No preview available
PROOF OF INSURANCE (2020 - 2020) CLOSEDDATE (MMIDDIYYYY) ^i CERTIFICATE OF LIABILITY INSURANCE 11/27/2019 THIS CERTIFICATE IS ISSUED ASA 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(les) 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). iGuesno I I`AXLA1c, r � .. _.) .- PRODUCER CONTACT xt Aimee .. Cornerstone Specialty Insurance Services, Inc, _ (714@7314 7700 p y _ (714} 731-7750 PHONP 14252 Culver Drive, A299 IIDDRLSS: armee cornerstones eclalt .com INSURERS) AFFORDING COVERAGE MAIC If _ V Irvine CA 92604 INSURERA: Continental Casualty Company 20443 ..INSURED......,....._._„�..._.......,-..�..�.....�..._...._.._........�,__ _. INSURER B: Travelers Casualty & Surety Co. of America 31194 HAYER CONSULTANTS, INC. I INSURER C: 4067 Hardwick St. INSURER D PNB 250�._._.._......._.�...............__............................_.�.................._.............................................. INSURER E: .......... ,........._-,_..,.....w..........._., .., Lakewood CA 90712 INSURER F; COVERAGES_ ___ CERTIFICATE NUMBER? _ _ _ REVISION NUMBER: THIS IS TC CERTIFY THAT THE POLICIES OF IN LISTED BELOW HAVE BEEN ISSUED TO ThE iNSUREL NAMED ABOVE FOR'IrIE POLICY PERICL INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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 C -AIMS ILTR TYPE OF INSURANCE INSD'" iT D POLICY NUMBER pMlI ........._ OLICY E F P LICYEXP INSD WVD 1M DDIYYYYJ (MMIDDIYYYY) LIMITS COMMERCIAL GENERAL LIABILITY 2,000,000 X EACH OCCURRENCE $' 6AMAGE IO RENFLD 300,000 CLAIMS -MADE � OCCUR PREMISES (Ea occurrence) $ X ADDT'L INSURED! PRIMARY MED EXP (Any one persen) $ W,000 A X BLNKT WVR OF SUBRO - Y Y 6025376468 10/04/2019 10/04/2020 PERSONAL. &ADV INJURY $ 2,000,000 -GLNT AGGREGATE LIMIT APPLIES PER GL'dJI:RAG, �6G'C3Idi:.i',:W'M: a 4.000,000. ... ®�El isr'LICY L®._ tLOC AUTOMOBILELIABILITY r rt+R 11 .17 F„ I,C7NII I,. Ii1. �.,,_.........___....,.._....,...,.,.........._._.._.........,_...,_...�.......,..�....... ..,.....,._.,.._,,,,_. .................,,,.m�f.LJ�I&I=,dNk I�,, 700e...jt�r} # C, r V71 It -F•; L.nrr, I :I,I# P11I '00 ANY AUTO .1'3(.)1)11" INJURIt(I #..�_ .,.� .. I ..A. ,.. .... A OWNED SCHEDULED Y Y 60253,,6468 10/04/2019 10/04/2020 71N11 IN,JuRY(rnr acCI:iom % b AUTOS ONLY ._. AUTOS .. WW ._......_....... ........ .....,._.,.,, ., .... ....... p HIRED rl NDN -OWNED DAMA'Gin'. ., V AUTOS ONLY AUTOS ONLY P0.71 .11 ............t........._._......- ..._ ..�........._............. ...........,.....,......., 5 UMBRELLA LIAB $ 2,000,000 ..................... X OCCUR EACH OCCURRENCE $ VVV ...._ DED LIA RETENTION CLAIMS -MADE 6025376499 10/04/2019 10/04/2020 AGGREGATE $ s 2�000,000 ON $ B A EXCESS ,. WORKERS COMPENSATION SPER TATUTE EORH S ANY PPROPRIIE"FOR/PARTNER/EXECUTIVE YIN NIA �E,L EACH ACCIDENT, ,_5 AND EMPLOYERS' LIA 81LI` Y OFf=ICER/MEMBER EXCLUDED? )tYY? desenoe under II Yes RIPTION OF OPERATIONS below _ . , _ ,_...._ .. ....... �'_..... .�.I E L DISE �. . 4_.LLUESC - ASE - POLIOYLIMIT_ 5 EACH CLAIM � f $2,000,000 PROFESSIONAL LIABILITY B Claims Made 106639088 12/01/2019 12/01/2020 ANNUALAGGREGATE $2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of EI Segundo is Additional Insured for General Liability but only if required by written contract with the Named Insured prior to an occurrence and as per attached endorsement, Coverage is subject to all policy terms and conditions. *30 days notice of cancellation, except for 10 days notice for non-payment of premium, For Professional Liability coverage, the aggregate limit is the total insurance available for all covered claims reported within the policy period. CER'TIFICKrE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEIORE THE EXPIRATION DfcrE THEREOF, NO?ICE WILL BE DELIVERED IN City of EI Segundo -Attn: Building & Safety Department ACCORDANCE WITH IHE. POLICY PROVISIONS. 