PROOF OF INSURANCE (2024) CLOSED/
A� " CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DD/YYYY)
O5/22/2023
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
CONTACT Tina Cowie
NAME:
Cornerstone Specialty Insurance Services, Inc.
pAH/cNE. (714)731-7700 a/c, (714)731-7750
Ext: No:
14252 Culver Drive, A299
E-MAIL tina@cornerstonespecialty.com
ADDRESS:
INSURER(S) AFFORDING COVERAGE
NAIC #
INSURERA: RLI Insurance Company
13056
Irvine CA 92604
INSURED
INSURER B : Aspen American Insurance Company
43460
MILLER ARCHITECTURAL CORP.
INSURER C :
1177 Idaho Street
INSURER D :
Suite 200
INSURER E :
Redlands CA 92374
INSURER F :
COVERAGES CERTIFICATE NUMBER: 23/24 COVERAGES 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 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.
INSR
LTR
TYPE OF INSURANCEAUULbUBK
INSD
WVD
POLICY NUMBER
POLICY EFF
MM/DD/YYYY
POLICY EXP
MM/DD/YYYY
LIMITS
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$ 2,000,000
CLAIMS -MADE ® OCCUR
PREM SES Ea oNcurDrence
$ 1,000,000
MED EXP (Any one person)
$ 10,000
ADDTL INSURED / P & NC
X
BLNKT WVR OF SUBRO
PERSONAL &ADV INJURY
$ INCLUDED
A
PSB0006782
05/29/2023
05/29/2024
LAGGREGATE LIMITAPPLIES PER:
GENERAL AGGREGATE
$ 4,000,000
POLICY ® PRO ❑ LOC
JECT:
MOTHER
PRODUCTS-COMP/OPAGG
$ 4,000,000
$
AUTOMOBILE
LIABILITY
COMBINED SINGLE LIMIT
Ea accident
$ 2,000,000
BODILY INJURY (Per person)
$
ANYAUTO
A
OWNED SCHEDULED
AUTOS ONLY AUTOS
PSB0006782
05/29/2023
05/29/2024
BODILY INJURY (Pe r accide nt)
$
PROPERTY DAMAGE
Per accident
$
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE
$ 3,000,000
AGGREGATE
$
A
EXCESS LAB
CLAIMS -MADE
PSE0002919
05/29/2023
05/29/2024
DED I I RETENTION $
$
AOFFICER/MEMBER
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
ANY PROPRIETOR/PARTNER/EXECUTIVE
EXCLUDED?
(Mandatory in NH)
N /A
PSW0003805
O5/29/2023
O5/29/2024
PER OTH-
STATUTE ER
E.L. EACH ACCIDENT
1,000,000
$
E.L. DISEASE - EA EMPLOYEE
$ 1,000,000
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
1,000,000
$
E ach Claim
$3,000,000
B
Professional Liability
Claims Made
AAAE300196-03
05/29/2023
05/29/2024
Annual Aggregate
$3,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
City of El Segundo is Additional Insured for General Liability but only if required by written contract with the Named Insured prior to an occurrence and as
per attached endorsement. Coverage is subject to all policy terms and conditions. *30 days notice of cancellation, except for 10 days notice for non-payment
of premium. For Professional Liability coverage, the aggregate limit is the total insurance available for all covered claims reported within the policy period.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of El Segundo Public Works Deparment
ACCORDANCE WITH THE POLICY PROVISIONS.
350 Main Street
AUTHORIZED REPRESENTATIVE
ElSegundo CA 90245
, // �"
@ 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
Policy Number: PSB0006782
Named Insured: Miller Architectural Corp.
RLI Insurance Company
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RLIPack° FOR DESIGN 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
WORKERS' COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06
(Ed. 04-84)
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 % of the California workers' compensation premium otherwise due on such
remuneration.
Person or Organization
All persons or organizations that are party to a
contract that requires you to obtain this
agreement, provided you executed the contract
before aloss
Schedule
Job Description
Job performed for any person or organization that you
have agreed with in a written contract to provide this
agreement.
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 05/29/2023 Policy No. PSW0003805 Endorsement No.
Insured Miller Architectural Corporation Insurance Company RLI Insurance Company