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2019/09/25 West Coast Arborists, Inc. Certificate of Liability Insurance (3)
This certificate is executed by LIBERTY MUTUAL INSURANCE GROUP as respects such insurance as is afforded by those Companies LDI COI 268896 02 11 NM 772 07-10 Personal & Advertising Injury GENERAL LIABILITY CONFERS NO RIGHTS UPNFORMATION ONLY AND DOES NOT AMEND, EXTINSURANCE POLICY AND THIS CERTIFICATE IS ISS This is to Certify that NAME AND ADDRESS OF INSURED 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. OFFICE PHONE DATE ISSUED TYPE OF POLICY EXP DATE CONTINUOUS EXTENDED POLICY TERM POLICY NUMBER LIMIT OF LIABILITY WORKERS COMPENSATION RETRO DATE OCCURRENCE CLAIMS MADE AUTOMOBILE LIABILITY OWNED NON-OWNED HIRED OTHER ADDITIONAL COMMENTS * If the certificate expiration date is continuous or extended term, you will be notified if coverage is terminated or reduced before the certificate expiration date. 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 DAYS NOTICE OF SUCH CANCELLATION HAS BEEN MAILED TO: COVERAGE AFFORDED UNDER WC LAW OF THE FOLLOWING STATES:EMPLOYERS LIABILITY Bodily Injury by Accident Bodily Injury By Disease Bodily Injury By Disease Policy Limit Each Person Each Accident Each Accident—Single Limit Products / Completed Operations Aggregate Other Other Each Person Each Accident or Occurrence Each Accident or Occurrence UED AS A MATTER OF I ON YOU THE CERTIFICATE HOLDER. THIS CERTIFICATE IS NOT AN END, OR ALTER THE COVERAGE AFFORDED BY THE POLICIES LISTED BELOW. Certificate of Insurance General Aggregate Per Person / Organization B.I. And P.D. Combined CertificateHolderLiberty Mutual Insurance Group AUTHORIZED REPRESENTATIVE POLICY LIMITS ARE NO LESS THAN THOSE LISTED, ALTHOUGH POLICIES MAY INCLUDE ADDITIONAL SUBLIMIT/LIMITS NOT LISTED BELOW. COMMERCIAL Each Occurrence LDI COI 123456-7 89 10 3 Elaine Ulan 0564408 9/25/2019 Los Angeles / 0603 818 W 7th Street, Suite 850 Los Angeles CA 90017 213-443-0782 WEST COAST ARBORISTS, INC2200 EAST VIA BURTONANAHEIM CA 92806 Project: GPS Tree Inventory Project (Menifee Proposal #56723) City of Menifee29844 Haun RdMenifee CA 92586 30 insurance afforded by the GL policy for the benefit of the additional insured shall be primary and non-contributory. Waiver of Subrogation in favor specific jobs of the insured performed under written contract. GL deductible-$250,000. are additional insured with regards to general liability and auto liability as their interest may appear where required by written contract. The of City of Menifee and its officers, employees, agents and authorized volunteers on WC, General Liability and/or Auto Liability applies only to the RE: Project: GPS Tree Inventory Project (Menifee Proposal #56723) City of Menifee and its officers, employees, agents and authorized volunteers TB2-661-039499-0197/1/2020 $2,000,000 3 $2,000,000 $2,000,000 $2,000,000 Damage to premises rented toyou $300,000 7/1/2020 AS7-661-039499-039 $2,000,000 3 3 3 WA7-66D-039499-0797/1/2020 All States Except:ND, OH, WA, WYStatutory Limits $1,000,000 $1,000,000 $1,000,000 51365321 | LM_2819 | 7/19-7/20 - GL/2/2, AL/2, WC/1 | Connie Myszka | 9/25/2019 4:11:39 PM (CDT) | Page 1 of 1 COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 POLICY NUMBER: TB2-661-039499-019 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED – OWNERS, L ESSEES 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: 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: 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 Name Of Additional Insured Person(s) Or Organization(s): Location(s) Of Covered Operations Any owner, lessee, or contractor for whom you have agreed in writing prior to a loss to provide liability insurance Any location work is performed Information required to complete this Schedule, if not shown above, will be shown in the Declarations. © Insurance Services Office, Inc., 2012 Page of 1 1CG 20 10 04 13 COMMERCIAL GENERAL LIABILITY CG 20 37 04 13 POLICY NUMBER: TB2-661-039499-019 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED – OWNERS, L ESSEES 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. 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 Name Of Additional Insured Person(s) Or Organization(s):Location And Description Of Completed Operations 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. 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. © Insurance Services Office, Inc., 2012 Page of 1 1CG 20 37 04 13 POLICY NUMBER: TB2-661-039499-019 COMMERCIAL GENERAL LIABILITY CG 20 01 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CG 20 01 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 PRIMARY AND NONCONTRIBUTORY – OTHER 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 Condition and supersedes any provision to the contrary: Primary And Noncontributory Insurance 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 (2)You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. POLICY NUMBER:COMMERCIAL AUTO CA 20 48 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED FOR This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM SCHEDULE Name Of Person(s) Or Organization(s): Information required to complete this Schedule, if not shown above, will be shown in the Declarations. CA 20 48 10 13 © Insurance Services Office, Inc., 2011 Page 1 of 1 COVERED AUTOS LIABILITY COVERAGE 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. 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. AS7-661-039499-039 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 the scope of coverage or the limits of insurance provided inthis policy. POLICY NUMBER:COMMERCIAL AUTO CA 04 44 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM SCHEDULE CA 04 44 10 13 © Insurance Services Office, Inc., 2011 Page 1 of 1 AGAINST OTHERS TO US (WAIVER OF SUBROGATION) Name(s) Of Person(s) Or Organization(s): Information required to complete this Schedule, if not shown above, will be shown in the Declarations. With respect to coverage provided by this endorsement,the provisions of the Coverage Form apply unless modified by the endorsement. The Transfer Of Rights Of Recovery Against Others To Us condition does not apply to the person(s)or organization(s)shown in the Schedule, but only to the extent that subrogation is waived prior to the "accident"or the "loss"under a contract with that person or organization. Premium: $ AS7-661-039499-039 Any person or organization for whom you perform work under a written contract if the contract requires you to obtain this agreement from us, but only if the contract is executed prior to the injury or damage occurring. INCL COMMERCIAL GENERAL LIABILITYPOLICY NUMBER: CG 24 04 05 09 TB2-661-039499-019 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV – Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule below because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products- completed operations hazard". This waiver applies only to the person or organization shown in the Schedule below. SCHEDULE Name Of Person Or Organization: Any person or organization with whom you have agreed in writing to waive any right of recovery prior to a loss. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. © Insurance Services Office, Inc., 2008 Page of 1 1CG 24 04 05 09 F] XLMW XLMW -WWYIHF] *SVEXXEGLQIRXXS4SPMG]2S)JJIGXMZI(EXI 4VIQMYQ -WWYIHXS ;IWX'SEWX%VFSVMWXW-RG 0MFIVX]-RWYVERGI'SVTSVEXMSR 4EKI