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PROOF OF INSURANCE (2016) CLOSEDCERTIFICATE OF LIABILITY INSURANCE ;A�;i�o° Y" 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 pollcy(les) 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 COlnllE. C Victoria Mitchell -� - Landscape Contractors (Lic #0755906) 11110NIEL F,,,,- (559)650 -3555 FAeNe tsss>sso -assa Insurance services, Inc. .vanderson @lcisinc.com 1835 N. Fine Avenue INSURERtsI AFFORDING COVERAGE NAIC9 Fresno CA 93727 INSURERA Atlantic Specialty Insurance 7154 INSURED.: .�.. WSU B: Oliver Holt Landscape INSURERC: 8611 Amestoy Avenue INSURER 0: Northridge CB. 91325 I INSURER F COVERAGES CERTIFICATE NUMBER :15/16 Pk9 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 MAYHAVE BEEN REDUCED BY PAID CLAIMS. TYPE OF INSURANCE a co nm' NUMBER POLICY P 1.1C EFF P LtlCY EXP' LIMITS 'NI41tiIFDf.7 YYM M1�1i'OZ.ifYYYY GENERAL LIABILITY '',. ... EACH OCCURRENCE Is 1,000,000 }� Gd'MIwYt 1iV "IrCfi,L 'ra'O.�JEI`A(, 1, INdVI„p1 "d — rA f�s.xp'��""65 dP w"GePrcfigytry.l..� $ .,. 100,000 CLAOIS -MACE, 50 OCCUR �� 18- 00� -07 -33 -0000 /16/2015 �7 /16/2016 MED EXP tAnvone e son) $ 5, 000 PERSONAL a ADV INJURY $ 1, 000 , 000 $500 na Dea GENERAL AGGREGATE s 2,000,000 GfwJdB A.0,I7EGAT.;:LIMITAPrJ.1FSPER PRODUCTS - COMPIOPAGG $ 2,000,000 " I POUCtl r r LOC AUTOMOBILE LIABILITY LCD 7 „ON' .k .e.r i,wL ° LPM BODILY !fJ,1URY (Per person) S ANY AUTO ALL OV%JED SCHEDULED AUTOS AUTOS BODILY INJURY (,Per accidenll $ NON- OVtKEO ffioIT r » q Y ,`IWAGIa $ HIRED AUTOS ALTOS `11i d9 CWord) — UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS40ADE'... AGGREGATE �•. C1FC3.. RETEnITiON .'t $ _ WORKERS COMPENSATION VAC STATU- OTH- AND EMPLOYERS` LIABILITY YIN TORY I IMIT§ FR E EACH ACCIDENT $ ANY PROPRIETOPIPARTNERIE (>JTIVE OFFICERIMEMBFR EXCLUDED? ❑ N fA E.L DISEASE - EA EMPLOYEE, — $ (Mandatary In NH) If yzs 6c Cp4iy under rilr"SCRIPTION OF OPFRATION', holnvc L3iSEASE- POLICY LIMIT 1 $ DESCRIPTION OF OPERATIONS/ LOCATIONS! VEHICLES (Attach ACORD 101, Addltlonal Remarks Schedule, It more space is required) RE: All landscape operations performed by or on behalf of the named insured. Blanket Additional insured per attached OBPGGL04340414 City of El Segundo and its officers, elected officials, and employees (Excluding Professional Liability) are named as additional insured per attached endorsement. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DA'T'E THEREOF, NOTICE WILL BE DELIVERED IN City O El Segundo ° I ACCORDANCE WITH THE POLICY PROVISIONS, City Clerk A 350 Main Street Roan 5 IJTNORIZEOR EPRESENTATIVE El Segundo, CA 90245 -3813 V Mitchell /ACOMBE ._,._.._...,.. r ACORD 25 (2010105) x'1988 -2010 ACORD CORPORATION, All rights reserved. IN5025 (201005)01 The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, BLANKET ADDITIONAL INSURED ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM A. The following is added to Paragraph 2. In SECTION If - WHO IS AN INSURED: Any person or organization you are required by written contract or agreement to name as an additional insured subject to the following: Any such person or organization must be approved in writing by us as an additional insured. Coverage for such person or organization will begin on the date of our approval. a. No such person or organization is an additional insured for your acts, errors or omissions if such acts, errors or omissions are not also covered under such person or organization's liability insurance. a. No such person or organization is an additional insured for "bodily injury" or "property damage" for acts, errors or omissions of any additional insured. A. With respect to the insurance afforded to the additional insureds under Paragraph A. above, the following is added to SECTION III - LIMITS OF INSURANCE: The most we will pay on behalf of the additional insured is the amount of insurance: a. Required by the contractor agreement; or a. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement does not increase the applicable Limits of Insurance shown in the Declarations. B. With respect to the insurance afforded to the additional insureds under Paragraph A. above, Paragraph I. Damage To Your Work in Paragraph 2. Exclusions of COVERAGE A — BODILIY INJURY AND PROPERTY DAMAGE LIABILITY in SECTION I -- COVERAGES is replaced by the following This insurance does not apply to: I. Damage To Your Work "Property damage" to "your work" arising out of it or any part of it and included in the "products - completed operations hazard ". C. With respect to the insurance afforded to the additional insureds under Paragraph A. above, The following is added to Paragraph 4. Other Insurance in SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: This insurance is primary if required by the contract or agreement. If there is no such requirement, this insurance will be excess and paragraph b. Excess Insurance applies. OBPG GL 0434 04 14 Contains copyrighted material of Insurance Services Office, Inc. with its permission. Page 1 of 2 Copyright, OneBeacon Insurance Group, 2014 COMMERCIAL GENERAL LIABILITY D. With respect to the insurance afforded to the additional insureds under Paragraph A. above, the following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us, in SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: However, we will waive our rights to recover against any additional insured for payments we make for injury or damage arising out of: a. Your ongoing operations; or b. "Your work" done under the contract or agreement and included in the "products completed operations hazard" if such waiver is required by the contract or agreement. Policy Number: 618- 00 -07 -33 -0000 Name Insured: Oliver Holt Landscape This endorsement is effective on the inception date of this policy unless otherwise stated herein. Endorsement Effective Date: 7/16/2015 OBPG GL 0434 0414 Contains copyrighted material of Insurance Services Office, Inc. with its permission. Page 2 of 2 Copyright, OneBeacon Insurance Group, 2014 CERTIFICA A E VF LIABILITY INSU 10/29/22015 NCE DA-r> (MM 015 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 INSU'R'ED, the policy(les) 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 Ileu of such endorsement(s). PRODUCER NAME, Victoria Mitchell Insurance Services, Inc. A Contractors MI �- �vanderson @lcisinc.eom Air Ne: tsss >6so- 3sse_ —_ 1835 N. Fine Avenue INSUREMS) AFFORDING COVERAGE NAIL A Fresno CA 93727 INSURERA.'Unitrin SDecialty 19852 INSURED INSURER B Oliver Holt Landscape INSURERC: 8611 Amestoy Avenue INSURER O ;. Northridge CA 91325 INSURERF: COVERAGES CERTIFICATE NUM BER:15 /16 Business Auto 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, EXCLUSIONSAND CONDRIONSOF SUCH POLICIES. LIMITS SHOWN MAYHAVE BEEN REDUCED BY PAID CLAIMS. 4 ^SR POLICY EF P ICY 5XP .,,..», -.. LTR TYPE OF INSURANCE z ' wnfn POLICY NUMBER 'M @d10D1YYY emwnnIYYYYI LIMITS GENERAL LIABILITY EACH OCCURRENCE. :G COMMERCIAL GENERAL LIA&LITY PG M FC Fa $ C v - CLAM MADE OCCUR MED EYP IAny one oerson) $ -•••• Pt R 31, "r�l!A!. 9+ r'�d:^!