PROOF OF INSURANCE (2019 - 2020) CLOSEDACR'�''0CERTIFICATE OF LIABILITY INSURANCE DATEJMM/DD1YYYYl
pw1 9/2012019
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMCO
ION ONLY AND CONFERS NO RIGHTS UPON I kTE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVEAMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOTNSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: It the certificate holder Is an ADDITIONAL INSURED, the p 11 o 11 1 1 1 1 cy(fos) must have A 1 0 1 DITIONAL INSURED provisions or 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 confbi rl
shts to the ' cartificate holder In lieu of such endorseme a
CONTACT
PRODUCER Patriot Risk& Insurance Services NA
. MA:
2415 Campus Drive, Suite #200 PHONE EAX
Irvine, CA 92612 49 486-7900 -7950
-ap Not: (9491486
ADDRESS:
INSURERIS)AFFORDING COVERAGE
NAIL M
www,petrisk.com OK07568
INSUR 0 - — ------ INSURERA: Nau'Ulusln�Luranc_e(�qrnq�gy,.....,. 17370
E jysuR�q B: Great Divide Insurance Comoonv 25224
Environmental Contractors Transportation, Inc.
DBA: ECTI A44WR -c-1 .......... .
957 Reece Street INSURER 0:
San Bernardino CA 92411-2356 INSURER E . .... .
INSURER F:
-COVERAGES CERTIFICATE NUMBER: 61258309 NAM
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.
A-1111 TYPE OF INSURANCE AG0LrSUBftJ-' I POLICY Eff'—VOLICY PXP ..........
LV97 [do WVD � POUCYNUM13ER iMMDWYYM JMWQoNyM LIMITS
J� COMMERCIAL GENERAL LIABILITY ECP01526043-18 12131/20'18 12131/2019 EACHOCcUppzNCE
CLAIMS -MADE [i] OCCUR -UAM0n6A#91Eff—
ioccurrence)aoccurrence) $ 300A0 li
✓ Mold Abatement MED EXP (Any one penw) $10000
✓ Pollution Llablil 10011000 PERSONAL& ADV INJURY $'1L000„000
GEN'L AGGREGATE LIMIT APPLIES PER:
0 P —1 _RENFRAL AGGREGATE s 2
POLICY J5RO- F PRODUCTS - COMPIOP
OTHER: CT LOC Ernp.1 . ......
17ee Benefits 1.000.000
AUTOMOBILELIABILITY BAP1526047-18 12/31,12018 12/3112019 COP& ED SINGLE LIMil $1000,00()
-f9p go
4d
ANY AUTO BODILY INJURY (Per person) $
OWNED
ED SCHEDULED
TOS ONLY AUTOS BODILY INJURY (Per accident) $
HIRED NON-OVIINED —PR61YE—RTY DAMAGE
-!L. AUTOS ONLY AUTOS ONLY
LY
✓
�OCCIUR —�FFX1526046-18 '12131/2018 1213112019
p.C IMS.N
EXCESS LIA13 CLAIMS -MADE AGO
$
AND EMPLOYER& LIABILITY W(WCA1526056-18 11112019 1/112020 PER Op.
ORKERS COMPENSATION YIN ✓
STATUTE ER
ANYPROPRIETOR/PARTNER;EXECUTNE
OFFIC9MMEMBEREXCLUDED? LY NIA 'YAL� EACH ACCIDENT '— $ 1.0OO.000
I (Mandatory In NH)
I E.L DISEASE -EAgMPLOYEE $AMQ
Dim daserbe under
SC
P SCRIPTION OF OPERATIONS, bebw E.LDISME.PCXICYL IT $1.000.000
A � rofessionsIG—ability �ECP01526043-18 12/311201841,=
13119 1,000,000
Deductible: $25,000
-DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required)
City of Ell Segundo Is named as Additional Insured, includes Prima and (Von -contributory as their Interest may appear
Waiver of subrogation applies to GL and WC and In favor of the additional Insured per endorsement attached,
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
CITY OF EL SEGUNDO THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
PubliMain c Woft StreetD�ept. ACCORDANCE WITH THE POLICY PROVISIONS.
350
El Segundo CA 90245
AUTHORIZED REPRESENTATIVE
Dave Jacobson
01988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
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4
Environmental Contractors Transportation, Inc.
DBA: ECTI
Poky No. ECP01526043.18
EN. 12/31/2018 ENDORSEMENT
This endorsement forms a part of the policy to which it is attached. Please read it carefully.
ADDITIONAL INSURED - BLANKET
This endorsement modifies insurance provided under the following:
ENVIRONMENTAL COMBINED POLICY
In consideration of the premium charged and notwithstanding anything contained In this poky to the contrary, it Is hereby
agreed and understood that this endorsement shall apply only to the Coverage Part(s) corresponding with the box or
boxes marked below.
