PROOF OF INSURANCE (2013) CLOSEDACORD TM CERTIFICATE OF LIABILITY INSURANCE Date (03 /2011'R)
10/03/2013
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 pol'iby(ies) must be endorsed, If SUBROGATION IS WAIVED, subject to the terms
and conditions of the policy, certain policies require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of
such endorsement(s).
Heffernan Professional Practice Insurance Brokers
License No. 0564249
6 Hutton Centre Dr., Suite 500
Santa Ana, CA 92707
102 CEO vt
INSURED
Veronica Tam & Associates, Inc. 0 20 � .i,
107 S. Fair Oaks Ave., Suite 212
Pasadena, CA 91105 I "P/ Sulft
Diana Chau
PHONE 714 - 361 -7700 FAX 714 -361 -7701
A/C,No Ext (A/C No):
EMAIL
ADDRESS: dianac @heffins.com
INSURERS AFFORDING COVERAGE
NAIC
INSURER A:
American Casualty Co. of Reading PA
20427
INSURER B:
Continental Casualty Co.
20443
INSURER C:
Valley Forge Insurance Co.
20508
INSURER D:
INSURER F:
ICOVERAGFS CFRTIFICATF NtIMRFR- Rr-VIl ll'ANI NI IIURFR-
THIS IS TO CERTIFY THAT 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
INSR
SUBR
WVD
POLICY NUMBER
POLICY EFF
MWDD ..
POLICY EXP
/D
MMD
LIMITS
GENERAL LIABILITY
B4019903754
11/16/2012
11/16/2013
EACH OCCURRENCE
$1,000,000
A
X COMMERCIAL GENERAL LIABILITY
DAMAGES( RENTED
$300,000
PREMISES (Ea occurrence)
CLAIMS -MADE F_x1 OCCUR
MED EXP An
( y one person) )
$10,000
X
PERSONAL & ADV INJURY
$1,000,000
GENERAL AGGREGATE
$2,000,000
GEN'L. AGGREGATE LIMIT APPLIES PER
'.. PRODUCTS - COMP /OP AGG
$2,000,000
POLICY X PROJECT LOC
$
A
AUTOMOBILE LIABILITY
B4019903754
11/16/2012
11/16/2013
COMBINED SINGLE LIMIT
''...... $1,000,000
(Ea accident)
BODILY INJURY (Per person)
$
ANY AUTO
ALL OWNED AUTOS SCHEDULED AUTOS
BODILY INJURY (Per accident)
$
NON -OWNED
X HIRED AUTOS X
PROPERTY DAMAGE
$
AUTOS
(Per accident)
_
$
UMBRELLA LAB OCCUR
EACH OCCURRENCE
$
EXCESS LIAB CLAIMS -MADE
NSA
AGGREGATE
$
DED RETENTION $
I.-
$
......_.. .................
WORKERS COMPENSATION
....._ ..._
... ..........
....................
_
WCSTATU- OTH-
X
_.._................
AND EMPLOYERS' LIABILITY Y/N
TORY LIMITS ER
i�.
ANY PROPRIETOR/PARTNEREXECUTIVE/
E.L. EACH ACCIDENT
$1,000,000
c
OFFICER/MEMBEREXCLUDED?
WA
X
WC430813948
07/01/2013
07/01/2014
(Mandatory in in N.H.)
E.L. DISEASE - EA EMPLOYEE
$1,000,000
If yes, describe under DESCRIPTION OF
E.L, DISEASE - POLICY LIMIT
............®-°°-------
$1,000,000
OPERATIONS below
B
PROFESSIONAL LIABILITY
N/A
MCH276199824
11/16/2012
11/16/2014
PER CLAIM
$1,000,0001-1
AGGREGATE
$2,000,000
DIEBCRIPTfON OF OPERATIONS/ LOCATIONS/ VEHICLES (Attach ACORO 101, Additlonal Remarks Sebodu�le,11 more space [a.IequIred)
Projects as on file with the insured. City of EL Segundo are named as additional insured on General Liability policy if required by written contract per
attached endorsement. Waiver of subrogation applies to Workers Compensation pollcy,
1111 L".111 i
City of EL Segundo
Attn: Kimberly Christense
AICP Planning Manager
350 Main Street
EL Segundo, CA 90245
ACORD
todAr41;I LLfk.III„/'II
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH
THE POLICY PROVISIONS.
/ff/L---
®1- 8-2010 ACORD
The ACORD name and logo are registered marks of ACORD
reserved.
CNA POLICY NUMBER: B4019903754 / SS-1 -A
{ d.01fg)
IMPORTANT: THIS ENDORSEMENT CONTAINS DUTIES THAT APPLY TO THE ADDITIONAL
INSURED IN THE EVENT OF OCCURRENCE, OFFENSE, CLAIM OR SUIT. SEE PARAGRAPH
C., OF THIS ENDORSEMENT FOR THESE DUTIES.
