PROOF OF INSURANCE (2017) CLOSEDG
CERTIFICATE OF LIABILITY INSURANCE ATE (MN /DDIYYYY)
7/13/2016
THIS CERTIFICATE IS ISSUER AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AF21RMATIVELY 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 PRODL CER, 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 th B policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of suci endorsement(s$,
PRODUCER
T
I AC'
tIAf, Victoria Mitchell
Landscape Contractors ILic #0755906)
� re1 a F,,Is (559) 650 -3555
(AI�c,NO):'.591650
-3558
..Insurance Services, Inc.
E401L
4ADDRESS ,:rlllitchell ?lcisinc.com
1835 N. Fine Avenue
INSURER(S) AFFORDING COVERAGE
NAICIN
Fresno C A 93727
INSURER A Atlantic Specialty Insurance
27154
INSURED
INSURERB:Unitrin Specialty
19852
Oliver Holt Landscape
INSURER C:
8611 Amestoy Avenue
INSURER D
INSURER E:
Northridge CA 91325
� INSURER F:
COVERAGES CERTIFICATE NUMBER:16 /17 Pkg
& Auto REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTEU BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICAIE D NUTWITHSTANDING ANY REQUIREMENT, TERIA OR CONDITION
OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
rFRTIFICATr MAY BE ISSUED C R MAY PERTAIN THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS C F SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS
WaSR ADDL SUER
TR_ TYPE OF INSURANCE POLICY N Ma R
POLICY EFF FOL4CY EXP
r „IBI Y 411,1+ MV1yI' LIMITS
X COMMERCIAL GENERAL LIABII ITY
EACH OCCURRENCE
1,000,000
A CLAIMS -MADE X OCC UP
OF E T'0 RENTED
FREf, MI IISES�Eac;su °renue
100,000
X 513- CG -OT - ?3 -000:
Ttl. /:i15 %1251?O1 MEDEXP An? ecer „ cn)
5,000
X $500 Pd Dad
PERSONAL & ADV INJURY
1,000,000
GEN "L AGGREGAIE. LIMIT APPLIES : ®P
GENERAL AGGREGATE
2,000,000
X POLICY 9E 0 I
PRODUCTS - COMP +OP AGO
2,000,000
0'1HE;R.
E^re. Pee Seneraw
1,000,000
AUTOMOBILE LIABILITY
I ,t. W IIN D :'.b rlls¢a W. LIMN I
9¢
1 , 000 , 000
ANY AU TO
BODILY INJURY :'Per =ersmi
ALJLTOV.1NED x SCHOESL L"-'D CCF- Ca36E22:3 -v1
AS
7r16 /2016 7/16 ?2017 BODILY INJURY � Per a=cten:;
T
X X NED
PROPPERTYIDAMAGE
HIRED AUTOS n*N-0�
..
P,cnz�wcat" ,elms
5.000
UMBRELLA LIAB OCC JR
EACH OCCURRENCE
EXCESS LIAR CLA AS -MADE
AGGREGATE
,
GIkx RETEN'1sOPi
WORKERS COMPENSATION
PEP, H•
AND EMPLOYERS' LIABILITY YIN
STATUTE ER
AW PROPAIETORdpIARTNER,FXEC"4 T'P rE
E L EACH ACCIDENT
-
OFF4CERNEMBCR EXCLUCED^ N I A
IMmidoor'y 4n. NH)
E L DISEASE • EA EMPLOYEE
4P ,11 a low0tti+»Ia,4,Jp
DE, SCRIPTtON 0; OPE'R if otisa. toI-d
_ F L DISEASE • P+OLIP«Y_. LIMIT
DESCRIPTION OF OPERATIONS I LOCATIOI S! VEHICLES IACORO 101, Addltlonst Remarks Schedule, may be anached If more space Is required)
RE: All landscape operations performed by or on behalf of the named insured.
Blanket Additional insu:ed per attached OBPGGLO4340414
City of E1 Segundo and Lts officers, elected officials, and employees (Excluding Professional Liability)
are named as additional insured per attached endorsement.
CERTIFICATE MOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City of E1 Sogun io THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City Clerk ACCORDANCE WITH THE POLICY PROVISIONS.
350 Main Street loom 5
El Segundo, CA )0245 -3613 AUTHORIZED REPRESENTATIVE
t7 o .-
I-Iicche -cl• ACO:•13E ..
1988.2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
INS02512ol4o11
COMMERCIAL GENERAL LIABILITY
THIS ENDC RSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
BLANKET ADDITIONAL INSURED ENDORSEMENT
This endorsemer It modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE FORM
A. The following is added to Paragraph 2. In SECTION II - WHO IS AN INSURED:
Any person or organization you are required by written contract or agreement to name as an
additional ins ured subject to the following:
Any such pe son or organization must be approved in writing by us as an additional' insured. Coverage
for such pers :)n 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, errxs or omissions are not also covered under such person or organization's liability
insuranci.
b. No such person or organization is an additional insured for "bodily injury" or "property damage" for
acts, err( rs or omissions of any additional insured.