0 COVERAGES PARTS A AND B — GENERAL LIABILITY
® COVERAGE D — CONTRACTORS POLLUTION LIABILITY
SECTION III — IIN HP IS AN INSURED is amended to Include as an Insured, with respect to Coverage A, B and D, any
person(s) or organization(s) when you and such person(s) or organizations) have agreed In a written contract or written
agreement that such person(s) or organization(s) be added as an additional Insured on your policy. Such written contract
or written agreement must be In effect prior to the performance of your work which is the subject of such written contract
or written agreement.
Such additional insured status applies only:
1. Under COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY and COVERAGE B PERSONAL
AND ADVERTISING INJURY LIABILITY for claims or suits resulting from:
a. Your work performed for such person(s) or orgenization(s) in the performance of your ongoing operations for
the additional insured; or
b. Your work performed for such person(s) or organizations(s) and included in the products -completed
operations hazard.
2 Under COVERAGE D CONTRACTORS POLLUTION LIABILITY for claims or suits arising out of pollution
conditions that are the result of:
a. Your work performed for such person(s) or organization(s) in the performance of your ongoing operations for
the additional insured; or
b. Your work performed for such person(s) or organizations(s) and included in the products -completed
operations hazard.
With respect to damages caused by your work, as described above, the coverage provided hereunder shall be primary
and not contributing with any other insurance available to those person(s) or organization(s) with which you have so
agreed in a written contract or written agreement.
ALL OTHER TERMS AND CONDITIONS OF THE POLICY SHALL APPLY AND REMAIN UNCHANGED.
ECP 1004 0816
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Page 1 of 1
Environrnontal Contractors Transportation, Inc.
DBA: ECT'I
Policy N0. ECP01526043-18
Eff. '12J3112018
ENDORSEMENT
This endorsement forms a part of the policy to which it is attached. Please read It carefully.
WAIVER OF SUBROGATION
It is agreed that the Company, In the event of any payment under this policy, waives Its right of recovery against any
Principal, but only at the specific written request of the Named Insured either before or atter loss, wherein such waiver has
been included before loss as part of a contractual undertaking by the Named Insured.
This waiver shall apply only with respect to losses occurring due to operations undertaken as per the specliic contract
existing between the Named Insured and such Principal and shall not be construed to be a waiver with respect to other
operations of such Principal In which the Named Insured has no contractual Interest.
No waiver of subrogation shall directly or indirectly apply to any employee, employees or agents of either the Named
Insured or of the Principal, and the Company reserves Re right or lien to be reimbursed from any recovery funds obtained
by any injured employee.
This waiver does not apply in any jurisdiction or situation where such waiver Is held to be illegal or against public policy or
in any situation wherein the Principal against whom subrogation is to be waived is found to be solely negligent.
02M by Barkley specleey Underwrierrg Mrlarrogara LLC, an aftle of Nautilus Insurance Company and l�" r fda Insurance Company. An rights reserved.
1f 12'efle by Ineurance services ofllc% Inc.,. malarial used by perm Won.
ENV 2004 OB OB Page 1 of 1
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FORM MCS -90 Revised 12/13/2018 OMS No.: 2126-0008 Expiration: 01/31/2020
US DOT Number: Date Received:
A Federal Agency may not conduct or sponsor,, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to
comply wIlh a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of Information displays a
current valid OM3 Control Number. The OMB Control Number for this Information collection is 2126-0008, Public reporting for this collection of
information Is estimated to be approximately 2 minutes per response, Induding the time for reviewing instructions, gathering the data needed, and
Burd
and revievWng the collection of Information. All responses to this collection of information are mandatory. Send comments regarding
IHs- burde'n estimate or any 61'her'a'spect of this collection of Information, Including 9tig§"tionVor reducing this burden lo; Information Collection
Clearance Officer, Federal Motor Carrier Safety Administration, MC -RRA, Washington, D.C. 20590.
0""'M owol$lollpp .......... k .
United States Department of Transportation
Federal Motor Carrier Safety Administration
Endorsement for Motor Carrier Policies of Insurance for Public Liability
under Sections 29 and 30 of the Motor Carrier Act of 1980
Issued to Brickley Construction Company, Inc. dba Brickley Environmental of 957 West Reece Street San Bernardino, CA 92411
(Motor Carrier name) (Motor Carrier state or province)
Dated at 1277 Treat, Boulevard, Walnut Creek, CA 94697 on this 13 day of December, 2018
Amending Policy Number: BAP1526047
Name of Insurance Company: Great Divide Insurance Company
Effective Date: 1213112018
Countersigned by:
(authorized company representaffi(a)
The policy to which this endorsement is attached provides primary or excess insurance, as indicated for the limits shown (check only one):
0 This insurance is primary and the company shall not be liable for amounts in excess of $ 1, 000, 000 for each accident.
El This insurance Is excess and the company shall not be liable for amounts in excess of $ for each accident in excess of the
underlying limit of $ for each accident.
