Loading...
PROOF OF INSURANCE (2022 - 2022) CLOSED.� C V CERTIFICATE OF LIABILITY INSURANCE DAT/24/2DIYYYY) �,. 11 24/2021 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 ($), ''..PRODUCER CONTACT Elizabeth Flinders _ Flinders/DePalma Insurance Agency "PHONE FAx P.O. Box 510 (A/C,.No,.Ex� (8118)843 8600 _�(AIc,No) (818)566 9841 E-MAIL Ilz flindersins com Burbank CA 91503- ADDRFSS� .. L _ INSURED g p 11770 ��pN,�6.� Pro resslve Companies ...�_ ... .... Clean Scene Services Inc tNsuRs R _ _ P O Box 500103 Palmdale CA 93591- .........:. ....... ,m u.. r.. i.��rirrn ^r^r •.r:r ■rrcti �^.ry. tDMIllctr9.m tut lira MOD.. 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. ...., ..rr _ ............. .... .... ..m -INSR _... ..... ... ......... AOOL4SUB-01. ......... .-:,.n_, ---.. ,. POLICYEF....: .-_ F POLICY EXP TYPE OF INSURANCE (.. LIMITS A X COMMERCIAL GENERAL LIABILITY X CCP938084 02/06/2021 2/06/2022 EACH„OCCURRENCE..,_�$2,000,000 X DAMAGE r0 ReNTED 100,000 CLAIMS -MADE OCCUR PRMISL(E.dccucrdGt)........ $ e EDEXP_Anyoneperson)..,, 8 ... 5,000 �,., .., .... ...._ __ ..............-,�,... .. .... ..... PERSQ,NA,L&ADVINIURY $ 2,000,000 ..W-.. ...-.-TAP GRL��'7r LIMIT APPLIES PER. GFNPCa C RELATE $ 2,000,000 - PRO- � cY LOC ... e- JECT ..1111­ P RODUCTSG,C,,,OMP/OP,AGG $ Include .• d B AUTOMOBILE _ 06342952-3 "11/22/2021 11/22/2022 COMBINED SINGLE LIMIT $ 1,000,000 -._ .............. ANY AUTO BODILY INJURY (Per person) $ .......:. .. _,..-. WNEDX SCHEDULED AUTOS INJURY BODILY INJURY (Per accident) $ . AUTOS ONLY AUTOS HIRED X NON OWNED PROPERTYDAMAGE $ ROPE ,..X-; AUTOS ONLY AUTOS ONLY (Beiaccident)- ,.,..... _ ... I $ UMBRELLA LIAB ..... OCCUR _EACH OCCURRENCE ...... ! $ ...__... EXCESS LIAB�_CL,&M§:MPE WORKERS COMPENSATION N aata PER OTH t, �E AND EMPLOYRS' LITY ANY PROPRIEEORIPARTI ER/EXECUTIVE m E ___ $ I,, EACH ACCIDENT - ....--_ OFFICERIMEMBER EXCLUDED? (Mandatory in NH) NIA If yes, describe under nF-sQg1p1IQN OF op E..L. OIS.EASE-POLICY LIMIT DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of El Segundo is named as an additional insured on the General Liability policy as per written contract. Endorsement attached. City of El Segundo 348 Main Street ElSegundo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. CA 90245- f AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reservea. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Policy # CCP938084 COMMERCIAL GENERAL LIABILITY CG20100413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES O CONTRACTORS - SCHEDULED D PERSON O ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Locations Of Covered Operations Information required to complete this Schedule, if not shown above, will be shown in the Declarations. 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: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. 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 additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. CG 20 10 04 13 0 Insurance Services Office, Inc., 2012 Pagel of 2 C. 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. Page 2 of 2 0 Insurance Services Office, Inc., 2012 CG 20 10 04 13 CITY OF EL SEGUNDO WORKERS' COMPENSATION DECLARATION WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL 'AND SUBJECTS AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN LABOR CODE § 3706, INTEREST, AND ATTORNEY'S FEES. I affirm under penalty of perjury under the laws of California one of the following declarations: (__) I have and will maintain a certificate of consent of self -insure for workers' compensation, issued by the Director of Industrial Relations as provided for by Labor Code § 3700 for the performance of the work set forth the agreement with the City of El Segundo. Policy No. („ )1 have and will maintain worirero' compensation insurance as required by Labor Code § 3700 for the performance of the worts for which the agreementwith the City of El Segundo is executed. My workers' compensation insurance carrier and policy number are: Carrier Policy Number Expiration Date Name of Agent phone # ( 1 I certify that, In the performance of the worts set forth In the agreement with the City of El Segundo, I will not employ any person in any manner so as to become subject to the workers' compensation laws of California„ and agree that, if I should become subject to the workers;' compensation provisions of Labor Code § 3700 1 must; Immediately comply with those provisions or the agreement will automatically become void. Signature of Applicant ~�, r, a✓ ° ..:�� Gate / Agreement for: Dated: Reviewed by: