No preview available
PROOF OF INSURANCE (2021) CLOSEDDATE(MMIDDnYACCERTIFICATE OF LIABILITY INSURANCENCE09211202011114�1 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(les) 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 .. (atN1Ad'i^f.. Whitney Ev ros" NAME: Krauter & Company, LLC, a division of RSC Insurance Brokerage, Inc. PHONE (415) 944-3051 FAx VAC' N Ea19: INC, Nal: 100 Pringle Ave ADDRESS, wevansr krautergroup,corm Suite 570 IINSURE'Rg51 AFFORDING COVERAGE NAIC ,0 Walnut Creek CA 94596 INSURERA: Travelers Property Casualty Company ofAmerica 25674 INSURED INSURER B : Lloyd's of London (see remarks for Syndicates) NIA Gatehouse MSI, LLC DBA McMurray Stem INSURER C: I 5 15511 Cannenita Rd. INSURER D I EACH OCCURRENCE 5 6,000,000 A EXCESS LIAR CUP-OL217629 CLAIMS -MADE INSURER E: S 8,000,000 _I DEDJ X) RE'T'ENT'tON S' 0 ante a rings A 90670 P 9 . ... INSURER F ' WORKERS COMPENSATION PERq tl XJ V R ERS COVERAGES CERTIFICATE NUMBER: OL2072168395 REVISION I NUMBER. ST E L EACHACCIDENT�! THIS IS TO CERTIFY THAT THE'POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLIC Y PERIOD OFFICER/MEMBER EXCLUDED? N la Y UB OL217107-20-14-G (Mandatory In NH) 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, E L DISEASE - POLICY LIMIT EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Each Claim/Aggregate I � POLICY EFF POLICYEXP TYPE OF INSURANCE IVSD WVDPOLICYNUMBER (MMIDD/YYYY1 (MMIDDIYYYYI ( LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 CLAIMS -MADE ® OCCUR PREMISES (Ea occlurrence) S 100,000 MED EXP (Any one person) S 5,000 A Y I Y Y-630-OL207870-TIL-20 07/3112020 07/31/2021 1,000,000 PERSONAL BADV INJURY $ GEN'L AGGREGATE LIMITAPPUES PER: GENERALAGGREGATE s 2,000,000 POLICY ® JE T LOC PRODUCTS-COMPIOPAGG $ 2,000,000 OTHER Deductible S 0 .... .. AUT ...CCr�9Yr�+S'fr8*0LE'LiMiT S 100 AUOMOBILELIABIIJTv MANY AUTO I'Ea atda ntll BODILY INJURY (Per person) ,0,000 5 A OWNED ED AUTOSONLY SCHEDULED Y AUTOS Y 810-DL131999 07/31/2020 07/31/2021 BODILY INJURY (Per accident) 5 HIRED El NON -OWNED PROPERTY DAMAGE S AUTOS ONLY AUTOS ONLY —IPou accidonO DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If mono space Is required) The City of EI Segundo, its officers, officials, employees, agents and volunteers are Included as Additional Insured, as their Interests may appear, in regards to the General Liability and Auto Liability policies as required by written contract subject to policy terms, conditions and exclusions. Coverage shall be primary and non-contributory over any other valid form of collectible insurance of the Additional Insureds as required by written contract. Waiver of Subrogation applies in regards to the General Liability, Auto Liability, and Workers' Compensation policies as required by written contract subject to policy terms, conditions and exclusions. �" The Insurer may cancel these policies by mailing or delivering to the First Named Insured written notice of cancellation at least: 10 days before the effectNi-' CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of EI Segundo ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street AUTHORIZED REPRESENTATIVE EI Segundo CA 90245 0 1 988-201 5 ACORD CORPORATION'. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD I 5 UMBRELLA LIAR OCCUR EACH OCCURRENCE 5 6,000,000 A EXCESS LIAR CUP-OL217629 CLAIMS -MADE 07/31/2020 07/31/2021 AGGREGATE S 8,000,000 _I DEDJ X) RE'T'ENT'tON S' 0 ! I s ' WORKERS COMPENSATION PERq tl XJ V R ERS AND EMPLOYERS' LIABILITY Y/ N ANY PROPRIETORIPARTNERIEXECUTIVE A ST E L EACHACCIDENT�! S 1,000,000 OFFICER/MEMBER EXCLUDED? N la Y UB OL217107-20-14-G (Mandatory In NH) 07!3112020 07/31!2021 I E.L.DISEASE- EA EMPLOYEE S 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E L DISEASE - POLICY LIMIT $ 1,000,000 Each Claim/Aggregate 1,000,000 Professional Liability B B0621PGATE001720 07/31/2020 07/31/2021 Deductible - each claim 10,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If mono space Is required) The City of EI Segundo, its officers, officials, employees, agents and volunteers are Included as Additional Insured, as their Interests may appear, in regards to the General Liability and Auto Liability policies as required by written contract subject to policy terms, conditions and exclusions. Coverage shall be primary and non-contributory over any other valid form of collectible insurance of the Additional Insureds as required by written contract. Waiver of Subrogation applies in regards to the General Liability, Auto Liability, and Workers' Compensation policies as required by written contract subject to policy terms, conditions and exclusions. �" The Insurer may cancel these policies by mailing or delivering to the First Named Insured written notice of cancellation at least: 10 days before the effectNi-' CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of EI Segundo ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street AUTHORIZED REPRESENTATIVE EI Segundo CA 90245 0 1 988-201 5 ACORD CORPORATION'. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD Policy #Y-630-OL207870-TIL-20 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED (Includes Products -Completed Operations If Required By Contract) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART•• PROVISIONS The following is added to SECTION 11— WHO IS AN INSURED: Any person or organization that you agree in a written contract or agreement to include as an additional insured on this Coverage Part is an insured, but only: a. With respect to liability for "bodily injury" or "property damage' that occurs, or for "personal injury" caused by an offense that is committed, subsequent to the signing of that contract or agreement and while that part of the contract or agreement is in effect; and b. If, and only to the extent that; such injury or damage is caused by acts or omissions of you or your subcontractor in the performance of "your work" to which the written contract or agreement applies. Such person or organization does not qualify as an additional insured with respect to the independent acts or omissions of such person or organization. The insurance provided to such additional insured is subject to the following provisions: a. If the Limits of Insurance of this Coverage Part shown in the Declarations exceed the minimum limits required by the written contract or agreement, the insurance provided to the additional insured will be limited to such minimum required limits. For the purposes of determining whether this limitation applies, the minimum limits required by the written contract or agreement will be considered to include the minimum limits of any Umbrella or Excess liability coverage required for the additional insured by that written contract or agreement. This provision will not increase the limits of insurance described in Section III — Limits Of Insurance. (1) Any "bodily injury", "property damage" or "personal injury" arising out of the providing, or failure to provide, any professional architectural, engineering or surveying services, including: (a) The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders or change orders, or the preparing, approving, or failing to prepare or approve, drawings and specifications; and (b) Supervisory, inspection, architectural or engineering activities. (2) Any "bodily injury' or "property damage" caused by "your work" and included in the "products -completed operations hazard' unless the written contract or agreement specifically requires you to provide such coverage for that additional insured during the policy period. c. The additional insured must comply with the following duties: (1) Give us written notice as soon as practicable of an "occurrence' or an offense which may result in a claim. To the extent possible, such notice should include: (a) How, when and where the "oorurrenoe" or offense took place; (b) The names and addresses of any injured persons and witnesses; and (c) The nature and location of any injury or damage arising out of the "occurrence" or offense. b. The insurance provided to such additional (2) If a claim is made or "suit" is brought against insured does not apply to: the additional insured: CG D2 46 0419 0 2018 The Travelers indemnity Company. All rights reserved. Page 1 of 2 COMMERCIAL GENERAL LIABILITY (a) Immediately record the specifics of the claim or "suit" and the date received; and (b) Notify us as soon as practicable and see to it that we receive written notice of the claim or "suit" as soon as practicable. (3) Immediately send us copies of all legal papers received in connection with the claim or "suit", cooperate with us in the investigation or settlement of the claim or defense against the "suit", and otherwise comply with all policy conditions. (4) Tender the defense and indemnity of any claim or "suit" to any provider of other insurance which would cover such additional insured for a loss we cover. However, this condition does not affect whether the insurance provided to such additional insured is primary to other insurance available to such additional insured which covers that person or organization as a named insured as described in Paragraph 4., Other Insurance, of Section IV —Commercial General Liability Conditions. Page 2 of 2 0 2018 The Travelers Indemnity Company. All rights reserved. CG D2 46 0419 POLICY NUMBER: Y-630-OL207870-TIL-20 COMMERCIAL GENERAL LIABILITY ISSUE DATE: 08-07-20 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY DESIGNATED PROJECT(S) GENERAL AGG EGAT LIMIT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designated Project Designated Project(s): General Aggregate(s): EACH "PROJECT" FOR WHICH YOU HAVE AGREED, IN $2,000,000 A WRITTEN CONTRACT THAT IS IN EFFECT DURING THIS POLICY PERIOD, TO PROVIDE A SEPARATE GENERAL AGGREGATE LIMIT, PROVIDED THAT THE CONTRACT IS SIGNED BY YOU BEFORE THE "BODILY INJURY" OR "PROPERTY DAMAGE" A. For all sums which the insured becomes legally 3. Any payments made under COVERAGE A. obligated to pay as damages caused by 'occur- for damages or under COVERAGE