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PROOF OF INSURANCE (2018 - 2019) CLOSED �R' CERTIFICATE OF LIABILITY INSURANCE q DATEJMMIDDIYYYY) U 06/14/2018 THIS CERTIFICATE IS ISSUED ASA 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 pollcy(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 tpyyE.__ 888)440-4094 S No Hassle insurance Agency (#19,No.ox* ( �p x CONTACT ip,tlol':(9'09')783.7900 1400 E.Cooley Dr. Ste. 202-A E-A1AII_ M rvlee luDla„as„slai0s.net Colton, CA 92324 ADDRCSs, sca License#: OE74924 1sI,AF aRotwrcc0„y"AGE,,, NAiCn � !M.s,P.R.E.R,.A..).........UNITED STATED..wJE#WTY.&SUJ3AN_Q �26$�5_------ INSURED .- Christpher Heppell N.S,URR,6„r, INSURER DBA:Precision Reef Systems s R RC:m_ 7712 Goddard Ave. INsuRERD: Los Angeles,CA 90045 INSURERS: ........................................ INSURER P; COVERAGES CERTIFICATE NUMBER: 00000000-18094 _ REVISION NUMBER: 6 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 TOALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS INSR TYPE OF INSURANCE 11 --wo. POLICYNUMBFR WMIDONYYV'I .t KOWYYYV1 LIMITS .J�T1t_.._.�.. . u�Ac�W�f�rY,_................�.�..... A X COMMERCIAL GENERAL LIABILITY Y Y CL1767886B 06/1112018 0611112019 EACH OCCURRENCE $ 1,000,000 _-�CLAIMS-MADE X OCCUR DXMA0r! PRFIVISE $ 100,000 one �..... 6,000 PE SONPA(L& NJURY ',3�,000,000 PRO- ❑LOC PRODUCTS $ 2gQ00,000 QF,;V� AG CREGATE UMITAPPLIES PER: GENERAL AGGREGATE $.__,,2.,00.,0,.000 �(� POLICY 2,000,000 CYrHF'R: $ G AUT OMOBILELIASILITY COMBINED SINGLE LIMIT $ 6BODILYIN INJURY(Per person)ANY AUTO $ SCHLUULEU AUTO O IUn4 . ..... r,L�Tcrs CyNLM1.. ,..Anlr09 HIRCJ NON-OWNED I OG RG4 rAMNAGF AUIOSONLY AUTOS ONLYUMBRIf?&IIxCMkklS , $ SLA LIAB .O_C._C.UR .. EACH OCCURRENCE EXCESLIAB _.. . ,S•MA E AGGREGE $$ __•_. .�..._..� DSD....�...............L...RETENTIQN.,-.5......�._......_. .•..,.,.,._ ._�...�, � pPER $ KERS PENSATION AND EMPLOYERS'LIABILITY ANY PROPRIET WPAXRC NDwP,ECUTIVE Y❑ N 1 A E,,.L ff ACCIDEN TOFF I1 es,doaadlaeunder 3 yy ELOMP YEE DESCRWTGON OF OPERATIONS below ( E,L.DISEASE POLICY LIMn' $ DESCRIPTION OF OPERATIONS f LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) CERTIFICATE HOLDER LSITED AS ADDITONAL INSURED CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF.NOTICE WILL BE DELIVERED IN The City of EI Segundo and its employees ACCORDANCE WITH THE P01ROVISIONS. 360 Main Street EI Segundo,CA 90246 AUTHORIZED REPRESENTATIVE p (JIMA) ©198 k4 eORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks ACORD Printed by JMA on June 14,2018 at 03:50PM POLICY NUMBER; CL1757886B COMMERCIAL GENERAL LIABILITY GG 20 10 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsertrent modifies insurance providrrd under the following: COMM RCIAl_ GENERAL LIABILI'r), CQVERAGt_PANT' SCHEDULE Narne of Additional Insured Persons) or orrtanizationts):, Location(s)Of Covered Operations Whom,rc,gtain;d toy written canine of or agroomont. All operations of the nrarned insured I The City of El Segundo and its employees 350 Main Street EI Segundo, CA 90245 r Information requ'ircd to cm,il�leto this Schedule,it notshown above,will )e shown in tho RoclurollQns� I A. Soction 11 ­ who is An Insurer! is Urne:nded to B. With respect to the insurance afrorded to those include as an aCICRI0n31 insured the parson(s) or additional insureds, the