Loading...
PROOF OF INSURANCE (2021 - 2022) CLOSEDDATE (MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 1 312212021 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 INSUREII 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 terns 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 Bolton & Company CAME CONTACT ,,,, ,,, _ 3475 E. Foothill Blvd., Suite 100 PHONE" E>f); (626) 799-7000 . (A x No): (s2s) 583-2117 Pasadena, CA 91107 [E-MAJL__ www.boltonco.com 0008309 INSURER A INSURED ..,., ....... ,.... , _.. INSURER B : Atkinson, Andelson, Loya, Ruud & Romo INSURER c: 12800 Center Court Drive #300 Cerritos CA 90703 INSURER D t F: CERTIFICATE NUMBER: sn7R790r, REVISION NUMBER: 111 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. . R INSR ADDL SU� � Y EXP' ., TYPE OF IN LTR INSURANCE POLICY NUMBER MtMfDDfYYYY MPMI DIYYYY I LIMITS A ✓' COMMERCIAL GENERAL LIABILITY ✓ 35344557 4/1/2021 4/1l2022 !'EACH ,0p0a 000 CLAIMS -MADE OCCUR r�AOi W2 teo PREMISES (Ea occurrence) t s 1 ,000,000_ MED EXP (Any one person) S 10r000 m PERSONAL ADV INJURY S 1„,000,000,,,,, GEN'LAGGREGATELIMIITAPPLIESPER: ,& GENERALAGGREGATE 52,000,000 m PRO_ POLICY L JECT ✓ LOC PRODUCTS - COMPIOP AGG S InCluded OTHER, r B " AUTOMOBILE LIABILITY 173508514 4/1/2021 4/1/2022 COMBINED SINGLE LIMIT _(Eaa, d,�nz) � 11 000 .... .. 1 ANY AUTO BODILY INJURY (Per person) S �..,.e. OWNEDSCHEDULED-- � 1 ` AUTOS ONLY AUTOS --- BODILY INJURY (Per accident) S .� HIRED NON -OWNED +✓ _. AUTOS ONLY , AUTOS ONLY (orr acE idooq , aN/wl; E S ..... $ 13 / UMBRELLA LIAB ,/ OCCUR 79757104 4/1/2021 4/1/2022 i EACH OCCURRENCE _ $ 1,5,000,000 1 EXCESS LIAB CLAIMS -MADE AGGREGATE S 15,000,000 DER '', RETENTIONS S B WORKERS COMPENSATION ✓ 71732870 4/1/2021 4/1/2022 OTH- ✓� AND EMPLOYERS' LIABILITY Y / N '.. ''. STR uTE r ER ANYPROPRIETORIPARTNER/EXECUTIVE N NIA g L EACH ACCIDENT $ 1,000,000 " OFFICERIMEMBER EXCLUDED? (Mandatory in NH) E L DISEASE - EA EMPLOYEE $ 1,„000,000_ If yes, describe under ' DESCRIPTION OF OPERATIONS below !. E.L., DISEASE - POLICY LIMIT $ 1.000,000 I DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101. Additional Remarks Schedule, may be attached it more apace Is required) Re: Client No. 0845 The firm does not own any autos and auto liability applies to hired and non -owned autos only. Additional Insured: The City of El Segundo, its elected or appointed officers, officials, employees and volunteers GL Additional Insured applies per 80022367507 attached, only if required by written contractlagreement. Client No. 0845 City Clerk, City of El Segundo 350 Main Street ElSegundo 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 (�I��//lA.�i William A. Lewis ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 60787295 1 AALRR 1 21-22 Master Certificate I Victor Morales 1 3/22/2021 5:35:21 PM (PDT) I Page 1 of 4 C H U B B® Liability Insurance Endorsement Policy Period Effective Date Policy Number Insured Name of Company Date Issued This Endorsement applies to the following forms: GENERAL LIABILITY Who Is An Insured 4/ 1 /2021 4/ 1 i 2021 35344557 4/ 1 /2022 Atkinson, Andelson, Loya, Ruud & Romo VIGELANT INSURANCE COMPANY 4/ l i 2021 Under Who Is An Insured, the following provision is added Additional Insured - Persons or organizations shown in the Schedule are insureds; but they are insureds only if you are Scheduled Person obligated pursuant to a contract or agreement to provide them with such insurance as is afforded by Or Organization 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 inured; • 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). • with respect to any assumption of liability (of another person or organization) by them in a contract or agreement. This limitation does not apply to the liability for damages, loss, cost or expense for injury or damage, to which this insurance applies, that the person or organization would have in the absence of such contractor agreement. Liability Insurance Additional Insured - Scheduled Person Or Organizafion continued Form 80-02-2367 (Rev. 5-07) En avant Page f 0r 1'"r'^II;. 