SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.
INSURER(S) AFFORDING COVERAGE
INSURER F :
INSURER E :
INSURER D :
INSURER C :
INSURER B :
INSURER A : NAIC #
NAME: CONTACT
(A/C, No): FAX
E-MAIL ADDRESS:
PRODUCER
(A/C, No, Ext): PHONE
INSURED
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
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).
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.
OTHER:
(Per accident)
(Ea accident)
$
$
N / A
SUBR WVDADDL
INSD
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. $
$
$
$ PROPERTY DAMAGE
BODILY INJURY (Per accident)
BODILY INJURY (Per person) COMBINED SINGLE LIMIT
AUTOS ONLY
AUTOS ONLY AUTOS NON-OWNED OWNED SCHEDULED
ANY AUTO
AUTOMOBILE LIABILITY
Y / N WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED?
(Mandatory in NH) DESCRIPTION OF OPERATIONS below
If yes, describe under
ANY PROPRIETOR/PARTNER/EXECUTIVE
$
$
$ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEEE.L. EACH ACCIDENT EROTH- STATUTE PER
(MM/DD/YYYY) LIMITS POLICY EXP(MM/DD/YYYY) POLICY EFFLTR TYPE OF INSURANCE POLICY NUMBER INSR
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
EXCESS LIAB
UMBRELLA LIAB EACH OCCURRENCE $ AGGREGATE $
$
OCCUR
CLAIMS-MADE DED RETENTION $
PRODUCTS - COMP/OP AGG $ GENERAL AGGREGATE $ PERSONAL & ADV INJURY $ MED EXP (Any one person) $
EACH OCCURRENCE $ DAMAGE TO RENTED
PREMISES (Ea occurrence) $ COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- JECT LOC
CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY)
CANCELLATION
AUTHORIZED REPRESENTATIVE
ACORD 25 (2016/03)
© 1988-2015 ACORD CORPORATION. All rights reserved.
CERTIFICATE HOLDER
The ACORD name and logo are registered marks of ACORD
HIRED
AUTOS ONLY
6/14/2024
SullivanCurtisMonroe Insurance Services (Pasadena)
2010 Main Street
Suite 700
Irvine, CA 92614
949-250-7172 949-852-9762
www.SullivanCurtisMonroe.com License # 0E83670
Linda Worthington
Pasadena Office
American Textile Maintenance Company
1667 W. Washington Blvd
Los Angeles CA 90007
80487256
✓
✓
The city, its officers, elected and appointed officials, employees, and volunteers are named as Additional Insured per attached form. applies per attached form.
Redondo Beach Police Dept.
410 Diamond Street
Redondo Beach CA 90277
Coverage is primary and non-contributory per attached form. Per Project aggregate applies to General Liability. 30 day notice of cancellation A CPO281720422 6/15/2024 6/15/2025 1,000,000
1,000,000
✓
10,000
✓
1,000,000
2,000,000
✓ ✓ 2,000,000
A CPO281720422 6/15/2024 6/15/2025 1,000,000
✓
B ✓ LA24EXC814734IC 6/15/2024 6/15/2025 5,000,000
✓ 5,000,000
C LDC4052491 1/1/2024 1/1/2025 ✓
$500,000 deductible 1,000,000 Y
1,000,000
1,000,000
D Excess Liability 2nd Layer EX5T84508424NF 6/15/2024 6/15/2025 $5M x $5M P / $5,000,000 Each claim E Excess Liability 3rd Layer ELD30062352600 $5M x $10M P / $5,000,000 Each claim American Guarantee and Liability Ins Co (AMB A++ X 26247 Navigators Specialty Insurance Company (AMB A+ XV) 36056 Safety National Casualty Corporation (AMB A++ XV) 15105 Travelers Property Casualty Co of America(A++, XV) 25674 Endurance American Specialty Ins Co 41718
80487256 | 2024-25 GLI CAU UMC WCO | Ellie Mendoza | 6/14/2024 8:59:13 AM (PDT) | Page 1 of 7 ACORD 101 (2008/01)
The ACORD name and logo are registered marks of ACORD
© 2008 ACORD CORPORATION. All rights reserved.
