PROOF OF INSURANCE (2017 - 2017) CLOSED CERTIFICATE OF LIABILITY INSURANCE � eAY. IM ►
.
1012512010
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(B), AUTHORIZED
REPRESENTATIVE
OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If tho certificate holder Is an ADDITIONAL INBURED, the polaoy(loe) must be endorsed. It 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 Ilou of such and'orserrlontMla�,
PRODUCER Phono: (019)9374000 Fax; (619)9374001 Olivia Rodrlq
PNOra1 uss
ENCIRCLE INSURANCE SERVICES,INC,DBA:ISU INSURANCE SERVICES Ak
1010 PIONEER WAY ,rr0I9)9374001
EL CAJON CA 92020.1923 4 44MUL-
INSURER(S)�wa...........
rto
WORDING COVERAGE NAIL/
Agency L1*0517010 I INEURERA :COLONY INSURANCE
TURF TEAM,INC, INeum s ;GUARD INSURANCE GROUP
DBA DIAMOND CUT MAINTENANCE o+ouRaAO : AEI,INSI#IiANPPO.
26600 W.AGOURA ROAD,#429 IROU R D;
CALABASAS CA 91301
INSURER a
INeu P I
T I N MIR: 22§12,
THIS 18 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 BB ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 18 SUBJECT TO ALL THE TERMS,I AA
EMU KPIROV091
mom TYPO OF INSURANCE a r w POLICY NUMeEtt POa aoY Ew'r LIMITS
_... ., 7�"TtltIt1A!OEd1(TYTI _.....�. _.�
A OONORAL UAa IYY OL004679701 02/11116 02/11/17 H OCCUR CE 1 1,0100,000
I. �.Rkij tt:ltg �w _w100,000
DK MID"EXP(Any one pawn) 1 �Ny 6,000
COMCLAIME MIADIe XL OCCUR r,N MlNSOa E►cwi��.. ...._� 1
PIReONALIADVINJURY 1,000,0000
GENERAL AGGREGATE ... 2,000,000
E0A7E LIMIT A _LOC . ! , �w.,hMaiHkD�I 'tE I��arr ... � I
Sa OOO
AUTOMOOI�t 9 NI'I PER; P RO TE-C MPIOP A 0 / 1,000,
ALL 1ULEp EDGILY INJURY(Pe. )q . ....... _..„
TOe AUNOON'NOO PE Y INJURY,..r o_ m,,,::,,..::A,,,,,,,,,,,,,_
ANY AUTO EODIL
OWNOD 1�,,...:,..,.. ..
�.,..... tIIREIJAUT 1
WtTY'
�......w, AUTOD I± I
UMBRELLA LIAN OCCUR EACH OCCU RENCI 1
Osaa N CLAIMNMADE AGGREGATE 9
wORREIIO COMPENSATION TUWC700008 02/06116 02106117 r Nvr aR 1
AND EMPLOYMRe' UAEIUrY E
ANY c PUN19Mlam"PKXGLU aurns N 1 A L.DI'E EE „EMPLOYIE r000 000.
Y'" L EACH ACCOUNT 01
1 000 000
104M000ry 10 N41 + I
f mf uPERATrONe b@W* _.......... E L.OI9 E�POLICY LIMIT 1,000000
C NOUIPMBNT FLOATER CP802370007 02/11/16 02111117
O
iii N OF OPERAT64 I LO-CAYIONO!VEHICLES(Ahools AGORD 101,Additions,Remhrk o Efad.oO.,"t"ry rvmrvrvry o-rs�opeoe NO rer lOd)
PROJECT:WALTON FIELD AND BRETT FIELD
THE CITY OF EL SEGUNDO,ITS OFFICERS,OFFICIALS,EMPLOYEES,AGENTS,AND VOLUNTEERS ARE NAMED AS ADDITIONAL INSURED ONLY At
THEIR INTERESTS MAY APPEAR,
"630 DAY NOTICE OF CANCELLATION FOR NON PAYMENT OF PREMIUM,
R . . ... _ .... .. �,II+CSLLATION
CE �(� LD'ICATE HO .
THE CITY OF EL SEGUNDO SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 1191101110
360 MAIN STREET THE EXPIRATION DATE THE'REOP, NOTICE WILL OE DELIVERED IN
EL SEGUNDO,CA 90246 ACCORDANCE WITH THE POLICY PROVISIONS,
au R Rss NvA
ttenflon:
ACORD 20(2010!00) . .. _.. .u. .,. 1008-2010., NATION, All right'e
Paul M,Caccami8
0 ACrrJRiD C�F�PC� a reserved,
The ACORD name and logo are reglstered marks of ACORD
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
TRANSFER GHTS OF RECOVERY
AGAINST OTHERS TO US
This endorsement modifies Insurance provided under the following: , ,.,...
COMMERCIAL GENERAL LIABILITY COVERAGE PART
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
The following Is added to Paragraph 8. Transfer Of Phfts Of Recovery Against Others To Us of Section
IV— C kxm,
We waive any rights of recovery we may have against any person or organization because of payments
we make for injury or damage resulting from your ongoing operations or "your work" done under a
contract with that person or organization and Included In the "products-completed operations hazard" If:
a. you agreed to such waiver;
b. the waiver is Included as part of a written contract or lease; and
c. such written contractor lease was executed prior to any loss to which this insurance applies.
ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED.
U047-0310 Includes copyrighted material of ISO Properties, Inc., Page 1 of 1
with its permission.
Insured
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CARffULLY.
ADDITIONAL INSURED -
OWNERS, O'R CONTRACTORS
SCHEDU PERSON OR ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Narne of Additional Insured Person(s)or OrganizatknXs)
(Additional insured): Location(sl of Covered Operations:
"ALL PERSONS OR ORGANIZATIONS AS "AS DESIGNATED IN WRITTEN
REQUIFED BY WRITrEN CONTRACT NTH CONTRACT WITH THE NAMED
THE INSUR®" INSURED"
A. S *ION II -WHO IS AN INSUREID Is amended to Include as an additional insured the person(s) or
organlzotion(s) shown in the Schedule for whom you are performing operations when you and such
person or organization have agreed In writing in a contract or agreement that such person or
organization be added as an additional Insured on your policy. Such person or organization is an
additional Insured only with respect to liability for "bodily Injury", "property damage" or "personal
and advertising Injury" casued, 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.
A person's or organization's status as an additional Insured under this endorsement ends when
your operations for that additional Insured are completed.
B. With respect to the insurance afforded to these additional Insureds, the following additional
exclusions apply:
This Insurance does not apply to:
Additional Insured Contractual Liability
"Bodily Injury" or "property damage" for which the additional insured(s) are obligated to pay
damages by reason of the assumption of liability In a contract or agreement.
Finished Operations or Work
"Bodily Injury" or"property damage" occurring after:
1. All work, including materials, parts or equipment fumished 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.
Negligence of Additional
"Bodily Injury" or "property damage" arising directly or indirectly out of the negligence of the
additional Insured(s).
ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED,
U156-0310 Includes, copyrighted material of ISO Properties, Inc., Page 1 of 1
with its permission,
Insured
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06
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
perform work under a written contract that requires you to obtain this agreement from us,)
You must melntain 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 1.Q§N of the California workers'compeneation premium
otherwise due on such remuneration.
SCHEDULE
PERSON OR ORGANIZATION JOB DESCRIPTION
THE CITY OF EL SEGUNDO, ITS OFFICERS PROJECT: WALTON FIELD AND BRETT
EMPLOYEES, AGENTS, AND VOLUNTEERS FIELD
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 Policy No,TUWC700008 Endorsement No.
Insured Premium $
Insurance Company
Countersigned By
... ,
-1908 by the Workers'Compensation Insurance Rating Bureau of California,All rights reserved,
CERTIFICATE OF LIABILITY INSURANCE D'1200 AI2016Y)
12�OlaJ3t)16
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 pollcy(les)must be endorsed. If SUBROGATION IS WANED,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
cortificate holder in lieu of such endorsement(a
.PRODUCER c ACT Matt LeLonh
Harvest Insurance Agency,Inc. '�: (E'Oa)�aE"21�a1a ranDe.DCm � m,,,, .....". . W „�_..__.....
2820 Townsgate Road,Suite 206 �..., NWWN ' " ' (E0S)4Be II108
Westlake Village,CA 91361 matt harva's'tNnall
License#: 0880966 INiI NUarlyl al"MNC gVIEFIAOS d NAIL 5
INSURED IN BAL.......v......_..
Turf Team .Iupit4t9 r
3863 Cottonwood Grove Tr JMRKA 0,
Calabasas,CA 91301 INOUIUIR r
IINiU Rea In;
+avGM
$
CERTIFICATE NUMBER: 0O00oo00•147881" 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.
. .. .A "Ybq �yS '��'ppwy .F _.
TYPE OFWSURAN'C'E POLIOYNUMDNR --_ 1',M1911w TY1 IM Tr Ti
I" urnl
COMMERCIAL GENERAL LIABILITY EACH OCC R
_.. ...................,.. .......,,
. .� . .w. � PERRaONAL�,ADV INJURY ,1 ,
V GTIIN"LAOOREOATa LIMIT AMR111 PER, ,n i
,,... ...,. . ....... ......... EN Q�O11tlN1'JN�,E Limit QQ II
POLICY J PRODUCTS COMPIOPA...
A � Y Y CCFICR169616603 oe►9o►2ote oer�o►2o1� 9oDILYINJURY(ParPewon)
AUTOMOaYLE LIABILITY i
ANY AUTO
A A SCHEDULED BODILY INJURY(Per aWdeM .i_..
IHIRED ALIT "R"N" �;�t'� tl.rvrvrvrvrvrvrv .«,,`.��
UMBRELLA LIAO OCCUR .CH OCCURRENCE Is
excess LIAa I DE. A i
i'
H-
W0RK9R#COMP9N9A'nQN
AND E'MPLOYERV LIAaI1«ITY
ANY PROPRIS KWAR NORYTi'CUTIVNI Y NIA B.L H ACCIDENT i
DE'E1;R4PTN C PrN E 1.DI PL
(Maur a101y M
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLE'e(ACOAD 151,Addlhlonal Romata 806dulo,May so 000 0d I1 r 0 iaPa00la roqulrod)
Certificate holder is named as an additional Insured as their Interest may appear.
OLDER CANCELLATON
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 09FORE
THE EXPIRATION DATE THEREOF,NOTICB WILL BE DELIVERED IN
City of El Segundo ACCORDANCE WITH THE POLICY PROVISIONS.
360 Main St
g seNton
EI Segundo,CA 90246 AUTHORIZED RARE
ELI
ZAG ACO1RD C ORATI'ON', All rights.roverved.
ACORD 25(?014101) The ACORD name and logo are registered marks of ACORD
Printed by MJL on December 09,2015 at 02:88PM