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PROOF OF INSURANCE (2016) CLOSED
� '`'�^'�"""�'� CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 5/15/2015 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 'RESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. RTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to ,rms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the icate holder in lieu of such endorsement(s). PRODUCER CONTACT Nancy Erickson NAME: Y (Nq. N.pa Fxtk "I l ? / ) 9 e ?22 Walter Mortensen Insurance INSURICA PHONE (760 379 -4651 �/� Ne.I ?6o/3? CA License #OD44424 E -MAIL nerickson @INSURICA.com ADDRESS: 5520 G4 Isabella Bl, POBx 2663 INSURERS AFFORDING COVERAGE NAIC# Lake Isabella CA 93240 INSURERA:AIX Specialty Insurance Company ,2i333 INSURED INSURER B: Rite Inc. INSURER C : The Perfect Field INSURER D: ....,. 2075 Corte del Nogal, Suite X INSURER E: Carlsbad CA 92011 INSURER F COVERAGES CERTIFICATE NUMBER:15 -16 GL 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 AUb_C l Efk POLICY EYF POLICY EXP.,,. LTR TYPE OF INSURANCE LIMITS POLICY NUMBER X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE, 1O ItDRTK . 100 000 A CLAIMS -MADE X OCCUR pRI MI(S (1 y z p J ygy M $ ,.. X L13A30154501 5/9/2015 5/9/2016 MED EXP (Any one person) ....._.. .......... $ 2,500 ............. ,_,_, ,,.,w,. PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 X POLICY JE0 LOC PRODUCTS - COMP /OPAGG $ ,. 2 000, 00 11 0 JTOMOBILE LIABILITY COMBINED SINOW HMI'1' $ ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS NON -OWNED okboE_0y AkAGI.......,' $ HIRED AUTOS AUTOS (Pea axrcoant) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB .... .. CLAIMS -MADE .1 AGGREG— A.T...E -------- .. . .,.,. ,,..,.... $ DED RETENTION $ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITY �, / N .STATUTE _, -_ - -- ER ANY PROPRIETOR /PARTNER /EXECUTIVE q `I E L. EACH ACCIDENT $ OFFICER /MEMBER EXCLUDED? u N/A - -- - - - - -- - (Mandatory in NH) E L DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E L DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) When required by written contract The City of E1 Segundo, its officers, officials, employees, agents & volunteers are added to the General Liability policy as Additional Insureds, per forms CG 20 37 (04/13) and IL 12 01 (11/85) attached, subject to the terms, conditions and exclusions of the policy. Insurance is primary and non contributory per form 801 -0073 (06/13). CERTIFICATE HOLDER CANCELLA City of E1 Segundo its officials & employees Attention: City Clerk 350 Main Street E1 Segundo, CA 90245 JRon Burcham /JDEMPS ©1988 -2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 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 ACORD 25 (2014/01) INS025 (201401) POLICY NUMBER: L13 A301545 01 COMMERCIAL GENERAL LIABILITY CG 20 37 04 13 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 PRODUCTS /COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Or anization s Location And Description Of Completed Operations. See form IL 1201 Information re wired 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. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following is added to organization(s) shown in the Schedule, but only Section III — Limits Of Insurance: with respect to liability for "bodily injury" or If coverage provided to the additional insured is property damage caused, in whole or in part, by required by a contract or agreement, the most we "your work" at the location designated and will pay on behalf of the additional insured is the described in the Schedule of this endorsement amount of insurance: performed for that additional insured and included in the "products- completed operations 1. Required by the contract or agreement; or hazard ". 2. Available under the applicable Limits of However: Insurance shown in the Declarations; 1. The insurance afforded to such additional whichever is less. insured only applies to the extent permitted This endorsement shall not increase the applicable by law; and Limits of Insurance shown in the Declarations. 