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PROOF OF INSURANCE (2018 - 2018) CLOSED
C�- "R CERTIFICATE OF LIABILITY INSURANCE DATE /YYYY) 11/03/2017 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 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). PRODUCER Phone: (619)937-4000 Fax: (619)937-4001 CONTACT Olivia Rodriguez ENCIRCLE INSURANCE SERVICES,INC.DBA: ISU INSURANCE SERVICES PHONE(AJBx) (619)937-4000 FAX IfAJO Nn) (619)937-4001 1010 PIONEER WAY E-MAJL Olivia@isuencircle.com EL CAJON CA 92020-1923 INSURERS) AFFORDING COVERAGE �I NAIC# Agency Uc#:OB27816 INSURER -COLONY INSURANCE INSURED TURF TEAM,INC. INSURER :NORGUARD INSURANCE COMPANY 31470 DBA DIAMOND CUT MAINTENANCE INSURER SCOTTSDALE INSURANCE CO. 26500 W.AGOURA ROAD,#429 INSURER D: m CALABASAS CA 91301 II INSURER E V INSURER F COVERAGES CERTIFICATE NUMBER: 24196 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. INSR ADD'L SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER LIMITS „ (MMIDD/YVYI') IMMIDDIVYMYI A GENERAL LtABI'LITY GL004679702 02/11/17 02/11/18 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY D""'pAI.iE TO RENTED 100,000 PREMISES dMSa aa.e:umrrrlr.eB $ CLAIMS-MADE X OCCUR MED EXP(Anyone person) $ 5,000 PERSONAL&ADV INJURY $ 1,0009000 GENERAL AGGREGATE $ 2,0009000 GEN'L AGGREGATE LIMIT APPLIES PER. PRODUCTS-COMP/OP AGG $ 2,000,000 X POLIC`f ----- --- � LOC: $' AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea..Went) $ ANY AUTO BODILY INJURY(Per person) 5 AI.��OWNED Sol'I@,:I'.'rl�ll.tm:0 AIJ.I.f.1,S, AUI'17S BODILY INJURY(Per accident) $ HIRED AUTOS NG:YN CIVwtVED PROPER IY DAMAGE JAI1'8"G,S lPani,attiiderwl $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION TUWC898512 02/05/17 02/05/18 X tQ�r�YLTIm'Ir', ,,::J:l� LI,,, AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNER/EXECUTIVE YIN E L EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? WA E L DISEASE-EA EMPLOYEE $ gManmalory in NH) 1,000,000 II yes,d—ribe under DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT $ 1,000,000 C EQUIPMENT FLOATER CPS2609598 02/11/17 02/11/18 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) THE CITY OF EL SEGUNDO,ITS OFFICERS,OFFICIALS,EMPLOYEES,AGENTS,AND VOLUNTEERS ARE NAMED AS ADDITIONAL INSURED ONLY M THEIR INTERESTS MAY APPEAR. ***30 DAY NOTICE OF CANCELLATION FOR NON PAYMENT OF PREMIUM. CERTIFICATE HOLDER CANCELLATION THE CITY OF EL SEGUNDO SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 350 MAIN STREET THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN EL SEGUNDO,CA 90245 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Attention: I Paul M. Caccamise ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD THIS ENDORSEMENT CHANGES THE POLJCY. PLEASE READ IT CAREFULLY. TRANSFER OF RIGHTS OFRECOVERY AGAINST OTHERSTO SIS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV— tions: We waive any rights of recovery we may have against any person or organization because of payments we make for injury or damage resulting from your ongoing operations or "your work" done under a contract with that person or organization and included in the "products-completed operations hazard" if: a. you agreed to such waiver; b. the waiver is included as part of a written contract or lease; and c. such written contract or lease was executed prior to any loss to which this insurance applies. ALL OTHER TERMS AND CONDITIONS OFTHE POLICY REMAIN UNCHANGED, U047-0310 Includes copyrighted material of ISO Properties, Inc., Page 1 of 1 with its permission. Insured THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEESOR CONTRACTORS SCHEDUL., PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE ��`" Name of Additional Insured Person(s) or Organization(s) (Additional Insured): Location(s) of Covered Operations: "ALL PERSONS OR ORGANIZATIONS AS "AS DESIGNATED IN WRITTEN REQUIRED BY WRITTEN CONTRACT WITH CONTRACT WITH THE NAMED THE INSURED" INSURED" A. SECTION II -WHO IS AN INSURED is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule for whom you are performing operations when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy. Such person or organization is an additional insured only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" casued, 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. A person's or organization's status as an additional insured under this endorsement ends when your operations for that additional insured are completed. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to: Additional Insured Contractual Liability "Bodily injury" or "property damage" for which the additional insured(s) are obligated to pay damages by reason of the assumption of liability in a contract or agreement. Finished Operations or Work "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. Negligence of Additional Insured "Bodily injury" or "property damage" arising directly or indirectly out of the negligence of the additional insured(s). ALL OTHER TERMS AND CONDITIONS OFTHE POLICY REMAIN UNCHANGED. U156-0310 Includes copyrighted material of ISO Properties, Inc., Page 1 of 1 with its permission. Insured %%SequenceNumber F 0003629CACCFIMV1595155-0400000 Financial Indemnity Company Financial Indemnity Company Administrative Offices Located At: 8360 LBJ Freeway, Suite 400 a part of Kemper specialty Dallas,TX 75243 Mail Correspondence To: PO BOX 223687 California Commercial Vehicle Policy Dallas,TX 75222-3687 Renewal Declaration Page Summary Named Insured(s) Your Agent/Broker TURF TEAM INC HARVEST INS AGY INC 3863 COTTONWOOD GROVE TRL 2820 TOWNSGATE 205 AGOURA HILLS CA 91301-5309 WESTLAKE VILLAGE CA 91361 805-496-9646 Policy Number Renewal of Policy Number Policy Period CCFIMV1595155-04 CCFICR1595155-03 From 08/30/2017 to 08/30/2018 12:01 a.m.standard time at the address of the named insured as stated herein. Policy,Endorsements,and Amendments Attached to Policy ABRTS(05/15) Auto Body Repair Consumer Bill Of Rights CA-650(04/12) Policy Amendatory Endorsement CA-651 (04/12) Employer's Non-Ownership Liability CA-9(04/12) Amendatory Endorsement-Termination Provision CA-999 04/12 POIIC Amendatory Endorsement* I *This form provides you with Information explainirrg additional fees that may apply. ( ) Y ry Please read it carefa�irI U-642(10/03) Designated Insured Endorsement U-644(12/03) Single Limit Of Liability U-652(12/03) Hired Car Coverage U-672 (04/12) California Commercial Auto Policy U-679 (12/03) Waiver Of Subrogation U-784 (07/03) Exclusion of Certified Act of Terrorism Total Premium and Fees Premium for all Vehicles(See Total Coverage Premium) $4, 265. 00 Policy Fee $80 00 Additional Insured Fee $75 , 00 Waiver of Subrogation Fee $60 . 00 Vehicle Assessment Fee $5. 28 Additional Endorsements(Coverage not shown in the Coverage Premium Schedule) $314 . 00 Discount(s)/Surcharge(s)Applied To This Policy General Liab or Business Owner Policy Total for this Policy Term $4, 799.28 In return for the payment of the premium and subject to all the terms of this policy, we agree with you to provide the insurance as stated in your policy documents. Declarations Print Date: 07/31/2017 CA-865 (04/12) Page 1 of 4 FORM:SDOCS.DECPGE Insured's Copy %%SequenceNumber F 0003629CACCFIMV1595155-0400000 "Important: The Limits shown in this Declaration for Part I-Liability Coverage, Part III-Uninsured Motorist and Underinsured Motorist Coverage, may be subject to reduction to the Minimum Financial Responsibility Limits specified by your state of$15,000 per person, $30,000 per accident and$5,000 for property damage for any losses involving a user of any vehicle,which qualifies as an insured vehicle in this Declaration and in other provisions of your policy,who is not listed on this Declaration as a driver. CA-855 (04/12) Page 2 of 4 Insured's Copy %%SequenceNumber F 0003629CACCFIMV1595155-0400000 Financial Indemnity Company Policy Number: CCFIMV1595155-04 Your Agent/Broker: HARVEST INS AGY INC Policy Effective Date: 08/30/2017 805-496-9646 Coverage is only provided where a limit of liability and a premium are shown for the coverage. Coverage Limits Premium Part I-Liability Coverage Combined Single Limit(LIAB) $1 , 000, 000 Each Accident $3 , 192 Part II-Medical Payments/Personal