Loading...
PROOF OF INSURANCE (2022 - 2022) CLOSEDPage 1 of 2 Fa DATE IN MIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 04/01/2021 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(les) 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 ri hts to the certificate holder in lieu of such endorsements ., PRODUCER CONTACTWillis Towers Watson Certificate Center AON 945-7378 1-888 467-237__. P.O. 26 C 30519Watson Northeast, Inc. D S 1 877 .., certifioates willis'.com .... —... .„_ c/a 26 Century Blvd E 7 8.... Nashville, TN 372305191 USA INSURERfS)AFFORDING COVERAGE __ NAICk INSURER A: Sompo America Insurance Company 11126 w.,............� .�� ... INSURED .� INSURERS: Travelers Property Casualty Company of Amaf 25674 ..... ..� Kyocera Document Solutions West, LLC """""""' '"' 14101 Alton Parkway ERC: Irvine, CA 92618 INSURER D : I INSURER.E. ...... - .......... ....m. INSURER F : COVERAGES CERTIFICATE NUMBER: W20612495 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. LIMITS OF INSURANCE POLICY NUMBER IMY/PAb(xY Y ILTRACfV' P X COMMERCIAL GENERALLIABILITY EACHOCCURRENCE 1,000 000 t I aT 5�a 1,000 000 CLAIMS -MADE XOCCUR _ A D BXPSAsan) 5, 000 Y Y CPL40361J0 04/01/2021 04/01/2022 1,000,000 PERSONAL & ADV INJURY 000, 000 ...._. AL AGGREGATE $ 2,000 0 CENI AGGREGATE LIMIT APPLIES PER: „„„„.µ [PRODUCTS-COMP/OPAGG z, 000 000 X POLICY JECT El LOC I $ 00 — I Is O'THER� AUTOMOBILE LIABILITY COMBINED S 111017.LIVif $ 1,000,000 X ANY AUTO BODILY INJURY (Per person) 1 $ A ACV41336K0 04/01/2021 04/01/2022 BODILY INJURY (Per accident) $ AUTOSP R09 PiTYDAPhIR�;6E.,, �HOWNED IRED ONLY NSCHEDULED ON OWNED (Per iodderil) AUTOS ONLY AUTOS ONLY X UMBRELLA LIAB X IOCCUR _.�.$ CPU41021VO .04/01/2021 04/Ol/2022�RENCE EXCESS LIAB CLAIMS -MADE AGGREGATE5,000,000� DED X RETENTION$ 10,000 WORKERS COMPENSATION X T.R'- L.Et? . ...AND .. �ANYPROPRIETORI/PAIRTBNEIR/EXECUTIVE TY YRN E„L.EACT 1 B LEACH ACCIDENT _ $ 1 000 000 OFFICER/MEMBER EXCLUDED? lIo NIA US-9N324130-21-14-G 01/01/2021 01/01/2022 0 (Mandatory In NH) E.L DISEASE EA EMPLOYEE( $ 1, 000, 00 EA.. DISEASE POLICY LIMI11 s, describe underT $„� 0 D SCRIPTION OF OPERATIONS below 1 i 3 I � DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached it more space is required) SCOPE OF WORK: Copier Sales, Leasing & Maintenance City of E1 Segundo with whom the Insured has agreed in written contract, agreement or permit is included as an Additional Insured with respect to liability arising out of the Insured's operations, personal property leased to the insured, premises owned or rented by, or temporarily occupied by the insured with permission of the owner. 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. City of El Segundo AUTHORIZED REPRESENTATIVE Attn: City Clerk 350 Main Street E1 Segundo, CA 90245-3813 01988-2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD an xo: 20920257 HATca: 2042621 2 of 5 27702 AGENCY CUSTOMER ID: LOC #: ACC>R& ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED Willis Towers Watson Northeast, Inc, Kyocera Document Solutions Went, LLC 14101 Alton Parkway POLICY NUMBER Irvine, CA 92618 See Page 1 CARRIER See Page 1 NAIC CODE g EFFECTI.._............ _...._._... See Page 1 VEDATE:See Page 1 AL;UtlU lUl (1U1Ut311U1) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SR ID: 20920257 BATCH:2042621 CERT: W20612495 POLICY NUMBER: CPL40361JO COMMERCIAL GENERAL LIABILITY CG20371219 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL _S OWNERS, _ LESSEESO CONTRACTORS - COMPLETED OPERATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations ANY PERSON OR ORGANIZATION WHERE COVERED PROPERTY YOU ARE OBLIGATED PURSUANT TO A WRITTEN CONTRACT OR AGREEMENT EXECUTED PRIOR TO A LOSS TO PROVIDE SUCH INSURANCE AS IS AFFORDED BY THIS POLICY. Information re aired to corn lete this Schedule, if not shown above, will be shown in the Declarations. CG 20 37 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 2 3 of 5 27702 A. Section II — 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 damage" 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 insured and included in the "products - completed operations hazard". However: 1. The insurance afforded to such additional 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. 