Loading...
PROOF OF INSURANCE (2027 - 2027)" 0 DATE (MM/DD/YYYY) C40R " CERTIFICATE OF LIABILITY INSURANCE ,.. 5/22/2026 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(). PRODUCER CONTACTWS FAX � �� fx1l Certificates Gallagher Brokerage &Insurance Solutions, Inc. alp 391 2141 Arc 50 California St G"Nat' NAME ADDRESS oerlr ". ... Floor 12 _ sts.l @Ig cpm ........... _ . San Francisco CA 94111 INSURER(S) AFFORDING COVERAGE NAIC# 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. ....... _ ..... .. ..... ICtl,SR,'.-'.". ....."..1�40Dd.'SUBrd ................. .... '..PO4.ICY'EFP POLICY£XP LIMITS LTR I TYPE OF INSURANCE IwVO POLICY NUMBER IMMODWYNY1 IMMIDOIYYYY A X COMMERCIAL GENERAL LIABILITY Y TCP702275413 5/26/2026 5/26/2027 EACHOCCUiRRENC,E 00000 .. $..1_ CLAIMS -MADE OCCUR f Y A XGF. Yti I � W D „MED II,...n... $1 C700 DDD _ EXPAa%one person) ... $ 15, Y $1 000 000 G EN'L �.,,X.. AGGR., .......... .. ... .... EGATE LIMIT APPLIES PER: ,�.._.,, � $ 2.000000 ������ — - PFO,.. ❑ AG. PRODUCTSGCOMPOPR I $ 2.000 000 POLICY J LOC $ A AUTOMOBILE OTHER- LIABILITY I TCP702275413 5/26/2026 5/26/2027 OMBINFD SINGLE LIMIT ).,,RY I $1,000,000 ..... ... X ANY son) BODILY INJURY person) $ OWNED SCHEDULED (Per ... g INJURY Per accident) $ f AUTOS ONLY AUTOS HIRED NON -OWNED BODILY I M1'e.CYPERTYDAMAt§F f $ AUTOS ONLY L._........... AUTOS ONLY .iegr_ar r_00n4) .. ........_. J .......... ........... .. $ A UMBRELLA X OCCUR � TCP702275413 5I26I2026 5/26/2027 'RENiE � EACH OCR�U6" „ $5 000 000 � X � EXCESS LIABAB CLAIPwIS-AfAG)E! AGGREGATE T " � $ 5 000 000 _ . ........ .I RETENnON'S WORKERS COMPENSATION I$ PER O S'iATUTr E.l�H.. 1 .............. ..---.. AND EMPLOYERS' LIABILITY YIN >L y I E L EACH ACCIDENT ..._._ $ ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N / A E.L. DISEASE EA EMPt.�OYF� ____ _ $ (Mandatory in NH) II yes, describe under f ......."__ ..... E.L. DISEASE POLICY LIMIT ............... ... � 5 0 SCAWTION OF OPERATIONS below • B CybenTech E&O/ Professional EET1416704 5/26/2026 5/26/2027 Per Claim/Aggregate ''.. Retention $5,000,000 $50.000 Liability DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Retroactive Date for Professional Liability- 2/15/2013. Line Of Coverage: Crime Policy # 82556901 Effective date 5/26/2026 - 5/26/2027 Carrier: Federal Insurance Company NAIC # 20281 Crime Limit: $1,000,000 See Attached... f�Akld`cl 1 ATIf1W 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, its officials, and employees 350 (Main Street El Segundo CA 90245 '.. AUTHORIZED REPRESENTATIVE Ga,uagq wr3Yt?rcP.t'ag&Er Iv►�S4,w"cP,SoUa_&&Y ; Iv1,Ci VlYi58-LUT.7Al.VRUVVrCrVRA1wl`I. r1111VIU01ca 1—m- ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: HDLCOMP-01 LOC #: AC ADDITIONAL REMARKS SCHEDULE Page 1 of AGENCY NAMED INSURED Gallagher Brokerage & Insurance Solutions, Inc. Hinderliter de Llamas & Associates _. .. ......................... HdL Software, LLC. POLICY NUMBER 120 S. State College Blvd, Suite 200 Brea, CA 92821 CARRIER NAIC CODE EFFECTIVE DATE: THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE (City of El Segundo, its officials, and employees are included as additional insured as respects General Liability to the extent provided in the attached form. Notice of Cancellation applies Wt;h respects General Liability to the extent provided in the attached form. ACORD 101 (2008/01) (U ZUUtf AGUKU 6UKYUKA I IUIV. All f19M5 FWbUF VtlU. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: TCP702275413 COMMERCIAL GENERAL LIABILITY CG 20 26 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): I 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(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, 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. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. 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; whichever is less. This endorsement shall not increase the applicable limits of insurance. CG 20 26 12 19 ©insurance Services Office, Inc., 2018 Page 1 of 1 POLICY NUMBER: TCP702275413 COMMERCIAL GENERAL LIABILITY CG 02 2410 93 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EARLIER NOTICE OF CANCELLATION PROVIDED BY CIS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Number of Days' Notice 30 (If no entry appears above, information required to complete this Schedule will be shown in the Declarations as applicable to this endorsement.) For any statutorily permitted reason other than nonpayment of premium, the number of days required for notice of cancellation, as provided in paragraph 2. of either the CANCELLATION Common Policy Condition or as amended by an applicable state cancellation endorsement, is increased to the number of days shown in the Schedule above. CG 02 24 10 93 Copyright, Insurance Services Office, Inc., 1992 Page 1 of 1 0 LIABILITY INSURANCE FOATE """` (MMfDD0512712026......CERTIFICATE...OF ."..._......_.........��.-.... _ m. ........ 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 ADDI TIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endo rsed. 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 ..................., .....,. ... NAME: .......Mar..,.... �, -... .... ..,. _ .,w..,.. ,......._... n, sh Affinity t`SNE 800-743 8130 - FAX - - Marsh Affinity PH .LAIC No, ExtF" � �-mm �AIC, No) mmmmm y,. a division of Marsh USA LLC.ADDE"MAIL ADPTo[alSource@marsh.com PO BOX 14404 E55, INSURER(S) AFFORDING COVER„ " Des Moines, IA 50306-9686 - „m„m„ mNAIC # AGE INSURER A: AIU Insurance Company 19399 INSURED INSURERB: ADP TolalSource DE IV, Inc. INSURER C: . 5800 Windward Parkway INSURER D :"". ..�..��. �,,..... Alpharetta, GA 30005 .... �..... ........__�.._. LJClF: INSURER E. Hinderliter de Llamas & Associates INSURER F r 120 S State College Blvd Suite 200 Brea, CA 92821 COVERAGES CERTIFICATE NUMBER: 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, AND SUCH POLDIDCIESU.BRIM BEEN REDUCEDDB D CLAIMS LIMITS SHOPOL _,yEXCLUSIONS" "m� � IN5R _ TYPE FIINSDUIRANCEOF LTR INSD - EFF POLICYEXP POLICY NUMBER WVD ( /YYYYt (MMIDD/YYW) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS -MADE OCCUR I.......... I FirkGE TO F1'ENTED $ f'�F&!C�Mp`'71'-S .._._.1 MED EXP (Any one person) $ PERSONAL & ADV INJURY $ ......... . GEN'L AGGREGATE LIMIT APPLIES PER: ..... GENERRALAL AGGREGATE ... $ �. PRO POLICY JECT LOC .. PRODUCTS'IhdiL4 OTHER: $,..,. ......... ...........,.... .-- AUTOMOBILE LIABILITY ------------------ ------- . OMRINFO S E LOIMITGG 750 IEaaccrda:aat} $ ANY AUTO BODILY INJURY (Per person) $ _._ OWNED SCHEDULED BODILY INJURY ( Per accident) $ AUTOS ONLY AUTOS I HIRED NON -OWNED I"aR'OPt„RT"r° DAMA.G.E $ AUTOS ONLY ''. AUTOS ONLY late .......... UMBRELLA LIAR.-m ............. OCCUR ............ ....m... ,._.............. ���..... EACHOCCURRENCE $ EXCESSLIAB CLAIMS -MADE AGGREGATE $ --.....,.. - _..... . .........._........ DED RETENTION $ _. _..... .. ........ _..,.. ..m.,.. ...._..�...... �.,.. $ ........ WORKERS COMPENSATION X STATUTE ER NIA.. ANDEdesoribeER de (ABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? YIN X WC 051661587 CA 07l01I2026 07101I2027 _ ,,,,,$ 2, EL. EACH ACCIDENT $ 2 000,000 A fMandato in NH E L. DISEASE - EA EMPLOYEE $ 2,000.000 __ DESCRIPTION OF OPERATIONS below E L DISEASE -POLICY LIMIT $ 2 00¢ 000 ........_......w DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES ._ ........... (ACORD 101, Additional Remarks Schedule, may be attached if more space ............. ........ is required) Ali wei employees war lit" foe Hiindertrrer da Llamas & A,s'socdaaas paid under ADP TOTALSOUR'CE, INC.'s payvo9l, 'are coveffed unclee the above sratod policy. Pro Iona as thepp aro m the AL7PT5q�uyroll etatodPartnerOExecutive or haves caniptated itm SO OIYlceffMerribo are not excluded as Pwiicdluation Addendum, WAIVER OF S�JBROGATION RN FAVOR FbF City cif El Segundo its o9flcnafs and emp&oyees,AS RESPECTS OF JOB PERFORMED BY 1f(rudeAtor CONTFfAtT. die Uama3s & Ass'ocdales AS REOUIRED BY WRITTEN . .........._'_ HOLDER CERTIFICATE H .. .�. -� " _.... _ CANCELLATION .� .. Cityy of 0 Segundo, its officials, and employees 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 REPRESENTATIVE ..m ©1988-2015 ACORD CORPOFOXION. All rights re The ACORD name and logo are registered marks of ACORD WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 43 03 06 4-84 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. (Th is 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. Schedule WAIVER OF SUBROGATION IN FAVOR OF City of El Segundo, its officials, and employees AS RESPECTS OF JOB PERFORMED BY Hinderliter de Llamas & Associates AS REQUIRED BY WRITTEN CONTRACT. Person or Organization City of El Segundo, its officials, and employees 350 Main Street El Segundo, CA 90245 Job Description Notes: 1. This endorsement may be used to waive the company's right of subrogation against named third parties who may be responsible for an injury. 2. The sentence in ( ) is optional with the company. It limits the endorsement to apply to specific jobs of the insured, and only to the extent that the insured is required to obtain this waiver. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (rhe information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 07/01/2026 Policy No. WC 051661587 CA. Endorsement No. Insured Insurance Company AIU Insurance Company ADP TotalSource DE IV, Inc. 5800 Windward Parkway Alpharetta, GA 30005 L/C/F: Hinderliter de Llamas & Associates 120 S State College Blvd Suite 200 Brea, CA 92821 Countersigned by ��� apt. ©1998 by the Workers'Co mpensation Insurance Rating Bureau of California. All rights reserved. From the WCIRB's California Workers' Compensation Insurance Forms Manual ©2001,