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PROOF OF INSURANCE (2018) CLOSED SEACLEA-01 T'IMH ACORN �� CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 06/05/2018 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 License#0252636 CppNTACT MAME; United Agencies PHONE FAX 887 Patriot Drive,Ste.D (AIC,No,Ext):(805)212-4890 (A/C,No),(805)212-4891 Moorpark,CA 93021 ADPRF$ $; INSURER(S)_AFFORDING COVERAGE NAIL# INSURER n:United National Insurance Company 13064 INSURED INSURER,B:Intego,n National Insurance Company 29742 Sea Clear Pools,Inc. INSURER C: National Union Fire Insurance Company of Pittsburgh,Pa.19445 23316 S Normandie Ave#BINSURER p:FaCasualty Company 15884 Torrance,CA 90502 INSURER E. ,IIS,Lake Fire and , INSURER 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 CONTRACTOR 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 'OLICIES LIMITS SHOWNMAY HAVE BEEN REDUCED BY PAID CLAIMS 1111, 1111 111,,1...., 1,111.„ INSR ADDL SUBR POLICY EFF POLICY EXP .1,115INSURANCE LIMITS TYPE F � ............, .. A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1'000'000 CLAIMS-MADE X OCCUR L7219632-E 07/01/2017 07/01/2018 DAMAGE TO RENTED 50,000, X PRFMISFS(F1 ocryrrenrP) $ MED,EXP(Any one person) $ 5,000 PERSONAL,&ADV INJURY $ 1'0009000 GEl,11-AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2'000'000 , Dl'X•Ml3,X'd �,„".,,,, PRO- I .....� ,.,ROD., S-COMP/OPAGG $ 2,000,000 X f OI.I!"k" LOC JECT P,,,,,, UCT $ B AU—OMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,0001 (Fa arridf�nl) $ X ANY AUTO 12004414 07/01/2017 07/01/2018 BODILY INJURY(Per person) $ OWNED ASCHEDULED AUTOS ONLY UTOS BODILY INJURY(Per accident) $ X AUTOS ONLY X AUTOS ONLDY Per accident)DAMAGE $ $ C UMBRELLA LIABX�OCCUR EACH OCCURRENCE $ 1,000,000 X EXCESS LIAB CLAIMS-MADE EBU014139286 07/01/2017 07/01/2018 AGGREGATE $ 1'000'000 DED I I RETENTION$ ... tl $ D WORKERS COMPENSATION X V PER {{OTH- AND EMPLOYERS'LIABILITY YIN a 9TATUTF I FR ANY PROPRIETOR/PARTNER/EXECUTIVE '� X FLA000020-01 0710112017 07/01/2018 EL EACH ACCIDENT $ 1'000'000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory In NH) EL DISEASE-EA EMPLOYEE. $ 1'000'000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.1. DISEASE-POLICY I.,IMIT $ ..........................,.,.,.,.,.....,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,., .. .,.,..,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,...,.,.,.,.,., .. ,.,.,.,.,.,.,.,.,.,.......... ,... ............ DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLESACORD 101,Additional Remarks Schedule,may be attached if more space Is required) *30 days notice of cancellation except 10 days for non-payment of premium. The City of EI Segundo is named as additional insured as required by written contract. A waiver of subrogation applies to the Workers'Compensation policy. *30 days notice of cancellation except 10 days for non payment of premium. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cit Of EI Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Y 9 ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main St. EI Segundo,CA 90245 AUTHORIZED REPRESENTATIVE ...............................MM..1111........... ....._........ ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: L7219632-E COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - (FOR B) This endorsement modifies insurance provided under the following; COMMERCIAL GENERAL LIABILITY COVERAGE PART. SCHEDULE Name of Person or Organization: AS REQUIRED BY WRITTEN CONTRACT (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of"your work"for that insured by or for you. CG 20 10 11 85 Copyright, Insurance Services Office, Inc., 1984 Page 1 of 1 0 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 2.5% of the California workers' compensation premium otherwise due on such remuneration. Schedule Person or Organization Job Description Blanket Waiver of Subrogation As respects to all CA jobs performed by the named insured during the policy period where by written contract a waiver of subrogation is required prior to the commencement of work. 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 07-01-2017 Policy No. FLA000020-01 Endorsement No. 1 Insured Insurance Company Sea Clear Pools,Inc.(A Corp) Falls Lake Fire&Casualty Company Countersigned By 8r"""^' H&rft,4V ©1998 by the Workers'Compensation Insurance Rating Bureau of California.All rights reserved.