Loading...
PROOF OF INSURANCE (2021) CLOSEDACCOR" ® CERTIFICATE OF LIABILITY INSURANCE I DATS/(19/202pYY) 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 Kristen Wade Ross & Yerger Insurance, Inc. PHONE FAX P.O. Box 1139 I (A/C. No. Ext): 601-948-2900 (A/C, No): 601-355-3227 Jackson MS 39215 I E-MAIL ADDRESS: DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Named Insured: Metrix Solutions, LLC General Liability and Auto Liability policies contain a Blanket Additional Insured Endorsement and Blanket Primary & Non -Contributory Endorsement as required by written contract subject to policy terms, conditions, and exclusions. Umbrella Follows form. The General Liability, Auto Liability, Workers Compensation, and Umbrella policies contain a Waiver of Subrogation as required by written contract subject to policy terms, conditions, and exclusions. CERTIFICATE HOLDER EI Segundo Police Department 348 Main Street EI Segundo CA 90245 AUTHORIZED REPRESENTATIVE © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 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. ACORD 25 (2016/03) INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Travelers Property Cas./Alpharetta 25674 INSURED PILCO INSURER B: Travelers Indemnity Co. of IL/Apharetta Pileum Corporation 190 East Capitol Street I INSURER C: Travelers Casualty Ins. Co. of America 19046 Suite 175 I INSURER D: Travelers Property & Casualty Co.of Am. 25674 Jackson MS 39201 I INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 241674618 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 ADDL SUBR POLICY EFF POLICY EXP TYPE OF INSURANCE LTR INSD WVD POLICY NUMBER (MM/DD/YYYYI IMM/DD/YYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY HZLP10N1767020I5 5/6/2020 5/6/2021 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED CLAIMS -MADE � OCCUR PREMISES (Ea occurrence) $ 300,000 MED EXP (Any one person) $ 10,000 PERSONAL &ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY ❑PRO � JECT LOC PRODUCTS - COMP/OP AGG $ 2,000,000 OTHER: $ B AUTOMOBILE LIABILITY BA9M60776120I5G 5/6/2020 5/6/2021 COMBINED SINGLE LIMIT $ 1,000,000 fEa accident) X ANY AUTO BODILY INJURY (Per person) $ OWNEDSCHEDULED BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS X HIRED I NON -OWNED PROPERTYDAMAGE $ AUTOS ONLY AUTOS ONLY fPer accident) X A X UMBRELLALIAB OCCUR CUP1N46258120I5 5/6/2020 5/6/2021 EACH OCCURRENCE $3,000,000 EXCESS LAB HCLAIMS-MADE AGGREGATE $ 3,000,000 DED I X I RETENTION $ in nnn $ C WORKERS COMPENSATION UB5K97421620I5G 5/6/2020 5/6/2021 X 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 D Professional ZPL14R3910220I5 5/6/2020 5/6/2021 2,000,000 Occurrence Liability 2,000,000 Aggregate DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Named Insured: Metrix Solutions, LLC General Liability and Auto Liability policies contain a Blanket Additional Insured Endorsement and Blanket Primary & Non -Contributory Endorsement as required by written contract subject to policy terms, conditions, and exclusions. Umbrella Follows form. The General Liability, Auto Liability, Workers Compensation, and Umbrella policies contain a Waiver of Subrogation as required by written contract subject to policy terms, conditions, and exclusions. CERTIFICATE HOLDER EI Segundo Police Department 348 Main Street EI Segundo CA 90245 AUTHORIZED REPRESENTATIVE © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 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. ACORD 25 (2016/03) COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the fo||nvvinSc COMMERCIAL GENERAL LIABILITY COVERAGE PART GENERAL DESCRIPTION OF COVERAGE - This endorsement broadens coverage. However, coverage for any injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsement to this Coverage Part, and these coverage broadening provisions do not apply to the extent that coverage is excluded or limited by such an endorsement. The following listing is a general coverage description only. Read all the provisions of this endorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered. A. Non -Owned Watercraft - 75 Feet Long Or Less B. Who Is An Insured - Unnamed Subsidiaries Interest C. Who Is An Insured - Employees - Supervisory Positions Successors Or Receivers 0. Who Is An Insured - Newly Acquired Or Formed Limited Liability Companies E. Who Is An Insured - Liability For Conduct Of Unnamed Partnerships Or Joint Ventures Entities - Permits Or Authorizations F. Blanket Additional Insured - Persons Or Organizations For Your Ongoing Operations As Required By Written Contract Or Agreement G. Blanket Additional Insured - Broad Form Vendors A. NON—OWNED WATERCRAFT — 75 FEET LONG OR LESS 1' The following replaces Paragraph (2) of Exclusion g~ Aircraft, Auto Or Watercraft, in Paragraph 2- of SECTION U — COVERAGES — COVERAGE A — BODILY INJURY AND PROPERTY DAMAGE LIABILITY: (2) /\ watercraft you do not own that is: (a) 75 feet long or less; and (b) Not being used to carry any person or property for a