Loading...
PROOF OF INSURANCE (2021 - 2021) CLOSEDCOMM-35 CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 010612020 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 endorsements . PRODUCER 626-795-9921 CONTACT Supple -Merrill & Driscoll Inc. HH o626-795 No 626 577 6656 I Insurance Agents and Brokers „ P. O. Box 2408 �!R„„„ Pasadena, CA 91102 Supple -Merrill & Driscoll Inc. INSUR RISC AFFORDING COVE EWW RAGE . ,.... ,,...,, ___ NAIC# INSURER a Arch rance Co 99 Specia„I Insu....... _. INSURED INSURERB:.State Compensation Ins. Fund _ .... ,.. Commercial Transportation Services Inc. P a Evanston Insurance Evan....... Dino Perugino 702 S. Treanor Avenue INS, RER R : . ,/ INSURE.Fi. D San Dimas, CA 91773 .,.,.,. ............. INSURER E m......_._ ........ --- — --- — .v,......� .... .........._ ,-�----"..... ..... INSURER F: CERTIFICATE NUMBER;. 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. .....TYPE OF INSURANCE .... ..- - --...... POLICY NUMBER .... ........".. ------__ INSR�AOI?LSUBRC POLICY EFF POLICY EXP ........... .... ..-, __ .. ..__..... ..,.,.,� LIMITS COMMERCIAL GENERAL LIABILITY A X co OCCURRENCE__ g 1,000,000 CLAIMS -MADE X OCCUR X X PLI0000133-01 09/01/2020 09/01/2021 mEgCH DAMAGE CO RENTED DAMAGEjjj�� - 100,000 ,_ µ 10,000 ,4MED EXP (Any oneperson,,, I $ PERSONAL & ADV INJURY j $ . ----- 1,000,000 .................. 2,000,000 � MITAPPLIES PER: _G'E'1'S POLICY PRO- X POLICY _ LOC PRQDUt'TS�COMP QP AGG $ 2.... 00 � OTHER' s� COMBINED SINGLE LIMIT AU TOMOBILE LIABILITY . EaI!�I&u�I mgla ...... '� $ ........� ANY AUTO (Perpersonj BODILY INJURYAUTOS S, .. OWNED SCHEDULED ONLY BODILY accident) LIT HIRED NM.PN pp h LY P R PER AMAG Per. .,.....,._ AUTOS ONLY AUTOS I . ..- .. -- 8 OCCUR EACH OCo URREN $ XDEDR SLR EXCES LIAB CLAIMS -MADE EZXS3029019 09/18/202009/01/2021[)AGGREGATE $2,000,000 2 000,000 REBENTION� — -- - -GE $ollow form GL B WORKERS COMPENSATION PER FAH $ AND EMPLOYERS' LIABILITY YIN X 1650779 09/01/2020 09/01/2021 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE ["j OFFICER/MEMBER EXCLUDED? f (Mandatory in NH) N / A"""""' �TUTE -X E L EA H ACCI,D,ENT,,,, E"L., DISEASE - EA EMPLOYEE ....,; 8 $ 1,000,000' „_....__ yes, describe under '' 1,000,000 .. DESCRIPTION OF OPERATIONS below E.L"DISEASE POLICY LIMIT DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) City of El Segundo i an additional insured with resepect the insureds operations. ualver of subrogation applies to the general liability and Workers compensation CITYELS City of El Segundo Bldg & Safe 350 Main Street El Segundo, 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 z, µ t ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: PLI0000133-01 ARCH SPECIALTY INSURANCE COMPANY COMMERCIAL GENERAL LIABILITY 00 AGL0100 0010 18 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. B�LAN ET ADDITIONAL INSURED ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SECTION II — WHO IS AN INSURED is amended to include any person or organization for whom you are performing operations when you and such person or organization have agreed in a written contract or agreement signed and dated prior to the loss for which coverage is sought that such person or organization be added as an additional insured on your policy, but only with respect to liability for "bodily injury", "property damage", or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of your subcontractors: a. In the performance of your ongoing operations or "your world', including your "completed operations"; or b. In connection with premises owned by or rented to you. The person or organization does not qualify as an additional insured with respect to any independent act(s) or omission(s) of such person or organization. However: 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. In the event that the limits of liability stated in the policy exceed the limits of liability required by a written contract that is signed and dated by you prior to the "occurrence" or offense for which coverage is sought, the insurance provided by this endorsement shall be limited to the minimum limits of liability required by such contract or agreement. This endorsement shall not increase the limits stated in Section III — Limits of Insurance. 2. The insurance provided to the additional insured is also limited as follows: a. The insurance provided to the additional insured by this endorsement is excess over any valid and collectible "other insurance," whether primary, excess, contingent or on any other basis, that is available to the additional insured for a loss we cover under this endorsement. b. However, if the written contract, which is signed and dated prior to the loss, specifically requires that this insurance 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 organization as a named insured for such loss, and, only if non- contributory is required, we will not share with that "other insurance." c, In all cases the insurance provided to the additional insured by this endorsement still is excess over any 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 such "other insurance." All other terms and conditions of this Policy remain unchanged. 00 AGLO100 00 10 18 Page 1 of 2 Endorsement Number: This endorsement is effective on the inception date of this policy unless otherwise stated herein. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Policy Number: Named Insured: Endorsement Effective Date: 00 AGLO100 00 10 18 Page 2 of 2 POLICY NUMBER: PLI0000133.01 COMMERCIAL GENERAL LIABILITY ARCH SPECIALTY INSURANCE COMPANY 00 AGL0103 00 02 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NON-CONTRIBUTING INSURANCE "THERE REQUIRED BY WRITTEN CONTRACT(S) ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART The following is added to Paragraph 4. Other Insurance under the Conditions section: d. Primary and Non -Contributing Insurance Where you are specifically required by a written contract to provide insurance that is primary and non- contributory and the written contract so requiring is executed by you before any `occurrence" or offense, this insurance will be primary and the other insurance will not contribute with this insurance, but only if and to the extent required by that written contract. All other terms and conditions of this Policy remain unchanged. Endorsement Number: This endorsement is effective on the inception date of this policy unless otherwise stated herein. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Policy Number: Named Insured: Endorsement Effective Date: 00 AGL0103 00 02 13 Page 1 of 1 POLICY NUMBER: PLI0000133-01 ARCH SPECIALTY INSURANCE COMPANY COMMERCIAL GENERAL LIABILITY 00 AGL0106 00 02 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF SUBROGATION ENDORSEMENT' This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: Where required by written contract The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us under the Conditions section: We waive any right of recovery we may have against the person or organization shown in the SCHEDULE above because of payments we make for injury or damage arising out of your operations or "your work" done under a written contract with that person or organization. All other terms and conditions of this Policy remain unchanged. Endorsement Number: This endorsement is effective on the inception date of this policy unless otherwise stated herein (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Policy Number: Named Insured: Endorsement Effective Date: 00 AGLO106 00 02 13 Page 1 of 1 PRODUCER ..—uu s, b SuPPle-Marrill & Driscoll Inc 626-795-9921 . CT Erika uentes insurance A ants and Broi�;rs HOME P. 0. Box 2498 626-796-9921 N656 Pasadena, rA 911 o2 9UPple-Merrill & Driscoll Inc. I COMMERCIAL GENERAL LIAB UTY- CLAIMS-MADE E OCCUR GEN'L AGGREGATE LIMIT APPLIES PER- POLICYLOC' POLICY a'_TIER.: A11TOMOSILE UABILITY ANY ALTO OWNED X SCHEDULED AUTOS ONLY AUTOS HIRED AUTOS ONLY �U%SWCAD UMBRELLA LfAS EXCESS LIAB p§O - --RETENTIQ IORKERS COMPENSA-nON ND EMPLOYERS' LKBILITY 4 YIN SHOULD ANY OF THE ABOVE DESCRIBED P&J110 jpF [01 ACORD 25 (2016103) C The 1988-2015 ACORD CORPORATION. All rights rag rved. ACORD name and logo are registered marks of ACORD ENDORSEMENT AGREEMENT WAIVER OF SUBROGATION BLANEET BASIS 1650779-20 RENEWAL SC 0-58-54-42 PAGE 1 HOME OFFICE SAN FRANCISCO EFFECTIVE SEPTEMBER 1, 2020 AT 12.01 A.M. ALL EFFECTIVE DATES ARE AND EXPIRING SEPTEMBER 1, 2021 AT 12.01 A.M. AT 12:01 AM PACIFIC STANDARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME COMMERCIAL TRANSPORTATION SERVICES 142 E BONITA AVE # 107 SAN DIMAS, CA 91773 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. THE ADDITIONAL PREMIUM FOR THIS ENDORSEMENT SHALL BE 2.00% OF THE TOTAL POLICY PREMIUM. SCHEDULE PERSON OR ORGANIZATION JOB DESCRIPTION ANY PERSON OR ORGANIZATION FOR WHOM THE NAMED INSURED HAS AGREED BY WRITTEN CONTRACT TO FURNISH THIS WAIVER BLANKET WAIVER OF SUBROGATION NOTHING IN THIS ENDORSEMENT SHALL BE HELD TO VARY, ALTER, WAIVE OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS POLICY OTHER THAN AS ABOVE STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR LIMITATIONS IN THIS ENDORSEMENT. COUNTERSIGNED AND ISSUED AT SAN FRANCISCO: AUTHORIZED REPRESENT WE SCIF FORM 10217 (REV.4-20181 AUGUST 18, 2020 14 f, PRESIDENT AND CEO 2572 OLD DP 217