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PROOF OF INSURANCE (2017) CLOSED DATE(MM/DD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE 10/28/2016
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 N
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. a
IMPOR'TAN'T:if the certificate holder is an ADDITIONAL.INSURED,the policy(ies)must Have ADDITIONAL INSURED provisions or 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 9
Aon Risk Services, Inc of Florida (NAME'
1001 Bri ckel l Bay Drive If N ,Exl); (866) 283-7122 I `` ) (800) 363-0105 9
Suite 1100 E-MAIL
Miami FL 33131 USA ADDRESS:, _
INSURER(S)AFFORDING COVERAGE NAIC#
INSURED INSURERA: Liberty Insurance Corporation 42404
LandCare USA, INSURER B: Starr Indemnity & Liability Company 138318
a California General Partnership
5295 westview Drive (INSURER C:
Suite 100 INSURER D:
Frederick MD 21703 USA
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: 57Llb642'59677 REVISION NUMBER:
(' THIS IS TO'CE'RTIF'Y THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED,NOTW'iTHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT'OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY HE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HE'RE'IN IS SUBJECT TO Ai-L THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH'POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, Limits shown are as requested I
IN5R ADOL'SUBH POLICY CFF POLICY LXr"
TR( TYPE OF INSURANCE I!N'SD WWD POLICY NUMBER fM1arY 1, Y Yy,I LIMITS
X COMMERCIAL GENERAL LIABILITY 1000100016161 6d/� CUYL(I I EACH OCCURRENCE $1,000,000:
CLAIMS-MADE IX (OCCUR SIR applies per policy terns & condi-ions UAMAVe I RLN I LU $1,000,000.
o PREMISES(Ea ocourrencet
X SIR$250,000 MED EXP(Any one person) ( S5,000
PERSONAL&ADV INJURY vI $1,000,000'
OE n
N"LAGGRFGAI'E LIMITAPPLIES PER: I^GENERAL AGGREGATE I $2,000,000,
POLICY �,PE a ❑X LOC M PRODUCTS-COMP/OP AGG S2,000,000
OTHER. I r
B
AUTOMOBILE SISIPCA08328716 04/29/2016 03/01/2017 COMBINED SINGLE LIMIT tl v'
OBILE LIABILITY U $5,000,000,
'dent)
AUTO WBODILY INJURY(Per person) C
Z
OWNED SCHEDULED BODILY INJURY accident .m+
AUTOS
HIRED AUOTOS NON-OWNED PROPERTY DAMAGE V
ONLY AUTOS ONLY Peracddent)
X Comp Ded$1,000 X Coll,Ded,$1,000
A X UMBRELLALIAB H OCCUR TH7661066754016 04/29/2016 03/01/2017'(EACH OCCURRENCE I $5,000,000 V
EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000
DED I X RETENTION S10,000 li
B WORKERS COMPENSATION AND 1000001707 04/29/2016 03/01/2017 X I PER STATUTE I IOTH-I
EMPLOYERS'LIABILITY F.R
B YIN 1000001706 04/29/2016 03/01/2017---
ANY PROPRIETOR I PARTNER I EXECUTIVE E L EACH ACCIDENT $1,000,000
B OFF C NM SEER EXCLUDED? NIA 1000002166 04/29/2016 03/Ol/2017I E L DISEASE-EA EMPLOYEE I S1,000,000
dA yqea describe undar
DESCRIPTION OF OPERATIONS balow E .DISEASE-POLICY LIMIT I $1,000,000
7
DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Addhlonal Remarks Schedule,may be attached If more space Is required)
RE: All California Landscape operations.
The City of E1 Segundo its officers, employees and agents are included as Additional Insured in accordance with the policy
provisions of the General Liability and Automobile Liability policies.
A waiver of Subrogation is granted in favor of The City of E1 Segundo its officers, employees and agents in accordance with the
policy provisions of the General Liability, Automobile Liability and workers Compensation policies.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE
POLICY PROVISIONS.
City Of El Segundo AUTHORIZED REPRESENTATIVE
City Clerks office/Purchasing
350 Main street
E1 Segundo CA 90245 USA
ark ssa _
01888.2015 ACORD CORPORATION.All rights reserved.
ACORD 25(2018103) The ACORD name and logo are registered marks of ACORD
POLICY NUMBER: 1000100016161 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 OR
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
Any person or organization that the insured has agreed Where required by written contract.
and/or is required by written contract to name as an
additional insured.
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 1. All work, including materials, parts or
include as an additional insured the person(s) or equipment furnished in connection with such
organization(s) shown in the Schedule, but only work, on the project (other than service,
with respect to liability for "bodily injury", "property maintenance or repairs) to be performed by or
damage" or "personal and advertising injury" on behalf of the additional insured(s) at the
caused, in whole or in part, by: location of the covered operations has been
1. Your acts or omissions; or completed; or
2. The acts or omissions of those acting on your 2• That portion of "your work" out of which the
behalf; injury or damage arises has been put to its
in the performance of your ongoing operations for intended use by any person or organization
the additional insured(s) at the location(s) other than another contractor or subcontractor
designated above. engaged in performing operations for a
principal as a part of the same project.
