PROOF OF INSURANCE (2019 - 2020) CLOSED.
TIFICTE F LIABILITY INSURANCE
CERTIFICATE
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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.
_.._ � ..
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IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the
poliry(ies) intist he endorsed. tr( 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
GON I"ACT
GriffithN60
Harold91'12
#Oc73821.
- 4-2788
R m rjo rg: 323 ., gAM,No 323-564-2788 .
Griffith Insurance & Financial Services, Inc
I'"'rrAgL Sandra@GriffithlnsurnaCefHnote.com
A L)D57k;S,w; ..,
4000 B1Vd.,.,,.,...
NAICiI.,.
CA 902BO
„(S)ArrORDI -_
Ihl,�upfPkl%_,Associated Indtlon
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INS011EplTGatey
Insuraizce F
State Cam ensa unJ
INSURER B : p
A-1 Sandblasting & SLucco Company, Inc
rNS'URI711C
115 Nevada Street
El Segudno CA 90245
I,NSURERE,',
INSURER F
COVERAGES CERTIFICATE NUMBER:
� . �.................................. . REVISION NUMBER:
.. HIS INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
I S TO CERTIFY THAT THE POLICIES OF .....
THIS IS
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 LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS
QPOLICIES
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IYP�1E OF INSURANCE
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A- COMMERCIAL GENERAL LIABILITY
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I EACH OCCURRENCE I S 1,000, 000
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EN1160'10000
CLAIMS-MADE OCCUR
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h PERSONALSADVINJURY 5 1, 000, 000
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NT AGGREGATE LIMIT APPLIES PER �
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E.L. DISEASE - POLICY LIMIT S 1,000, 000
_ I nESCP,IPTION OF OPERATIONS p.;levl I _
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DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may he attached If inure space is required)
CERTIFICATE HOLDER
City of El Segundo
Public Works Department
150 Illinois St
El Segundo CA 90245
CANCELLATION
SHOULD ANY OF IH 'ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIF-1TION LATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCOVAOAN ':L 41 IT ''HE POLICY PROVISIONS.
r4F 8'tE'�r-tl�ra°q 'Iglart=,
ACORD 25 2014-••... The ACORD - Ylcrcm m c ACORD RD CORPORATION. All rights reserved. d.
�... .. served.
( (01) name and logo are l C3 ",te
POLICY NUMBER: EN116010000
COMMERCIAL GENERAL LIABILITY
NX GL 189 05 11
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
BLANKET ADDITIONAL INSUREDS -
OWNERS, LESSEES OR CONTRACTORS
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART 11
J
Policy Number: EN116010000
Named Insured:
A - 1 SANDBLASTING & STUCCO CO INC
A - 1 SANDBLASTING & STUCCO CO INC
Endorsement Effective: 4/30/2019
Counter Signed By:
SCHEDULE
G
Name of Person or Organization.-
Any
rganization:Any person or organization that the named insured is obligated by virtue of a written contract or
agreement to provide insurance such as is afforded by this policy.
Location:
(If no entry appears above, information required to complete this endorsement will be shown in the Declarations
as applicable to this endorsement.)
A. Section II — Who Is An Insured is amended to include as an insured the person or organization shown
in the Schedule, but only to the extent that the person or organization shown in the Schedule is held
liable for your acts or omissions arising out of your ongoing operations performed for that insured.
B. With respect to the insurance afforded to these additional insureds, the following exclusion is added:
2. Exclusions
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 services, maintenance or repairs) to be performed by or on behalf of
the additional insured(s) at the site 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.
C. The words "you" and "your" refer to the Named Insured shown in the Declarations.
POLICY NUMBER:
COMMERCIAL GENERAL LIABILITY
NX GL 189 05 11
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
D. The following are added to SECTION V— DEFINITIONS:
"Your work" means work or operations performed by you or on your behalf; and materials, parts or
equipment furnished in connection with such work or operations.
E. The following additional provisions apply to any entity that is an insured by the terms of this
endorsement:
1. Primary Wordinq
With respect to the Third Party shown above, this insurance is primary and non-contributing. Any
and all other valid and collectable insurance available to such Third Party in respect of work
performed by you under written contractual agreements with said Third Party for loss covered by
this policy, shall in no instance be considered as primary, co-insurance, or contributing insurance.
Rather, any such other insurance shall be considered excess over and above the insurance
provided by this policy.
2. Waiver of p�rmation
If required by written contract or agreement: We waive any right of recovery we may have against
an entity that is an additional insured per the terms of this endorsement because of payments we
make for injury or damage arising out of "you work" done under a contract with that person or
organization.
