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PROOF OF INSURANCE (2021) CLOSEDACCOR" ® CERTIFICATE OF LIABILITY INSURANCE I DAT9/(10/202pYY)
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
Doris A Chambers
Dealey, Renton & Associates PHONE FAX
P. O. Box 12675 I (A/C. No. Ext): 510-465-3090 (A/C, No):
Oakland CA 94604-2675 I E-MAIL
ADDREss: dchambers@dealeyrenton.com
INSURER(S) AFFORDING COVERAGE NAIC #
INSURERA: XL Speciality Insurance Company 37885
INSURED LIONAKIS INSURER B: The Travelers Indemnity Company of Connecticut 25682
Lionakis
1919 - 19th Street I INSURER C: Travelers Property Casualty Company of America 25674
Sacramento CA 95814 I INSURER D:
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: 366182764 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 POLICY EFF POLICY EXP LIMITS
LTR INSD WVD POLICY NUMBER (MM/DD/YYYYI (MM/DD/YYYYI
C X COMMERCIAL GENERAL LIABILITY Y Y 6808J101951 9/1/2020 9/1/2021 EACH OCCURRENCE $1 000000
CLAIMS -MADE � OCCUR
GEN'L AGGREGATE LIMIT APPLIES PER:
PRO -
POLICY � ECT 1:1 LOC
OTHER:
B AUTOMOBILE LIABILITY
ANY AUTO
Y Y BA8J095706
OWNEDSCHEDULED
DAMAGE TO RENTED
AUTOS ONLY
$ 1,000,000
AUTOS
MED EXP (Any one person)
X HIRED
I X
I NON -OWNED
$ 1,000,000
AUTOS ONLY
GENERAL AGGREGATE
AUTOS ONLY
C X UMBRELLALIAB
H
OCCUR Y Y
CUP8J102449
EXCESS LIAB
9/1/2020 9/1/2021
CLAIMS -MADE
$ 1,000,000
DED I I RETENTION $
fEa accident)
C WORKERS COMPENSATION Y
UB3J842371
AND EMPLOYERS' LIABILITY Y / N
$
ANYPROPRI ETOR/PARTNER/EXECUTIVE
BODILY INJURY (Per accident)
OFFICER/MEMBER EXCLUDED? N/A
(Mandatory in NH)
$
If yes, describe under
f Per accident)
DESCRIPTION OF OPERATIONS below
A Professional
DPR9965602
Liability
EACH OCCURRENCE
Claims Made
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
REF: City of EI Segundo City Hall Window Replacement.
GENERAL LIABILITY/AUTOMOBILE LIABILITY ADDITIONAL INSURED. The City of EI Segundo, its officials, and employees are named as Additional
Insureds with respect to liability and defense costs arising out of the Insured's acts or omissions; said insurance shall be primary and any other insurance that
may be carried by the Additional Insureds will be excess. Waiver of Subrogation applies to Commercial General Liability, Automobile Liability and Workers
Compensation. 30 Day Notice of Cancellation.
CERTIFICATE HOLDER
CANCELLATION 30 Day NOC/10 Day for NonPaV of Prem
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, Public Works
350 Main Street 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
DAMAGE TO RENTED
PREMISES (Ea occurrence)
$ 1,000,000
MED EXP (Any one person)
$ 5,000
PERSONAL &ADV INJURY
$ 1,000,000
GENERAL AGGREGATE
$2,000,000
PRODUCTS - COMP/OP AGG
$ 2,000,000
9/1/2020 9/1/2021
COMBINED SINGLE LIMIT
$ 1,000,000
fEa accident)
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
$
f Per accident)
9/1/2020 9/1/2021
EACH OCCURRENCE
$5,000,000
AGGREGATE
$ 5,000,000
9/1/2020 9/1/2021X
I PER STATUTE ERH
E.L. EACH ACCIDENT
$ 1,000,000
E.L. DISEASE - EA EMPLOYEE
$ 1,000,000
E.L. DISEASE - POLICY LIMIT
$ 1,000,000
9/1/2020 9/1/2021
$5,000,000 per Claim
$5,000,000 Annl Aggr.
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
REF: City of EI Segundo City Hall Window Replacement.
GENERAL LIABILITY/AUTOMOBILE LIABILITY ADDITIONAL INSURED. The City of EI Segundo, its officials, and employees are named as Additional
Insureds with respect to liability and defense costs arising out of the Insured's acts or omissions; said insurance shall be primary and any other insurance that
may be carried by the Additional Insureds will be excess. Waiver of Subrogation applies to Commercial General Liability, Automobile Liability and Workers
Compensation. 30 Day Notice of Cancellation.
CERTIFICATE HOLDER
CANCELLATION 30 Day NOC/10 Day for NonPaV of Prem
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, Public Works
350 Main Street 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
POLICY NUMBER: 6808J101951
COMMERCIAL GENERAL LIABILITY
ISSUED DATE: 9/10/2020
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
SCHEDULE
Name Of Additional Insured Person(s) Or Organization(s):
Any person or organization that you agree in a written contract to include as an additional
insured on this Coverage Part for "bodily injury" or "property damage" included in the "products -
completed operations hazard", provided that such contract was signed and executed by you
before, and is in effect when, the bodily injury or property damage occurs.
