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PROOF OF INSURANCE (2018) CLOSED " , CERTIFICATE OF LIABILITY INSURANCE page 1 of 2 G 06/131/2017' 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 have ADDITIONAL INSURED provisions or be endorsed II 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 NAMES ... FAX Willis of P. 0. Boxn305191 Blvd.nia, Inc, (PJ EE.SS' C rtl.flC ef- ? _�_l (A N ) •88-.467-2378 O._ XTy. 87 7 ,9 4.. E-MAIL Nashville, TN 37230-5191 INSURER(S)AFFORDINGC0VERAGE NAI INSURERA: XL Insurance America, Inc. 24554-003 INSURED . 25674-008 Fieldturf USA, Inc. INSURER B: Travelera Property Casualty Company of Am 7445 Cote-de-Liesae Road, Suite 200 INSURERC:Travelers Indemnity Company 25658-001 Montreal, QC 134T 1G2 INSURERD:The Charter Oak Fire Insurance C Canada .................................................................................... ..ompany 25615-001 INSURER E: R INSURER F: COVERAGES CERTIFICATE NUMBER.25520997 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 I 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. 'bra TYPE OF INSURANCE nL... ry ......................... gn .......... .......................................................... ..............„y...... UBC C POLICY.E. 41 POLICY NUMBER 4 �`,`,a 1UMDYE�XP , LIMITS A X ,COMMERCIAL GENERAL LIABILITY y Y US00010327LI17A 5/1/2017 5/1/2018 EACH OCCURRENCE $ CLAIMS-MADLL�OCCUR O& i � orTEDn_a) $ 500 ,000 MED EXP(Any one person) $ ,PERSONAL&ADVINJURY $ 1�QQQr�QQ GEN'L AGGREGATE_LIMIT APPLIES PER: ,GENERALAGGREGATE $ OTHER: .X� PE0. 0 LOC 'PRODUCTS-COMP/OP AGG $ 2._,QOO,OOO,,,,,,,,, $ rB COMBident)SINGLE LIMIT AUTOMOBILE LIABILITY y Y TJCAP823K312A16 9/28/2016 9/28/2017 COMBINED $ 2,000,000 X ANYAUTO BODILY INJURY(Per person) $ OWNED 'SCHEDULED BODILY INJURY(Peraccident) $ _ .............. AUTOS ONLY AUTOS _ HIRED NON�OWNED �Rt"A 't`'('I'I''1'C?APo�1Aw,F.� . . 0 1�. 0 X $1,000 Y � ..(Per accident) $ X...., A 'T'O ONLY AUTOS ONLY $ ..._ ............. ............... X EXCESS LIABAB ,X OCCUR MADE Y US00010615LI17A 5/1/2017 5/1/2018 AGGR,OCCTE, RENC,E $ 51000,000 UMBRELLA R A $ 51 000,1 000 DED I X (RETENTION$ 10,000 $ C WORKERS COMPENSATION Y ADS TC2HUB823K310616 9/28/2016 9/28/2017 ,X 1Ep IITF wIH AND EMPLOYERS'LIABILITY YIN D ANY PROPRIETOR/PARTNER/EXECUTIVE Y ** TROUB823K311816 9/28/2016 9/28/2017 E.LEACHACCIDENT $ 11000,000 OFFICER/MEMBER EXCLUDED? N ' N/A �' ridatory,ynN,H -'y"" E.L.DISEASE-EAEMPLOYEE $ 11000,000 I = des 1.1 e n�er D' I"iC'V�;AION'OF OPERATIONS below EL DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS d VEHICLES(ACORD 101,Add'itionat Remarks Schedule,may be attached if more space is required) WC Policies: AOS-covers all other states. **-covers AZ, MA, OR, WI only. Project: E1 Segundo Athletic Fields Turf Replacement �a "MW City of E1 Segundo, its officers, officials, employees, agents and volunteers are included as Additional Insureds on the General Liability and Automobile Liability policy, as respects to the dliability arising out of ongoing and completed operations performed on the project specified in the Bconstruction contract for the period of time rgSWired within the' contract. 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 E1 Segundo Attn: Ken Berkman AUTHORIZED REPRESENTATIVE Interim Public Work Director 350 Main Street El Segundo, CA 90245 Co11:5087936 Tpl:2143661 Cert:25520997 ©1988-2015ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 41607.5 LOC#: ..................................... .....______. a ADDITIONAL REMARKS SCHEDULE Page of AGENCY NAMED INSURED Fieldturf USA, Inc. Willis of Pennsylvania, Inc. 7445 Cote-de-Liesse Road, Suite 200 POL CY..NUMBER Montreal, QC H4T 1G2 Canada _See First Page . CARRIER............. ,.,.,.............................. ..... .........,. NAIC CODE.... ....,.. See First Page EFFECTIVEDATE: See First Page ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25_ FORM TITLE; CERTIFICATE OF LIABILITY INSURANCE It is further agreed that such insurance as is afforded shall be Primary and Non-contributory with any other insurance in force for or which may be purchased by the Additional Insureds, where required by written contract executed prior to loss and permitted by law. Waiver of Subrogation applies in favor of Cit�r of E1 Segundo, its officers, officials, employees, avents and volunteers with respects to Genera Liability, Automobile Liability, 'Umbrella/Excess Liability and Workers Compensation coverage where required by written contract subject to policy terms and conditions and as permitted