Loading...
PROOF OF INSURANCE (2020) CLOSEDJLEEENG-01 YIJE„N,Q ACORO DATE (MMIDD/YYYY) �� CERTIFICATE OF LIABILITY INSURANCE L8/912019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 11­m� m 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 g ......... ........ .-u of such endorsement(s). this certificate does not confer rl hts to the certificate holder in n lieu PRODUCER License # OE67768 CONTACT Gigi Yuen NAME;, IDA Insurance Services PHONE FAx 3875 Ho and Road (AIC, NoJ:(925) 416-7869 Suite 200y AD(AIC, No, Ext): Gig i9 3514 Yu'e 6 50008 t7 iaaUSa,.CCI'rn Pleasanton, CA 94588 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Travelers Property Casualty Company of America 26674 INSURED INSURER 8: Arch Insurance Company 11156 JLee Engineering, Inc. INSURER C 430 S. Garfield Avenue, #301 INSURER D: Alhambra, CA 91801 INSURER E 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 REDUCED BY PAID CLAIMS, INSR TYPE OF INSURANCE 'ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS I T INs.A_ W.ul?._ mmmmm........ _w...m.ly!.4 Y`? Yl....LM.iRl7�?f�- A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE CE ,b 2,000,000 CI..AIMS-IMADE X OCCUR 6802HO13864 9/1/2019 9/1/2020 DAMAGE TO RENTED 1,000,000 PREMISES (Ea ticwi enr„,e) MFG EXP (Any one Person) J� 10'000 PERSONAL x ADV INJURY 2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) All Operations of the Named Insured. General Liability only: City of EI Segundo, its officers, officials, employees, and authorized volunteers is named as Additional Insured but only as respects liability arising out of the Named Insured's operations in Professional Services Agreement; such coverage is Primary and Non -Contributory as respects any insurance carried by the Additional Insured with respect to work performed by the Named Insured. Also, note that the aforementioned General Liability includes coverage for Hired & Non -Owned Auto Liability. NOTE: No company-owned vehicle. Above policies include Waiver of Subrogation in favor of the aformentioned Additional Insured. CERTIFICATE HOLDER City of EI Segundo 350 Main Street El Se undo CA QnJAI; SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE g ACORD 25 2016/03 O 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 4'000'000 tl;'SEN'!M AiGGR'cGA7E 1-11MIIT APPLIES PFR GENERAL, AGGREGATE 1 POLICY i/« ,rft:"i'"f I.........JI Lr. -u:: PRODUCTS- COMPIOPAGG s 4,000,000 n A COMBINED SINGLE LIMIT 2,000,000 AUTOMOBILE LIABILITY (Ea pccidenl) S. ANY AUTO 6802HO13864 9/1/2019 9/112020 BODILY IN.IURY I,Pe, person), , S OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY t ,Ppr acc.idenl), S X HIRES X Ni?_Y�I.."'J£C A61, �" ONLY ,,,,, A1.9"CSi, NLY PROPERTY DAMAGE (Peraccidentl S S UMBRELLA LIAB OCCUR EACH OCCURREN(.;E $ EXCESS LIAB CLAIMS -MADE AGGREGATE. S DED RETENTIONS S A .mm.. WOR mmITIT �.,mm..... ...._...___..,,. PER STATUTE F,RH- EMPLOYERS' LIABILITY AND EMPLOYERS' LIABILITY I.ITIT.^.,ITIT.,.,., UB3J84391A 9/1/2019 9/1/2020 XL. 1,000,000 ND (EXECUTIVE IY-t-N. EACH ACCIDENT �! FICE',�'R,MEMBER EXCLUDED? NIA i 1 ���('�(�� OnPR 4r� dalory in NH) _ E DISEASE - EA EMPLOYEE S If yes, describe under 1,000,000 D OF OPERATIONS belowITITITIT..., ..............................._._.................___...................... E L DISEASE -POLICY LIMIT J; ...................ESCRIPTION B . IT.......,., Professional Liab. PAAEP00102501 9/1/2019 9/1/2020 Per Claim 1,000,000 B Professional Liab. PAAEP00102501 9/1/2019 9/1/2020 Aggregate 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) All Operations of the Named Insured. General Liability only: City of EI Segundo, its officers, officials, employees, and authorized volunteers is named as Additional Insured but only as respects liability arising out of the Named Insured's operations in Professional Services Agreement; such coverage is Primary and Non -Contributory as respects any insurance carried by the Additional Insured with respect to work performed by the Named Insured. Also, note that the aforementioned General Liability includes coverage for Hired & Non -Owned Auto Liability. NOTE: No company-owned vehicle. Above policies include Waiver of Subrogation in favor of the aformentioned Additional Insured. CERTIFICATE HOLDER City of EI Segundo 350 Main Street El Se undo CA QnJAI; SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE g ACORD 25 2016/03 O 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NO. 6802HO13864 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY,. BLANKET ADDITIONAL INSURED (ARCHITECTS, ENGINEERS AND SURVEYORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART The following is added to SECTION II — WHO IS AN INSURED: Any person or organization that you agree in a "written contract requiring insurance" to include as an additional insured on this Coverage Part, but: a. Only with respect to liability for "bodily injury", "property damage" or "personal injury"; and b. If, and only to the extent that, the injury or damage is caused by acts or omissions of you or your subcontractor in the performance of "your work" to which the "written contract requiring insurance" applies, or in connection with premises owned by or rented to you. The person or organization does not qualify as an additional insured: c, With respect to the independent acts or omissions of