ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED?
INSR ADDL SUBR
LTR INSD WVD
PRODUCER CONTACT NAME: PHONE FAX
(A/C, No, Ext): (A/C, No): E-MAIL ADDRESS:
INSURER A :
INSURED INSURER B :
INSURER C :
INSURER D :
INSURER E :
INSURER F :
POLICY NUMBER POLICY EFF POLICY EXP TYPE OF INSURANCE (MM/DD/YYYY) (MM/DD/YYYY) LIMITS
AUTOMOBILE LIABILITY
UMBRELLA LIAB
EXCESS LIAB WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
AUTHORIZED REPRESENTATIVE
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 JECT LOC PRODUCTS - COMP/OP AGG OTHER: $ COMBINED SINGLE LIMIT
(Ea accident) $ ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident) $
$ OCCUR EACH OCCURRENCE CLAIMS-MADE AGGREGATE $ DED RETENTION $ PER OTH- STATUTE ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE $
If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT INSURER(S) AFFORDING COVERAGE NAIC #
COMMERCIAL GENERAL LIABILITY
Y / N
N / A
(Mandatory in NH)
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.
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.
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 endorsement(s).
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
CERTIFICATE HOLDER CANCELLATION
ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved.
CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY)
$
$
$
$
$
The ACORD name and logo are registered marks of ACORD
1/14/2025
License # 0757776
(714) 569-2718 2718 (714) 242-9723
36056
Pacific Aquascape International Inc.
17520 Newhope Street Suite 120
Fountain Valley, CA 92708
20260
20044
A 1,000,000
X X LA24CGLZ0H0WVIC 4/30/2024 4/30/2025 300,000
Retention: NIL
Contractual Liab Inc 1,000,000
2,000,000
2,000,000
CAP:$10,000,000 per project EBL AGGREGATE 1,000,000
B 1,000,000
X X 50010346001 10/31/2024 4/30/2025
A 1,000,000
X X LA24EXCZ0H3MSIC 4/30/2024 4/30/2025 1,000,000
0 C
X PAWC539196 3/2/2024 3/2/2025 1,000,000 N 1,000,000
1,000,000
RE: Wilderness Park Pond Repair
The City of Redondo Beach, its officers, elected and appointed officials, employees, and volunteers are Additional Insured as respects to General Liability and Auto Liability as required by written contract. 30 Day Notice of Cancellation will be provided as per policy provisions. General Liability, Auto Liability and Workers' Compensation Waiver of Subrogation included as required by written contract. General Liability is Primary and Non-Contributory as respects The City of Redondo Beach, its officers, elected and appointed officials, employees, and volunteers is agreed in writing. Umbrella Liability is Following Form over the General Liability, Auto Liability and Employer's Liability.
City of Redondo Beach
Public Works Department
Engineering Services Division
P.O. Box 270
Redondo Beach, CA 90277-0270
PACIAQU-01 ARODRIGUEZ6
HUB International Insurance Services Inc.
4695 MacArthur Court
Suite 600
Newport Beach, CA 92660
Henry Zamora
[email protected]
Navigators Specialty Insurance Company
Infinity Select Insurance Company
Berkshire Hathaway Homestate Insurance Company
X
X
X
X
X
X
X
X X
X
X
X
CG 20 12 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 POLICY NUMBER:LA24CGLZ0H0WVIC COMMERCIAL GENERAL LIABILITY CG 20 12 04 13
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - STATE OR GOVERNMENTAL
AGENCY OR SUBDIVISION OR POLITICAL
SUBDIVISION - PERMITS OR AUTHORIZATIONS
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
State Or Governmental Agency Or Subdivision Or Political Subdivision:
Any State Or Governmental Agency Or Subdivision Or Political Subdivision for whom during the policy period you and such State Or Governmental Agency Or Subdivision Or Political Subdivision have agreed in writing in a contract or agreement that such State Or Governmental Agency Or Subdivision Or Political Subdivision be added as an additional insured on your policy.
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 any state or
governmental agency or subdivision or political
subdivision shown in the Schedule, subject to the
following provisions:
1. This insurance applies only with respect to
operations performed by you or on your behalf
for which the state or governmental agency or
subdivision or political subdivision has issued a
permit or authorization.
However:
a. The insurance afforded to such additional
insured only applies to the extent permitted
by law; and
b. 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.
