Loading...
PROOF OF INSURANCE (2021 - 2022) CLOSEDDATE (MM/DDIYYYY) R..J"YF'4.L CERTIFICATE OF LIABILITY INSURANCE 01/28/2021 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 rights to the certificate holder In lieu of such endorsement(s). PRODUCER NAME, , CONTACT Blanca De La Hoz Insurance Danmar Services Inc. PHONE (951) 509-0509 (951) 509.0; 15(951) 509 05'15FAX A/C No x ANe License # OD36873 E-MAII. blancad@danmarins.com ADDR9899 Indiana Avenue, Ste 101 INSURER(S) AFFORDING COVERAGE NAIC # Riverside CA 92503 INSURERA: Travelers Property Casualty Cc of America 25674 LNsuRED INSURERS: Pacific Compensation Insurance Company 11555 Denn Engineers, Inc. INSURER C : OBE North America Insurance Group 3914 Del Amo BI., Ste 921 INSURER D c Torrance CA 90503 1INSURER F : COVERAGES CERTIFICATE NUMBER: CL2112809628 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 INSD POLICY NUMBER POLICY MM/DD/YYYY MMIDD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 � G1��������� PRISES'Eaoccanrrmnce) E'M $ 1000,000 CLAIMS -MADE OCCUR MED EXP (Any one person) $5,000 ''PERSONAL&ADVINJURY $ 1,000,000 A Y 680-9N963609-20-47 09/01/2020 09/01/2021 GEN'LAGGREGATE .LIMITAPPLIESPER: GENERAL AGGREGATE $ 2,000,000 PRO, ❑ POUCY JiE;CT LOC PRODUCTS -COMPIOPAGG 2,000,000 $ ' Employee dishonesty $ 75,000 OTHER AUTOMOBILE LIABILITY- COMBINED SING LE LIM.CT (Es, accident $ BODILY INJURY (Per person) $ ANYAUTO BODILY INJURY (Per accident) $ OWNED SCHEDULED AUTOSONLY AUTOS HIRED NON -OWNED - ER DAMAGE acrddant - $ AUTOS ONLY AUTOS ONLY(Par UMBRELLA LIAR OCCUR EACH OCCURRENCE $ AGGREGATE s EXCESS LIAB CLAIMS -MADE DED I I RETENTION $ $ WORKERS COMPENSATION /�. S ATUTE ERPER H. X AND EMPLOYERS' LIABILITY YIN .,„ENT$ 0,000 B ANY � NIA Y WA00725500 02/01I2021 02/01I2022 E,L.EACHACCIID EMPLOYEE $ 1,000,000 OFFICER/MEMBER EXCLUDED? L.�J M nCER/MinNHR/PARTNER/EXECUTIVE (Mandatory ) E.L. DISEASE -POLICY LIMIT 1,000,000 $ 0,000 If yes, describe under DESCRIPTION OF OPERATIONS below Each Claim 1,000,000 C Professional Liability ANE41960-01 11I07/2020 11/07/2021 Aggregate 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: As per Contract or Agreement on file with the insured. City of El Segundo Public Works Department, its officers elected and appointed officials employees and volunteers are included as additional insured on the General Liability policy CGD381 0915 endorsement attached. Workers Compensation Waiver of Subrogation endorsement WC990316. *WORKERS COMPENSATION POLICY RENEWED* SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of El Segundo, Public Works DepartmentAttn: Floriza Rivera ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street AUTHORIZED REPRESENTATIVE EI Segundo CA 90245„ �1D a ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED (ARCHITECTS, ENGINEERS AND SURVEYORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 1. The following is added to SECTION II — WHO IS AN INSURED: Any person or organization that you agree in a "written contract requiring insurance" to include as an additional insured on this Coverage Part, but: a. Only with respect to liability for "bodily injury", "property damage" or "personal injury"; and b. If, and only to the extent that, the 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 requiting Insurance" applies, or in connection with premises owned by or rented to you. The person or organization does not qualify as an additional insured: c. With respect to the independent acts or omissions of such person or organization; or d. For "bodily injury", "property damage" or "personal injury" for which such person or organization has assumed liability in a contract or agreement. The insurance provided to such additional insured is limited as follows: e. This insurance does not apply on any basis to any person or organization for which coverage as an additional insured specifically is added by another endorsement to this Coverage Part. f. This insurance does not apply to the rendering of or failure to render any "professional services". g. In the event that the Limits of Insurance of the Coverage Part shown in the Declarations exceed the limits of liability required by the "written contract requiring insurance", the insurance provided to the additional insured shall be limited to the limits of liability required by that "written contract requiring Insurance". This endorsement does not increase the limits of insurance described in Section III — Limits Of Insurance. h. This insurance does not apply to "bodily injury" or "property damage" caused by "your work" and included in the "products - completed operations hazard" unless the "written contract requiring insurance" specifically requires you to provide such coverage for that additional insured, and then the insurance provided to the additional insured applies only to such ""bodily injury" or "property damage" that occurs before the end of the period of time for which the "written contract requiring insurance" requires you to provide such coverage or the end of the policy period, whichever is earlier. 