Loading...
PROOF OF INSURANCE (2022 - 2022) CLOSEDCERTIFICATE OF LIABILITY INSURANCE DATE`10/25//2021 Y' 021 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 CONTACT NAME: Jim Ledbetter CA License #OH74270 Assured Partners of Washington, LLC PHONE` --- FA,X A/E Insurance Services p0r"Ca-EMY 360-626-2019 t Noj.360-626-2019 E-MAIL111 PMB #369, 19689 7th Ave NE, Ste 183 ADDRESS. I!irl-Ie-d �stter@ FFORo NGlcov R� �� 0 Poulsbo WA 98370 AGE NAIC# 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. T SURANCE... ......._.._...._ --------- LIMN.....- ... „e,,.. ... INSR' ..YPE OF IN , ... .... .....,ADDL�SU I�' POLICY NUMBER MMIDDFF .IMMLYCY E"XP 1.. - TS . LTR ... D.IYYYY MM/DD/YYYY -. B X COMMERCIAL GENERAL LIABILITY Y Y PSB0008537 10/15/2021 10/15/2022 EACH OCCURRENCE $2,000,000 �X DAMAGE TO RENITED 1 000 000 CLAIMS -MADE OCCUR PREMISE�„Fa gecurrencpi $ MED EXP (Any one person) I $ 10 000 I PERSONAL & ADV INJURY $ 2 000,000 ....,...... --- �GEN'LAGGREGATELIMITAPPLIESPER_ I GENERAL AGGREGATE .$4000000 X PRE $ 4 000 000 ER JCTLOC I POLICY PRODUCTS - COMP/OP AGG� I I � $ OTHER. B AUTOMOBILE LIABILITY Y ! Y PSB0008537 1 10/15/2021 10/15/2022 COMBINED S. NGLE LIMIT S 2,000,000 I ANY AUTO BODILY INJURY (Per person) i $ ' OWNED SCHEDULED BODILY INJURY (Per accident) I $ AUTOS ONLY AUTOS X HIRED X NON -OWNED �.., , „ ,, ...,,,.._._ € PROPr RTYOA9wVAGE $ '.: AUTOS ONLY AUTOS ONLY o ., '. i�"ers u�deraC) ... . ...... .... .................. $ B UMBRELLA LIAB X OCCUR Y Y PSE0004233 10/15/2021 10/15/2022 EACH OCCURRENCE $ 1,000,000 X '... EXCESS LIAB CLAIMS -MADE '.. AGGREGATE $ 1,000,000 j I DED RETENTION$ 1 $ . WORKERS COMPENSATION J OTH- PTAT TE 1m R AND EMPLOYERS' LIABILITY YIN j ANYPROPRIETOR/PARTNERIEXECUTIVE E L EACH ACCIDENT NIA OFFICER/MEMBER EXCLUDED. J __ I (Mandatory in NH) E L DISEASE EA EMPLOYEEi S ,Ifyes, describe under I, DESCRIPTION OF OPERATIONS below I E..L. DISEASE -POLICY LIMIT . A Professional Liability N Y ANE4360102 10/15/2021 10/15/2022 Per Claim J $2,000.000 I Aggregate $4,000.000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Certificate holder is, when agreed in a contract or agreement, afforded Additional Insured and waiver of subrogation coverage under General Liability Additional Insured form PPB 304G 04 13, products completed PPB 304G 04 13, and Is primary and non-contributory. Auto additional insured form PPA 300VVA 03 13 and 'Waiver of su'bro.9a, lon PPA 30O'WA 03 13. Protect: STREET IMPROVEMENTS FEASIBILITY STUDY FOR Tl-I 500 BLOCK OF ARENA STREET AND 613 ARENA STREET CEIR I WI[ A I E HULULK 11, AI4L CLLH I IUF'4 City of El Segundo 350 Main St. 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 f U 1 W513-2U15 AGUKU GUKNUKA I IUN. All rignts reservea. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Policy Number: PSB0008537 RLI Insurance Company Named Insured: JohnMCruikshank THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. RLIPack° FOR PROFESSIONALS BLANKET ADDITIONAL INSURED ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM - SECTION II — LIABILITY C. WHO IS AN INSURED is amended to include as an additional insured any person or organization that you agree in a contract or agreement requiring insurance to include as an additional insured on this policy, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused in whole or in part by you or those acting on your behalf: a. In the performance of your ongoing operations; b. In connection with premises owned by or rented to you; or c. In connection with "your work" and included within the "product -completed operations hazard". 2. The insurance provided to the additional insured by this endorsement is limited as follows: a. This insurance does not apply on any basis to any person or organization for which coverage as an additional insured specifically is added by another endorsement to this policy. b. This insurance does not apply to the rendering of or failure to render any "professional services". c. This endorsement does not increase any of the limits of insurance stated in D. Liability And Medical Expenses Limits of Insurance. 3. The following is added to SECTION III H.2. Other Insurance — COMMON POLICY CONDITIONS (BUT APPLICABLE ONLY TO SECTION II — LIABILITY) However, if you specifically agree in a contract or agreement that the insurance provided to an additional insured under this policy must apply on a primary basis, or a primary and non-contributory basis, this insurance is primary to other insurance that is available to such additional insured which covers such additional insured as a named insured, and we will not share with that other insurance, provided that: a. The "bodily injury" or "property damage" for which coverage is sought occurs after you have entered into that contract or agreement; or b. The "personal and advertising injury" for which coverage is sought arises out of an offense committed after you have entered into that contract or agreement. 4. The following is added to SECTION III K. 2. Transfer of Rights of Recovery Against Others to Us — COMMON POLICY CONDITIONS (BUT APPLICABLE TO ONLY TO SECTION II — LIABILITY) We waive any rights of recovery we may have against any person or organization because of payments we make for "bodily injury", "property damage" or "personal and advertising injury" arising out of "your work" performed by you, or on your behalf, under a contract or agreement with that person or organization. We waive these rights only where you have agreed to do so as part of a contract or agreement with such person or organization entered into by you before the "bodily injury" or "property damage" occurs, or the "personal and advertising injury" offense is committed. ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED. PPB 304 02 12 Page 1 of 1 Policy Number: PSE0004233 RLI Insurance Company John M Cnsikshank THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. RLIPack° FOR DESIGN PROFESSIONALS EXCESS LIABILITY ENHANCEMENT SCHEDULE OF COVERAGES ADDRESSED BY THIS ENDORSEMENT A. General Aggregate Limit — Per Project Or Per Location B. Additional Insured — Primary/Non-contributory C. Waiver Of Transfer Of Rights Of Recovery Against Others To Us This endorsement modifies insurance provided under the following: COMMERCIAL EXCESS LIABILITY COVERAGE FORM A. General Aggregate Limit — Per Project Or Per Location Paragraph 2.a. of C. Limits of Liability of SECTION I — INSURING AGREEMENT is deleted and replaced by the following: a. The limit of liability stated in the Declarations as general aggregate is the most we will pay during each policy period for all ultimate net loss, except ultimate net loss because of: (1) injury and damage included in the products - completed operations hazard or; (2) any coverage included in underlying insurance to which no underlying aggregate applies. The general aggregate applies separately to each of your "projects" away from premises owned by or occupied by you or to each of your locations owned by or occupied by you. "Projects" mean an area away from premises owned by or rented to you at which you are performing operations pursuant to a contract or agreement. For the purposes of determining the applicable aggregate limit of insurance, each "project" at the same "location" shall be considered a single "project'. For the purposes of this provision, "location" means (1) premises involving the same or connecting lots; (2) premises where connection is interrupted only by a street, roadway, waterway or right- of-way of a railroad; or (3) premises where operations are performed in sections, stages or phases as a continuation of the same contract or agreement, even if the premises do not involve connecting lots. B. Additional Insured — Primary/Non-contributory Paragraph K. Other Insurance of SECTION IV — CONDITIONS is deleted and replaced by the following: K. Other Insurance If other insurance, whether collectible or not, is available to the insured covering a loss also covered by this policy, the insurance afforded by this policy shall be in excess of, and shall not contribute with, such other insurance. However, if the underlying insurance provides coverage to an additional insured on a primary basis, or a primary and non-contributory basis, this insur- ance shall be available to such additional insured on an excess basis over the underlying insurance. We will not share with other insurance which covers such additional insured as a named insured. C. Waiver Of Transfer Of Rights Of Recovery Against Others To Us Paragraph L. Subrogation of SECTION IV — CONDITIONS is deleted and replaced by the following: PPU 304 06 10 Page 1 of 2 L. Subrogation In the event of any payment under this policy, the insured must notify us of any of the insured's rights of recovery against any person or organization. We shall be subrogated to all such rights. The insured shall execute and deliver instruments and papers and do