2. This insurance does not apply to:
a. "Bodily injury", "property damage" or "personal
and advertising injury" arising out of operations
performed for the federal government, state or
municipality; or
b. "Bodily injury" or "property damage" included
within the "products-completed operations
hazard".
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.
Kemper Auto Commercial
11700 Great Oaks Way, Suite 450
Alpharetta, GA 30022
Underwritten by: Infinity Select Insurance Company
Customer Service: (800) 722-3391 Claims Service: (800) 334-1661
ADDL INSURED COPY
50461AIS01
ENDORSEMENT : 1-2
ADDITIONAL NAMED INSURED ENDORSEMENT
Copy To Policy ID Number Expiration Date
City of Redondo Beach
Public Works Department
Engineering Services Division
P.O. Box 270
Redondo Beach, CA 90277-0270
50010346001 4/30/2025 12:01 a.m.
Named Insured
Pacific Aquascape, Inc.
This endorsement is attached to and forms a part of the listed policy.
No changes will be effective prior to the time changes are requested.
The City of Redondo Beach, its officers, elected and appointed officials, employees, and volunteers Additional Insured
Part A - Liability Coverage, is changed as follows:
The definition of insured is changed to include the additional insured named above. Adding an insured will not increase the limit of our liability. The insurance provided by this endorsement will be excess over any other valid and collectible insurance.
All other parts of this Policy remain unchanged.
Kemper Auto Commercial
11700 Great Oaks Way, Suite 450
Alpharetta, GA 30022
Underwritten by: Infinity Select Insurance Company
Customer Service: (800) 722-3391 Claims Service: (800) 334-1661
ADDL INSURED COPY
500PNCV01
ENDORSEMENT : 1-2
PRIMARY AND NONCONTRIBUTORY ENDORSEMENT
Copy To Policy ID Number Expiration Date
50010346001 4/30/2025 12:01 a.m.
Named Insured
Pacific Aquascape, Inc.
This endorsement is attached to and forms a part of the listed policy. The following endorsement applies only if Form Number 500PNCV01 appears on your Declarations Page.
This endorsement modifies the insurance provided under your COMMERCIAL AUTO POLICY.
PART A – LIABILITY COVERAGE OTHER INSURANCE – PART A ONLY The following is added to this section:
The coverage afforded under your Commercial Auto Policy is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that:
a. You have agreed in writing in a contract or agreement that the coverage afforded under your Commercial Auto Policy would be primary and would not seek contribution from any other insurance available to such additional insured; and
b. Such additional insured is a named insured under such other insurance.
ALL OTHER TERMS, LIMITS, CONDITIONS, AND PROVISIONS OF THE POLICY REMAIN UNCHANGED.
City of Redondo Beach
Public Works Department
Engineering Services Division
P.O. Box 270
Redondo Beach, CA
90277-0270
Kemper Auto Commercial
11700 Great Oaks Way, Suite 450
Alpharetta, GA 30022
Underwritten by: Infinity Select Insurance Company
Customer Service: (800) 722-3391 Claims Service: (800) 334-1661
ADDL INSURED COPY
50461SWF01
ENDORSEMENT : 1-2
WAIVER OF SUBROGATION
Copy To Policy ID Number Expiration Date
City of Redondo Beach
Public Works Department
Engineering Services Division
P.O. Box 270
Redondo Beach, CA 90277-0270
50010346001 4/30/2025 12:01 a.m.
Named Insured
Pacific Aquascape, Inc.
This endorsement is attached to and forms a part of the listed policy. No changes will be effective prior to the time changes are requested.
In return for your premium payment shown below, we agree that our rights of subrogation or rights of recovery under the policy will not apply against the following person or organization:
The City of Redondo Beach, its officers, elected and appointed officials, employees, and volunteers
(name of person or organization)
Additional premium in the amount of $25.00 will be retained by us regardless of any early termination of this endorsement or the policy.
All other policy provisions remain unchanged.
CG 24 04 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 1 POLICY NUMBER: LA24CGLZ0H0WVIC
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:
Any person or organization when you and such person or organization have agreed in writing in a contract or agreement that you will waive any right of recovery against such person or organization.
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
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
above 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 "productscompleted operations hazard". This waiver applies only to the person or organization shown in the
Schedule above.