2. The following is added to Paragraph 4.a. of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: The insurance provided to the additional insured is excess over any valid and collectible other insurance, whether primary, excess. contingent or on any other basis, that is avallable to the additional insured for a loss we cover. However, if you specifically agree in the "'written contract requiring insurance" that this insurance provided to the additional 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 available to the additional insured which covers that person or organizations as a named insured for such loss, and we will not share with the other Insurance, provided that: (1) The "bodily injury" or "property damage" for which coverage is sought occurs; and (2) The "personal injury' for which coverage is sought arises out of an offense committed; after you have signed that "written contract requiring Insurance". But this insurance provided to the additional insured still is excess over valid and collectible other insurance, whether primary. excess, contingent or on any other basis, that is available to the additional insured when that person or organization is an additional insured under any other insurance. CG D3 81 0915 ® 2015 The Travolem Indemnity Oompamy, All rights resemod. Page 1 of 2 includes the copyrighted melodal of Insurance Servttos Olg'te, Ins., w Ah its permission COMMERCIAL GENERAL LIABILITY 3. The following is added to Paragraph 8.. Transfer Of Rights Of Recovery Against Others To Us, of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: We waive any right of recovery we may have against any person or organization because of payments we make for "bodily injury% "property damage" or "personal injury" arising out of 'your work" performed by you, or on your behalf, done under a "written contract requiring insurance" with that person or organization. We waive this right only where you have agreed to do so as part of the "written contract requiring insurance" with such person or organization signed by you before, and in effect when, the "bodily injury" or "property damage" occurs, or the "personal injury" offense is committed. 4. The following definition is added to the DEFINITIONS Section: "Written contract requiring insurance" means that part of any written contract under which you are required to include a person or organization as an additional insured on this Coverage Part, provided that the "bodily injury" and "property damage" occurs and the "personal injury" is caused by an offense committed: a. After you have signed that written contract; b. While that part of the written contract is in effect; and c. Before the end of the policy period. Page 2 of 2 0 2015 The Travelers Indemnity Company, Al nights reserved. CG D3 8109 15 Includes the copyrighted mateft or Insurance Services Office; Ina, with Its permission AC CERTIFICATE OF LIABILITY INSURANCE DAne/21i2OD "'' _ .W.... u _ _ ._.� _. _ _ n _. _ j THISCERTIFICATEISISSUEDASAMATTEROFINFORMATIONONLYANDCONFERSNORIGHTSUPONTHECERTIFICATEHOLDER.THISCERTIFICATEDOESNOTAFFIRMATIVELYORNEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTI FICATE 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 SU BROGATION IS WAIVED, subject to the terms and cond pions 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). Michael PRODUCER CONTACT . _ _ _., ........ _ P NAME: Mlchael P Delaney j r...... ' elaney(295BC5T) PHONE FpX 2340 Plaza Del Amo Ste 200 (A/c, N D EXT): 31 D 782 8566 (A/C, NO): 310-787-0039 E-MAIL Torrance CA 90501-3453 ADOREss: mdelaney@fannersage nl.com I NSURER(S) AFFORDING COVERAGE NAIL k INSURED. _. . ..�_..... INSURER A....._Truck Insurance EXCha,.. „' _.. . _... ..... i nge 21709 5 1 _. ...... ,,._... ....._. — ....., INSURERS: Farmers Insurance Exchange 21652 Mid , DENN ENGINEER INC I INSURERC Century Insurance 4`n mNTY F 21687 3914 DEL AMO BLVD STE 921 INSURER D: _. TORRANCE CA 90503 INSURERE INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS 15 TO CERTIFY THAT THE POLICIES OF INSURANCE L15TED BELOW HAVE BEEN ISSUED TO THE INSURED NAME ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TOALLTHE TERMS. EKLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, �. TYPE OF INSURANCE ADDTL SUER ........ .. POLICY EFF � POLICY EXP ._. ..__. .. . LTR ANCE INSD WVD POLICY NUMBER ,,.... � (MM/DD/YYYY) I (M1w1/DD/YYYYj ... 1r. ... a COMMERCIAL GENERAL LIABI LITY 1 1..,. I EAT`wHOCCURAADicf 6s i DM4AGETOAR NTErd S, 1 CLAIMS -MADE OCCUR - PR¢f,TILrES QEa Or,t,'Gn rencej i 1 I � � � � rrMECr E}tPtAnyawra trpl�oraj 15 ! f PEASONAL YAD'P IN)UP,v .ss N L AGI�RY GAITEILIMI;APPLIESPEr'I':' � f I GENERA'LAGG.LRE41ATE }s 1 ^ l PULN[Y PROJECT J LC,roC � } PRODUCTS C"OL1PY OP AG+" 5,, I f. L I:✓4 MMERd• ... I COMBINED5IN;NGLEM&PT , ARJTOMOBItE'#iABILtTb tEaaccldo 1p S 1,000,00R ANYAUTO BODILY INJURY (Perpoicmn) ..S f C%hVNEP.'9AUILTS SCHEMAED BOOIL'rINjURY(Peroccudentl'S C Or�NLN AUTOS y 6D666a01 i 00113/2020 D9C13 2021 ' 11IRED'4U'6'OS I NDrd•Ou"aNED PROPER7'N iruaro.DE h OINLYAUTOISONLY f �S CPtlr accident) UMBRELLA LIAS r OCCUR EACH'OCGURRENL.E 3 -. EXCESSUAS , CI.AIMS�MADE AGGREGATE. .. „w .,. DEO RE C IENIIC,N .— r WORKERS COMPENSATION .. _._ _,.... I PER AND EMPLOYERS'LIAaILITY STATUTE 1 OTHER 1a � M4YPROPRNETOrTPARTNER/ "$'P1 E L EACIIACCIDENT ExECUTlVEOF'FICFR/MEMB%rR N/A s IEXCLUDED? (Mandatory in NH) ,........} E L D5EA5E. EAE5P1OVFF If ,..r. OPERATIONS EL DISEASE- , POLICYLIM„r 1S i 1 DIT$0UPTION OFOPERATIONS/t.00AVONS/VE141CLtS (ACOAD 10 3, AddRloniW Remarks Schedule. maybe attached if more space Is requIred) ..._ .... ,.. ,...y IThe City of El Segundo, its D(1 CWS, elected ano appointed officials, employees and volunteers named as Additional Insured With respect to tiabilily aritsing out of �aulermobiies Owned. leased, hired or borrowed by or on behalf of the consultant Denn Engineers. Inc See attached Additional Insured Endorsement CA20480299 I CERTIFICATE HOLDER CANCELLATION _ Ci! of a unao Plu6ic or�i0e' rti�ir6hI - L EXPIRATION m - y g � SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION 350 Mein Street DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ElSegundo, CA 90245 AUTHORIZED REPRESENTATIVE ttn - IHoriza Rivera_ ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All Rights Reserved 31-1769 11-15 The ACORD name and logo are registered marks of ACORD POLICY NUMBER: 60666-50-17 Policy Period 9/13/20 to 9/13/21 CO►ri d,ERCIAL AUTO CA 20 49 02 99 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" under the Who Is An Insured Provi- sion of the Coverage Form. This endorsement does not alter coverage provided In the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indi- cated below. Endorsement Effective: 09/13/2020 Named Insured: ......em.� DENN ENGINEER INC Countersigned By: SCHEDULE Name of Person(s) or Organization(s); City of El Segundo Public'"t arks Department, 350 Main Street, El Segundo, CA 90245 (If no entry appears above, Information required to complete this endorsement will be shown in the Declarations as applicable to the endorsement.) Each person or organization shown in the Schedule is an "insured" for Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured Provision contained in Section II of the Coverage Form. The City of El Segundo, its officers, elected and appointed officials, employees and volunteers named as Additional Insured with respect to liability arising out of automobiles owned, leased, hired or borrowed by or on behalf of the consultant Denn Engineers, Inc. CA 20 48 02 99 Copyright, Insurance Services Office, Inc., 1998 Page 1 of 1 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY 11 `" cCo� - WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - ff CALIFORNIA A CopperPoint Insurance Company 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 otherwise due on such remuneration (minimum $50). Person or Organization City of E1 Segundo Public Works Department 350 Main Street E1 Segundo, CA 90245 3.00 % of the California workers' compensation premium Schedule Job Description Engineering work This endorsement changes the policy to which it is attached and is effective on the policy effective date unless otherwise stated. This endorsement, effective on 02-01-21 Policy Number WA-007255-00 of the Policy Effective Date 02-01-21 to 02-01-22 at 12:01 A.M. standard time, forms a part of Pacific Compensation Insurance Company NCCI Carrier Code 11555 Insured Name Denn Engineers (A Corp) Endorsement No. 1 ISSUED 01/28/21 AT 02:34 PM BY U59 Premium $ Countersigned at 1housand Oaks,c on gy: 2000-12-0119W Authorize Representative WC 99 03 16 (Ed 1-14)