Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
PROOF OF INSURANCE (2022) CLOSED
CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 2/1 /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 Arthur J. Gallagher Risk Management Services, Inc. 46179 Westlake Dr #300 Sterling VA 20165 INSURED PUBSAFE-01 wruSURER B: isuRERc: AGE Proters ert a&Lloy C sual Lqndon Insu ante Co— _---- 21230 Center for Public Safety Excellence Inc � '�""""""��---m'' 4501 Singer Court_..._._......W..........____.P_....Y... ..__..______!.... 0699 Suite 180 IN.S..RE—RD .. Chantilly VA 20151 ........ _______._..... _._____.�__.............._. � ........ INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 1982156824 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 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, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICY EFF IxI.. POLICY EXP...I..........,..,.,...........,.,.,....... _....._.........._._, tNSR .,,,,,. __... _ ..._..... ...�diOLI...................... _._ ------ LTR TYPE OF INSURANCE V POLICY NUMBER MMIDDIY'YYY V MMMDNYYY LIMITS c X COMMERCIALGENERALLIABILITY Y D52182463 1/1/2021 1/1/2022 EACH OCCURRENCE $1,000,000 .... ......, CLAIMS %� OCCUR $ 1,000 000 -MADE EM POSES, tea pggk! rent . ___.... —...-- MED EXP (Any one person) $10 000 _ PERSONAL &ADV INJURY ''.. $ 1,000,000 GENT N L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2 000 000 POLICY ❑ PJE 'RO- T n LOG PRODUCTS- COMP/OP AGG $ 2,000 000 OTHERr. 1 $ C .A.UTOMOBILEUABILITY .,. D52182463 1Hl2021 1/112022 C04uNiIN D INGLEu_UMbT .9 tl ue 11,000,000 �....,..... ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY INJURY (Per accident) $ .,,. X AUTOS ONLY l ` AUTOS HIRED X 1 NON -OWNED BJROPER3YDAMAGE $ AUTOS ONLY AUTOS ONLYpaEdd+,3sLC, -- ... C X UMBRELLALIA13 X OCCUR UMBD52182505 1/1/2021 1/1/2022 EACHOCCURREN C� 1,000000 EXCESS LIAR CLAIMS -MADE AGGREGATE $1,000,000 ..J'._... � DED RETENTION $ $ A WORKERS COMPENSATION 2271765862 1/1/2021 1/1/2022 X I I EORH AND EMPLOYERS' LIABILITY Y / N ,,,,„$ATUT,_,l„„, . ____. ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? NIA E L EACH ACCIDENT $ 1 000,000 (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If DESCdescribe RIPTION under OPERATIONS below E,L.,_��.......... POLICY ............... DISEASE-P C m^...---^.—_..�.._...................,.., ''....$1,000,000 B Professional Liability MPL4355074.21 1/1/2021 1/1/2022 Errors & Omissions IiM 4 $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of El Segundo, it officials and employees are additional insured under the general liability on a primary basis as their interest may appear.; City of El Segundo 314 Main Street El Segundo CA 90245 USA 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 ©1933-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD CHUBS" NOTICE OF CANCELLATION TO SCHEDULED PERSONS OR ORGANIZATIONS (EXCEPT NON-PAYMENT OF PREMIUM) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE Person(s) Or Organization(s): City of Segundo Address: 314 Main Street El Segundo, CA 90245 Number Of Days Notice Of Cancellation: 30 Information required to c,omplete this Schedule, if not shown above, will be sho%vn in the Declarations. The following condition is added to Section III — Common Policy Conditions: NOTICE OF CANCELLATION TO SCHEDULED PERSONS OR ORGANIZATIONS (EXCEPT NON- PAYMENT OF PREMIUM) When we cancel this policy for any reason, other than non-payment of premium, we will notify the person(s) or organization(s) shown in the Schedule at least the number of days shown in the Schedule in advance of the effective date of cancellation. Any failure by us to notify such person(s) or organization(s) will not: 1. Impose any liability or obligation of any kind upon us; or 2. Invalidate such cancellation. All other terms and conditions of this policy remain unchanged. MS-5506 (ol/17) Includes copyrighted material of Insurance Services Office, Inc., Page i of i with its permission, P017 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13 (Ed. 4-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT 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.) This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule AS REQUIRED PER WRITTEN CONTRACT 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 01-01-21 Policy No. (22) 7176-58-62 Endorsement No. Insured CPSE, INC Premium $ Incl. Insurance Company Chubb Indemnity Insurance Company Countersigned By WC 00 03 13 (Ed. 4-84) 0 1983 National Council on Compensation Insurance. Insured Copy