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PROOF OF INSURANCE (2020 - 2021) CLOSED
ACCOR" ® CERTIFICATE OF LIABILITY INSURANCE I DATE CERTIFICATE 05/22/2020 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 I CONTACT Blanca De La Hoz NAME: Danmar Insurance Services Inc. PHHCONN .Ext): (951) 509-0509 � (FAXAJC Not: (951) 509-0515 fAJLicense # OD36873 I E-MAIL ADDRESS: 9899 Indiana Avenue, Ste 101 I INSURER(S) AFFORDING COVERAGE NAIC # Riverside CA 92503 I INSURERA: Travelers Property Casualty Co ofAmerica 25674 INSURED INSURER B: Preferred Employers Insurance Company 10900 Denn Engineers, Inc. I INSURER C: OBE North America Insurance Group 3914 Del Amo BI., Ste 921 I INSURER D: INSURER E: Torrance CA 90503 I INSURER F : COVERAGES CERTIFICATE NUMBER: CL205608834 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 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 ADDL SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY $ 1,000,000 CLAIMS -MADE ❑X OCCUR 1,000,000 PREMISES (Ea occurrence) $ A Y 680-9N963609-19-47 GEN'LAGGREGATE LIMITAPPLIES PER $ 11000,000 P PRO- ❑PRO ❑LOC $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 OTHER: $ 162,000 AUTOMOBILE LIABILITY $ ANY AUTO OWNED SCHEDULED $ _ AUTOS ONLY AUTOS $ HIRED NON -OWNED $ AUTOS ONLY AUTOS ONLY - UMBRELLA LAB OCCUR HCLAIMS-MADE EXCESS LAB $ DED I I RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N B ANY PROPRIETOR/PARTNER/EXECUTIVE N/A Y WKN165362-3 OFFICER/MEMBER EXCLUDED 1,000,000 $ (Mandatory in NH) $ 1,000,000 If yes, describe under $ 1,000,000 DESCRIPTION OF OPERATIONS below Professional Liability $1,000,000 C AN E40469-00 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 1,000,000 PREMISES (Ea occurrence) $ MED EXP (Any one person) $ 5,000 09/01/2019 09/01/2020 I PERSONAL &ADV INJURY $ 11000,000 GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 Erisa $ 162,000 COMBINED SINGLE LIMIT $ (Ea accident) BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ (Per accident) EACH OCCURRENCE $ AGGREGATE $ XI PER I I STATUTE EERH E.L. EACH ACCIDENT 02/01/2020 02/01/2021 1,000,000 $ E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 Claims made 11/07/2019 11/07/2020 Per Claim $1,000,000 Aggregate $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: As per Contract or Agreement on file with the insured. City of EI Segundo Public Works Department, its officers elected and appointed officials employees and volunteers are included as additional insured on the General Liability policy CGD381 0915 endorsement attached.and Workers Compensation Waiver of Subrogation endorsement PEI104 05/01/98. 'Replaces Previously issued certificate on 05/18/20" CERTIFICATE HOLDER City of EI Segundo, Public Works Department Attn: Floriza Rivera 350 Main Street EI Segundo I CA 90245 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. AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 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 U —VVHQ IS AN|NSURE0: Any person or organization that you agree in a "written contract requiring insurance" ioinclude as an additional insured onthis Coverage Part, but: a. Only with respect to liability for "bodily injury"' "property damage" or"personal injuryr;and b^ If, and only to the extent that, the injury or damage is caused by acts or omissions of you oryour subcontractor in the performance of "your work" to which the "written contract requiring insurance" applies, orinconnection with premises owned bvorrented ioyou. The person or organization does not qualify as an additional insured: c. With respect to the independent acts or omissions ofsuch person ororganization; or d. For "bodily injury", "property damage" or "personal injury" for which such person or organization has assumed liability in a contract oragreement. The insurance provided iosuch additional insured is limited as follows: e. This insurance does not apply onany basis io any person or organization for which coverage asan additional insured specifically is added by another endorsement to this Coverage Part. t This insurance does not apply to the rendering of or failure to render any "professional services" g. In the event that the Limits ofInsurance ofthe 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 ofliability required bythat "written contract requiring insurance" This endorsement does not increase the limits of insurance described in Section U| — Limits CfInsurance. 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 isearlier. 3. The following is added to Paragraph 4.a. of SECTION |V — 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 wecover. 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 ora primary and non-contributory basis' this insurance is primary to other insurance available to the additional insured which covers that person ororganizations as anamed 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 issought occurs; and (3) The "personal injury"for which coverage is sought arises out ofanoffense 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. CG03O1O915 @zo1nThe Travelers Indemnity Company. All rights reserved. Page of COMMERCIAL GENERAL LIABILITY 3. The following is added to Paragraph O.' Transfer Of Rights QfRecovery Against Others To Us' of SECTION |V — 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, oronyour 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 ofany written contract under which you are required ioinclude aperson ororganization asan additional insured on this Coverage Part' provided that the "bodily injury" and "property damage" occurs and the "personal injury" is caused bvanoffense 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 ZofZ @zo1nThe Travelers Indemnity Company. All rights reserved. CG03O1O915 Workers Compensation and Employers Liability rreferred EM09yer5 Insurance Policy w s to tt to c, t; c; t> ttl A N Y Waiver of Our Right to Recover from Others Endorsement — California 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 determined by multiplying the California workers' compensation premium due on such remuneration by the factor 0.050 Schedule Person or Organization City of EI Segundo Public Works Department 350 Main Street EI Segundo, CA 90245 Job Description RE: Engineering work This endorsement is subject to a minimum premium charge of $200 Nothing in this endorsement shall vary, alter, waive or extend any of the terms, conditions or limitations of this policy other than as stated above. Nothing elsewhere in this policy shall be held to vary, alter, waive or limit the terms, conditions, agreements or limitations of this endorsement. This Endorsement when attached to Policy Number: WKN 165362-3 issued to DENN ENGINEERS, INC. shall be valid and shall form part of referenced policy. The effective date of this endorsement is 02/01/20 at 12:01 A.M. Endorsement No.: 19 Producer Number: 12886 Agency Name: DANMAR INSURANCE SERVICES PE1104 05/01/98 Date Issued: 12/30/19 Refer To Signature Page Authorized Representative