No preview available
PROOF OF INSURANCE (2022 - 2022) CLOSED DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 8/30/2021 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 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). CONTACT PRODUCER Xanh Tran NAME: FAX PHONE (949)679-3701 (949)679-3700 IQ Risk Insurance Services, LLC (A/C, No): (A/C, No, Ext): E-MAIL xtran@iqrisk.com 225 N Bush Street ADDRESS: INSURER(S)AFFORDINGCOVERAGENAIC# Santa AnaCA92701 James River Insurance Company12203 INSURER A : INSURED Falls Lake Fire and Casualty Company15884 INSURER B : CC LAYNE & SONS INC. INSURER C : 216 Standard Street INSURER D : INSURER E : El SegundoCA90245 INSURER F : CL2181107887 COVERAGESCERTIFICATENUMBER:REVISIONNUMBER: 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. ADDLSUBR INSRPOLICY EFFPOLICY EXP TYPE OF INSURANCELIMITS POLICY NUMBER LTR(MM/DD/YYYY)(MM/DD/YYYY) INSDWVD COMMERCIAL GENERAL LIABILITY X 1,000,000 EACHOCCURRENCE$ DAMAGE TO RENTED 100,000 CLAIMS-MADEOCCUR$ AX PREMISES(Eaoccurrence) X 00120201-08/10/20218/10/2022 5,000 MEDEXP(Anyoneperson)$ 1,000,000 PERSONAL&ADVINJURY$ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE$ PRO- X 2,000,000 POLICYLOCPRODUCTS - COMP/OP AGG$ JECT $ OTHER: COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY$ (Eaaccident) BODILYINJURY(Perperson)$ ANY AUTO ALLOWNEDSCHEDULED BODILYINJURY(Peraccident)$ AUTOSAUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS (Peraccident) AUTOS $ UMBRELLA LIAB EACHOCCURRENCE$ OCCUR EXCESS LIAB CLAIMS-MADEAGGREGATE$ $ DEDRETENTION$ PEROTH- WORKERS COMPENSATION x STATUTEER AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACHACCIDENT$ 1,000,000 N / A OFFICER/MEMBER EXCLUDED? B FLA008293-032/1/20212/1/2022 (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE$ 1,000,000 Ifyes,describeunder E.L. DISEASE - POLICY LIMIT$ 1,000,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) *10 Days Notice of Cancellation for Non-Payment of Premium. RE: Covered CA Operations Performed By Or On Behalf of the Named Insured. The City of El Segundo, its officers, officials, employees, agents, and volunteers are named additional insured as respects general liability and this insurance is primary and noncontributory with any other insurance of the additional insured; and waiver of subrogation applies as respects workers compensation as required by written contract, per endorsements attached. CERTIFICATE HOLDERCANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of El Segundo ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street El Segundo, CA 90245 AUTHORIZED REPRESENTATIVE Xanh Tran/XANH ©1988-2014ACORDCORPORATION.Allrightsreserved. ACORD25(2014/01)TheACORDnameandlogoareregisteredmarksofACORD INS025 (201401) EBUF!)NN0EE0ZZZZ* DFSUJGJDBUF!PG!MJBCJMJUZ!JOTVSBODF 1:01203132 UIJT!DFSUJGJDBUF!JT!JTTVFE!BT!B!NBUUFS!PG!JOGPSNBUJPO!POMZ!BOE!DPOGFST!OP!SJHIUT!VQPO!UIF!DFSUJGJDBUF!IPMEFS/!UIJT DFSUJGJDBUF!EPFT!OPU!BGGJSNBUJWFMZ!PS!OFHBUJWFMZ!BNFOE-!FYUFOE!PS!BMUFS!UIF!DPWFSBHF!BGGPSEFE!CZ!UIF!QPMJDJFT CFMPX/!!UIJT!DFSUJGJDBUF!PG!JOTVSBODF!EPFT!OPU!DPOTUJUVUF!B!DPOUSBDU!CFUXFFO!UIF!JTTVJOH!JOTVSFS)T*-!BVUIPSJ\[FE SFQSFTFOUBUJWF!PS!QSPEVDFS-!BOE!UIF!DFSUJGJDBUF!IPMEFS/ JNQPSUBOU;!!Jg!uif!dfsujgjdbuf!ipmefs!jt!bo!BEEJUJPOBM!JOTVSFE-!uif!qpmjdz)jft*!nvtu!ibwf!BEEJUJPOBM!JOTVSFE!qspwjtjpot!ps!cf!foepstfe/ Jg!TVCSPHBUJPO!JT!XBJWFE-!tvckfdu!up!uif!ufsnt!boe!dpoejujpot!pg!uif!qpmjdz-!dfsubjo!qpmjdjft!nbz!sfrvjsf!bo!foepstfnfou/!!B!tubufnfou!po uijt!dfsujgjdbuf!epft!opu!dpogfs!sjhiut!up!uif!dfsujgjdbuf!ipmefs!jo!mjfv!pg!tvdi!foepstfnfou)t*/ DPOUBDU QSPEVDFS Njdifmmf!Nbsujo OBNF; GBY QIPOF Qbvm!Lbhbo!Jot!boe!Gjo!Twt!Jod 673.:58.1662673.:54.6775 )B0D-!Op*; )B0D-!Op-!Fyu*; F.NBJM 26:11!Jnqfsjbm!IjhixbznjdifmmfAqbvmlbhbo/ofu BEESFTT; Mb!Njsbeb-!DB!:1749.3625 JOTVSFS)T*!BGGPSEJOH!DPWFSBHFOBJD!$ Tubuf!Gbsn!Nvuvbm!Bvupnpcjmf!Jotvsbodf!Dpnqboz36289 JOTVSFS!B!; JOTVSFE JOTVSFS!C!; DD!Mbzof!'!Tpot!Jod JOTVSFS!D!; 327!Tuboebse!Tusffu JOTVSFS!E!; Fm!Tfhvoep!DB!:1356.4648 JOTVSFS!F!; JOTVSFS!G!; DPWFSBHFTDFSUJGJDBUF!OVNCFS;SFWJTJPO!OVNCFS; UIJT!JT!UP!DFSUJGZ!UIBU!UIF!QPMJDJFT!PG!JOTVSBODF!MJTUFE!CFMPX!IBWF!CFFO!JTTVFE!UP!UIF!JOTVSFE!OBNFE!BCPWF!GPS!UIF!QPMJDZ!QFSJPE JOEJDBUFE/!!OPUXJUITUBOEJOH!BOZ!SFRVJSFNFOU-!UFSN!PS!DPOEJUJPO!PG!BOZ!DPOUSBDU!PS!PUIFS!EPDVNFOU!XJUI!SFTQFDU!UP!XIJDI!UIJT DFSUJGJDBUF!NBZ!CF!JTTVFE!PS!NBZ!QFSUBJO-!UIF!JOTVSBODF!BGGPSEFE!CZ!UIF!QPMJDJFT!EFTDSJCFE!IFSFJO!JT!TVCKFDU!UP!BMM!UIF!UFSNT- FYDMVTJPOT!BOE!DPOEJUJPOT!PG!TVDI!QPMJDJFT/!MJNJUT!TIPXO!NBZ!IBWF!CFFO!SFEVDFE!CZ!QBJE!DMBJNT/ BEEMTVCS JOTSQPMJDZ!FGGQPMJDZ!FYQ UZQF!PG!JOTVSBODFMJNJUT QPMJDZ!OVNCFS MUS)NN0EE0ZZZZ*)NN0EE0ZZZZ* JOTEXWE DPNNFSDJBM!HFOFSBM!MJBCJMJUZ FBDI!PDDVSSFODF% EBNBHF!UP!SFOUFE DMBJNT.NBEFPDDVS% QSFNJTFT!)Fb!pddvssfodf* NFE!FYQ!)Boz!pof!qfstpo*% QFSTPOBM!'!BEW!JOKVSZ% HFO(M!BHHSFHBUF!MJNJU!BQQMJFT!QFS;HFOFSBM!BHHSFHBUF% QSP. QPMJDZMPDQSPEVDUT!.!DPNQ0PQ!BHH% KFDU % PUIFS; DPNCJOFE!TJOHMF!MJNJU BVUPNPCJMF!MJBCJMJUZ% YY19029031321302903133 792!6269.C29.86 )Fb!bddjefou* BOZ!BVUP CPEJMZ!JOKVSZ!)Qfs!qfstpo*% 2-111-111 21023031321502303133 779!2764.E23.86 PXOFETDIFEVMFE CPEJMZ!JOKVSZ!)Qfs!bddjefou*% B2-111-111 BVUPT!POMZBVUPT 779!2813.E23.8621023031321502303133 OPO.PXOFE IJSFEQSPQFSUZ!EBNBHF % 2-111-111 )Qfs!bddjefou* BVUPT!POMZBVUPT!POMZ 7:7!:444.C19.8619019031321302903133 % VNCSFMMB!MJBC FBDI!PDDVSSFODF% PDDVS FYDFTT!MJBC DMBJNT.NBEFBHHSFHBUF% % EFESFUFOUJPO% QFSPUI. XPSLFST!DPNQFOTBUJPO TUBUVUFFS BOE!FNQMPZFST(!MJBCJMJUZ Z!0!O BOZ!QSPQSJFUPS0QBSUOFS0FYFDVUJWF F/M/!FBDI!BDDJEFOU% O!0!B PGGJDFS0NFNCFS!FYDMVEFE@ )Nboebupsz!jo!OI* F/M/!EJTFBTF!.!FB!FNQMPZFF% Jg!zft-!eftdsjcf!voefs F/M/!EJTFBTF!.!QPMJDZ!MJNJU% EFTDSJQUJPO!PG!PQFSBUJPOT!cfmpx EFTDSJQUJPO!PG!PQFSBUJPOT!0!MPDBUJPOT!0!WFIJDMFT!!)BDPSE!212-!Beejujpobm!Sfnbslt!Tdifevmf-!nbz!cf!buubdife!jg!npsf!tqbdf!jt!sfrvjsfe* Beejujpobm!Jotvsfe;!Uif!Djuz!pg!Fm!Tfhvoep-!jut!pggjdfst-!pggjdjbmt-!fnqmpzfft-!bhfout-!boe!wpmvouffst/! DFSUJGJDBUF!IPMEFSDBODFMMBUJPO TIPVME!BOZ!PG!UIF!BCPWF!EFTDSJCFE!QPMJDJFT!CF!DBODFMMFE!CFGPSF UIF!FYQJSBUJPO!EBUF!UIFSFPG-!OPUJDF!XJMM!CF!EFMJWFSFE!JO BDDPSEBODF!XJUI!UIF!QPMJDZ!QSPWJTJPOT/ Djuz!pg!Fm!Tfhvoep!! BVUIPSJ\[FE!SFQSFTFOUBUJWF 461!Nbjo!Tusffu Dpnqmfufe!cz!bo!bvuipsj{fe!Tubuf!Gbsn!sfqsftfoubujwf/!Jg!tjhobuvsf! Fm!Tfhvoep-!DB!:1356 jt!sfrvjsfe-!qmfbtf!dpoubdu!b!Tubuf!Gbsn!bhfou/ ª!2:99.3126!BDPSE!DPSQPSBUJPO/!!Bmm!sjhiut!sftfswfe/ BDPSE!36!)3127014*Uif!BDPSE!obnf!boe!mphp!bsf!sfhjtufsfe!nbslt!pg!BDPSE 2112597!!24395:/24!!15.33.3131 COMMERCIAL GENERAL LIABILITY CG 20 10 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Location(s) Of