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PROOF OF INSURANCE (2017) CLOSEDAC*" R" CERTIFICATE OF LIABILITY INSURANCE (MMIDDIYYYY) � 11 1 6/6/2016 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(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 endorsoment(s). PRODUCER CONTACT FrankCrum Insurance Agency, Inc. PHONE (727)412-7765 EAL.— — (Al ft(727) 608-152 100 South Missouri Avenue „r „n�,cq,,FCIA @frankcrum.com INSURERSI AFFORDING AIC . . . ...... Clearwater FL 33756 INSURERA:Lloyd' s Of London INSURED INSURER -Travelers Casualtv Insurance Co of 31194 James Michael McNary dba Bino Construction INSURER C 12101 Van Nuys Blvd #34 INSURER E :. . . . . ....... Sylmar CA 91342 1 INSURER F: 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. NTR . ..... �KbdL�06R' , - ­_ --""""--P-O-Ll-C-Y"E—FF-",-P-OL,IC-Y-,E,X-P... LM- TYPE OF INSURANCE INSD WVD POLICY NUMBER IMMIDRIYYYY) (MMIDDffM) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 BAWAUE TO-kTRTEU- A CLAIMS-MADE 51 OCCUR DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) CERTIFICATE HOLDER jhegvold@elsegundo.org City of El Segundo 350 Main Street EI Segundo, CA 90245 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 Matt Crum/JK 1_� ©1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS025 (901141011 X PGIARK0503801 5/29/2016 5/29/2017 MED EXP (Anyone person) $ 10,000 . .. . .... . ....... . . .... ........... . . . . . PE RS & ADV INJL!�Y $ 1,000,000 .......................... q,EN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 -] POLICY F P"0 F LOC JER . ........ . . ... ------ 00,000 $ 2,0 OTHER: Damage to Premises Rented $ 300,000 AUTOMOBILE LIABILITY _­C­CTM_BIT;F[b9lNGLE LIM11 (, a accider0l $ 1,000,000 BODILY URY (Per person) INJ $ ANY AUTO B ALL OWNED SCHEDULED BA1H49756716SEL 5/1/2016 5/1/2017 BODILY INJURY (Per accident) $ AUTOS AUTOS NON-OWNED i5R(Pt"R — YEAM E .......... $ X X HIRED AUTOS X AUTOS _TafflaLt�, 1. - __ Medical payments $ 5,000 UMBRELLA LIAB OCCUR a 000 A EXCESS LAB CLAIMS-MADE AGGREG ATE $ 9-0 -0 _00�0 DED [ RETENTION $ PGIXS0036901 5/29/2016 5/29/2017 WORKERS COMPENSATION "ITY PER OTH- L AND EMPLOYERS' I Y/N _L _JFER ANY PROPRIETOR /PARTNER /EXECUTIVE r--1 EL,E�,ACCIDENT $ OFFICER/MEMBER EXCLUDED? ...... ....... . ....... (Mandatory in NH) EL. DISEA'SE - E'A EMPLOYEE' $ If yes, describe under �NIA DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) CERTIFICATE HOLDER jhegvold@elsegundo.org City of El Segundo 350 Main Street EI Segundo, CA 90245 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 Matt Crum/JK 1_� ©1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS025 (901141011 Policy Number: PGIARK05038 -00 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 SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Locations Of Covered Operations Any person(s) or organization(s) whom the Named Insured agrees, in a written contract, to name as an Additional insured. However, this status exists only for the project specified in that contract. 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 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) designated above. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. 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 2. 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. CG 20 10 07 04 Policy number: PGIARK05038 -00 COMMERCIAL GENERAL LIABILITY CG 20 37 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following:. COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Location And Description Of Completed Or Organizations : Operations Any person(s) or organization(s) whom the Named Insured agrees, in a written contract, to name as an additional insured. However, this status exists only for the project specified in that contract. 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 organization(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 designated and described in the schedule of this endorsement performed for that additional insured and included in the "products- completed operations hazard ". CG 20 37 07 04 © ISO Properties, Inc., 2004 PRIMARY AND NON - CONTRIBUTORY ENDORSEMENT This endorsement changes the Policy. Please read it carefully. LIN8.1yan1n Name of Person or Organization: Any person(s) or organization(s) whom the Named Insured agrees, in a written contract, to provide Primary and /or Non - contributory status of this insurance. However, this status exists only for the project specified in that contract. In consideration of the premium charged, it is hereby agreed that this policy shall be considered primary to any similar insurance held by third parties in respect to work performed by you under any written contractual agreement