C. for rences" under COVERAGE A. (SECTION 1), and medical expenses shall reduce the Desig- for all medical expenses caused by accidents un- nated Project General Aggregate Limit for der COVERAGE C (SECTION 1), which can be that designated "project". Such payments attributed only to operations at a single desig- shall not reduce the General Aggregate Limit nated "project" shown in the Schedule above: shown in the Declarations nor shall they re - 1. A separate Designated Project General Ag- duce any other Designated Project General gregate Limit applies to each designated "pro- Aggregate Limit for any other designated ject". and that limit is equal to the amount of "project" shown in the Schedule above. the General Aggregate Limit shown in the 4. The limits shown in the Declarations for Each Declarations, unless separate Designated Occurrence, Damage To Premises Rented Project General Aggregate(s) are sched- To You and Medical Expense continue to uled above. apply. However, instead of being subject to 2. The Designated Project General Aggregate the General Aggregate Limit shown in the Limit is the most we will pay for the sum of all Declarations, such limits will be subject to the damages under COVERAGE A., except applicable Designated Project General Ag - damages because of "bodily injury" or "prop- gregate Limit. erty damage" included in the "products- B. For all sums which the insured becomes legally Completed operations hazard", and for medi- obligated to pay as damages caused by "occur - cal expenses under COVERAGE C, regard- rences" under COVERAGE A. (SECTION 1), and less of the number of: for all medical expenses caused by accidents un - Insureds; der COVERAGE C. (SECTION 1), which cannot be attributed only to operations at a single desig- nated "project" shown in the Schedule above: c. Persons or organizations making claims or bringing "suits". CG D211 01 04 Copyright, The Travelers Indemnity Company, 2004 Page 1 of 2 COMMERCIAL GENERAL LIABILITY 1. Any payments made under COVERAGE A. for damages or under COVERAGE C. for medical expenses shall reduce the amount available under the General Aggregate Limit or the Products -Completed Operations Ag- gregate Limit, whichever is applicable; and 2. Such payments shall not reduce any Desig- nated Project General Aggregate Limit. C. Part 2. of SECTION III — LIMITS OF INSURANCE is deleted and replaced by the following: 2. The General Aggregate Limit is the most we will pay for the sum of: a. Damages under Coverage B; and b. Damages from "occurrences" under COVERAGE A (SECTION 1) and for all medical expenses caused by accidents under COVERAGE C (SECTION 1) which cannot be attributed only to operations at a single designated "project" shown in the SCHEDULE above. D. When coverage for liability arising out of the "products -completed operations hazard" is pro- vided, any payments for damages because of "bodily injury" or "property damage" included in the "products -completed operations hazard" will reduce the Products -Completed Operations Ag- gregate Limit, and not reduce the General Aggre- gate Limit nor the Designated Project General Aggregate Limit. E. For the purposes of this endorsement the Defini- tions Section is amended by the addition of the following definition: "Project" means an area away from premises owned by or rented to you at which you are per- forming operations pursuant to a contract or agreement. For the purposes of determining the applicable aggregate limit of insurance, each "project" that includes premises involving the same or connecting lots, or premises whose con- nection is interrupted only by a street, roadway, waterway or right-of-way of a railroad shall be considered a single "project". F. The provisions of SECTION III — LIMITS OF INSURANCE not otherwise modified by this en- dorsement shall continue to apply as stipulated. Page 2 of 2 Copyright, The Travelers Indemnity Company, 2004 CG D211 01 04 Policy #810-OL131999 COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED - PRIMARY AND NON-CONTRIBUTORY WITH OTHER INSURANCE This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM PROVISIONS The following is added to Paragraph A.1.c., Who Is An Insured, of SECTION II — COVERED AUTOS LIABILITY COVERAGE: This includes any person or organization who you are required under a written contract or agreement between you and that person or organization, that is signed by you before the "bodily injury" or "property damage" occurs and that is in effect during the policy period, to name as an additional insured for Covered Autos Liability Coverage, but only for damages to which this insurance applies and only to the extent of that person's or organization's liability for the conduct of another "insured". 