by law. ACORD 101 (2008/01) Coll:5087936 Tpl:2143661 Cert:25520997 ©2008 ACORD CORPORATION.All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER:US00010 27L117A COMMERCIAL GENERAL LIABILITY EFFECTIVE GATE:0dai1112017 CG 20 14 4413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance pro,ded under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) ,,.... Or Organizationfs) Locationfsl Of Covered Operations „ City of El Segundo,its officers,officials, Project: El Segundo Athletic Fields Turf employees,agents&volunteers Replacement Attn:Ken Berkman,Interim Public Work Director 35 Main Street El Segundo,CA 90245 Information required to complete this Schedule,if riot 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 persons) or additional insureds, the following additional organization(s) shown in the Schedule, but only exciusions apply: with respect to liability for"bodily injury",`property Tthi�s insurance does not apply to'bodily injury'or damage or "personal and advertising injury" "property damage"occurring after: caused,in whole or in part,lay: 1. Your acts or omissions;or 1. All v rM,,, Including materials, parts or equi,pment 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 p eeflwrned by or in the perforrnance 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. Tttat portion of "your work' out of which the Injury or damage arises has been put to its 1. The Insurance afforded to such additional intended use by any person OF 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 inspired is principal as a part of the same project. required by a contract or agreement, the C.With respect to the insurance afforded to these insurance afforded to such additional insured additional insureds, the following is added to will not be broader than that which you are Section III-Limits Of Insurance: required by the contract or agreement to provide for such additional insured. CG 20 10 0413 0-4 Insurance Services Office,Inc..2012 Page 1 of 2 K mverage pmvded to the aftbonai insupad in 2. Available under the appfi cable Limits of re4uired by a contract or agreemerd,the mort 4ve umsjrance shown in the Decicirat�om wlfl pay on betiag of the additonal iirmured is Me aunt of nrmrance- whichever is lei. I. Required by the contract or agmernent-1 iw This endorsement shaN not Increase &e appifimble Umft, of Insurance shown in the [Dedaratmns. Page 2 of 2 0 Bnsurance Seroces Office,Inc..,Mi 2 CG 2010 0413 POLICY NUMBER,US0001413271_117A COMMERCIAL GENERAL LIABILITY EFFECTIVE DATE:0&1IM17 CG 20 37 04 113 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance prTvided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTSICOMPLETED OPERATIONS LIABILFFY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations City of Ell Segundo,Its officers,officials,employees, agents,8 volunteers Progect: El Segundo Athletic Fields Turf Attn:lien Berkman,Interim Public Work Director Replacement 35 Main Street F1 Reg,iin CA GI1)A.r,, 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. itli 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 wilt 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 tia.and"_ 2. Available under the applicable Limits of However: Insurance shown in the Declarations; 1. The insurance afforded to such additional whichever is Less_ insured onty applies to the extent permitted Timis endorsement shall not increase the applicable by law,and Limits of Insurance shown in the Decarations. 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 0413 Q Insurance Services Office;Inc_,2012 Page 1 of 1 POLICY NUMBER-US01K 1 G 327L117A 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 PR DUCTSfCOMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization_ Any person or organization that you are required in a written contract or wdtt--n agreement to waive any right of recovery we may have against the person or organization,provided the'Bodily Injury'or`Property Damage* occurs subsequent to the execution of the written contract or written agreement. Information reouiired to complete this Schedule.if not shown above,will be shown in:he Declarations, The following is added to Paragraph B.