PROOF OF INSURANCE (2018 - 2018) CLOSED ARCPLUM-01 PPE'RE'Z
CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDMW) V
10104/2017
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(les)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).
License#OC36891 _�_.. N cp ACT
PRODUCER NAMJ, Pati Perez
L dd Martin Company PHONE FAX
2Q300 Ventura Blvd,Suite 340 (AIC,No,Est):(310)548-1959 I= Nc),(310)548-1346
Woodland Hills,CA 91364 Mss;patiQlyddymartin.com
INSURER($),AFFORDING COVERAGE NAIC#
INSURER A:Nationwide Mutual Insurance Company ,23787
INSURED INSURERB:AMCO Insurance Company„ ,19100
Ruben Chavarin, DBA, ARC Plumbing INSURERC:Twin City Fire Insurance Company 29459
3124 Rosecrans Avenue INSURER D:
Hawthorne,CA 90250
' INSURER E
INSURER F:
COVERAGES CERTIFICATE NUMBED: 1 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,
I
EXCLUSIONS LICYEXP
JOB ,APDOCO CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY NUMBERVE BEEN REDUCED F PMOL Cc IMS. LIMITS
A X COMMERCIAL GENERAL LIABILITY 1,000,000
EACH OCCURRENCE �S
CLAIMS-MADE X !OCCUR ACPGL03008333597 07/18/2017 07/18/2018 DAMAGE TO RENTED 100,000
X X PREMISES Me or trreme) $
MED EXP(Any,one person), „$ 5,000
PERSONAL,BADV,INJURY $, 1,000,000
1-1LOC
$ 2,000,000
POLICY jP y 2,000,000 LOC PRODUCTS L
AGGREGATEi GENERALAGGREGA
O'THE'R $
A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000
(Ed sssa:llont) $
ANY AUTO X X ACPBA3008333597 07118/2017 07/18/2018 BODILY INJURY(Per,person)
OWNED X SCHEDULED
AUTOS ONLY AUTOS BODILY INJURY(Per accident),�
X AURTOS ONLY X A 'fO�N Y' (t asO R MtOAMAGE $
B X UMBRELLA LIAB OCCUR EACH OCCURRENCE , 1'000'000
EXCESS LIAR CLAIMS-MADE ACPCAA3008333597 07/18/2017 07/18/2018
AGGREGATE $
DED RETENTIONS $ 1,000,000
C WORKERS COMPENSATIONPER OTH-
AND EMPLOYERS'LIABILITY YIN X STATUTE ER
72WECZ19068 04/01/2017 04/01/2018 1,000,000
ANY CCPROPREI ffl)l EXCLUDED?ECUTIVE E 1. EACHACCIDENT S
IandaMry In NH) CLUDED7 NIA 1,000,000
E L DI'S'EASE-EA EMPLOYEE S
If yyes,deschbe under 1,000,000
DESCRIPTION QE,OPERATIONS Wow E L DISEASE-POLICY LIMIT S
mmDESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Addltlonal Remarks Schedule,may be attached 11 mom swee Is to abed)
The City Of El Segundo,a general law city and municipal corporation("City"")are named as addi'tion'al pVnsuredIN)as pertains to general liability per the
attached blanket additional insured endorsements CG 73 2312 16.
I
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION ATE NO
City Of EI Segundo ACCORDANCE WITH THE POLICY PROVI3 ONSCE WILL BE DELIVERED IN
350 Main Street
EI Segundo,CA 90245
AUTHORIZED REPRESENTATIVE
ACORD 25(2016/03) ®1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
COMMERCIAL GENERAL LIABILITY
CG 73 23 12 16
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CONTRACTORS ENHANCEMENT PLUS ENDORSEMENT
INCLUDING MEDICAL PAYMENTS
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
A. Lost Key Coverage D. Expanded Property Damage Coverage
1. Under Section I —Coverages, Coverage A 1. For the purposes of this endorsement only:
Bodily Injury And Property Damage Section I — Coverages, Coverage A
Liability, coverage is extended to include Bodily Injury And Property Damage
the following: Liability, 2. Exclusions, Exclusion j.
If a customer's master or grand key, Damage To Property is amended as follows:
excluding electronic key card, is lost, a. Paragraphs(3), (5), and (6)are deleted
damaged or stolen while in your care, in their entirety.
custody or control we will pay the cost of b. Paragraph (4) is deleted in its entirety
replacing the keys, including the master lock and replaced with:
and all keys used in the same lock, the cost (4) Personal property in the care,
of adjusting locks to accept the new keys, or custody, or control of the insured:
the cost to replace the locks, whichever is
less. (a) for storage or sale at premises
2. Limit of Insurance—For the purpose of this you own, rent or occupy; or
coverage the most we will pay is $ 10,000 (b) while being transported by any
per"occurrence". aircraft, "auto" or watercraft
B. Voluntary Property Damage owned or operated by or rented
1. Section I — Coverages, Coverage A Bodily to or loaned to any insured.
Injury And Property Damage Liability, c. The coverage provided by this
coverage is extended to include the following: endorsement does not apply to
"property damage .