2. The following is added to Paragraph B.S., Other Insurance of SECTION IV — BUSINESS AUTO CONDITIONS: Regardless of the provisions of paragraph a. and paragraph d. of this part S. Other Insurance, this insurance is primary to and non-contributory with applicable other insurance under which an additional insured person or organization is the first named insured when the written contract or agreement between you and that person or organization, that . is signed by you before the "bodily injury" or "property damage" occurs and that is in effect during the policy period, requires this insurance to be primary and non-contributory. CA T4 74 02 16 © 2016 The Travelers Indemnity Company. All rights reserved. Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc. with its permission. Policy #Y-630-OL207870-TIL-20 COMMERCIAL GENERAL I LIABILITY c. Method Of Sharing If all of the other insurance pen -nits 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 less 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 insurers share is based on the ratio of its applicable limit of insurance to the total applicable limits of insurance of all insurers. 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 5. Premium Audit a. We will compute all premiums for this Coverage Part in accordance with cur rules and rates. b. Premium shown in this Coverage Part as advance premium is a deposit premium only. At the close of each audit period we will compute the earned premium for that period and send notice to the first Named Insured. The due date for audit and retrospective premiums is the date shar✓n as the due date on the bill. If the sum of the advance and audit premiums paid for the policy period is greater than the earned premium, we will return the excess to the first Named Insured. a. The statements in the Declarations are accurate and complete; b. Those statements are based upon representations you made to us; and C. We have issued this policy in reliance upon your representations. The unintentional omission of, or unintentional error in, any information provided by you which we relied upon in issuing this policy will not prejudice your rights under this insurance, However, this provision does not affect our right to collect additional premium or to exercise our rights of cancellation or nonrenewal in accordance with applicable insurance lags or regulations. 7. Separation Of Insureds Except with respect to the Limits of Insurance, and any rights or duties specifically assigned in this Coverage Part to the first Named Insured, this insurance applies: a. As if each Named Insured were the only Named Insured; and b. Separately to each insured against whom claim is made or "suit" is brought. Transfer Of Rights Of Recovery Against Others To Us If the insured has rights to recover all or part of aiy payment we have made under this Coverage Part, those rights are transferred to us. The insured must do nothing after loss to impair then. At our request, the insured will bring "suit" or transfer those rights to us and help us enforce them. 9. When We Do Not Renew If we decide not to renew this Coverage Part, we will mail or deliver to the first Named Insured shown in the Declarations written notice of the nonrenewal not less than 30 days before the expiration date. If notice is mailed, proof of mailing will be sufficient proof of notice. SECTION V — DEFINffIONS 1. "Advertisement" morns a notice that is broadcast or published to the general public or specific market segments about your goods, products or services for the purpose of attracting customers or supporters. For the purposes of this definition: C. The first Named Insured must keep records of a. Notices that are published include material the infcrmaticn we need for premium placed on the Internet or on similar electronic computation, and send us copies at such times means of communication; and as we may request. b. Regarding websites, only that part of a website 6. Representations that is about your goods, products or services By accepting this policy, you agree: for the purposes of attracting customers or supporters is considered an advertisement_ Page 16 of 21 0 2017 The Travelers Indemnity Company. All rights reserved. CG T1 00 02 19 Includes copyrighted material of Insurance Services Office, Inc. with its permission. AdW WORKERS COMPENSATION TRAVELERSJ AND ONE TOWER SQUARE EMPLOYERS LIABILITY POLICY HARTFORD CT 06183 ENDORSEMENT WC 99 03 76 ( A) - 003 POLICY NUMBER: UB-OL217107-20-14-0 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA (BLANKET WAIVER) 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. The additional premium for this endorsement shall be 2.00 % of the California workers' compensation pre- mium. Schedule Person or Organization ANY PERSON OR ORGANIZATION FOR WHICH THE INSURED HAS AGREED BY WRITTEN CONTRACT EXECUTED PRIOR TO LOSS TO FURNISH THIS WAIVER. INCLUDING: (CONTINUED FROM WC 99 03 76 1 A) - 002) VALLEY, CA 93065. LOCATION- HERMES OF PARIS; 1 WORLD WAY; LAX AIRPORT TBIT; LOS ANGELES, CA 90045 Job Description This endorsement changes the policy to which it is attached and is effective 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 Insured Insurance Company Policy No. Countersigned by Endorsement No. Premium DATE OFISSUE: 08-04-20 ST ASSIGN: Page 1 of 1