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PROOF OF INSURANCE (2017) CLOSED MICHMCC-02 13SHAN CERTIFICATE OF LIABILITY INSURANCE DAT . 111112017D 11!2 THIS NFER ONLY AND CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION O N CO S 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 pollcy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terns 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). _ . CONTACT._............, ........ .�....,w.. .m....m............ _. .. .. License#OC36861 NAM 1 E PRODUCER Eileen Kivllgl n New York-Alllant Ins Svc Inc PHONEFA ' I±UM n HP) 320 west 57th st New York,NY 10019 A L Elleen.klv'Vi lTn alllan'LCOm INSURERA&AEfORDING COVERAGE NAIC N „ INSURER A:W06CO Insurance Company _ 2 INSURED INSURER 13:Security National Insurance Company 19879 '�,.... .._, .._....................... Michael McCall DBA Make Overhead Door INSURER C 5618 E La Palma Ave. INSURER 0: .,.......... .w _................................................. Anaheim,CA 92807 INSURER E: ....... ........... ww w- INSURER F: COVERAGES mm mm m.�m 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 POLIC ES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY'AID CLAIMS. �. .y...�......�... HUMBER .. .,.f�.l'dug FIB rdLfcYfi!Ekp . ..., „„ „...... ... ..,.,„ ... �.._... �. INIIA. NINR,._ Y MM/OO YYYYB jjNk[iDCICYYY) �^_., . LIMITS m ... TYPE OF INSURANCE Ppl1C A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000, 3F+ rmea S CLAIMS-MADE X OCCUR X X 'WPP1182831 02 08/01/2018 08/01/2017 100...,....,0001 M ...,..... MED EXP(Any one personl_...�$ _ 6,0001 .._....._...w........_W. ... ........... PER90NAL 8 ADV INJURY $ ,00 ................,...............10,000' GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000, POLICY❑JECT LOC PROD......A mm....-COMP/OP AGG .S. w....... 2,000,000 UCTS AUTOMOBILE LIABILITY I COMBINED 21tlPIGLE LIMIT $ w. ANY AUTO BODILY INJURY(Per person) S _._. ALL OWNED w._.. SCHEDULED _accident) $ ................. ... AUTOS BODILY INJURY(Par accident) S AUTOS NON-OWNED I+ t11�1s'R'7�IJANVAOE HIRED AUTOS AUTOS Ili .C�?ekr�91 _ .... _ _ s A _ .. �w ._... CLAIMS-MADE EACH OCCURRENCE S .. 1..'000,00.. X UMBRELLA LIAR X OCCUR 0 EXCESS LIAR WUM1196494 02 08/01/2016 08101/2017 AGGREGATE s 1,000,000i DED I X REj @!q ON It._....._10,000. � '_. _. $ B WORKERS Y PROPRIETOR/PARTNERIEXECUTIVE r—Y�N NIA X SWC1120521 08/01/2016 08101/2017 E(.EACH ACCIDENT s 1,000,000 AND EMPLOYERS'LIABILITY CTATUTF„ __ ER OFFICER/MEMBER EXCL DED? 000 000 (Mandatory In NH) � E.L.DISEASE-E:AEMPLOYEE! 1,000,000 K y describe under E.L.DISEASE-POLICY LIMIT S 1,000,00 yy DES RIPTIQN OF QPER!�TIONB below _ ....... 0 ......... ... ...__.............. DESCRIPTION OF OPERAT10NO I LOCATIONS I VEHICLES(ACORD 101,Addlgonal Remarks Schedule,may be akach...._._.._._ .. . ......,. , W.. y ed M more epees U required) City of El Segundo,Its officials,and employees are Included as Additional Insured whore required by written contract.Coverage Is primary and non-contrlbutory and a Waiver of Subrogation applies ea required by wd tan contract. CERTIFICATE ATE HOLDER _..mm.._. ®.�._. �.,. CANCELLATION _ATION ...... _ � .�..._w..� .. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City Of El Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City Clark 360 Main Street,Room 6 ACCORDANCE WITH THE POLICY PROVISIONS. El Segundo,CA 90246.3813 ---...... AUTHORIZED REPRESENTATIVE .w a 01986-2014 ACORD CORPORATION. All rights reserved. ACORD 26(20141011 The ACORD name and loco are realstered marks of ACORD POLICY NUMBER:WPP1182831 02 COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON O ORGANIZATION This endorsement modifies insurance provided under the following: " COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location(s) Of Covered Operations City of El Segundo, its officials, and All locations as required by written contract. employees are included as Additional Insured where required by written contract as required by written contract. i 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 B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following additional organization(s) shown in the Schedule, but only exclusions apply: with respect to liability for "bodily injury", "property This insurance does not apply to "bodily injury" or damage" or "personal and advertising injury" "property damage"occurring after: caused, in whole or in part, by: 1. All work, including materials, parts or 1. Your acts or omissions; or equipment furnished in connection with such 2. The acts or omissions of those acting on your work, on the project (other than service, behalf; maintenance or repairs) to be performed by or in the performance of your ongoing operations for on behalf of the additional insured(s) at the the additional insured(s) at the location(s) location of the covered operations has been designated above. completed; or However: 2. That portion of "your work" out of which the 1. The insurance afforded to such additional injury or damage arises has been put to its intended use by any person or organization insured only applies to the extent permitted by other than another contractor or subcontractor law; and engaged in performing operations for a 2. If coverage provided to the additional insured is principal as a part of the same project. 