PROOF OF INSURANCE (2018 - 2019) CLOSED * DATE(MIMOD"m
ACCIII CERTIFICATE OF' LIABILITY INSURANCE 02107/20118
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 ceilffivate holder is an AwTIONAL INS'UR'ED, (lie pollcy(les)must tie endorsed. It SUBROGATION IS WAIVED, subject to I
the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the 1
certificate holder In IIGU Of SUCh 011dDrsement(s),
PRODUCER e'ONTAC'r Joe Van Dyke
NAME:
Avco Insurance Services Inc PHONE I 7 A 7
25283 at Sufte 113 L
'CAI�I�41;7 14-944-1831
CRd, %
'Laguna Hills, CA 92653 AOIsure0
-
in byjqq@yahqp,corq,
A.
INSURER(S-)ATFORDING COVERAGE, NAIC#
INSANtED IMURERA:Wesco Insurance C an
ALOHA DOORS INC imuRERB:United Specilafty Insurance CompaqM
214 MAIN STREET#119 TM!M!;
E.L.SEGUNDO, CA 90245 !NWRER 0
ANSURER E
INSURERF:
COVERAGES CERTIFICATE NUMBIER- REVISION NUMBER:
ITIM IS TO,CLRTIFYTHAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN, ISSUEDTO THE NSURM NAMED,ABOVE FOR THE POLICY PERIOD
INM CATED, N0'fVJITHSTAf,M11NG ANY REQUIREMENT, TERM OR CON 01yrIONI OF ANY CC9TTRACT OR O'n1ER DOCUMEN"r WITH RESPECT TO WHIMH THUS
CERTWICATE MAY BE ISSUED OR MAY PERTAIN, THE WSURANCE AFFORDFO, BY THE POLICIES DESCRIBED HEREIN IS SUB,JECT'ro ALL TIFF TERM S,
EXCLUVIONSANO cc"OrriONSOF SUCH ursPOLICIES,LHAITSSHCAM MAYHAVEBEEN REDUCED SYPA10CLAIMS,
NS A ObOd-V14PIP "' - - -- — -- -
TYPE OF MR)RANCE LICY NUMBER I(MIAwwwy) UNITS
..... ...............................
GENERAL ILIA. EACH OCCURREN� 1.0901,000
k, 1�" �� I IN'll l '!
CLAIMSMADE ✓
B SII514B21878126/2017 812EV2018 MED E�'P 5.011001
PERSONAL&ADV INJUPY_
-10001 000
(�EII aGGREGA.TI2,000 00
APPLIES PER PRODUCTS-COMPIOPAII
L9C
AUTOMOBILE LIABILITY COMBINED SINGLE LINITT
(Ea accta-rt)
8001 1N
N ,1UPY(Per pers-xq)
j I SCHEDULEDAUTOS BODILY INJUR Y(Per accictert) t
i;ii6PERTY DWAGE
HIREDAUTOS 4 (Per axWerit)
NC�N-CV.NED AUTOS
UMIBRELLA LM OCCLp
EACH OCCURRENCE
EXCEW LIAB
1 CELDUCTZLE
IrETENTiow s
WORKERS COMPENSATION
AND EMPLOYERV LIABILITY vk
YIN 2/112018 211/2019
A
® NIA VVI/VC,1328237
fmandkory in WIN) .�LPISF-ASE-EAEMPLOYEE
�S,&qmte undle,
OF CPERAMN1-tWvv EL [I`011-�:VLNIT IF 1 00Q OI(X)
-----------
........................
CE-SCMIPNO P 9 4V, 0 PERA"ON$ILO CAP 0 INS I%lUICLES,I Aft ch A C 0 OW 1010 A dd 0voM 8 o rsav ks,Sc he dAa,4 M ort sp act a oquw 0 d)
City Of E Segundo are named as additional Insureds in regards to the general IlabilRy policy.
