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PROOF OF INSURANCE (2019 - 2020) CLOSED
(AM/DDNYYYY) CERTIFICATE OF LIABILITY INSURANCE o2i2 8/19 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 INSURED,the ltbe endorsed. If this IWANED,rights subject to thetaiontholicy,cipolies may require n endorsementAstatemen on th s certificcate not confer ptto the and certificate holder In f such ertas) PRODUCER CONTACT HELEN SHERLOCK TRI WORLD INSURANCE AGENCY IN NAME: P1n.EW1: (9�19)756-086 a(Ata (949)75r (943)756»1356' E�r Ao 4000 BIRCH STREET,STE 201 B HSHERLOCK "I'.FtC,MhI,OiRL DINS.CONI NEWPORT BEACH,CA 92660 ADDRESS. 800-617.8428 INSURER(S)AFFORDING COVERAGE NAICN INSURER A• ARCH SPECIALTY INS CO. A+XV 21 199 INSURED MARX BROS.FIRE EXTINGUISHER CO. INSURER B; RSUI INDEMNITYCO. A+XIV 22314 IN COOK FIRE EXTINGUISHER INSURER C: SECURITY NATIONAL INS CO.A XV 33120 1 159 S.SOTO STREET I INSURER D: LOS ANGELES,CA 90023 INSURER E: I 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. L1j, TYPE OF INSURANCE ADauaA POLICY EFF POLICY EXP LIMITS "R WMP POLICY NUMBER TMMMONYYYn (MMIDOWM GENERAL UABlUTY EACH OCCURRENCE $ 1,000,000 AMAX COMMERCIAL GENERAL LIABILITY PRA MSS eENc e�neorw) s 50,000 =CLAIMS-MADE PIOCCUR MED EXP(Any one pennon) s 5,000 A X OCP Y DPC102191500 03/26/19 03/26/20 PERSONAL&ADV INJURY $ 1,000,000 _ CENERAL AGGREGATE s 2,000,000 GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $210001000 POLICY Ro AUTOMOBILE LIABILITY LOC ......., Ma no idea SONG UE LAId(T �. ,(Ea ecddenll $ ANYAUTO BODILY INJURY(Per person) S __-... ALL OWNED SCHEDULED BODILY INJURY(Per acddent) $ AUTOS AUTOS NON-OWNED PROPERTYDAMAGE HIRED AUTOS AUTOS -(Per eccidonnI F 'i i — UMBRELLA LIAS I OCCUR .,..,, � � � EACH OCCURRENCE s 4,000,000 B EXCESS LIAS X NHA244559 03/26/t9 08/26/20 4,000,000 CLAIMS-MADE AGGREGATE $ I DED PRODUCTS/OPS s 4,000,000 ......-.. WORKERS COMPENSATION X I WC STATLL TH- ANDEMPLOYERTLIABILRY YIN SWC 1231759 02/18/19 02/18/20 TORYLIMITa `........I0;t `+ I1 NY PROPRIETO AKrNER1DXC UTN �, E E.L EACH ACCIDENT Is 1,000,000 Oi 00MEAMEM10 CWotW ® N/A Y ^I (Mandatory In NH) I E DISEASE-EA EMPLOYEE IV i 1,000,000 If yes.describe under p s 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT OE6CRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Allach ACORD 101,AddlUomol Remarks Schedule,I/more spaos Is required) ALL OPERATIONS-SERVICE AGREEMENT CITY OF EL SEGUNDO,ITS EMPLOYEES,REPS,OFFICERS AND AGENTS ARE ADDITIONAL INSURED PER ATTACHED ENDORSEMENTS. WORK COMP WAIVER OF SUBROGATION ENDORSEMENT ATTACHED. THIRTY(.30)DAYS NOC APPLIES TO ALL LISTED POLICIES. CERTIFICATE. HOLDER CANCELLATION CITY OF EL SEGUNDO SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE PUBLIC WORKS DEPARTMENT THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 350 MAIN STREET ACCORDANCE WITH THE POLICY PROVISIONS, EL SEGUNDO,CA 90245-3813 AY1H9FJJ P Itl%'I'ft§CflTltiT I ®1988-2010 ACORD CORPORATION.All rights reserved. ACORD25(2010/05) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: DPC102191500 NAMED INSURED: MARX BROS FIRE EXTINGUISHER CO., INC. COMMERCIAL GENERAL LIABILITY CG 20 37 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LEASEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL UABILITY COVERAGE PART SCHEDULE Name of Person or Organization: ALL PERSON(S) OR ORGANIZATIONS) AS REQUIRED BY WRITTEN CONTRACT DESCRIPTION: ALL OPERATIONS (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) Section II - Who is An Insured is amended to include as an insured the person(s) or organization(s) shown In the Schedule, but only with respect to liability for "bodily injury" or"property damage" caused, in whole or in part, by "your work"at the location designated and described In the schedule of this endorsement performed for that additional Ensured and Included in the"products-completed operations hazard". PRIMARY INSURANCE CLAUSE: To the extent that this insurance Is afforded-to any additional insured under this policy,such insurance shall apply as primary and not contributing with any insurance carried by such additional insured, as required by written contract. CG 20 37 07 04 C ISO Properties, Inc., 2000 Page 1 of 1 POLICY NUMBER: DPC102191500 NAMED INSURED: MARX BROS FIRE EXTINGUISHER CO., INC. COMMERCIAL GENERAL LIABILITY CG 20 10 07 04 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 PERSON OR ORGANIZATION: ALL PERSON(S) OR ORGANIZATIONS) AS REQUIRED BY WRITTEN CONTRACT LOCATION/DESCRIPTION: ALL OPERATIONS A. Section II—Who is An Insured is amended to include as an insured any person(s)or organization(s)shown in the Schedule, but 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 u above. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions applies: This insurance does not apply to"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 other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. PRIMARY INSURANCE CLAUSE: To the extent that this insurance is afforded to any additional insured under this policy, such insurance shall apply as primary and non contributory with any insurance carried by such additional insured, as required by written contract. CG 20 10 07 04 ©ISO Properties, Inc., 2004 Page 1 of 1 DATE(MM/DDIYYYY) �. CERTIFICATE OF LIABILITY INSURANCE 03/13/2019 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(les)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). PRODUCERBryce.Mckell,Agent .... . CONTACT ... NAME Janlece Williams AX 413 E Foothill Blvd Ste 102 LAIC Mp,Ext):909-305-1370 ( ,Noi 90975915 :7055 MAI.StaT'fehirm San Dimas, CA 91773 ADD Ess honle@bmckell c m INSURER(S)AFFORDING COVERAGE I, NAIC# INSURERR A State,Farm„Mutual Automobile Insurance Company 25179 INSURED Marx Brothers Fire Extinguisher Co Inc INSURER B 1159 S Soto St INSURER C: Los Angeles, CA 90023-2198 INSURER° INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 2013.2014 RENEWAL 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. ILT TYPE OF R INSURANCE .. . �AO°I:SB LQ_ __........POLICY NUMBER (MM DDIIYYYYI (MMIDDIYYYYI. .. I� LIMITS E ❑I ACHOCCURRENCE I$ GENERAL LIABILITY l—I COMMERCIAL GENERAL LIABILITY 1 FIRE ISES iEa ocro aencn) $ CLAIMS-MADE OCCUR I MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE �,$ GE N'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY� '�J�t"O1" LOC A AUTOMOBILE LIABILITY y p 022 5740-B22-75 02/22/2019 08/22/2019 �Ip;. ,r�u I',ulr„;L'I:;dYrNY $ 0 Y tl I BODILY INJURY(Per person) 1,000,000 ANY AUTO 041 1832-B22-75 02/22/2019 1 08/22/2019 AUTOS ALL OWNED 1 X SCHEDULED I BODILY INJURY(Per accident)' $ 1,000,000 AUTOS404 5720-D19-75 11/19/2018 05/19/2019 NON-OWNED I.PIROPrRTY DAMAGE I,5 1,000,000 AUTOS 454 0524-E08-75 11/08/2018 05/08/2019 (per eciedenth HIRED AUTOS i f $ UMBRELLA LIAB OCCUR EACH OCCURRENCE S ATE DEDRETENTION$ ADE . ,., EXCESS LI CLAIMS-M„ ., WORKERS ANDD EMPLOPROPRYERS' LIABILITY IAB NO R/EXECUTIVE E,L, TORY d.I,�iIT ,„, FR .,, .. N WC YIN OFFICEIMEMBER EXCLUDED? ❑ N/A EACH ACT DEN $ ASE ACCIDENT M (Mandatory in NH) EMPLOYEE $ �•� E,L DISE If yes,describe under 1 DF F P elow J E1 DISEASE-POLICY LIMIT $ A EMPLOYERS NON-OWNED/HIRED AUTOBODILY INJURY(Per person) $1,000,000 1Y 1'1� 5610896-606-75 02/06/2019 08/0612019 LIABILITY BODILY INJURY(Per accident) $1,000,000 PROPERTY DAMAGE(Per accident) $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Automobile Liability Section:State Farm provides certification for Scheduled Autos only,described as all vehicles insured by State Farm,under the Producer named above,including Employers Non-owned/Hired Auto Liability. Additional Scheduled Auto:Policy No 474 1500-F21-75D(Eff 12/21/2018 to 06/21/2019). This insurance is primary and non-contributory with respects to claims arising out of the operation of the described vehicle. Additional Insured to be named on all policies:'the City,its officials,and employees'. Cancellation Clause to include 30 days written notice to the Certificate Holder listed below. (Certificate Holder contact:jallen@elsegundo.org) CERTIFICATE HOLDER CANCELLATION City of EI Segundo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Y g THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Attn: City Clerk ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street AUTHORIZED REPRESENTATIVE EI Segundo, CA 90245-0989 Digitally signed by Janiece Williams - LSA5 @ 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 1001466 132849.8 01-23-2013 StateFarm A, 6028BU ADDITIONAL INSURED (Prior Notice of Termination) This endorsement is a part of the policy. Except for the changes this endorsement makes, all other provisions of the policy remain the same and apply to this endorsement. 1. A person or organization shown on the Declarations Page as an Additional Insured is provided Liability Coverage, but only to the extent that person or organization qualifies as an insured as defined in Liability Coverage. 2. An Additional Insured has the same right of recovery under Liability Coverage as if they had not been shown on the Declarations Page as an Additional Insured. 3. If Liability Coverage is changed or terminated as to the interest of the Additional Insured, unless another number of days notice is shown on the Declarations Page, we will provide the Additional Insured: a. 10 days notice of such change or termination if the policy is nonrenewed or the cancellation is for nonpayment of premium; and b. 20 days notice of such change or termination if the cancellation is for any reason other than nonpayment of premium. Additional Insured: 'the City,its officials,and employees' Page 1 of 1 6028BU ©,Copyright,State Farm Mutual Automobile Insurance Company,2011 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed.04-841 WAIVER ODOUR 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 2.00% of the California workers' compensation premium otherwise due on such remuneration. Schedule I Person or Organization Job Description Any person or organization as required by written contract. n This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. POLICY NUMBER: SWC1231759 INSURED: MARX BROS. FIRE EXTINGUISHER CO.,INC. Coverage Provided By: SECURITY NATIONAL INSURANCE COMPANY WC 04 03 06 (Ed.04-84)