Loading...
PROOF OF INSURANCE (2020 - 2021) CLOSEDACCOR" ® CERTIFICATE OF LIABILITY INSURANCE I DAT 4�9�20 oYYY) 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 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 CONTACT NAME: Tracy Bennett Arthur J. Gallagher & Co. Insurance Brokers of CA., Inc. PHONE FAx 21820 Burbank Blvd., Suite 175 I (A/C. No. Ext1: 805-422-3545 (A/C, No): 805-426-8804 Woodland Hills CA 91367 I E-MAIL ADDRESS: @ jg ADDREss: trac bennett a com INSURER(S) AFFORDING COVERAGE NAIC # License#: 07262931 INSURER A: Evanston Insurance Company 35378 INSURED ADVAACC-01 INSURER B: Nationwide Mutual Insurance Company 23787 Advanced Access Controls, Inc. 15414 Cabrito Rd Ste A I INSURER C: Topa Insurance Company 18031 Van Nuys CA 91406 I INSURER D: Insurance Company of the West 27847 INSURER E: Sentinel Insurance Company Ltd 11000 INSURER F: Lloyds of London Syndicate 1919 COVERAGES CERTIFICATE NUMBER: 1217949997 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 EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER (MM/DD/YYYYI (MM/DD/YYYYI A X COMMERCIAL GENERAL LIABILITY Y Y MKLV5PSC001386 1/17/2020 1/17/2021 EACH OCCURRENCE $ 1 000 000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) *CITY OF EL SEGUNDO, ITS OFFICIALS & EMPLOYEES ARE LISTED AS ADDITIONAL INSURED* CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of EI Segundo 350 Main Street AUTHORIZED REPRESENTATIVE EI Segundo CA 90245 © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD DAMAGE TO RENTED CLAIMS -MADE � OCCUR PREMISES (Ea occurrence) $ 50,000 MED EXP (Any one person) $ 5,000 PERSONAL &ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRO - POLICY � 1:1 LOC PRODUCTS COMP/OP AGG $ 2,000,000 ECT - OTHER: $ B AUTOMOBILE LIABILITY Y ACP7894593214 8/26/2019 8/26/2020 COMBINED SINGLE LIMIT $ 1,000,000 fEa accident) ANY AUTO BODILY INJURY (Per person) $ OWNED X SCHEDULED BODILY INJURY $ AUTOS ONLY AUTOS (Per accident) X HIRED X NON -OWNED PROPERTYDAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) C UMBRELLALIAB OCCUR XL00201493-02 1/17/2020 1/17/2021 EACH OCCURRENCE $5,000,000 X EXCESS LIAB CLAIMS -MADE VI AGGREGATE $ 5,000,000 DED I I RETENTION $ $ D WORKERS COMPENSATION Y WVE 5047214 01 4/1/2020 4/1/2021 X I SPER TATUTE EORH AND EMPLOYERS' LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE Y / N E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 E BUS PERSONAL PROPERTY 72SBAAK3924 1/17/2020 1/17/2021 LIMIT: $260,400 F PROFESSIONAL LIABILITY PS1009925945 1/17/2020 1/17/2021 LIMIT: $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) *CITY OF EL SEGUNDO, ITS OFFICIALS & EMPLOYEES ARE LISTED AS ADDITIONAL INSURED* CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of EI Segundo 350 Main Street AUTHORIZED REPRESENTATIVE EI Segundo CA 90245 © 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 01 04 13 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 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 that: (1) The additional insured is a Named Insured under such other insurance; and (2) You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. © Insurance Services Office, Inc., 2012 Page 1 of 1 CG 20 01 04 13 POLICY NUMBER: MKLV5PBC001386 COMMERCIAL GENERAL LIABILITY CG 20 10 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): As agreed to by written contract or agreement Location(s) Of Covered Operations All locations Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or 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. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf 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 intended 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. © ISO Properties, Inc., 2004 Page 1 of 1 ❑ CG 20 10 07 04 POLICY NUMBER: MKLV5PBC001386 COMMERCIAL GENERAL LIABILITY CG 20 37 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Location And Description Of Completed Operations As agreed to by written contract or agreement All locations Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the schedule of this endorsement performed for that additional insured and included in the "products - completed operations hazard". © ISO Properties, Inc., 2004 Page 1 of 1 ❑ CG 20 37 07 04 POLICY NUMBER: MKLV5PBC001386 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 PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: As agreed to by written contract or agreement 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 "your work" done under a contract with that person or organization and included in the "products - completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. © Insurance Services Office, Inc., 2008 Page 1 of 1 CG 24 04 05 09 ACP7894593214 COMMERCIAL AUTO AC 04 44B 03 16 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. The Transfer Of Rights Of Recovery Against Others To Us Condition does not apply to any person(s) or organization(s) to the extent that subrogation is waived prior to any "accident" or "loss" under a written contract with that person or organization. AC 04 44B 03 16 Includes copyrighted material of Insurance Services Office, Inc. Page 1 of 1 with its permission. COMMERCIAL AUTO AC 20 41 07 11 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - PRIMARY AND NON-CONTRIBUTORY ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM SCHEDULE Name of Person(s) or Organization(s): Per Written Contract (If no entry appears above, information required to complete this endorsement will be shown in the Declara- tions as applicable to the endorsement.) A. SECTION II- LIABILITY COVERAGE Who Is An Insured is amended to include as an additional insured for Liability Coverage: Each person or organization shown in the Schedule, but only to the extent that person or organization qualifies as an "insured". Loss must arise out of ongoing operations performed for the Named Insured. B. SECTION IV- BUSINESS AUTO CONDITIONS SECTION V- GARAGE CONDITIONS The following paragraph is added to B.5 of Other Insurance: e. If required by a written contract or written agreement executed before the "accident' occurred, any insurance carried by the per- son or organization shown in the schedule shall be noncontributory with respect to the coverage provided to you. All terms and conditions of this policy apply unless modified by this endorsement. ACPBA784593214 AC 20 41 07 11 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 1 with its permission WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 06 34 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - BLANKET 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). The additional premium for this endorsement shall be otherwise due. Person or Organization ANY PERSON / ORG WHEN REQUIRED BY WRITTEN CONTRACT 2 % of the total California Workers' Compensation premium Schedule Job Description ALL CA OPERATIONS 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 04/01/2020 Policy No. WVE 5047214 01 Endorsement No. Insured ADVANCED ACCESS CONTROLS INC Premium $ INCL. Insurance Company INSURANCE COMPANY OF THE WEST WC 99 06 34 (Ed. 8-00) Countersigned By INSURED