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PROOF OF INSURANCE (2018) CLOSED �h. I DATE(MM/DD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE 1210612017
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 r�1
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED v
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. 0
IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)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 w
certificate does not confer rights to the certificate holder in lieu of such endorsement(s►.
PRODUCER CONTACT V D
Aon Risk Services, Inc of Florida ............................. °._.w....
1001 B ri ckel l Ba Drive W No.Ext): (866) 283-7122 I FAX <so0) 363-0105 y
Bay 'AIr°.Nom.....__..._. .. 2
Suite 1100 E-MAIL
Miami FL 33131 USA ADDRESS: _
INSURER(S)AFFORDING COVERAGE NAIC#
INSURED INSURERA: Starr Indemnity & Liability Company 38318
LandCare USA, INSURER B: XL Insurance America Inc 24554
a California General Partnership
5295 Westview Drive INSURER C:
..........................................-........................
Suite 100 INSURER D:
Frederick MD 21703 USA
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: 670059421336 REVISION NUMBER:
'HI's'IS'1'0 CEn'rIFY'ri-w''niE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN tSSUED TO THE INSORED 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 Limits shown are as requested
INSR ADDU SUBR' POLICY EFF' POLPL:Y'EXP
LTR TYPE OF INSURANCE I'NS WVO POLICY NUMBER g'MMRDDYYYYY' �qMMA)DIYYYYI LIMITS
A X COMMERCIAL GENERAL LIABILITY 100010001b171 03/0'1,12'0103/01/2018 EACH OCCURRENCE $1,000,000
SIR applies per policy terns & cor l'.IOnS DAMAGE TO RENT ED
CLAIMS-MADE x OCCUR $1,000,000
REMISES(Ea occurrence)
X SIR$250.000 M�.......m.. .._,.(Any
ED EXP(Any one person) $5,000
PERSONAL&ADV INJURY $1,000,000 m
GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 m
JECT N
POLICY PR®- x LOC PRODUCTS-COMP/OPAGG $2,000,000
OTHER r
A SISIPCA08328717 03/01/201'7 03/01/2018'COMBINED SINGLE LIMIT
AUTOMOBILE LIABILITY 15,000,000
„lccidentl
X ANYAUTO BODILY INJURY(Per person) Z
— OWNED SCHEDULED I BODILY INJURY(Per accident) y
AUTOS ONLY AUTOS }'
HIREDAUTOS NON-OWNED PROPERTY DAMAGE V
ONLYFAUTOS ONLY (Per accident) ;�
t_
d
B UMBRELLA LIAB X OCCUR US00078227L117A 03/01/2017 03/01/2018 EACH OCCURRENCE $5,000,000 L)
EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000
X ..�.._, .W_w __ ......_......_.................................................
IRETENTION
1000001707 63/01/20ii
AA WORKERS�OMPENIT ION AND YIN 1000001706 03/01/2017 03/01/2018 X VSTATUTE I IFIR o
EMPLOYERS'LIABILITY 2018 i
ANY PROPRIETOR/PARTNER/EXECUTIVE E L EACH ACCIDENT $1,000,0001
A OFFICER/MEMBER EXCLUDED? NIA 1000002166 03/01/2017 03/01/2018,,._...... .....................................
(Mandatory in NH) LLL���JJJ E L DISEASE-EA EMPLOYEE S1,000,000
If yes,describe under
DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT $1,000,000—
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES('ACORD 101,Additional Remarks Scihodule,may be attached if more space is required)
RE: All California Landscape operations. The City of El Segundo its officers, employees and agents are included as Additional
insured in accordance with the policy provisions of the General Liability and Automobile Liability policies. A waiver of
Subrogation is granted in favor of The City of El Segundo its officers, employees and agents in accordance with the policy
provisions of the General Liability, Automobile Liability and workers' Compensation policies.
V I
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 El Segundo AUTHORIZED REPRESENTATIVE
City Clerks Office/Purchasing
350 Main Street
El Segundo CA 90245 USA
eXXaia e./
©1988-2015 ACORD CORPORATION.All rights reserved.
ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD
POLICY NUMBER: 1000100016171 COMMERCIAL GENERAL LIABILITY
CG 20 10 04 13
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES O
CONTRACTORS - SCHEDULED 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): Location(s) Of Covered Operations
Any person or organization that the insured has agreed Where required by written contract.
and/or is required by written contract to name as an
additional insured.
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 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 work, on the project (other than service,
with 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
other than another contractor or subcontractor
the additional insured(s) at the location(s) engaged in performing operations for a
designated above. principal as a part of the same project.
However:
1. The insurance afforded to such additional C. With respect to the insurance afforded to these
insured only applies to the extent permitted by additional insureds, the following is added to
law; and Section III—Limits Of Insurance:
2. If coverage provided to the additional insured is If coverage provided to the additional insured is
required by a contract or agreement, the required by a contract or agreement, the most we
insurance afforded to such additional insured will pay on behalf of the additional insured is the
will not be broader than that which you are amount of insurance:
required by the contract or agreement to 1. Required by the contract or agreement; or
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.
