PROOF OF INSURANCE (2018 - 2018) CLOSED Client#:1291580 305CORRACON
BILITY INSURANCE DAWIMM)DD/YYYY)
THIS CERTIFICATE IS I$SUvERTMAFeCA N ERO FN IA
09/10/"2018
ONL AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT:If the certificate holder Is an ADDITIONAL INSURED,the policy(les)must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on
this BB&T Insurance iServices confer any rights to the certificate holder n lieu of aAJJ DrndAo e 9 28
I II a (e)
N g, A Tfg a Lopez
o1' 29 Q FAX No):
of Orange County a'n9ellqueJopez@bbandtcom
2400 E Katella Ave.Suite 1100 INSURER(S)AFFORDING COVERAGE NAICt
Anaheim,CA 92806 INSURER A:Colerrylmmmiw CaaPeef 39993
INSURED I INSURER B: 1---Caepey 37974
Corral Construction&Development Inc :s4NConpxrltionq,dFundofCA 35076
5211 E.Washington Blvd.#2-122 INSURER
Commerce,CA 90040 INSURER D:A""—Fire end O—Wrao 24066
INSURER E: p
INSURER F: Id
COVERAGES CERTIFICATE NUMBER: RE'VI'SION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
N' AGDL UB'R Pp wO�
TYPE OF INSURANCE IQ'll$tL y+�'IpD POLICY NUMBER I'MMIdf (MM616 1210 R,JI
8/201 UMITS
A X COMMERCIAL GENERAL LIABILITY 101 GLOW316104 12/08/201"7 EEAApCH OCCURRENCE s2,OOO.000
CLAIMS-MADE �OCCUR PR S„{Eat+raSr $50.000
X BI/PD Ded:500 MED EXP(Any one person) 55.000
RPERSONALAADV INJURY IS2.000,000
GEN'L Q APPUE PER: GENERAL AGGREGATE I 3.000.000
POLICY PRO LOC PRODUCTS-COMPIOPAGG Is3,000.000
OTHER: IS
p AUTOMOBILE LIABILITY BAA57476683 12/0812017 12/08/201C'OMSINEDSSINGLE LIMIT G$1,000,000
ANYAUTO BODavINJURY(Perperson) Is
....... AlW ORONLYH
AUTOS ED (BODILY MLIURY(Peraccidern)I$
X HIREDONLYAUTOS ONLY i PROPERTY DAMAGE $
••••..........
..................AUTOS .:
$
B X UMBRELLAUAS X I OCCUR V EMX0323948 11/21/2017 11121/2018 EACHoccunRENCE s3,000.000
'EXCESS UAB CLAIMS-MADE( (AGGREGATE $3.000.000
V DED 9 I RETENTIONS . � $ I'
WORiCERSCOMPEN'SATTON PER OTH-
C 903611817 12/01/201712101/201 X Fra
AND EMPLOYERSrUABIILlfV IN T —...••�
ANY92rpOP'r�STOMP RIWCUTIVE� E-L-EACHACCIDENT $1,000.000
OFFIOERIMEM'SE,RE ED y NIA
( loryInNH) IE.L.DISEASE-EA EMPLOYEE $1.000,000
USs,do=bo undo
SCRIPTION OF OPERAMONSbokw - E.L.DISEASE-POLICY LIMrr 0,000,000
DESCRWTION OF OPERATIONS/LOCATIONS/i
I
4 VEHICLES
(ACORD tot,Additional Remarks Scledula,maybe eBschad if more, is Ieaullsl
City Of EI Segundo,Its officials,and employees
are included as additional insured with respect to general
liability as required by written contract Primary wording applies.Waiver of Subrogatlon applies to work
4 comp,endorsement to follow.
CERTIFICATE HOLDER CANCELLATION
City of EI Segundo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
350 Main Street ACCORDANCE WITH THE POILICY PROVISIONS.
EI Segundo,CA 90245
AUTHORIZED REPRESENTATIVE
ENiAT1VE
®1988.2015 ACORD CORPORATION.All rights reserved.
ACORD 25(2016103) 1 of 1 The ACORD name and logo are registered marks of ACORD
#S20953222/M19192333 ATMAR
101 GL 0003161-04
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES
OR CONTRACTORS S - BLANKET COVERAGE
INCLUDING PRIMARY / NON CO TRIBUTORY
AND WAIVER OF SUBROGATION
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): Li Location(s)of Covered Operations:
All persons or organizations as required by a written Locations as required by a written contract or
contract or agreement with the named insured. agreement with the named insured.
v
A. SE'C'"T"ION 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"caused, 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 at 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).
U156A-0313 Includes copyrighted material of ISO Properties, Inc., Page 1 of 2
with its permission.
101 GL 0003161-04
C. SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS, 4. Other Insurance is
amended and the following added:
The insurance afforded by this Coverage Part for the additional insured required by a written contract
or agreement with the named insured is primary insurance and we will not seek contribution from any
other insurance available to that additional insured.
D. SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS, 8. Transfer Of Rights Of
Recovery Against Others To Us is amended and the following added:
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 OF THE POLICY REMAIN UNCHANGED.
U156A-0313 Includes copyrighted material of ISO Properties, Inc., Page 2 of 2
with its permission.
STATE ENDORSEMENT AGREEMENT BROKER COPY
WAIVER OF SUBROGATION
9036118-1
FUND RENEWAL
SP
HOME OFFICE 2-83-35-91
SAN FRANCISCO PAGE 1 OF 1
ALL EFFECTIVE DATES ARE
AT 12;01 AM PACIFIC EFFECTIVE SEPTEMBER 15, 2018 AT 12.01 A.M.
STANDARD TIME OR THE AND EXPIRING DECEMBER 1, 2018 AT 12.01 A.M.
TIME INDICATED AT
PACIFIC STANDARD TIME
CORRAL CONSTRUCTION &
5211 E WASHINGTON BLVD STE 2
COMMERCE, CA 90040
ANYTHING IN THIS POLICY TO THE CONTRARY NOTWITHSTANDING,
IT IS AGREED THAT THE STATE COMPENSATION INSURANCE FUND
WAIVES ANY RIGHT OF SUBROGATION AGAINST,
CITY OF EL SEGUNDO
WHICH MIGHT ARISE BY REASON OF ANY PAYMENT UNDER THIS
POLICY IN CONNECTION WITH WORK PERFORMED BY,
CORRAL CONSTRUCTION &
IT IS FURTHER. AGRE'E'D THAT THE INSURED SHALL MAINTAIN
PAYROLL RECORDS ACCURATELY SEGREGATING THE REMUNERATION
OF EMPLOYEES WHILE ENGAGED IN WORK. FOR. THE ABOVE
EMPLOYER.
IT IS FURTHER AGREED THAT PREMIUM ON THE EARNINGS OF SUCH
EMPLOYEES SHALL BE INCREASED BY 03%.
NOTHING IN THIS ENDORSEMENT CONTAINED SHALL BE HELD TO VARY, ALTER, WANE
OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS
POLICY OTHER THAN AS STATED. NOTHING ELSEWHERE IN THIS POLIC`! SHALL BE
HELD TO VARY, ALTER',. WAIVE. OR LIMIT THE TERMS, CO'NDIT'IONS, AGREEMENTS OR
LIMITATIONS OF THIS ENDORSEMENT.
COUNTERSIGNED AND ISSUED AT SAN FRANCISCO: SEPTEMBER 18, 2018 2570
A�lTIR3RIED REPRESENT 9VE PRESIDENT AND CEO
SCIF FORM 10217 (REV.7-2014) OLD OP 217