Loading...
PROOF OF INSURANCE (2020 - 2021) CLOSEDACCOR" ® CERTIFICATE OF LIABILITY INSURANCE I DAT 526/2020YY> 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 GMGS Risk Management & Insurance Services I CONTACT NAME: Jennifer Barton 6201 Oak Canyon, Suite 100 I WCCC,ONE No. Ext): 949-559-3394 FAX Irvine, CA 92618 E-MAIL (A/c. 949-559-6703 No): ADDRESS: lenniferb@gmgs.com INSURER(S) AFFORDING COVERAGE NAIC # www.gmgs.com OB84519 I INSURER A: Great Divide Insurance Company 25224 INSURED INSURER B: American Fire and Casualty Company 24066 EEC Environmental dba Enviromental Engineering Contracting Inc., I INSURER C: One City Boulevard West, Suite 1800 I INSURER D: Nautilus Insurance Company 17370 Orange CA 92868 I INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 55648010 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 LTR INSD WVD POLICY NUMBER POLICY EFF POLICY EXP LIMITS (MM/DD/YYYYI (MM/DD/YYYYI A �/ COMMERCIAL GENERAL LIABILITY GLP2006942-17 10/31/2019 10/31/2020 EACH OCCURRENCE $5,000,000 CLAIMS -MADE 1/ OCCUR DAMAGE TO RENTED PREMISES fEa occurrence) $ 300,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 5,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 5,000,000 POLICY ECT LOC PRODUCTS - COMP/OP AGG $ 5,000,000 OTHER: $ B AUTOMOBILE LIABILITY BAA(20)58333458 10/31/2019 10/31/2020 EOaaBINEDtSINGLELIMIT $1,000,000 ✓ ANY AUTO BODILY INJURY (Per person) $ OWNEDSCHEDULED BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS HIRED NON -OWNED PROPERTYDAMAGE $ ✓ AUTOS ONLY ✓ AUTOS ONLY (Per accident) UMBRELLALIAB OCCUR HCLAIMS-MADE EACH OCCURRENCE $ EXCESS LIAB AGGREGATE $ DED I I RETENTION $ $ A WORKERS COMPENSATION WCA200881517 5/24/2020 5/24/2021 AND EMPLOYERS' LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE Y �/ SPER TATUTE EORH 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 Pollution Liability CCP2006941-17 10/31/2019 10/31/2020 Each Poll Occurrence $5,000,000 Professional Liability Each Prof Liab Claim $5,000,000 General Aggregate: $10,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: Sewer System Management Plan As respects General Liability coverage, City of EI Segundo, its officials and employees are added as Additional Insureds per CG20100413 and CG20100413 and CG20370413 attached, and this insurance is primary per CG20010413 attached. As respects Automobile Coverage, Business Auto Coverage Form CA00011001 applies. As respects Workers' Compensation coverage, a Waiver of Subrogation is hereby included per WC040306 attached. As respects General Liability coverage, 30 -day written notice of cancellation (10 days for non-payment of premium) applies per IL00171198 attached. CERTIFICATE HOLDER Sewer System Management Plan City of EI Segundo Public Works 350 Main Street EI Segundo CA 90245 ACORD 25 (2016/03) 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 Griff Griffith © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 55648010 1 19-20 G/A/UMB/POLL/E&O 20-21 WC I Jennifer Barton 1 5/26/2020 4:38:58 PM (PDT) I Page 1 of 7 POLICY NUMBER: GLP2006942-17 COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 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) Any person, organization, or project with whom the named insured executes a written contract prior to the start of the project and is shown on a certificate of insurance issued by our authorized representative prior to the start date of the project. Location(s) Of Covered Operations 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. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. CG 20 10 04 13 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. © Insurance Services Office, Inc., 2012 55648010 1 19-20 G/A/UMB/POLL/E&O 20-21 WC I Jennifer Barton 1 5/26/2020 4:38:58 PM (PDT) I Page 2 of 7 Page 1 of 2 C. With respect to the insurance afforded to these additional insureds, the following 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 will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits Insurance shown in the Declarations; whichever is less. This endorsement shall not increase applicable Limits of Insurance shown in Declarations. of the the Page 2 of 2 © Insurance Services Office, Inc., 2012 CG 20 10 04 13 55648010 1 19-20 G/A/UMB/POLL/E&O 20-21 WC I Jennifer Barton 1 5/26/2020 4:38:58 PM (PDT) I Page 3 of 7 POLICY NUMBER: GLP2006942-17 COMMERCIAL GENERAL LIABILITY CG 20 37 0413 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 PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Any person, organization, or project with whom the named insured executes a written contract prior to the start of the project and is shown on a certificate of insurance issued by our authorized representative prior to the start date of the project. Location And Description Of Completed Operations 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" 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". However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. CG 20 37 04 13 B. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to required by a contract or will pay on behalf of the amount of insurance: the additional insured is agreement, the most we additional insured is the 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 shall not increase the applicable Limits of Insurance shown in the Declarations. © Insurance Services Office, Inc., 2012 55648010 1 19-20 G/A/UMB/POLL/E&O 20-21 WC I Jennifer Barton 1 5/26/2020 4:38:58 PM (PDT) I Page 4 of 7 Page 1 of 1 GLP2006942-17 EEC Environmental 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 CG 20 01 04 13 (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 55648010 1 19-20 G/A/UMB/POLL/E&O 20-21 WC I Jennifer Barton 1 5/26/2020 4:38:58 PM (PDT) I Page 5 of 7 Page 1 of 1 %VC 04 03 06 04 91, L 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 0.00%, of the California workers' compensation premium otherwise due on such remuneration. Schedule This endorsement changes the policy to which it is attached and is effectiive 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 5/24/2020 Insured EEC Environmental Insurance Company. Great Divide Insurance Company Policy No, WCA200881517 Countersigned by WC 04 03 06 04 84 1998 by the Workers' Compensation Insurance Rating Bureau of California. All rights reserved. From the WCIRB's California Workers' Compensation Insurance Forms Manual 2001. 55648010 1 19-20 G/A/UMB/POLL/E&O 20-21 WC I Jennifer Barton 1 5/26/2020 4:38:58 PM (PDT) I Page 7 of 7 Me Premium Page I of I