charge; 2. The following replaces Paragraph 2.e. of SECTION DU — WHO IS AN e. Any person or organization that, with your express or implied NL Blanket Additional Insured - Controlling Interest 1. Blanket Additional Insured - Mortgagees, Assignees, Successors Or Receivers JL Blanket Additional Insured - Governmental Entities - Permits Or Authorizations Relating To Premises N. Blanket Additional Insured - Governmental Entities - Permits Or Authorizations Relating To Operations L. Medical Payments - Increased Limit M. Blanket Waiver Of Subrogation N. Contractual Liability - Railroads 0. Damage To Premises Rented To You consent, either uses or is responsible for the use of a watercraft that you do not own that is: (1) 75 feet long or less; and (2) Not being used to carry any person or property for a charge. B. WHO IS AN INSURED — UNNAMED SUBSIDIARIES The following is added to SECTION UU — WHO IS AN INSURED: Any of your subsidiaries, other than a partnership or joint venture, that is not shown as a Named Insured in the Declarations is a Named Insured it a You are the sole owner of, or maintain an ownership interest of more than 5096 in, such subsidiary on the first day of the policy period; and CG D4 17 02 19 C 20l7 The Travelers Indemnity Compaoy. All rights reserved. Page 1 of 5 COMMERCIAL GENERAL LIABILITY 0L Such subsidiary is not an insured under similar other insurance. No such subsidiary is an insured for "bodily injury" or "property damage" that occurred, or "personal and advertising inju ~ caused by an offense cornnnittocL a. Before you maintained an ownership interest of more than 5096 in such subsidiary; or h. /\ftmn the date, if any, during the policy period that you no longer maintain an ownership interest of more than 5096 in such subsidiary. For purposes of Paragraph 1' of Section UU - Who Is An Insured, each such subsidiary will be dmmnnmd to be designated in the Declarations as: a. /\ limited liability company; b. An organization other than a partnership, joint venture or limited liability company; or C. Abust as indicated in its name or the documents that govern its structure. C. WHO IS AN INSURED — EMPLOYEES — SUPERVISORY POSITIONS The following is added to Paragraph 3La.(1) of SECTION UU — WHO IS AN Paragraphs (1)(a)(b) and (c) above do not apply to "bodily injury~ to a co- "employee" o- "enn | " while in the course of the co -"employee's" employment by you arising out of work by any of your ~ennokovees~ who hold a supervisory position. 0.WHO IS AN INSURED — NEWLY ACQUIRED OR FORMED LIMITED LIABILITY COMPANIES The following replaces Paragraph 3. of SECTION UU — WHO IS AN INSURED: ]i Any organization you newly acquire or form, other than a partnership or joint venture, and of which you are the sole owner or in which you maintain an ownership interest of more than 5096, will qualify as a Named Insured if there is no other similar insurance available to that organization. However: a. Coverage under this provision is afforded only: (1) Until the 180th day after you acquire or form the organization or the end of the policy period, whichever is earlier, if You do not report such organization in writing to us within 180 days after you acquire or form it; or (2) Until the end of the policy period, when that date is later than 180 days after you acquire or form such organization, if you report such organization in writing to us within 180 days after you acquire or form it; b. Coverage /4 does not apply to "bodily injury" or "property damage" that occurred before you acquired or formed the organ- ization; and C. Coverage 8 does not apply to "personal and advertising hljuny" arising out of an offense committed before you acquired or formed the organization. For the purposes of Paragraph 1, of Section UU - Who Is An Insured, each such organization will be deemed to be designated in the Declarations as: a. /\ limited liability company; NL An organization, other than a partnership' joint venture or limited liability company; or C. /\trust; as indicated in its name or the documents that govern its structure. E. WHO IS AN INSURED — LIABILITY FOR CONDUCT OF UNNAMED PARTNERSHIPS OR JOINT VENTURES The following replaces the last paragraph of SECTION 11 - WHO IS AN INSURED: No person or organization is an insured with respect to the conduct of any current or past partnership or joint venture that is not shown as a Named Insured in the Declarations. This paragraph does not apply to any such partnership or joint venture that otherwise qualifies as an insured under Section DD - Who Is An The following is added to SECTION KV — WHO IS AN INSURED: Any person or organization that is not otherwise an insured under this Coverage Part and that you have agreed in a written Page 2 of 5 Q 2017 The Travelers Indemnity Company. All rights reserved. CG D4 17 02 19 contract or agreement to include as an additional insured on this Coverage Part is an insured, but only with respect to liability for "bodily injury" or "property damage" that: a. Occurs subsequent to the signing of that contract or agreement; and 0L Is caused, in vvho|o or in pad, by your acts or omissions in the performance of Your ongoing operations to which that contract or agreement applies or the acts or omissions of any person or organization performing such operations on your behalf. The limits of insurance provided to such insured will be the nnininnunn limits that you agreed to provide in the written contract or agreement, or the limits shown in the Declarations, whichever are |oss^ G. BLANKET ADDITIONAL INSURED — BROAD FORM VENDORS The following is added to SECTION 18 — WHO IS AN INSURED: Any person or organization that is a vendor and that you have agreed in a written contract or a8rmmnnmlt to include as an additional insured on this Coverage pari is an insured, but only with respect to liability for "bodily injury~ or ''property damage" that a. Occurs subsequent to the signing of that contract or agreement; and NL Arises out of "your products~ that are distributed or sold in the regular course of such vendor's business. The insurance provided to such vendor is subject to the following provisions: a. The limits of insurance provided to such vendor will be the nnininnurn limits that you agreed to provide in the written contract or agreement, or the limits shown in the Declarations, whichever are |eoo' b. The insurance provided to such vendor does not apply to: (1) Any express warranty not authorized by you or any distribution or sale for a purpose not authorized by you; (2) Any change in "your products" made by such vendor; (3) Repackaging, unless unpacked solely for the purpose of inspection, demonstration, testing, or the substitution of parts under instructions from the COMMERCIAL GENERAL LIABILITY manufacturer, and then repackaged in the original container; (4) Any failure to make such inspections, adjustments, tests or servicing as vendors agree to perform or normally undertake to perform in the regular course of business, in connection with the distribution or sale of "your products"; (5) Demonstration, installation, servicing or repair operations, except such operations performed at such vendor's premises in connection with the aa|m of "your products"; or (6) "Your products" that, after distribution or sale by you, have been labeled or relabeled or used as a container, part or ingredient of any other thing or substance by or on behalf of such vendor. Coverage under this provision does not apply to: a. Any person or organization from whom you have acquired "your products", or any ingredient, part or container entering into, accompanying or containing such products; or h. Any vendor for which coverage as an additional insured specifically is scheduled by endorsement. NL BLANKET ADDITIONAL INSURED — CONTROLLING INTEREST 1. The following is added to SECTION 81 — WHO IS AN INSURED: Any person or organization that has financial control of you is an insured with respect to liability for "bodily injury^, "property damage" or "personal and advertising injury" that arises out a. Such financial control; or b. Such 's or organization's ownership, maintenance or use of premises leased to or occupied by you. The insurance provided to such person or organization does not apply to structural alterations, new construction or demolition operations performed by or on behalf of such person or organization. 2. The following is added to Paragraph 4~ of SECTION 11 — WHO IS AN INSURED: This paragraph does not apply to any premisesowner, manager or lessor that has financial control of you. CG C>4 17 02 19 @ 2017 The Travelers Indemnity Company. All rights reserved. page 3 of 5 COMMERCIAL GENERAL LIABILITY 1. BLANKET ADDITIONAL INSURED — MORTGAGEES, ASSIGNEES, SUCCESSORS OR RECEIVERS The following is added to SECTION KN — WHO IS AN INSURED: Any person or organization that is a mortgagee, assignee, successor or receiver and that you have agreed in a written ommhaot or agreement to include as an additional insured on this Coverage Pad is an insured, but only with respect to its liability as mortgagee, aaaU]noo, successor or receiver for "bodily injury", "property damage" or "personal and advertising injury" that: a. Is "bodily injury" or "property damage" that occurs, or is "pmrsona| and advertising injury" caused by an offense that is committed, subsequent to the signing of that contract or agreement; and NL Arises out of the ownership, maintenance or use of the premises for which that mortgagee, assignee, successor or receiver is required under that contract or agreement to be included as an additional insured on this Coverage Pad' The insurance provided to such mortgagee, assignee, successor or receiver is subject to the following provisions: a. The limits of insurance provided to such mortgagee, assignee, successor or receiver will be the rnininnunn limits that you agreed to provide in the written contract or agreement, or the limits shown in the Declarations, whichever