DATE (MM/DD/YYYY)
ACORD® CERTIFICATE OF LIABILITY INSURANCE
05/20/2025
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 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.
CONTACT vivian windross
PHONE FAG NOI:
QAE INSURANCE BROKERAGE INC PHONE Fa 714 793 8262
E-MAIL
13382 GOLDENWEST ST, SUITE 118 ADDRESS:
WESTMINSTER CA 92683 INSURERS) AFFORDING COVERAGE NAIC # INSURER A: BENCHMARK INSURANCE COMPANY 41394
INSURER B: INFINITY SELECT INSURANCE COMPANY 20260
INSURED
OM ROOFING INC INSURERC: GUIDEONE NATIONAL INSURANCE COMPANY 14167 18000 Studebaker Road, Suite 700 INSURER D: BERSHIRE HATHAWAY DIRECT INSURANCE COMPANY 10391 Cerritos CA 90703 INSURER E: WESTCHESTER INSURANCE COMPANY 10172 INSURER F:
COVERAGES CERTIFICATE NUMBER: 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 REDUCER SYRACY EXPAIMS.
INSR LIMITS
COMMERCIAL GENERAL LIABILITY CURRENCE 2,000,000
BIC5028750 01/14/2025 01/14/202e DAMAGE TO RENTED 100,000 PREMISES. (Ea occurrence)
ERRORS & OMMISION MED EXP (Any one person) 5,000
A / EMPLOYMENT LIABILITY PERSONAL & ADV INJURY 1,000,000 GENL AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE 2,000,000 PRODUCTS - COMP/OP AGG 2,000,000
EACH CLAIM/AGG 2,000, 000
OTHER
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000
504610131059001 11/08/2024 11/08/2025 (Ea accident)
BODILY INJURY (Per person)
L ANY AUTO
ALL OVNED SCHEDULED Y BODILY INJURY (Per acodent)
NON-OWNED PROPERTY DAMAGE
HIRED AUTOS AUTOS
UMBRELLA LIAB 560002933-02 01/14/202501/14/2026 EACH OCCURRENCE 5,000,000 OCCUR
C EXCESS LIAB AGGREGATE 5,000,000
"ENTENS 10000
WORKERS COMPENSATION STATUTE TOTH
AND EMPLOYERS' LIABILITY N9WC542384 06/15/2024 06/15/2025 YIN 1,000,000
ANY PROPRIETOR/PARTNER/EXECUTIVE EL EACH ACCIDENT
D OFFICER/MEMBER EXCLUDED' N/A Y
(Mandatory in NH) 1,000,000
DESCRIPTION OPERATIONS DEIDN desenbu
EL DISEASE - POLICY LIMITE 1,000,000
E POLLUTION LIABILITY Y Y G74404509 002 01/14/202501/14/2026 EACH OCC/AGG $2,000,000 DESCRIPTION OF OPERATIONS/ LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: VARIOUS LOCATTONS SOUTHERN CA
to go tele led appointy of cial inployde and volunteere are named additiona.
CANCELLATION NOTICE VEL BE DELEV RED IN ACEDANCE MET THE POLICY PR TORS THE EXTRATION DATE THEREOP, A 30 DAY OF
CERTIFICATE HOLDER CANCELLATION
CITY OF REDONDO BEACH SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THEREOF, NOTICE WILL BE DELIVERED IN
415 DIAMOND STREET ACCORDANCE WITH THE POLICY PROVISIONS.
REDONDO BEACH, CA 90277
AUTHORIZED REPRESENTATIVE
© 1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: BIC5028750 COMMERCIAL GENERAL LIABILITY
G0103 09 18
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
PRIMARY BLANKET ADDITIONAL INSURED
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
Section II - Who Is An Insured is amended to
nclude as an Additional Insured any person(s) o
raanization(s) that the Named Insured has agreed ir
an "insured contract" to name such person or
organization as an Additional Insured, but only with
respect to liability for "bodily injury" and "property
damage", , and provided that: (i) the "bodily injury" or "property damage" occurs subsequent to the dividing (i) the amount of covered damages execution of the "insured contract", and (ii) the arising out of "your work", by (ii) the total amount "bodily injury" or "property damage" arises from "your of loss paid or payable to the plaintiffs) by all work" performed during the policy period. persons and organizations in connection with the claim giving rise to the "suit".
With respect to the insurance provided to an
Additional Insured under this endorsement, the 4. The applicable limit of the company's liability following also applies: shall not be increased by the inclusion of any number of person(s) or organization(s) who
1. The following subparagraph d. is added to qualify as Additional Insureds.
Section IV - Commercial General Liability
Conditions, paragraph 4. Other Insurance, 5. Other than as expressly modified herein, Deductibles and Self-Insured Retentions: coverage for the Additional Insured is governed by the terms and conditions of this policy.
d. Notwithstanding anything to the contrary in
paragraphs 4.a., 4.b., or 4.c. hereof, the
indemnity provided by this insurance is
primary and non-contributory for any person or
organization who qualifies as an Additional
Insured under this policy and for whom you
have agreed, in an "insured contract", to
provide primary additional insured coverage.
2. We will pay sums on behalf of an Additional
Insured only to the extent of payment for
damages because of "bodily injury" or "property
damage" arising out of the negligence or strict
liability of the Named Insured. No coverage is
provided for damages because of "bodily injury"
or "property damage" arising out of acts, errors
or omissions of the Additional Insured.
3. We have the right but not the duty to defend an
Additional Insured in any "suit" seeking damages
covered by this policy. If, however, you are
obligated under an "insured contract" to defend
a person or organization who qualifies as an
Additional Insured in a "suit" brought by a third
party against that Additional Insured seeking
ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED.
G0103 09 18 © WESTCAP 2018 Page 1 of 1
POLICY NUMBER: BIC5028750 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
SCHEDULE
Name Of Person Or Organization:
Blanket as required by an "insured contract"
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
vour work" done under a contract with that persor
or organization and included in the "products-
completed operations hazard". This waiver applies
only to the person or organization shown in the
Schedule above.
CG 24 04 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 1 KEMPER Auto INFINITY Infinity Commercial Auto
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
WAIVER OF SUBROGATION
CALIFORNIA
Copy To Policy ID Number Expiration Date
OM ROOFING INC 504-61013-1059-001 11/08/2025 12:01 AM
18000 STUDEBAKER AVE STE #700 Named Insured
Cerritos, CA 90703 OM ROOFING INC
Changes wis Defeate pher to and for hange ore gued policy. No Potty wif not apy agains the olowing person, ver gane that our rights of subrogation or i recovery under the
ANY PERSON OR ORGANIZATION FOR WHOM THE NAMED INSURED HAS AGREED BY WRITTEN
CONTRACT TO FURNISH THIS WAIVER
RE: BLANKET WAIVER OF SUBROGATION
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. 50461SWF01 Amend Date: 10/14/2024