1 ,G+O.A.R '2 KwL— C"','v It I ItQ' 1 � ICt.gr M11— :s [ I 2412" 5, VI; 'I. PIW M,tl' [ is '� .1 rd a CHUBBe Liability Endorsement (continued) 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 WRITTEN CONTRACT' OR AGREEMENT BETWEEN YOU AND SUCH PERSON OR ORGANIZATION, TO PROVIDE WITH SUCH INSURANCE AS IS AFFORDED BY THIS POLICY; BUT THEY ARE "INSUREDS" ONLY IF AND TO THE MINIMUM EXTENT THAT SUCH CONTRACT OR AGREEMENT RT QI.11RE THE PERSON OR ORGANIZATION TO BE AFFORDED STATUS AS AN "INSURED". HOWEVER, NO PERSON OR ORGANIZATION IS AN "INSURED" UNDER THIS PROVISION WHO IS MORE SPECIFICALLY DESCRIBED UNDER ANY OTHER PROVISION OF THE WHO IS AN INSURED SECTION OF THIS POLICY (REGARDLESS OF ANY LIMITATION APPLICABLE THERETO). All other terms and conditions remain unchanged. Authorized Representative , a Liability Insurance Additional Insured - Scheduled Person Or Organization last page Form 80.02.2 "(Rev. 5-07) Endorsement Page 2 boa ..wI iALRR 1 2 � Q u�IA,'tll�,�11 1 h,"V". I VI11PkIL es I ," r,2R ,, +, � 1, PM PM 1 3 00� 4 WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY INSURANCE POLICY WC 99 03 04 (Ed. 7-08) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT- CALIFORNIA This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different date is indicated below. (The following "attaching clause" need be completed only when this endorsement is issued subsequent to preparation of the policy.) This endorsement, effective on 4/1/2021 PV9 Policy No. 71732870 issued toAtkinson, Andelson, Loya, Ruud & Romo Endorsement No. at 12:01 A. M. standard time, forms a part of of the FEDERAL INSURANCE COMPANY (NAME OF INSURANCE COMPANY) 6� ,+( , a;n Authorized Representative 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 the blanket waiver offered by this endorsement shall be 1.00% of total California premium. Schedule Person or Organization WHERE REQUIRED BY WRITTEN CONTRACT WC 99 03 04 (Ed. 7-08) Job Description 8Drys 1 AJALRR. i i 12 Rry—�e' C,vrr,tl ,car, Y vii rr.,,,. M,71: B6;d p � 5�2 uuH (Pram) I rr u,,,, 4 :It 4 IINSURANCE YYY)°CERTIFICATE OF LIABILITY ISURACE 05/2o/202l 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 po i 'y(ies) must 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 endorsornont(s). PRODUCER 1-847-385-6800 CONTACT Rob Herchert NAME. Edgewood Partners Insurance Center PHONE 847-385-6800 FAX Lemme, a division of EPIC (AIC.)iCp II)n I°) 111 West Campbell I MAILAPPA9p.§, PSGCertsmlemme.com 4th Floor -_ INSUREf[S)AhFOIr Arlington Heights, IL 60005 — ING COVERAGE NAIC# —------------ INSURER .• Scottsdale Ins Co and various insurer. INSURED Atkinson, Andelson, Loyal, Ruud & Romo, PC 12800 Center Court Drive Suite 300 Cerritos, CA 90703 COVERAGES CERTIFICATE NUMBER- 62244080 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. �.. .__.,.W,...,, .. „._.. _..... .................... ...... 'iPISRI AOdtY.�slJs POLICY EFIF POLO Y EXP POLICY NUMBER..... LTR I TYPE OF INSURANCE � M /pyypMr ryqMgpD,ryyr... LIMITS GENERAL LIABILITY EACH OCCURRENCE 'bAM�6kefgf ........... .................. -- -.._-. COMMERCIAL GENERAL . ,. one $—.—..... CLAIMS -MADE OCCUR I MED EXP (Any ny one person) person) $ PERSONAL & ADV INJURY j GENERAL AGGREGATE $ GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ PRO— „ POUCY i JECIf LO $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT () a ap;.dgnlJ. _ ---- ANY AUTO BODILY INJURY (Per person) $ ALL OWNED j SCHEDULED BODILY INJURY (Per accident ) $ AUTOS 'fp ...., .-$— _..Pik -- ....... NON -OWNED 0Iff V 5AfubA4E' . HIRED AUTOS �.......,., AUTOS ff'orac'tdmnS)i .....-- -.. _ ,.. $ UMBRELLA LAB OCCUR 7 EACH OCCURRENCE -- ......... .. $$ ..... ......... EXCESS LIAR CLAIMS -MADE ............:.. ............. ...... ... 4----- AGGREGATE ........�. $ ......... ... .....,...., DED BETE... NTION $ P....... I. $ WORKERS COMPENSATION J W(. STA"IU �OTH LITY Y/N ECUTIVE CIDENT FFII EXCLUDEANY D? OFFICER/MEMBER❑ NIA $ CER/MEMBEFR A (Mandatory ) DISEASE EA EMPLOYE - If yes, describe under ...... ......... .. .,......,,....... .........., DESCRIPTION OF OPERATIONS below E L DISEASE POLICY LIMIT $ A Professional i ity LWS C aim 7Agagoegate 2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CERTIFICATE HOLDER CANICELLAII'ON SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City Clerk, City of El Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street AUTHORIZED REPRESENTATIVE `� ///� E1 Segundo, CA 90245 4 p�,QA�{— q21 " USA I4"'V".., ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD Sue.Phillips®lemme.COm LEM 62244080