However:
1. The insurance afforded to such additional C. With respect to the insurance afforded to these
insured only applies to the extent permitted by additional insureds, the following is added to
law; and Section III—Limits Of Insurance:
2. If coverage provided to the additional insured is If coverage provided to the additional insured is
required by a contract or agreement, the required by a contract or agreement, the most we
insurance afforded to such additional insured will pay on behalf of the additional insured is the
will not be broader than that which you are amount of insurance:
required by the contract or agreement to 1. Required by the contract or agreement; or
provide for such additional insured. 2. Available under the applicable Limits of
B. With respect to the insurance afforded to these Insurance shown in the Declarations;
additional insureds, the following additional whichever is less.
exclusions apply: This endorsement shall not increase the
This insurance does not apply to "bodily injury" or applicable Limits of Insurance shown in the
"property damage"occurring after: Declarations.
CG 20 10 04 13 ©Insurance Services Office, Inc., 2012 Page 1 of 1
Starr Indemnity & Liability Company
Dallas, TX 1-866-519-2522
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
Policy Number: SISIPCA08328716 Effective Date: 4/29/2016 at 12:01 A.M.
Named Insured: LandCare USA, LLC dba LandCare
ADDITIONAL INSURED - WHERE REQUIRED UNDER
CONTRACT OR AGREEMENT
This policy is amended as follows:
BUSINESS AUTO COVERAGE FORM
SCHEDULE
ADDITIONAL INSURED
ANY PERSON OR ORGANIZATION FOR WHOM YOU ARE CONTRACTUALLY BOUND TO PROVIDE
ADDITIONAL INSURED STATUS BUT ONLY TO THE EXTENT OF SUCH PERSON OR
ORGANIZATIONS LIABILITY ARISING OUT OF THE USE OF A COVERED "AUTO"
I. SECTION II —LIABILITY COVERAGE A. Coverage, 1. Who is Insured, is amended to add:
d. Any person or organization, shown in the schedule above, to whom you become obligated to
include as an additional insured under this policy, as a result of any contract or agreement
you enter into which requires you to furnish insurance to that person or organization of the
type provided by this policy, but only with respect to liability arising out of use of a covered
"auto". However, the insurance provided will not exceed the lesser of:
(1) The coverage and/or limits of this policy, or
(2) The coverage and/or limits required by said contract or agreement.
Signed for STARR INDEMNITY& LIABILITY COMPANY
Charles H. Dangelo, Presiderit Nehemiah E. Ginsburg, Generalpounsel
SICA 1016 MD (04/12) Page 1 of 1
Includes copyrighted material of ISO Properties,Inc.,used with its permission.
* Starr Indemnity & Liability Company
Dallas, TX 1-866-519-2522
THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY
WAIVER OF TRANSFER OF RIGHTS OF RECOVERY
AGAINST OTHERS TO US
Policy Number: SISIPCA08328716 Effective Date: 4/29/2016 at 12:01 A.M.
Named Insured: Trugreen Landcare LLC
This endorsement modifies insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
Section IV - Business Auto Conditions, A. - Loss Conditions, 5. - Transfer of Rights of
Recovery Against Others to Us, is amended to add:
However, we will waive any right of recovery we have against any person or organization with
whom you have entered into a contract or agreement because of payments we make under this
Coverage Form arising out of an "accident' or"loss" if:
(1) The "accident' or"loss" is due to operations undertaken in accordance with the contract
existing between you and such person or organization; and
(2) The contract or agreement was entered into prior to any "accident' or "loss".
No waiver of the right of recovery will directly or indirectly apply to your employees or employees
of the person or organization, and we reserve our rights or lien to be reimbursed from any recovered
funds obtained by any injured employee.
All other terms, conditions and exclusions of the policy shall remain unchanged.
Signed for STARR INDEMNITY& LIABILITY COMPANY
Charles H. Dangelo, resident Nehemiah E. Ginsburg, Generalpounsel
SICA 1020 MD(03/12) Page 1 of 1
Includes copyrighted material of ISO Properties,Inc.,used with its permission.
POLICY NUMBER: 1000100016161 COMMERCIAL GENERAL LIABILITY
CG 24 04 05 09
WAIVER OF TRANSFER OF' RIGHTS 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
SCHEDULE
Name Of Person Or Organization:
Any person or organization to whom you become obligated to waive your rights of recovery against, under any
contract or agreement you enter into prior to the occurrence of loss.
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
The following is added to Paragraph 8. Transfer Of
Rights Of Recovery Against Others To Us of Section
IV—Conditions:
We waive any right of recovery we may have against the
person or organization shown in the Schedule above
because of payments we make for injury or damage
arising out of your ongoing operations or "your work"
done under a contract with that person or organization
and included in the "products-completed operations
hazard". This waiver applies only to the person or
organization shown in the Schedule above.
CG 24 04 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 1
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13
(Ed. 04-84)
WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT
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.)
This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule.
Schedule
Any person or organization to whom you become obligated to waive your rights of recovery against, under
any contract or agreement you enter into prior to the occurrence of loss.
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.: Endorsement No.:
Insured: Premium:
Insurance Company: Countersigned by:
WC 00 03 13
(Ed. 04-84) Page 1 of 1