Press Alt + R to read the document text or Alt + P to download or print.
This document contains no pages.
PROOF OF INSURANCE (2020) CLOSEDACCC)R117' CERTIFICATE OF LIABILITY INSURANCEDATE(MMIDDIYYYY)
41112020 I 8/26/2019
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 INSURERIS), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the pollcy(les) must have ADDITIONAL INSURED provisions or be endorsed.
I If SUBROGATION IS WAIVED, subject to the terms and conditions of the pollcy, certain pollcles may require an endorsement A statement on
this certificate does not confer rights to the certificate holder In lieu of such endomement(s).
. PRODUCER LOCKTON COMPANIES C p t
3657 BRIARPARK DRIVE, SUITE 700 t Eall:, Nop:
HOUSTON TX 77042 '
866-260538'
INJURERdst AFEORP1N9 COVERAGE NAIC d
INSURER A: Associated Industries Insurance Co, Inc. 23140
INSURED Safe Fleet Holdings, LLC INSURER 8: Libcrty Mutual Fire Insurance Companv 23035
1378689 and its subsidiaries INSURERC; See Attached
(See Attached Named Insured Schedule)
6800 E. 163rd Street SFR n'
Belton MO 64012 INSUR R E,
INSU89BF
COV`91R.AGESCERTIFICATENUMBER: 16268604 REVISION?
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.
P' TYPE OF INSURANCE g POLICY NUMBER I QWyd(i2UWfi LIMITS
A COMMERCIAL GENERAL LIABILITY Y N AES104170603 4/1/2019 4/1/2020 EACH OCCURRENCE .1—L.000.000
CLAIMS -MADE FX-� OCCUR
GEN'L AGGREGATEUMET.APPLIES PER
POLICY❑ %C LOC
OTHER
B AUTOMOBILE LIABILITY
"
ANY AUTO
AUONLY R6y8RUUEEDp
AUTOS ONLY AN DOSS ONLY
A -X UMBRELLA UAB INCLAIMS-
DED
OCCUR
EXCESS UAB MA l ) RETENTION S
B _ II R COMPENSATION
....... OYERS' --YIN N WC2-Z91-465520-019
ANY PROPRIETOWP'ARTNER*.*CUnVE
OFFICERAIEMaER EXCWDE0T NN ,N / A
Mandatory In NH)oecm
II 0 dlbo Under
N N AS5-Z91465520-039
N I N EXA118687801
RENTED It1ami
t 500,000
MED EXP (Any one oerson)
S XXXXXXX
PERSONAL a ADV INJURY
S 1,000,000
GENERAL AGGREGATE
is 2.000.000
PRODUCTS - COMP/OP AGG
2.000.000 I
s
4/1/2019 4/1/2020 Ceo.Ma"9%1 GLELIMIT
L
$ 1.000.000 1
BODILY INJURY (Per person)
DE
N N AS5-Z91465520-039
N I N EXA118687801
RENTED It1ami
t 500,000
MED EXP (Any one oerson)
S XXXXXXX
PERSONAL a ADV INJURY
S 1,000,000
GENERAL AGGREGATE
is 2.000.000
PRODUCTS - COMP/OP AGG
2.000.000 I
s
4/1/2019 4/1/2020 Ceo.Ma"9%1 GLELIMIT
L
$ 1.000.000 1
BODILY INJURY (Per person)
S XXXXXXX
BODILY INJURY (Peraeeidenl
S XXXXXXX
1,T1OrpcEaJR�airMAGE
$XXXXXXX
1PD Deductible
$ 1,000
4/1/2019 4/1/2020
16ACH OCCURRENCE
S 5,000,000
AGGREGATE
$ 5.000.000
s XXXXXXX 1
4/1/2019 4/1/2020 X ISTATUTE I IDP
EL.EACHACCIDENT
S 1.01010.000
,L,
aDISEASE • EA EMPLOYE
S 1.000.000
DESCRIPTION OF OPERATIONS below I
EL DISEASE - POLIeV LIMIT 11000,000 1
C Excess Liability N N See Attached 4/1/2019 4/1/2020 See Attached
DESCRIPTION OF OPERATIONS, LOCATIONS I VEHICLES (ACORD lot. AddtVonat Romerlta Sohadola, may ba Attached ft morespace Is re ulred
P q )
Additional Insured in favor or The City of EI Segundo, its officials, and employees on the General Liability policy where and to the extent required by
written contract. The General Liability policy contains a. provision, with Primary and Man -Contributory wwortlin,g.
