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PROOF OF INSURANCE (2018 - 2018) CLOSED
m _,- V DATE(MMIDDIYYYY) - .... ANC' 2/27/2017 CERTIFICATE OF LIABILITY INSURANCE ---_--- 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 pollcy(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 enclorsernent(s). PRODUCER CONTA(dT Mail Je e8en - .................... e NAME: pP g INC,Ne'.FRG): 9-6452 FAX, (.562.)429-6511 E-MAIL- License and Associates Risk M mt & Insurance Svc (800)50 dA!c Net 2200 Powell St., Suite 1080 ( I Emeryville CA 94608 IN'SURERA:Colonyulnsura ce, co1Xapany NAIC>r„ Pr'aafDlNe,covf:N INSURED INSURERB;Insurance Con7Tranv of the West Krause ACT, Inc. INSURER C,.wentinel Insuraance Company DBA: Air Cleaning Technolo gy NS..I3 EaD: 411 Rowland Ave INSURER E Santa Ana CA 92707 INSURER P'. COVERAGES CERTIFICATE NUMBER:2017-18 GL, XS 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 R I'I , D;S'UtONC POLICY NUMBER AM CYCrYYY YY (MIMI 4.. - .. _ TYPE OF INSURANCE INSD.'.W"d N I � COMMERCIAL GENERAL LIABILITY Y EXP tt EACH OCCURRENCE LIMITS 1,000,000 X CO U IYYYYI EAt,r, C, �$:';h°tt.�J'fkat;y - y N Ir A( U a a7 r',Idraern t?5,,, $ 0 A -- - I CLAIMS-MADE 1A R I OCCUR X $2,50,0 Deductible X PACE303159 3/7/2017 3/7/2018 MEDMEXP(my one person) $ 305,000 each occurence PERSONAL 1000,000 ONAL&ADV INJURY $ 0 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 I 'r PRODUCTS OPIOP AGG $ 2,,o POLICY' X 4�ECrdC,'� LOC I -CM 00,000 OTwt'ER° $ AUTOMOBILE LIABILITY COMBINED SINGLE LI'MI'G $ ANY t (k e,f�rrd�,(airpp,) B INJURY Per accident) HIRED AUTOS I AUTOS BODILY VSNJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS NON-OWNED rY VA�GA(,L 14 nla_ $ $ UMBRELLA X EXCESS LIAeI� � X ,OCCUR LAIMS-MADE ... � LGGNR®GATERRENCE $.... 4,000,000 I A A I $ 4,000,000 DED RETENTION$ EXC30213.1 3/7/2017 3/7/2018 $ WORKERS - E:L.EACH(ACCI ENT(,,,,' OFFICERIMEMBER EXCLUDED: II I H AND EMPLOYERS'LIABI LIABILITY o PER FR ANY PROPRIETORlPARTNER/EXECUTIVE YIN'N1A $ 1,000,000 B y WSA 5035621 00 1/1/2017 1/1/201S E 11000,000 00 IfM es,desccrribe under DISEASE-POLICY LIMIT 5 E,L DISEASE EA E , DESCRIPTION OF OPERATIONS below - - L $10,000/$10 C �Contractors Equip/Tools B%557761799 2/1/2017 2/1/2016 II Lirnds 00 I A Errors & Omissions PACE303159 3/7/2017 3/7/2018 Aggregate $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) IRE: E1 Segundo Fire Department, 314 Main Street, El Segundo, CA 90245. The City of El Segundo is included as Additional Insured with regard to General Liability per attached forms EPACE100-0814 & EPACE101-0814. Waiver of Subrogation applies to Workers' Compensation per attached form WC990634. CERTIFICATE HOLDER CANCELLATION _._._................. _.. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of El Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Attn: City Clerk ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street El Segundo, CA 90245 AUTHORIZED REPRESENTATIVE Greg Havill/TPMP ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INS025001401t THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED: - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: EnviroPACE Insurance Policy SCHEDULE Name Of Additional Insured Person(s) Location And Description Of Completed Or Organization(s) Operations Where Required By Written Contract Where Required By Written Contract I r A. Section XX. WHO IS AN INSURED, Coverage Part 1 and Part 2 is amended to include as an additional insured the person(s) or organization(s) shown in the SCHEDULE above, but only with respect to liability for bodily injury, property damage, environmental damage, or cleanup costs caused, in whole or in part, by your work at the location designated and described in the SCHEDULE of this endorsement performed for that additional insured and included in the products-completed operations hazard. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 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. B. With respect to the insurance afforded to these additional insureds, the following is added to section XXI. LIMITS OF LIABILITY AND DEDUCTIBLE: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Liability shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Liability shown in the Declarations. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED, EPACE100-0814 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 1 with its permission. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL S - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: EnviroPACE Insurance Policy SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location(s) Of Covered Operations Where Required By Written Contract Where Required By Written Contract A. Section XX. WHO IS AN INSURED, Coverage Part 1 and Part 2 is amended to include as an additional insured the person(s) or organization(s) shown in the SCHEDULE above, but only with respect to liability for bodily injury, property damage, personal and advertising injury, environmental damage, or cleanup costs caused, 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. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 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. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to bodily injury or property damage occurring after: 1. All work, including materials, parts or equipment furnished 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 other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. EPACE101-0814 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 2 with its permission. C. With respect to the insurance afforded to these additional insureds, the following is added to section XXI. LIMITS OF LIABILITY AND DEDUCTIBLE: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Liability shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Liability shown in the Declarations. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED, EPACE1 01-0814 Includes copyrighted material of Insurance Services Office, Inc., Page 2 of 2 with its permission. AC"Ili CERTIFICATE OF LIABILITY INSURANCE D 03128/20177 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- IMPORT'AIWI'T: If the certificate holder Is an ADDITIONAL INSURED, the ollcy(les) Lust be endorsed. If SUBROGATION I 8 WAIVED,subject to Me 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 endorsementls). PRODUCER Dan.... rArKa1hy Ferry ... _. . ,. ...... .. Rickabus PHONE' 9,49-363-7100, ,Itff statefermWCoTD t _. 363-1836._ State Farm Insurance �-N9 0 a _- �Iterrll kalh ' _ I9 30131 Town Center Drive, Suite 275 " Laguna Niguel, CA 92677 �s1 oPrDR> Ne OTMVEltILGE NNUCs mee ..- INSURER A_, m fate Farm Mutual Automobile Insurance Company 25178 INSURED ICrausl A C T INSURERs ......�... .. .....�....�._...�..__..,._�,.. ....._. ......,,.. �..�...�. .... DBA Air Cleaning Technology INSURERC 411 Rowland Ave INS... U'RER D Santa Ana, CA 927073445 _INSURER �. iNSURErM E INSURER.E COVERAGES CERTIFICATE NUMBER: 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. NOTMTHSTANDING ANY REOUIREMENT,'TER'M 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 _..v.q CLAIMS, TYPE FI URANC POUCYNU06RIER lili rM �. LIMITS COMMERCIAL GENERAL LIABILITY :Cd�URRENCE .S CLAIMS-MADE OCCUR - 10 &YC O .�. ...w. �., .. _.... _ BAi.IJCRP Ar one sorb $ _.._.,� mm.m...k ....m . . PE'r$SMNVAP„&ADVWhX.JIJ'Rh`._... S._........ ., GEN'L AGGIMGAT'E LJMITAPPLIES PER: NRJLA GREGATE S I PR L� PFiDtTS•AMP OP AG C OE ... . COM ONEDSING3LE.I:i A (AUTOMOBILE LIABILITY Y 545 8874-C01-75 0310112017 09101/2017 (c m GrJaaill $ 1,000,000 ANY AUTO 5191539-001-75 0310112017 09/01/2017 BODILY INJURY(Per on) $ ,,, ^, .. X, ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) S 545176301-75 03!0112017 09/01/2017 AUTOS ED 4971093-C01-75 03101/2017 09/01/2017 'PR 'ER y oAU d _ , HIRED AUTOS AUTOS '' �S LAG'',H OCCURRENCE S .... .. EXCESS B 9mw AGGREGATE b _ OCCUR CLhJMSxMADE„ _.,m..-._ ... .w...—,... .. .. �DEO 1TENN$ S WIO ERS O ATN - PB R OTH AND EMPLOYERS'LIABILITY YINR ANY WL. _._.._ .„..,... m., Of-'PICERI MEMMBEREXCLUDIEW N/A $ �7�«f�l E L FACH ACCIDENT (andil In NN) _ E L DI')r.ASIn EA E,MGPLOYI U UP 0$de nbo pander _.. ,�...,,.�..�.�.....� .. A ..._„ ,.. ... S RIPTION'QF'CPERATt0 tGkelanN Et, DI�aE'As�` -PDI GL'Y'Ull S A E'Nt3G Y IrJCIGSL 391 3576-C01-75 03/01/2017 09101/2017 $250 Physical Damage deductible DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached R more space is required) City of El Segundo,its officials and employees are named additional insured I Location:Ell Segundo Fire Department CERTIFICATE HOLDER CANCELLATION' El Segundo Fire Department SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 350 Maln St THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN EI Segundo,CA 90245 ACCORDANCE WITH THE POLICY PROVISIONS.,, 1 AUTHORED REPRESENTATIVE ®1988.20 CORD CORPORATICY All rights,reserved, ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD 100' 86 132849.9 024)4-2014 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 06 34 (Ed. 8-00) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT-BLANKET 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). The additional premium for this endorsement shall be 3 % of the total California Workers'Compensation premium otherwise due. Schedule Person or Organization Job Description ANY PERSON OR ALL CALIFORNIA ORGANIZATION WHEN OPERATIONS REQUIRED BY WRITTEN CONTRACT 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 01/01/2017 Policy No. WSA 5035621 00 Endorsement No. Insured Krause ACT, Inc. Premium $ INCL. Insurance Company INSURANCE COMPANY OF THE WEST Countersigned By WC 99 06 34 (Ed.8-00) INSURED