� IiMI�.A.PR'H $ GENERAL AGGREGATE 5 C,%rI L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP /OP AGG POLICY piiA "r. F"0 r T LOC ...�.�.�.._... S AUTOMOBILE LIABILITY r` "ry LIMIT $ l _ 000 000 A ANY AUTO ALL OWNED SCHEDULED AUTOS JX AUTO S NOIJ- Oth99F.D HIFtE'DAUi4S AIJ70S 862299 1/16/2015 / /16/2016 BODILY INJURY (Per person) $ BODILY INJUR`! (F ar accldeni) $ fPCrardetan . $ '.....Medicalna ` rnenls $ 5.000 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ ..•,..•.._. EXCESS LIAB CLAWS-MADE (.)ED RETENTIONS S WORKERS COMPENSATION VCS r'AT'U - AND EMPLOYERS' LIABILITY Y f N �'°""",.rnAY Ib.,,�,,,..,,,,,„,, „,�cR E L EACH ACCIDENT $ ANY PROPRIETOMPARTNERJE%ECUTIVE OPFICERRAEMSM EXCI -UDED ❑ Ne A EL DISEASE EAF1APLOY't;L 3 (Mandatory In NH) If yygeS dprsorr),e under L7E.SCRIrTION OF OPERATIONS below E L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (Attach ACORD 101, Addltional Remarks Schedule, it more space Ir required) 'RE: All landscape operations performed by or on behalf of the named insured. �I CERTI FICA 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. City Clerk � auT++owzs:D REPRESENTATIVE 350 Main Street Room 5 El Segundo, CA 94245 -3813 V Mitchell /ACOMBE ACORD 25 (2010/05) Q 1988 -2014 ACORD CORPORATION. All rights reserved. INS025 (2ntoosl of The ACORD name and logo are registered marks of ACORD AC" CERTIFICATE, IFICATE OF LIABILITY INS NCE D 1DDlYYYY) 4//9/29 /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 pollcy(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 NAM -.0 Victoria Mitchell Landscape Contractors (Lic #0755906) ;HOB FY,. (559) 650 -3555 Fa1c Nol (559) 650-3558 Insurance Services, Inc. ,vanderson @lcisinc.com 1835 N. Fine Avenue INSURER(S) AFFORDING COVERAGE NAIC Fresno CA 93727 INSURERA ,StateCompensationlnsurance Fund 35076 INSURED INSURER B Oliver Holt Landscape INSURER C; 8611 Amestoy Avenue INSURER D:: Northridae CA 91325 COVERAGES CERTIFICATE NUMBER:15 /16 WC 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. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE wca Mn POLICY NUMBER (MMJDD1YYYY) (MMIDDIYYYY) LIMITS GENERAL LIABILITY I VC I 1 OCC UI I2ENCE $ �Illa��n;.��i��oi�l�r1 C:C)IW11`UI -RCIAV GI (NEPAL I IFIi311.-.IVY I%R? hAl`_r �$ CL.UIIaY.'.3 11,4ADE El OCCUR ME D 8.XP (AnrJ ore person $ I I'i {)IrlAd lCAWIINJUlR $ GENERAL AC GPL'.GAI 1: $ PRODUCI .o - CX Mf-IOP A.GG $ Cq.:!IrI'L-. P GG1 ErGiA1 . L -.(MAT AI II L 01 ,, l'f: -R PRO_ 8�� O_ L - rw C $ AUTOMOBILE LIABILITY 1111':3 �h7I.t!: L_Lpo11" nC {;Ir.14, Inf l AINYAUi10 BODILY INJURY (Per person) $ AI I CIVINI_Lii 0111 UUL_II) BODILY NU.Jf3Y(I "'al ir,cdr,ll) $ ALUI 'lS, AIJI�� °�; '', I -Itl1.1 I)AUT01 AU10S f , .. c4 d m $ UMBRELLA LIAB OCCUR E AG "1 [ OCC,UI1 R[._.NCV'.:: $ EXCESS LIAB C�L_NIV IV1f41_iI nr G RI.1G3/kIE $ DEfl fdl IIHN-1ION$ $ A WORKERS COMPENSATION � If iinir! AND EMPLOYERS' LIABILITY Y / N r , ANY PROPRIETORIPARTNERIEXECUTIVE [::] OFFICERIMEMBER EXCLUDED? NIA 1. 1. AC:II A4 ti 110(_ _1,I I $ 1.000.000 _m (Mandatory in NH) 9129706 -15 /1/2015 /1/2016 w ,J E11�,E'.04 [ EAENIYLOwI".E'. $ 1.000.000 m0 yac =., c;rw cl Ilan; luriclr,,li n �:1� -41r r Ir,1�l e,I UP RAI IONS Iueloti Cy 1. IIl,frII $ 1. 000 000 DESCRIPTION OF OPERATIONS I LOCATIONS I 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 City of E1 Segundo City Clerk 350 Main Street Roam 5 E1 Segundo, CA 90245 -3813 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 Mitchell /ACOMBE ACORD 25 (2010/05) © 1988 -2010 ACORD CORPORATION. All rights reserved. INS025 (201005) 01 The ACORD name and logo are registered marks of ACORD