At your request, we will pay for "property (1) Arising out of the disappearance or
damage to property of others caused by you loss of use of personal property; or
and while in your possession, arising out of your
business operations and occurring during the (2) Included in the "products-completed
policy period. operations hazard".
2. Limit of Insurance—For the purpose of this 2. Limit of Insurance - The most we will pay
coverage the most we will pay is$1,500 per for loss arising out of any one "occurrence"
"occurrence". is$5,000.
C. Non-Owned Watercraft 3. Deductible - Our obligation to pay for a
Under Section I — Coverages, Coverage A covered loss applies only to the amount of
Bodily Injury And Property Damage Liability, loss in excess of$250.
2. Exclusions, Exclusion g. Aircraft, Auto Or We will pay the deductible amount to effect
Watercraft Paragraph(2)(a) is replaced with: settlement of any claim or "suit" and, upon
(a) Less than 51 feet long; and notification of this action having been taken,
you shall promptly reimburse us for the
deductible as has been paid by us.
CG 73 23 1216 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 5
with its permission.
CG 73 23 12 16
This insurance is primary to any expanded d. All reasonable expenses incurred by the
property damage coverage provided by a insured at our request to assist us in the
separate endorsement attached to this investigation or defense of the claim or
policy, and it will supplant any deductible in "suit", including actual loss of earnings up to
said endorsement $500 a day because of time off from work.
E. Damage To Premises Rented To You G. Newly Formed And Acquired Organizations
1. Under Section I —Coverages, Coverage A Under SECTION II — WHO IS AN INSURED
Bodily Injury And Property Damage Paragraph 3.a. is replaced with:
Liability, the last paragraph of 2. a. Coverage under this provision is afforded
Exclusions is replaced with: only until the 1801h day after you acquire or
If Damage To Premises Rented To You is form the organization or the end of the policy
not otherwise excluded, Exclusions c. period, whichever is earlier;
through n. do not apply to damage by fire, H. Additional Insured — Automatic Status When
lightning, explosion, smoke, or sprinkler Required In An Agreement Or Contract With
leakage to premises while rented to you or You
temporarily occupied by you with permission Section II —Who Is An Insured is amended to
of the owner.
include:
2. Under Section III — Limits Of Insurance, 1. Any person(s)or organization(s)described
Paragraph 6 is replaced with: in Paragraph a.—d. below with whom you
6. Subject to 5. above, the Damage To have agreed in writing in a contract or
Premises Rented To You Limit is the written agreement that such person or
most we will pay under Coverage A for organization be added as an additional
damages because of"property damage" insured on your policy during the policy
to any one premises, while rented to period shown in the Declarations.
you, or in the case of damage by fire, 2. Any other person or organization you are
lightning, explosion, smoke or sprinkler required to add as an additional insured
leakage, while rented to you or under the contract or agreement described
temporarily occupied by you with in Paragraph 1.above.
permission of the owner. The limit is The person or organization added as an
increased to$1,000,000. insured by this endorsement is an insured
3. Under Section IV — Commercial General only for liability due to:
Liability Conditions, 4. Other Insurance, b. a. Lessors of Leased Equipment — with
Excess Insurance (1) (a) (ii) is replaced
with: respect to their liability for"bodily injury",
"property damage", or "personal and
(ii) That is Fire, Lightning, Explosion, Smoke advertising injury", caused in whole or in
or Sprinkler leakage insurance for part by your maintenance, operation, or
premises rented to you or temporarily use of equipment leased to you by such
occupied by you with permission of the person(s) or organization(s). This
owner. insurance does not apply to any
F. Supplementary Payments "occurrence" which takes place after the
Under Section I — Coverages, Supplementary equipment lease expires.
Payments — Coverages A and B Paragraphs However, their status as additional
1.b and 1.d. are replaced with: insured under this policy ends when
b. Up to $2,500 for cost of bail bonds required their lease, contract, or agreement with
because of accidents or traffic law violations you for such leased equipment expires.
arising out of the use of any vehicle to which b. Managers or Lessors of Premises —
the Bodily Injury Liability Coverage applies. with respect to liability arising out of the
We do not have to furnish these bonds. ownership, maintenance, or use of that
part of the premises you own, rent,
lease, or occupy.
Page 2 of 5 Includes copyrighted material of Insurance Services Office, Inc., CG 73 23 12 16
with its permission.