04/22/2019 1:28FN FAX 18104721857 Dorian InsiArance Agency 1&0002/0002 1
A-1 SA -1 ofJOLLA
A4C7C>RE-*" VATE(MMIODM-M
CERTIFICATE OF LIABILITY INSURANCE'' 0412212019
THIS CERTIFICATF 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 THRcoveRAGE AFFORDED BY THE VOLICIE;
BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),,AUTHORIZEDI
REPRESENTATWE OR PRODUCER, AND THE CERTIFICATE HOLDER,
IMPORTANT; If the certificate holder Is an ADDITIONAL INSURED, the policy(iss) Must have ADDITIONAL INSORIE0 provIsIons or be ondomft�
If SUSROGATION 18 WAIVED, subject to ft terms and conditions of Ow ptigg
, certain po0cies may requira an endorsemqnt A Statement or,
this carcato! do
cortfficatah 1E1a±2uotzut.hgrp2atLs),
310-472-6686 ragory CrD6arldalan, CPCU T
PRODUCUR ion G I -
D#tlmn Ingu�rance Agenoy 3 6412-6688 jox, ,,,310-472-1657
PO Box 49518
Los Angeles, CA 00049,0518
NAILS
...IMMR A Lk)ert, . ;At nsurance
INSU r Rgp-A-i -Sandblesting & Stucco CO., C INsunr;k a Lib
_prty Mutual Insurance
Vicente Torre,
11$ Nevada StrCet INSURER c;
El Segundo, CA 90245
rrIfS is To CERTIFY THAT THE POLICIES OF INSURA610E LISTED BELOW HAVE SEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE P0LIQrY PERIOD
INDICATED, N01Wl THSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO VMICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 1$ SUBJECT TO ALL THE TEF' MS,�
EXCLUSIONS AND CONNTION$ OF SUCH POLICIE& LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
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A 10 M r SwfO SOMMITZ01 WMI YIN '4CH ACODENT
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w, mvugnx�t.�, aECUTIVE MIA E,L L
A.L DISEASE. VA FMOID
d6vealSe ander
—J) s RIPTION OF GREVwAY"I'RQh6II ct�a U:
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rW&CKI"ON OY OPERATIONS I LOCATIONS I VP1401.116 (AOORO 101, 06186"W ReMAKIM G&II4010, rday be oftdwd If morn Waco I& requited)
SX&IkIkALE—IjO -
LQF-R- ,
City of EI Segundo
360 Main Street, Room 5
E( Segundo, CA 90246
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-jj6&R-10 25 (20*03)
BKOULD ANY 0? THIS ABOVE OPSCRISE0 POLICIES BE CANCELI.RD BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL 'BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS,
AUTHORM REPRESANTA7M
Q 19$6.2015 ACORD CORPOPATION, All rights reserved.
The ACORD name and logo Are registered marks of ACORD
ENDORSEMENT AGREEMENT
WAIVER OF SUBROGATION
9239668-18
NEW
NA
PAGE 1
HOME OFFICE
;AN FRANCISCO EFFECTIVE MAY 2, 2019 AT 12.01 A.M.
ALL EFFECTIVE DATES ARE AND EXPIRING OCTOBER 6, 2019 AT 12.01 A.M.
%T 12:01 AM PACIFIC
)TANDARD TIME OR THE
"IME INDICATED AT
'ACIFIC STANDARD TIME
A-1 SANDBLASTING & STUCCO CO., INC
115 NEVADA ST
EL SEGUNDO, CA 90245
ANYTHING IN THIS POLICY TO THE CONTRARY NOTWITHSTANDING,
IT IS AGREED THAT THE STATE COMPENSATION INSURANCE FUND
WAIVES ANY RIGHT OF SUBROGATION AGAINST,
CITY OF EL SEGUNDO
WHICH MIGHT ARISE BY REASON OF ANY PAYMENT UNDER THIS
POLICY IN CONNECTION WITH WORK PERFORMED BY,
A-1 SANDBLASTING & STUCCO CO., INC
IT IS FURTHER AGREED THAT THE INSURED SHALL MAINTAIN
PAYROLL RECORDS ACCURATELY SEGREGATING THE REMUNERATION
OF EMPLOYEES WHILE ENGAGED IN WORK FOR THE ABOVE
EMPLOYER.
IT IS FURTHER AGREED THAT PREMIUM.ON THE EARNINGS OF SUCH
EMPLOYEES SHALL BE INCREASED BY 03$..
NOTHING IN THIS ENDORSEMENT SHALL BE HELD TO VARY, ALTER, WAIVE OR EXTEND
ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS POLICY
OTHER THAN AS ABOVE STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE
HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR
LIMITATIONS IN THIS ENDORSEMENT.
COUNTERSIGNED AND ISSUED AT SAN FRANCISCO: MAY 3, 2019 2570
AUTHORIZED REPRESEENT IVE PRI=S0FNT ANn CFn