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 operation-s 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 (9 Insurance Services Office,Inc.,208 Page 1 of i I2 ENDORSEMENT#0 Ppws ond:)rsenr#,,M c4fLc-tve 12V a.m.,May 1, MIT folrMS a paA of pol[Cyik.Ull ,aiDEIZ)2 7 U17A issko-d to 7arket,EncksTprises,,Jrw..by XL insucanoe Am"Da,he. 7WS ENDORSEMENT 04ANGES THE POLICY. RLEASE READ[T CAREFJLLY. PRIL41ARY INSURANCE CLAUSE ENDORSEMENT This endorse im ent modiries Vnsurance provdC -d under the,fdiowiniy COMMERc"LAL GENEPAL UABIUTY COVER kGIE PART PFRODUCTS(Cw"AWLETED OPERATION 3 COVERAGE PAIR7 I a is agreed that to the extent that insurance is aforded to any Additonal Insured urWer this poky,qhis- insurano-shall apply as primary and not M,ontnbu ting vAlh any in-sarance s-dr-ried by such Add 60nal 1psur,°d,as Tequkcd!)-y writter. oontr3rA. Al other*erms and cond=ns of his poky q-lk-qn an unchanged. XIL 424 OWE 0,21305,XtAmerica, Inc. ENDORSEMENT 4rrBB This endorsement effective 12r-DI a.m_June 11,2017,forms a par,of Policy Number LIG4300103271-117A issued to TARVEIT ENTERPRISES,INC.by XL insurance America.Inc. THIS ENDORSEMENT CHANGES THE POLICY, PL GE READ 17 CAREFULLY. CANCELLATION NOTIFICATION TO OTHERS ENDORSEMENT In the event cover-age is cancelled foranystatuturfly perm-ftc-d reason,other than nonpaymen m t of preium, advanced watt en notx ill be m&led or delivered to person(s)or enWies,,according to the noffc:ktion schedule shown below: NumberofDays Name of Person(s)or Entity(.*ees) Mailing Address- Advanced ofcanoellazion� City,DfEl Segundo Attn: Ken Berkman,Interim Public 30 Work Director 35 M&-in Street El Segundo,CA 90245 I. II II II II An offierterms and conditions crfthe Policy remain unchanged. IM 4115 491 0&1 V-2017 AP Q- 2010 X-L.America,Inc. Afl Rights Reserved. May not be copied without perrmssion- POLK;Y NVMDER; W-CAPOMMA-TIL-16 CO)AMERCAL AUTO THIS ENDORSEMENT CHANGES THE POLICY.PtEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED -PRIMARY AND NON-CONTRIBUTORY WITH OTHER INSURANCE 7hs endorsenwit rro,,i"ies insurance prcv�cpc underthe fd owng_ BUSINESS AU70 COVERAGE FORM PROVISIONS 2- The fiolloving is adde4 to Parapapn B.5.,Other 1. The follomwing,is added to Paragrapm A-1'e-,Who Irmurance of SECTI(M IV-BUSINESS AUTO Is An t reA of SECTION It — COVERED CONDRIONS: AUTOS LIABILITY COVERAGE. Regardless of 0*provml onrs of pwagrapi a, and Tr's kooludes,any person or organization who you pxaograv,&of this part 5-Other insurance,this am rcqj-ec under a written crmtraa or insurance is priffory to and non-contrbumry with ,i, appl,cable, other insurance under vwmch an .Toement tewevn you and " person or organ' on, that is signed by you before ifionaJ insured o�rscjn or organization 's the 'bodily injLW or"propefty darrage occurs arcs first nanwl insured when the written"tact or mv is in*.f d ur rq the-pol oy Wivc,to n arne a7ec4nerwt becom.—P you and Ihat person or as � additoma; nsured for Covered A,.,,os trga at,on, that * signed by you befwe tK-- Liab Ity Ccvea2e,but or,:ly for ziama r_s to whin* 'bw'y or'p o�-rly camage' mc�,,s am this insuramp apoies and only to The extent of ttat is in;,4d during The policy period,requiTes triat persor's of organizlions liaWky f4m,the this insurance to be pnmwy and non-comt.iory. amdu&.gf anwher-mmumd'- CA T4 74 02 IQ 0.2.u�E Tme Page I of I dna dCEt COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. BLANKET WAIVER OF SUBROGATION This endorsement modi"des invaranoe provided under the following- AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM The fiallowing replasoes Paragraph A.5., Transfer of required of you by a wrden contract execut ed Rights Of Recovery Against Otherr To Us,of the prior ID any"amcldent'or'loss'.provided that the CONDMONS Section: 'accidenr or 1ass' arises out of the operalons 5- Transfer Of Rights Of Recovery Against Oth- contemplated by such cantract- The waiver ap- ers To Us plies only to the person or organization desip- We waive any right of re=ver� we may have nated in such contract- against any person or organization to the extent CA 3 3 40 02 15 0 2015 The Travelears M"n.ty c .r;ony.Ail rightr reseroel. Page 1 of I �"Oudes copylotted matedal of Maxance Sergo--fi OZOe,ft,WM*2 PeM I&SW WORKERS COMPENSATION "far hc Au.m.r2hnvkr*GfwP AND EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 99 03 76(00) POLICY NUMBER: TC2HUB823K310616 POLICY EFFECTIVE DATE: 9/28/2016 NAMED INSURED: Fielditurf USA, Inc. WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT— CALIFORNIA (BLANKET WAIVER) 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. 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 %of the California workers' compensation premium otherwise due on such remuneration. Schedule Person or Organization Job Description City, its officers, officials, employees, agents and Project: El Segundo Athletic Fields Turf volunteers Replacement 0