B. With respect to the insurance afforded to the additional insureds under Paragraph A. above, the
following is a ided to SECTION III - LIMITS OF INSURANCE:
The most we will pay on behalf of the additional insured is the amount of insurance:
a. Requirec by the contract or agreement; or
b. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less.
This endorse -nent does not increase the applicable Limits of Insurance shown in the Declarations.
C. 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 da nage" to "your work" arising out of it or any part of it and included in the "products -
completed of erations hazard ".
D. With respect to the insurance afforded to the additional insureds under Paragraph A. above, The
following is f dded to Paragraph 4. Other Insurance in SECTION IV — COMMERCIAL GENERAL
LIABILITY C )NDITIONS:
This insurance Is primary If required by the contract or agreement. If there is no such requirement, this
insurance wil 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
�10111* I
• 0 1 MEWTOM I M 14 ;0] F21KCI 4 04:111 am M =11111 I WALOL0121 oil I Lei
Policy Rumber: 61E.00-07-33-0001
Name Insured: 011v )r Holt Landscape
Endorsement Effeclive Date: 7/16/2016
OBPGGLO4340414 Contains copyrighted material of Insurance Services'Office, Inc. with its permission, Page 2 of 2
Copyright, OneBeacon Insurance Group, 2014
ACCMD, CERTIFICATE OF LIABILITY INSURANCE 3/2ii2016n
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($), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the pofty(les) must be endorsed. If SUBROGATION IS WAIVED, Sul:oct 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 andorsernent(s)..
PRODUCER �Xr`111" Victoria Mitchell
Landscape Contractors (Lic#0755906) PHONE (559) 650 -3555 . (559)$50 -3550
Insurance Services, Inc. "I° %Ltchell I lei 9 inc. com
1835 N. Fine Avenue INSURERS AFFORDING COVERAGE NAICa
Fresno CA 93727 INSURER A:StateCODI ensationInsurance Fund 35076
INSURED INSURER B:
Oliver Holt Landscape 1N URERC:
8611 Amestoy Avenue INOURER O:
Northrid a CA 91325 IN R
COVERAGES CERTIFICATE NUMBER:16 /17 WC renewal
REVISION NUMBER,.
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELO': J HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED NOTWITHSTANDING ANY REQUIREMENT TERM OR CONDITION OF ANY CONTRACT OR OTHER
DOCUMENT VVITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN IJAY HAVE BEEN REDUCED BY PAID CLAIMS,
IRA! TYPE OF INSURANCE VL. * � P YN M r1LI Y 7 —LIT
LIMITS
GENERAL LIABILITY '
EACH OCCURRENCE S
At"J "T�'t'ET ...... .........
C01+' AEnVALOENCRA';..,,IAB %11'Y 14
� S
CLA'II,IS4AADE [:]I OCCwA
MEaEXP A:' Oro, oroln) S
f I
PERSONAL & ADV INJURY S
I
V
OENERAL AGGREGATE S
OEN'L AOCREOA7E LIMIT APILls PER,
PRODUCTS • COMPIOP AGO S
POLICY PiC LOC 'f f
S
AUTOMOBILE LIABILITY
ANY AUTO (
� I
BODILY INJURY (Per petaon) S
AUTOS NED ASTOSULE' �
BODILY INJURY (Pe, a=donl) � S
NON•OWNEO
HIRED AUTOS AUTOS
ra S
5
UMBRELLA LIAR OCCUR S I
F„ACN OCCURRENCE S
EXCESS LIAB
m • CLAe.15 =.u0E( j
AGGREOAT° S
DED T NTI N.. f
S
A COMPENSATION
�( Y,.y A U M.
AND BMPSLO RS' L ABIUTYry u
-YIN
ANY PROPRIE-ORIPARTNER.'- XE„'r'�V- V I
OFFICERIMEM.BEREXCLUDE:') ❑ NIA`
Id/n,�'C�M,$
E CH ACCIDENT S 1 000 .000.
' w �6/1/20I7
(Mandatory In NH ;,9129706 -16
SE • EA EMPL OYE S 1 00 000
It ee, do$0te ,.Mdo I
O SCRIPTION OF OPERATIONS as ,w i
F ASE • POLICY LIMIT 11' 1 000 000
1
I I
DESCRIPTION OF OPERATIONS I LOCATIONS i VEHICLES (Attach ACORD 191, Additional Remarks Schedule, If more space Ia required)
R>Z: All landscape operations performed by or on behalf 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
City of E1 Segundo ACCORDANCE WITH THE POLICY PROVISIONS,
City Clerk AUTHORIZED REPRESENTATNE
350 Main Street Room 5
El Segundo, CA 90245 -3813
V Mitchell /ACOME •W.... .w
ACORD 26 (2018146) Z 1988.2018 ACORD CORPORATION. All rights reserved,
I11,18025 12DIDDS) Ot The ACORD name and logo are registered marks of ACORD