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PROOF OF INSURANCE (2020) CLOSEDCertificate of Insurance THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON YOU THE CERTIFICATE HOLDER. THIS CERTIFICATE IS NOT AN INSURANCE POLICY AND DOES NOT AMEND, EXIFND, OR ALTER TILE CM'E,'RA(3k AFFORDED BY THE POLICIES LISTED BELOW. POLICY LIMITS ARE NO LESS THAN THOSE LISTED. ALTHOUGH POLICIES MAY 1NCLJJDE ADDITIONAL SLU:II.IMIT/I.IM11'S NOT LISTED BELOW, This is to Certify that WEST COAST ARBORISTS, INC 2200 EAST VIA BURTON NAME AND Libe ty, M ANAHEIM CA 92806 ADDRESS . OF INSURED INSURANCE is, at the issue date of this certificate, insured by the Company under the policy(ies) listed below. The insurance afforded by the listed policy(ies) is subject to all their terms, exclusions and Conditions and is not altered by any requirement, term or condition of any contract or other document with respect to which this certificate may be issued. EXP DATE ❑ CONTINUOUS TYPE OF POLICY [:]EXTENDED POLICY NUMBER LIMIT OF LIABILITY m POLICY TERM WORKERS 7/1/2020 WA7-66D-039499-079 COVERAGE AFFORDED UNDER WC EMPLOYERS LIABILITY LAW OF THE FOLLOWING STATES: COMPENSATION Statutory Limits All States Except: Bodily m ury b 1 by Accident ND, OH, WA, WY 000' Exch Acaideol Bodily Injury By Disease $1,000,000 P„ti Bodily Injury By Disease $1.000.000 Ex...... COMMERCIAL 7/1/2020 TB2-661-039499-019 Genera I Aggregate GENERAL LIABILITY $2,000,000 m OCCURRENCE Products / Completed Operations Aggregate $2.000,000 ❑ CLAIMS MADE Each Occurrence $2,000,000 RP.TRO DATE AUTOMOBILE I 7/1/2020 AS7-661-039499-039 LIABILITY (� OWNED m NON -OWNED ❑ HIRED OTHER S ADDITION AL COMMENTS See Addendum. Personal & Advertising Injury $2,000,000 Per Person/ Organization Oihcr .ther Dania a to�t remises rented to Vats S�.0tIi1 Each Acri(cnt—Single Limit $2,0001000 B.I. And PA), Combined • If the certificate expiration date is continuous or extended term you will be notified if coverage is terminated or reduced before the certificate expiration data NOTICE OF CANCELLATION: (NOT APPLICABLE UNLESS A NUMBER OF DAYS IS ENTERED BELOW.) BEFORE THE STATED EXPIRATION DATE THE COMPANY WILL NOT CANCEL OR REDUCE THE INSURANCE AFFORDED UNDER THE ABOVE POLICIES UNTIL AT LEAST 30 DAYS NOTICE OF SUCH CANCELLATION HAS BEEN MAILED TO: Each Person Each Accident or Occurrence Each Accident or Occurrence Liberty Mutual Insurance Group F!Clty of EI Segundo (�C.t�.�� 350 Mein Sheet Elaine Ulan q EI Segundo CA 90245 Los Angeles / 0603 AUTHORIZED REPRESENTATIVE f z 818 W 7th Street, Suite 850 0564408 Los Angeles CA 90017 213-443-0782 6/18/2019 OFFICE PHONE DATE ISSUED This certificate is executed by LIBERTY MUTUAL INSURANCE GROUP as respects such insurance as is afforded by those Companies NM 772 07-10 49340192 1 LM 261.9 1 7/19-7/20 - GL/2/2, AL/2, WC/1 I Donna Smitala 1 6/18/2019 8:51:15 AM (CDT) I Page 1 of 2 LDI COI 268896 02 11 CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER_ : NM FORM TITLE: Certificate of Casualty Insurance (07/10) HOLDER: City of EI Segundo ADDRESS: 350 Main Street EI Segundo CA 90245 -------------- The City of E1 Segundo, its officials, and employees are additional insured with regards to general liability and automobile liability, as their interest may appear, where required by written contract. The insurance afforded by the general liability policy for the benefit of the additional insured shall be primary and non-contributory. Waiver of Subrogation is included in favor of the additional insured on workers compensation, where allowed by statute, and applies only to the specific jobs of the insured performed under written contract, and where applicable by law. ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ADDENDUM 49340182 1 LM 2819 1 7/19-7/20 - GL/2/2, AL/2, WC/1 I Donna Smitala 1 6/18/2019 8:51:15 AM (CDT) I Page 2 of 2 AGENCY CUSTOMER ID: LM 2819 LOC #: A� E � ADDITIONAL REMARKS SCHEDULE Page of AGENCY NAMED INSURED INC Liberty Mutual Insurance Co. National Insurance West 2200 EAST VIA BURTONTS, POLICY NUMBER ANAHEIM CA 92806 CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER_ : NM FORM TITLE: Certificate of Casualty Insurance (07/10) HOLDER: City of EI Segundo ADDRESS: 350 Main Street EI Segundo CA 90245 -------------- The City of E1 Segundo, its officials, and employees are additional insured with regards to general liability and automobile liability, as their interest may appear, where required by written contract. The insurance afforded by the general liability policy for the benefit of the additional insured shall be primary and non-contributory. Waiver of Subrogation is included in favor of the additional insured on workers compensation, where allowed by statute, and applies only to the specific jobs of the insured performed under written contract, and where applicable by law. ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ADDENDUM 49340182 1 LM 2819 1 7/19-7/20 - GL/2/2, AL/2, WC/1 I Donna Smitala 1 6/18/2019 8:51:15 AM (CDT) I Page 2 of 2 POLICY NUMBER: T132-661-039499-019 COMMERCIAL GENERAL LIABILITY CG 2010 0413 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 A. Section II — Who Is An Insured is amended to include as an additional insured the 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 above. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is 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. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury' or "property damage" occurring after: Name Of Additional Insured Person(s) Or Organization(s): Any owner, lessee, or contractor for whom you have agreed in writing prior to a loss to provide liability insurance 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. C. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: SCHEDULE 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. Location(s) Of Covered Operations Any location work is performed Information required to complete this Schedule, if not shown above, will be shown in the Declarations. CG 20 10 0413 0 Insurance Services Office, Inc., 2012 Page 1 of 1 POLICY NUMBER: TB2-661-039499-01 9 COMMERCIAL GENERAL LIABILITY CG 20 37 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART A. Section II — Who Is An Insured is amended to include as an additional 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 insured and included in the "products -completed operations hazard". However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is 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. Name Of Additional Insured Person(s) Or Organization(s): B. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. SCHEDULE All persons or organizations with whom you have entered into a written contract or agreement, prior to an occurrence or offense, to provide additional insured status. Location And Description Of Completed Operations All locations as required by a written contract or agreement entered into prior to an occurrence or offense. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. CG 20 37 0413 C Insurance Services Office, Inc., 2012 Page 1 of 1 POLICY NUMBER:AS7-661-039499-039 COMMERCIAL AUTO CA 20 48 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED FOR COVERED AUTOS LIABILITY COVERAGE This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. !`-*Kl*111114=1 Name Of Person(s) Or Organization(s): Any person or organization whom you have agreed in writing to add as an additional insured, but only to coverage and minimum limits of insurance requited by the written agreement, and in no event to exceed either tl?e scope of coverage or the limits of insurance provided in this policy. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Each person or organization shown in the Schedule is an "insured" for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Paragraph A.1. of Section II - Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms and Paragraph D.2. of Section I - Covered Autos Coverages of the Auto Dealers Coverage Form. CA 20 48 10 13 0 Insurance Services Office, Inc., 2011 Page 1 of 1 POLICY NUMBER: TB2-661-039499-019 COMMERCIAL GENERAL LIABILITY CG 20 01 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. .. I'" III • • • • "" • • This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance (2) You have agreed in writing in a contract or Condition and supersedes any provision to the agreement that this insurance would be contrary: primary and would not seek contribution Primary And Noncontributory Insurance from any other insurance available to the additional insured. This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and CG 20 01 04 13 0 Insurance Services Office, Inc., 2012 Page 1 of 1 WAIVER OF OUR 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% of the California workers' compensation premium otherwise due on such remuneration. Schedule Additional premium is a percent of the California Manual Workers Compensation premium. Subject to a minimum premium charge of $ 250. Person or Organization Where required by contract or written agreement prior to loss and allowed by law Issued by Liberty Insurance Corporation 21814 For attachment to Policy No. WA7-66D-039499-079 Effective Date Premium $ Issued to West Coast Arborists, Inc. WC 04 03 06 Page 1 of 1 Ed: 04/1984