CERTIn, CATE HOLDER CANCELLATION
SHOULD ANY OF TIME ABOVE DESCRIBED POUCIES SE CANCELLED BEFORE
C4 of El Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL SE DELIVERED M,
350 Main Stre!et ACCORDANCE fflrli THE POLICY PROVISIONS.
El Segundo, CA 90245 AUT14OWEDREPRESENWIVE
0 19,98-2'00 ORD CORPORATION, All rights reserved.
ACORID 25(2,009J09) The ACO'RD naime arull Iogo are mg 4�/,*! d'fmarks of, D
ENDORSEMENT TO POLICY NO. 10b
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
UNITED SPECIALTY INSURANCE COMPANY
COMMERCIAL GENERAL LIABILITY POLICY ,:
BLANKET ADDITIONAL INSURED <_-
INCLUDING
..INCLUDING PRIMARY COVERAGE AND WAIVER OF SUBROGATION
The section of the policy entitled II. — WHO IS AN with such work, on the project (other than service,
INSURED is amended to include as an additional maintenance or repairs) to be performed by or on
insured any person or organization for whom you are behalf of the additional insured(s) at the location of the
performing operations when you and such person or covered operations has been completed; or when that
organization have agreed in writing in a contract or portion of "your work" out of which the injury or
agreement that such person or organization be added damage arises has been put to its intended use by any
as an additional insured on your policy. The coverage person or organization, including another contractor or
afforded by this endorsement is only; subcontractor engaged in performing operations as
(1) with respect to liability of the Additional part of the same project.
Insured in connection with the original Named
Insured's ongoing operations performed for The coverage provided for the Additional Insured is
said Additional Insured; and only to the extent that the additional insured is held
(2) only if the Additional Insured performs all liable for the negligence or strict liability of the Named
obligations required under the Policy. Insured. No coverage is provided for liability based
upon the acts, errors and omissions of the Additional
The coverage afforded to an Additional Insured is Insured.
limited to a claim made for a Covered Loss not
covered by other insurance available to an Additional No coverage is provided to an Additional Insured for
Insured, and is limited by SECTION IV. — damages because of "bodily injury" to an employee of
COMMERCIAL GENERAL LIABILITY CONDITIONS, the original Named Insured, whether suit is brought or
paragraph 4. Other Insurance, b., of the policy, which claim is made by the employee or the parent, spouse,
provision applies equally to an Additional Insured child or sibling of such employee, or any entity seeking
and is made a part of this Endorsement. damages because of injury to such employee.
Other than as expressly modified herein, coverage for If required by written contract: the insurance afforded
the Additional Insured is governed by the terms and by the policy to the Additional Insured shall be
conditions of this policy, including the insuring primary insurance, and any insurance or self-
agreement. No coverage is afforded under the insurance maintained by the above Additional
"products-completed operations hazard" for an Insured shall be excess of the insurance afforded to
Additional Insured pursuant to this endorsement. the Named Insured and shall not contribute to it.
The coverage afforded to an Additional Insured
under this endorsement ends as of the date of If required by written contract or agreement: We waive
completion, abandonment or termination of the work of any right of recovery we may have against an entity
- the original Named-Insured at-any joslte, project or that as an Add itional_Insured_per_the_terms _of _this__
structure. endorsement because of payments we make for injury
or damage arising out of "your work" done under a
The "work" of the original Named Insured will be contract with that person or organization.
deemed completed as of the date all work, including
materials, parts or equipment furnished in connection
Except as set forth above, all of the terms, conditions, and exclusions of this policy apply and remain in effect.
Policy No.: S110514B215744 ,;c,. United Specialty Insurance Company
3250 Grey Hawk Ct, Ste. Z
Date 08/26/2017 Carlsbad, CA 92010
By:
Time: 12:01 a.m. "
PA uthori ed presentative
SIS-TC-0101 (07/13) END 10b 1 of 1
IF
1ffl§UMD—CJFrS -0161 9!� L,t
—SI ,fPOLFOY, Ell
T CAREFULLY,
UNIT EF)S PE`("'21,A1-1r Y Ill tilt" LI
-ke(uly P01.1cy
ADDITIS NAL., INSURED-O,W'NERS, LESSEES OR CONT111ACTORS
(FORM B)
1 his ar-Worsiamaint niodiffes firtsiurarice proOded under the foflowh �
COMMERCIAL GENERAL UA11131UTYCOVIE"AAGE PAIRT.