are less. 0L The insurance provided to such person or organization does not apply to: (1) Any "bodily injury" or "property damage" that occurs, or an "personal and advertising injury" caused by an offense that is committed, after such contract or agreement is no longer in effect or (2) Any "bodily irqury~, ~property damage" or "personal and advertising injury~ arising out of any structural alterations, new construction or demolition operations performed by or on behalf of such mortgagee, assignee; successor or receiver. J. BLANKET ADDITIONALANSURED— ENTITIES — PERMITS OR AUTHORIZATIONS RELATING TO PREMISES The following is added to SECTION 18 — WHO IS AN INSURED: Any governmental entity that has issued a permit or authorization with respect to premises wvvnmd or occupied by, or rented or loaned to, you and that you are required by any ordinance, |am\ building code or written contract or a8rmmnnmnt to include as an additional insured on this Coverage Part is an insured, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" arising out of the existence, ownership, use, maintenance, repair, construction, erection or removal of any of the fm||ovvinS for which that governmental entity has issued such permit or authorization: advertising signs, awnings, canopies, cellar enhances, coal holes, driveways, manholes, marquees, hoist away openings, sidewalk vaults, elevators, sheet banners or decorations. K. BLANKET ADDITIONAL INSURED — GOVERNMENTAL ENTITIES — PERMITS OR AUTHORIZATIONS RELATING TO OPERATIONS The following is added to SECTION 18 — WHO IS AN INSURED: Any governmental entity that has issued a permit or authorization with respect to operations performed by you or on your behalf and that you are required by any ordinance, law, building code or written contract or agreement to include as an additional insured on this Coverage Part is an insured, but only with respect t liability for "bodily injury~, "property damage" or "personal and advertising injury" arising out of such operations. The insurance provided to such governmental entity does not apply to: a. Any "bodily injury", "property damage" or "personal and advertising olyury' arising out of operations performed for the governmental entity; or b. Any "bodily injury" or "property damage" included in the "products - completed operations hazard"' The fo||ovYh1g replaces Paragraph 7[ of SECTION III — LIMITS OF INSURANCE: 7. Subject to Paragraph 5. above, the Medical Expense Limit is the most we will pay under Coverage C for all medical expenses because of "bodily injury~ sustained by any one person, Page 4 of 5 Q 2017 The Travelers Indemnity Company. All rights reserved. CG D4 17 02 19 and will be the higher of: @L $10,000C or b. The amount shown in the Declarations of this Coverage Part for Medical Expense Limit. M. BLANKET WAIVER OF SUBROGATION The following is added to Paragraph 8., Transfer Of Rights Of Recovery Against Others To 0s, of SECTION UV — COMMERCIAL GENERAL LIABILITY CONDITIONS: If the insured has agreed in a contract or aBrmornmnt to waive that inaurmd's right of recovery against any person or organization, we waive our right of recovery against such person or organization, but only for payments we make because of: a. "Bodily injury" or "property damage" that occurs; or h. "Personal and advertising injury~ caused by an offense that is committed; subsequent to the execution of the contract or agreement. COMMERCIAL GENERAL LIABILITY N. CONTRACTUAL LIABILITY — RAILROADS 1- The fp||mvvinS replaces Paragraph C. of the definition of "insured contract" in the DEFINITIONS Section: C. Any easement or license agreement; 2. Paragraph f0> of the definition of "insured contract" in the DEFINITIONS Section is deleted. 0. DAMAGE TO PREMISES RENTED TO YOU The following replaces the definition of "premises dannaSo" in the DEFINITIONS "Premises damage" means "property damage" to: a. Any premises while rented to you or temporarily occupied by you with permission of the owner; or h. The contents of any premises vvhi|m such premises is rented to you, if you rent such premises for a period of seven or fmvvor consecutive days. CG C>4 17 02 19 @ 2017 The Travelers Indemnity Company. All rights reserved. page 5 of 5 Aftk TRAVELERS WORKERS COMPENSATION AND ONE TOWER SQUARE EMPLOYERS LIABILITY POLICY HARTFORD, CT 06183 A il 10101 ox"I :11 ky, I ag I ATITloyllarolalUU#JIM We have the right to recover our payments from anyone fiaNe for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedu[e. (This agreement applies only to the extent that you perform work under a written, contract that requires your to obtain, this agreement from us.) This agreement shall not operate directly or indirectly to benefit any one not named in the: Schedu0e. 01411061:10111M DESIGNATED PERSON: DESIGNATED ORGANIZATION: ANY PERSON OR ORGANIZATION FOR WHICH THE INSURED HAS AGREED BY WRITTEN CONTRACT EXECUTED PRIOR TO LOSS TO FURNISH THIS WAIVER. DATE OFISSUE: 0-9-12-20 ST ASSIGN: PAGE 1 BFB.