whatever else is necessary to secure such rights. The insured shall do nothing after loss to prejudice such rights. However we waive any rights of recovery we may have against any person or organization if the underlying insurance also waives such rights. Any amount recovered through subrogation or otherwise shall be apportioned in the inverse order of payment of the claim or claims involved to the extent of actual payment thereof by all interests. The expenses of all such recoveries and proceedings in connection therewith shall be apportioned in the ratio of respective recoveries. With respect to proceedings conducted solely by us, if there is no recovery, we will bear the expense thereof. If there is a recovery, we shall be reimbursed in full from such recovery for the amount of all expenses incurred by us before apportionment of such recovery as herein provided. ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED. PPU 304 06 10 Page 2 of 2 Policy Number: Ps®0008537 PS80008537 RLI Insurance Company Named Insure&ohn M Cruikshank THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. RLIPack° NOTICE OF CANCELLATION OR NONRENEWAL — DESIGNATED PERSON OR ORGANIZATION Schedule Designated Person or Organization: City of El Segundo Email Address: US Mail Address: 350 Main St,, El Segundo, CA 90245 If we cancel or chose to nonrenew this policy for any reason other than nonpayment of premium we will provide written notice at least (30 ) days before the effective date of the cancellation or nonrenewal to the designated person or organization in the above schedule. Such notice will be sent via the US mail address or E-mail address listed above. Proof of mailing or e-mailing will be sufficient proof of notice. PPK 2108 05 11 Page 1 of 1 CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 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). CONTACT PRODUCER SUNZ Insurance Solutions, LLC ID: (Optimum) I NAME ,,, Raquel Badayos c/o Optimum Employer Solutions, LLC PHONE .xtt 949-650 7800 x 221 %Ax Ne( 2530 Red HIII Ave., Suite 200 MAIL Santa Ana, CA 92705 Ia1DRs's., ....... ratllui ro)wrmknmhr.net NNSURER(SI AFFORDING COVERAGE INSURER A United WISCOnSin Insyr „ 2nce COmpa INSURED INSURER B : Optimum Employer Solutions, LLC LCF John M Cruikshank Consultants Inc dba JMC2 wsuRERc m ,,,, 2530 Red Hill Ave. INSURER D Suite 200 INSURER E;' Santa Ana CA 92705 _ I.UVGRAb CJ �.CRllr'11..AIG IYUIYIG CR:. Y'74.y '34UL. RGYIAIMY IYvino�r�. 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. LTR I TYPE OF INSURANCE POLICYNUMBER ( M... IYYYY I M1DD(YXYY I. LIMITS j COMMERCIAL GENERAL LIABILITY ( 7 EACH OCCURRENCE $ �..... ( i I iIAMAv`f=rU itt=YJi�u.. CLAIMS -MADE OCCUR ,.... ......... _ PREf1AISE,(Ea,occur,Lenre), .,,., ,,,,„ - MED EXP (Any one person) $ .... ---- ,., ------ ...... ERSONALBADVINJURY $ GEN L AGGREGATE LIMIT APPLIES PER: G ENERALAGGREGATE $ POLICY ICJC . IECT N RODUCTS COMP/OP AGG $ ,m„m. .... ..... . OTHER $ AUTOMOBILE LIABILITY � COMBINEO SINGLE LIMI l $ ANY AUTO BODILY INJURY (Per person) $ __- ,..-...... OWNED SCHEDULED I ..... _............ .. ............ ,,,,e..... BODILY INJURY (Per accident) $ AUTOS ONLY ;_._._ AUTOS HIRED NON -OWNED PHOPERrYDAMAGE $ -..,...,r AUTOS ONLY „........ _ AUTOS ONLY ...(.P UMBRELLALIAB j, OCCUR EXCESS LIAB ! ci Amos EACH OCCURRENCE is AGGREGATE JS A WORKERS COMPENSATION WC527-00135-021-SZ 7/1/2021 7/1/2022 PER Uli" AND EMPLOYERS' LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE N I A YIN L. EACH ACCIDENT $ 1r OOO OOO IOFFICER/MEMBEREXCLUDED? -" (Mandatoryin NH) f E L DISEASE - EA EMPLOYEE $ 1 �(�(� Q(�� If ves, describe under ------ DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached it more space is required) Coverage provided for all leased employees but not subcontractors of: John M Cruikshank Consultants Inc dba JMC2 Client Effective: 9/16/2019 Project: STREET IMPROVEMENTS FEASIBILITY STUDY FOR THE 500 BLOCK OF ARENA STREET AND 613 ARENA STREET CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cltx of El Segundo Public Works Department THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 35U Fain Street ACCORDANCE WITH THE POLICY PROVISIONS. El Segundo CA 90245 AUTHORIZED REPRESENTATIVE r 7 (" Rick Leonard ©1988-2015 ACORD CORPORATION. All rights reserved, ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 64739402 1 John M Cruikshank Consultants (CA) MCP 00135 1 Raquel Castro 1 10/27/2021 5:47:32 PM (EDT) I Page 1 of 1