SC3 WOW
.w..._.......
...
f&ne of Porson(si)or Orgardzatlon(s);Loc-ation(s)of covered operations; Add1bional Irmureda(s) Addre&s:
Ci-ty of E]. Sequnido
(If no entry appears above,the information required to complete this endorsement will be shown in the DeclaraAjons as
applicable to this endorsement.)
A. Section 11 -who Is An Insured is amended to include as an additional insured the
person(s) or organization(s) shown in the Schedule, but only with respect to liability
for'bodily injury,""properly damage"or"personal and advertising injury" used, In
whole or in part, by:
1. Your acts or omissions;or /7f
2.Thea or omissions of those acting on your behalf
In the performance of your work for the additional insured(s) at the locatilon(s)
designated above performed for that insured and included in the"products-
completed operations hazard in accordance with this policy.
Except as set forth above, all of the terms, conditions, and exclusions of this policy apply and remain in effect,
Policy No, S1X0S14S21S?44 United Specialty Insurance Company
3250 Grey Hawk Ct, Ste. Z
Date 8/26/2017 Carlsbad, CA 92010
By:
12-01 a.rm
..........
Reprosentative
END S11 24 9926 16 07
w �� CERTIFICATE OF LIABILITY INSURANCE I DATE(02I09/2018)
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).
PRODUCER CONTACT
NAME:
Automobile Club Of Southern California PHONE FAX
2601 S.Figueroa Blvd#H302 (AJC,,,tJ_ Ext Q9Q,�1¢,-2402 (AACI,,,No,),;21 741-3012
Los Angeles,CA E-MAIL
ADDRESS:
INSURER(S)AFFORDING COVERAGE NAIC#
INSURER A: Infinity Select Insurance Company 20260
INSURED INSURED B
INSURED C:
Aloha Doors Inc INSURED D
214 Main St
Apt 119 INSURED E
EI Segundo,CA 90245 g
V INSURED F
COVERAGES CERTIFICATE NUMBER: 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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS
LTR INSD WVp 40$/1412017! (OSI14/20161
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $
CLAIMS-MADE �OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) $
........................................................................................................... I MED EXP(Any one person) $
PERSONAL&ADV INJURY $
GEN'L AGGREGATE LIMIT APPLIES PER: I GENERAL AGGREGATE $
POLICY 0PRO- LOC I
JECT PRODUCTS-COMP/OP AGG $
OTHER: $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1,000,000
(Ea accident)
ANY AUTO BODILY INJURY(Per person) $
OWNED SCHEDULED
A
AUTOS ONLY AUTOS X 504610016497001 BODILY INJURY(Per accident) $
HIRED NON-OWNED PROPERTY DAMAGE $
AUTOS ONLY AUTOS ONLY (Per accident)
$
UMBRELLA LIABOCCUR EACH OCCURRENCE $
EXCESS LIAR CLAIMS-MADE ( AGGREGATE is
DED I I RETENTION$ 1$
WORKERS COMPENSATION N/A LJ E L I STATACCIDENT I ERPER H I
AND EMPLOYERS'LIABILITY Y J N IQ
ANYPROPRIETOR/PARTN ER/EXECUTI V E
S
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH) F I. t ISEI E•EA I lwuq i:)Yk;C',
IY yyrus,doscrdbn under
D4:SCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT $
DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
City of EI Segundo ACCORDANCE WITH THE POLICY PROVISIONS.
350 Main St
EI Segundo,CA 90245 AUTHORIZED REPRESENTATIVE
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06
( d.04-84)
WAIVER 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%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 contract.
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 21112018 Policy No. W VC3328237 Endorsement No. 1
Insured Aloha Doors Inc Premium$ 4286
Insurance Company Wesco Insurance Company
Countersigned by
WC 04 03 06
(Ed.04-84)