Endorsement Effective: Policy No.:
Insured:
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY
WC 99 04 10 C
(Ed. 01-19)
WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT-CALIFORNIA
BLANKET BASIS
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 perform work under a written contract that requires you to obtain this agreement from us.) The additional premium for this endorsement shall be calculated by applying a factor of 2% to the total manual premium, with a minimum initial charge of $350, then applying all other pricing factors for the policy to this calculated charge to derive the final cost of this endorsement.
This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule.
Schedule
Blanket Waiver
Person/Organization Blanket Waiver – Any person or organization for whom the Named Insured has agreed by written contract 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 No.:
Premium $
Insurance Company:
WC 99 04 10 C
Countersigned by ______________________________________ (Ed. 01-19)
Job Description
All CA Operations
Berkshire Hathaway Homestate Ins Co
PAWC539196
Waiver Premium (prior to adjustments)
03/02/2024
Pacific Aquascape International, Inc.
IL 00 17 11 98 Copyright, Insurance Services Office, Inc., 1998 Page 1 of 1
COMMON POLICY CONDITIONS
All Coverage Parts included in this policy are subject to the following conditions.
A. Cancellation
1. The first Named Insured shown in the
Declarations may cancel this policy by mailing
or delivering to us advance written notice of
cancellation.
2. We may cancel this policy by mailing or
delivering to the first Named Insured written
notice of cancellation at least:
a. 10 days before the effective date of
cancellation if we cancel for nonpayment of
premium; or
b. 30 days before the effective date of
cancellation if we cancel for any other
reason.
3. We will mail or deliver our notice to the first
Named Insured's last mailing address known to
us.
4. Notice of cancellation will state the effective
date of cancellation. The policy period will end
on that date.
5. If this policy is cancelled, we will send the first
Named Insured any premium refund due. If we
cancel, the refund will be pro rata. If the first
Named Insured cancels, the refund may be
less than pro rata. The cancellation will be
effective even if we have not made or offered a
refund.
6. If notice is mailed, proof of mailing will be
sufficient proof of notice.
B. Changes
This policy contains all the agreements between
you and us concerning the insurance afforded.
The first Named Insured shown in the Declarations
is authorized to make changes in the terms of this
policy with our consent. This policy's terms can be
amended or waived only by endorsement issued
by us and made a part of this policy.
C. Examination Of Your Books And Records
We may examine and audit your books and
records as they relate to this policy at any time
during the policy period and up to three years
afterward.
D. Inspections And Surveys
1. We have the right to:
a. Make inspections and surveys at any time;
b. Give you reports on the conditions we find;
and
c. Recommend changes.
2. We are not obligated to make any inspections,
surveys, reports or recommendations and any
such actions we do undertake relate only to
insurability and the premiums to be charged.
We do not make safety inspections. We do not
undertake to perform the duty of any person or
organization to provide for the health or safety
of workers or the public. And we do not warrant
that conditions:
a. Are safe or healthful; or
b. Comply with laws, regulations, codes or
standards.
3. Paragraphs 1. and 2. of this condition apply not
only to us, but also to any rating, advisory, rate
service or similar organization which makes
insurance inspections, surveys, reports or
recommendations.
4. Paragraph 2. of this condition does not apply to
any inspections, surveys, reports or
recommendations we may make relative to
certification, under state or municipal statutes,
ordinances or regulations, of boilers, pressure
vessels or elevators.
E. Premiums
The first Named Insured shown in the
Declarations:
1. Is responsible for the payment of all premiums;
and
2. Will be the payee for any return premiums we
pay.
F. Transfer Of Your Rights And Duties Under This
Policy
Your rights and duties under this policy may not be
transferred without our written consent except in
the case of death of an individual named insured.
If you die, your rights and duties will be transferred
to your legal representative but only while acting
within the scope of duties as your legal
representative. Until your legal representative is
appointed, anyone having proper temporary
custody of your property will have your rights and
duties but only with respect to that property.
INTERLINE
IL 00 17 11 98
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 06 07 E (Ed. 01-22)
WC 99 06 07 E Page 1 of 2
(Ed. 01-22)
CALIFORNIA CANCELLATION ENDORSEMENT
This endorsement applies only to the insurance provided by the policy because California is shown in Item 3.A. of the Information Page.
The cancellation condition in Part Six (Conditions) of the policy is replaced by these conditions:
Cancellation:
1. You may cancel this policy. You must mail or deliver advance written notice to us stating when the cancellation is to take effect.
