Loading...
PROOF OF INSURANCE (2024) CLOSEDACCORD® CERTIFICATE OF LIABILITY INSURANCE `.... DATE(MM/DD/YYYY) 7/25/2023 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 IOA Insurance Services 130 Vantis, Suite 250 Aliso Viejo, CA 92656 CONTACT NAMEBetty Tran PHONE FAX A/C No Ext : 949-297-5962 A/C No): 949-297-5960 ADDRESS: betty.tran@ioausa.com INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: RLI Insurance Company 13056 www.ioausa.com CA License #OE67768 INSURED Omnis Consulting Inc. 14726 Ramona Avenue, Suite S20 INSURER B INSURERC: INSURERD: Chino CA 91710 INSURER E INSURER F : COVERAGES CERTIFICATE NUMBER: 75466798 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. INSR LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICYNUMBER POLICY EFF MM/DD POLICY EXP MM/DD LIMITS A �/ COMMERCIAL GENERAL LIABILITY / �/ PSB0002339 7/22/2023 7/22/2024 EACH OCCURRENCE $2,000,000 CLAIMS -MADE 11/1 OCCUR Scheduled Al Endt #PPB3130212 DAMAGE PREM SESO RENTED ocurrence $ 1 ,000,000 / MED EXP (Any one person) $10,000 Prim/NonCon Professional Services / Wvr of Subr PERSONAL &ADV INJURY $2,000,000 performed by the Insured GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $4,000,000 are Excluded PRO - POLICY ✓� ECT LOC PRODUCTS - COMP/OPAGG $4,000,000 $ OTHER: A AUTOMOBILE LIABILITY ✓ ✓ PSA0001537 7/22/2023 7/22/2024 Ee aBINEDtSINGLE LIMIT $ 1 000 000 ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY ✓ AUTOS ONLY Designated Insured Endt #CA20481013; Prim/NonCon and Blkt Wvr of Subr included on pg 2 of Form ✓ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ ✓ TY (Per acdenDAMAGE $ / $ Prim/NonCon / Wvr of Subr #PPA3000313 UMBRELLALIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LAB CLAIMS -MADE DED RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N OF ICER/MEMBEREXCLU EXCLUDED? ECUTIVE ❑Y N/A ✓ PSW0002073 Waiver of Subrogation Endt #WC0403060484 7/22/2023 7/22/2024 �/ SPER TATUTE OERH E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1 000 000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1 ,000,000 A Professional Liability RDP0051598 7/22/2023 7/22/2024 $1,000,000 Each Claim Claims -Made $2,000,000 Annual Aggregate DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) Certificate Holder is an Additional Insured with respect to General Liability (GL) and Automobile Liability when required by contract with the Insured, but only to the extent provided within the Endorsements noted above. GL includes Separation of Insureds and Contractual Liability per limitations in the BusinessOwners' Coverage form. A Workers' Compensation Waiver is included for the person or organization named in the Schedule that are parties to a written contract, but only to the extent provided within the Endorsement noted above. Coverage is subject to all policy terms, limitations and exclusions. 30 Day Notice of Cancellation / 10 Days for Non -Payment in accordance with policy provisions. CERTIFICATE HOLDER CANCELLATION Engineering, Design and Plan Check Services of the Insured City of El Segundo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Department of Public Works - Engineering Division ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street El Segundo CA 90245 AUTHORIZED REPRESENTATIVE (AVC) Alicia K. Igram ACORD 25 (2016103) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 75466798 17/23-24 GL, AUTO, WC & PL I Noel Zemla 17/25/2023 12:59:46 PM (PST) I Page 1 of 5 Policy Number: PGB000233y Named Insured: <}mnioConsulting, Inc. RLI Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: Schedule Name nfPeronn(s)orOrgan izehon(s): City of El Segundo 1' SECTION |U C'Who Is An Insured is amended to include as an additional insured the person or organization shown in the schedule above, 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: m' |nthe performance ofyour ongoing operations; b. In connection with premises owned byorrented toyou; or o. In connection with ''your vvork" and included within the ''produdt-comp|eted operations hezend" 2. The insurance provided tothe additional insured by this endorsement is limited as follows: a' This insurance does not apply tuthe rendering of or failure to render any "professional b. This endorsement does not increase any of the limits of insurance stated in D. Liability And Medical Expenses Limits ofInsurance. 3' The following ioadded toSECTION U|U H'2. Other Umamnmmce — COMMON POLICY CONDITIONS (BUT APPLICABLE ONLY TO SECTION U| — However, if you specifically agree in e contract or agreement that the insurance provided to an additional insured under this policy must apply on a primary beois, or a primary and non-contributory baaia, this insurance is primary to other insurance that is available to such additional insured which covers such additional insured eoa named insunad, and we will not share with that other inaunanme, provided that: m' The "bodily injury" or "property demuge" for which coverage is sought occurs after you have entered into that contract oragreement; 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 oragreement. 4' The following isadded hoSECTION Ill K.2 Transfer of Rights of Recovery Against Others to Um — C0AHAH00 POLICY CONDITIONS (BUT APPLICABLE TO SECTION D— PROPERTY AND SECTION 11 — 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 beha|f, under a contract or agreement with that person or organization. VVewaive these rights only where you have agreed to do so as pad of e contract or agreement with such person or organization entered into by you before the "bodily injury" or"property damage" occurs, orthe "personal and advertising injury" offense iocommitted. ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED. UU-31019"I AN 75466798 1 7/23'24 GL' AUTO, wc ^ sL I Noel xemla 1 7/25/2023 12.59.46 pm (PST) I Page 2 of 5 Page 1 of 1 POLICY NUMBER: PSA0001537 0 il i� I , , 0 1 N-JOURF THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED FOR COVERED AUTOS LIABILITY COVERAGE This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: Ornnis Consulting, Inc. Endorsement Effective Date: 7/22/2023 SCHEDULE Name Of Person(s) Or Organ ization(s): City of El Segundo Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Each person or organization shown in the Schedule is an "insured" for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Paragraph A.I. of Section 11 — Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms and Paragraph D.2. of Section I — Covered Autos Coverages of the Auto Dealers Coverage Form. CA 20 48 10 13 @ Insurance Services Office, Inc., 2011 75466798 1 7/23-24 GL, AUTO, WC & PL I Noel Zemla 1 7/25/2023 12:59:46 PM (PST) I Page 3 of 5 Page I of 1 This endorsement modifies insurance provided under the following: A. Broad Form Named Insured The following is added to the SECTION U| — COVERED AUTOS LIABILITY COVERAGE, Para- graph A.I.Whm Is An Insured Provision: Any business entity newly acquired orformed bvyou during the policy poriod, provided you own fifty percent (5O%)urmore ofthe business entity and the business entity is not separately insured for Bus- ineosAuho Coverage. Coverage is extended up to a maximum of one hundred eighty (180) days following the acquisition or formation of the business entity. This provision does not apply to any person or organization for which coverage is excluded by endorsement. B. Employees AaInsureds The following is added to the SECTION U| — COVERED AUTOS LIABILITY COVERAGE, Para- graph A.I.nVhp|nAm|msmredProvision: Any "employee" of yours is an "insured" while using a covered "auto" you don't ovvn, hire or borrow in your business or your personal affairs. C. Blanket Additional Insured The following is added to the SECTION U| — COVERED AUTOS LIABILITY COVERAGE, Para- graph /u.I.VKhm Is An Insured Provision: Any person or organization that you are required to include as an additional insured on this coverage form in a contract oragreement that is executed by you before the "bodily injury" or "property damage" occurs isan^insurod^for liability coverage, but only for damages to which this insurance applies and only to the extent that person or organization qualifies as an ''inauned" under the Who Is An Insured provision contained in SECTION |U — COVERED AUTOS LIABILITY COVERAGE. The insurance provided tothe additional insured will be on a primary and non-contributory basis to the additional ineured'a own business auto coverage if you are required hodosoinucontract oragreement that is executed by you before the "bodily injury" or `` property damage" occurs. D. Blanket Waiver Of Subrogation The following is added to the SECTION K#— BUSI- NESS AUTO CONDITIONS, A. Loss Conditions, S- Transfer Of Rights Of Recovery Against Others To Us: We waive any right nfrecovery wmmay have against any person or organization to the extent required of you by a contract executed prior to any "accident" or "loss", provided that the "accident" or "loss" arises out ofthe operations contemplated bvsuch contract. The waiver applies only to the person or organization designated insuch contract. E. Employee Hired Autos 1. The following is added to the SECTION D| — COVERED AUTOS LIABILITY COVERAGE' Paragraph A-1'Who DoAm Insured Provision: An "employee" of yours is an "insured" while operating an "auto" hired or nanbad under u contract or agreement in that "employee's" name, with your permission, while performing duties related tothe conduct ofyour business. 2. Changes |nGeneral Conditions: Paragraph �b. of the Other Insurance Con- dition in the BUSINESS AUTO CONDITIONS is deleted and nap|eoed with the following: b. For Hired Auto Physical Damage Covenage, the following are deemed to be covered ''eutno"you own: (1) Any covered "auto" you |easo, hine, rent or borrow; and (2) Any covered "auto" hired or rented by your ^emp|ovee'under acontract inthat individual "employee's" name, with your permiaoion, while performing duties related tothe conduct nfyour business. However, any ''autn" that is |euoed, hired, rented orborrowed with adriver is not acovered ''aubo" F. Fellow Employee Coverage SECTION U| — COVERED AUTOS LIABILITY COVERAGE, ExnUmeimm B.5' does not apply if you have workers compensation insurance in -force coveringall ofyour employees. G. Auto Loan Lease Gap Coverage SECTION III —PHYSICAL DAMAGE COVERAGE, C. Limit Of Insurance, is amended bvthe addition ofthe following: In the event of e total ^|oao^ to a covered ^eubf shown in the Schedule ofDeclarations, we will pay any unpaid amount due on the lease or loan fore covered ''euto"less: 1. The amount puk1 under the PHYSICAL DAMAGE COVERAGE aeohnn of the policy; and 2. Any: a. Overdue lease/loan payments otthe time of 75466798 1 7/23'24 GL' AUTO, wc ^ sL I Noel xemla 1 7/25/2023 12.59.46 pm (PST) I Page 4 of 5 Page 2 of 5 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 2 % of the California workers' compensation premium Person mrOrganization City of El Segundo Schedule Job Description Jobs performed for any person ororganization that you have agreed with in awritten contract to provide this agreement. This endorsement changes the policy tmwhich xisattached and |eeffective onthe date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 7/22/2023 Insured ornuisConsulting, Inc. Pol1q/NuPBW0002073 Insurance Company RL|Insurance Company — A�,lw 5 i: � � �,X� -, � @11998 bythe Workers' Compensation Insurance Rating Bureau nYCalifornia. All rights reserved. 75466798 1 7/23'24 GL' AUTO, wc ^ sL I Noel xemla 1 7/25/2023 12.59.46 pm (PST) I Page 5 of 5