PROOF OF INSURANCE (2021 - 2021) CLOSED.,,, 0 � DATE (MMIDD/YYYY)
A
(,,,,/RV CERTIFICATE OF LIABILITY I INSURANCE 12/9/2020
Ill
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS S 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 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 I NAME t,i Julie Rybak
Kellogg & Moreland Agency, Inc. DBA
Arroyo Insurance Services
1654 Plum Lane
Wry7
Redlands .. CA 9234-4532_ww.._.......,�,.
INSURED
Californ.l.a Street.. Lighting, A California Corp
3200 Guasti Road #100
PHONEg; FAX
(AFC, NaY:
Iv¢vl'va•a0an(909)79-
EMAIL
ADDRESS, j �ulier@arra Oiris.Com
_
.. ,.,....,,.,.
INSUREI AFFORDING COVERAGE ...__., .w.w...
NAIL R
INSURER A; Berkley Assurance Company
39462
INSURER B: United Financial Casualty Co.,._.....
,.. —1 1.1770
pINSURER c,Insurance Company of the West
127647
N'URERD:
INSURER E
Ontario CA 91761. INsuRERF:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS'1O CERTIFY THAT THE POLICIES OF INSURANCE LISTED BEI ..OW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FORTHE POLICY PERIOD
INDICATED. NO"I"WI I"HSTANDING ANY REQUIREMENT, TERM OR CONDI II OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT I'D \NHICH THIS
CERTIFICATE MAYBE 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 R,FDUCED BY PAID CLAIMS
INSR TYPE.. OF INSURANCE —TADDL SUBIR �. � POLICY' EFF (POLICY EXP � LIMITS
LTR ImoaVI) .., POLICY NUMBER YMMIDDIYYY'Y1 (MIMPDDNYYYY
....,. 1 DREMISE AMAGE TO F�'NMI C'E I �
X COMMERCIALGFNERALLIABILITY FA(,N Of"f'"UHHFN
��D
A
CLAIMS MADE X C7(1C.11lf"; GurrerwCeV I $
X Y I Vi7T3B0162533 12/1/2020 1.7./1/2021 MED, EXP' (A7 one person) I
�..... 1'rEl'iSUNA.LAAF)VINJURY S
GEN't AGC;t'aEGAI E LIMIT APPI,IFS P' R rx'EINERAI, A,GGR'I':GA'I F $
PRC0 LOC,
F(7t IC'r" 1FCT
_ 01 RLR
AUTOMOBILE LIABILITY ..
X ANYAU(O
ALI, O),W)rED SCt{fC1l)I.Tt,7 06588638-2
AUTOS I I AU'TCj5
NON O'd"NEO
X-11W'DAUTOS X AUTOS
UMBRELLA UAB OCCUR
A X EXCESS L.IAB Cum"films MADIF
DFD II RETENTION $ VUMB0162553
WORKERS COMPENSATION.... ...
AND EMPLOYERS' LIABILITY Y I N
ANY PROPRIETOfd'14rAR I NF IR'LF9LCl1TIVE ❑ N p A
OFFICEWMF'MHFR EXCLUDED? C (Mandatory in NH) Y wavE 50581'x8 00
if A ;scrb, under(7F-,5<:,(zilPtir,)t'J C)F OF''ERATVCIplS hmI¢�w
PROIDLIC;TS - C OMP)OP AGO 5
1-5
1,000,000
100, 000
Excluded
1,000,000
2,000,000
2,000,000
COMBNEU SINGLE L !MIT $ 1,000,000
!Fa aCf.Vd ertl ..._ ._................
BODILY' INJLRY Per Person) $
2/23/20,20 2/23/2021 BOfUILY' INJURY ;,Per accident) 1 $
l RO1P'ER'TY DAMAGt.:;
RP'er acidelnO
�$
1.2/1/2020 12/1/2021
12/1/2020 12/1/202.8
IEACH QCC:UHHENCF $ 2x000,000
AGGREGATE $ 2 , 000,000
XI PER STA.UIE 1 N
E EACH ACCIDENT 1 $
1 I:: 1. DISEASE , EA FMPI.OY'EE $
t;,,l. DISEASE- (POLICY I IMI I I $
DESCRIPTION OF OPERATIONS P LOCATIONS P VEHICLES (ACORD 101, Additional Remarks Schedule, r'nay to attached If mere apace is requlredl
"City of El Segundo, its officials, and employees are additional insureds per attached forms #CG201.0 &
#CG20371" Such insurance is primary per attached form #VCAS2035. Waiver of Subrogation applies per
attached formas #CG2404 & #WC990634� 30 days written notice of cancellation applies.
CERTIFICATE HOLDER
CANCELLATION
1,000,000
1,000,000
1,000,000
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City of El Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELBVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
City Clerk
350 Main Street, Room 5
El Segundo, CA 90245.3813 AUTHORu7EDREPRESENTATIVE
/
Ju1.i.. i?,za„sl r"JUl.,li; ()YU�r
C) 1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
INS025 ;2x141,'11)
COMMERCIAL. GENERAL LIABILITY
CG 20 10 12 19
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS - SCHEDULED PERSON OR
ORGANIZATION,
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL. UAMLITY COVERAGE PART
SCHEDULE
Narne Of Additional Insured Person(s)
Or Organization(s) �R�Afion(s) Of Covered Qpe,rat.ionis-
As required by written contract executed prior
to the date of occurrence but only to the extent
pern,iitted by law. 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.
As designated in written contract with the Named
Insured.
.. . . . ... . ... ......
Information r -qLjired to complete this Schedulle, if not shown above, will be shown in the Declarations.
