Loading...
PROOF OF INSURANCE (2022 - 2022) CLOSEDFDATE (MM/DDIYYYY) C CERTIFICATE OF LIABILITY INSURANCE lill 11 / 15/2021 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 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 . Christina Hernandez NAME: The Liberty Company Insurance Brokers AtC, N t (949) 777-0570 Nd, (877) 693-9834 E-MAIL chernandez .com @ rty P y ......... Lic #OD79653 ADDRESS. Jibe cam an 111 Pacifica, Suite 230 INSURER(S) AFFORDING COVERAGE NAIC # Irvine CA 92618 INSURERA: Atlantic Specialty Insurance Co 27154 INSURED INSURER B : Comp West Insurance Company 12177 Bell Event Services, Inc, INSURER C 531 Main St.. #228 INSURER D i INSURER E r El Segundo CA 90245 INSURERF: COVERAGES CERTIFICATE NUMBER: 21-22 Master: GL/BA/IM/ REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW NAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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. N R .......... .PST.,. POLICY L "Y LY YC LTR TYPE OF INSURANCE INSD I D POLICY NUMBER MMIDDIYYYY MM/DDIYYYY LIMITS - ......... ........�. COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE ❑ OCCUR PREMISES(Ea occurrence) $ 1,000,000 A GEN'LAGGREGATE LIMITAPPLIES PER: ,'.. POLICY ❑ 7HC; ❑ LOC EC.T OTHER: AUTOMOBILE LIABILITY ANY AUTO A AUTOS ONLY AUTOS ULED HIRED NON -OWNED OWNEDq....... AUTOS ONLY P. AUTOS ONLY UMBRELLA A ��''. EXC SS pBA6 �' OCCUR Y II Y 1 GL05496-01 710-03-96-78-0001 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N B ANY PROPRIETOR/PARTNER/EXECUTIVE"" Y "� N /A Y WCV5505108 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below I A Equipment R H 00511-01 MED EXP (Any one person) $ 10,000 09/25/2021 09/25/2022 PERSONAL BADVINJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000.006 PRODUCTS - COMP/OPAGG $ 2,000.000 COMBINED SINGLE. LIMIT g 1,000.000 _(Fa SL1;1 t2.............................................................. BODILY INJURY (Per person) $ 09/25/2021 09/25/2022 BODILY INJURY (Per accident) S Frff d FxGE ........ �........ ........ Pkr aC2dout HiredAuto Physical Dmg s `Included EACH OCCURRENCE S 1,000,000 AGGREGATE S 1,000,000 09/25/2021 09/25/2022 rxi 05/25/2021 j 05/25/2022 E.L. EACH ACCIDENT I S 1,000 000 E.L. DISEASE- EA EMPLOYEE S 1,000 000 E. L. DISEASE -POLICY LIMIT S 1,000,000 Leased/Rented $310.000 09/25/2021 109/25/2022 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Whereby required by written contract or agreement, Certificate Holder is included as an Additional Insured under the Commercial General Liability on a Primary/Non-Contributory basis.. Waiver of Subrogation in favor of the Additional Insured applies to the General Liability and Workers Compensation, subject to a written contract or agreement *30 days written notice of cancellation, with the exception of 10 days for non -pay. The City of El Segundo its officers, officials, employees, agents, and volunteers 3501 Main St. ElSegundo CA 90425 l.AN6r_LLAI IUIY 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 @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: GL05496-01 COMMERCIAL GENERAL LIABILITY 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; City of El Segundo 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 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 ongoing operations or "your work" done under a contract with that person or organization and included in the "products -completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 05 09 0 Insurance Services Office, Inc., 2008 Page 1 of 1 0 POLICY NUMBER: GL05496-01 COMMERCIAL GENERAL LIABILITY CG 20 26 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE 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", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: 1. In the performance of your ongoing operations; or 2. In connection with your premises owned by or rented to you. 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 shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 26 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 COMMERCIAL GENERAL LIABILITY CG 20 01 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY TRISUTO Y - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance Condition and supersedes any provision to the contrary: Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and (2) You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. CG 20 01 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 03 13 C (Ed. 7-09) 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. The additional premium for this endorsement shall be $ 500 Schedule Any person or organization that you perform work for that is liable for an injury, covered by this policy, that prior to the injury has written contract requiring a waiver of our right to recover from them. Person or Organization Job Description 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 05/25/2021 Policy No. WCV 5505108 Endorsement No. 000 Insured BELL EVENT SERVICES, INC. Insurance Company COMPWEST INSURANCE COMPANY Countersigned by.—.�.............. WC990313C (Ed. 7-09)