CG 20 10 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1
POLICY NUMBER: 1000100016171 COMMERCIAL GENERAL LIABILITY
CG 20 37 0413
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:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART Mmm Y
SCHEDULEa
Name Of Additional Insured Person(s) Or Location And Description Of Completed
Organization(s): Operations
Where Required By Written Contract Where Required By Written Contract
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 required by the contract or agreement to
include as an additional insured the person(s) or provide for such additional insured.
organization(s) shown in the Schedule, but only
with respect to liability for "bodily injury" or B. With respect to the insurance afforded to these
"property damage" caused, in whole or in part, by additional insureds, the following is added to
"your work" at the location designated and Section III— Limits Of Insurance:
described in the Schedule of this endorsement If coverage provided to the additional insured is
performed for that additional insured and included required by a contract or agreement, the most we
in the"products-completed operations hazard". will pay on behalf of the additional insured is the
However: amount of insurance:
1. The insurance afforded to such additional 1. Required by the contract or agreement; or
insured only applies to the extent permitted by 2. Available under the applicable Limits of
law; and Insurance shown in the Declarations;
2. If coverage provided to the additional insured is whichever is less.
required by a contract or agreement, the
insurance afforded to such additional insured This endorsement shall not increase the applicable
will not be broader than that which you are Limits of Insurance shown in the Declarations,
CG 20 37 0413 © Insurance Services Office, Inc., 2012 Page 1 of 1
POLICY NUMBER: 1000100016171 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
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
SCHEDULE
Name Of Person Or Organization:
Any person or organization to whom you become obligated to waive your rights of recovery against, under any
contract or agreement you enter into prior to the occurrence of loss.
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
The following is added to Paragraph 8. 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 operations 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 © Insurance Services Office, Inc., 2008 Page 1 of 1
. Starr Indemnity & Liability Company
Dallas, TX 1-866-519-2522
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
Policy Number: SISIPCA08328717 Effective Date: 03/01/2017 at 12:01 A.M.
Named Insured: LandCare USA, LLC dba LandCare
ADDITIONAL INSURED - WHERE REQUIRED UNDER
CONTRACT OR AGREEMENT
This policy is amended as follows:
BUSINESS AUTO COVERAGE FORM
SCHEDULE
ADDITIONAL INSURED
ANY PERSON OR ORGANIZATION FOR WHOM YOU ARE CONTRACTUALLY BOUND TO PROVIDE
ADDITIONAL INSURED STATUS BUT ONLY TO THE EXTENT OF SUCH PERSON OR
ORGANIZATIONS LIABILITY ARISING OUT OF THE USE OF A COVERED "AUTO"
I, SECTION II — LIABILITY COVERAGE A. Coverage, 1. Who is Insured, is amended to add:
d. Any person or organization, shown in the schedule above, to whom you become obligated to
include as an additional insured under this policy, as a result of any contract or agreement
you enter into which requires you to furnish insurance to that person or organization of the
type provided by this policy, but only with respect to liability arising out of use of a covered
"auto". However, the insurance provided will not exceed the lesser of:
(1) The coverage and/or limits of this policy, or
(2) The coverage and/or limits required by said contract or agreement.
Signed for STARR INDEMNITY& LIABILITY COMPANY
Al
Charles H. Dangelo,"70resident Nehemiah E. Ginsburg, Generalr ounsel
SICA 1016 MD (04/12) Page 1 of 1
Includes copyrighted material of ISO Properties,Inc.,used with its permission.
Starr Indemnity & Liability Company
Dallas, TX 1-866-519-2522
THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY
WAIVER OF TRANSFER OF RIGHTS OF RECOVERY
AGAINST OTHERS TO US
Policy Number: SISIPCA08328717 Effective Date: 03/01/2017 at 12:01 A.M.
Named Insured: LandCare USA, LLC dba LandCare
This endorsement modifies insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
Section IV - Business Auto Conditions, A. - Loss Conditions, 5. - Transfer of Rights of
Recovery Against Others to Us, is amended to add:
However, we will waive any right of recovery we have against any person or organization with
whom you have entered into a contract or agreement because of payments we make under this
Coverage Form arising out of an "accident"or"loss" if:
(1) The "accident' or"loss" is due to operations undertaken in accordance with the contract
existing between you and such person or organization; and
(2) The contract or agreement was entered into prior to any "accident' or "loss".
No waiver of the right of recovery will directly or indirectly apply to your employees or employees
of the person or organization, and we reserve our rights or lien to be reimbursed from any recovered
funds obtained by any injured employee.
All other terms, conditions and exclusions of the policy shall remain unchanged,
Signed for STARR INDEMNITY& LIABILITY COMPANY
Charles H. Dan gelo, 'resident Nehemiah E. Ginsburg, General ounsel
SICA 1020 MD (03/12) Page 1 of 1
Includes copyrighted material of ISO Properties,Inc.,used with its permission.
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06
(Ed. 04-84)
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 2 •o of the California workers' compensation premium
otherwise due on such remuneration.
Schedule
Person or Organization Job Description
Where required by contract
Any person or organization to whom you become obligated to waive
your rights of recovery against, under any contract or agreement you
enter into prior to the occurrence of loss.
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: Policy No.: Endorsement No.:
Insured: Premium:
Insurance Company: Countersigned by:
WC 04 03 06
(Ed. 04-84) Page 1 of 1