350 Main Street AUTHORIZED REPRESENTATIVE EI Segundo CA 90245' �(, w,,,TM .cL,.._ ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD INSURED: Hayer Consultants, Inc. POLICY PERIOD: 10/04/2019 to 10/04/2020 POLICY NUMBER: 6025376468 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED WITH PRODUCTS -COMPLETED OPERATIONS COVERAGE AND BLANKET WAIVER OF SUBROGATION / AGGREGATE LIMIT (PER PROJECT) This endorsement modifies insurance provided under the following: BLISINESSOWNERS LIABILITY COVERAGE FORM BLISINESSOWNERS COMMON POLICY CONDITIONS 1. Blanket Additional Insured with Products -Completed Operations Coverage and Blanket Waiver of Subrogation A. Who Is An Insured is amended to include as an 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, but the written contract or written agreement must be: 1. Currently in effect or becoming effective during the term of this policy; and 2. Executed prior to the: a. "Bodily injury" or "property damage"; or b. Offense that caused the "personal and advertising injury;" for which the additional insured seeks coverage. B. The insurance provided to the additional insured is limited as follows: 1. That person or organization is an additional insured only with respect to such person or organization's liability for: a. "Bodily injury", "property damage" or "personal and advertising injury to the extent caused by: (1) Your acts or omissions; or (2) Acts or omissions of those acting on your behalf; in the performance of your ongoing operations specified in the written contract; or b. "Bodily injury" or "property damage" to the extent caused by "your work" specified in the written contract or written agreement and included in the "products -completed operations hazard", but only if: (1) The written contract or written agreement requires you to provide the additional insured such coverage; and (2) This Coverage Part provides such coverage. 2. The Limits of Insurance applicable to the additional insured are those specified in the written contract or written agreement or in the Declarations of this policy, whichever is less. These limits of Insurance are inclusive of, and not in addition to, the Limits of Insurance shown in the Declarations. 3. The insurance provided to the additional insured does not apply to "bodily injury," "property damage," "personal and advertising injury" arising out of an architect's, engineer's, or surveyor's rendering of or failure to render any professional services, including: SB300176D17 (6-16) Page 1 of 3 Copyright, CNA All Rights Reserved. ��iA'T-.Al- a. The preparing, approving, or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications by any architect, engineer or surveyor performing services on a project of which you serve as a construction manager; or b. Inspection, supervision, quality control, engineering or architectural services done by you on a project of which you serve as construction manager. 4. This insurance provided to the additional insured does not apply to "bodily injury," "property damage," or "personal and advertising injury" arising out of construction or demolition work while you are acting as a construction or demolition contractor. C: With respect only to the insurance provided by this endorsement, the condition entitled Other Insurance of the BUSINESSOWNERS COMMON POLICY CONDITIONS is amended to delete paragraphs 2. and 3., and replace them with the following: 2. This insurance is excess over any other insurance available to the additional insured, whether primary, excess, contingent or on any other basis. But if required by the written contract or written agreement, this insurance will be primary and noncontributory relative to insurance on which the additional insured is a Named Insured. 