DATE (MM/DD/YYYY)
ACORD® CERTIFICATE OF LIABILITY INSURANCE
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 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).
CANTACT Brenda Edwards
Inszone Insurance Services, LLC FAX, No):
2721 Citrus Road, Suite A (A/C No. Ext): (562) 372-8870 E-MAIL
Rancho Cordova CA 95742 ADDREss: [email protected] INSURERS) AFFORDING COVERAGE NAIC #
License ISMA61 INSURERA: AIX Specialty Insurance Company 12833 INSURED INSURER B: California Automobile Insurance Co 38342 Ron's Maintenance, Inc. DBA: Ron's Maintenance
INSURER C :
11542 Horley Avenue
Downey, CA 90241 INSURER D:
INSURER E:
INSURER F:
CERTIFICATE NUMBER: 744602993 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
TYPE OF INSURANCE
X COMMERCIAL GENERAL LIABILITY
DAMAGE TO RENTED
CLAIMS MADE X OCCUR PREMISES (Ea occurrence) $ 100,000
MED EXP (Any one person) $5,000
PERSONAL & ADV INJURY $1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY PRO. PRODUCTS - COMP/OP AGG $2,000,000
TECT LOC
OTHER:
10/21/2023 COMBINED SINGLE LIMI $1,000,000
AUTOMOBILE LIABILITY BA040000047562 10/21/2022 (Ea accident X 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 L13 J545230 00 9/7/2023 9/7/2024 EACH OCCURRENCE $ 3,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 3,000,000
DED RETENTION S $
WORKERS COMPENSATION STATUTE
AND EMPLOYERS' LIABILITY Y/ N
ANYPROPRIETOR/PARTNER/EXECUTIVE EL. EACH ACCIDENT $
OFFICER/MEMBEREXCLUDED? N/ A
(Mandatory in NH) EL. DISEASE - EA EMPLOYEE S
scribe uni
ESCRIPTION OF OPERATIONS bek EL. DISEASE - POLICY LIMIT S Verification Of insurances/LOCATIONS VEHICLES (ACORD 101, Aditonal Romark Schedul, may be atachod more paco a roqured)
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
ACCORDANCE THE POLICY PROVISIONE WILL BE DELIVERED IN
City of Redondo Beach
531 N. Gertruda Avenue AUTHORIZED REPRESENTATIVE
Redondo Beach, CA 90277
© 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
DATE (MM/DD/YYYY)
ACORD® CERTIFICATE OF LIABILITY INSURANCE
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 or this certificate does not confer rights to the certificate holder in lieu of such endorsements).
Nella Insurance Services, Inc. [AIC, No): 213-745-2840
21031 Ventura Blvd., Suite 512 (AG. No, Ext): 213-745-2858 AMEs: [email protected]
INSURERS) AFFORDING COVERAGE NAIC #
License#: 0G33274 INSURERA: Clear Springs Property & Casualty Company 15563 RONMAIN-01
INSURED INSURER B:
Ron's Maintenance Inc.
INSURER C :
11542 Horley Ave
Downey CA 90241 INSURER D:
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: 797384975 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.
INSR ADDL SUBR POLICY EFF POLICY EXP
TYPE OF INSURANCE (MM/DD/YYYY) (MM/DD/YYYY) LIMITS
LTR INSOWVD. POLICY NUMBER
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 JECT LOC
OTHER:
AUTOMOBILE LIABILITY COMBINED SINGLE LIMI
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
DED RETENTIONS
WORKERS COMPENSATION CS-WC- 015202-01 7/1/2023 7/1/2024 STATUTE
AND EMPLOYERS' LIABILITY
ANYPROPRIETOR/PARTNER/EXECUTIVE EL. EACH ACCIDENT $1,000,000 OFFICER/MEMBEREXCLUDED? IN/ A
(Mandatory In NH) E.L. DISEASE - EA EMPLOYEE $1,000,000 SRPERATIONS below E.L. DISEASE - POLICY LIMIT$1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additlonal Remarks Schedule, may be attached if more space is required
BLANKET WOS APPLIES
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Redondo Beach ACCORDANCE WITH THE POLICY PROVISIONS.
Attn: Public Works Departmen
531 N. Gertruda Avenue AUTHORIZED REPRESENTATIVE
Redondo Beach CA 90277
588
© 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 04-84)
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 ur right against the person or organization named in the Schedule. (This agreement applies only to the exten hat you perfor work under written contract that requires to trement 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 2.50% of the California workers' compensation premium otherwise due on such remuneration.
SCHEDULE
PERSON OR ORGANIZATION JOB DESCRIPTION
Any Person or Organization for which the insured has agreed by written contract executed prior to loss to furnish this waiver 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 7/1/2023 12:01 AM Policy No. CS-WC- 015202-01 Endorsement No. 0 Insured Ron's Maintenance Inc Premium Included
Insurance Company Clear Spring Property and Casualty Masterl Cite Company Countersigned by
©1998 by the Workers' Compensation Insurance Rating Bureau of California. All rights reserved.
From the WCIRB's California Workers' Compensation Insurance Forms Manual © 1999.