DATE (MM/DD/YYYY)
ACORD® CERTIFICATE OF LIABILITY INSURANCE
12/01/2022
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 INSURERS), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL 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 confer rights to the certificate holder in lieu of such endorsements).
Natalie Guillozet, CRIS CISR
James G. Parker Insurance . (559) 222-7722 (559) 222-1724 License #0554959 [email protected]
ADDRESS:
P O Box 3947 INSURERS) AFFORDING COVERAG NAIC *
Fresno CA 93650 Clear Blue Specialty Ins C 37745
INSURER A:
Allstate Insurance Co 19232
INSURED INSURER B:
Avalon Roofing Inc INSURER C:
16828S Broadway INSURER D:
INSURER E:
CERTIFICATE NUMBER: 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 THI
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
POLICY NUMBER
X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 3 100,000
CLAIMS-MADE OCCUR PREMISES (Ea occurrence)
MED EXP (Any one person) 3 5.000
Y Y AR01RS220548100 12/02/2022 12/02/2023 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY XPECT PRODUCTS - COMPIOP AGG $ 2,000,000
LOC
OTHER:
AUTOMOBILE LIABILITY COMBINED SINGLE LIMI $ 1,000,000
Ea accident
ANY AUTO BODILY INJURY (Per person)
OWNED SHEDULED 64891563502 12102/2022 12/02/2023 BODILY INJURY (Per accident) $
AUTOS ONLY AUTOS
HIRED NON-OWNED PROPERTY DAMAGE
X AUTOS ONLY AUTOS ONLY (Per accident)
UMBRELLA LIAB OCCUR EACH OCCURRENCE
EXCESS LIAB CLAIMS-MADE AGGREGATE
DED RETENTION $ $
WORKERS COMPENSATION T STATUTE I
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE EL EACH ACCIDENT
OFFICER/MEMBER EXCLUDED? N/ A
(Mandatory in NH) EL DISEASE - EA EMPLOYEE S
If yes, describe under
DESCRIPTION OF OPERATIONS below EL DISEASE - POLICY LIMITs DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Caver surgin ap 89, eras 20100415, 06203 013. 020 13 8 0 20 00 a lional nured, coverage is primay and
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFOR
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Redondo Beach ACCORDANCE WITH THE POLICY PROVISIONS 415 Diamond St
AUTHORIZED REPRESENTATIVE
Redondo Beach CA 90277 Lans A Pahea
© 1988-2015 ACORD CORPORATION. All rights reserved
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Policy Number: AR01RS220548100
COMMERCIAL GENERAL LIABILITY
CG 24 04 05 09
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
SCHEDULE
Name Of Person Or Organization:
As agreed to by written contract or agreement
Information required to complete this Schedule, if not shown above, will be shown in the Declarations. 'he following is added to Paragraph 8. Transfer O
lights Of Recovery Against Others To Us o
Section IV - Conditions:
We waive any right of recovery we may have against
the person or organization shown in the Schedule
above because of payments we make for injury o
damage arising out of your ongoing operations or
only to the person or organization shown in the
© Insurance Services Office, Inc., 2008 Page 1 of 1
CG 24 04 05 09
Policy Number: AR01RS220548100
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 As agreed to by written contract or agreement All Locations 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 B. With respect to the insurance afforded to these additional insureds, the following is added to
Section III - Limits Of Insurance:
with respect to liability for "bodily injury" or If coverage provided to the additional insured is "property damage" caused, in whole or in part, by required by a contract or agreement, the most we 'your work" at the location designated anc vill pay on behalf of the additional insured is th described in the Schedule of this endorsement mount of insurance
1. Required by the contract or agreement; or
. Available under the applicable Limits of
hazard". nsurance shown in the Declarations
However:
whichever is less.
1. The insurance afforded to such additional
insured only applies to the extent permitted This endorsement shall not increase the applicable by law; and Limits of Insurance shown in the Declarations.
2. If coverage provided to the additional insured
is required by a contract or agreement, the
Insurance afforded to such additlonal Insured
will not be broader than that which you are
required by the contract or agreement to
provide for such additional insured.
© Insurance Services Office, Inc., 2012 Page 1 of 1
CG 20 37 04 13
Policy Number: AR01RS220548100
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) Locations) Of Covered Operations
As agreed to by written contract or agreement All Locations Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
1. All work, including materials, parts or
A. Section II - Who Is An Insured is amended to
include as an additional insured the person(s) or equipment furnished in connection with such organization(s) shown in the Schedule, but only work, on the project (other than service, with respect to liability for "bodily injury" ' "property maintenance or repairs) to be performed by or or "personal and advertising injury" on behalf of the additional insured(s) at the location of the covered operations has been
caused, in whole or in part, by:
completed; or
1. Your acts or omissions; or
2. That portion of "your work" out of which the
2. The acts or omissions of those acting on your injury or damage arises has been put to its behalf; intended use by any person or organization
in the performance of your ongoing operations for other than another contractor or subcontractor the additional insured(s) at the location(s) engaged in performing operations for a designated above. principal as a part of the same project.
However: C. With respect to the insurance afforded to these
1. The insurance afforded to such additional additional insureds, the following is added tr insured only applies to the extent permitted by Section Ill - Limits Of Insurance:
law; and If coverage provided to the additional insured is
2. If coverage provided to the additional insured is required by a contract or agreement, the most we reauired by a contract or agreement. the will pay on behalf of the additional insured is the insurance afforded to such additional insured amount of insurance:
will not be broader than that which you are 1. Required by the contract or agreement; or 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:
© Insurance Services Office, Inc., 2012 Page 1 of 2
CG 20 10 04 13
2. Available under the applicable Limits of
Insurance shown in the Declarations:
whichever is less.
This endorsement shall not increase
applicable Limits of Insurance shown in
Declarations.
© Insurance Services Office, Inc., 2012 Page 2 of 2
CG 20 10 04 13
Policy Number: AR01RS220548100
COMMERCIAL GENERAL LIABILITY
CG 20 01 04 13
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
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 added to the terns ance
Condition and supersedes provision to the
contrary: rom any other insurance available to the
Primary And Noncontributory Insurance 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
© Insurance Services Office, Inc., 2012 Page 1 of 1
CG 20 01 04 13
DATE (MM/DD/AYYY)
ACORD® CERTIFICATE OF LIABILITY INSURANCE 12/08/2022
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 INSURERS), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
MPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorse SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement o this certificate does not confer rights to the certificate holder in lieu of such endorsements).
NAME
Bouchard Insurance for WBS - TG 0: 6) 293-3600 ext. 623
INSURERS) AFFORDING COVERAGE
INSURER A: American Zurich Insurance Company 40142
INSURED INSURER B:
Workforce Business Services CA, LLC Labor Contractor, for co-employees of: Avalon INSURER C:
Roofing Inc
1401 Manatee Ave. West Ste 600 INSURER D:
Bradenton, FL 34205-6708
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER:22FL079814416 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
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.
INSR ADDL SUBR LIMITS
TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYY\ (MM/DD/YYYY LTR
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $
DAMAGE TO RENTED
CLAIMS-MADE OCCUR PREMISES (Ea occurrence)
MED EXP (Any one person)
PERSONAL & ADV INJURY
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $
PRO PRODUCTS - COMP/OP AGG
POLICY IECT LOC
OTHER:
COMBINED SINGLE LIMIT $
AUTOMOBILE LIABILITY (Ea accident)
ANY AUTO BODILY INJURY (Per person) $
OWNED SCHEDULED BODILY INJURY (Per accident) $
AUTOS ONLY AUTOS
HIRED NON-OWNED PROPERTY DAMAGE $
AUTOS ONLY AUTOS ONLY (Per accident)
$
UMBRELLA LIAB OCCUR EACH OCCURRENCE
EXCESS LIAB CLAIMS-MADE AGGREGATE
WORKERS COMPENSATION X STATUTE
AND EMPLOYERS' LIABILITY
ANYPROPRIETOR/PARTNER/EXECUTIVE 12131/2022 12/31/2023 EL EACHACCIDENT 1.000.000 OFFICER/MEMBER EXCLUDED? N/A X WC 90-00-846-12
EL. DISEASE - EA EMPLOYEE S 1,000,000
ÉSCRIPTION OF OPERATIONS belov EL DISEASE • POLICY LIMIT S 1.000.000 Location Coverage Period: 12/31/2022 12/31/2023 Client# 053648 ESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is require Avalon Roofing In
Coverage is provided for 16828 S Broadway
only those co-employees
of, but not subcontractors Gardena, CA 90248
to:
Endorsements: Waiver of Subrogation, 30 days written cancel notice (10 days for non payment of premium
CERTIFICATE HOLDER CANCELLATION
City of Redondo Beach its officers, elected, appointed
officials, employees and volunteers EXPIRATION DATE THEREOF, ACCORDANCE WITH THE POLICY PROVISIONS.
415 Diamond Street
Redondo Beach, CA 90277
AUTHORIZED REPRESENTATIVE
Tokl Sarge
© 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016/03) The ACORD name and loao are reaistered marks of ACORD
DATE (MM/DDYYYY)
ACORD® CERTIFICATE OF LIABILITY INSURANCE 12/08/2022
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.
MPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorse + SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement o this certificate does not confer rights to the certificate holder in lieu of such endorsements).
Bouchard Insurance for WBS - TG PHN. Ex: 866) 293-3600 ext. 623 Clearwater, FL 33758-6090
INSURERS) AFFORDING COVERAGE
INSURER A : American Zurich Insurance Company 40142
INSURER B:
Workforce Business Services CA, LLC Labor Contractor, for co-employees of: Avalon INSURER C :
1401 Manatee Ave West Ste 600 INSURER D:
Bradenton, FL. 34205-6708
INSURER E:
COVERAGES CERTIFICATE NUMBER:22FL079814416
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
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.
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $
DAMAGE TO RENTED
CLAIMS-MADE OCCUR PREMISES (Ea occurrence)
MED EXP (Any one person)
PERSONAL & ADV INJURY
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE
PRO
POLICY LOC PRODUCTS - COMP/OP AGG
$
OTHER:
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
(Ea accident)]
ANY AUTO BODILY INJURY (Per person) $
OWNED SCHEDULED BODILY INJURY (Per accident)| $
AUTOS ONLY AUTOS
HIRED NON-OWNED ROPERTY DAMAGE $
AUTOS ONLY AUTOS ONLY Per accident
UMBRELLA LIAB OCCUR EACH OCCURRENCE
EXCESS LIAB CLAIMS-MADE AGGREGATE
RETENTION S
WORKERS COMPENSATION X STATUTE
AND EMPLOYERS' LIABILITY
A OFFICERMEMBER EXCUDE XECUTIVE 12/31/2022 12/31/2023 EL EACH ACCIDENT 1,000,000 WC 90-00-846-12
(Mandatory In NH) EL DISEASE - EA EMPLOYEE S 1,000,000
DEST OPERATIONS below EL DISEASE - POLICY LIMIT S 1,000,000 Location Coverage Period: 12/31/2022 12/31/2023 Client# 053648 DESCRIPTION OF OPERATIO AValon Rooting INGLES (AGORO 101, Adlonal Remarks Schedul, may be atached if more space is required) Coverage is provided for 16828S Broadway
only those co-employees
of, but not subcontractors Gardena, CA 90248
CERTIFICATE HOLDER CANCELLATION
City of Redondo Beach Public Works Department SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 531 N Gertruda Ave ACCORDANCE WITH THE POLICY PROVISIONGE WILL BE DELIVERED IN Redondo Beach, CA 90277
AUTHORIZED REPRESENTATIVE
Teed Forge
© 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016/03) The ACORD name and loao are reaistered marks of ACORD WORKERS' COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 4-84)
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 per- form 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 of the California workers' compensation premium otherwise due on such remuneration.
SCHEDULE
Person or Organization Job Description
IN FAVOR OF:
City of Redondo Beach its officers,elected, appointed officials, employees and volunteers
415 Diamond Street
Redondo Beach, CA 90277
This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective: 12/31/2022 Policy No: WC 90-00-846-12 Endorsement No:
Insured: Workforce Business Services CA, LLC Labor Contractor, for co-employees of:
Avalon Roofing Inc
Insurance Company: American Zurich Insurance Company Countersigned by WC 04 03 06
Copyright 1983 National Council on Compensation Insurance