Loading...
PROOF OF INSURANCE (2015) CLOSEDleza4z CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DD /YYYY) 8/21/2014 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 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). INSR POLICY EFF POLICY EXP PRODUCER A CONTACT Merlene Barbour NAME Commercial Lines - (804) 267 -3100 ,. .... ,........ PHONE 804- 267 -3136 g Ne 877 827 -0725 tAB ,w Wells Fargo Insurance Services USA, Inc. 4/112015 . �,__. .) ... .... ..... — .&� ------- . -_. .l .. EDMAULSS merlene.barbour@wepIsfargo.com 9020 Stony Point Parkway, Suite 200 F. S AFFORDING COVERAGE NAIC # Richmond, VA 23235 _ INSURER A: Phoenix Insurance Company 25623 INSURED _m.,......,n..�.. INSURER B: Travelers Indemnity Company 2 658 Audio Fidelity Communications Corporation dba Whitlock INSURER c : Travelers Property Casualty Co of America 25674 ................ 12820 West Creek Parkway, Suite M PREMISES (Ea occurrence) ...... INSURER D: Travelers Indemnity Co of America............. ......... ..........................25666 X - - Contractual Liability.. . included ............ ............................... INSURER E: Richmond VA 23238 1, INSURER F CnVFRArFS CFRTIFICATF NIIMRFR. 8071355 RFVIiRIAN NI IMRFR- ';P.B hpinw 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 POLICY EFF POLICY EXP TYPE OF INSURANCE LIMITS LTR POLICY NUMBER MM /DDIYYYY MM /DD/YXYY A COMMERCIAL GENERAL LIABILITY 630- 3E408535 411/2014 4/112015 EACH OCCURRENCE $ 1,000,00 I AMAIEYV "I 1C _m.,......,n..�.. .� CLAIMS -MADE 6.. X.. OCCUR PREMISES (Ea occurrence) ...... $ 300,000 .. X - - Contractual Liability.. . included ............ ............................... MED EXP (Any one person) $- .................. 10,000 X XCU not excluded .......ELIMIT.......,.....PE, PERSONAL & ADV INJURY $ 1,000,000 ...... GEN' LAGGRE... AGGREGATE APPLIES PER: GENERAL AGGREGATE $ 00 PE 0 POLICY X X LOC PRODUCTS - COMP /OP AG ^_ "_ $ 2 ..�- ._W.. m- _ 2 000 ,000 OT'I IER: $ B AUTOMOBILE LIABILITY 8104E389145 4/1/2014 4/1/2015 COMBINED SINGLE .LM r $ 1,000,000 ..._-..."', X ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS X X NON -OWNED PROPERTY D,Ih.N,d,E HIRED AUTOS AUTOS Per accident -) -- - $.. --------- ---- -- X UMBRELLA LIAB X CUP- 3E408535 4/1/2014 4/1/2015 E _ $ ___ 10,000,00..- - ...... EXCESS LIAR CLAIMS -MADE _ — AGGREGATE n.. n., ... $ 10,000,000 .......... . OEO X RETENTION $ 10,000 $ D WORKERS COMPENSATION HH- UB3E394201 4/1/2014 4/1/2015 X PER 0TH _TAT TE ER AND EMPLOYERS' LIABILITY YIN -• - ........ ........ ER/EXECUTIVE ry 1 000 000 $ OFFICER /M MBE' EXCLUDED? N/A ........0 CEA - E.L. DISEASE EMPLOYEE $ 1,000,000 If describe under I ............................. 1,000,000 DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The City of El Segundo, its officers and employees are included as additional insureds under General Liability when required by written contract or written agreement for work being performed by the Named Insured. Coverage is primary and non - contributory when required by written contract or written agreement under General Liability. The City of El Segundo 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 ge- The ACORD name and logo are registered marks of ACORD ©1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) POLICY NUMBER: 630- 3E408535- PHX -14 COMMERCIAL GENERAL LIABILITY ISSUE DATE: 09 -08 -14 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. It ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: CITY OF EL SEGUNDO, ITS OFFICIALS AND EMPLOYEES 348 MAIN STREET EL SEGUNDO, CA 90245 Location And Description of Completed Operations: CITY OF EL SEGUNDO POLICE DEPARTMENT Section 11 — Who Is An Insured is amended to include as an insure he person or organization shown in the Schedule, but only with respect to liability arising out of "your work' at the location designated and described in the schedule of this endorsement performed for that insured and included in the "products- completed operations hazard ". CG D3 73 11 05 Includes the copyrighted material of Insurance Services Office, Inc. with its permission,. Page 1 of 1 POLICY NUMBER: 630- 3E408535- PHX -14 COMMERCIAL GENERAL LIABILITY ISSUE DATE: 09 -08 -14 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: CITY OF EL SEGUNDO, ITS OFFICIALS AND EMPLOYEES 348 MAIN STREET EL SEGUNDO, CA 90245 (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) A. Section II — Who Is An Insured is amended to include as an insured the person or organization shown in the Schedule, but only with respect liability arising out of your ongoing operation er- formed for that insured. B. With respect to the insurance afforded to these additional insureds, the following exclusion is added: 2. Exclusions This insurance does not apply to "bodily in- jury" or "property damage" occurring after: (1) All work, including materials, parts or equipment furnished in connection with such work, on the project (other than ser- vice, maintenance or repairs) to be per- formed by or on behalf of the additional insured(s) at the site of the covered op- erations has been completed; or (2) That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or or- ganization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. CG 2010 10 01 0 ISO Properties Inc., 2000 Page 1 of 1 o� 0 m nor o� o. 005531 Aftk TRAVELERSJ WORKERS COMPENSATION ONE TOWER SQUARE AND HARTFORD, CT 06183 EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 00 03 13 (00) -01 POLICY NUMBER: (HHUS- 3E39420 -1 -14) 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 any one not named in the Schedule. SCHEDULE DESIGNATED PERSON: DESIGNATED ORGANIZATION: ANY PERSON OR ORGANIZATION FOR WHICH THE INSURED HA' AGREED BY WRITTEN CONTRACT EXECUTED PRIOR TO LOSS TO FURNISH THIS WAIVER. DATE OF ISSUE: 04 -10 -14 ST ASSIGN: