Loading...
PROOF OF INSURANCE (2020 - 2021) CLOSEDGVPVE-1 Q92. �^ ^ DATE (MMIDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 0610/2020 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). 918-773-380 ISU/Francis-Pinna Ins. PO�cT D ' ianne Nielse 916-773-3800 ........... ] VAX2266 Lava Ridge Court Ste 200 (h!C No, Ext)arry, 916-773-4484 P.O. Box 619050 , _ E-A I dnlelseti+iurs.com s Roseville, CA 95661-9050 c t�a.-_._.......,._...-T........... _ _.................. Bruce Winning )N,4V.R9aisl AFF PiN,p cPVERAGE Ir rc _�. �.... _., I Hartford Insurance GrCcinan—_d18058 _. y etas INSURER Sentinel Insurancehia Group n22357 INSURED INSURER 8: GVP Ventulr�s Inc. ..�. . _. .... I?BAc' Bob IVlurra & Associ Insurance Company Ltd 11000 544 Eureka Road Ste.. 280 w..........• Roseville, CA 9561 INSURER DD :.,.__ ...._. . �NslaN,fR E INSUR ERF': I COVERAGES C'ERTI'FQAI,=_NyR: REVISION Nt/(IBER: , .MIJETHIS 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 'ERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, LIMITS _ ...... _ E . LIMITS SHOWN MAY H AVE BEEN RviEawDUACE DYBY PAID CLAIMS, J.W TYPE OF INSURANCE SUBR1 POLICY mn POLIO NUMBER POLICY EXP C X COMMERCIAL GE RAL LIABILITY JW===I ..... .........,L—IMITUIIS ., .m... EACH OCCURRENCE N S 2,00,000 - CLAIMS -MADE occuR IEX . ,1,000000 AProfessional iE PHSD1544663 0,0001axn�a , „_ Claims Made PHSD1544663 PER s0NAL �..�Dv p��l le�v,....._�..,. 00 cN'L AGGREGATE LIMIT AP 0 PRO• P 2 Ol)0� _ SECT LIES PER: ..GENA 14(,. Ca R) 9afk ' ..S' 4,00'Q,000 P Y F EILOC PkQDUC I'S.. mm. .,._....^.. OTHER E8r0 1,000,000 .........�....., .. AUTOMOBILE LIABILITY COMB'INEO SINGLE LIMIT. ANY AUTO AUTOS ONLY AUTOS S T LEaFdG�RI_. . X x 57SBABG7707 06!16/2020 06/16!2021 H �PPILY I„L Y 1N'URr ('P0r P 5951_1 (. so OWNED SCHEDULED men.)..,........,............ 2,000,0001 ... AR 6, ONLY u...X„ AUOOS� ( ROPER rv1AMACxE S OCCUR t..., E . UdRENC ...................... �..._...OEDEXCE UMBRELLA S AB CLAIMS -MAD RETBENTION S AND EMPLOYERS' LIABILITY X PER I OTH fi ANY'7Gc' r F I TOP F PATrvp 'I ;�E`, ,Er"LI"P1L?E Y 1, N i A ' - ". $T. LLn.,E._ ....m.. I S WORKERS P,MAPGI ER* i X — -- __- RS CO -_, 57WBCtaG0320 0611612020 06116/2021 1,000,000 E. FACIa CIDcNr . 1,OOO,fa' mm If yes�derc be un EL 67N5,E,ASE - EA E,MPLOYEEI $ 00 under DESCRIPTION OF OPERATIONS belaw+ E L DISEASE - POR ICY LIMITS 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) RE:E:xecutive recruitment of Public Works Director The City of El Segundo, its officials, and employees are included as additional Insured(s) as required by written contact per attached endorsements. City of EI Segundo 350 Main Street EI Segundo, CA 90245 ACORD 25 (2016/03) ELSEG-1 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. The ACORD name and logo are registered marks of ACORD DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) RE:E:xecutive recruitment of Public Works Director The City of El Segundo, its officials, and employees are included as additional Insured(s) as required by written contact per attached endorsements. City of EI Segundo 350 Main Street EI Segundo, CA 90245 ACORD 25 (2016/03) ELSEG-1 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. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: 578BAEG7707 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL. INSURED . DESIGNATED PERSON OR ORGANISATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: The City of EI Segundo, its officials, and employees RE:Executive recruitment of Public Works Director (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in the Schedule as an insured but only with respect to liability arising out of your operations or premises owned by or rented to you. CG 20 26 11 85 Copyright, Insurance Services Office, Inc., 1984 POLICY NUMBER: 57SBA13G7707 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. 0 A IIG A r j, 0.. r. 11 • This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: The City of EI Segundo, its officials, and employees RE:Executive recruitment of Public Works Director (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement. With respect to insurance organization shown in Endorsement, Condition replaced by the following: 4. Other Insurance. provided to the person or the Schedule of this 4. Other Insurance is If other valid and collectible insurance is available for a loss we cover under Coverages A and B of this Coverage Part, our obligations are limited as follows: a. Primary Insurance This insurance is primary and we will not seek contribution from other insurance available to the person or organization shown in the Schedule of this endorsement except when b. below applies. (1) That is Fire, Extended Coverage, Builder's Risk, Installation Risk or similar coverage for "your work;" (2) That is Fire Insurance for premises rented to you; or (3) If the loss arises out of the maintenance or use of aircraft, "autos" or watercraft to the extent not subject to Exclusion g. of Coverage A (Section 1). When this insurance is excess, we will have no duty under Coverage A or B to defend any claim or "suit" that any other insurer has a duty to defend. If no other insurer defends, we will undertake to do so, but we will be entitled to the insured's rights against all those other insurers. b. Excess Insurance When this insurance is excess over other This insurance is excess over any of the other insurance, we