Loading...
PROOF OF INSURANCE (2024 - 2025)DATE06 2 /20 4YYY) CERTIFICATE OF LIABILITY INSURANCE 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(les) must have ADDITIONAL INSURED ,Provisions or be endorsed. It 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 endor'sement(s), PRODUCER COWrAC'T' NAME. AOn Risk Insurance services West, Inc, ,F......... (g66} 2g3 7122mm WW1 F"mm (g00) 363 D105 San Francisco CA Office tC Ne` ExtP pq=N 425 Market Street E-MAIL Suite 2800 ADDRESS: San Francisco CA 94105 USA INSURER(S) AFFORDING COVERAGE NAIC # 15105 INSURED INSURER A: Safety National casualty Corp _-...... mmm .... Lyft, Inc. INSURERB: Old Republic Union Insurance Company 31143 185 Berry Street, Suite 400 ......" San Francisco CA 94107-2503 USA INSURER C. INSURER D: ..,_.,.. " INSURER E: ........_.....�....,�. ...............,,,,. INSURER F: ......�.....�.. ,ren...rv.nRRYtll4^InW1INil Wt4MRFR� vT141S IS TO CERTIFY THAT THE POLICIES OF.. _... N --- F INSURANCE✓ LISTIITD BELOW HAVE BEEN ISSUED TO THE INSURED NAePuiED 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. Limits shown are as requested LTA. TYPE OF INSURANCE INS. WVO POLICY NUMBER MWDDlYyyY MIDDAYY LIMITS X COMMERCIAL GENERAL LIABILITY MWLY J EACH OCCURRENCE $1 000 000' CLAIMS -MADE OCCUR X SIR applies per policy terns & condi :ionsA'A0tt7H�Ef5id PR,EN1iggq IFa occurrence __ $106000 mmmm� ' MED EXP (Any one person) ....... _.�. ...... .. .................... _......­ PERSONAL B ADV INJURY .�.,..............00 $1 O,OOO. GEN'LAGGREGATE LIMIT APPLIES PER GENERALAGGREGATE $2,000, 000.. PRO- ❑ LOC X POLICY I PRODUCTS COMP/OPAGG $2,000,000' JECT OTHER: COMBINED SINGLE LIMB AUTOMOBILE LIABILITY A a id. nt ..._ BODILY INJURY ( Per person) ANY AUTO ..(,. .,._._.�. w._.. _.. SCHEDULED BODILY INJURY( Pe accident)...mm.. OWNED AUTOS AUTOS ONLY PROPERTY DAMAGE HIRED AUTOS NON -OWNED (Peraccident} .�ONLY AUTOS ONLY ...Per UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS -MADE AGGREGATE ...... ,............... �.........., ................ DEDI RUTEN'T101N A WORKERS COMPENSATION AND PRA406827 07 1 20 4 0710112 5 X PER STATUTE OTTH-' EMPLOYERS' LIABILITY 'Y r N ANY PROPRIETOR / PARTNER / EXECUTIVE r . _] E.L. EACH ACCIDENT $1, 000 , 000 OFFICER/MEMBER EXCLUDED? 11 '" 141 N / A "" """" """ E.L. DISEASE EA EMPLOYEE __ """""' $1, 000 000 (Mandatory In NH) , If yes, describe under E,L. DISEASE -POLICY LIMIT $1, 00. O00 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Addltlonal Remarks Schedule, may be attached H more space Is requlrad) Proof of insurance for Lyft, Inc. RE: General services Agreement between The City of El Segundo and Lyft, Inc. Any such coverage extended to the Additional Insured by the General Liability policy will apply as Primary and Non -Contributory, to the extent of liability assumed under contract. Waiver of Subrogation applies for General Liability and Workers' Compensation coverages where required by written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. city of El Segundo AUTHORIZED REPRESENTATIVE 350 Main Street E1 Segundo CA 90245 USA ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD m cc N W m 0 0 Ln O Z r cc 0 t= U LYFT-XL-01 ' -...LIE Af►i O ° DATE (MMIDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 9/25/2023 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) mustITp mm� .. 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 Alliant Insurance Services, Inc. 3850 N Causeway Blvd Suite 1150 Metairie, LA 70002 INSURED Lyft, Inc. 185 Berry St #400 San Francisco, CA 94107 Ds Mobilitas I NAIC # OVERAGI........... _. CERTIFICATE Nb)IIII: VI'),�3N NtIMBI';R ......._ THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIODmmm 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 TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EF ICY EXP LIMITS ........ .... . COMMERCIAL GENERAL LIABILITY FACHOCCURRENCE,$,,, _ .. 7 CLAIMS -MADE N OCCUR DAMAGE TO RENTED .... , ....,........... --.e MED EXP {Any one pe,rsan� $_. .. ------- --------........ PERSONAL 4 ADV INJURY G�EN L AGGREGATE LIMIT APPLIES PER: ENERAL AGGREGATE,,, POLICY rl PRO_ L._....� LOC .PRODUCTS AGGI. S .. 10 A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $........ ANY AUTO CABAIIT6624548270 10/1/2023 10/1/2024 BODILY.INULIRY, Per erson, 50,000 OLITOSWNEDONLY SCHEDULED as'cafdINJU 'DY DAMAGE °'q�ti' 1..... 100 000 AUTOS ONLY AUTOS ONLYideo?,k $ ,,., 30 000 HIRED NON -OWNED „.. .. X Symbol 10 X Period 1 X._. _......... ..... EACHUMBRELLA OCCURRENCE $ AGGREG A EXCESS ABIAB CLAIMs MADE TCABAIT8624548270 10/1/2023 10/1/2024 DED I t RETENTION $ n.........._�., _������._... _. 1 XS Auto CSL $ 200,000 WORKERS COMPENSATION m.. _1 PER STATl1T. TFiO AND EMPLOYERS' LIABILITY l "'"" "'" >L. EACH ACCIDENT $ YrN OFFICER/MEMBER EXCLUDANY ED ECUTIVE NIA (Mandatory in NH) _ EL DISEASE.,-, EA EMPLOYEE $........... ......_,,,IT,,, .... ._. ---- If yes, describe under , DESCRIPTION OF OPERATIONS below E„ . DISEASE - POLICY LIMIT ......._r___�... .......__ ......,. ......._... A Symbol 10/Prima i CABA2T6624548270 10/1/2023 10/1/2024 Period 2/CSL 1,000,000 A Symbol 10/Primary CABA3T6624548270 10/1/2023 10/1/2024 Period 3/CSL 1,000,000 DESCRIPTThe AutoON Physical cal Damage limits is are I provided under Period 2 and Period 3�pol policies and will be If or the p / LOCATIONS VEHICLES (ACORD .s Schedule, che y is required) y • 9 p p Cost of Repair, whichever is less, less the $2,500 deductible. Policy for Period 3 includes UM/UIM $1,000,000 CSL Evidence of Insurance Only for the State of CA. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXP Lyft, Inc. ACCORDANOTI NCE WITH THE POLICY PROTION DATE VIS ONSCE WILL BE DELIVERED IN 185 Berry St #400 San Francisco, CA 94107 ............ -wwwwwwwwwwwwwww ....... AUTHORIZED REPRESENTATIVE _ ............... _ :........ ....... ...................... ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD IL 10 (04/18) OLD REPUBLIC UNION INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - SCHEDULED PERSON OR ORGANIZATION - PRIMARY AND NON-CONTRIBUTORY BASIS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART/FORM SCHEDULE Name Of Person Or Organization: Where required by written contract A. SECTION II — WHO IS AN INSURED is amended to include as an Additional Insured, the person or organization (referred to throughout this endorsement as Additional Insured) shown in the above Schedule but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" arising out of, 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. The insurance provided under this policy to the Additional Insured is primary insurance and we will not seek contribution from any other insurance available to the Additional Insured provided that: 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. GL 799 008 0721 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 2 MWZY 316409 24 Lyft, Inc. 07/01/24 - 07/01/25 However: 1. If the Additional Insured is solely liable for the loss, this insurance shall be excess and shall contribute to the loss as set forth in the policy; 2. The insurance afforded to such Additional Insured only applies to the extent permitted by law; and 3. 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. The coverage provided by this endorsement shall be subject to all the terms, conditions and exclusions of the policy and all endorsements attached thereto. GL 799 008 0721 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 2 of 2 MWZY 316409 24 Lyft, Inc. 07/01/24 - 07/01/25 IL 10 (04/18) OLD REPUBLIC UNION INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART/FORM Name of Person(s) Or Organization(s): In the event of payment under this policy, we waive our right of subrogation against any person or organization where the insured has waived liability of such person or organization as part of a written contractual agreement between the insured and such person or organization entered into prior to the "occurrence" or offense. The following is added to Paragraph 8. Transfer Of Rights of Recovery Against Others