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. CG 20 37 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLICY CHANGES Policy Change Number POLICY NUMBER POLICY CHANGES COMPANY EFFECTIVE L13 A301545 01 05/09/2015 AIX Specialty Insurance Company NAMED INSURED AUTHORIZED REPRESENTATIVE Inc. Worldwide Facilities, Inc. - 1001273 COVERAGE PARTS AFFECTED nmercial General Liability Coverage Form CHANGES ;G 20 37- Additional Insured - Owners, Lessees or Contractors - Completed Operations, Name of Additional nsured Persons or Organizations shall read as follows: 1) State of California, The Trustees of the California State University, and the employees, officers and agents of :ach for San Diego State University 'rocurement Management, James Durante 3500 Campanile Drive, San Diego CA 92182 2) The City of El Segundo, its officials employees, agents and volunteers %ttn: City Clerk 350 Main St, El Segundo, CA 90245 3) FirstService Residential California LLC, and any of its managed associations I Polaris Way, Suite 100 %liso Viejo, CA 92656 Authorized Representative Signature IL 12 01 11 85 Copyright, Insurance Services Office, Inc., 1983 Page 1 of 1 ❑ Copyright, ISO Commercial Risk Services, Inc., 1983 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY NON - CONTRIBUTORY ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS /COMPLETED OPERATIONS LIABILITY COVERAGE PART When required by written contract or agreement, the insurance provided by endorsement, *See Below , is primary insurance and we will not seek contribution from any other insurance available to the person or organization covered as additional insured hereunder unless the other insurance is provided by a contractor, other than you, for the same operations and job location. Then we will share that other insurance by the method described in SECTION IV — CONDITIONS, Paragraph 4. Other Insurance subparagraph c. Method Sharing. ALL OTHER TERMS, CONDITIONS, AND EXCLUSIONS REMAIN UNCHANGED, CG 20 26 & CG 20 37 801 -0073 06 13 Includes copyrighted material of Insurance Services Office, Inc., with its permission Page 1 of 1 ), 0.O [:f3 (MM /DD/YYYY) C " CERTIFICATE OF LIABILITY INSURANCE 10/2015 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 CONTACT Nancy Erickson Walter Mortensen Insurance / INSURICA NAMEn (AIC.No (760) 379 -4651 (A (760) 379 -8722 Ext); /C, No): CA License #OD44424 E4AtL nerickson @INSURICA.com ADDRESS; 5520 G4 Isabella Bl, POBX 2663 INSURER(S) AFFORDING COVERAGE _ NAIC# Lake Isabella CA 93240 INSURERA:Wesco Insurance Company 25011 INSURED INSURER B : Rite, Inc. INSURER C: .. dba The Perfect Field INSURER D : 2075 Corte del Nogal Suite X INSURER ,,,,,,,,,,,,,,,,,,,, .,.,. ..... .. Carlsbad CA 92011 INSURER F: COVERAGES CERTIFICATE NUMBER:15 -16 BA 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. N� � � ... .. , .., ... .., ,., POLICY POLICY TR TYPE OF INSURANCE POLICY NUMBER MM YYY M/L Y LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DANYgG 70 RENTED CLAIMS -MADE OCCUR PREMIER FS IEa,pccurrenca),,,,,,,, , $... MED EXP Any one person) $ PERSONAL & ADV INJURY $ 4 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ Ifp 11 POI IICY f LOC PRODUCTS COMP /OP AGG $ e UH'HFR $. AUTOMOBILE LIABILITY COMUMEO SiNGLL I IM0 lE� �G t 3�aei urn„ $ 1,000,000 ANY AUTO BODILY INJURY (Per person) $ A_ .... .......... ALL OWNED %.... AUTOS SCHEDULED AUTOS WPA103308101 3/16/2015 3/16/2016 BODILY INJURY (Per accident) .. $ X.. NON - OWNED X, f)A(IAOF $ HIRED AUTOS .m,„ AUTOS 0cii i (Per accprlpr¢I) ,... .., Underinsured motorist $ 500 , 000 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE $ DED ! RETENTION $ $ WORKERS COMPENSATION PER OI H- I AND EMPLOYERS' LIABILITY Y / N STATUTE FR ANY PROPRIETOR /PARTNER /EXECUTIVE p 'p E L EACH ACCIDENT $ OFFICER /MEMBER EXCLUDED? N/A (Mandatory in NH) E L DISEASE - EA EMPLOYEE% $ if yes, describe under DFSCR.IPTION. OF OPERATIONS below ; E L DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of E1 Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN its officials & employees ACCORDANCE WITH THE POLICY PROVISIONS. c/o City Clerk 350 Main Street, Room #5 AUTHORIZED REPRESENTATIVE E1 Segundo, CA 90245 -3813 , f Ron Burcham /JDEMPS ©1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD I N S025 (201401)