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PROOF OF INSURANCE (2017) CLOSEDCertificate of Insurance S CFf I JFlCA`I F IS ISSUED AS A MATTER OF INFORMATION ONLY AND t ONF RS NO RIGIHS UPON YOU HIF C11.RI]I ICAI R; HOLD[-R. "HAS ("1 R`11I 1C A I F IS N(Yl AN URA' V ltd L "Y AND DOES NOT AMEND, J. dIaJL " "!, CII( ALI I K THE 93Y HIE POLICIES IES L1S`B J) BELOW POt.1CY LIMI "fS ARE NO LLSS TI'IAN I "lfosri I'E'D ALTIA UCP14 F'(7LICIES MA'S'' 9'NC:IMOF, ADDI°6"IF7NAR_ ShJt3I.,IMI "rd1 9M1"l S NC71` 9..1 r 11,17 RdF;LC)W. This is to Certify that I WEST COAST' AI BORIISTS, INC 2200 EAST "VIA. BURTON NAME AND "" "er tual, ANAHEIM CA 92806 ADDRESS OF INSURED - _..�.�...._.....m. INSURANCE is, at the issue date ofthis certificate, insured by the Company under the policy(ies) listed below, The insurance afforded by the listed policy(ies) is subject to all their terns, exclusions and Conditions and is not altered by any requirement, term or condition of any contract or other document with respect to which this certificate may be issued,. Umbrella Excess Liability ADDITIONAL COMMENTS See Addendum. • Ifthe certificate expiration date is continuous or extended tern, you will be notified if coverage is terminated or reduced before the certificate expiration date NOTICE OF CANCELLATION: (NOT APPLICABLE UNLESS A NUMBER OF DAYS 1S ENTERED BELOW,) BEFORE THE STATED EXPIRATION DATE THE COMPANY WILL NOT CANCEL OR REDUCE THE INSURANCE AFFORDED UNDER THE ABOVE POLICIES UNTIL AT LEAST 30 DAYS NOTICE OF SUCH CANCELLATION HAS BEEN MAILED TO: Liberty Mutual Insurance Group F—City of El Segundo 350 Main Street Elaine Ulan a El Segundo CA 90245 Los Angeles / 0603 AUTHORIZED REPRESENTATIVE z 818 W 7th Street, Suite 850 0564408 Los Angeles CA 90017 213 - 624 -1171 6/16/2016 OFFICE PHONE DATE ISSUED This certificate is executed by LIBERTY MUTUAL INSURANCE GROUP as respects such insurance as is afforded by those Companies NM 772 07 -10 30425492 i LM_2819 i 7/16 -7/17 - GL /2/1, AL /2, WC /1, U/5 i Donna Smitala i 6/16/2016 9:16:16 AM (CDT) i Page 1 of 2 LDI COI 268896 02 11 EXP DATE ❑ CONTINUOUS TYPE OF POLICY ❑ EXTENDED POLICY NUMBER LIMIT OF LIABILITY ❑ POLICY TERM WORKERS 7/1/2017 WA7-66D- 039499 -076 COVERAGE AFFORDED UNDER WC EMPLOYERS LIABILITY LAW OF THE FOLLOWING STATES: COMPENSATION All States Except. Bodily In my by Ac6dcnt ND, OH, WA, WY Statutory Limits 1 000 OOOFarh Acridrm Bodily Injury By Disease 1 000 000 Bodily Injury By Disease $1,000,000 COMMERCIAL 7/1/2017 TB2- 661 - 039499 -016 General Aggregate GENERAL LIABILITY $2,000,000 m OCCURRENCE Products / Completed Operations Aggregate $2,000,000 ❑ CLAIMS MADE Each Occurrence $1,000,000 Personal & Advertising Injury RETRO DATE $1,000,000 Per Person/ Organization Other Other Damage to remises rented to Medical Expense $5,000 AUTOMOBILE 7/1/2017 AS7 -661- 039499 -036 Each Aceident Single Limit $2,000 OOO B.I. And P.D. Combined LIABILITY ��77II Each Person IJ OWNED Each Accident or Occurrence NON -OWNED IJ HIRED Each Accident or Occurrence OTHER 7/1/2016 - 7/1/2017 1 TH7- 661 - 039499 -046 $5,000,000 Per Occurrence /Aggregate Umbrella Excess Liability ADDITIONAL COMMENTS See Addendum. • Ifthe certificate expiration date is continuous or extended tern, you will be notified if coverage is terminated or reduced before the certificate expiration date NOTICE OF CANCELLATION: (NOT APPLICABLE UNLESS A NUMBER OF DAYS 1S ENTERED BELOW,) BEFORE THE STATED EXPIRATION DATE THE COMPANY WILL NOT CANCEL OR REDUCE THE INSURANCE AFFORDED UNDER THE ABOVE POLICIES UNTIL AT LEAST 30 DAYS NOTICE OF SUCH CANCELLATION HAS BEEN MAILED TO: Liberty Mutual Insurance Group F—City of El Segundo 350 Main Street Elaine Ulan a El Segundo CA 90245 Los Angeles / 0603 AUTHORIZED REPRESENTATIVE z 818 W 7th Street, Suite 850 0564408 Los Angeles CA 90017 213 - 624 -1171 6/16/2016 OFFICE PHONE DATE ISSUED This certificate is executed by LIBERTY MUTUAL INSURANCE GROUP as respects such insurance as is afforded by those Companies NM 772 07 -10 30425492 i LM_2819 i 7/16 -7/17 - GL /2/1, AL /2, WC /1, U/5 i Donna Smitala i 6/16/2016 9:16:16 AM (CDT) i Page 1 of 2 LDI COI 268896 02 11 AGENCY CUSTOMER ID: LM 2819 LOC #: A ADDITIONAL REMARKS SCHEDULE AGENCY NAMED INSURED West WEST COAST ARtORISTS, INC Llbertp Mutual Insurance Co. National Insurance .............. 