Injury Protection Medical Payments(MED) $5, 000 Each Person $63 Part III-Uninsured/Underinsured Motorist Coverage non-stacked Bodily Injury(LIMBI) $1 , 000, 000 Each Person $435 $1 , 000, 000 Each Accident PROPERTY DAMAGE(UMPD) See Schedule Each Accident $7 Part IV-Coverage For Damage to Your Auto Other Than Collision(OTC) See Schedule Deductible Applies $225 Collision(COL) See Schedule Deductible Applies $343 Part V-Waiver of Collision Deductible(with limits the same as Part III-Property Damage)(CDW) ADDITIONAL COVERAGE(S) Employee Non Owner(ENO) Up to the Liab limits per endorsement $233 Hired Car(HC) Up to the Liab limits per endorsement $81 Total Coverage Premium $4, 579 "Important: The Limits shown in this Declaration for Part I-Liability Coverage; Part III-Uninsured Motorist and Underinsured Motorist Coverage, may be subject to reduction to the Minimum Financial Responsibility Limits specified by your state of$15,000 per person, $30,000 per accident and$5,000 for property damage for any losses involving a user of any vehicle,which qualifies as an insured vehicle in this Declaration and in other provisions of your policy,who is not listed on this Declaration as a driver. .......-.............. .. LEGEND: • INC-Included . EXCL-Excluded • NCV-No Coverage • NA-Not Applicable . ACV-Actual Cash Value • Y-Yes • N-No . DED-Deductible • SCHD-Schedule . NP-Named Perils CA-855 (04/12) Page 3 of 4 Insured's Copy %%SequenceNumber F 0003629CACCFIMV1595155-0400000 Financial Indemnity Company Policy Number: CCFIMV1595155-04 Your Agent/Broker: HARVEST INS AGY INC Policy Effective Date: 08/30/2017 805-496-9646 Coverage is only provided where a limit of liability and a premium are shown for the coverage. SCHEDULE OF VEHICLES COVERED Veh Garage Gar Radius Lien/ Vehicle VIN Vehicle (DEDUCTIBLES) Num Zip Tarr Max Lose Description Assessment OTC/NP COL UMPD Payee $ $ $ $ 8728 91301 NA 50 N 2004 FORD F-250 1FTNW21P14EC88728 ACV 250 250 NCV 1557 91301 NA 50 N 2005 FORD F-250 iFTSX205X5ED01557 ACV 250 250 NCV 0316 91301 NA 500 N 2011 FORD F-250 iFT7W2BT2BEA30316 ACV 250 250 NA COVERAGE PREMIUMS Coverage is provided only for those vehicles where a premium amount is shown for the coverage. CDW/ UMPD TOTAL Veh LIAB MED UMBI UMPD OTC COL LIMIT PREM Num $ $ $ $ $ $ $ $ 8728 985 19 145 NCV 72 86 NCV 1,307 1557 900 18 145 NCV 60 79 NCV 1,202 0316 1307 26 145 7 93 178 250 1,756 LISTED DRIVER(S) FINANCIAL VIOLATION/ DRIVER RESPONSIBILITY DRIVER ACCIDENT DRIVER LICENSE NO. DATE OF BIRTH FILING STATUS POINTS TONATIUH G GREGORIO CASTREJON F8365030 09/30/1976 N INSURED O NANCY VIGIL N4490097 12/25/1957 N INSURED O BERT VIGIL V8129512 01/08/1960 N INSURED 0 ADDITIONAL INTEREST(S) TYPE VEHICLE NAME/ADDRESS CITY STATE ZIP Additional Insured ALL CITY OF EL SEGUNDO 350 MAIN ST EL SEGUNDO CA 90245 Additional Insured ALL LOS ANGELES COMM COLLEGE DISTR 770 WILSHIRE BLVD LOS ANGELES CA 90017 Additional Insured ALL VENTURA COUNTY COMMUNITY COLLE 255 W STANLEY AVE STE 150 VENTURA CA 93001 Waiver of Subro ALL CITY OF EL SEGUNDO 350 MAIN ST EL SEGUNDO CA 90245 Waiver of Subro ALL LOS ANGELES COMM COLLEGE DISTR 770 WILSHIRE BLVD LOS ANGELES CA 90017 ..-............_............... _ LEGEND: • INC-Included • EXCL-Excluded . NCV-No Coverage • NA-Not Applicable • ACV-Actual Cash Value • Y-Yes . N-No . DED-Deductible • SCHDSchedule • NP-Named Perils CA-855 (04/12) Page 4 of 4 Insured's Copy WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed.4-84) 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 shall be i.o_5a/o of the California workers' compensation premium otherwise due on such remuneration. Schedule Person or Organization Job Description The City of EI Segundo 350 Main Street, EI Segundo, CA 90245 This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise slated. (The information below Is required only when this endorsement Is Issued subsequent to preparation of the policy.) Endorsement Effective Policy No, TUWC898512 Endorsement No. Insured Insurance Company Countersigned By ©1998 by the Workers'Compensation Insurance Rating Bureau of California.All rights reserved.