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PROOF OF INSURANCE (2015 - 2016) CLOSEDClient #: 1255108 305A1 ENT DATE (MMIDD/YYYY) ACORDTM CERTIFICATE OF LIABILITY INSURANCE 6119/2015 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. IMP ...... ORT ___.. ate holder is an ADDITIONAL ANT: If the certificate L (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 CONTACT Vanessa Maldonado BB &T Insurance Services PHONE 714 941 2956 FAX 877- 297 -1116 1AFC,R Nsr Exll ......... ., 6-- .,.... (A)C, Np) ^_ of Orange County E -MAIL vmaldonado @bbandt.com ADDRESS 2400 Katella Avenue Ste 1100 -° INSURER(S) AFFORDING COVERAGE NAIC # Anaheim, CA 92806 James River Insurance Com anv w " " " "" p .... 12203 INSURED A -1 Enterprises Inc. dba A -1 Fence Company 2831 E La Cresta Ave Anaheim, CA 92806 INSURER A: INSURER B: Topa Insurance Company 18031 INSURER C: Zurich American Insurance Co 16535 INSURER E: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS INDICATED. CERTIFICATE EXCLUSIONS �..,, A IS TO CERTIFY THAT THE POLICIES NOTWITHSTANDING ANY REQUIREMENT, MAY BE ISSUED OR MAY PERTAIN, AND CONDITIONS OF SUCH TYPE OF INSURANCE .,. ,....,.,....,....,.,.____ GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR OF POLICIES. ADDLSUBFi ucQ vim._ INSURANCE THE 7�vn �,„ LISTED BELOW HAVE BEEN TERM OR CONDITION OF ANY INSURANCE AFFORDED BY THE LIMITS SHOWN MAY HAVE BEEN ..., ,_POLICY NUMBER 000202728 ISSUED TO CONTRACTOR POLICIES REDUCED PO.ICYEFF �MM -PDly "Y) 12101/2014 THE INSURED OTHER DOCUMENT DESCRIBED BY PAID CLAIMS,. POLICY EXP ,�,M PmD„,q).yxyy1.' 12/01/201 NAMED ABOVE FOR THE POLICY PERIOD WITH RESPECT TO WHICH THIS HEREIN IS SUBJECT TO ALL THE TERMS, LIMITS _ EACH OCCURRENCE $1;000tOOO DAMAGE�O( RENTED PRFMIRP_ ,Fa N.TE anc $50.000 MED EXP (Anv one Derson) . $ Excluded X BI /PD 00 5�0 s R PERSONAL ADVINJU Y 000.000 $1,..... �...Ded .._. .................. .............................._ GENERAL AGGREGATE _.,..__�.ww. $2,000,000 - .....- _ PER: GEN'L AGGREGATE LIMIT APPLIES _ PRODUCTS - COMP /OP AGG $2 OOO,OOO POLICY X PRO LOC $ ,.......... m., -, __ AUTOMOBILE LIABILITY ................................. _ .......... COMBINED SINGLE LIMIT (Fa acrid —h A ANY AUTO BODILYW INJURY (Per person) $ ALL OWNED ........ SCHEDULED ... BODILY INJURY (Per accident) ................. ............................... $ AUTOS I AUTOS N-OWNED PROPERTY DAMAGE (P ROPER_Antl $ HIRED AUTOS AUTOS B UMBRELLA LIAB X OCCUR XL660584601 12/01/2014 12 01 201 EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGi'�EGA1 "B, $5,000 OOO 00 C WORKERS COMPENSATION YIN WC966159202 110112015 01/01/201 X CSryATU—C,_�..........._ . AN D POP RIETO PARTNE E „L. DISEAACCIDENT $1 ANY 9� 'G�OPPRISrO68JPAR'rNERlEXECUTIVE E L. EACH OFFICEMME'MBER EXCLUDE D? � N / A °.- SE EA EMPLOYEE $1 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $1 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) RE: Pump Station 18 at east end of 2050 East Hughes Way, EI Segundo, CA. The City of El Segundo, its officers, officials, employees, agents, and volunteers are named additional insured as respects general liability and this insurance is primary and noncontributory with any other insurance of the additional insured; and waiver of subrogation applies as respects general liability and workers compensation as required by written contract, per endorsements attached. (See Attached Descriptions) ^ I %'Al"RICL -A I IV IN City of El Segundo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE y g THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Attn: Floriza Rivera, PW Dept ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street El Segundo, CA 90245 AUTHORIZED REPRESENTATIVE @ 1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) 1 of 2 The ACORD name and logo are registered marks of ACORD #S14347187/M13450517 CTN SAGITTA 25.3 (2010/05) 2 Of 2 #S14347187/M13450517 POLICY NUMBER: 000202728 COMMERCIAL GENERAL LIABILITY CG 20 10 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSU EGA - OWNERS, "NERS, LESSENS OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Where required by written contract or agreement Location(s) Of Covered Operations All operations of the Named Insured's. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to B 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. 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 oth- er than another contractor or subcontractor engaged in performing operations for a prin- cipal as a part of the same project. CG 20 10 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 ❑ POLICY NUMBER: 000202728 COMMERCIAL GENERAL LIABILITY CG 20 37 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL, INSURED - OWNERS, LESSEES O CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART ,�V3:1�1ell Name Of Additional Insured Person(s) Location And Description Of Completed Opera - Or Ornanization(s): tions Where required by written contract or agreement All operations of the Named Insured's. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organiza- tion(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location desig- nated and described in the schedule of this endorse- ment performed for that additional insured and included in the "products- completed operations hazard ". CG 20 37 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 ❑ Policy #000202728 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. .!RIMARY AND NON CONTRIBUTORY ENDORSEMENT This endorsement modifies insurance provided under the following: ALL COVERAGE PARTS Name Of Additional Insured Person(s) Or Oraanization(s): Blanket as required by written contract If no entry appears above, this endorsement applies to all Additional Insureds covered under this Dolicv. Any coverage provided to an Additional Insured under this policy shall be excess over any other valid and collectible insurance available to such Additional Insured whether primary, excess, contingent or on any other basis unless a written contract or written agreement specifically requires that this insurance apply on a primary and noncontributory basis. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED, AP5031 US O4 -10 Page 1 of 1 Policy #000202728 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CARFEULLY. WAIVER OF'SUBROGAT'ION AS REQUIRED B • '.. ` This endorsement modifies insurance provided under the following: ALL COVERAGE PARTS The Company agrees to waive any right of recovery against any person or organization, as required by written contract, because of payments we make for injury or damage which is limited to liability directly caused by "your work" which is imputed to such person or organization. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. AP5004US 11 -06 Page 1 of 1 Policy No. WC966159202 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 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 0 % of the California workers' compensation pre- mium otherwise due on such remuneration. Person or Organization ANY PERSON OR ORGANIZATION FOR WHOM YOU ARE REQUIRED BY WRITTEN CONTRACT OR AGREEMENT TO OBTAIN THIS WAIVER OF RIGHTS FROM US. WC 252 (4 -84) WC 04 03 06 (Ed. 4-84) Schedule Job Description BLANKET WAIVER OF SUBROGATION Page 1 of 1 I.......... _ .... ..... JINSURERF __ � ��J ..........._.. ... Bola, Arianne From: Sent: To: Cc: Subject: 'rOk s fSom f Nguyen, Trang Tuesday, June 23, 2015 5:20 PM Bola, Arianne Hegvold, Julie RE: Insurance for A -1 Fence From: Bola, Arianne Sent: Tuesday, June 23, 2015 7:19 AM To: Nguyen, Trang Cc: Hegvold, Julie Subject: Insurance for A -1 Fence Hi Trang, Can you please review the attached copies of insurances A -1 Fence have? This is regarding the Pump Station 18 Fence Repair Project. WWalrrne t Regards, ii�hriarine Bola ,onkor l ra+ „O¢ Etl o i ” Him I 1 F(,)F?W °' I'"I PJ'9qR � ik'il°'.r' ^4..i.... I' 4 3 � 0) 52,4 2364 CITY OF EL SEGUNDO 350 Main Street EI Segundo, CA 90245 -3813 visit us at wwwel erju do orq