2. We may cancel this policy for one or more of the following reasons:
a. Non-payment of premium;
b. Failure to report payroll;
c. Non-payment of deductible billing;
d. Failure to permit us to audit payroll as required by the terms of this policy or of a previous policy issued by us; e. Failure to pay any additional premium resulting from an audit of payroll required by the terms of this policy or any previous policy issued by us;
f. Material misrepresentation made by you or your agent; g. Failure to cooperate with us in the investigation of a claim; h. Material failure to comply with Federal or State safety orders; i. Material failure to comply with written recommendations of our designated loss control representatives; j. The occurrence of a material change in the ownership of your business; k. The occurrence of any change in your business or operations that materially increases the hazard for frequency or severity of loss;
l. The occurrence of any change in your business or operation that requires additional or different classification for premium calculation;
m. The occurrence of any change in your business or operation which contemplates an activity excluded by our reinsurance treaties.
3. If we cancel your policy for any of the reasons listed in (a) through (g), we will give you 10 days advance written notice, stating when the cancellation is to take effect. Mailing that notice to you at your mailing address shown in Item 1 of the Information Page will be sufficient to provide notice. If we cancel your policy for any of the reasons listed in Items (h) through (m), we will give you 30 days advance written notice; however, we agree that in the event of cancellation and reissuance of a policy effective upon a material change in ownership or operations, notice will not be provided.
4. If we mail the notice to you, the stated periods of notice and your right to remedy the condition will be extended by 5 days if the place of mailing and your mailing address is within California, 10 days if the place of mailing or your mailing address is outside of California and 20 days if the place of mailing or your mailing address is outside of the United States.
5. The policy period will end on the day and hour stated in the cancellation notice.
6. A short rate penalty applies if you cancel this policy or if we cancel due to non-payment of premium, failure to report payroll, or non-payment of deductible billing. First, the standard premium, defined as the base premium (computed in accordance with Part 1, Section 2, Subsection 2 of the WCIRB’s California Basic Underwriting Manual) adjusted for the experience modification factor and all other pricing factors except for premium discount and expense constant, will be multiplied by the quotient of the number of days for which the policy was written divided by the number of days the policy remained in force to produce the full standard premium. Second, the extended number of days will be determined by dividing the number of days the policy was in force by the number of days for which the policy was written and multiplying the quotient by 365 days. When the policy is written for a one-year period, the extended number of days will equal the number of days the policy remained in force. Third, the short rate percentage corresponding to the extended number of days will be obtained from the short rate cancellation table. Fourth, the short rate premium will be equal to the product of the full standard premium times the short rate percentage. The short rate table below will be used in computing the short rate premium. In no event will the final earned premium be less than the policy minimum premium.
NPC-905 03 09 Page 1 of 1
COMMERCIAL GENERAL LIABILITY COVERAGE PART
DECLARATIONS
Policy Number: LA24CGLZ0H0WVIC Effective Date: April 30, 2024 12:01 A.M., Standard Time
LIMITS OF INSURANCE
Each Occurrence $1,000,000 Included
General Aggregate $2,000,000 Included
Products / Completed Operations Aggregate $2,000,000 Included Personal Injury / Advertising $1,000,000 Included
Damage to Premises Rented to You $100,000 Any One Premises Medical Payments Excluded
RETROACTIVE DATE (CG 00 02 only)
Coverage A of this insurance does not apply to “bodily injury” or “property damage” which occurs before the Retroactive Date, if any, shown here: None
BUSINESS DESCRIPTION AND LOCATION OF PREMISES
Form of Business:
Individual Partnership Joint Venture Limited Liability Company Other Trust Business Description: Commercial Water Feature Contractor
PREMIUM
Classification Code No. Rate Premium Basis Exposure Premium (97047) Landscape Gardening 97047 $8.3400 $1,000 Gross Revenue $32,000,000 $266,880 Total Advance Premium $266,880
Forms and Endorsements:
See Schedule of Forms and Endorsements NPC-903 08/07
THESE DECLARATIONS ARE PART OF THE POLICY DECLARATIONS
CONTAINING THE NAME OF THE INSURED AND THE POLICY PERIOD. © Insurance Services Office, Inc., 2012 Page 1 of 1
CG 20 01 04 13
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 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: LA24CGLZ0H0WVIC