2200 EAST VIA BURTON POLICY NUMBER ANAHEIM CA 92806 CARRIER I NAIC CODE EFFECTIVE DATE: AMITIONAL REMARKS Page of ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ADDENDUM 30425492 1 LM_2819 1 7/16 -7/17 - GL /2/1, AL /2, WC /1, U/5 I Donna Smitala 1 6/16/2016 9:16 :16 AM (CDT) I Page 2 of 2 POLICY INUMBEk T1132-661 039499416 i Nii XFY CG 20 1 uiD 11 0114 13 M��°IIS ENDO,IIWISEIWEIYT CIIIIII1AJYG II,IS THE 120I .11 °S A'Ul EASE I IIPItE IIII,,11p1Y :ULLIIIIII' �. ADDITIONAL 1 L n , I m..: Ilmllll. O Iw 15, LESSEES OR G I Po w I Wg SCHEDULED F s N OR RG IIII This eindorsiewment irwA insurance rant provided under to foRo III, VM mspeict to 'no inSUrance afforded -to these m ddifional Imisureds. the falliawing addMonall exclusions app�y: „'his insurance does not apply to "bodily in ur "' or, 14 1prGperty damage, OCCUrring after Information requkW to caimpiete this Schedule, iff not shown above, w & be shown in Hie IlDedlar fion . II II 10 04 IN °uir'r iu °arise SwVic 101' 11111)IG fur °mrwlll 2012 � I) r LICY III'll IIIM 1'.1 .:.11 BZ 6. '''m I , 39A I')411115" CG �20 37 1 11 a I " °" 6 V ��115 IIIIII��IIIII��IIIIII' iiii it lj ° ° °p " "'��11��''Ad��f� ��Illh��'Yh 6w��,� IIV Illllllllllll��m��'�� '�IIIIII�III�� ADDITIONAL,. IINSURED — 0"AtNERS, I—ESSEES O R�(��, TORS 1— COMPLE111111111-E P E RU% VIII' O II16"':� rhis endarsirierneird Ii Insurance provided underthe f'0owprm m COMMERCIAL GENE RAL 1.14ABIll IITY COVERAGE PART PIROKYUCTSICOMPLETED OPERATIONS III,,,, LAII31111 ...III" m l IE PA ° T CH IIIIIIIIIII DIU III it OrganftA. on(s): IlAcaUion And Description f Comp'loWd Operadarms All pemorts, or rmr arkation kh whairum you have All locations required by a wrlien contract or entered Into a wrWItn contract or agreement pirlor to an agreement entered into prior -to an occurrence or occurrence or a rose, to IparnAde additionall immured offense. status. Information r qu imd to complete thils Sdhe&de, W I shown above" wM IPm - :Darr in tine IDedlaraWo nL CG 20 3 7 014 13 0 hisaurr unrwr. Services r iffice„ hic., 2012 1)agilll t ulllr ° "III POLICY NUMBER:AS7- 661 -039499 -036 COMMERCIAL AUTO CA 20 48 10 13 pp This endorsement modifies Insurance provided under the following AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. Any person or organization whom you have agreed in writing to add as an additional insured, but only to coverage and minimum limits of insurance required by the written agreement, and in no event to exceed either the scope of coverage or the limits of insurance provided in this policy. Each person or organization shown in the Schedule is an "insured" for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Paragraph A.I. of Section II - Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms and Paragraph D.2. of Section 1 - Covered Autos Coverages of the Auto Dealers Coverage Form. CA 20 48 10 13 © Insurance Services Office, Inc., 2011 Page 1 of 1 rr 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 record's accurately segregating the remuneration of your employees while engaged in the worm described' in the Schedule, The additional premium for this endorsement shall be 2% of the Callfornia workers' compensation premium otherwise due on such remuneration. Schedule Additional premium Is a percent of the Califomia Manual Workers Compensation premium. Subject to a minimum premium charge of $ 250. Person or lr anigafion Jqb Do cri tion Where required by contract or written agreement prior to loss and allowed by law issued by Liberty Insurance Corporation 21814 For attachment to Policy No. WA7 -66D- 039499 -076 Effective Date Premium $ Issued to West Coast Arborists, Inc. WC 04 83 06 Ed: 04/1984 Page 1 of 1