252 (4434)
WC 04 03 06 (6d. 484)
Schedule
Job Description
ALL CA OPERATIONS
e V 9
Page 1 dl
SWIH9 Mona
From: Hegvold, Julie
Sent: Tuesday, December 30, 2014 11:44 AM
To: Shilling, Mona
Cc: Rivera, Floriza; Bola, Arianne
Subject: Best - Pump Station 18 Roof
Attachments: Best - Pump Station 18 Roof Repair Contract.CM.pdf; Best Insurance.pdf
Hi Mona,
Here is a contract for finalization with Best Contracting for the Pump Station 18 Roof. No bonds were required for this
contract.
I will drop off the hard copies to your office today. Please let us know if you need anything further. Thanks!
Julie Hegvold, Management Analyst
CITY OF EL SEGUNDO I Public Works Dept.
350 Main Street, El Segundo, CA 90245
Tel. (310) 524 -2365 1 jhegvold @elsegundo.org
C'1'1[T)( IIIAL.L, LS CILDSE.D ON 1?R 0.)A...ViS
From: Garcia, Angelina
Sent: Thursday, December 18, 2014 10:08 AM
To: Hegvold, Julie
Cc: Shilling, Mona; Rivera, Floriza; Bola, Arianne
Subject: RE: Best - Pump Station 18 Roof
Hi Julie,
This-1ooks good. approved. please forward to Mona S,. for processing
From: Hegvold, Julie
Sent: Thursday, December 18, 2014 8:14 AM
To: Garcia, Angelina
Cc: Shilling, Mona; Rivera, Floriza; Bola, Arianne
Subject: Best - Pump Station 18 Roof
Good Morning Angie,
Did this insurance suffice-? T,Or do I need to request the vendor to alter an endorsement?
if so, I'd like to get that request into the vendor, so they can request from their insurance agent prior to the
holidays. Thanks!
Thank you,
Julie Hegvold, Management Analyst
CITY OF EL SEGUNDO I Public Works Dept.