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PROOF OF INSURANCE (2019 - 2020) CLOSED
DELTA-2 CIP ID: MS DATE(MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 02101/2019 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 NTAOT Jack Novic}o Insurance Agency PHO�d�Cxt1.916-783k0000....................... Fr1X j1.1 91.......... _Cecil 2746 Sacramento, meJack o, CA 95815 EWAI. - 6-485 4998 fal: .0........................w_... INSURER(SLAFEORDING COVERAGENAIC ff _ INSURERAU.S.Specialty Insurance..C° ........ _29599 .. INSURED Delta Electric INSURER B:TrumbullInsurance Company Rolando Estevez 17007 Strawberry Pine Court wsuRER c: Santa Clarita,CA 91387 .�§_URER o;, ITm INSURER E: 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 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, IL rR .... .TYPE OF INSURANCE ....,... ldd'♦,US POLICYNUM BER,.. . �p(MM�In YYYYj, fM�.--, .._.,,._.._.........w.._.w..._.. LIR INSURANCE oucr€xP Mfl1DIVYVYI, LIMITS A X 1 COMMERCIAL GENERAL LIABILI fY EACH OCCURRENCE S 1,00 mm 0,00 q CLAIMS-MADE X„ c.o�:CUIt X X UIBAC8396004 10/01/2018 10101/2019 MsEs�(E ocLurOervc s „ „ _ 100,00 MED EXP,(Any one person) S 6,00 PERSONAL a ADV INJURY $ 1,000,00 GEN`L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00 POLICY mX 6 !.7c) PRODUCTS yCOMP10P AGG^ .5 2,0000000 AU f0(r10BILE LIABILITY COMBINED SINGLE LIMIT 5 r,:a accident) ...................... ANY AUTO BODILY INJURY(Per person) $ ALLOWNEO SCHEDULED BODILY INJURY(Per ac AUTOS AUTOS Paccident) $ HIRED AUTO AOi-OWNED UTOS $ q{ Ae �._X OCCUR OCCURRENCE S-MADE UISACS396004 01/24/2019, 10/01!2019 AGGREGATE 1,000,00 X EXCESSL ABCLAIMGATE .... - 1,000,0O�Oa'�� ..,. ryry .....,.,,., ,,...,...... .................. .......... ........w...w....... , DED U RETENTIONS $ 1 WORKERS COMPENSATION PER.....AND EMPLOYERS'LIABILITY f B � STATUTE ER H OFFICEWM IE OER EXCLrUDEDpXECUTIVE N/A X 67WECZU3213 01/1112019 01111/2020 CL EACH ACCfDENT 5 �,..,., _ 1,000,000 (Mandatory In NH) E L.DISEASE-EA EMPLOYEE $ 1,000,00Cyes,describe under ' DESCRIPTION OF OPERATIONS below E�Lm DISEASE-POLICY LIMIT 5 1, ,000,OOC' DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space Is required) RE: Downtown Landscape Lighting Project, Project No: PW 18-24 Additional Insured: City of EI Segundo,Its officers,officials,employees, and volunteers. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of EI Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Y B ACCORDANCE WITH THE POLICY PROVISIONS. City Clerk 350 Main Street AUTHORIZED REPRESENTATIVE EI Segundo,CA 90245 Cecil Jack ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 26(2014101) The ACORD name and logo are registered marks of ACORD F)OL ICY IgIJMI3L(*2: IJ17AC,83960-- COMMU.-. Cl/- L Gf:NE'RAI.. I_I/1BIL,ITY CG 20 10 07 04 THIS ENDORSEMENT CHANGES 't HE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insuranec:provided under file following: COMMiERC:IAL GENERAL LIABILITY COVERAGE PART SCHEDULE ....._,...m.,._..Nante Of Additional Insured Person(s) Or Organization(s): ...-..,.,.....m.,__.�..W .L..oc,..a...t..i..o._oa_j_s_j._..e...f�.C._.�4..vered Qperttiolas �.... �..�_._..,,..,,..�._-.�,.... Any porson or organization for w horn you arc. pc,rforming oper..alions dUrinq they policy pcadod whon you and sm,,ia f>c.,o mll or haa.c*aapreod ill waritintt in<a conlroc.t or ca(fr.cwe a'tent (hat sur h pt'rson or organization be aadd d at; ,in aaddilional i'rasurc.el arra your'policy. fr,forraaaalrc>n rc, ttrt'Gef to cart let,e~ ttais ,�cltcdralc,, it not staovr(a� � _.. ...� _.,.............w _.�.._�."....... ....�...�.,._��..... __'_...:.,� be shown in ttac Declarations. above, will b A. Section II -- Who Is An Insured is amended to B. With respert to tine inSurMnoc afforded to these inchidt, as an additional intrured the; person(s) or additional insureds, the foliownring additional exclu- orgaani;ra(ion(s) $flowrwn in the Schedule, but only siolls apply: Mala rccssfar;cf to liability for "bodily injury" "Iaropc;rly This Insurancacy does not )pply to "bodily injury" at, dawn-rxage" car "pe somal and a(Ver1lsl0q in)tary ""property damage"accurricact,after: c:aaursed, in whole tar-in part, Icy, 1. All work, including n°aaaferrai4;, faaar`d:a or ectrarp's<. 1. Your acts or omissions;or men( furnishc d in connection will') such words, 2. 