Loading...
PROOF OF INSURANCE (2020 - 2021) CLOSEDDATE (MM/DDIYYYY) AC'C>dR'0 CERTIFICATE OF LIABILITY INSURANCE 1/17/zo2o 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 pol'icy(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). PRODUCER I NAM ACI Glen GayUmlo, Pohl y Renewals Chrysalis Insurance Agency (Incorporated) IkHONES. Ext)r 714-464-8080 I SpA/ Ido); 714-464-8070 3001 Red Hill Ave, Suite. 2-226 ADDRESS: _ len cia ro.net DDREss: g ............... P INSURERS AFFORDING COVERAGE MAIC N Costa Mesa CA 92626 I INSURER A : SENTINEL INS CO LTD 11000 _................. ....................... ..... .................... _WW. INSURED [INSURER B: PROPERTY & CAS INS CO OF HARTFORD 34690 .........................WEBIPLEX, INC. URER C : ACE FIRE UNDERWRITERS INS CO 20702 9 Corporate Park, Suite 240 INSURER D: INSURER E Irvine CA 92606 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THNS 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 CONTRACTOR 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...................................... AUV ;WbK .............. LTR TYPE OF INSURANCE 'INSD WVD POLICY NUMBER POLILY EFF PULICY eXP (MMIDDIYYYY) (MMIDDIYYYY) I LIMITS )C COMMERCIAL GENERAL LIABILITY�I EACH OCCURRENCE $ CLAIMS -MADE Dc� OCCUR PREMISES Ea occurrence) $ MED EXP (Any one person) $ A Y Y 72SBABA9522 11/22/2019 11/22/2020 PERSONAL In ADV INJURY $ _ GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE s POLICY Po .IIS, - LOC PRODUCTS - COMP/OP AGO S OTHER,$ ............... . ......_.......... ............................. . MrytEt,IM9iw $ AUTOMOBILE LIABILITY [f-aacc&?nlb — ANY AUTO BODILY WJURY (Per person) $ """"'""'OWNED SCHEDULED Y Y 72SBABA9522 A 11/22/2019 11/22/2020 BODILY INJURY (Per accident) ,$ _ AUTOS ONLY AUTOS _ w° mo,yHIRED�/r NON -OWNED I'► AUTOS ONLY /'M. AUTOS ONLY I.�R,uJ'HL, Ptlr I,,AMAc„ C S (P'er a'cc''aomn , n UMBRELLA LIAB OCCUR EXCESS LIAB HCLAIMS-MADE DED I P RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE N / A Y 72WECAA9ZAU B OFFICER/MEMBER EXCLUDED? Y [Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below C TECH E&O AND CYBER I EONCAF137939312 01/01/2020 01/01/2021 $ EACH OCCURRENCE AGGREGATE $ $ STATUTE I I Ei2 H _ E L EACH ACCIDENT S E L DISEASE - EA EMPLOYEE S E L DISEASE- POLICY LIMIT S EACH CLAIM 11/22/2019 11/22/2020 AGGREGATE ................. ............. _.vvv......w. DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) 2,000,000 1,000,000 10,000 2,000,000 4,000,000 4,000,000 2,000,000 $1,000,000 $1,000,000 $1,000,000 $ 5,000,000 $ 5,000,000 Certificate Holder is named Additional Insured under blanket endorsement and Waiver of Subrogation applies. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of El Segundo ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street AUTHORIZED REPRESENTATIVE El Segundo, CA 90245 0�� ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, A This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) .__Or0jrpnization(s) Location(s) Of Covered Operations City of El Segundo 350 Main Street El Segundo, CA 9045 Information required to complete this Schedule, if not shown, above, will be shown in the Dedarations, A. Section 11 — Who Is An Insured is amended to include as an additional insured the person(s) or orgap4alion(s) shown in the Schedule but only with respect to fiabinity for "bodily injury", "propedy damage" or "personal and advertising injury" caused, in whole at 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 for the additional insured(s) at the location(s) designated above. However 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. :f coverage provided to the ad6fional insured 3s ,ec ' luired by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contact or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional -insureds, the following add4iional exclus'tons apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, !including materials, parts or equpmenl furnished in conriecliun wkn such work, on the prcjec° 'other than sere ce, maintenance or repairs) to be performed by or on oehalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of "'your work" out of which the injury or damage arises has been put to its irtended use by any person or organization other than another contractor or subcontractor engaged In performing operations for a principal as a part of the same project. CG 2010 0413 C Insurance Services Office, Inc-, 2012 Page 1 of 2 C. With respect to t^e insurance aflorded to these additional insureos, the fo�iowing 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 wilt pay on behalf of the addjtions4 inswed is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shelf not increase the applicable Limits of insurance shown in the Declarations. Page 2 of 2 0 Insurance Services Office, Inc., 2012 CO 2010 0413 BUSINESS LIABILITY COVERAGE FORM F. OPTIONAL ADDITIONAL INSURED 3. Additional Insured ' Grantor CKFranchise COVERAGES WHO IS AN INSURED under Section C. is }flisted orshown awapplicable inthe Dou|ensh amended to include ouan additional insuredo»�. one o/ more of the following Optional Additional th*penson(o>wrurgeni��hnn(o)uhownin�ho Insured Coverages also spp|y� V�onenyc8��sse Declarations as on Additional Insured - Grantor Of Franchise, bu�un|ywith respect to OptionalOptionalAdditional Insured Coverages apply their liability magrantor of franchise tuyou Paragraph 6. (Additional Insureds When Raqp�,e� byWr)|\en Conoact. Written Agreement or Permit) 4. Additional Insured ' Lessor Of Leased of Sec! Who �� �o \s An Insured, does not apply Equipment to the person or organization shown in the m. WHO |8ANINSURED under Section C.is Declarations. These coverages are subject tothe amended to include as an additional Lenno and conditions applicable