following additional exclu- organization(s) shown in the Schedule, but only slons apply: with respect to Hability for"bodily In)uIy", "property This irmirtanoo e oou not Apply to "bodily injury" or darnavV or "prar,�onal and ndvartising injury" ",pry gatrrty damafg °"occurring oftor: 1. Youu caused,in whole or in port, �g, All work, including rnateri is, parts or equip- 1. r cats ur omissions;or or r meat flurniahed in aonner.Ilon with such work, 2. The acts or orn lsslons of those acting on your on the project(other than service,maintenance I behalf, or repalis) to be performed by or on behalf of In the pefformance of your ongoing operations for the additional insured(s) at the locaSia'ri,of the the ad'ditlorrr�l Insured(s) at ffio lauitlon(a) d+,sig- covered opaeratlon,lues been coli pleteel or nates d w,iQove, 2. That portion of "your work" out of which Me injury or damage arises has boon put to Its In- tonded um, by any purrm or organization oth- er than another contractor or subcontractor ongaged in performing e,porations for o prin- cipal as a part of the tremae project, r I CG 20 10 07 04 it)ISO Proraerties,Inc„2e]04 Pape 1 of 7 Cg I I i 'I ENDORSEMENT ) N1�7,NQ. � 7 II {eq P4r24rp91 h u WAIVER OF Sl,.RR IfiATION -BLANKET IT IS AGREED, FOR AN ADDITIONAL PREMIUM OF$INCLUDIED In M& ,THAT THE TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US(SECTION IV-COMMERCIAL GENERAL LIABILITY CONDITIONS)IS AMENDED AS FOLLOWS: WE WAIVE ANY RIGHT OF RECOVERY WE MAY HAVE AGAINST ANY PERSON OR ORGANIZATION THAT QUALIFIES AS AN ADDITIONAL INSURED PURSUANT TO THE TERMS OF v ENDORSEMENT NUMBER 1 BECAUSE OF PAYMENTS WE MAKE FOR BODILY INJURY OR PROPERTY DAMAGE ARiS1N(3 OUT OF(E)YOUR WORK PERFORMED DURING THE POLICY C PERIOD UNDER AN INSURED CONTRACT WITH THAT PERSON OR ORGANIZATION,PROVIDED THAT THE BODILY INJURY OR PROPERTY DAMAGE OCCUR$ SUBSEQUENT TO THE � EXECUTION OF THE;INSURED CONTRACT,OR(ii)YOUR PRODUCT MANUFACTURED OR SOLD DURING THE POLICY PERIOD UNDER AN INSURED CONTRACT WITH THAT PERSON OR ORGANIZATION, PROVIDED THAT THE BODILY INJURY OR PROPERTY DAMAGE OCCURS SUBSEQUENT TO THE EXECUTION OF THE INSURED CONTRACT. I e I I I i Y i 9 ALL OTHER TERMS ANI!C ONDIT'IONS C�t='t"d"s POLICY REMAIN UNCHANGED. Pok, Ntirral o ........ ... M I'aa��ttr�d �:`tdrtsVr� I CL1757885B Christopher Heppell DBA: Precision Reef Systems 06/11/2018 Countersignature of AuthariaO Representat]VW- a V,12009 2009 W INTCA P AC CERTIFICATE OF LIABILITY INSURANCE °"m'"�`°°"""' 071162018 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- N the certltkalle holder Is an A00ITION'AL INSURED,the pollcy(les)must have ADDITIONAL INSURED provlsbns or be endorsed If SUBROGATION IS WANED,subject to 1Nho leans and condillons of the policy,certain polkles mey require an endorserno nL A stat'oment on this certificats does not conler itpllts to the artifkete holder In Neu of such mWorsement(s). FRoouttn I COm A "T Melissa Sanders NAa1If,, sbotpOwm Brent K VN1Rbck Insurance Agency Inc A,Enk =421-0864 FAXno: 310-3069022 26441 HNghodge Rd.,Ste_503 RFs„ mekW3.saMms.w"statefarm.com Rolling Hills Estales,CA 90247 IMF . I Af rORDiNd COVE I wrc 0 wwROI A State Farm Mutual Automobile Inkxance Cwnparry 25178 004m D RMLIRER e ChftUvher HwW w c DBA Precision Reef Systems 7712 Goddard Ave E I Los Angeles,Ca 00045 ITmSLI'APR F