PROOF OF INSURANCE (2017 - 2018) CLOSED CERTIFICATE OF LIABILITY INSURANCE 03/06/2017°`r`"'
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(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,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 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).
Joe Van Dyke _. M
PRODUCER
NAME:
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Avco Insurance Services Inc PIIIrkE ..........._" FAQ
25283 Cabot Rd,Suite 113 A-MAIL .Er Insur 9I 1831 (Ara uans
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Laguna Hills, CA 92653 v s ;/joq@ yahoo com
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CUSTOMER ID P:
INSURER(S)AFFORDING COVERAGE NAIC
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INSURED Specialty Insurance apnce Company lily
ALOHA DOORS INC INSURERC"United I•--- _.INSURER B INSURER
214 MAIN STREET#119 I -
EL SEGUNDO, CA 90245
INSURERD:,
INSURER E:
INSURER F:
COVERAGES CETI''FICATE 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 POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAYHAVE BEEN REDUCED BY PAID CLAIMS.
I,4,.,TFd:.L .......... TYPE OF INSURANCE .,iA�s,�...... ......_..,.... ........ww,.,...OLICY..... RA NCE............... .. _
E R 'MVD� POLICY NUMBER 0,1fX
� l: t# � �^.._�........�......I'�»RfbC�O Y''N Pp (MMIDDfYYYY) LIMITS............ .
GENERAL LIABILITY EACH VC=URFENC17
✓. r` t 1.000 000
='D MIME,'C I,Z SENEF.='L L!==iLIT y AM.A,GI 50,000 ...
- �;r»kLC ... „ F ✓ ✓ I `nv .-.. .,1 B S11051413200143 8/26/2016 8/26/2017 FERrAL [uI IJJP{ $ 00
, 0.0.....00,,...
I' p GENEFALAGGREC-A:E x2,000,000
PRODUCTS COMPI PAGG $1,000,000,
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AUTOMOBILE LIABILITY 0:4ABINED SINGLE LIMIIT BODILY"LL OlAt
V,..._.., BODILY PI,lLiRY iPar�m ..
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.erawdernry ....... $
ED
HULED."UT_-S FR_,•EFTYDAMAGE
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., NON-CA,NEDPLTOa ... ..............._ $. ............._......,,....w.. �
UMBRELLA LIAR OCCUP EACH OCCURRENCE $
EXCESS LIAB .. ....,. ._.. .................
-ktaDE AGGREGATE $
......... DECUCTIELE $
�ITIT RETENTADN 5
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WORKERS COMPENSATION f
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A OFFICERfi1B.tE�?E�CLIICgr: NIA WWC3258833 2/1/2017 2/1/2018 E L�s CIDENT E
(Man--yin My . -EA EMPLOYEE. $J.,,
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Iryes,describe under
OESCRIPTION OF OFFP.ATA"?NG below E L DISEASE-POLICY LIMIT $1,000,000
V
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Adito"Renu*s Schedule,ff more space is reglaed)
CITY OF EL SEGUNDO are named as additional insureds in regards to the general liability policy.
CERTIFICATE FOLDER CANCELLATION
CITY OF EL SEGUNDO SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Public Works Dept. ACCORDANCE WITH THE POLICY PROVMONS.
350 Main Street,
El Segundo, CA 90245 AUTHORIZED REPRESENTATIVE
O 19 -2. ACORD CORPORATION. Ail rights reserved.
ACORD 25(2009109) The ACORD name and logo are esteredma s ACORD
ENDORSEMENT TO POLICY NO. 10b
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
UNITED SPECIALTY INSURANCE COMPANY
COMMERCIAL GENERAL LIABILITY POLICY
BLANKET ADDITIONAL INSURED
INCLUDING PRIMARY COVERAGE AND WAIVER OF SUBROGATION
The section of the policy entitled II. — WHO IS AN with such work, on the project (other than service,
INSURED is amended to include as an additional maintenance or repairs) to be performed by or on
insured any person or organization for whom you are behalf of the additional insured(s) at the location of the
performing operations when you and such person or covered operations has been completed; or when that
organization have agreed in writing in a contract or portion of "your work" out of which the injury or
agreement that such person or organization be added damage arises has been put to its intended use by any
as an additional insured on your policy. The coverage person or organization, including another contractor or
afforded by this endorsement is only; subcontractor engaged in performing operations as
(1) with respect to liability of the Additional part of the same project.
Insured in connection with the original Named
Insured's ongoing operations performed for The coverage provided for the Additional Insured is
said Additional Insured; and only to the extent that the additional insured is held
(2) only if the Additional Insured performs all liable for the negligence or strict liability of the Named
obligations required under the Policy. Insured. No coverage is provided for liability based
upon the acts, errors and omissions of the Additional
The coverage afforded to an Additional Insured is Insured.
limited to a claim made for a Covered Loss not
covered by other insurance available to an Additional No coverage is provided to an Additional Insured for
Insured, and is limited by SECTION IV. — damages because of "bodily injury" to an employee of
COMMERCIAL GENERAL LIABILITY CONDITIONS, the original Named Insured, whether suit is brought or
paragraph 4. Other Insurance, b., of the policy, which claim is made by the employee or the parent, spouse,
provision applies equally to an Additional Insured child or sibling of such employee, or any entity seeking
and is made a part of this Endorsement. damages because of injury to such employee.
Other than as expressly modified herein, coverage for If required by written contract: the insurance afforded
the Additional Insured is governed by the terms and by the policy to the Additional Insured shall be
conditions of this policy, including the insuring primary insurance, and any insurance or self-
agreement. No coverage is afforded under the insurance maintained by the above Additional
"products-completed operations hazard" for an Insured shall be excess of the insurance afforded to
Additional Insured pursuant to this endorsement. the Named Insured and shall not contribute to it.
The coverage afforded to an Additional Insured If required by written contract or agreement: We waive
under this endorsement ends as of the date of
completion, abandonment or termination of the work of any right of recovery we may have against an entity
that is an Additional Insured per the terms of this
the original Named Insured at any jobsite, project or
structure. endorsement because of payments we make for injury
or damage arising out of "your work" done under a
The "work" of the original Named Insured will be contract with that person or organization.
deemed completed as of the date all work, including
materials, parts or equipment furnished in connection
Except as set forth above, all of the terms,conditions, and exclusions of this policy apply and remain in effect.
Policy No.: S11051413200143 United Specialty Insurance Company
3250 Grey Hawk Ct, Ste. Z
Date 08/26/2016 Carlsbad, CA 92010
By:
Time: 12:01 a.m.
Authorized preserllative
SIS-TC-0101 (07/13) END 10b 1 of 1