to Business insured the person(s) or organization(s) Liability Coverage in this po|ioy, except as shown inthe Declarations osanAdditional provided below. Insured - Lessor of Leased Equipnnemt, 1' Additional Insured 'Dmwigmated Penamm Or but only with respect to liability for "bodily Organization injury", "property damage" or "personal WHO |G AN INSURED under Section C. is and advo�mingi�u�"caused' |nwhole or amended to include as an additional insured in part, by your maintenance, operation or Mheperson(o) ororganizohshown in use of equipment leased to you by suchon<�) Deo|a,anmna, but only with mapec\\oUabUhy pm�on(w)oromQan|zadon(»> � for 'bmd0y in)ury'. "properly damage' or h. With respect to the insurance afforded to ^perxonai and advertising injury" uouaed, in these additional insureds, this insurance whole or in part, by your acts or omissions or does not apply to any "oonurnence" which the acts or omissions of those acting on your takes place after you cease to lease that behalf: equipment. m. In the performance of your ongoing S. Additional Insured - Owners Or Other operations; or Interests From Whom Land Has Been b. In connection with your premises owned Leased byorrented toyou. m. WHO |SANINSURED under Section C.is Additional Insured ' Managers Or Lessors amended �o include ma an additional2. insured the person(s) or organization(s)C�Pr��i�om shown inthe Declarations asonAdditional m. VMO IS AN INSURED under Section C. is |noumd-OwnersOrOthor|ntenests From amended tninclude meanadditional insured Whom Lend Has Been Leaowd, but only the pemon(s)ur#nganicstion(o)shown inthe with respect tnliability arising out ofthe Declarations as an Additional Insured ' ownership, maintenance oruse cf that part Designated Person (l,Organization; but only ofthe land leased toyou and shown |nthe with respect to liability arising out of the Declarations. ownership, maintenance oruse mfthat part of b. With na»pe�to the insurance afforded »o �epnsmises|omsedtoyouandohmwninthe these additional insuredo, the following Declarations. additional exclusions apply: b. With respect to the insurance afforded to This insurance does not apply to: these additional inouredy, the following additional exclusions apply: (1) Any "occurrence" that takes place after you cease tulease th�land; or Thiminuurmooedmm�n��app|y|o� (1) Any "occurrence" which takes place (2) St/uo\urm| alterations, new construction or demolition operations -- after you cease to be w tenant in that my h performed by or on behalf such premises; or person ororganization. (2) Structural alterations. now 6. Additional Insured ' ��� Or Political construction or demolition operationsSubdivimimn -Pemnieo performed by or on behalf of such a. WHO |8ANINSURED under Section C.|a person o/organization. amended to include as an additional insured the state or political subdivision shown inthe Declarations osanAdditional ��SS0088 04o5 ��1����4 BUSINESS LIABILITY COVERAGE FORM Insured — State Or Political Subdivision - (e) Any failure to make such Permits, but only with respect to inspections, adjustments, tests or operations performed by you or on your servicing as the vendor has agreed behalf for which the state or political to make or normally undertakes to subdivision has issued a permit. make in the usual course of b. With respect to the insurance afforded to business, in connection with the these additional insureds, the following distribution or sale of the products; additional exclusions apply: (f) Demonstration, installation, This insurance does not apply to: servicing or repair operations, (1) "Bodily injury", "property damage" or except such operations performed 'personal and advertising injury„ at the vendor's premises in arising out of operations performed for connection with the sale of the the state or municipality; or product; (2) "Bodily injury" or "property damage" (g) Products which, after distribution included in the "product -completed or sale by you, have been labeled operations" hazard. or relabeled or used as a container, part or ingredient of any 7. Additional Insured —Vendors other thing or substance by or for a. WHO IS AN INSURED under Section C. is the vendor; or amended to include as an additional (h) "Bodily injury" or "property insured the person(s) or organization(s) damage" arising out of the sole (referred to below as vendor) shown in the negligence of the vendor for its Declarations as an Additional Insured - own acts or omissions or those of Vendor, but only with respect to "bodily its employees or anyone else injury" or "property damage" arising out of acting on its behalf. However, this "your products" which are distributed or exclusion does not apply to: sold in the regular course of the vendor's (i) The exceptions contained in business and only if this Coverage Part "bodily Subparagraphs (d) or (f); or provides coverage for injury" or "property damage" included within the (ii) Such inspections, "products -completed operations hazard". adjustments, tests or servicing b. The insurance afforded to the vendor is as the vendor has agreed to subject to the following additional exclusions: make or normally undertakesto make in the usual course of (1) This insurance does not apply to: business, in connection with (a) "Bodily injury" or "property the distribution or sale of the damage" for which the vendor is products. obligated to pay damages by (2) This insurance does not apply to any reason of the assumption of insured person or organization from liability in a contract or agreement. whom you have acquired such This exclusion does not apply to products, or any ingredient, part or liability for damages that the container, entering into, vendor would have in the absence accompanying or containing such of the contract