To Us of SECTION V — CONDITIONS: We waive any right of recovery against the person(s) or organization(s) shown in the Schedule above because of payments we make under this Coverage Part. Such waiver by us applies only to the extent that the insured has waived its right of recovery against such person(s) or organization(s) prior to loss. This endorsement applies only to the person(s) or organization(s) shown in the Schedule above. GL 799 007 0721 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 1 MWZY 316409 24 Lyft, Inc. 07/01 /24 - 07/01/25 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 42 03 04 B TEXAS WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement applies only to the insurance provided by the policy because Texas is shown in Item 3.A. of the Information Page. 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, but this waiver applies only with respect to bodily injury arising out of the operations described in the Schedule where you are required by a written contract to obtain this waiver from us. This endorsement shall not operate directly or indirectly to benefit anyone not named in the Schedule. The premium for this endorsement is shown in the Schedule. SCHEDULE Specific Waiver (x) Blanket Waiver Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. 2. Operations: 3. Premium: $ The premium charge for this endorsement shall be percent of the premium developed on payroll in connection with work performed for the above person(s) or organization(s) arising out of the operations described. 4. Advance Premium: 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 07/01/2024 Policy No. PRA4068277 Endorsement No. !Named Insured LYFT, INC. Premium $ Included Insurance Company Safety National Casualty Corporation Countersigned By WC 42 03 04 B (06 14) © Copyright 2014 National Council on Compensation Insurance, Inc. All Rights Reserved. WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 43 03 05 UTAH WAIVER OF SUBROGATION ENDORSEMENT This endorsement applies only to the insurance provided by the policy because Utah is shown in Item 3.A. of the Information Page. 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.) This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Our waiver of rights does not release your employees' rights against third parties and does not release our authority as trustee of claims against third parties. SCHEDULE WHERE A WA EVER OF OUR. RIGHT TO RECOVER FROM OTHERS IS REQUIRED BY WRITTEN CONTRACT, SUCH ADDITIONA:I., ENTITIES SHALL BE CONSIDERED AUTOMATICALLY SCHEDULED :BY THE COMPANY. INDIVIDUA:L,:I:,Y SCHEDULED WAIVERS SHALL NOT BE CONSTRUED TO OVERRIDE NOR NEGATE: THIS BLANKET WACVER.. 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 07/01/2024 Policy No.PRA4 0 6 8 2 7 7 Endorsement No. Insured LYFT, INC. Premium $ Included Insurance Company Safety National Casualty Corporation Countersigned By WC 43 03 05 (07 00) © 2000 National Council on Compensation Insurance, Inc. Page 1 of 1 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT 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.) This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. SCHEDULE WHERE A WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS IS REQUIRED BY WRITTEN CONTRACT, SUCH ADDITIONAL ENTITIES SHALL BE CONSIDERED AUTOMATICALLY SCHEDULED BY THE COMPANY. INDIVIDUALLY SCHEDULED WAIVERS SHALL NOT BE CONSTRUED TO OVERRIDE NOR NEGATE THIS BLANKET WAIVER. THIS FORM APPLIES ONLY TO THE FOLLOWING STATE(S) IF COVERED BY YOUR POLICY. IF A STATE IS NOT LISTED BELOW, THIS FORM DOES NOT APPLY IN THAT STATE. AL, AZ, CO, CT, DC, FL, GA, HI, IL, IN, IA, LA, ME, MD, MA, MI, MN, MO, MT, NV, NM, NY, NC, OK, OR, PA, RI, SC, SD, TN, VT, VA, WI 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 07/01/2024 Policy No. PRA4068277 Endorsement No. Insured LYFT, INC. Insurance Company Safety National Casualty Corporation Countersigned By WC 00 03 13 (04 84) ©1983 National Council on Compensation Insurance. Premium $ Included Page 1 of 1