CG 73 23 12 16
This insurance does not apply to: (1) Your acts or omissions; or
(1) Any "occurrence" which takes place (2) The acts or omissions of those
after you cease to be a tenant in acting on your behalf; in the
that premises. performance of your ongoing
(2) Structural alterations, new con- operations performed for that
struction, or demolition operations additional insured, whether the work
performed by or on behalf of the is performed by you or on your
person or organization. behalf.
However, their status as additional The insurance does not apply to:
insured under this policy ends when you (1) "Bodily injury", "property damage",
cease to be a tenant of such premises. or "personal and advertising injury"
c. State or Political Subdivision — arising out of the rendering of or the
Permits Relating to Premises — with failure to render any professional
respect to the following hazards for architectural, engineering, or survey
which the state or political subdivision services, including:
has issued a permit or authorization in (a) The preparing, approving, or
connection with premises you own, rent, failing to prepare or approve
or control and to which this insurance maps, shop drawings, opinions,
applies. reports, survey, field orders,
(1) The existence, maintenance, repair, change orders, or drawings and
construction, erection, or removal of specifications; or
advertising signs, awnings, (b) Supervisory, inspection, archi-
canopies, cellar entrances, coal tectural or engineering activities.
holes, driveways, manholes, This exclusion applies even if
marquees, hoist away openings, the claims against any insured
sidewalk vaults, street banners, or allege negligence or other
decorations and similar exposures; wrongdoing in the supervision,
or hiring, employment, training or
(2) The construction, erection, or monitoring of others by that
removal of elevators; or insured, if the "occurrence"
(3) The ownership maintenance or use which caused the "bodily injury"
of any elevators covered by this or "property damage", or the
insurance. offense which caused the
"personal and advertising
This insurance does not apply to: injury", involved the rendering
(1) "Bodily injury" or "property damage" of, or failure to render, any
or "personal or advertising injury" professional, architectural,
arising out of operations performed engineering, or surveying
for the state or municipality; or services.
(2) "Bodily injury" or "property damage" (2) "Bodily injury" or"property damage"
included within the "products- occurring after:
completed operations hazard". (a) All work, including materials,
However, such state or political parts, or equipment furnished in
subdivision's status as additional connection with such work, on
insured under this policy ends when the the project (other than service,
permit ends. maintenance, or repairs) to be
d. Owners, Lessees, or Contractors — performed by or on behalf of the
with respect to liability for"bodily injury", additional insured(s) at the
location of the covered
to damage", or "personal and operations has been completed;
advertising injury" caused in whole or in or
part, by:
CG 73 23 12 16 Includes copyrighted material of Insurance Services Office, Inc., Page 3 of 5
with its permission.
CG 73 23 12 16
(b) That portion of "your work" out b. You have agreed in writing in a contract
of which the injury or damage or agreement that this insurance would
arises has been put to its be primary and would not seek
intended use by any person or contribution from any other insurance
organization other than another available to the additional insured.
contractor or subcontractor I. Employee Bodily Injury To Another Employee
engaged in performing Under Section II — Who Is An Insured The
operations for a principal as a
part of the same project. following is added to Paragraph 2.a.(1):
However, a person or organization's Paragraphs 2.a.(1) (a), (b) and (c) do not apply
status as additional insured under to "bodily injury" to a co"employee" in the
this policy ends when your course of the co-"employee's" employment by
operations for that additional insured you, or to "bodily injury" to a co-"volunteer
are completed. worker" while performing duties related to the
With respect to the insurance afforded to conduct of your business.
such additional insureds a. — d. described J. Broad Form Named Insured
above, the following is added to Section III Under Section II — Who Is An Insured The
—Limits Of Insurance: following is added to Paragraph 2.:
If coverage provided to the additional e. Any business entity incorporated or
insured is required by a contract or
agreement,the most we will pay on behalf of organized under the laws of the United State
the additional insured is the amount of of America (including any State thereof), its
territories or possessions, or Canada
insurance: (including any Province thereof) in which the
1. Required by the contract or agreement; Named Insured shown in the Declarations
or owns, during the policy period, an interest of
2. Available under the applicable Limits of more than fifty percent. If other valid
Insurance shown in the Declarations: collectible insurance is available to any
whichever is less. business entity covered by this solely by
This endorsement shall not increase the reason of ownership by the Named Insured
applicable Limits of Insurance shown in the shown in the Declarations in excess of fifty
Declarations. percent, this insurance is excess over the
However, the insurance afforded to such other insurance, whether primary, excess,
additional insureds a.—d. described above: contingent, or on any other basis.