Whenever required by the Federal Motor Carrier Safety Administration (FMCSA), the company agrees to furnish the FMCSA a duplicate
of said policy and all its endorsements. The company also, agrees, upon telephone request by an authorized representative of the
FMCSA, to verify that the policy is In force as of a particular date. The telephone number to call is: _925-472-8203
Cancellation of this endorsement may be effected by the company of the insured by giving (1) thirty-five (35) days notice in writing to the
other party (said 35 days notice to commence from the date the notice is mailed, proof of mailing shall be sufficient proof of notice), and
(2) if the insured is subject to the FMCSA's registration requirements under 49 U.S.C. 13901, by providing thinly (30) days notice to the
FMCSA (said 30 days notice to commence from the date the notice is received by the FM CSA at its office in Washington, DC),
Filings must be transmitted online via the Internet at httoJ/www,fmcsa.dotqov urs.
. .. .. .. .. ...
(continued on next page)
FORM MCS -90 Page 1 of 3
FORM MCS -90 Revised 0110612017 OMS No.: 2126.0008 Expiration; 01/3112020
US DOT Number: Date Received:
A Federal Agency may not conduct or sponsor, and a person Is not required to respond to, nor shall a person be subject to a penally for fallurato
comply with B collection of information subject to the requirements ofthe Paperwork Reducllonftl unless that collection ollniormallondloplays a
current valid OMlB Co*ol Number.The OMB Central Number for thishiformallon Ppbl)q repont'no for this collealton of
Information Is estimated to be approximately 2 minutes per response, Including the time for revIelving Instructions, g'alh e'dn'g1he"clat a' 'needed, and
completing and reviewing the collection of information. All responses to this collection of information are mandatory, Send comments regarding
this burden as Ilmote or any *a r aspect of this collection of Information, Including suggestions for reduoing this burden to: Information Collection
Clearance Officer, Federal Motor Carder Safety Administration, MC -RRA, Washington, D.C. 20590.
pil .—, I I
Was Department of7ranap6rtation
Endorsement for Motor Carrier Policies of Insurance for Public Liability
under Sections 29 and 30 of the Motor Carrier Act of 1980
0"R M MC;`Sa9 0
Issued to Environmental, Contractors Transpcirtotlom Inc dba ECTI of 967 West Reece Street San Bernardino, CA92411
?V65—t Confer name) (Motor Comer stela orprovince)
Dated at 1277 Treat, Boulevard, Walnut Creek, CA 94607 on this 7 day of December, 2017
Amending Policy Number, FFX 1626046-17 Effective Date: 12131/2017
Name of Insurance Company: Nautilus Insurance Company
Countersignod by'
(a uttrortxad comp any rspresantstk+oj
The policy to Which this endorsement Is attached provides primary or excess Insurance, as Indicated for the limits shown (check only one):
MIS InsUranCo Is priMarl and the CoMpanyahall not be liable for ainowls In excess of$ for each ooddent.
91 This Insurance Is excess and the company shelf not he Itaide for amaimls In excess at$ AIQQ.OM for each accident In excess of the
Undar1Y1n9ffM#cf$ man— for each accident.
Whenever required by the Federal MolorCardar Safety Administration (FMCSA), the company agrees to furnish the FMCSA a duplicate
of said policy and all 110 endorsements, The company also agrees, upon telephone: request by an authorized representative of the
FMCSA, to verily that the policy Is In force as of a particular date. The telephone number to call Is:.925-472-8203,
Cancellation of this endorsement may be affected by the company of the Insured by giving (1) thirty-five (35) days notice In writing to the
other patty (sold 35 days notice to oDmmence from the date the notice Is mailed, proof of malting shall be sufficient proof of notice), and
(2) If the Insured Is subject to the FMCSA!s registration requirements under 49 VS,C. 13901, by providing thirty (30) days notice to the
FMCSA (said 30 days notice to commence from the date The notice is received by, the FMCSA at Its office in Washington, DC).
.... . . ... . . ... . . .........
Filings m ust be tra nsmItted online via the Internet at blo.11www1hicso,dotmoviurs.
(continuedon next page)
FORM MCS -90 Page 1 of 3
WORKSRS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POUCY
VX 04 03 06 04 84
We have the right to recover our payments from anyone 'liable for an (Nury covered by this policy. We, will not
enforce our right against the person or organization named in the Schedule. (Tlhls agreement applies only to the
extent that you perform worn under a written contract that requires you to obtain this agreement from us.)
You roust 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 shah be 0.00° of the California workers' compensation premium
otherwise due on such remuneration.
Schedule
Person or Organftlion
Any Principal wherein such waiver has been included before toss as pert,of a contractual underW114) by the
Named Insured.
This whdorsoment changes the policy W which It Is 8#90hed and is afto jve an Ute dais issued unless adavides slated
(The Informedon below to required only when thin endorsement Is Issued subsequent to preparation of the pagcy)
Endorsement Effective 01/01/2019 Policy No. WCA1526056-18 Endorsement No.
Insured Environmental Contractors Transportation, Inc. Premium
DBA, ECTI
` '4/
Insurance Company. Countersigned '
by
Great Divide Insurance Company
WC 04 03 06 04 84 1898 by the V"IWo*oW Compensation Insurance Ruling Bureau of Callfomis. Page 1 of 1
All rights reserved, From the WCOM California Worst W Compenandon
Insurance Fonno Manuel 2001.
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