'Fit(, acts or omissions of those acting on your ora tho project (olher than servico-, raraairaltanitnce bohialf; or rel;aairs) to be performed by or can behalf of ill €hc; I)carfor'ntanGe of your onttoing operaatioras for file aadditional insured(s) at the location of tyre the, additional insored(s) at lhra location(s) dosig- covered operations has been completed; or mated aaLbovc„ 2. t'l"part portion of "your wrrorlc," Out of which the Irajarry Or da4a'aaage byadses Iris been Taut to its In- tended use by any parson or organimtion olhoi, than aanothor contractor or subcontractor carr- gaged in performing Operations for" a prttac:ipaal as as Pad of the s<araar proje-CL CG 20 10 07 04 CEJ ISO Propc:riios, Inc., 2004 Page 1 of 1 C7 r'(')LICY NUMBER: 1117AC83060 GOI>,rIMVROIAL GENIF,RAL LIABILITY HCS 040 06 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ iT CAREFULLY, PRIMARY AND NONCONTRIBUTORY AND BLANKET WAIVER OF SUBROGATION .......:"iiis•trtdor5emetit r�re,di!'tcs instat�ance rovidrei tlrxlti:r-tt'ie•fotiowin ' COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART A. PRIMARY AND NON-CONTRIBUTORY TO B, WAIVER OF SUBGROGRATION ...BLANKET OTHSR INSURANCE Uncles SECTION IV •- COMMERCIAL. GENERAL Willi lc;st,cwct to any t"aer;OA car'or�,t<11)irr)lift that is LIABILITY CONDITIONS, The Transfer Of all additional insured under this Ccvor;rc)t° Paft, Rights Of Recovery Against Others To Us llao following is ander to partrrgr'iph 4. of Condition is amended by the: addition of the: SECTION IV -- COMMERCIAL. 'GENERAL fallowing: LIABILITY CONDITIONS: Wc, waive any d(Illt of recovery we may have If you have agreed in wr'itiny in a (,o{)tract or arc)trinst arty person or cart tartiaatian Ix.e,ausa of agreement that this insurance is primary and tion- payrrier'rts we mako for injury or dan'tage arising c,ontributor'y relative to an additional insured's Lawn out of: insurance, then tfii,s insurance is primary and we a. Your ongoing operations; or will not seek c,ontrit)trtion bunt (flat other Ir)SUr'anGe. For the purpose o1' this ertdcarscar•rrent, b. "Your work" included in the "I>rUduct,•• the additional insured's own il)SUl�tnCe; Means �©rnpietedUl7eralit}i1Stita'l..arCt". insurance on which the additional insured is a However, Iltis waiver applies only when you have Named Insured. ca fIt'ert;tt ill writing to waiver such rights of recovery W an this endorsement is attached to the policy it in a Contract or "19reememi, and only if the, contraert supersedes all other insurance conditions within. or agreement: a. ig in effect or becomes effc-ctivo during the U,nin of this policy; and b. Was exocuted prior to loss. IJCS 040 06 10 13 Page 1 of 3 includes copyrighted miterial of Imuralloe Services Office,Inc:.,Willi its pemtission. CI CW A02 10 11 CERTIFICATE OF INSURANCE This certificate is issued for informational purposes only. It certifies that the policies listed in this document have been issued to the Named Insured. It does not grant any rights to any party nor can it be used, in any way, to modify coverage provided by such policies. Alteration of this certificate does not change the terms, exclusions or conditions of such policies. Coverage is subject to the provisions of the policies, including any exclusions or conditions, regard- less of the provisions of arty other contract, such as between the certificate holderand the Named Insured. The limits shown below are the limits provided at the policy inception.Subsequent paid claims may reduce these limits. Certificate r. Named Insured: ALEX ESTEVEX DBA-DELTA ELECTRIC ALEX ESTEVEZ 17007 STRAWBERRY PINE CT 17007 STRAWBERRY PINE CT ISANTA CLARITA, CA 91387-6952 SANTA CLARITA CA 91387-6952 Automobile Liability Insurer Name: Allstate Insurance Company PolicyNumber 648157658 1-Any Auto 2-Owned Autos Only 3-Owned Priv.Pass.Autos Only 4-Owned Autos Other Than Priv. 5-Owned Autos Subject to No 6-Owned Autos Subject to a Compulsory UM Law Pass.Autos Only Fault X 7-Specifically Described Autos 8-Hired Autos Only 9-Non-owned Autos Only Policy ate: 04-07-2018 Policy Expiration . 04-07-2019 Limits Of $ 2,000,000 Combined Single Limit(each accident) Y Insurance: BI Per Person BI Per Accident PD Per Accident Description of Operations/Locations/Vehicles/Endorsements/Special Provisions Into : CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT GRANT ANY COVERAGE OR RIGHTS TO THE CERTIFICATE HOLDER. IF THIS CERTIFICATE INDICATES THAT THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED, THE POLICY(IES) MUST EITHER BE ENDORSED OR CONTAIN SPECIFIC LANGUAGE PROVIDING THE CERTIFICATE HOLDER WITH ADDITIONAL INSURED STATUS.THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED ONLY TO THE EXTENT INDICATED IN SUCH POLICY LANGUAGE OR ENDORSEMENT. Producer CABRINI INS AGY INC Authorized Representative: Date: 12-27-18 Includes copyrighted material of Insurance Services Office, Inc.,with its permission CI CW A02 10 11 Allstate Insurance Company Page 1 of 1 Cerfikate Copy THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA Policy Number: 57 WEC ZU3213 Endorsement Number: Effective Date: 01/11/19 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address: ROLAND ESTEVEZ 17007 STRAWBERRY PINE CT CANYON COUNTRY CA 91387 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 from whom you are required by written contract or agreement to obtain this waiver of rights from us Countersigned by Authorized Representative Form WC 04 03 06 (1) Printed in U.S.A. Process Date: 12/02/18 Policy Expiration Date: 01/11/20