CERTIFICATE HOLDER
CANCELLATION See Attachments
16268604
City of EI Segundo Police Department
City of EI Segundo — City Clerk
350 Main Street
EI Segundo CA 80245-3813
ACORD 25 (2018103)
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
Cf --4
01988.2016 ACORD CORPORATI All rights reserved
The ACORD name and logo are registered marks of ACORD
Attachment Code : D546635 Master ID: 1378689, Certificate ID: 16268604
General Liabilittguffer
Insurer: Endurance American Specialty Ins. Co. NAIC# 41718
Policy No.: ELD30000624701
Policy Term: 4/1/2019 - 4/1/2020
Excess Liability $SM X SM'
Insurer: Endurance American Specialty Ins. Co. NAIC# 41718
Policy No.: ELD30001022300
Policy Term: 4/1/2019 - 4/1/2020
Excess Liability $ISM X $10M
Insurer: Everest National Ins. Co. NAIC# 10120
Policy No.: XCSEX00720-191
Policy Term: 4/1/2019 - 4/1/2020
Excess Liability $25M X $25M
Insurer: Liberty Insurance Underwriters, Inc NAIC#19917
Policy No.: 1000334918-01
Policy Term: 5/1/2019 - 4/1/2020
Limits: $1M Each Occurrence
$2M General Aggregate
$2M Products Comp./Op. Agg.
Limits: $5M Each Occurrence
$5M General Aggregate
Limits: $ISM Each Occurrence
$ISM General Aggregate
Limits: $25M Each Occurrence
$25M General Aggregate
Attachment Code: D561683 Master ID: 1378689, Certificate ID: 16268604
Named Insured Schedule
Swordfish Holdings, L.P.
Swordfish Intermediate Holdings, Inc.
Swordfish Intermediate Holdings, Inc.
Safe Fleet Holdings LLC
Safe Fleet Acquisition Corporation
SMC/CPC Holdings, Inc.
Specialty Manufacturing, Inc.
ROM Holdings, Inc.
ROM Acquisition Corporation
IEM, Inc. (DBA: Prime Design)
Fire Research Corp. (DBA: FRC)
Randall Manufacturing LLC
SEON Holdings Corp.
SEON Design USA Corp.
Rear View Safety
Elkhart Brass Manufacturing Co., Inc.
Coban Technologies, Inc.
AmVan Blocker, Inc.
American Van Equipment, LLC
Roll Rite Interco LLC
Transportation Equipment, Inc.
Roll -Rite LLC
SF Mobile Vision, Inc.
POLICY NUMBER: AES1041706 04
COMMERCIAL GENERAL LIABILITY
CG 20 37 04 13
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
SCHEDULE
Name Of Additional Insured Person(s)
Or Organization(s) Location And Description Of Completed Operations
All persons or organizations where required by written
contract with the Named Insured
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
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.
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.
CG 20 37 0413 © Insurance Services Office, Inc., 2012 Page 1 of 1
WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT
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.)
This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule.
Not applicable in AR, NV, NH, NJ and WI,
This waiver does not apply to any right to recover payments which the
Minnesota Workers Compensation Reinsurance Association may have or pursue
under M.S. 79.36.
Schedule
Any person or organization for which the employer has agreed by written contract, executed prior to loss, may
execute a waiver of subrogation. However, for purposes of work performed by the employer in Missouri, this waiver
of subrogation does not apply to any construction group of classifications as designated by the waiver of right to
recover from others (subrogation) rule in our manual.
Where required by contract or written agreement prior to loss and allowed
by law
In the states of AL, AZ, CO, GA, ID, IL, IN, KS, MI, MN, MS, MO, NC, OK,
PA and SC, the premium charge is 2% of the total manual premium, subject
to a minimum premium of $100 per policy.
In the states of CT, FL, IA and OR, the premium charge is 1% of the total
manual premium, subject to a minimum premium of $250 per policy.
In the states of NY and TN, the premium charge is 2% of the total manual
premium, subject to a minimum premium of $250 per policy.
In the state of LA, the premium charge is 2% of the total standard
premium, subject to a minimum premium of $250 per policy.
In the state of VA, the premium charge is 5% of the total manual premium,
subject to a minimum premium of $250 per policy.
Issued by Liberty Mutual Fire Insurance Company 16586
For attachment to Policy No. WC2-Z91-465520-019 Effective Date Premium $
Issued to Safe Fleet Holdings, LLC
WC 00 03 13 © 1983 National Council on Compensation Insurance, Page 1 of 1
Ed. 04/01/1984