COVERAGES CERTIFICATE NUMBER: REVISIONNI.IIMBE'W THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE MURED NAMED,. „. , ABOVE FOR THE POLICY PER100 INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT NTH RESPECT TO MICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, (CIES.LIMITS SHOWN MAY HAVE BEEN REDUCEDBY PAID CLANS, ms" N C'MAU (EXCLUSIONS .,, SUCH PDT/.1CYItiF .., �R TYPE Of INSURANCE . o N POLICY WimmER TAN 1 Wmamw�'MYW"'w Lam ., COWAERCIALGENMA,LIANUTr iAI ItC L)PRLKC 9', CIAAIS4AADE -- OCCUR EDIT TJoM dd,mr atmmrm°EDI ....,'I MED EXP tart'v.oesoi,l 1 PRO V PERS4NIAL SADV IN,RIRv S r°iD.aTT,.�T rm°L..w,^'.� kP,%-m,I1„LIYrT APPLIES PER Aa AGGREGATE % r. I �`OLICY DELT LDC r AUT 612 9574014-75 03/1. 6..E ' �LIY 412018 09/1412018 ANY AUTO UWA r, i�ScteDULEO P'�"1°'��YV. i 1.000,0 owrE ar;f+� .....,,.... .I i 1.000,000 1 URY IP A AUTOS ONLY AUTOS I N' Y �4T'° TARED !RON04WEO V',' A,,N "e 'm r", 4 i 1,000,000 i A!JTOSONLY I AUTOS MY I I i fl UIIMLLA LIAa I OCCUR ( 1. 6 � 'T_. B 1 I rLAWSAiAOE ff^CNTCW ^ ACORLWE- ITFIENTIONS L ..,.. WOMEnS COMPENSATION AND MESS' TY ..., ... STATUTE -- -- --- A%'P�m 'a�1 u11 NIJm1, ,p mm TW"'mfl'E,T!N;�IY'Irm' rN1 ' F I rACHACC90ENT i T AFII,'FP?','*wma-I,�Imn.ur l�.;M�,�.p.',fi r'�,"x � NfA (A*"d4$wy in NH( "." E.L D ISCASC-EA EMPLOYEE S mum rmmnxaYa uwlr^ LLDISEASE-POUC:YLWrI S i DESCRMTM OF CPERIITIONS I LOCATIONS I VEMKXn(ACORD M.Amd0s,r1 Rssmts Zdwd b.s,q M&Nash"V mm sps is nq iei CER,TI'FWATE HOLDER CANCELLATION I � SHOULD ANY OF THE ABOVE DESCRIBED POL.IC"BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE MILL BE DELIVERED W The Cdy of EI Segundo and Its employees ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street AUT w ATnrr Ogun Sedo.CA 90245 .............. ...... ®1 NO-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016f03) The ACORD raw*and logo are regishwed nmulm of ACORD 1004M 171611/12 0346-20" CITY OF EL SEGUNDO WORKERS' COMPENSATION DECLARATION WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SUBJECTS AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN LABOR CODE § 3706, INTEREST,AND ATTORNEY'S FEES. I affirm under penalty of perjury under the laws of California one of the following declarations: () I have and will maintain a certificate of consent of self-insure for workers'compensation, issued by the Director of Industrial Relations as provided for by Labor Code§3700 for the performance of the work set forth the agreement with the City of EI Segundo. Policy No. _....._w.......__..._. ..._......_ _ (_)I have and will maintain workers'compensation insurance as required by Labor Code§3700 for the performance of the work for which the agreement with the City of EI Segundo is executed. My workers'compensation insurance carrier and policy number are: Carrier _ _........ Policy Number Expiration Date Name of Agent Phone# Neel certify that, in the performance of the work set forth in the agreement with the City of EI Segundo, I will not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that, if I should become subject to the workers' compensation provisions of Labor Code § 3700 1 must immediately lly ith thoseo^v�is`t^ .sLJ"or the aer�wernw ent�w.. i_llr._a ✓u�lc rnaticniY y mm mmm become void. Signature of Applicantr C y r Date 151 Agreement for: � �-�"' � �_ Dated: Reviewed by: 1