Covered Operations Information required to complete this Schedule, if not shown above, will be shown in the Declarations. is amended to B.With respect to the insurance afforded to these include as an additional insured the person(s) oradditional insureds, the following additional exclu- organization(s) shown in the Schedule, but onlysions apply: with respect to liability for "bodily injury", "property This insurance does not apply to "bodily injury" or damage" or "personal and advertising injury" "property damage" occurring after: caused, in whole or in part, by: 1. All work, including materials, parts or equip- 1. Your acts or omissions; or ment furnished in connection with such work, 2.The acts or omissions of those acting on youron the project (other than service, maintenance behalf;or repairs) to be performed by or on behalf of the additional insured(s) at the location of the in the performance of your ongoing operations for covered operations has been completed; or the additional insured(s) at the location(s) desig- nated above. 2. That portion of "your work" out of which the injury or damage arises has been put to its in- tended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a princi- pal as a part of the same project. CG 20 10 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 POLICY NUMBER: COMMERCIAL GENERAL LIABILITY CG 20 37 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. 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 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. is amended to B.With respect to the insurance afforded to these include as an additional insured the person(s) oradditional insureds, the following is added to organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or If coverag e provided to the additional insured is "property damage" caused, in whole or in part, by required by a contract or agreement, the most we "your work" at the location designated and will pay on behalf of the additional insured is the described in the Schedule of this endorsement amount of insurance: performed for that additional insured and 1. Reqment; or uired by the contract or agree included in the "products-completed operations hazard". 2. Available under the applicable Limits of Insurance shown in the Declarations; However: whichever is less. 1. The insurance afforded to such additional insured only applies to the extent permitted This endorsement shall not increase the applicable by law; and Limits of Insurance shown in the Declarations. 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. CG 20 37 04 13 © Insurance Services Office, Inc.,2012 Page 1of 1 COMMERCIAL GENERAL LIABILITY POLICY NUMBER:5057-5035 CG 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: Any person or organization against whom you have agreed to waive your right of recovery in a written contract or written agreement, provided such contract or agreement was executed prior to the date of loss, injury or damage. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. ThefollowingisaddedtoParagraph 8.TransferOf RightsOfRecoveryAgainstOthersToUs of Wewaiveanyrightofrecoverywemayhaveagainst thepersonororganizationshownintheSchedule abovebecauseofpaymentswemakeforinjuryor damagearisingoutofyourongoingoperationsor "yourwork"doneunderacontractwiththatperson ororganizationandincludedinthe"products- completedoperationshazard".Thiswaiverapplies onlytothepersonororganizationshowninthe Schedule above. CG 24 04 05 09© Insurance Services Office, Inc., 2008 Page1 of 1 This endorsement, effective: 08/10/202 (at 12:01 A.M. standard time at the address of the Named Insured as showing in the Declarations) forms a part of Policy No: 5057-5035 Issued to: CC Layne & Sons Inc. By:Allied World Surplus Lines Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. OTHER INSURANCE AMENDATORY ENDORSEMENT It is agreed that this policy is amended as follows: SECTIONIV-COMMERCIALGENERALLIABILITYCONDITIONS,Condition 4.OtherInsurance isdeletedinits entirety and replaced by the following: 4.Other Insurance a.This insurance is primary, except when b. below applies. b.Excess Insurance: (1)Thisinsuranceisexcessoveranyotherinsurancethatisvalidandcollectibleinsuranceavailabletothe insuredoranyadditionalinsuredwhethersuchinsuranceisprimary,excess,contingentoronanyotherbasis andregardlessofthenature,type,dateofissuanceorlimitsofsuchotherinsuranceavailabletotheinsured oranyadditionalinsured.Ourobligationunderthispolicyshallnotariseuntilthelimitsofsuchother insurance are exhausted. (2)Whenthisinsuranceisexcess,wewillhavenodutyunderCoverages A or B todefendtheinsuredagainst any"suit"ifanyotherinsurerhasadutytodefendtheinsuredagainstthat"suit".Ifnootherinsurerdefends, we will undertake to do so, but we will be entitled to the insured's rights against all those other insurers. (3)Whenthisinsuranceisexcessoverotherinsurance,wewillpayonlyourshareoftheamountoftheloss,if any, that exceeds the sum of: (a)The total amount that all such other insurance would pay for the loss in the absence of this insurance; and (b)The total of all deductible and self-insured amounts under all that other insurance. c.Asaconditionprecedenttoourobligationstoprovideorcontinuetoprovideindemnity,coverageordefense shallfirstdemandindemnity,coverageanddefensefromeachotherinsurerthatmayprovideindemnity,coverage ordefensetoit.Theinsuredwaivesanyrightitmayhavetoinsistthatweprovideindemnity,coverageor defensewhenanyotherinsurermayalsoprovideindemnity,coverageordefensetotheinsured.Theinsured waivesanyrightsitmayhavetoatargetedtenderoranyotherrighttoselectusastheinsurertoprovide indemnity, coverage or defense. All other terms, conditions and exclusions under the policy are applicable to this endorsement and remain unchanged. CSGL 00208 00 08 16IncludescopyrightedmaterialofPage1of1 InsuranceServicesOffices,Inc.,usedwithitspermission WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 4-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT-CALIFORNIA 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. otherwise due on such remuneration. Schedule Person or OrganizationJob Description Blanket Waiver of SubrogationAs respects to all CA jobs performed by the named insured during the policy period where by written contract a waiver of subrogation is required prior to the commencement of work. 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 02-01-2021Policy No.FLA008293-03Endorsement No. InsuredInsurance Company CC Layne & Sons, Inc (a Corp)Falls Lake Fire & Casualty Company Countersigned By