Loading...
PROOF OF INSURANCE (2024) CLOSEDACOR 7 0 CERTIFICATE OF LIABILITY INSURANCE 11/9/2024 DATE (MMIDD/YYYY) 11/7/2023 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 Lockton Insurance Brokers,LLC CA License #OF15767 777 S. Figueroa Street, 52nd fl. Los Angeles CA 90017 CONTACT NAME: PHONE FAX Ext : ac No Male ADDRESS: 213-689-0065 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Transportation Insurance Company 20494 INSURED Wllldan Engineering 1506306 2401 East Katella Avenue, Suite 300 INSURER B : National Fire Insurance Co of Dartford 20478 INSURER C : Allied World Sul -plus Lines Insurance Company 24319 INSURER D : The Continental Insurance Company 35289 Anaheim, CA 92806 INSURER E : American Casualty Company of Reading, PA 20427 INSURER F : COVERAGES WILLDOI CERTIFICATE NUMBER: 19811079 REVISION NUMBER: XXXXXX_x 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 I SUBR POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR Y N 7063481190 11/9/2023 11/9/2024 EACH OCCURRENCE $ 1,000,000 DAMAGE Tg RETE PREM SESOEa oocu... enc $ 1,000,000 X MED EXP (Any one person) $ 15,000 Emp. Benefits Llab. X Contr. Llab. Incl. PERSONAL & ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY JE� � LOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER: A AUTOMOBILE LIABILITY Y NT 7063491156 11/9/2023 11/9/2024 Ea 'cc(CMBIEDtSINGLE LIMIT $ 1,000,000 X BODILY INJURY (Per person) $ XXXXXxx ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ XXXXXxx PROPERTY DAMAGE Per accident $ �r�r�rYXx�� HIRED NON -OWNED AUTOS ONLY AUTOS ONLY r s xxxxxxx UMBRELLA LIAB OCCUR NOT APPLICABLE EACH OCCURRENCE $ xxxx= AGGREGATE $ XXXXXxx EXCESS LIAB CLAIMS -MADE DED I I RETENTION $ $ XXXXXX _x D E WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICER/MEMBER EXCLUDED? ❑N (Mandatory in NH) N / A Y 7063481173 (AOS) 706348 1187 (CA) 11/9/2023 11/9/2023 11/9/2024 11/9/2024 PER OTH- Y 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 I $ 1,000,000 C Arch&Eng Prof N Y 0313-5950 11/9/2023 11/9/2024 Per Claim:$1,000,000 Aggregate:$1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: Fire plan review services. City of El Segundo is included as Additional Insured(s) in accordance with the provisions of the General Liability and Automobile Liability policies. A Waiver of Subrogation is granted in favor of City of E1 Segundo in accordance with the policy provisions of the Professional Liability and Workers' Compensation policies. aha NII;1Lh_\INo:Lei 4Ua: hG1►Lha111111WLULaJ►�WWlIIi�iTiiT�ii 19811079 City of El Segundo Attention: Nicole Pesqueira 350 Main Street 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 t71988-201sACOt2D CORPORATION_ All riahtc rpcprvpd ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Attachment Code: D604000 Certificate ID: 19811079 This endorsement changes the policy to which it is attached. It is agreed that Part One - Workers' Compensation Insurance G. Recovery From Others and Part Two - Employers' Liability Insurance H. Recovery From Others are amended by adding the following: We will not enforce our right to recover against persons or organizations. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) PREMIUM CHARGE - Refer to the Schedule of Operations The charge will be an amount to which you and we agree that is a percentage of the total standard premium for California exposure. The amount is Blanket Waiver of Subrogation Percentage Charge 2.00%. All other terms and conditions of the policy remain unchanged. This endorsement, which forms a part of and is for attachment to the policy issued by the designated Insurers, takes effect on the Policy Effective date of said policy at the hour stated in said policy, unless another effective date (the Endorsement Effective Date) is shown below, and expires concurrently with said policy unless another expiration date is shown below. Form No: G-19160-B (11-1997) Policy No: 7063481187 (CA) Endorsement Effective Date: 11/9/2023 Policy Effective Date: 11/9/2023 Endorsement Expiration Date: 11/9/2024 Policy Page: Endorsement No: Page: 1 of 1 Underwriting Company: American Casualty Company Of Reading, PA © Copyright CNA All Rights Reserved.