with such third party. It is further agreed that any other insurance which the person(s) or organization(s) named in the schedule may have is excess and non - contributory to this insurance. PGI EL 020 0210 Page 1 of 1 COMMERCIAL GENERAL LIABILITY CG 24 04 10 93 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: Any person(s) or organization(s) whom the Named Insured agrees, in a written contract, to provide a waiver of subrogation. However, this status exists only for the project specified in that contract, (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement). The TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Condition (Section IV — COMMERCIAL GENERAL LIABILITY CONDITIONS) is amended by the addition of the following: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products- completed operations hazard ". This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 10 93 Insurance Services Office, Inc., 1992 DATE(MM /DDIYYYY) A '"R " CERTIFICATE OF LIABILITY INSURANCE 06!17/2016 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 CONTACT Bouchard Insurance for Frank Crum PHONe` FAC° 101 StarcrestDrive tPl.6 °dt— _ E -MAIL Clearwater, FL 33758 ADDRLS .— ww . ­ ........... - - -- , _........ INSURER(SI AFFORDING COVERAGE ..... .._.,�n y m NAIC w ..•_ Zurich Insurance CoTPpan� _ — - 40142 — - � ... .. ... ......_............ ... -..�.. ... ,, ....,........ A....m... ' INSURER A , Amencan........ �.._. ,, , ,... _ .�.. ......_.. INSURED INSURER B -- -­ ........... .......,n.._, ..._.,._...� —.m... ,m...,,,.n.,,..,., .......m... FrankCrum 11, Inc. Labor Contractor, for co- employees of: McNary, James INSURERC : dba: Bino Construction m. ......................... ............. .. 100 South Missouri Avenue INSURER ° Clearwater, FL 33756 INSURERF INSURER F : COVERAGES CERTIFICATE NUMBER: 16FLO80850944 REVISION NUMBER: THIS IS TO CERTIFY ..... .... Y 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. .._ SR TYPE OF INSURANCE A y POLICY NUMBER _____ LMM DD/YEYFXY li 'POLICY E7tP tMMI°OIYYYY LIMITS '., COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS -MADE E.1 OCCUR -..._ ......... .............................. EX.P.,An one persogL.. -... _8 MED PERSONAL & ADV INJURY $ GEML. a'%GG'R%E:GATE: LIMIT APPLIES PER: GENERAL AGGREGATE $ PRO - ..- PGL•RCY,,, JECT (� LOC PRODUCTS- COMP /OPAGG $ OTHER $ .,,A�.., ......... ......._�... -_. � SI tl I AUTOMOBILE LIABILITY $ Em necldenR� ANY AUTO BODILY INJURY (Per person) $ '' ALL OWNED j SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS -P' R GE -. - HIREDAUTOS I^'ePlrcCadOrVb $ �-_.. ... AUTOS j..� -�... � $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE $ .,....m -..,,, w ... ... .... ............... DE RETENTION$ ........ ._. ... ... _ ................ . $ ... ... ONYYG RIMEMaOR EXCLUDED? PROPRIETOR/PARTNER/EXECUTIVE / N NIA E.L. EACH ACCIDENT ORH wOR KERS COMPENSATION �I EMPLOYERS' LIABILITY A Mandates In NH Ll X WC 54 -70- 649 -04 06/01/2016 06/01/2017 E.L. DISEASE EA EMPLOYE $ 1,000 000 t 1 i!t es, dascribo under D SCRIPTION OF OPERATIONS be liw E.L. DISEASE - POLICY LIMIT $ 1,000,000 Location Coverage Period: 06/01/2016 06/01/2017 Client# 11329 -CA DESCRIPTION OF OPERATIONS /LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe PW attached IIItRm more e space Is requYrort " McNary, Jarnes dba; Blno Construction Vista Sliding Door -And Deck Slope Waterproof Project only t Coverage Is provided for 9520 Topanga Canyon Blvd STE 204 only tlrosrcl co-employees of, bul nol s,obcontractors Chatsworth, C'A, 91311 to: Endorsements: Waiver of Subrogation, 30 days written cancel notice (10 days for non payment of premium) CERTIFICATE HOLDER CANCELLATION City of El Segundo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 350 Main Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN El Segundo, CA 90245 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988 -2014 ACORD CORPORATION. All rights reserved. I- A IAA\ Tha ArnRn nama and Inn^ nra ranicfararl marks of Ar.nRft 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„ .:..... -w of the California workers' compensation premium otherwise due on such remuneration. Person or Organization IN FAVOR OF: City of El Segundo 350 Main Street El Segundo, CA 90245 SCHEDULE Job Description Re: PW 14 -17 Park Vista Sliding Door -And Deck Slope Waterproof Project 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: 06/17/2016 Policy No: WC 54- 70- 649 -04 Insured: FrankCrum 11, Inc. Labor Contractor, for co- employees of: McNary, James dba: Bino Construction Insurance Company: American Zurich Insurance Company WC 04 03 06 Copyright 1983 National Council on Compensation Insurance Endorsement No: Countersigned by