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PROOF OF INSURANCE (2019 - 2019) CLOSED DATE(MMIDD1YYYY) CC>R"'�°'� CERTIFICATE OF LIABILITY INSURANCE kyr 1 7/18/2018 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 INSUREII AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must 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 Victoria Mitchell NAME: Landscape Contractors (Lic#0755906) PH - (559) 0-3558 O,,No,,Ext);,,,(559)6503555 dA1r.I1,�i 65 PHONE FAX Insurance Services, Inc. E MAIL vmitchell@lcisinc.com 1835 N. Fine Avenue INSURER(S)AFFORDING COVERAGE NAIC# Fresno CA 93727 INSURERA:WeSCO Insurance Company 25011 INSURED INSURER B: Oliver Holt Landscape INSURERC' 8611 Amestoy Avenue INSURER INSURERE: Sherwood Forest CA 91325 INSURER COVERAGES CERTIFICATE NUMBER:18/19 Ptg & Auto 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 IN r POLICY NUMBER fMMfDD1YYY " POLICY EXP .. ........ ....... CAU L R POLICY LIMITS ay�r� YYY� IMMIDPIYXYY! X COMMERCIAL GENERAL LIABILITY p „ ', .q.'y;1 y,l, $ 1,000,000 a „ A S I r,!', I,!' X � I I II I 100,000.., X WPP1644498 00 7/16/2018 7/16/2019 p,i', ,I'Ir',I v„r�r„ I'"' 'ISI 5,000 X $1,000 Pd Ded $ 1,OD0,000 2,000,000 XT 'IIII III I I 1 $ 2,000,000 T,-iE;mIIII y,, $ 1,000,000 AUTOMOBILE LIABILITY I� "h,`��I, I',' °''"I'�""I'I $ 1,000,000 I I' II'I'I III I,I . . A X � I WPP1644498 00 7/16/2018 7/16/2019 I! II ILII II I l 4",. ;",Y„"'I" ,::.fry'"I:,.."',R;�:. ................. .. L, 5,000 UMBRELLA LIAB EXCESS LIAB II b;l'I Irl "II ViICOCvlIGfiU,lU4aA WlN�i,l'i� A1MYID IEEMIf'IL.E'P'111PRS`L IIA11181IIL.II"II"1r' Y f N H_.C.!'r' I'""....... 1=1-V'4ItIC.14-YAFd-I-t ':a-I1.111Ff'•r N/A Wanidafnrv. In 1,041 I_'�L::,i.:'RII (pJ P.7 CSI"CSI"'F lanl Il�L!sa brbarro � I�I'•' ';,'I I'.it h , III'.."'I y. DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) RE: All landscape operations performed by or on behalf of the named insured. (See Attached CG20100413) City of E1 Segundo and its officers, elected officials, and employees (Excluding Professional Liability) are named as additional insured per attached endorsement. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of El Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City Clerk ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street Room 5 El Segundo, CA 90245-3813 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved„ ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401) POLICY NUMBER: WPP 1644498 00 COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR 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 Blanket as required by written contract. Blanket as 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 B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following additional organization(s) shown in the Schedule, but only exclusions apply: with respect to liability for"bodily injury", "property This insurance does not apply to "bodily injury" or damage" or "personal and advertising injury" "property damage"occurring after: caused, in whole or in part, by: 1. All work, including materials, parts or 1. Your acts or omissions;or equipment furnished in connection with such 2. The acts or omissions of those acting on your work, on the project (other than service, behalf; maintenance or repairs) to be performed by or in the performance of your ongoing operations for on behalf of the additional insured(s) at the the additional insured(s) at the location(s) location of the covered operations has been designated above. completed;or However: 2. That portion of "your work" out of which the injury or damage arises has been put to its 1. The insurance afforded to such additional intended use by any person or organization insured only applies to the extent permitted by other than another contractor or subcontractor law;and engaged in performing operations for a 2. If coverage provided to the additional insured is principal as a part of the same project. required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. CG 20 10 04 13 ©Insurance Services Office, Inc.,2012 Page 1 of 2 C. With respect to the insurance afforded to these 2. Available under the applicable Limits of additional insureds, the following is added to Insurance shown in the Declarations; Section III—Limits Of Insurance: whichever is less. If coverage provided to the additional insured is This endorsement shall not increase the required by a contract or agreement, the most we applicable Limits of Insurance shown in the will pay on behalf of the additional insured is the Declarations. amount of insurance: 1. Required by the contract or agreement; or Page 2 of 2 C Insurance Services Office, Inc.,2012 CG 20 10 04 13 AC CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) dam, 10/5/zols 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(ies) must 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 Victoria Mitchell NAME Landscape Contractors (Lic#0755906) PHONE Exitl (559)650-3555 FAX No): (559)650-3556 Insurance Services, Inc. ADDRESS�°E•MA'X vmitchell@lcisinc.com I 1835 N. Fine Avenue INSURER(S,)AFFORDING COVERAGE NAIL# Fresno CA 93727 INSURERA:State Compensation Insurance Fund 35076,,,, INSURED INSURER B Oliver Holt Landscape INSURER C: 8611 Amestoy Avenue INSURER D: INSURER E: Sherwood Forest CA 91325 INSURER F: COVERAGES CERTIFICATE NUMBER:18-19 WC 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 ,4N p SWVD POLICY NUMBER IMNOIIDR�VYI 1MMIDCY EXP LIMITS POLI DIYYYYI COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S DAMAGE 76 ftE1u7ETY CLAIMS-MADE OCCUR PREMISES(Ea occurrences $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY .„ PR y f--- PRO I 1 Jk'6"¢ L] LOC PRODUCTS COMPfOP AGG G T P.d'E,R $ AUTOMOBILE LIABILITYJEr af1lNi`D I.IMp1 $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) 5 AUTOS AUTOS NON-OWNED PRG'Dfi+E'R'TY(J,h,h,RAGE 5 HIRED AUTOS AUTOS 'IPer aiwpi�anry") UMBRELLA LIAB OCCUR EACH OCCURRENCE fs EXCESS LAB CLAIMS-MADE AGGREGATE S DED RETENTIONS $ WORKERS COMPENSATION S PER O'I'H- AND EMPLOYERS'LIABILITY YIN STATI)TE ER „ ANY PROPRIETOR/PARTNER/EXECUTIVE E L EACH ACCIDENT S 1,000,000 OFFICER/MEMBER EXCLUDED? N I A A (Mandatory in NH) y 9129706-2016 4/1/2018 4/1/2019 E L DISEASE-EA EMPLOYEE S 1,000,000 If yes,describe under ` DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT S 11000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) RE: All landscape operations performed by or on behalf of the named insured ***** WC Waiver of Subrogation attached ******* This revises certificate dated 03/30/2018 & 9/26/2018 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of E1 Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City Clerk ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street Room 5 El Segundo, CA 90245-3813 AUTHORIZED REPRESENTATIVE V Mitchell/KSAENZ ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD IN S025(201401) _ ENDORSEMENT AGREEMENT BROKER COPY WAIVER OF SUBROGATION 9129706-18 ® RENEWAL NE HOME OFFICE 1-53-82-86 SAN FRANCISCO PAGE 1 OF 1 ALL EFFECTIVE DATES ARE AT 12:01 AM PACIFIC EFFECTIVE APRIL 1, 2018 AT 12.01 A.M. STANDARD TIME OR THE TIME INDICATED AT AND EXPIRING APRIL 1, 2019 AT 12.01 A.M. PACIFIC STANDARD TIME OLIVER HOLT LANDSCAPE 8611 AMESTOY AVE SHERWOOD FOREST, CA 91325 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, OLIVER HOLT LANDSCAPE IT IS FURTHER AGREED 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, WAIVE OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS POLICY OTHER THAN AS STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR LIMITATIONS OF THIS ENDORSEMENT. COUNTERSIGNED AND ISSUED AT SAN FRANCISCO: OCTOBER 3, 2018 2570 AUTHORIZED REPRESENT WE PRESIDENT AND CEO SCIF FORM 10217 IREV.7-2014) OLD DP 217