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 amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable limits of insurance; whichever is less. This endorsement shall not increase the applicable limits of insurance. CG 20 37 12 19 © Insurance Services Office, Inc., 2018 Page 2 of 2 POLICY NUMBER: CPL40361JO COMMERCIAL GENERAL LIABILITY CG20101219 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. • �; � • �rir� f�Y f� r�w� • • awe: I This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Locations Of Covered Operations ANY PERSON OR ORGANIZATION WHERE COVERED PROPERTY YOU ARE OBLIGATED PURSUANT TO A WRITTEN CONTRACT OR AGREEMENT EXECUTED PRIOR TO A LOSS TO PROVIDE SUCH INSURANCE AS IS AFFORDED BY THIS POLICY. Information required to complete this Schedule, if not shown agove, wni ae shown in the veciaraiions. I CG 20 10 12 19 © Insurance Services Office, Inc., 2018 Pagel of 2 4 of 5 27702 A. Section II — Who Is An Insured is amended to B. include as an additional insured the person(s) or organization(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 performance 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 The acts or omissions of those acting on your behalf; 2. If coverage provided to the additional insured is required by a contract or agreement, the C. 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. 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 injury 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. 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 amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable limits of insurance; whichever is less. This endorsement shall not increase the applicable limits of insurance. CG 20 10 12 19 © Insurance Services Office, Inc., 2018 Page 2 of 2 POLICY NUMBER: CPL40361JO COMMERCIAL GENERAL LIABILITY CG24041219 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFEROF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGION) This endorsement modifies insurance provided under the 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 SITES PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART UNDERGROUND STORAGE TANK POLICY DESIGNATED TANKS SCHEDULE Nance Of Person(s) Or Organization(s): PARTIES WITH WHOM THE INSURED HAS ENTERED INTO A WRITTEN WAIVER AGREEMENT PRIOR TO THE DATE OF LOSS. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV — Conditions: We waive any right of recovery against the person(s) 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 organization(s) prior to loss. This endorsement applies only to the person(s) or organization(s) shown in the Schedule above. CG 24 04 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1 5 of 5 27702 ,,,�„��,�,,���"� WORKERS COMPENSATION AND ONE TOWER SQUARE EMPLOYERS LIABILITY POLICY HARTFORD, CT 06183 ENDORSEMENT WC 99 03 76 ( A) — 001 POLICY NUMBER: (YJUB-9N324130) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA (BLANKET WAIVER) 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. The additional premium for this endorsement shall be 02.00 % of the California workers' compensation pre- mium. Schedule Person or Organization Job Description ANY PERSON OR ORGANIZATION FOR WHICH THE INSURED HAS AGREED BY WRITTEN CONTRACT EXECUTED PRIOR TO LOSS TO FURNISH THIS WAIVER, INCLUDING KASHIWA FUDOSAN AMERICA, INC., METRO PROPERTIES, LLC TAK DEVELOPMENT, INC RIVERROCK REAL ESTATE GROUP, INC. 395/400 OYSTER POINT BOULEVARD SOUTH SAN FRANCISCO, CA 94080 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 Policy No. Endorsement No. Insured Premium Insurance Company Countersigned by DATE OF ISSUE: 01-15-20 ST ASSIGN: Page 1 of 1