A, Section 11 — Who Is An Insured ts amended to
include as an additional insured the person(s) or
orgw)ization(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 perforrnance 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. it coverage provided to the additional insured is
required by a contract or agreement, tne
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 12 10 Q Insurance Services Office,, Inc,, 2018 Page 1 of 3
R 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
inpury 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.
Page 2 of 3 (0 Insurance Services Office, 4)c,, 201,8 CG 20 10 12 19
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 ir)SUred is
required by a contract or agreement, the most we
w1H pay on behalf of the additional insured is the
arnOUnt of insurance!,
1.. Required by the contract or agreement" or
2, Available under the applicable imits of
insurance;
whichever is less.
This endorsernent shall not increase the
applicable 1':imits of insurance.
GG 20 10 12 19 (0 lnSL0'af)Ce Services Office, Inc,, 20,1118 Page 3 of 3
POLICY NUMBER: VU�IB0162533
COMMERCIAL GENERAL LIABILITY
CG 20 37 12 19
A
0 Mel 0 11 Z f.A' to 01 a IVA
This endorsement modifies dnsurance provided under the following:
COMMI" RCIAL GENERAL, LIABILITY COVERAGE PART
PRO[)6i',TS/COMPLETED OPERATIiONS LIABILITY COVERAGE PART
rlffm�
ante Of Additional Insured Person(s)
Or Location And Descri lot 0 Completed Oper tions
�seiignated in written contra"ict with the Named
As reqoired by written contract executed prior Insured,
to the date of occurrence but only to the extent
permitted by law and the insurance afforded to
such additional insured will not be broader than
that wrich you are required by the contract or
agreement to provide for sizadditional insured.
Inform n required to cora �_Schedule, if not shown above, will be shown in the Declarations,
A, Section If - 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 coinage" 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 msured and included
in the "products -completed operations hazard",
However. -
1, 'the Insurance afforded to such addificnail
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 12 19 0 Insurance Services Office, inc., 2018 Page 1 of 2
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 the, additional insured is
required by a contract or agreement, the most we
will pay on behalf of the additional insured is the
arnount of insurance;
I. Required by the contract or agreerylentr1 or
2. Available under the applicable limits of
insurance
whichever is Iess.
This endorsement shall not increase the
applicable limits of insurance,
Page 2 of 2 @ Insurance Services Office, Inc., 2018 CG 20 37 12 19
This endorsenient rnodifies ir)SUrance provided Under the following:
COMMEF�ClAt. GI,,.`NERAL LIABILITY COVERAGE
PRODUCTS/C OMPI.E MID OPERATIONS LIABILII-Y COVERAGE
With respect to coverage provided to an additional insured via attachment of an Additional Insured endorsement to
tNs policy, such coverage is, primary insurance and we will riot seek contribution from any other insurance available
to that additional insured.
11:ii;; T9.1 �*MMIZIH'11[ Mll��
10
VCA 03 11 10 Page 1 of 1
POLiCY NUMBER: VI)MBOI,62533 COMMERCIAL GENERAL LIABILITY
C�G 24 04 12 19
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
WAIVER OF TRANSFER, OF RIGHTS OF RECOVERY
AGAINST OTHERS TO US (WAIVER OF SUBROGATION)
f'his endorsement modifies insurance provided under trw following;
COMMERCIAL GENERAL LIABILITY COVERAGE PART
ELECTRONIC DATA LIABILITY COVERAGE PART
LIQUOR LIABILITY COVERAGE PART
POLLUTION LIABILITY COVERAGE PART DESIGNATED SITES
POLLUTION LIABILITY LIMITED COVERAGE PART DESIGNATED SF'f1.S
PRODUCTSICO,MPLETED OPERATIONS LIABILITY COVERAGE PART
RAILROAD PROTECTIVE LIABILITY COVERAGE PART
UNDERGROUND STORAGE TANK POLICY DESIGNATED 1"ANKS
SCHEDULE
Name Of Person(s) Or Organization(s):
Any person or organization to whom or to which you are obligated by virtue of a written corittact to waiver your
right of recovery.
.... . ... ............ . .. ......
Inforniation reqyired to complete this Schedule, if riot shown above, will be shown in the 0eclaratiorls.
Jhe following is added to Paragraph 8. Transfer Of
Rights Of Recovery Against Others To Us of
Section IV — Conditions:
We waive any nght of recovery against the person($)
or organization(s) shown in the Schedule above
because of payments we make under this Coverage
Part Such waiver by us, applies only to the extent that
the insured has waived its right of recovery against
such person(s) or or"ganization(s) prior to loss, This
endorsement applies on4y to the person(sy or
organization(s) shown in the Schedule above,
CG 24 04 12 19 Insurance Services Office, Inc., 2018 Page 1 of 1
Ll
Irol"till
We have the right to recover our payments from anyone liable, for an injury covered by (his policy, We will not enforce
our right against the person or organization nailed in, the Schedule, (This agreement applies only to the extent that
you perfonn work Under a written contract that requires you to obtain this agireiennt from us).
The additional preffliL11'r) for this endorsement shall be
otherwise due
mom
2 % of the total Cafttnia Workers' Compensation premium
Schedule
,Job Description
ALL CA OPERATIONS
I'his endorsenvrit changes the policy Co 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.)
Endorsery-L,nt Effective 12/1/20 Policy No. WVE 5058158 00 Endorsement No,
Insured CALIFORNIA STREET LIGII.T."ING Prerniurn $ INCL.
insurance Company INSURANCE COMPANY OF THE NEST
Countersigned By
WC 99 016 34
(Ed. 8-W)
vSuRED