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: FORM TITLE:
ADDITIONAL REMARKS
ADDITIONAL REMARKS SCHEDULE Page of
AGENCY CUSTOMER ID:
LOC #:
AGENCY
CARRIER NAIC CODE
POLICY NUMBER
NAMED INSURED
EFFECTIVE DATE:
Named Insured Schedule:
American Textile Maintenance Company
Shames Family Trust and Shames GST Trust dba: Jewal, LLC Steven Lewis and Michele Lewis, trustees of Lewis Family Trust Bradley Shames and Julie Shames, Trustees of Shames Family Trust American Textiles Maintenance Company DBA: Medico Professional Linen Services American Textiles Maintenance Company DBA: Republic Master Chefs American Textiles Maintenance Company DBA: Medico Healthcare Service Shames Family Trust, Lewis Family Trust, Deena R. Wachtel 2020 Exemption Trust, Lisa J.
Perlson 2020 Exemption Trust - dba BMS Investments
Bradley Shames and Julie Shames and Lisa Myer, trustees of Shames GS Trust Lisa J. Perlson 2020 Exemption Trust
Deena R. Wachtel 2020 Exemption Trust
Linen Kids LLC
SullivanCurtisMonroe Insurance Services (Pasadena) American Textile Maintenance Company 1667 W. Washington Blvd
Los Angeles CA 90007
25 Certificate of Liability (03/16)
ATTACHMENT
HOLDER:
ADDRESS:
Redondo Beach Police Dept.
410 Diamond Street Redondo Beach CA 90277
80487256 | 2024-25 GLI CAU UMC WCO | Ellie Mendoza | 6/14/2024 8:59:13 AM (PDT) | Page 2 of 7 POLICY NUMBER: COMMERCIAL GENERAL LIABILITY
CG 20 18 12 19
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CG 20 18 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1 INTERNAL USE ONLY Wolters Kluwer Financial Services, Inc. | Uniform Forms ADDITIONAL INSURED –
MORTGAGEE, ASSIGNEE OR RECEIVER
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name(s) Of Person(s) Or Organization(s) Designation Of Premises Any person or organization, other than an architect,
engineer or surveyor, whom you are required to add
as an additional insured under this policy under a
written contract or written agreement executed prior
to loss
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 the person(s) or
organization(s) shown in the Schedule, but only
with respect to their liability as mortgagee,
assignee or receiver and arising out of the
ownership, maintenance or use of the premises by
you and shown in the Schedule.
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. This insurance does not apply to structural
alterations, new construction and demolition
operations performed by or for that person or
organization.
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;
whichever is less.
This endorsement shall not increase the
applicable limits of insurance.
American Textile Maintenance Company
CPO281720422
80487256 | 2024-25 GLI CAU UMC WCO | Ellie Mendoza | 6/14/2024 8:59:13 AM (PDT) | Page 3 of 7 6/14/2024
American Textile Maintenance Company
CPO281720422 6/15/2024 6/15/2025
80487256 | 2024-25 GLI CAU UMC WCO | Ellie Mendoza | 6/14/2024 8:59:13 AM (PDT) | Page 4 of 7 Additional Insured – Automatic – Owners, Lessees Or
Contractors
U-GL-1175-F CW (04/13)
Includes copyrighted material of Insurance Services Office, Inc., with its permission.
Policy No. Eff. Date of Pol. Exp. Date of Pol. Eff. Date of End. Producer No. Add’l. Prem Return Prem.
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
Named Insured:
Address (including ZIP Code):
This endorsement modifies insurance provided under the:
Commercial General Liability Coverage Part
A. Section II – Who Is An Insured is amended to include as an additional insured any person or organization whom you are required to add as an additional insured on this policy under a written contract or written agreement. Such person or organization is an additional insured 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 or "your work" as included in the "products-completed operations hazard", which is the subject of the written contract or written agreement.
However, the insurance afforded to such additional insured:
1. Only applies to the extent permitted by law; and
2. Will not be broader than that which you are required by the written contract or written agreement to provide for such additional insured.
B. With respect to the insurance afforded to these additional insureds, the following additional exclusion applies:
This insurance does not apply to:
"Bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of, or failure to render, any professional architectural, engineering or surveying services including:
a. The preparing, approving or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or b. Supervisory, inspection, architectural or engineering activities.
