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PROOF OF INSURANCE (2020 - 2020) CLOSEDACC CERTIFICATE OF LIABILITY INSURANCE DATEIMM,DD-) "M I 7/25,%'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. IMPORTAN'IT; If the certificate holder is an ADDITIONAL INSURED, the policy(ies) 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 end'orsement(s). PRODUCER g�jC 't' Natasha Federoff Landscape Contractors (Lic#0755906) PHONE lam (559) 650-3555 �; la Noi (559)650-3558 InBura �.... p .S,,.S........ INSUREMSV AFFORDING COVERAGE m- ...................._ iFresnonce Services, Ind 93727 n....^�,� -- - ederoff@lcisinc c INSURER A "G NAIC A 1635 N. Fine Avenue Greenwich .Ins Cc 22322 INSURED �INSURERB:XL Specialty Ins Co 37885 Oliver Holt I INSURERC� ................... ...... .,.........,, DBA: Oliver Holt Landscape INSURERD _._ 8611 Amestoy Avenue INSUREREi_... Sherwood Forest CA 91325 INSURERS COVERAGES CERTIFICATE NUMBER:19-20 ;kg, IM & Auto 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 .... _ .. ILT R 'AD9'TI YNSD 'Wm'R% ",.. .. POLICY EFF I POLICY C YY"d"91V LIMITS ,.,.,.,., INSURANCETYPE OF mm IC°P' EXP POLICY NUMBER 0MW0DJYY'y l I IMMM RS ". RAL LIABILITY EACH Or'CURF�IS'-7GL 0 S 1,000,000 LA X COMMERCIAL ...........N DAMAU`E f0 RENMI �.. ..,"...� yC OCCUR F:',�°r+l E51 a� n r n7 ^! 5 100, 000 .."R ,2;44!_. _ X NPC -10016024-00 7/16/2019 7/16/2020 MED EXP fA,,y ou',r aorsold yS 5,000 X 51.000 PD DED IPERSONAL BADVINJURY 5 1,000,000 GENT AG LIMIT .APPI..ILS PI'�:I'R: GENERAL AGGREGATE S 2, 000,000 P 2,000,000 XX pl ICY AGGREGATE ,,GT LOC PRODUCTS - COMPIOP AG,G S (ICII- r v AUTOMOBILE LIABILITY... .. .." .. f t+u� Iceh;y7aVPILE U?11T 5 1,000,000 ... A %t ANY AUTO tlP.)DIi 1r INJURY (IIN I,,ersm) 5 AUTOS ALL OWNED X7 SCHEDULED 1001025-00 7 16/2019 7/16/2020 F _ NON -OWNED . wp.4 t DAMAGE hfAaE"ro:¢'iduirull 5 (I'�bru —� X AUTOS L s r.ivL oil .................... HIRED AUTOS "�, S AUTOS 11AndlcalrsPn c� S 5,000 UMBRELLA LIAB I I-y¢,CLII,R EACH OCCURRENCE S EXCESS AB Ili(FiC.7E AG,-KI-GA;TF S f t s ,. UCIU ( RETENTIONS - S WORKERS COMPENSATION I-'E'f Ila"IPI-n rY ) Eay.T;..MI PLOYS .', ANY PROPRIETORMARTNER/EXECUTIVE �I ' EACH ACCIDENT i 5 AND EMPLOYERS' LIABILITY y. 1 ty (Mandato in NH E L DISEASE1 S 14 es, describe under -•-- u OFFICER/fJ�EMBER EXCLUDED t DESCRIPTION OF OPERATIONS bPlnw DISEASE - POLICY LIMIT S B Inland Marine .NYFi-1001026-00 !X6 ;::0'1:1 7/16/2020 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: All landscape operations performed by or on behalf of the named insured. (See Attached CG20100413) City of El Segundo and its officers, elected officials, and employees (Excluding Professional Liability) are named as additional insured per attached endorsement. CERTIFICATE HOLDER CANCELLA'T'ION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City Of El Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City Clerk ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street Room 5 El Segundo, CA 90245-3813 AUTHORIZED REPRESENTATIVE IV Mitchell/ARUIZ :-- ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS025 (201401) POLICY NUMBER: NPC -10010024-00 COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 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 Additional Insured Person(s) Or Organization(s) Blanket as required by written contract. Location(s) Of Covered Operations Blanket as required by written contract 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", "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: 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. CG 