The URL can be used to link to this page

PROOF OF INSURANCE (2014) CLOSEDPolicy Number: 0400701077 Date Entered: 12/20/2012 CERTIFICATE OF LIABILITY INSURANCE °�'�(M�' ° °'"" � 12 2 12/20/20 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 the terms and conditions of theh Oder I an certain policies ADDITIONAL INSURED, the endorsement. must be endorsed. If SUBROGATION IS WAIVED, subject to p y( policy, p y q nt. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorSen4ent(s). PRODUCER CONTACT Mary Barnard Insurance NAM "� Ne � � l M Camarena � P410 NE (08 286 1334 E-MAIL , FAX 499)F86-642 (,5 2190 Stokes Street " ) Suite 201 ADDRESS . ..... ... C.... SPECIALTY - -.... NNSURER'S AFFORDING COVER�AGE� � ..., NAIC# San Jose CA 95128 aaarilapr0 INSURANCE COL�ANY INSURED Range Maintenance Services, L.L.C. John and Donna Foggiato n §RR_ERc: P. O. BOX 2270 INSURER D:. Arnold, CA 95223 ENSURER E! COVERAGES CERTIFICATE NUMBER- REVISION NUMBER: 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. ..... .. ADDL Sq TIiSR '.. LTA: TYPE OF INSURANCE ,IM _ POL4i"YNUh16ER I°WLtlCY :f�F PU CY [T0,_ _""""""""".. ........., 'fpfflohDyffyy7" „, M:1rDr3fYYYyi LIMITS... ENERAL LIABILITY G..:., _ 000, OOOm..... A . COMw�MERCIALGEF�tlmRALLIAliILAY x, 0400701077 PR E,_CN_�alrr ...... $�„ '1120/2013 /20/201.4 C�f14w�L�i�LN,i�'13� °" 100,000 le'4A;PIv1S- MAAtl7E: � OCCUR _. ,,,,,LL✓. ML.D EXp...(A one...o�l— $. 5, 000 PERSONAL & ADV INJURY $1,000,000 _ GENERAL AGGREGATE $2,000,000 GF'NLAGGR'EG,oIELI APPLIES PER PRODUCTS COAPIOP'AGG ~$. INCLUDED POLICY .O_ q.¢',)C $ AUTOMOBILE LIABILITY COMA WNED SINGLE LIMIT ANYAUTO BODILY INJURY (Per person) $ ALL OWNED .. SCHEDULED ................. ,......,� ,...,.... AUTOS AUTOS BODILY INJURY (Per accident) $ HIRED AUTOS NON -OWNED AUTOS $.. : °UAlu4A.Cq. pi ....., ..... (PrrrOF W UMBRELLALIAB OCCUR EACH OCCURRENCE "OCCURRENCE EXCESS LIAB CLAIMS -MADE ... A4GREGATk $ _ -..� .,... _ _ ,..... ... m..... ....._ ....... _...�, .. PIED RETENTION $ S WORKERS COMPENSATION 4YAC. STATU, 0.71.4m AND EMPLOYERS' LIABILITY YIN T(T ^ M PB . - - ...................... --- - - - - -- ANY PROPRICV'Ou°�JP,r,R'TNEE -Ut' ,W„IE4 UT'IVE ❑ CYJ FtCVWACwMfAR Irk.( „`LM,E;FF; k"A'i N 1 A E1. EACI IACCIDENT" [Mcaaldalory in NH) If describe undor D RI6 T IOiN OF OPERATIONS tru0tr,u E L DISEASE EA EIVaP'LOYd -E- wW a wwwww . ITITm E L. DISEASE . POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) RE: ALL OF INSURED'S OPERATIONS. CITY OF EL SEGUNDO, CITY CLERK ARE NAMED AS ADDITIONAL INSURED AS PER ADDITIONAL INSURED ENDORSEMENT ATTACHED. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN POLICY NUMBER: 0400701077 COMMERCIAL GENERAL LIABILITY CG 20 10 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS -SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, 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; in the performance of your ongoing operations for the additional insured(s) at the location(s) desig- nated above. B. With respect to the insurance afforded to these additional insureds, the following