Loading...
PROOF OF INSURANCE (2021) CLOSEDAC '' ( DATE (MMIDD/YYYY) Ili CERTIFICATE OF LIABILITY INSURANCE 9/3/2020 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 CONTACT PealeBox Renton Associates P MANE 510-465-3090 Na 5101-452-2193 Oakland CA 94604-2675 AD$9 DREE. cerl'iflcates(a dealeyrenton com . INSURER(S) AFFORDING COVERAGE ... .............................................N.A.�.C..#...... l,iGen$e#,',_0020739 INSURERA: Continental Insurance Company 35289 INSURED CANNCOR-02 INSURER 6: Valley Forge Insurance Company 20508 Cannon Corporation INSURER C: HARTFORD INSURANCE COMPANY 38288 1050 Southwood Drive San Luis Obispo CA 93401 INSURER D: American Casualty Company of Reading, 20427 INSURER E: Beazley Insurance Company Inc 37540 INSURER F: COVERAGES CERTIFICATE NUMBER: 1448044358 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 Abb-L'3l1BIi POLICY E'FF POLICY EXP LTR TYPE OF INSURANCE INS- WD POLICY NUMBER IMMIDDM'YYYI IMMIDWYYYY,1 LIMITS B X COMMERCIAL GENERAL LIABILITY Y Y 6079204724 9/1/2020 9/1/2021 EACH OCCURRENCE $1,000,000 fiAiNAC "C't1 ♦rl 't'I'l) CLAIMS -MADE („ X I OCCUR _IPRE,M6S[S tF.;a a, :cu..._rwengcra,)� $ 500,000 X Contractual Liab MED EXP (Any one person) $ 15,000 _ Included PERSONAL BADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY („X„I PRO- X.....I LOC JECTPRODUCTS -COMP/OP AGG $ 2,000,000 OTHER' $ D AUTOMOBILE LIABILITY Y Y 6079209373 9/1/2020 9/1/2021 COMBINED SWG:,LEIAMIIT $1,000,000 4[a �cc�denr X ANY AUTO BODILY INJURY (Per person) $ OWNED ( ASCHEDULED AUTOS ONLY UTOS BODILY INJURY (Per accident) $ , X AUTOS ONLY X.... NON -OWNED PROPFiTY DAMAGE $ AUTOS ONLY tPer fecuidenlb $ .A ....X.... UMBRELLA LIAB .XOCCUR Y Y 6079210751 9/1/2020 9/1/2021 ...EACH ..OCCURRENCE ......................L..$..9,,,.0.0.0.:.0.0.0................ . EXCESS LIAB CLAIMS -MADE AGGREGATE $ 9,000,000 DED.. L..X RETENTION $ �17..UD0 ....... ..I $.... .... ..... C WORKERS COMPENSATION Y 57WEOL6HIH 9/1/2020 9/1/2021 X AND EMPLOYERS' LIABILITY Y / N„S,T.P,TU.T,E......L............L, ER,,,,,,,,,, ANYPROPRIETORIPARTNER/E OIERIMEMBE EXCLUDED? l`1 NIA...E.:.L...DSEASECEAEMPLOYEE...$1,000,000........ (Mandatory . ) (.�..ff If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE POLICY LIMIT $ 1,000, 000 E Professional Liability V27737190102 9/1/2020 9/1/2021 V I Limit $2,000,000 ( Aggregate $2,000„000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Umbrella Liability policy is a follow -form to underlying General Liability/Auto Liability/Employers Liability. Project Number/Name: #1906381 City of EI Segundo Water Yard Improvements City of EI Segundo, its officials, and employees are named as Additional Insured as respects General and Auto Liability as required per written contract or agreement. General Liability and Auto Liability are Primary/Non-Contributory per policy form wording. 30 Days Notice of Cancellation CERTIFICATE HOLDER CANCELLATION 30 Day Notice of 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 St. 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 .................. NA CNA PARAMOUNT Blanket Additional Insured - Owners, Lessees or Contractors - with Products -Completed Operations Coverage Endorsement This endorsement modifies Insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART It is understood and agreed as follows: I. WHO IS AN INSURED is amended to include as an Insured any person or organization whom you are required by written contract to add as an additional insured on this coverage part, but only with respect to liability for bodily injury, property damage or personal and advertising injury caused in whole or in part by your acts or omissions, or the acts or omissions of those acting on your behalf: A. in the performance of your ongoing operations subject to such written contract; or B. in the performance of your work subject to such written contract, but only with respect to bodily injury or property damage included in the products -completed operations hazard, and only if: 1. the written contract requires you to provide the additional insured such coverage; and 2. this coverage part provides such coverage. II. But if the written contract requires: A. additional insured coverage under the 11-85 edition, 10-93 edition, or 10-01 edition of CG2010, or under the 10- 01 edition of CG2037; or B. additional insured coverage with "arising out of language; or C. additional insured coverage to the greatest extent permissible by law; then paragraph I. above is deleted in its entirety and replaced by the following: WHO IS AN INSURED is amended to include as an Insured any person or organization whom you are required by written contract to add as an additional insured on this coverage part, but only with respect to liability for bodily injury, property damage or personal and advertising injury arising out of your work that is subject to such written contract. III. Subject always to the terms and conditions of this policy, including the limits of insurance, the Insurer will not provide such additional insured with: 0 A. coverage broader than required by the written contract; or N B. a higher limit of insurance than required by the written contract. N IV. The insurance granted by this endorsement to the additional insured does not apply to bodily injury, property damage, or personal and advertising injury arising out of: A. the rendering of, or the failure to render, any professional architectural, engineering, or surveying services, including: 1. the preparing, approving, or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; and 2. supervisory, inspection, architectural or engineering activities; or B. any premises or work for which the additional insured is specifically listed as an additional insured on another endorsement attached to this coverage part. V. Under COMMERCIAL GENERAL LIABILITY CONDITIONS, the Condition entitled Other Insurance is amended to add the following, which supersedes any provision to the contrary in this Condition or elsewhere in this coverage part: CNA75079XX (10-16) Policy No: 6079204724 Page 1 of 2 Endorsement No: 8 AMERICAN CASUALTY CO OF READING , PA Effective Date: 0 9 / 01 / 2 019 Insured Name: CANNON CORPORATION Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission. N CNA PARAMOUNT Blanket Additional Insured - Owners, Lessees or Contractors - with Products -Completed Operations Coverage Endorsement Primary and Noncontributory Insurance With respect to other insurance available to the additional insured under which the additional insured is a named insured, this insurance is primary to and will not seek contribution from such other insurance, provided that a written contract requires the insurance provided by this policy to be: 1. primary and non-contributing with other insurance available to the additional insured; or 2. primary and to not seek contribution from any other insurance available to the additional insured. But except as specified above, this insurance will be excess of all other insurance available to the additional insured. VI. Solely with respect to the insurance granted by this endorsement, the section entitled COMMERCIAL GENERAL LIABILITY CONDITIONS is amended as follows: The Condition entitled Duties In The Event of Occurrence, Offense, Claim or Suit is amended with the addition of the following: Any additional insured pursuant to this endorsement will as soon as practicable: 1. give the Insurer written notice of any claim, or any occurrence or offense which may result in a claim; 2. send the Insurer copies of all legal papers received, and otherwise cooperate with the Insurer in the investigation, defense, or settlement of the claim; and 3. make available any other insurance, and tender the defense and indemnity of any claim to any other insurer or self -insurer, whose policy or program applies to a loss that the Insurer covers under this coverage part. However, if the written contract requires this insurance to be primary and non-contributory, this paragraph 3. does not apply to insurance on which the additional insured is a named insured. The Insurer has no duty to defend or indemnify an additional insured under this endorsement until the Insurer receives written notice of a claim from the additional insured. VII. Solely with respect to the insurance granted by this endorsement, the section entitled DEFINITIONS is amended to add the following definition: Written contract means a written contract or written agreement that requires you to make a person or organization an additional insured on this coverage part, provided the contract or agreement: A. is currently in effect or becomes effective during the term of this policy; and B. was executed prior to: 1. the bodily injury or property damage; or 2. the offense that caused the personal and advertising injury; for which the additional insured seeks coverage. Any coverage granted by this endorsement shall apply solely to the extent permissible by law. All other terms and conditions of the Policy remain unchanged. This endorsement, which forms a part of and is for attachment to the Policy issued by the designated Insurers, takes effect on the effective date of said Policy at the hour stated in said Policy, unless another effective date is shown below, and expires concurrently with said Policy, CNA75079XX (10-16) Policy No: 6079204724 Page 2 of 2 Endorsement No: 8 AMERICAN CASUALTY CO OF READING, PA Effective Date: 09/01/2019 Insured Name: CANNON CORPORATION Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission, r�11117111.i� � i IN I.. Business Auto Policy Poky Endarserrient It is understood and agreed that this endorsement amends the BUSINESS AUTO COVERAGE FORM as follows: SCHEDULE Name of Additional Insured Person Or Organization ANY PERSON OR ORGANIZATION THAT YOU ARE REQUIRED BY WRITTEN CONTRACT OR WRITTEN INSURED AGREEMENT TO NAME AS AN ADDITIONAL Iwww 1. In conformance with paragraph A.1.c. of Who Is An Insured of Section II - LIABILITY COVERAGE, the person or organization scheduled above is an insured under this policy. 2. The insurance afforded to the additional insured under this policy will apply on a primary and non-contributory basis if you have committed it to be so in a written contract or written agreement executed prior to the date of the "accident" for which the additional insured seeks coverage under this policy. All other terms and conditions of the policy remain unchanged This endorsement, which forms a part of and is for attachment to the policy issued by the designated Insurers, takes effect on the Policy Effective date of said policy at the hour stated in said policy, unless another effective date (the Endorsement Effective Date) is shown below, and expires concurrently with said policy. Form No: CNA71527XX (10-2012) Policy No: 6079209373 Endorsement Effective Date: Endorsement Expiration Date: Policy Effective Date: 09/01/2019 Endorsement No: 15; Page: 1 of 1 Policy Page: 69 of 170 Underwriting Company: American Casualty Company of Reading, Pennsylvania, 151 N Franklin St, Chicago, IL 60606 Copyright CNA All Rights Reserved, CNA CNA PARAMOUNT Waiver of Transfer of Rights of Recovery Against Others to the Insurer Endorsement 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: ANY PERSON OR ORGANIZATION WHOM THE NAMED INSURED HAS AGREED IN WRITING IN A CONTRACT OR AGREEMENT TO WAIVE SUCH RIGHTS OF RECOVERY, BUT ONLY IF SUCH CONTRACT OR. AGREEMENT: 1. IS IN EFFECT OR BECOIflES EFFECTIVE DURING THE TERM OF THIS COVERAGE PART) AND 2. WAS EXECUTED PRIOR TO THE BODILY INJURY, PROPERTY DAMAGE OR PERSONAL AND ADVERTISING INJURY GIVING RISE TO THE CLAIM. (Information required to complete this Schedule, if not shown above, will be shown in the Declarations.) Under COMMERCIAL GENERAL LIABILITY CONDITIONS, it is understood and agreed that the condition entitled Transfer Of Rights Of Recovery Against Others To Us is amended by the addition of the following: With respect to the person or organization shown in the Schedule above, the Insurer waives any right of recovery the Insurer may have against such person or organization because of payments the Insurer makes for injury or damage arising out of the Named Insured's ongoing operations or your work included in the products -completed operations hazard. All other terms and conditions of the Policy remain unchanged. m This endorsement, which forms a part of and is for attachment to the Policy issued by the designated Insurers, takes a effect on the effective date of said Policy at the hour stated in said Policy, unless another effective date is shown below, and expires concurrently with said Policy. O O N O !7 �I CNA75008XX (10-16) Policy No: 6079204724 Page 1 of 1 Endorsement No: 10 AMERICAN CASUALTY CO OF READING, PA Effective Date: 09/01/2019 Insured Name: CANNON CORPORATION Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission. Business Auto Policy PoHcy Endors-erner1t THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: CANNON CORPORATION Endorsement Effective Date: 09/01/2019 SCHEDULE Name(s) Of Person(s) Or Organization(s): ANY PERSON OR ORGANIZATION FOR WHOM OR WHICH YOU ARE REQUIRED BY WRITTEN CONTRACT OR AGREEMENT TO OBTAIN THIS WAIVER FROM US. YOU MUST AGREE TO THAT REQUIREMENT PRIOR TO LOSS. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. 1 The Transfer Of Rights Of Recovery Against Others To Us condition does not apply to the person(s) or organization(s) shown in the Schedule, but only to the extent that subrogation is waived prior to the "accident" or the "loss" under a contract with that person or organization. Form No: CA 04 44 10 13 Policy No: 6079209373 Endorsement Effective Date: Endorsement Expiration Date: Policy Effective Date: 09/01/2019 Endorsement No: 6; Page: 1 of 1 Policy Page: 54 of 170 Underwriting Company: American Casualty Company of Reading, Pennsylvania, 151 N Franklin St, Chicago, IL 60606 0 Copyright Insurance Services Office, Inc., 2011 l X16 IVB h r ( � I Business Auto Policy Pc}HC\` P:ndQF,,cer ent THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: CANNON CORPORATION Endorsement Effective Date: 09/01/2019 SCHEDULE Name Of Person(s) Or Organization(s): ANY PERSON OR ORGANIZATION THAT THE NAMED INSURED IS OBLIGATED TO PROVIDE INSURANCE WHERE REQUIRED BY A WRITTEN CONTRACT OR AGREEMENT IS AN INSURED,BUT ONLY WITH RESPECT TO LEGAL RESPONSIBILITY FOR ACTS OR OMISSIONS OF A PERSON/ORGANIZATION FOR WHOM LIABILITY COVERAGE IS AFFORDED UNDER THIS POLICY Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Each person or organization shown in the Schedule is an "insured" for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Paragraph A.1. of Section II - Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms and Paragraph D.2. of Section I - Covered Autos Coverages of the Auto Dealers Coverage Form. Form No: CA 20 48 10 13 Policy No: BUA 6079209373 Endorsement Effective Date: Endorsement Expiration Date: Policy Effective Date: 09/01/2019 Endorsement No: 5; Page: 1 of 1 Policy Page: 49 of 135 Underwriting Company: American Casualty Company of Reading, Pennsylvania, 151 N Franklin St, Chicago, IL 60606 Copyright Insurance Services Office, Inc., 2011 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA Policy Number: 57WEOL6H1H Endorsement Number: Effective Date: 09/01/2020 Effective hour is the same as stated on the Information Page of the policy.. Named Insured and Address: Cannon Corporation 1050 Southwood Drive San Luis Obispo, CA 93401 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. Authorized Representative Policy Expiration Date: 09/01/2021