This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence" which caused the "bodily injury" or "property damage", or the offense which caused the "personal and advertising injury", involved the rendering of or the failure to render any professional architectural, engineering or surveying services. 6/14/2024
CPO281720422
6/15/2024 6/15/2025
American Textile Maintenance Company
1667 W. Washington Blvd
Los Angeles CA 90007
80487256 | 2024-25 GLI CAU UMC WCO | Ellie Mendoza | 6/14/2024 8:59:13 AM (PDT) | Page 5 of 7 U-GL-1175-F CW (04/13)
Includes copyrighted material of Insurance Services Office, Inc., with its permission.
C. The following is added to Paragraph 2. Duties In The Event Of Occurrence, Offense, Claim Or Suit of Section IV – Commercial General Liability Conditions:
The additional insured must see to it that:
1. We are notified as soon as practicable of an "occurrence" or offense that may result in a claim;
2. We receive written notice of a claim or "suit" as soon as practicable; and
3. A request for defense and indemnity of the claim or "suit" will promptly be brought against any policy issued by another insurer under which the additional insured may be an insured in any capacity. This provision does not apply to insurance on which the additional insured is a Named Insured if the written contract or written agreement requires that this coverage be primary and non-contributory.
D. For the purposes of the coverage provided by this endorsement:
1. The following is added to the Other Insurance Condition of Section IV – Commercial General Liability Conditions:
Primary and Noncontributory insurance
This insurance is primary to and will not seek contribution from any other insurance available to an additional insured provided that:
a. The additional insured is a Named Insured under such other insurance; and b. You are required by written contract or written agreement that this insurance be primary and not seek contribution from any other insurance available to the additional insured.
2. The following paragraph is added to Paragraph 4.b. of the Other Insurance Condition of Section IV – Commercial General Liability Conditions:
This insurance is excess over:
Any of the other insurance, whether primary, excess, contingent or on any other basis, available to an additional insured, in which the additional insured on our policy is also covered as an additional insured on another policy providing coverage for the same "occurrence", offense, claim or "suit". This provision does not apply to any policy in which the additional insured is a Named Insured on such other policy and where our policy is required by a written contract or written agreement to provide coverage to the additional insured on a primary and noncontributory basis.
E. This endorsement does not apply to an additional insured which has been added to this policy by an endorsement showing the additional insured in a Schedule of additional insureds, and which endorsement applies specifically to that identified additional insured.
F. With respect to the insurance afforded to the additional insureds under this endorsement, the following is added to Section III – Limits Of Insurance:
The most we will pay on behalf of the additional insured is the amount of insurance:
1. Required by the written contract or written agreement referenced in Paragraph A. of this endorsement; 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.
All other terms and conditions of this policy remain unchanged. 80487256 | 2024-25 GLI CAU UMC WCO | Ellie Mendoza | 6/14/2024 8:59:13 AM (PDT) | Page 6 of 7 Notification to Others of Cancellation
U-GL-1446-A CW (05/10)
Includes copyrighted material of Insurance Services Office, Inc., with its permission.
Policy No. Eff. Date of Pol. Exp. Date of Pol. Eff. Date of End. Producer No. Add’l. Prem Return Prem.
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
This endorsement modifies insurance provided under the:
Commercial General Liability Coverage Part
Liquor Liability Coverage Part
Products/Completed Operations Liability Coverage Part
A. If we cancel this Coverage Part(s) by written notice to the first Named Insured for any reason other than nonpayment of premium, we will mail or deliver a copy of such written notice of cancellation:
1. To the name and address corresponding to each person or organization shown in the Schedule below; and
2. At least 10 days prior to the effective date of the cancellation, as advised in our notice to the first Named Insured, or the longer number of days notice if indicated in the Schedule below.
B. If we cancel this Coverage Part(s) by written notice to the first Named Insured for nonpayment of premium, we will mail or deliver a copy of such written notice of cancellation to the name and address corresponding to each person or organization shown in the Schedule below at least 10 days prior to the effective date of such cancellation.
C. If notice as described in Paragraphs A. or B. of this endorsement is mailed, proof of mailing will be sufficient proof of such notice.
SCHEDULE
Name and Address of Other Person(s) /
Organization(s):
Number of Days Notice:
All other terms and conditions of this policy remain unchanged. 6/14/2024
American Textile Maintenance Company
CPO281720422
6/15/2024 6/15/2025
30 Day Redondo Beach Police Dept.
80487256 | 2024-25 GLI CAU UMC WCO | Ellie Mendoza | 6/14/2024 8:59:13 AM (PDT) | Page 7 of 7