additional exclu- sions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equip- ment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to its in- tended use by any person or organization other than another contractor or subcontractor en- gaged in performing operations for a principal as a part of the same project. Policy Number: BAP0165200 Date Entered: 11/30/2012 =DATE(MMIDWYYYY) Ate I � I�� I I I 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 Ipolicy(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 enclorsea tent s', N ?x�ARL 286 1334 ENA 408) 286 -6425 PRODUCER � &'AdAE CT ''E�aTt.�.a M CAMAR Mary Barnard Insurance pHONr PAX v� 2190 Stokes Street PMdAIL Suite 201 I "'utirSUldC, NATIONAL INSURANCE -...! 'E ... ..�.... NANC N _. San Jose CA 95128 AL�Lx cra CENTURY NATS Arr09i.DINt"CRAN,•._,_,", _.. NSURANCE COMPANY INSURED Range Maintenance Services, L.L.C. . .... _. John and Donna Foggiato rN4UgtE4a "..... _ ...� _............ _ _. P. O. Box 2270 Arnold, CA 95223 INSURE.RF COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD ANY REQUIREMENT„ TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS INDICATED. NOTWITHSTANDING THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, EXCLUSIONS AND POLICIES LIMITS MAY BEEN RED PAID CLAIMS. CONDITIONS OF SUCH PsNt�L — 90,6 OF INSURANCE L POLICY NUMBERE hMp�A OMYBYk ProMMiDOIYYYY LIMITS L GENERAL LIABILITY EACH OCCURRENCE COMMERCIAL GENERAL LIABILITY IwFaFsl ra"`ctlrreWtreme CLAIMS -MADE 0 OCCUR ' I ��• PE SONA(L & A RN,iR�Y $m�• GENERAL A.._ GGREGATE $ P'RODIJCT�' - COM1�'!OP AGO S GEhJ°L AGGREGATE LIMITCrPPI.IES PER: . PRO �m. LOC P ° I OL(L� _... IPJWIIN y I1M9G LC LN..l 1 $ 000, OOO AUTOMOBILE LIABILITY tCellnn "4 k_�? .._. .,..,, ._.._.... .,.,,... .,. BODILY INJURY (Per person) $ ANY AUTO ALL OWNED -•' SCHEDULED ..,.....".." .... ".._ ..................",...,.,_ .,. ......._._._ BODILY INJURY (Per accident) S A AUTOS autos NON -OOWNED ' RCMP& =R"t"f BAE 016 5 2 0 0 2 11/24/2013 I nrcc Inr DAIAACs �"""""'� " " " "— ""'W'�;.,.....'_'_.........'. HIRED AUTOS AUTOS $_. UMBRELLA LIAR OCCUR EACH OCCURRENCE $,wwwwwwwwwwwm EXCESS LIAR CLAIMS -MADE ._ ..._�. - ._._.__, -� .n..E, S '$ .... �WC SIA OTRR WORKERS COMPENSATION'9d 1 - _� . AND EMPLOYERS' LIABILITY YIN E� I L.AGI•.p ACCIDENT '$ ANY'PP,{�Croril E'TOI�Ik AF #'I'k�NEk't kFaU4.,N'1'1'yrE � N / A IXCLUOED9 ' 4"Y3�F'I�,Ln1MI.tm"IEkER (Mandatory' in NH.) E L DISEASE EA ,EMPLOYEE, It yyesW tMe be aMnd8f tbFS' RIPPIONOQ" O'F"Er+"+4TiC1hNS4'yc39a'�'r�w' +W ASFI- POLICY LIMIT E.L. EG79wrE' •� DESCRIPTION OF OPERATIONS I LOCATIONS/ VEHICLES (Alt ... ach ACORD 101, Additional Remarks Schedule, if more space is required) C'ITy OF EL SEGUNDO, CITY CLERK ARE NAMED AS ADDITIONAL INSURED AS PER ADDITIONAL INSURED ENDORSEMENT ATTACHED.. CERTIFICATE FOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Policy Number: 1760432-12 Date Entered: 11/14/2012 =ATE (MMIDOrYYYY) 'MMroDP AC �4i2l CERTIFICATE OF LIABILITY INSURANCE 11114/2012 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. -i- ------- If SUBROGATION' IS WAIVED, subject o IMPORTANT. If the certificate holder is an ADDITIONAL INSURED, the oficy(ies) must be endorsed. 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) _TA" Pearl X. Kena C1111 PRODUCER JFAx Mary Barnard Insurance (408) 286-6425 PHONE: (408)286-1334 2190 Stokes Street Suite 201 ME Pin±ffORD1 NG!gQyFRAGF San Jose CA 95128 M,,,,,,,,STATE COMPENSATION INSURANCE FUI _— ---- ........... INSURED Range maintenance services, L.L.C. G 2 John and Donna Foggriato . ...... . P. O. Box 2270 Arnold, CA 95223 ILI, I 1:1 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS INDICATED. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED CLAIMS- ....... morguffo — _ , __ . TYPONSURANCE POLICYN(AIRFA BYYPAID " -P-01136Y EFF LIMITS AEMTO&MLQ� GENERAL LIABILITY EACH OCCURRENCE____� S COMMERCIAL ENERAL(JARILITY CLAIMS-MADE OCCUR E X? An �L� , )�r M _��N PERSONAL & ADV INJURY 3 .......... ... . ... .. _2ENERAL, qq ALTltlE PRODUCTS-COMPIOPAGG �S C"I'L AGGREGATE LIMIT APPLIES PER: - ----- :21—OLIC-1 —LOC urY AUTOMOBILE LIABILITY _01111 —arski-I L_____ 's BODILY INJURY (Per person) $ ANY AUTO $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) AUTOS AUTOS nwkry�bwmx(Tc ---- - -- - S NON-OWNED HIREDAUTOS AUTOS S MBRELLA LIAR UMBRELLA [,I EACH OCCURRENCE EXCESS LTAB CLAIMS-MADE _AGGREGATE LQ111 RFTEhXT VU, WORKERS COMPENSATION 'j,$T . ...... AND EMPLOYERS' LIABILITY YIN F L EA('H ACCIDENT S1,000,000 A ANY PROPRIErOPJPARTNEREXECU-nVE ❑ F__1 N I A 1760432-12 EXCLUDED? 1/01/2012 110112013 wv OFFICERWEMBER Vaandatoiy in NH) � E L DISEASE -EA EMPLOYEE 1110001000 - 1.. 1000,000 ll PS, ciov�nbe under E.L. DISEASE - POUCY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CERTIFICATE HOLDER 19 NAMED AS ADDITIONAL INSURED AND WAIVER OF SUBROGATION APPLIES AS PER ATTACHED ENDORSEMENT. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CITY OF EL SEGUNDO ACCORDANCE WITH THE POLICY PROVISIONS. HOME OFFICE SAN FRANCISCO ALL EFFECTIVE DATES ARE AT 12:01 AM PACIFIC STANDARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME ENDORSEMENT AGREEMENT 1760432 -12 RENEWAL NG 6- 17 -16 -03 PAGE 4 OF 6 EFFECTIVE NOVEMBER 1, 2012 AT 12.01 A.M. AND EXPIRING NOVEMBER 1, 2013 AT 12.01 A.M. RANGE MAINTENANCE SERVICES, LiC PO BOx 2270 ARNOLD, CA 95223 ANYTHING IN THIS POLICY TO THE CONTRARY NOTWITHSTANDING, IT IS AGREED THAT THE STATE COMPENSATION INSURANCE FUND WAIVES ANY RIGHT OF SUBROGATION AGAINST, CITY OF EL SEGUNDO CITY CLERK WHICH MIGHT ARISE BY REASON OF ANY PAYMENT UNDER THIS POLICY IN CONNECTION WITH WORK PERFORMED BY, RANGE MAINTENANCE SERVICES, LLC IT IS FURTHER AGREED THAT THE INSURED SHALL MAINTAIN PAYROLL RECORDS ACCURATELY SEGREGATING THE REMUNERATION OF EMPLOYEES WHILE ENGAGED IN WORK FOR THE ABOVE EMPLOYER. IT IS FURTHER AGREED THAT PREMIUM ON THE EARNINGS OF SUCH EMPLOYEES SHALL BE INCREASED BY 03 %. NOTHING IN THIS ENDORSEMENT CONTAINED SHALL BE HELD TO VARY, ALTER, WAIVE OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS POLICY OTHER THAN AS STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE