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PROOF OF INSURANCE (2015) CLOSED (2)DATE (MM /DD /YYYY) AC CERTIFICATE OF LIABILITY INSURANCE 5/5/2015 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 NA CONTACT Robert Romar B & B Premier Insurance Solutions air' N F ,,. (818) 223 -8383 IA /C_ No,. (818)223 -eiel 5008 Chesebro Road Suite 200 , „DeF!4�­robertr @bbpremierins.com AFFORDING COVERAGE II NAIC p Agoura Hills CA 91301 INSURERA:Geminl Insurance Company INSURED _ INSURER B MerCury Insurance Group James McNary DBA: Bino Construction INSURER CNational Union Fire Ins. Co. 9520 Topanga Canyon Blvd # 204 INSURER D: Chatsworth CA 91311 1 INSURER F: COVERAGES CERTIFICATE NUMBER:CL155509391 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, CLT R LTR. '.,. TYPE OF INSURANCE IMCP Min POLICY NUMBER. POLICY EFF IMM /DDIYYYYI P LICY EXP IM_MIDDIYYYYI LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 °',', .COMMERCIAL GENERAL LIABILITY �. P FMIRFR IFa nrrilr ;;) $ 300,000 A CLAIMS -MADE a x -] OCCUR GR1001576 -01 4/29/2014 /29/2015 MED EXP (Any one person) $ _ 5,000 PERSONAL 8 ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 2,000,000 Fot. &CY PRO. LOC JECT $.. . AUTOMOBILE LIABILITY na aax.ident '1” " " $ 1.000.000 ANY AUTO BODILY INJURY (Per person) $ B ALL OWNED X SCHEDULED A040000006286 5/1/2015 5/1/2016 BODILY INJURY (Per accident) $ AUTOS Par asoci�de -n1 AMA $ X X NO OWNED HIRED AUTOS AUTOS Medicaloavments $ 5.000 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 C EXCESS LIAB CLAIMS -MADE ,X DED .._... RETENTION$ $ BU 020703513 /14/2014 /29/2015 KERS COMPENSATION WC STATU- 0TH - EMPLOYERS' LIABILITY YIN Tr1DV 11�,11TC FIJ PROPRIETOR/PARTNER /EXECUTIVE E L. EACH ACCIDENT $ ER /MEMBER EXCLUDED? TAN NIA atory in NH) E L DISEASE - EA EMPLOYEE describe under RIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) Certificate Holder is named as an additional insured as per policy terms, limits, conditions, coverages and exclusions as their interests may appear in the operation of the named insured. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN µ ACCORDANCE WITH THE POLICY PROVISIONS. City of E1 Segundo, its offiers, official employees, agents, and volunteers 350 Main Street AUTHORIZED REPRESENTATIVE E1 Segundo, CA 90245 -3813 Robert Romar /KYLE ACORD 25 (2010105) ©1988 -2010 ACORD CORPORATION. All rights reserved. INS025 onlnnsi n1 Tho Arnpn name anri Innn me rnnietnrnri mar4c of Af:f1Rr1 ENDORSEMENT -- ADDITIONAL INSURED COMPLETED OPERATIONS - SCHEDULED PERSON OR ORGANIZATION - PRIMARY COVERAGE THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following; FIRE AND WATER DAMAGE RESTORATION CONTRACTOR'S LIABILITY POLICY SCHEDULE ame Of Additional Insure Persons} or Or anization s): Locatioh(s) FFUC overecfO per ations CITY OF EL SEGUNDO, ITS OFFICERS, OFFICIALS, AS REQUIRED BY WRITTEN CONTRACT PRIOR EMPLOYEES, AGENTS AND VOLUNTEERS TO THE COMMENCEMENT OF WORK co A. SECTION V — Who Is an Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule above but only with respect to liability for "bodily injury" or "property damage " 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 and in connection with "your work" and included in the "products•com leted operations hazard" you have done on behalf of the additional insured(s) at the locations) descdnated above. B. With respect to the Insurance afforded to the additional insured(s), the following additional exclusion applies: This insurance does not apply to "bodily injury" or "property damage" occurring before; 1. The contract or agreement has been executed. Execution of the contract or agreement will be considered to happen when your performance begins or when the contract or agreement is signed, whichever happens first; or 2. The inception of this insurance. C. This insurance for the benefit of the additional Insureds) shown In the Schedule is primary Insurance. Any other insurance maintained by the additional insureds shall be excess and noncontributory but only as respects "bodily injury" or "property damage'" caused by your operations if the injury or damage is determined to be the result of your negligence or sole y your responsibility.. THIS ENDORSEMENT MUST BE ATTACHED TO A CHANGE ENDORSEMENT WHEN ISSUED AFTER THE POLICY IS WRITTEN. qW CG 75 75 0607 02007 Gemini Insurance Company Page 1 of 1 Includes material copyrighted by ISO Properties, Inc., with its permission ENDORSEMENT - ADDITIONAL INSURED - OWNERS, LESSEES, OR CONTRACTORS - AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: FIRE AND WATER DAMAGE RESTORATION CONTACTOR'S LIABILITY POLICY A. SECTION V — WHO IS AN INSURED is amended to include as an additional insured any person or organization for whom you are performing operations when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an add'Itional insured on your policy, Such person or organization is an additional insured 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. A person's or organization's status as an additional insured under this endorsement ends when your operations for that additional insured are completed. B. EXCLUSION — With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to: 1. "Bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of, or the failure to render, any professional architectural, engineering or surveying services, including: a. The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or b. Supervisory, inspection, architectural or engineering activities. 2. "Bodily injury" or "property damage" occurring after: a. All work, including materials, parts or equipment 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 b. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. THIS ENDORSEMENT MUST BE ATTACHED TO A CHANGE ENDORSEMENT WHEN ISSUED AFTER THE POLICY IS WRITTEN. w CG 75 44 07 04 © 2005 Gemini Insurance Company Page 1 of 9 Includes material copyrighted in 2004 by ISO Properties, Inc,, with its permission ENDORSEMENT - WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: FIRE AND WATER DAMAGE RESTORATION CONTRACTOR'S LIABILITY POLICY SCHEDULE Name of Person or Organization: Address: ANY PERSON OR ORGANIZATION FOR WHOM YOU ARE PERFORMING OPERATIONS WHEN YOU AND SUCH PERSON OR ORGANIZATION HAVE AGREED IN WRITING IN A CONTRACT OR AGREEMENT. (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) SECTION VI — COMMON CONDITIONS — Condition N., Transfer of Rights of Recovery Against Others to Us Condition is amended by the addition of the following: w • • THIS ENDORSEMENT MUST BE ATTACHED TO A CHANGE ENDORSEMENT WHEN ISSUED AFTER THE POLICY IS WRITTEN. CG 75 39 10 93 © 2005 Gemini Insurance Company Page 1 of 1 Includes material copyrighted in 1992 by ISO Properties, Inc., with its permission DATE (MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 05/23/2014 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(I'es) must be endorsed. If SUBROGATION IS WAIVED, subject to the terns 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 endorsomentfsl. PRODUCER Bouchard Insurance for Frank Crum 101 Starcrest Drive Clearwater, FL 33758 INSURED FrankCrum 11, Inc. Labor Contractor, for leased workers to: James McNary dba: Bino Construction 100 South Missouri Avenue Clearwater, FL 33756 COVERAGES CERTIFICATE NUMBER: 14FLO80850944 A: American Zurich Insurance Company 1, 40142 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. S... .. _._.�. ._. _ INSR A POLICY EFF POLICY EXP I TA TYPE OF INSURANCE luco wvn POLICY NUMBER lMMIDDAWYI (MMlDDIVYYVI .— .. ...... LIMITS GENERAL LIABILITY EACH OCCURRENCE $ .. A_WA rYr"RY .... .... ...:.......�_..._ _. COMMERCIAL GENERAL LIABILITY $ CLAIMS -MADE OCCUR MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN" L AGGREGATE .LIMIT APPLIES PER: PRODUCTS -COMPIOPAGG ,.,..�-- , ..........:.. $ ,.w.,,............ POLICY D PRO. LOC Il $ AUTOMOBILE LIABILITY cdda� mm p .T .^. ANY AUTO BODILY INJURY (Per person) $ ...�w^ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS _.__. ._ .....- _._ _m..... NON-OWNED �ROPFRTYCtlAMACwE $ HIRED AUTOS AUTOS P�a a9�ldgn* $ UMBRELLA LIAB OCCUR EACH OCCURRENCE .,. IAB EXCESS L - CLAIMS-MADE AGGREGATE $ _DFn FNTI_ N $ WORKERS COMPENSATION WC STATAUT- X TAV IC CG AND EMPLOYERS' LIABILITY YIN A ANY d RIry EET ER/EXCLUDED? CUTIVE OFFICER/MENIBER EXCLUDED? ''.... N X WC 54-70- 649-02 06/01/2014 06/01/2015 EACH E,l PASECEA EMPLOYE... $ 1.000.000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 Location Coverage Period: 06101/2014 06/011201511 Client# 11329 -CA DESCRIPTION OF OPERATIONS 1 LOCATIONS! VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) James McNary dba^ Bino Construction Coverage 9s provided For 9520 Topanga. Canyon' Blvd STE 204 Cov rage employees leased to but not Chatsworth, CA 91311 subcontractors of: Endorsements: Waiver of Subrogation CERTIFICATE HOLD ACORD 25 (2010/05) 071 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 ©1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD CITY OF EL SEGUNDO ATTEN: ARIANNE BOLA 350 MAIN STREET EL SEGUNDO, CA 90245 ACORD 25 (2010/05) 071 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 ©1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD WORKERS' COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 4 -84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT — CALIFORNIA 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 per- form 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 $o of the California workers' compensation premium otherwise due on such remuneration. SCHEDULE Person or Organization Job Description IN FAVOR OF: CITY OF EL SEGUNDO ATTEN: ARIANNE BOLA 350 MAIN STREET EL SEGUNDO, CA 90245 This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated, (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective: 06/01/2014 Policy No: WC 54 -70- 649 -02 Endorsement No: Insured: FrankCrum 11, Inc. Labor Contractor, for leased workers to: James McNary dba: Bino Construction Insurance Company: American Zurich Insurance Company Countersigned by WC 04 03 06 Copyright 1983 National Council on Compensation Insurance