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PROOF OF INSURANCE (2021 - 2021) CLOSED
Client#: 1252713 305STRADYOC ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 1 01/26/2021 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER McGriff Insurance Services 2400 E KateIla Ave Suite 1100 Anaheim, CA 92806 CONTACT Kimberly Elfring PHONE 714 941-2822 FAX Anna Lo, Ext : (A/c, No): 877 297-9247 ADDRESS: kelfring@McGriffinsurance.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Vigilant Insurance Company 20397 INSURED Stradling Yocca Carlson & Rauth APC 660 Newport Center Drive, Suite #1600 Newport Beach, CA 92660 INSURER B: Federal Insurance Company 20281 INSURER C INSURER D : INSURER E 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 CONTRACTOR 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. LTR TYPE OF INSURANCE NSRLSUBR WVD POLICY NUMBER POLICY EFF (MM/DDIYYYY) POLICY EXP (MM/DDIYYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY X 35327003 05/01/2020 05/01/2021 EACH OCCURRENCE $1,0003000 CLAIMS -MADE [* OCCUR PREMISES (Ea RENTED ) $130003000 MED EXP (Any one person) $103000 PERSONAL & ADV INJURY $130003000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY JECTPRO- LOC PRODUCTS - COMP/OPAGG $INCLUDED $ OTHER: B AUTOMOBILE LIABILITY 74988851 05/01/2020 05/01/2021 (CEO acccldenI)S LE LIMIT $130003000 BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ X HIRED NON -OWNED AUTOS ONLY X AUTOS ONLY $ B X UMBRELLA LAB X OCCUR 79726620 05/01/2020 05/01/2021 EACH OCCURRENCE s27,000,000 AGGREGATE s27,000,000 EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ N / A X 2071700994 11/03/2020 11/03/2021 X STATUTE EERH E.L. EACH ACCIDENT $130003000 E.L. DISEASE - EA EMPLOYEE $130003000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $130003000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) ************************* SUPERSEDES CERTIFICATE PREVIOUSLY ISSUED ON 1/24/2021 ************************** RE: Contract Agreement Certificate Holders name is amended to include: City of El Segundo its officials, and employees. Certificate holder is included as Additional Insured including Primary/Noncontributory wording with respects to General Liability as required by written contract, per form attached. Waiver of Subrogation (See Attached Descriptions) a:I11aLh6\I=§:Lei 11111a:I City of El Segundo Attn: Administrative Technical Specialist 350 Main Street El Segundo, CA 90245 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 ACORD 25 (2016/03) 1 of 2 #S27245309/M25661207 © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD KSELF DESCRIPTIONS (Continued from Page 1) applies to Workers Compensation per form attached. 60 Day Notice of Cancellation/Nonrenewal (20 Day in the event of non-payment) applies per form attached. SAGITTA 25.3 (2016/03) 2 of 2 #S27245309/M25661207 Liability Insurance Endorsement Policy Period 05/01/2020 05/01/2021 Effective Date Policy Number 35327003 Insured Stradling Yocca Carlson & Rauth APC Name of Company VIGILANT INSURANCE COMPANY Date Issued This Endorsement applies to the following forms: GENERAL LIABILITY Under Who Is An Insured, the following provision is added. Who Is An Insured Additional Insured - Scheduled Person Or Organization Liability Insurance Persons or organizations shown in the Schedule arc insureds; but they arc insureds only if you arc obligated pursuant to a contract or agreement to provide them with such insurance as is afforded by this policy. However, the person or organization is an insured only: • if and then only to the extent the person or organization is described in the Schedule; • to the extent such contract or agreement requires the person or organization to be afforded status as an insured; • for activities that did not occur, in whole or in part, before the execution of the contract or agreement; and • with respect to damages, loss, cost or expense for injury or damage to which this insurance applies. No person or organization is an insured under this provision: • that is more specifically identified under any other provision of the Who Is An Insured section (regardless of any limitation applicable thereto). Additional Insured - Scheduled Person Or Organization Form 80-02-2367 (Rev. 5-07) Endorsement continued Page 1 Who Is An Insured Additional Insured - with respect to any assumption of liability (of another person or organization) by them in a Scheduled Person contract or agreement. This limitation does not apply to the liability for damages, loss, cost or Or Organization expense for injury or damage, to which this insurance applies, that the person or organization (continued) would have in the absence of such contract or agreement. Under Conditions, the following provision is added to the condition titled Other Insurance. Conditions Other Insurance — If you are obligated, pursuant to a contract or agreement, to provide the person or organization Primary, Noncontributory shown in the Schedule with primary insurance such as is afforded by this policy, then in such case Insurance — Scheduled this insurance is primary and we will not seek contribution from insurance available to such person Person Or Organization or organization. Schedule Persons or organizations that you are obligated, pursuant to a contract or agreement, to provide with such insurance as is afforded by this policy. All other terms and conditions remain unchanged. Authorized Representative Liability Insurance Additional Insured - Scheduled Person Or Organization Form 80-02-2367 (Rev. 5-07) Endorsement last page Page 2 Stradling Yocca Carlson & Rauth APC 35327003 CHUBB® Conditions Audit Of Books And Records Common Policy Conditions Contract The following Conditions are included under each part of the policy, unless stated otherwise. We may audit your books and records as they relate to this insurance at any time during the term of this policy and up to three years afterwards. ....................................................................................................y.......................P......y............::::::::::::::..:g ............ Y.::::::.:: Cancellation The first named insured ma cancel this olic or an of its individual covera es at antime b sending us a written request or by returning the policy and stating when thereafter cancellation is to take effect. We may cancel this policy or any of its individual coverages at any time by sending to the first named insured a notice 60 days (20 days in the event of non-payment of premium) in advance of the cancellation date. Our notice of cancellation will be mailed to the first named insured's last known address, and will indicate the date on which coverage is terminated. If notice of cancellation is mailed, proof of mailing will be sufficient proof of notice. The earned premium will be computed on a pro rata basis. Any unearned premium will be returned as soon as practicable. ....................................................................................................::::::::::::::::::::::::::: Changes This policy can only be changed by a written endorsement that becomes part of this policy. The endorsement must be signed by one of our authorized representatives. ::..............................................................................................................................................................:...:.:.::.:::::.::::::::.::::.:::::::::::::.::::::::::::::::::::::::::::::::......:::::::.: Compliance By Insureds We have no duty to provide coverage under this policy unless you and any other involved insured have fully complied with all of the terms and conditions of the policy. .................................................................................................................................................................................................................................................................................. .................................................................................................................................................................................................................................................................................. .................................................................................................................................................................................................................................................................................. .................................................................................................................................................................................................................................................................................. Compliance With This insurance does not apply to the extent that trade or economic sanctions or other laws or Applicable Trade regulations prohibit us from providing insurance. Sanctions ................................................................................................................................................................................................................................................................................. . ................................................................................................................................................................................................................................................................................. . ................................................................................................................................................................................................................................................................................. . ................................................................................................................................................................................................................................................................................. . ................................................................................................................................................................................................................................................................................. . Conformance Any terms of this insurance which are in conflict with the applicable statutes of the State in which this policy is issued are amended to conform to such statutes. ................................................................................................................................................................................................................................................................................. . ................................................................................................................................................................................................................................................................................. . ................................................................................................................................................................................................................................................................................. . First Named Insured The person or organization first named in the Declarations is primarily responsible for payment of all premiums. The first named insured will act on behalf of all other named insureds for the giving and receiving of notice of cancellation or nonrenewal and the receiving of any return premiums that become payable under this policy. ................................................................................................................................................................................................................................................................................. . ................................................................................................................................................................................................................................................................................. . ................................................................................................................................................................................................................................................................................. . Inspections And Surveys We may: make inspections and surveys at any time; give you reports on the conditions we find; and recommend changes. Common Policy Conditions Form 80-02-9090 (Rev. 6-05) Contract Page 1 of Conditions Inspections And Surveys Any inspections, surveys, reports or recommendations relate only to insurability and the premiums (continued) to be charged. We do not make safety inspections. We do not undertake to perform the duty of any person or organization to provide for the health or safety of workers or the public. And we do not warrant that conditions: are safe or healthful; or comply with laws, regulations, codes or standards. This condition applies not only to us, but also to any rating, advisory, rate service or similar organization which makes insurance inspections, surveys, reports or recommendations for us. .................................................::::::The titles of the .::::::ara:.r.ri.::.ofilic::::.:..:::::::::::::::::if.:::::......::::.::::::...:... :1:::::................. Titles Of Paragraphs variousp gaps th s po y and endorsements, any, attached to this policy are inserted solely for convenience or reference and are not to be deemed in any way to limit or affect the provisions to which they relate. .................................................................................::::..Q:::::.................................................................................................................................................................................... Transfer Of Rights And Your rights and duties under this insurance may not be transferred without our written consent. Duties However, if you die, then your rights and duties will be transferred to your legal representative, but only while acting within the scope of duties as your legal representative, or to anyone having temporary custody of your property until your legal representative has been appointed. ........................................................................ ...................... .................................................................................................................................................::::::.::::::..................... When We Do Not Renew If we decide not to renew this policy, we will mail or deliver to the first named insureds last known address, written notice of the nonrenewal not less than 60 days before the expiration date. If notice of nonrenewal is mailed, proof of mailing will be sufficient proof of notice. Common Policy Conditions Form 80-02-9090 (Rev. 6-05) Contract Page 2 of 2 Workers' Compensation and Employers' Liability Policy Named Insured Endorsement Number Stradling Yocca Carlson & Rauth APC Policy Number Symbol: Number: 2071700994 Policy Period Effective Date of Endorsement 11/03/2020 TO 11/03/2021 Issued By (Name of Insurance Company) Vi ilant Insurance Company Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the polic . CALIFORNIA WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement applies only to the insurance provided by the policy because California is shown in Item 3.A. of the Information Page. 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, but this waiver applies only with respect to bodily injury arising out of the operations described in the Schedule, where you are required by a written contract to obtain this waiver from us. You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. Schedule 1. (❑) Specific Waiver Name of person or organization Any person or organization where you are required pursuant to a written contract or agreement to waive rights of subrogation against such person or organization. (®) Blanket Waiver Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. 2. Operations: 3. Premium: The premium charge for this endorsement shall be 1 % percent of the premium developed on payroll in connection with work performed for the above person(s) or organization(s) arising out of the operations described. 4. Advance Premium: Authorized Representative WC 90 03 75 (05/18) This page has been left blank intentionally.