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PROOF OF INSURANCE (2024 - 2025) CLOSEDMILLE-9 OP 112;
FD
CERTIFICATE OF LIABILITY INSURANCE ATE (MMIDD/YYYY)
03/0112024
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 endorsements .
PRODUCER 760-471
Alliance Mgt. & Insurance Sery
356 Via Vera Cruz #7
CA AgenUBrok'er Lie# 0737966
San lVlarcos, CA 92078
Michelle A. Nowell
& Associates Inc
INSURER F
StarStone Specialty Ins
760-471-9378
44776
OVERAGES CER11FI ATE NUMBER' rcc I Ivnf :Uffi0 rc:
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.
'�NSR TYPE OF INSURANCE DDL UBR POLICY NUMBER POLICY EFF POLICY EXPITR LIMITS
A X COMMERCIAL GENERAL LIABILITY EACH DCCURREtIgg.. '$. 1 000 000
DAMAGE TO RENTED 100,666
CLAIMS -MADE X occuR xWSGP000122 1011312023 10/13I2024
�X Errors & Omission M D F_XP AnyRQ.P_P.@ on 1 5,000
......,
000
_PE NAL PpVI,N,ILIRY $ 1'0......
........0
5,000,000
GENLAGGR APPLIES PER: �NERAL AGGREGATE . .........
ELATE LIMIT
X POLpCY .._d JEGT LOC PRPap CAMP/OPAGG 1,000,000
OTHER:' COMBINED SINGLE: LIMIT 1000000
A
AUTOMOBILE LIABILITY y, gyyq�„„,„„......
ANY AUTO WSGP000122 10/13/2023 10/13/2024 BODILYINJLIRY, Per p.rson
OWNED SCHEDULED
AUTOS ONLY AUTOS60DILY INJURY Per accident ...........
g
X.. ACJ ONLY X AAti)S Oh1CY I�C?PETW7Y gAMAC,E
er
..i
I
UMBRELLA LIAB OCCUR
AOH
._EACliOCOIO RRENCE
1�
...........
........
'. EXCESS
...................DED
ITAGGREGATE
,,,,,,,,,,,CE._
�LIA"BCLAIMS-MADE
WORKERS COMPENSATION
PER OTH-
AND EMPLOYERS' LIABILITY
Y
ANY PROPRIETOR/PARTNER/EXECUTIVE
EXCLUDED?
NIA
_E L EACH ACCIDENT
�_"IT,_„_,
W.15ER/MEMBER
anatory In NH)
E,L„ DISEASE - EA EMPLOYE
If yes, describe uer
DESCRIPTION FndPERATIONS below
E,L. DISEASE.- POLI Y LIMIT
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required)
City of El Segundo,, its directors, officers, employees, and agents, are
named as an additional insured With respects to the Work performed by the
named insured..
Investigation, CA --
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
Human Resource Manager
350 Main Street AUTHORIZED REPRESENTATIVE
El Segundo, CA 90245
ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
POLICY NUMBER: WSGP000122
COMMERCIAL GENERAL LIABILITY
CIGL 79 03 18
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
• • • 9
• `I PA.1% I Lei
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person(s)
Or Organization(s)
Location(s) Of Covered Operations
Blanket as required by valid written contract.
Blanket as required by valid written contract.
Additional Information:.
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 or organization
shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and
advertising injury" arising out of:
1. Your acts or omissions; or
2. The acts or omissions of those acting on your behalf;
in the performance of your operations for the additional insured at the location shown in the Schedule.
However:
a. The insurance afforded to such additional insured only applies to the extent permitted by law;
b. If coverage provided to the additional insured is required by a contract or agreement, the insurance
CIGL 79 03 18 Includes copyrighted material of Insurance Services Office, Inc. Page 1 of 2
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; and
c. Regardless of the date of occurrence or when the injury or damage first occurs or is first discovered, a
person's or organization's status as an additional insured under this endorsement ends upon the earliest
of:
(1) The completion or termination of the contract or agreement between you and the additional insured
for the location shown in the Schedule;
(2) The date you cease actively performing operations for the additional insured at the location shown in
the Schedule; or
(3) The expiration or termination date of the policy or this endorsement.
B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply:
This insurance does not apply to liability or damages for "bodily injury', "property damage", or "personal and
advertising injury':
1. Caused by, arising from, or included in the "products -completed operations hazard";
2. Arising out of the additional insured's sole negligence;
3. Arising out of work or operations performed by you that were completed prior to the effective date of this
endorsement; or
4. Which continues or progressively deteriorates after you cease actively performing operations for the
additional) insured at the location shown in the Schedule, even if the injury or damage first occurred, or is
alleged to have first occurred, during the course of your operations for the additional injured.
C. Solely for purposes of this endorsement, the following definition is deleted in its entirety and replaced by the
following:
1. ""Products -completed operations hazard":
a. Includes all "bodily injury" and "property damage" occurring away from premises you own or rent and
arising out of "your product" or "your work" except:
(1) Products that are still in your physical possession; or
(2) Work that has not yet been completed or abandoned. However, "your work" will be deemed
completed at the earliest of the following times:
(a) When all of the work called for in your contract has been completed;
(b) When all of the work to be done at the location shown in the Schedule has been completed if
your contract calls for work at more than one location; or
(c) When that part of the work done at the location shown in the Schedule has been put to its
intended use by any person or organization other than another contractor or subcontractor
working on the same project.
Work that may need service, maintenance, correction, repair or replacement, but which is otherwise
complete, will be treated as completed.
D. 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.
CIGL 79 03 18 Includes copyrighted material of Insurance Services Office, Inc. Page 2 of 2
tya DATE (MMIDDNYYY)
CERTIFICATE OF LIABILITY INSURANCE
10/02/2024
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).
PHONE... ....nce Agency Inc
Automatic Data Processing Insurance Agency, Inc. CI A 1- 800-5 4-7024Insurance PRODUCER t4AMEA Processing a
.._ - ....... "FAX
9fAJC, No, ExW N wa).. ...
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. ........
.............. .... TYPE OF INSURANCE ..... POLICY.. ...... ... ......... �,..... LIMI..._....__ ....-----.......
INSRpp ... .. ......--. �ADSD I$WVD ............. NUMBER --- �..MMIOD/YYYY MMIOD P
G fYYYY LIMITS
COMM GENERAL LIABILITY
OCCURRENCE
$
.....,,
^�
"DAMAGE Tt�'RENTED ..
..... .. ....
AIMS -MADE
I REI'aRfS n occtx r_kacel
$......
EXP (Any one person)
$
PED
ERSONAL & ARV NJ Y
$ ... ....
GEN'L
........ .._.._..- _..........,,...
AGGREGATE LIMIT APPLIES PER.
i
GENERAL AGGREGATE
....
...,.-.. ...
$ ......,,�.
....
POLICY o; LOC
PRODUCTS-COMP/OPAGG
$
AUTOMOBILE LIABILITY
,, M N IN L A,
,�k7 ncc9drcanC)
$
........,_._.. ,.. .. .........
--
.... ANY AUTO
B 0 I N J U R Y(P er p a rson)
$
OWNED SCHEDULED
....,..._
BODILYINJURY(Per accident)
$
AUTOS
HIRED NON -OWNED
PROPFR"9'YCkAMAR°a:
$
AUTOS ONLY
(Peracg4ent), ......,m.
UMBRELLA LIAB OCCUR
EACH OCCURRENCE
$
LIAB
EXCESS CLAIMS MADE
AGGREGATE
$
-
DE RETENTION $
$
WORKERS COMPENSATION
E ERH
STATUTE
AND EMPLOYERS' LIABILITY
$ 1,000,000
A
ANY PROPRIETOR/PARTNER/EXECUTIVE ��YIN
NIA
N 9294695-2024
03/18/2024
E.L EACH ACCIDENT
03/18/2025 '° """ ,
OFFICER/MEMBER EXCLUDED? Y.....
(Mandatory in NH)
I'll..
1',000,000
.......
If yes, describe under
DESCRIPTION OF OPERATIONS below
1
E.L DISEASE -POLICY LIO IT
$ 1,000,000
1
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
rFRTIFICATF 14AIT[FR CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of El Segundo ACCORDANCE WITH THE POLICY PROVISIONS.
350 Main Street
AUTHORIZED REPRESENTATIVE
ElSegundo CA 90245
Ot 19RR-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD