ACORD" CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 11/03/2023
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.
"PORTANT: If the certificate holder is an ADDITIONAL INSURED, the policylies) must have ADDITIONAL INSURED provisions or be endorsed. ericate does is conle rights to the cerate holder in let of such endorsements)ain polites may require an endorsement. A statement on th
PRODUCER GAMEACT CLIENT CONTACT CENTER
FEDERATED MUTUAL INSURANCE COMPANY
HOME OFFICE: P.O. BOX 328 (A/C, Ho, Ext): 898-333-4949 FRIC, No: 507-446-4664 OWATONNA, MN 55060 ABs: [email protected]
INSURERS AFFORDING COVERAGE MAIC #
INSURER A:FEDERATED MUTUAL INSURANCE COMPANY 13935
INSURED 383-378-7 INSURER B:
CJ CONCRETE CONSTRUCTION, INC. MASURER C:
10142 SHOEMAKER AVE
SANTA FE SPRINGS, CA 90670-3404 INSURER D:
INSURER E:
INSURER F:
CERTIFICATE NUMBER: 108 REVISION NUMBER: 0
SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
TYPE OF INSURANCE ARRY BAR POLICY NUMBER LIMITS
X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000 _CLAIMS-MADE X OCCUR RADE SO GEATED PREMIBES $100,000
ED EXP (Any one perse $10,000
A Y Y 1845023 11/12/2023 11/12/2024 IRSONAL & ADVIRAJUR $1,000,000 GEL AOGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 32,000,000 POLICY LOC PRODUCTS & COMPIOP AGO $2,000,000
OTHER:
AUTOMOBILE LIABILITY $1,000,000
X ANYAUTO BODILY INJURY (Por Person)
A OWNED AUTOS ONLY 1845023 11/12/2023 11/12/2024 BODILY INJURY (Per Acc/dont)
HIRED AUTOS ONLY PROPERTY DAMAGE
X UMBRELLA LIAB X occur EACH OCCUARENCE 58,000,000
EXCESS LIAB CLAIMS-MADE N N 1845025 11/12/2023 11/12/2024 ADOREDATE $8,000,000
RETENTION
WORKERS COMPENSATION TPER STATUTE | OTHER
AND EMPLOYERS' LIABILITY YIN
ANY PROPRIETOR/PARTNER/ EXECUTIVE EL EACH ACCIDENT
FFICERIMEMBER EXCLUDED' N/A
Mandalory in NH E.L DISEASE EA EMPLOYEE
describe under
DESCRIPTION OF OPERATIONS bolow E.L DISEASE • POLICY LIMIT DESCRIPTION OF OPERATIONS/ LOCATIONS / VEHICLEB (ACORD 101, Additional Remarks Schedule, may be altached It more space is requred)
SEE ATTACHED PAGE
CERTIFICATE HOLDER CANCELLATION
383-378-7 108 0 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
ENGINERINO AND BELIEVEST OF BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 15 DIAMOND ST ACCORDANCE WITH THE POLICY PROVISIONS.
EDONDO BEACH, CA 90277-2831
AUTHORIZED REPRESENTATIVE
© 1988-2015 ACORD CORPORATION, All rIghts reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 383-378-7
ACORD® LOC #:
ADDITIONAL REMARKS SCHEDULE Page 1 of 1
ADENCY
FEDERATED MUTUAL INSURANCE COMPANY CJ CONCRETE CONSTRUCTION, INC. 10142 SHOEMAKER AVE
POLICY NUMBER SANTA FE SPRINGS, CA 90670-3404
SEE CERTIFICATE # 108.0
CARRIER NAIC CODE EFFECTIVE DATE: SEE CERTIFICATE # 108.0 SEE CERTIFICATE #108.0
ADDITIONAL REMARKS
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LABILITY INSURANCE PROJECT: CITY OF REDONDO BEACH 415 DIAMOND SO RV, ADDEDA FASJRED INCLUDES: THE CITY, ITS OFFICERS, ELECTED AND
SUBJECT TO THE TERMS AND CONDITIONS OF THE
EMPLOYEES, AND VOLUNTEERS.
THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED ON GENERAL LIABILITY SUBJECT TO THE CONDITIONS OF THE ADDITIONAL
INSURED - OWNERS, LESSEES OR CONTRACTORS (FORM B) ENDORSEMENT
THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED SUBJECT TO THE CONDITIONS OF THE ADDITIONAL INSURED BY CONTRACT
ERENCE REP BE NE A PAIR OF TAE RE OF RECOER CAREST TEN TO US HAVE OF SUARATION)
SHOULD ANY OF THE POLICIES LISTED
OF PREMIUM, WE WILL MAIL THE CERTIFICATE HOLDER WRITTEN NOTICE 30 DAYS IN ADVANCE.
ACORD 101(200B/01) © 2008 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
ACORD® DATE (MM/DD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE
11/08/2023
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 f SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain pollcies may require an endorsement. A statement o this certificate does not confer rights to the certificate holder in lleu of such endorsements).
COACT Automalic Data Processing Insurance Agency, Inc
Automatic Data Processing Insurance Agency, Inc. PIG, No, EX: 1-800-524-7024 ADDRESS:
1 Adp Boulevard INSURER(8) AFFORDING COVERAGE
Roseland NJ 07068 INSURER A: SIRIUSPOINT AMERICA INSURANCE COMPANY INSURED CJ Concrete Construclions Inc
INSURER B:
INSURER C:
10142 Shoemaker Ave INSURER D:
INSURER E:
Santa Fe Springs CA 90670 INSURER F:
COVERAGES CERTIFICATE NUMBER: 3296983 REVISION NUMBER:
INDICATED NOTTISANDING ANY REQUIREMENT, OR CONTINO ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
ERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERN CLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIN
ADDL SUBR DLICY E
TYPE OF INSURANCE INSp WVD POLICY NUMBER LIMITS
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $
DAMAGE TO RENTED
CLAIMS-MADE OCCUR PREMISES (Ea occurrenco)
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
(En accident)
ANY AUTO BODILY INJURY (Per person)
OWNED SCHEDULED BODILY INJURY (Per accident) s
AUTOS ONLY
HIRED NON-OWNED
AUTOS ONLY AUTOS ONLY
UMBRELLA LIAB OCCUR EACH OCCURRENCE
EXCESS LIAB CLAIMS-MADE AGGREGATE
DED RETENTIONS
WORKERS COMPENSATION XI STATUTE| TER
AND EMPLOYERS' LIABILITY V / N
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 1,000,000 A OFFICER/MEMBER EXCLUDED? Y N/A N WC7398102 05/08/2023 05/08/2024 (Mandatory In NH) EL. DISEASE - EA EMPLOYEE $ 1,000,000 I yes, describe undur $ 1,000,000
ESCRIPTION OF OPERATIONS balow E.L. DISEASE - POLICY LIMIT DESCRIPTION OF OPERATIONS / LOCATIONS/ VEHICLES (ACORD 101, Addillonal Remarks Schedule, may be allached if more spaco is required)
CERTIFICATF HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFOR
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED I City of Redondo Beach ACCORDANCE WITH THE POLICY PROVISIONS. 415 Diamond Street
AUTHORIZED REPRESENTATIVE
Redondo Beach CA 90277 70. Thin
© 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
COMMERCIAL AUTO
CA 04 49 11 16
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
PRIMARY AND NONCONTRIBUTORY -
OTHER INSURANCE CONDITION
This endorsement modifies insurance provided under the following:
AUTO DEALERS COVERAGE FORM
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.
