Loading...
PROOF OF INSURANCE (2021) CLOSEDENVISCI-05 MCGRAWM AC vKL! CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) `.�• 1112512020 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 License # OE67768 CONTACT Ali Smith NAME: IOA Insurance Services PHONE FAX 4370 La Jolla Village Drive (A/C, No, Ext): (619) 788-5795 50206 (A/C, No):(619) 574-6288 E-MAIL Suite 600 ADDRESS: Aii.Smith@ioausa.com San Diego, CA 92122 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: RLI Insurance Company 13056 INSURED INSURER B: Crum & Forster Specialty Insurance Company 44520 Environmental Science Associates I INSURER C: 5309 Shilshole Ave. NW #200 INSURER D: Seattle, WA 98107 INSURER E I INSURER F: COVERAGES CERTIFICATE NUMBER: 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 CONTRA:T OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLIC ES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH DOLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY 'AID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD (MM/DD/YYYYI (MM/DD/YYYYI A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,0001 CLAIMS -MADE OCCUR X X PSB0007416 X Cont Liab/Sev of Int X XCU GEN'L AGGREGATE LIMIT APPLIES PER: PRO El LOC POLICY � JECT OTHER A AUTOMOBILE LIABILITY X ANY AUTO X X PSA0002468 OWNEDSCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY X Comp.: $1,000 X Coll.: $1,000 A X UMBRELLA LIABX OCCUR EXCESS LIAB ILII CLAIMS -MADE PSE0003196 DED I X I RETENTION $ 10,000 A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y X PSW0004135 ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? N / A (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below B Prof Liab/Ded. $25K PKC110515 B Poll Liab/Ded. $25K PKC110515 12/1/2020 12/1/2021 DAMAGE TO RENTED PREMISES (Ea occurrence) $ MED EXP (Anv one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ Deductible $ COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ EACH OCCURRENCE $ 12/1/2020 12/1/2021 AGGREGATE $ IXI STATUTE EERH 12/1/2020 12/1/2021 E.L EACHACCIDENT $ 12/1/2020 12/1/2021 12/1/2020 12/1/2021 E.L DISEASE - EA EMPLOYEE $ E.L DISEASE -POLICY LIMIT $ Per Claim/Aggregate Occurrence/Aggregate DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: All Operations 1,000,000 10,000 2,000,0001 4,000,0001 4,000,0001 OI 1,000,0001 3,000,000 3,000,000 1,000,000 1,000,000 1,000,000 5,000,000 5,000,000 City of EI Segundo is Additional Insured with respect to General and Auto Liability per the attached endorsements as required by written contract. Insurance is Primary and Non -Contributory. Waiver of Subrogation applies to General Liability, Auto Liability and Workers' Compensation. 30 Days Notice of Cancellation with 10 Days Notice for Non -Payment of Premium in accordance with the policy provisions. CERTIFICATE HOLDER 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. AUTHORIZED REPRESENTATIVE City of Segundo t 350 Main Street oar EI Seaundo. CA 90245-3813 ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Named Insured: Environmental Science Associates RLI Insurance Company Policy Number: PSBUUO7418 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ |TCAREFULLY. RUPacko FOR PROFESSIONALS BLANKET ADDITIONAL INSURED ENDORSEMENT This endorsement modifies insurance provided under the following: 8US|NESSUVVNER8COVERAGE FORM - SECTION U—LIABILITY C. WHO IS AN INSURED haamended 8o include as onadditional insured any person ororganization that you agree in a contract or agreement requiring insurance 0oinclude asanadditional insured onthis po|iuy, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury' caused in whole or in part by you orthose acting onyour behalf: a. |nthe performance ofyour ongoing opemUone� b. In connection with premises owned by or nan1nd nmyou; or o. In connection with "your work" and included within the "product -completed operations hazard" 2. The insurance provided tothe additional insured by this endorsement is limited as follows: a. This insurance does not apply on any basis to any person or organization for which coverage omanadditional insured specifically isadded by another endorsement tothis policy. b. This insurance does not apply tothe rendering of or failure to render any "professional c. This endorsement does not increase any of the limits of insurance stated in D. Liability And Medical Expenses Limits ofInsurance. 3, The following is added to SECTION U| H.2. Other Insurance — COMMON POLICY CONDITIONS (BUT APPLICABLE ONLY TO SECTION N — LIABILITY) Howaver, if you specifically agree in a contract or agreement that the insurance provided to an additional insured under this policy must apply on m primary bosis, or a primary and non-contributory bosim, this insurance is primary to other insurance that is swmi|mb|a to such additional insured which covers such additional insured asanamed insured, and we will not share with that other insurance, provided that: a. The 'bodily injury" m"property damage" for which coverage is sought occurs after you have entered into that contract oragreement; or b. The "personal and advertising injury" for which coverage is sought arises out of an offense committed after you have entered into that contract oragreement. 4. The following is added to SECTION U| K. 2. Transfer ofRights of Recovery Against Others to Us — COMMON POLICY CONDITIONS (BUT APPLICABLE TO ONLY TO SECTION U — U/\B|L|7Y) We waive any rights of recovery we may have against any person or organization because of payments we make for "bodily injury", ''property damage" or"personal and advertising injury" arising out of ''your work" performed by you, or on your boho|f, under e contract or agreement with that person or organization. We waive these rights only where you have agreed to do mo as part of a contract or agreement with such person or organization entered into by you before the "bodily injury' ar"property damage" occurs, orthe "personal and advertising injury" offense iocommitted. ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED. PPB 304 02 12 Page 1 of 1 Named Insured: Environmental Science Associates Policy Number.- PSAD002468 BUSINESS AUTO COVERAGE FORM A. Broad Form Named Insured The following is added to the SECTION U — COVERED AUTOS LIABILITY COVERAGE, Para- graph A.1.Whm|sAn|nsuredProvis|on: Any business entity newly acquired orformed byyou during the policy period, provided you own fifty percent (GO94)urmore ufthe business entity and the business entity ianot separately insured for Qun'ineon Auto Coverage. Coverage is extended up to a maximum ufone hundred eighty (18O)days following the acquisition urformation ofthe business entity. This provision does not apply to any person or organization for which coverage is excluded by endorsement. B. Employees AmInsureds The following is added to the SECTION U — COVERED AUTOS LIABILITY COVERAGE, Para- graph A.f.Who|s^An|nsunedProvioion: Any ~mmp|nyeo''ofyours iomn"insurad"while using a covered ^auto^you don't own, hire orborrow inyour business oryour personal affairs. C. Blanket Additional Insured The following is added to the SECTION U — COVERED AUTOS LIABILITY COV2RAG2, Para- graph A.I. Who Is An Insured Provision: aroQnaph/ki.VVho|a/kninaunedProxoion: Any person or organization that you are required to include 000nadditional insured onthis coverage form in a contract or agreement that is executed by you before the "bodily injury" or"property damage" occurs is an "insured" for liability covonage, but only for damages towhich this insurance applies and only to the extent that person ororganization qualifies aoon "insured" under the Who Is An Insured provision contained in SECTION i| — COVERED AUTOS LIABILITY COVERAGE. The insurance provided bnthe additional insured will be on a primary and non-contributory basis tothe additional inxunyd'm own business auto coverage if you are required to do so in a contract oragreement that is executed by you before the "bodily injury" or ^pnxpertydamage" occurs. D. Blanket Waiver Of Subrogation The following is added to the SECTION N/ — BUSI- NESS AUTO CONDITIONS, A.Loss Conditions, 5. Transfer Of Rights Of Recovery Against Others To Us: VVewaive any right ofrecovery wemay have against any person or organization to the extent required of you byocontract executed prior toany ^nooidmnt"o, ^|omn^,provided that the "aocidmrt"or"|ono"arises out PPA 300 03 13 of the operations contemplated bysuch contract. The waiver applies only to the person or organization designated in such contract. E. Employee Hired Autos 1. The following is added to the SECTION U — COVERED AUTOS LIABILITY COVERAGE' Paragraph A.1.Who IaAn Insured Provision: An ^ornp|oyoe^ of yours is an "insured" while operating an "auto" hired or rented under o contract oragreement inthat "emp|nyee'o^name, with your permimsion, while performing duties related tothe conduct ofyour business. 2. Changes |nGeneral Conditions: Paragraph 6.b. of the Other Insurance Con- dition in the BUSINESS onditionintheBUS|NE8S AUTO CONDITIONS is deleted and replaced with the following: b. For Hired Auto Physical Damage Coverage, the following are deemed to be covered ~au1os"you own: (1) Any covered "auto" you |omse, hime, rent or borrow; and (2) Any covered "auto" hired or rented by your "employme"under ocontract inthat individual "employee's" name, with your permission, while performing duties related to the conduct of your business. However, any "outo"that isleased, hired, rented orborrowed with a driver is not covered "auto", F. Fellow Employee Coverage SECTION N — COVERED AUTOS LIABILITY COVERAGE, Exclusion B.5. does not apply if you have workers compensation insurance in -force covering all ofyour employees. G. Auto Loan Lease Gap Coverage SECTIONN—PHYSkCAL DAMAGE COVERAGE. C.Limit OfInsurance, iaamended bythe addition of the following: |nthe event ofatotal "|oaa"toacovered "auto"shown in the Schedule of Doclora*ions, we will pay any unpaid amount due onthe lease orloan for acovered 1. The amount paid under the PHYSICAL DAMAGE COVERAGE section cfthe policy; and 2. Any: a' Overdue lease/loan payments atthe time nf WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 4-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT—CALIFORNIA 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. Person or Organization Schedule Job Description All persons or organizations that are party to a contract that Jobs performed for any person or organization that you requires you to obtain this agreement, provided you executed have agreed with in a written contract to provide this the contract before the loss. agreement. 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.) Named Insured: Environmental Science Associates Policy Number: PSWO004135 Insurance Company: RLI Insurance Company Countersigned By 01898 by the Workers' Compensation Insurance Rating Bureau of California. All rights reserved.