such person or organization; or d. For "bodily injury", "property damage" or "personal injury" for which such person or organization has assumed liability in a contract or agreement. The insurance provided to such additional insured is limited as follows: e. This insurance does not apply on any basis to any person or organization for which coverage as an additional insured specifically is added by another endorsement to this Coverage Part. f. This insurance does not apply to the rendering of or failure to render any "professional services". g. In the event that the Limits of Insurance of the Coverage Part shown in the Declarations exceed the limits of liability required by the "written contract requiring insurance", the insurance provided to the additional insured shall be limited to the limits of liability required by that "written contract requiring insurance". This endorsement does not increase the limits of insurance described in Section III — Limits Of Insurance. h. This insurance does not apply to "bodily injury" or "property damage" caused by "your work" and included in the "products - completed operations hazard" unless the "written contract requiring insurance" specifically requires you to provide such coverage for that additional insured, and then the insurance provided to the additional insured applies only to such "bodily injury" or "property damage" that occurs before the end of the period of time for which the "written contract requiring insurance" requires you to provide such coverage or the end of the policy period, whichever is earlier. 2. The following is added to Paragraph 4.a. of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: The insurance provided to the additional insured is excess over any valid and collectible other insurance, whether primary, excess, contingent or on any other basis, that is available to the additional insured for a loss we cover. However, if you specifically agree in the "written contract requiring insurance" that this insurance provided to the additional insured under this Coverage Part must apply on a primary basis or a primary and non-contributory basis, this insurance is primary to other insurance available to the additional insured which covers that person or organizations as a named insured for such loss, and we will not share with the other insurance, provided that: (1) The "bodily injury" or "property damage" for which coverage is sought occurs; and (2) The "personal injury" for which coverage is sought arises out of an offense committed; after you have signed that "written contract requiring insurance". But this insurance provided to the additional insured still is excess over valid and collectible other insurance, whether primary, excess, contingent or on any other basis, that is available to the additional insured when that person or organization is an additional insured under any other insurance. CG D3 81 09 15 O 2015 The Travelers Indemnity Company. All rights reserved. Page 1 of 2 Includes the copyrighted material of Insurance Services Office, Inc„ with its permission COMMERCIAL GENERAL LIABILITY 3. The following is added to Paragraph 8., Transfer Of Rights Of Recovery Against Others To Us, of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: We waive any right of recovery we may have against any person or organization because of payments we make for "bodily injury", "property damage" or "personal injury" arising out of "your work" performed by you, or on your behalf, done under a "written contract requiring insurance" with that person or organization. We waive this right only where you have agreed to do so as part of the "written contract requiring insurance" with such person or organization signed by you before, and in effect when, the "bodily injury" or "property damage" occurs, or the "personal injury" offense is committed. 4. The following definition is added to the DEFINITIONS Section: "Written contract requiring insurance" means that part of any written contract under which you are required to include a person or organization as an additional insured on this Coverage Part, provided that the "bodily injury" and "property damage" occurs and the "personal injury" is caused by an offense committed: a. After you have signed that written contract; b. While that part of the written contract is in effect; and c. Before the end of the policy period. Page 2 of 2 © 2015 The Travelers Indemnity Company. All rights reserved. CG D3 81 09 15 Includes the copyrighted material of Insurance Services Office, Inc., with its permission Avok ������ � WORKERS COMPENSATION AND ONE TOWER SQUARE EMPLOYERS LIABILITY POLICY HARTFORD CT 06183 ENDORSEMENT WC 99 03 76 ( A) - 001 POLICY NUMBER: Us-3J84391A WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA (BLANKET WAIVER) 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. The additional premium for this endorsement shall be 2.00 % of the California workers' compensation pre- mium. Schedule Person or Organization Job Description ANY PERSON OR ORGANIZATION FOR ENGINEERS WHICH THE INSURED HAS AGREED BY WRITTEN CONTRACT EXECUTED PRIOR TO LOSS 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 Effective Policy No. Endorsement No. Insured Premium Insurance Company Countersigned by DATE OF ISSUE: 07-09-18 ST ASSIGN: Page 1 of 1