1. Only applies to the extent permitted by K. Aggregate Limit Per Location
law; and Under Section III — Limits Of Insurance the
2. Will not be broader than that which you following is added to Paragraph 2:
are required by the contract or The General Aggregate Limit under Section III
agreement to provide for such additional Limits Of Insurance applies separately to each
insured. of your locations owned by or rented to you or
3, Primary and Noncontributory — Other temporarily occupied by you with the permission
Insurance Conditions of the owner. For the purposes of this provision,
The following is added to the Other location means premises involving the same or
Insurance Condition and supersedes any connecting lots, or premises whose connection
provisions to the contrary: is interrupted only by a public street, roadway,
Primary and Noncontributory Insurance waterway or railroad right-of-way.
This insurance is primary to and will not L. Aggregate Limit Per Project
seek contribution from any other insurance Under Section III — Limits Of Insurance The
available to an additional insured under your following paragraph is added to Paragraph 2:
policy provided that: The General Aggregate Limit under Section III
a. The additional insured is a Named Limits Of Insurance applies separately to each
Insured under such other insurance; and of your construction projects away from
premises owned by or rented to you.
Page 4 of 5 Includes copyrighted material of Insurance Services Office, Inc., CG 73 23 12 16
with its permission.
CG 73 23 1216
M. Medical Payments inception date of the policy shall not
Under Section III — Limits Of Insurance, prejudice the coverage afforded by this
Paragraph 7. is replaced with: policy provided such failure to disclose all
7. Subject to 5. above, the higher of: hazards or prior"occurrences" or offenses is
a. $10,000; or not intentional. This provision does not
affect our right to collect additional premium
b. The amount shown in the Declarations or exercise our right of cancellation or non-
for Medical Expense Limit is the most renewal.
we will pay under Coverage C for all P. Waiver Of Subrogation
medical expenses because of "bodily Under Section IV — Commercial General
injury" sustained by one person. Liability Conditions, 8. Transfer Of Rights Of
This coverage does not apply if Coverage C Recovery Against Others To Us the following
— Medical Payments is excluded either by paragraph is added:
the provisions of any coverage forms If required by a written contract executed prior to
attached to the policy or by endorsement. loss, we waive any right of subrogation we may
N. Knowledge Of An Occurrence have against the contracting person or
Under Section IV — Commercial General organization because of payments we make for
Liability Conditions, the following is added to injury or damage arising out of your ongoing
2. Duties In The Event Of Occurrence, operations or "your work" done under a contract
Offense,Claim Or Suit: with that person or organization and included in
e. Knowledge of an occurrence, offense, claim the"products-completed operations hazard".
or suit by an agent or employee of any Q. Liberalization
insured shall not in itself constitute Under Section IV — Commercial General
knowledge of the insured unless you, a Liability Conditions, the following paragraph is
partner, if you are a partnership; or an added:
executive officer or insurance manager, if 10. Liberalization
you are a corporation receives such notice
of an occurrence, offense, claim or suit from If we revise this coverage form to provide more
the agent or employee. coverage without additional premium charge,
f. The requirements in Paragraph b. will not your policy will automatically provide the
be considered breached unless there is additional coverage as of the day the revision is
knowledge of occurrence as outlined in effective in your state.
Paragraph e. above. R. Broadened Bodily Injury Definition (Mental
O. Unintentional Failure To Disclose Hazard Anguish)
Under Section IV — Commercial General Under Section V — Definitions Definition 3.
Liability Conditions, Condition 6. "Bodily Injury" is replaced with:
Representations the following paragraph is 3. "Bodily injury" means physical injury,
added: sickness, or disease to a person and if
d. Your failure to disclose all hazards or prior arising out of the foregoing, mental anguish,
"occurrences"or offenses existing as of the mental injury, shock, or humiliation,
including death at any time resulting
therefrom.
All terms and conditions of this policy apply unless modified by this endorsement.
CG 73 23 12 16 Includes copyrighted material of Insurance Services Office, Inc., Page 5 of 5
with its permission.
it
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
WAIVER OF OUR RIGHT TO RECOVER FROM
OTHERS ENDORSEMENT - CALIFORNIA
Pollcy Number: 72 WEC ZI9068 Endorsement Number:
Effective Date: 04/01/16 Effective hour is the same as stated on the Infonnetlon Page of the policy.
Named Insured and Address: RUBEN CHAVARIN
DBA ARC PLUMBING
3124 W ROSECRANS AVE STE B
HAWTHORNE, CA 90250
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 shall be 2 % of the California workers' compensation
premium otherwise due on such remuneration.
SCHEDULE
Person or Organization Job Description
ANY PERSON OR ORGANIZATION AS REQUIRED BY WRITTEN
FROM WHOM YOU ARE REQUIRED CONTRACT.
BY WRITTEN CONTRACT OR
AGREEMENT TO OBTAIN THIS
WAIVER OF RIGHTS FROM US.
Countersigned by
Authorized Representative
Form WC 04 03 06 (1) Printed in U.S.A.
Process Date: 04/15/16 Policy Expiration Date: 04/01/17