or agreement; products. (b) Any express warranty unauthorized by you; (c) Any physical or chemical change in the product made intentionally by the vendor; (d) Repackaging, unless unpacked solely for the purpose of inspection, demonstration, testing, or the substitution of parts under instructions from the manufacturer, and then repackaged in the original container; S. Additional Insured — Controlling Interest WHO IS AN INSURED under Section C. is amended to include as an additional insured the person(s) or organization(s) shown in the Declarations as an Additional Insured — Controlling Interest, but only with respect to their liability arising out of: a. Their financial control of you; or b. Premises they own, maintain or control while you lease or occupy these premises. Form SS 00 08 04 05 Page 119 of 24 BUSINESS LIABILITY COVERAGE FORM This insurance does not apply to structural alterations, new construction and demolition operations performed by or for that person or organization. 9. Additional Insured — Owners, Lessees Or Contractors — Scheduled Person Or Organization a. WHO IS AN INSURED under Section C. is amended to include as an additional insured the person(s) or organization(s) shown in the Declarations as an Additional Insured — Owner, Lessees Or Contractors, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: (1) In the performance of your ongoing operations for the additional insured(s); or (2) In connection with "your work" performed for that additional insured and included within the "products - completed operations hazard", but only if this Coverage Part provides coverage for "bodily injury" or "property damage" included within the "products -completed operations hazard". b. With respect to the insurance afforded to these additional insureds, this insurance does not apply to "bodily injury", 'property damage" or 'personal an advertising injury" arising out of the rendering of, or the failure to render, any professional architectural, engineering or surveying services, including: (1) The preparing, approving, or failure to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders, designs or drawings and specifications; or (2) Supervisory, inspection, architectural or engineering activities. 10. Additional Insured — Co -Owner Of Insured Premises WHO IS AN INSURED under Section C. is amended to include as an additional insured the person(s) or Organization(s) shown in the Declarations as an Additional Insured — Co - Owner Of Insured Premises, but only with respect to their liability as co-owner of the premises shown in the Declarations. The limits of insurance that apply to additional insureds are described in Section D. — Limits Of Insurance, How this insurance applies when other insurance is available to an additional insured is described in the Other Insurance Condition in Section E. — Liability And Medical Expenses General Conditions. G. LIABILITY AND MEDICAL EXPENSES DEFINITIONS 1. "Advertisement' means the widespread public dissemination of information or images that has the purpose of inducing the sale of goods, products or services through: a. (1) Radio; (2) Television; (3) Billboard; (4) Magazine; (5) Newspaper; b. The Internet, but only that part of a web site that is about goods, products or services for the purposes of inducing the sale of goods, products or services; or c. Any other publication that is given widespread public distribution. However, "advertisement' does not include: a. The design, printed material, information or images contained in, on or upon the packaging or labeling of any goods or products; or b. An interactive conversation between or among persons through a computer network. 2. "Advertising idea" means any idea for an "advertisement". 3. "Asbestos hazard" means an exposure or threat of exposure to the actual or alleged properties of asbestos and includes the mere presence of asbestos in any form. 4. "Auto" means a land motor vehicle, trailer or semi -trailer designed for travel on public roads, including any attached machinery or equipment. But "auto" does not include "mobile equipment". 5. "Bodily injury" means physical: a. Injury; b. Sickness; or c. Disease sustained by a person and, if arising out of the above, mental anguish or death at any time. S. "Coverage territory" means: Page 20 of 24 Form SS 00 08 04 05 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13 (Ed. 4-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT 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. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule Schedule Any person or organization from whom you are required by written contract or agreement to obtain this waiver or rights from us 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.) En.jws,ement WEBIPLEX, INC. Effective Policy No. 72SBABA9522 Endorsement No. $1,139.00 un,stve.:9 Premium Insurance Company The Har,,foW Countersigned by Und,.,rv,,�jtvr SENTINEL INS CO LTD WC 00 0313 (Ed. 4-84) ® 1983 National Council on Compensation Insurance. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA Policy Number: 72 WEC AA9ZAU Endorsement Number: Effective Date: 01/01/20 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address: Webiplex, Inc. 9 CORPORATE PARK STE 240 IRVINE CA 92606 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. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 2 % of the California workers' compensation premium otherwise due on such remuneration. SCHEDULE Person or Organization Job Description Any person or organization from whom you are required by written contract or agreement to obtain this waiver of rights from us Countersigned by <A� Authorized Representative Form WC 04 03 06 (1) Printed in U.S.A. Process Date: 11/20/19 Policy Expiration Date: 01/01/21