A. The following is added to the Other Insurance B. The following is added to the Other Insurance Condition in the Business Auto Coverage Form Condition in the Auto Dealers Coverage Form and and the Other Insurance - Primary And Excess supersedes any provision to the contrary:
Insurance Provisions in the Motor Carrier This Coverage Form's Covered Autos Liability Coverage Form and supersedes any provision to Coverage and General Liability Coverages are the contrary: primary to and will not seek contribution from any This Coverage Form's Covered Autos Liability other insurance available to an "insured" under Coverage is primary to and will not your policy provided that:
contribution from any other insurance available to 1. Such "insured" is a Named Insured under an "insured" under your policy provided that: such other insurance; and
1. Such "insured" is a Named Insured under 2. You have agreed in writing in a contract or such other insurance; and agreement that this insurance would primary and would not seek contribution from
2. You have agreed in writing in a contract or any other insurance available to such agreement that this insurance would be
"insured".
primary and would not seek contribution from
any other insurance available to such
"insured".
CA 04 49 11 16 © Insurance Services Office, Inc., 2016 Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED BY CONTRACT ENDORSEMENT
This endorsement modifies insurance provided under the following:
BUSINESS AUTO COVERAGE PART
With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement.
A. WHO IS AN INSURED for "bodily injury" and "property damage" liability is amended to include:
Any person or organization other than a joint venture, for which you have agreed by written contract to procure bodily injury or property damage "auto" liability insurance arising out of operation of a covered "auto" with your permission. However, this additional insurance does not apply to:
(1) The owner or anyone else from whom you hire or borrow a covered "auto". This exception does not apply if the covered "auto" is a "trailer" connected to a covered "auto" you own. (2) Your "employee" if the covered "auto" is owned by that "employee" or a member of his or her household.
(3) Someone using a covered "auto" while he or she is working in a business of selling, servicing, repairing, parking or storing "autos" unless that business is yours. (4) Anyone other than your "employees", partners (if you are a partnership), members (if you are a limited liability company), or a lessee or borrower or any of their "employees", while moving property to or from a covered "auto".
(5) A partner (if you are a partnership), or a member (if you are a limited liability company) for a covered "auto" owned by him or her or a member of his or her household.
B. The coverage extended to any additional insured by this endorsement is limited to, and subject to all terms, conditions, and exclusions of the Coverage Part to which this endorsement is attached.
In addition, coverage shall not exceed the terms and conditions that are required by the terms of the written agreement to add any insured, or to procure insurance.
C. The limits of insurance applicable to such insurance shall be the lesser of the limits required by the agreement between the parties, or the limits provided by this policy.
D. Additional exclusions. The insurance afforded to any person or organization as an insured under this endorsement does not apply:
1. To "loss" which occurs prior to the date of your contract with such person or organization;
2. To "loss" arising out of the sole negligence of any person or organization that would not be an insured except for this endorsement.
To "loss" for any leased or rented "auto" when the lessor or his or her agent takes possession of the leased or rented "auto" or the policy period ends, whichever occurs first.
Includes copyrighted material of Insurance Services Office, Inc. with its permission.
CA-F-127 (03-03) Policy Number: 1845023 Transaction Effective Date:11/12/2022 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
BLANKET WAIVER OF TRANSFER OF RIGHTS OF RECOVERY
This endorsement modifies insurance provided under the following:
BUSINESS AUTO COVERAGE PART
With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement.
In the event of any payment for a loss under this Business Auto Coverage Part arising out of your ongoing operations, we agree to waive our rights under the TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US condition against any person or organization, its subsidiaries, directors, agents or employees, for which you have agreed by written contract, prior to the occurrence of any loss, to waive such rights, except when the payment results from the sole negligence of that person or organization, its subsidiaries, directors, agents or employees.
Includes copyrighted material of Insurance Services Office, Inc. with its permission.
CA-F-128(03-03) Policy Number: 1845023 Transaction Effective Date:11/12/2022
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
Condion and supersedes any proveron to nee (2) You have agreed in writing in a contract contrary:
Primary And Noncontributory Insurance
This insurance is primary to and will not seek
contribution insurance
available to an additional insured under vour
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 Policy Number: 1845023 Transaction Effective Date: 11/12/2022
COMMERCIAL GENERAL LIABILITY
CG 20 33 04 13
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS - AUTOMATIC STATUS WHEN
REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
A. Section II - Who Is An Insured is amended to B. tonal in to reds, sue to atong to that include as an additional insured any person or
organization for whom you are performing exclusions apply:
operations when you and such person or This insurance does not apply to:
organization have agreed in writing in a contract damage"
1. "Bodily injury", "property or
or agreement that such person or organization be
"personal and advertising injury" arising out
added as an additional insured on your policy.
of the rendering of, or the failure to render,
Such person or organization is an additional
insured only with respect to liability for "bodily any professional architectural, engineering or injury", "property damage" or "personal and surveying services, including:
advertising injury" caused, in whole or in part, by: a. The preparing, approving, or failing to prepare or approve, maps, shop drawings,
1. Your acts or omissions; or
opinions, reports, surveys, field orders,
2. The acts or omissions of those acting on your change orders or drawings and behalf; specifications; or
in the performance of your ongoing operations for b. Supervisory, inspection, architectural or the additional insured. engineering activities.
However, the insurance afforded to such
additional insured: This exclusion applies even if the claims against negligence
1. Only applies to the extent permitted by law; wrongdoing supervision, employment, training or monitoring of others by
2. Will not be broader than that which you are that insured, if the "occurrence" which caused the required by the contract or agreement to "bodily injury" or "property damage", or the provide for such additional insured.
advertising injury", involved the rendering of or
person's or organization's status as an
the failure to render any professional
additional insured under this endorsement ends architectural, engineering or surveying services. when your operations for that additional insured
are completed.
© Insurance Services Office, Inc., 2012 Page 1 of 2
CG 20 33 04 13 Policy Number: 1845023 Transaction Effective Date: 11/12/2022
2. "Bodily injury" or "property damage" C. With respect to the insurance afforded to these occurring after: additional insureds, the following is added to a. All work, including materials, parts or Section III - Limits Of Insurance:
equipment furnished in connection with The most we will pay on behalf of the additional such work, on the project (other than insured is the amount of insurance:
service, maintenance or repairs) to be 1. Required by the contract or agreement you performed by or on behalf of the additional have entered into with the additional insured; insured(s) at the location of the covered
or
operations has been completed; or
• Available under the applicable Limits c
That portion of "your work" out of which nsurance shown in the Declaration the injury or damage arises has been put
whichever is less.
to its intended use by any person or
organization other than another contractor his endorsement shall not increas the or subcontractor engaged in performing pplicable Limits of Insurance shown in thi operations for a principal as a part of the Declarations. same project.
CG 20 33 04 13 Policy Number: 1845023 Transaction Effective Date: 11/12/2022
FEDERATED INSURANCE COMPANIES
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
BLANKET 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 any person or organization 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", except when the payments result from the sole negligence of that person or organization. We waive this right only when you are required to do so by written contract or agreement with that person or organization, executed by you prior to the occurrence of any loss.
Includes copyrighted material of Insurance Services Office, Inc. with its permission CG-F-81 (04-13) Policy Number: 1845023 Transaction Effective Date: 11/12/2022 Federated Mutual Insurance Company
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
LIMITED AMENDMENT OF CANCELLATION PROVISIONS
All Coverage Parts included in this policy are subject to the following conditions:
If we cancel this policy, we will mail advance notice to the person(s) or organizations) as shown in the Schedule.
SCHEDULE
Name and Address of Person(s) Or Organization(s):
City of Redondo Beach Public Works
Department, Engineering Division Attn: City
Engineer
415 Diamond St
Redondo Beach, CA 90277-2836
Number of days advance notice for any reason other than non-payment of premium: 30 Number of days advanced notice for non-payment of premium: See Common Policy Conditions Insured: CJ Concrete Construction, Inc.
10142 Shoemaker Ave
Santa Fe Springs, CA 90670-3404
Includes copyrighted material of Insurance Services Office, Inc., with its permission.
IL-F-50 (04-13) Policy Number: 1845023 Transaction Effective Date: 07/26/2023