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY,
BLANKET ADDITIONAL INSURED ENDORSEMENT
WITH PRODUCTS - COMPLETED OPERATIONS COVERAGE
BLANKET WAIVER OF SUBROGATION
Architects, Engineers and Surveyors
This endorsement modifies Insurance provided under the following:
BUSINESSOWNERS LIABILITY COVERAGE FORM
BUSINESSOWNERS COMMON POLICY CONDITIONS
A. WHO IS AN INSURED (Section C.) of the 4.
Businessowners Liability Coverage Form is amended
to include as are insured any person or organization
whom you are required to add as an additional insured
on this policy under a written contract or written
agreement; but the written contract ar written
agreement must be:
1. Currently in effect or becoming effective daring the
term of this policy; and
2. Executed prior to the "bodily injury, " "property
damage," or 'personal and advertising injury."
B. The insurance provided to the additional insured is
limbed as follows:
SB -1 6968 A Page 1 of 2
(Ed.. 110)
1. That person or organization is an .additional
insured solely for liability due to your negligence
specifically resulting from "your work" for the
additional insured which is the subject of the
written contract or written agreement. No
coverage applies to liability resulting from the sole
negligence of the additional Insured.
2. The Limits of Insurance applicable to the
additional Insured are those specified In the
wrltten contras or written agreement or in the
Declarations of tivs policy, whichever is less.
These Umils of Insurance are inclusive of, and not C.
In addition to, the Limits of insurance shown in the
Declarations,
,.,..,
3. The coverage provided to the additional lns�urad
within this endorsement and section fitled
LIABILITY AND MEDICAL EXPENSE
DEFINITIONS — "insured Contract" (Section
F.9.) within the Susinessownecs Liability Coverage
Form, does not apply to "bodily injury" or "property
it
damage" arising out of the "products- aampleled
..�.�
uperaii"m hecard" unlewi 3vquhW by the written
zontract or written agreement
SB -1 6968 A Page 1 of 2
(Ed.. 110)
2. Tender the defense and indemnity of any claim or
"suit" to us for a loss we cover under this
Coverage Part;
3. Tender the defense and indemnity of any claim or
"suit" to any other insurer which also has
insurance for a loss we cover under this Coverage
Part; and
4. Agree to make available any other insurance
which the additional insured has for a loss we
cover under this Coverage Part.
We have no duty to defend or indemnify an additional
insured under this endorsement until we receive
written notice of a claim or "suit" from the additional
insured.
D. OTHER INSURANCE (Section H. 2. & 3.) of the
Businessowners Common Policy Conditions are
deleted and replaced with the following:
2. This insurance is excess over any other insurance
naming the additional insured as an insured
whether primary, excess, contingent or on any
other basis unless a written contract or written
agreement specifically requires that this insurance
be either primary or primary and noncontributing
to the additional insured's own coverage. This
insurance is excess over any other insurance to
which the additional insured has been added as
an additional insured by endorsement.
3. When this insurance is excess, we will have no
duty under Coverages A or B to defend the
additional insured against any "suit" if any other
insurer has a duty to defend the additional insured
SB- 146968 -A
(Ed. 01 /06)
SB- 146968 -A
(Ed. 01/06)
against that "suit" If no other insurer defends, we
will undertake to do so, but we will be entitled to
the additional insured's rights against all those
other insurers.
When this insurance is excess over other
insurance, we will pay only our share of the
amount of the loss, if any, that exceeds the sum
of:
(a) The total amount that all such other insurance
would pay for the loss in the absence of this
insurance; and
(b) The total of all deductible and self- insured
amounts under all that other insurance.
We will share the remaining loss, if any, with any
other insurance that is not described in this
Excess Insurance provision and was not bought
specifically to apply in excess of the Limits of
Insurance shown in the Declarations of this
Coverage Part.
E. TRANSFER OF RIGHTS OF RECOVERY AGAINST
OTHERS TO US (Section K.2.) of the
Businessowners Common Policy Conditions is deleted
and replaced with the following:
2. We waive any right of recovery we may have
against any person or organization against whom you
have agreed to waive such right of recovery in a
written contract or agreement because of payments
we make for injury or damage arising out of your
ongoing operations or "your work" done under a
contract with that person or organization and included
within the "products - completed operations hazard."
Page 2 of 2
CNA Ed 911197)
WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY INSURANCE POLICY
BLANKET WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS
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.)
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 2.%.
G- 19160 -B Page 1 of 1
(Ed. 11137)
HEFFERNAN INSURANCE BROKERS
6 HUTTON CENTRE DR. SUITE 500
SANTA ANA, CA 92707
CITY OF EL SEGUNDO
ATTN: KIMBERLY CHRISTENSEN
AICP PLANNING MANAGER
350 MAIN ST
EL SEGUNDO CA 90245 -3813