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 10 0413 0 Insurance Services Office, Inc., 2012 Page 1 of 2 C. With respect to the insurance afforded to these 2. Available under the applicable Limits of additional insureds, the following is added to Insurance shown in the Declarations; Section III—Limits Of Insurance: whichever is less. If coverage provided to the additional insured is This endorsement shall not increase the required by a contract or agreement, the most we applicable Limits of Insurance shown in the will pay on behalf of the additional insured is the Declarations. amount of insurance: 1. Required by the contract or agreement; or Page 2 of 2 © Insurance Services Office, Inc., 2012 CG 20 10 04 13 POLICY NUMBER: WPP1182831 02 COMMERCIAL GENERAL LIABILITY CG 20 37 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES O 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 Organization(s) Location And Description Of Completed Operations City of El Segundo, its officials, and employees are included as Additional Insured where required by All Locations written contract as required by written contract. Blanket as required by written contract. u 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 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 CERTIFICATE OF LIABILITY INSURANCE Date. 1212912016 PRODUCER; THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Employers Insurance Admin.Corp. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. 1240 N.Lakeview Ave,„Ste.130 THIS CERTIFICATE DOES NOT AMEND,EXTEND,OR ALTER THE Anaheim,CA 92807.1831 COVERAGE AFFORDED BY THE POLICIES BELOW. Tel:(714)970.6500 COMPANIES AFFORDING COVERAGE License#0296134 Company A: MERCURY CASUALTY INSURED: MAKO OVERHEAD DOOR Company B: 5618 E. LA PALMA AVENUE ANAHEIM,CAL.IFORNIA 92807 Company C: Company D: COVERAGES _ ..._.._._ .. THIS IS TO CERTIFY THAT 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 ITEMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, POLICY. POLICY LTA ' ,TyP OF:IN B CE POUR NUMBEE _ EFF�CTI�"E"��F�� _: E P.DATE GENERAL LIABILITY GEN,AGGREGATE. [X)COMMERCIAL LIAR. PRODUCTS-COJtP/OP AGG: ( )CLAIMS MADE PERSONAL&ADV INJURY: [X]OCCUR EACH OCCURANCE: [ ]OWNERS& FIRE DAMAGE: CONTRACTORS'S PROT (any one fire) [ ] MED EXP: Carey one person) AUTOMOBILE LIABILITY A [X )ANY AUTO COMBINED SINGLE LIMIT:$1,000,000 [ )ALL OWNED AUTOS BODILY INJURY` $ [ )SCHEDULED AUTOS CCA0018100 10113/2016 10,1312017 (Per Person) [X)HIRED AUTOS BODILY INJURY:S [X ]NON-OWNED (Per Accident) AUTOS PROPERTY DAMAGE:S [ 1 EXCESS LIASILTY [ )UMBRELLA FORM EACH OCCURANCE. ( ]OTHER THAN UMBRELLA WORKER'S,COMP & - - WC STAI UATORY LIMITS � EMPLOYER'S LIABILITY THE PROPRIETER'/ EACH ACCIDENT S PARTNERSIEXECUTIVE DISEASE POL LIMIT S OFFICERS ARE: EACH EMPLOYEE S [ )INCLUDED I 1 EXCL DE8 RCPTION OF OPERATIONSIL�OCATIONS,APEHICLESI iPECIAL ITEMS, NO { � ✓ t✓ r r ✓✓ C r ✓ 1 t � y" r i , U'�;�'y�l Hf�r�lllr�� yG,�eV h'r d�^1��„/;�1yrtiY�Y ✓�"s��� a ,,, ,.G ✓ it itr; � ° ✓ i J , r' i. � a r rl �ri� '✓ey ,FDrf 1`';l*t ; / ,' d t „9 ✓✓ ! ✓� 6.r ✓ rt ✓ �. w.7i t�' ✓i a��„"v" �f�a±r;",ifI�i xi-�1�",� i wy ✓ .,� r t✓ u H :u° i�,,, r �,. ✓✓� ✓ ,tir11rvri� (r.,W o i �w^,k. .-m�,�� ,� �m..(�+����d n"��r����� 1"�ry x., �7 ;,is fi .r;rw, ,w. a.r,. , l�,r.r,o -..r,:.. ,r„,,.,,�;, -,:i r 6,Y..ea. ✓i.a; �,,.d.,�ws.,C Cr, ;� SHOULD ANY OF THE A&�a�V DES' POLICIES k3 CANCELLED EO � CITY OF EL SEGUNDO BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE City Clerk CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL 350 Main Street, Room 5 SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILTY OF ANY El Segundo, CA 90245-3813 KIND UPON THE COMPANY, IT'S,AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTA r fIVE ACCORD 26-6(1.96) WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 01-84) 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 perform 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 2%of the California workers'compensation premium otherwise due on such remuneration. Schedule Person or Organization Job Description Any person or organization as required by written contract. $2,081.00 This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below Is required only when this endorsement is Issued subsequent to preparation of the policy.) Endorsement Effective 8/1/2016 Policy No. SWC1120521 Endorsement No. 0 Insured Michael McCall Premium$ 63936 Insurance Company Security National Insurance Company Countersigned by,,,,,,,__,_ WC 04 03 06 (Ed.01-84)