3. When this insurance is excess, we will have no duty under Business Liability insurance to defend the additional insured against any "suit" if any other insurer has a duty to defend the additional insured against that "suit" if no other insurer defends, we will undertake to do so, but we will be entitled to the additional insured's rights against all those other insurers. When this insurance is excess over other insurance, we will pay only our share of the amount of the loss, if any, that exceeds the sum of: (a) The total amount that all such other insurance would pay for the loss in the absence of this insurance; and (b) The total of all deductible and self-insured amounts under all that other insurance. We will share the remaining loss, if any, with any other insurance that is not described in this Excess Insurance provision and was not bought specifically to apply in excess of the Limits of Insurance shown in the Declarations of this Coverage Part. D. Additional Insured — Extended Coverage When an additional insured is added by this or any other endorsement attached to this Coverage Part, Who Is An Insured is amended to make the following natural persons insureds. If the additional insured is: a. An individual, then his or her spouse is an insured; b. A partnership or joint venture, then its partners, members and their spouses are insureds,- c. nsureds;c. A limited liability company, then its members and managers are insureds; or d. An organization other than a partnership, joint venture or limited liability company, then its executive officers, directors and shareholders are additional insureds; but only with respect to locations and operations covered by the additional insured endorsement's provisions, and only with respect to their respective roles within their organizations. Please see the Estates, Legal Representatives and Spouses provision of this endorsement for additional coverage and restrictions applicable to spouses of natural person insureds. E. Blanket Waiver of Subrogation The condition entitled Transfer of Rights of Recovery Against Others To Us of the BUSINESSOWNERS COMMON POLICY CONDITIONS is amended to delete paragraph 2. and replace it with the following: 2. We waive any right of recovery we may have against any person or organization against whom you have agreed to waive such right of recovery in a written contract or agreement because of payments we SB300176D17 (6-16) Page 2 of 3 Copyright, CNA All Rights Reserved- 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 within the "products -completed operations hazard." 2. Amendment- Aggregate Limits of Insurance (Per Project) A. For all sums which the insured becomes legally obligated to pay as damages caused by 'occurrences" under Coverage A.1., and for all medical expenses caused by accidents under Coverage A.2., which can be attributed only to ongoing operations at a single construction project: 1. A separate Construction Project General Aggregate limit applies to each construction project. The Construction Project General Aggregate limit is equal to the amount of the General Aggregate limit shown in the Declarations. 2. The Construction Project General Aggregate limit is the most we will pay for the sum of all damages payable under Coverage A.1., except damages because of "bodily injury" or "property damage" included in the "products -completed operations hazard," and for medical expenses payable under Coverage A.2. regardless of the number of: a. Insureds; b. Claims made or "suits" brought; or c. Persons or organizations making claims or bringing "suits." 3. Any payments made under Coverage A.I. for damages or under Coverage A.2. for medical expenses shall reduce the Construction Project General Aggregate limit for the applicable construction project. Such payments shall not reduce the General Aggregate limit shown in the Declarations nor shall they reduce any Construction Project General Aggregate limit applicable to other construction projects. 4. The limits shown in the Declarations for Liability and Medical Expenses, Damage to Premises Rented to You, and Medical Expenses continue to apply. However, instead of being subject to the General Aggregate limit shown in the Declarations, such limits will be subject to the applicable Construction Project General Aggregate limit. B. All: 1. Damages because of "personal and advertising injury", regardless of the number of construction projects involved; 2. Damages under Coverage A.1. which cannot be attributed solely to ongoing operations at a single construction project, except damages because of "bodily injury" or "property damage" included in the "products -completed operations hazard"; and 3. Medical expenses under Coverage A.2. caused by accidents which cannot be attributed solely to ongoing operations at a single construction project; will reduce the General Aggregate Limit shown in the Declarations, and shall not reduce any Construction Project General Aggregate Limit. C. When coverage for liability arising out of the "products -completed operations hazard" is provided, any payments for damages because of "bodily injury" or "property damage" included in the "products -completed operations hazard" will reduce the Products/Completed Operations Aggregate limit, and not reduce the General Aggregate limit nor any Construction Project General Aggregate limit. D. If a construction project has been abandoned, delayed, or abandoned and then restarted, or if the authorized contracting parties deviate from plans, blueprints, designs, specifications or timetables, the project will still be deemed to be the same construction project. E. The provisions of the Limits Of Insurance section not otherwise modified by this endorsement shall continue to apply as stipulated. All other terms and conditions of the Policy remain unchanged. SB300176D17 (6-16) Page 3 of 3 Copyright, CNA All Rights Reserved, CERTHOLDER COPY Sc P.O, BOX 8192, PLEASANTON, CA 94588 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 06-20-2019 CITY OF EL SEGUNDO SC 350 MAIN ST EL SEGUNDO CA 90245-3813 GROUP: POLICY NUMBER: 9100543-2019 CERTIFICATE ID: 19 CERTIFICATE EXPIRES: 05-24-2020 05-24-2019/05-24-2020 THIS CERTIFICATE SUPERSEDES AND CORRECTS CERTIFICATE # 19 DATED 05-24-2019 This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 10 days advance written notice to the employer We will also give you 10 days advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy. 2 Authorized Representative President and CEO EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT #0015 ENTITLED ADDITIONAL INSURED EMPLOYER EFFECTIVE 2019-05-24 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. NAME OF ADDITIONAL INSURED: CITY OF EL SEGUNDO ENDORSEMENT #2570 ENTITLED WAIVER OF SUBROGATION EFFECTIVE 2019-06-20 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. THIRD PARTY NAME: CITY OF EL SEGUNDO ENDORSEMENT #1651 - JASVINDER KAUR PRESIDENT - EXCLUDED. ENDORSEMENT #1651 - NAVDEEP KAUR SEC,TRES - EXCLUDED. EMPLOYER HAYER CONSULTANTS, INC. SC 4067 HARDWICK ST PMB 250 LAKEWOOD CA 90712 [JRC,CNj (REV.7-2074) PRINTED : 08-20-2019 STATE ENDORSEMENT AGREEMENT COMP E N, AT ION WAIVER OF SUBROGATION 9100543-19 FUND RENEWAL SC HOME OFFICE SAN FRANCISCO PAGE 1 OF 1 ALL EFFECTIVE DATES ARE AT 12:01 AM PACIFIC EFFECTIVE JUNE 20, 2019 AT 12.01 A.M. STANDARD TIME OR THE TIME INDICATED AT AND EXPIRING MAY 24, 2020 AT 12.01 A.M. PACIFIC STANDARD TIME HAYER CONSULTANTS, INC. 4067 HARDWICK ST PMB 250 LAKEWOOD, CA 90712 ANYTHING IN THIS POLICY TO THE CONTRARY NOTWITHSTANDING, IT IS AGREED THAT THE STATE COMPENSATION INSURANCE FUND WAIVES ANY RIGHT OF SUBROGATION AGAINST, CITY OF EL SEGUNDO WHICH MIGHT ARISE BY REASON OF ANY PAYMENT UNDER THIS POLICY IN CONNECTION WITH WORK PERFORMED BY, HAYER CONSULTANTS, INC. IT IS FURTHER AGREED THAT THE INSURED SHALL MAINTAIN PAYROLL RECORDS ACCURATELY SEGREGATING THE REMUNERATION OF EMPLOYEES WHILE ENGAGED IN WORK FOR THE ABOVE EMPLOYER. IT IS FURTHER AGREED THAT PREMIUM ON THE ZARNINGS OF SUCK EMPLOYEES SHALL BE INCREASED BY 03%. NOTHING IN THIS ENDORSEMENT SHALL BE HELD TO VARY, ALTER, WAIVE OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS POLICY OTHER THAN AS ABOVE STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR LIMITATIONS IN THIS ENDORSEMENT. COUNTERSIGNED AND ISSUED AT SAN FRANCISCO: AUTHORI"LED REPRESENT IVI SCIF FORM 10217 (REV.4-2018) JUNE 24,2019 2570 PRESIDENT AND CEO OLD DP 217