Location And Description Of Completed Operations
Any project to which an applicable contract described in the Name of Additional
Insured Person(s) or Organization(s) section of this Schedule applies.
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
Section II — Who Is An Insured is amended to in-
clude as an additional insured the person(s) or or-
ganizations) shown in the Schedule, but only with
respect to liability for "bodily injury" or "property dam-
age" 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 in-
sured and included in the "products -completed opera-
tions hazard".
CG 20 37 07 04 © ISO Properties, Inc., 2004 Page 1 of 1
POLICY NUMBER 6808J101951
COMMERCIAL GENERAL LIABILITY
ISSUED DATE: 9/10/2020
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
Names of Additional Insured Person(s) or Organization(s):
Any person or organization that you agree in a written contract, on this Coverage Part, provided
that such written contract was signed and executed by you before, and is in effect when the
"bodily injury" or "property damage" occurs or the "personal injury" or "advertising injury" offense
is committed.
Location of Covered Operations:
Any project to which an applicable written contract with the described in the Name of
Additional Insured Person(s) or Organization(s) section of this Schedule applies.
(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 in-
clude 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", "personal injury" or "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) desig-
nated above.
B. With respect to the insurance afforded to these
additional insureds, the following additional exclu-
sions apply:
This insurance does not apply to "bodily injury" or
"property damage" occurring, or "personal injury"
or "advertising injury" arising out of an offense
committed, after:
1. All work, including materials, parts or equip-
ment furnished in connection with such work,
on the project (other than service, mainte-
nance or repairs) to be performed by or on
behalf of the additional insured(s) at the loca-
tion of the covered operations has been com-
pleted; or
2. That portion of "your work" out of which the
injury or damage arises has been put to its in-
tended use by any person or organization
other than another contractor or subcontrac-
tor engaged in performing operations for a
principal as a part of the same project.
CG D3 61 03 05 Copyright 2005 The St. Paul Travelers Companies, Inc. All rights reserved. Page 1 of 1
Includes copyrighted material of Insurance Services Office, Inc. with its permission.
NAMED INSURED: Lionakis
COMMERCIAL GENERAL LIABILITY COVERAGE
POLICY NUMBER: 6808J101951
ADDITIONAL COVERAGES BY WRITTEN CONTRACT OR AGREEMENT
This is a summary of the coverages provided under the following forms (complete forms available):
Excerpt from COMMERCIAL GENERAL LIABILITY COVERAGE (FORM #CG T1 00 02 19)
SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS
4. OTHER INSURANCE - d. PRIMARY AND NON-CONTRIBUTORY INSURANCE IF REQUIRED
BY WRITTEN CONTRACT:
If you specifically agree in a written contract or agreement that the insurance afforded to an insured under
this Coverage Part must apply on a primary basis, or a primary and non-contributory basis, this insurance
is primary to other insurance that is available to such insured which covers such insured as a named
insured, and we will not share with that other insurance, provided that:
(1) The "bodily injury" or "property damage" for which coverage is sought occurs; and
(2) The "personal and advertising injury" for which coverage is sought is caused by an offense that is
committed;
subsequent to the signing of that contract or agreement by you.
Excerpt from XTEND ENDORSEMENT FOR ARCHITECTS, ENGINEERS AND SURVEYORS
(FORM #CG D3 79 02 19)
PROVISION M. - BLANKET WAIVER OF SUBROGATION - WHEN REQUIRED BY WRITTEN
CONTRACT OR AGREEMENT:
If the insured has agreed in a written contract or agreement to waive that insured'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
b. "Personal and advertising injury" caused by an offense that is committed;
subsequent to the signing of that contract or agreement.
Page 1
COMMERCIAL AUTO
POLICY NUMBER: BA -8J095706 ISSUE DATE: 09- 08-20
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
DESIGNATED INSURED FOR
COVERED AUTOS LIABILITY COVERAGE
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 modi-
fied 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 pro-
vided in the Coverage Form.
SCHEDULE
Name Of Person(s) Or Organization(s):
ANY PERSON OR ORGANIZATION THAT YOU ARE REQUIRED TO INCLUDE
AS AN ADDITIONAL INSURED ON THIS COVERAGE FORM IN A WRITTEN
CONTRACT OR AGREEMENT THAT IS SIGNED AND EXECUTED BY YOU
BEFORE THE "BODILY INJURY" OR "PROPERTY DAMAGE" OCCURS AND
THAT IS IN EFFECT DURING THE POLICY PERIOD.
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 provi-
sion contained in Paragraph A.1. of Section II — Cov-
ered 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.
CA 20 48 10 13 C Insurance Services Office, Inc., 2011 Page 1 of 1
TRAVELERS!' WORKERS COMPENSATION
AND
EMPLOYERS LIABILITY POLICY
ENDORSEMENT WC 00 03 13 (00) -
POLICY NUMBER: UB -3J842371
WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT
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.)
This agreement shall not operate directly or indirectly to benefit any one not named in the Schedule.
SCHEDULE
DESIGNATED PERSON:
ANY PERSON OR ORGANIZATION FOR WHICH THE INSURED HAS AGREED BY WRITTEN CONTRACT
EXECUTED PRIOR TO LOSS TO FURNISH THIS WAIVER.
DESIGNATED ORGANIZATION:
DATE OF ISSUE: - - ST ASSIGN: