DATE (MM/DD/YYYY)
ACORD CERTIFICATE OF LIABILITY INSURANCE 10/08/2024
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 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).
PRODUCER NAME" CLIENT CONTACT CENTER NAME:
FEDERATED MUTUAL INSURANCE COMPANY PHONE FAX, No): 507-446-4664 HOME OFFICE: P.O. BOX 328 (A/C, No, Ext): 888-333-4949
OWATONNA, MN 55060 EMIRESS: [email protected] INSURERS AFFORDING COVERAGE NAIC #
INSURER :FEDERATED MUTUAL INSURANCE COMPANY 13935
INSURED INSURER B:
CJ CONCRETE CONSTRUCTION, INC. INSURER C:
10142 SHOEMAKER AVE
SANTA FE SPRINGS, CA 90670-3404 INSURER D:
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: 108 REVISION NUMBER: 0
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 OI SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS
TYPE OF INSURANCE POLICY NUMBER LIMITS
X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000 CLAIMS-MADE X OCCUR ENCE TO RENTED PREMISES $100,000
MED EXP (Any one person) $10,000
A Y Y 1845023 11/12/2024 11/12/2025 PERSONAL & ADV INJURY $1,000,000 GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY LOC PRODUCTS & COMPIOP ACC $2,000,000
OTHER:
AUTOMOBILE LIABILITY COMBINED SINGLE LIMI $1,000,000
Ea acciden
X ANYAUTO BODILY INJURY (Per Person)
A LOWNED AUTOS ONLY 1845023 11/12/2024 11/12/2025 BODILY INJURY (Per Accident)
HIRED AUTOS OWNLY PROPERTY DAMAGE
Per Accident,
X UMBRELLA LIAB X OcCUR EACH OCCURRENCE $8,000,000
A EXCESS LIAB CLAIMS-MADE N N 1845025 11/12/2024 11/12/2025 AGGREGATE $8,000,000
DED RETENTION
ORKERS COMPENSATIC TPER STATUTE OTHER
ID EMPLOYERS' LIABILI YIN
ARE AN ACTED RECUTIVE ELL EACH ACCIDENT
N/A
E.L DISEASE EA EMPLOYEE
DESCRIFTION OF OPERATIONS below EL DISEASE • POLICY LIMIT DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
SEE ATTACHED PAGE
CERTIFICATE HOLDER CANCELLATION
CITY OF REDONDO BEACH DEPARTMENT OF 108 0
ENGINEERING AND BUILDING SERVICES SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 415 DIAMOND ST BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN REDONDO BEACH, CA 90277-2836 ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
Nichola R. Toever
@ 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID:
ACORD LOC #:
ADDITIONAL REMARKS SCHEDULE Page 1 of 1
AGENCY NAMED INSURED
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 LIABILITY INSURANCE PROJECT: CITY OF REDONDO BEACH 415 DIAMOND ST.
SUBJECT TO THE TERMS AND SONINE ARE INCLUDES: THE CITY, ITS OFFICERS, ELECTED AND APPOINTED OFFICIALS, 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 ENDORSEMENT FOR BUSINESS AUTO LIABILITY.
INSURANCE PROVIDED BY THE GENERAL LIABILITY COVERAGE IS PRIMARY AND NONCONTRIBUTORY OVER OTHER INSURANCE SUBJECT TO THE CONDITIONS OF THE PRIMARY AND NONCONTRIBUTORY CLAUSE- OTHER INSURANCE CONDITION.
INSURANCE PROVIDED BY THE BUSINESS AUTO LIABILITY IS PRIMARY AND NONCONTRIBUTORY OVER OTHER INSURANCE SUBJECT TO THE CONDITIONS OF THE PRIMARY AND NONCONTRIBUTORY CLAUSE- OTHER INSURANCE CONDITION.
GENERAL LIABILITY CONTAINS A WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION:
AUTOMATIC ENDORSEMENT
BUSINESS AUTO LIABILITY CONTAINS A WAIVER OF SUBROGATION IN FAVOR OF THE CERTIFICATE HOLDER SUBJECT TO THE CONDITIONS OF THE BLANKET WAIVER OF RIGHTS OF RECOVERY ENDORSEMENT.
SHOULD ANY OF THE POLICIES LISTED
ACORD 101(2008/01) @ 2008 ACORD CORPORATION. All rights reserved.
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 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 seek 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 be 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
primary and would not seek contribution from "insured". any other insurance available to such
"insured".
© Insurance Services Office, Inc., 2016 Pace 1 of 1
CA 04 49 11 16 Policy Number: 1845023 Transaction Effective Date: 11/12/2024 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.
3. 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: 11/12/2024 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: 11/12/2024
COMMERCIAL GENERAL LIABILITY
CG 20 01 12 19
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
LIQUOR 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
(1) The additional insured is a Named Insured
under such other insurance; and
© Insurance Services Office, Inc., 2018 Page 1 of 1
CG 20 01 12 19 Policy Number: 1845023 Transaction Effective Date: 11/12/2024
COMMERCIAL GENERAL LIABILITY
CG 24 53 12 19
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
WAIVER OF TRANSFER OF RIGHTS OF RECOVERY
AGAINST OTHERS TO US (WAIVER OF SUBROGATION) -
AUTOMATIC
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PAR
LECI RONIC DALA LABILLY COVERAGE PARI
LIQUOR LIABILITY COVERAGE PART
'OLLUTION LIABILITY COVERAGE PART DESIGNATED SITE
'OLLUTION LIABILITY LIMITED COVERAGE PART DESIGNATED SITE
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
RAILROAD PROTECTIVE LIABILITY COVERAGE PART
UNDERGROUND STORAGE TANK POLICY DESIGNATED TANKS
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 against any person or
organization, because of any payment we make under
this Coverage Part, to whom the insured has waived
its right of recovery in a written contract or
agreement. Such waiver by us applies only to the
extent that the insured has waived its right of recovery against such person or organization prior to loss.
© Insurance Services Office, Inc., 2018 Page 1 of 1
CG 24 53 12 19 Policy Number: 1845023 Transaction Effective Date: 11/12/2024