will pay only our share of the insurance whether primary, excess, amount of the loss, if any, that exceeds the contingent or on any other basis: sum of: Form HC 24 08 11 94 Page 1 of 2 © 1995 The Hartford Insurance Group (Includes copyrighted material of Insurance Services Office with its permission. Copyright, Insurance Services Office, 1995) (1) The total amount that all such other insurance would pay for the loss in the absence of this insurance; and (2) The total of all deductible and self-insured amounts under all that other insurance. We will share the remaining loss, if any, with any other insurance that is not described in the Excess Insurance provisions and was not bought specifically to apply in excess of the Limits of Insurance shown in the Declarations of this Coverage Part. c. Method of Sharing If all of the other insurance permits contribution by equal shares, we will follow this method also. Under this approach each insurer contributes equal amounts until it has paid its applicable limit of insurance or none of the loss remains, whichever comes first. If any of the other insurance does not permit contribution by equal shares, we will contribute by limits. Under this method, each insurer's share is based on the ratio of its applicable limit of insurance to the total applicable limits of insurance of all insurers. Page 2 of 2 Form HC 24 0811 94 578BABO7707 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: BUSINESS LIABILITY COVERAGE FORM We waive any right of recovery we may have against: 1. Any person or organization shown in the Declarations, or 2. Any person or organization with whom you have a contract that requires such waiver, Form SS 12 15 03 00 0 2000, The Hartford Page 1 of 1 57SBABG7707 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTICE OF CANCELLATION TO CERTIFICATE HOLDER(S) This policy is subject to the following additional Conditions: A. If this policy is cancelled by the Company, other If notice is mailed, proof of mailing to the last known than for non-payment of premium, notice of such mailing address of the certificate holder(s) on file with cancellation will be provided at least thirty (30) days the agent of record or the Company will be sufficient in advance of the cancellation effective date to the proof of notice. certificate holder(s) with mailing addresses on file Any notification rights provided by this endorsement with the agent of record or the Company. apply only to active certificate holder(s) who were issued B. If this policy is cancelled by the company for non- a certificate of insurance applicable to this policy's term. payment of premium, or by the insured, notice of Failure to provide such notice to the certificate holder(s) such cancellation will be provided within ten (10) will not amend or extend the date the cancellation days of the cancellation effective date to the becomes effective, nor will it negate cancellation of the certificate holder(s) with mailing addresses on file policy. Failure to send notice shall impose no liability of with the agent of record or the Company. any kind upon the Company or its agents or representatives. Form SS 12 23 0611 Page 1 of 1 © 2011, The Hartford THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTICE OF CANCELLATION TO CERTIFICATE HOLDER(S) Policy Number: 57 WBC GG0320 Endorsement Number: Effective Date: 06/16/20 Effective hour is the same as stated on the Information Page of the policy, Named Insured and Address: GVP VENTURES INC., 1544 EUREKA RD STE 280 ROSEVILLE CA 95661 This policy is subject to the following additional Conditions: A. If this policy is cancelled by the Company, other than for non-payment of premium, notice of such cancellation will be provided at least thirty (30) days in advance of the cancellation effective date to the certificate holder(s) with mailing addresses on file with the agent of record or the Company. B. If this policy is cancelled by the Company for non-payment of premium, or by the insured, notice of such cancellation will be provided within ten (10) days of the cancellation effective date to the certificate holder(s) with mailing addresses on file with the agent of record or the Company. Form WC 99 03 94 Printed in U.S.A, Process Date: 05/07/20 If notice is mailed, proof of mailing to the last known mailing address of the certificate holder(s) on file with the agent of record or the Company will be sufficient proof of notice. Any notification rights provided by this endorsement apply only to active certificate holder(s) who were issued a certificate of insurance applicable to this policy's term. Failure to provide such notice to the certificate holder(s) will not amend or extend the date the cancellation becomes effective, nor will it negate cancellation of the policy. Failure to send notice shall impose no liability of any kind upon the Company or its agents or representatives. © 2011, The Hartford Policy Expiration Date: 06/16/21 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA Policy Number: 57 WBC GG0320 Endorsement Number: Effective Date: 06/16/20 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address: GVP VENTURES INC., 1544 EUREKA RD STE 280 ROSEVILLE CA 95661 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 Form WC 04 03 06 (1) Printed in U.S.A. Process Date: 05/07/20 Authorized Representative Policy Expiration Date: 06/16/21