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PROOF OF INSURANCE (2018) CLOSED Certificate of Insurance THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON YOU THE CERTIFICATE HOLDER THIS CERTIFICATE IS NOT AN INSURANCE POLICY AND DOES NOT AMEND,EXTEND,OR ALTER THE COVERAGE AFFORDED BY THE POLICIES LISTED BELOW.POLICY LIMITS ARE NO LESS THAN THOSE �IJSTFD,Al THOUGH POI.TCTFS MAY INCT,.IIDF ADDITIONAI.SI BLIMIT/LIMITS NOT LISTED BELOW. This is to Certify that WEST COAST ARBORISTS, INC 2200 EAST VIA BURTON NAME AND "'„� ANAHEIM VI 9 ADDRESS OFINSURED L -II INSURANCE is,at the issue date ofthis certificate,insured by the Company under Che p olicp(ica,)listed bellow. The insurance afforded by the listed policy(ies)is subject to all their terms,exclusions and Conditions and is not altered by any requirement,tenon m i aondrtron of imv cfj.iva Qi or other document with respect to which this certificate may be issued, EXP DATE TYPE OF POLICY ❑CONTINUOUS POLICY NUMBER LIMIT OF LIABILITY [:]EXTENDED ❑POLICY TERM WORKERS 7/1/2018 WA7-66D-039499-077 COVERAGE AFFORDED UNDER WC EMPLOYERS LIABILITY LAW OF THE FOLLOWING STATES: COMPENSATION All States Except. Bodily In my hw Accldenp Statutory Limits ND,OH,WA,WY �1.000.00OFarn AvridmR Bodily Injury By Disease $1.000,000 Pte” Bodily Injury By Disease $1.000,000 COMMERCIAL 7/1/2018 T132-661-039499-017 General Aggregate GENERAL LIABILITY $2,000,000 m OCCURRENCE Products/Completed Operations Aggregate $2,000,000 ❑CLAIMS MADE Each Occurrence $1,000,000 R F:I lCv)DATE I Personal&Advertising Injury $1,000,000 Per Person/Organization Other IOther Damagge to premises rented to Medical Expense$5,000 Y t 1 300.000 AUTOMOBILE7/1/2018 AS7-661-039499-037 Each Accident—single Limit LIABILITY $2,000,000 B.I.And P.D.Combined 21 Each Person OWNED ........ �m NON-OWNED Each Accident or Occurrence IJ HIRED Each Accident or Occurrence OTHER 7/1/2017-7/1/2018 TH7-661-039499-047 $5,000,000 Per Occurrence/Aggregate Umbrella Excess Liability ADDITIONAL COMMENTS See Addendum. •If the certificate expiration date is continuous or extended term,you will be notified if coverage is terminated or reduced before the certificate expiration date NOTICE OF CANCELLATION:(NOT APPLICABLE UNLESS A NUMBER OF DAYS IS ENTERED BELOW) Liber Mutual BEFORE THE STATED EXPIRATION DATE THE COMPANY WILL NOT CANCEL OR REDUCE THE Liberty INSURANCE AFFORDED UNDER THE ABOVE POLICIES UNTIL AT LEAST 30 DAYS NOTICE Insurance Group OF SUCH CANCELLATION HAS BEEN MAILED TO: FCity of EI Segundo 350 Main Street Elaine Ulan c EI Segundo CA 90245 Los Angeles/0603 AUTHORIZED REPRESENTATIVE f z 818 W 7th Street,Suite 850 0564408 Los Angeles CA 90017 213-443-0782 6/13/2017 LOFFICE PHONE DATE ISSUED This certificate is executed by LIBERTY MUTUAL INSURANCE GROUP as respects such insurance as is afforded by those Companies NM 772 07-10 36128761 1 LM_2819 1 7/17-7/16 - GL/2/1, AL/2, WC/1, U/5 I Donna Smitala 1 6/13/2017 11:20:48 AM (CDT) I Page 1 of 2 LDI COI 268896 02 11 AGENCY CUSTOMER ID: LOC#: ADDITIONAL REMARKS SCHEDULE Page of .......... NAMED INSURED Liberly Mutual Insurance Co.National Insurance West WEST COAST ARBORISTS,INC2200 EAST VIA BURTON POLICYNUMBER ANAHEIM CA 92806 CARRIER J'NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: NM FORM TITLE:Certificate of Casualty Insurance(07110) HOLDER: City of El Segundo ADDRESS:350 Main Street El Segundo CA 90245 ....... The City of El Segundo, its officials, and employees are additional insured with regards to general liability and automobile liability, as their interest may appear, where required by written contract. The insurance afforded by the general liability policy for the benefit of the additional insured shall be primary and non-contributory. Waiver of Subrogation is included in favor of the additional insured on workers compensation, where allowed by statute, and applies only to the specific jobs of the insured performed under written contract, and where applicable by law. ACORD 101 (2008/01) @ 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ADDENDUM 36128761 1 LM 2819 1 7/17-7/18 - GL/2/1, AL/2, WC/1, U/5 I Donna Smitala 1 6/13/2017 11:20:48 AM (CDT) I Page 2 of 2 POLICY NUMBER:T132-661-039499-017 COMMERCIAL GENERAL LIABILITY CG 2010 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONALLESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section 11 — 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 with work, on the project (other than service. 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: C. With respect to the insurance afforded to these 1. The insurance afforded to such additional additional insureds, the following is added to insured only applies to the erdent permitted by Section III—Limits Of Insurance: law;and If coverage provided to the additional insured is 2. If coverage provided to the additional insured is required by a contract or agreement, the most we required by a contract or agreement, the will pay on behalf of the additional insured is the insurance afforded to such additional insured will amount of insurance: not be broader than that which you are required 1. Required bythe contract or agreement;or by the contract or agreement to 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. SCHEDULE Name Of Additional insured Person(s) Location(s)Of Covered Operations Or Organization(s): Any owner.lessee,or contractor for whom you have Any location listed in such agreement agreed in writing prior to a loss to provide liability insurance Information required to complete this Schedule,if not shown above,will be shown in the Declarations. CG 2010 0413 0 Insurance Services Office, Inc.,2012 Page 7 of 1 POLICY NUMBER:AS7-661-039499-037 COMMERCIAL AUTO CA 20 48 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED FOR COVERED AUTOSLIABILITY COVERAGE This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement identifies person(s)or organization(s)who are"insureds"for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement does not alter coverage provided In the Coverage Form. SCHEDULE Name Of Persons)Or Organization(s): Any person or organization whom you have agreed in writing to add as an additional insured,but only to coverage and minimum limits of insurance required by the written agreement,and in no event to exceed either the scope of coverage or the limits of insurance provided in this policy. Information required to complete this Schedule,if not shown above,will be shown In the Declarations. Each person or organization shown in the Schedule is an"insured"for Covered Autos Liability Coverage,but only to the extent that person or organization qualifies as an"insured"under the Who Is An Insured provision contained in Paragraph A.1.of Section II - Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms and Paragraph D.2.of Section 1 - Covered Autos Coverages of the Auto Dealers Coverage Form. CA 20 48 10 13 ©Insurance Services Office, Inc.,2011 Page 1 of 1 POLICY NUMBER:TB2-661-039499-017 CON1 IM EF-11C.'11141M (,j4E11JF , I 1AF'.iH11 [1"Y' ,CG 20 37 04 13 THIS �IE'l�l�4DI",� ll::,11,,SE�INMIlll:..:..:.lil,i,r CHANGES I 1-41E 11:210111 ICYIP1 11""ASE READ I°li CAREF::I PILI N, INSUFCEI) �......... ()1W1qEF'ZS, I OR claq r1111AC,rims , COININ Ell EID 01PERA-110114S This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCT S/COMPLETED OPERATIONS LIABILITY COVERAGE PART A. Section 11 — Who Is An Insured is amended to 13. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the folloding is added to organization(s) shown in the Schedule, but only Section III—Limits Of Insurance: Frith respect to liability for "bodily injury, or If coverage prowl to the additional insured is "'properly damage" caLlSed, in whole or in part, [)y required by a contract or agreement, the rnosst we "your work" at the location designated and will 1jay 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 hazard'. 1. Required by the contract or agreement,or However: 2. Available under the applicable Limits of 1. The insurance afforded to such additional Insurance shown int Declarations, insured only applies to the e)dent permitted by whichever is less. law,and This endorsement shall not increase the applicable 2. If coverage provided to the additi(xial insured' is Limits of Insurance shown in the Declarations. required J)y a contract or agreernent, 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. 51CHIIEDIJI IE Name Of Additional insured Person(s) Or Organization(s): Location And Description Of Completed Operations All persons or organizations with whom you have All locations as required by a written contract or entered into a written contract or agreement, for to an agreement entered into prior to an occurrence or occurrence or offense,to provide additional insured offense. status. I nformation required to complete this Schedule,R not shown above,will be shown in the Declarations. (.:"',G ::20 37 a4 '13 0 Insurance Services Office,Inc.,2012 121aige 1 of 1 COMMERCIAL GENERAL LIABILITY CG 20 0104 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY INSURANCEOTHER This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance (2) You have agreed in writing in a contract or Condition and supersedes any provision to the agreement that this insurance would be contrary: primary and would not seek contribution Primary And Noncontributory Insurance from any other insurance available to the additional insured. This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance:and CG 20 0104 13 0 Insurance Services Office, Inc.,2012 Page 1 of 1 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 shah be 2% of the Califomia workers, compensation premium otherwise due on such remuneration. Schedule Additional premium is a percent of the Ca&fomia Manual Workers Compensation premium. Subject to a minimum premium charge of$250. Person or Organization Job Description Where required by contract or written agreement prior to loss and allowed by law Issued by Liberty insurance Corporation21814 For attachment to Policy No.WA7-66D-039499-077 EffecWe Date Premium$ Issued to West Coast Arborists,Inc. WC 04 03 06 Pa0e 1 of 1 Ed:0411984