20 10 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 2 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: 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. Page 2 of 2 © Insurance Services Office, Inc., 2012 CG 20 10 04 13 Policy Number: NPC -10010024-00 COMMERCIAL GENERAL LIABILITY CG 20 01 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTNER INSURANCE CONDITION 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 0413 0 Insurance Services Office, Inc., 2012 Page 1 of 1 �+ 0' I DATE (MMIDDIYYYY) � CERTIFICATE OF LIABILITY INSURANCE 9/27/2019 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(ies) 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). PRODUCER CONTACT Victoria Mitchell NAME Landscape Contractors (Lic#0755906) WC Mss I xt, (559) 650-3555 FAX (AIC,No,, (559)650-3558 Insurance Services, Inc. p'DMD�L vmitchell@lcisinc.com 1835 N. Fine Avenue IN,S,URER(S)AFFORDING COVERAGE NAIC,# Fresno CA 93727 INSURERRAA:State Compensation Insurance Fund 35076 INSURED Oliver Holt Landscape INSURER C: 8611 AmestoY Avenue INSURER D INSURER E: Sherwood Forest CA 91325 INSURER COVERAGES CERTIFICATE NUMBER:19-20 WC 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. INTI TYPE OF INSURANCE ADOL,SUS POLICY POLICY EFF POLICY EXP LIMITS � IRrn Y NUMBER (MMIODfYYYYI (MMIODIYYYY) COMMERCIAL GENERAL EACH OCCURRENCE DAMAGECCRENT ED L. $ CLAIMS -MADE OCCUR ,PRFMI<SFE (F8 Ppourn ncP) MED EXP (Any one person) $ PERSONAL & ADV INJURY $ CT /O,,,, GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE POLICY ❑ E] LOC PRODUCTS -COMP PAGG I,$, I OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT I $ ANY AUTO BODILY INJURY (Per person)I$ ALL OWNED SCHEDULED ( accident) $ AUTOS AUTOS BODILY ) Y INJURY Per . . NON -OWNED PRCbPERTY Dr"4AAGE' $ HIRED AUTOS AUTOS Per uKy Id,e,nt $ UMBRELLA LIABOCCUR EACH OCCURRENCE $ I DED SS LI AB AB CLAIMS -MADE AGGREGATE I RETENTION WORKERS COMPENSATION g PER OTH AND EMPLOYERS' LIABILITY YIN 9TATUT - ANY $ 1, OFFICER/MEMBER EXCLUDED? NIA NIA Ander 9129706-2019 4/1/2019 4/1/2020 EL E L DISEASE EA EMPLOYEE ACCIDENT $ 1,000,,0,00 DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 000, 000 (Mandatory andat ry in be NH)EMPLOYEE$ 1,DDD,ODO DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: All landscape operations performed by or on behalf of the named insured. ***** WC Waiver of Subrogation attached ******* **This revises certificate dated 09/18/19 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 City Clerk ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street Room 5 El Segundo, CA 90245-3813 AUTHORIZED REPRESENTATIVE V Mitchell/ARUIZ ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS025 (201401) HOME OFFICE SAN FRANCISCO ALL EFFECTIVE DATES ARE AT 12:01 AM PACIFIC STANDARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME ENDORSEMENT AGREEMENT WAIVER OF SUBROGATION BROKER COPY REP 05 9129706-19 RENEWAL NE 1-53-82-86 PAGE 1 OF 1 EFFECTIVE SEPTEMBER 19, 2019 AT 12.01 A.M. AND EXPIRING APRIL 1, 2020 AT 12.01 A.M. OLIVER HOLT LANDSCAPE 8611 AMESTOY AVE SHERWOOD FOREST, CA 91325 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, OLIVER HOLT LANDSCAPE 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 CONTAINED SHALL BE HELD TO VARY, ALTER, WAIVE OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS POLICY OTHER THAN AS STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR LIMITATIONS OF THIS ENDORSEMENT. COUNTERSIGNED AND ISSUED AT SAN FRANCISCO: SEPTEMBER 24, 2019 AUTHORIZED REPRESENT IUE PRESIDENT AND CEO SCIF FORM 10217 (REV.7-2014) 2570 OLD DP 217