Loading...
PROOF OF INSURANCE (2014) CLOSEDDATE (MM /DD/YYYY) �.. CERTIFICATE OF LIABILITY INSURANCE N A,A,In4o 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). PRODUCER Wood Gutmann & Bogart License Number 0679263 15901 Red Hill Ave., Suite 100 Tustin CA 92780 INSURED APAEN-1 INSURER B: 9 R APA Engineering, Inc. INSURE C: 9880 Irvine Center Drive Irvine CA 92618 INSURER D ...... ....... .................. INSURER E INSURER F i COVERAGES CERTIFICATE NUMBER: 144760576 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, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. N �.�.. ... ............ . -.. - -� ........... ..... ... .......... -- ILTR ..... -- .. .... ....MM TYPE OF INSURANCE pOLICV NUMBER DD.IYXXY M !'M"`YXYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ AM'A6V id-A NfEi7 _. COMMERCIAL GENERA LIABILITY PREMI ES n rr $ !�� 4 �� Anse) $ _ CLAIMS -MADE OCCUR MEDEXP (Any one person) m m mm $ PERSONAL & ADV IN JURY . $ GENERALAGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: '.. PRODUCTS - COMP /OP AGG PRA},. POLICY LOC AUTOMOBILE LIABILITY - (Lma � )........... ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BOD ILY INJURY (Per accident) $ AUTOS AUTOS NON -OWNED DAMAGE _. $ HIRED AUTOS AUTOS iepryaccda �enop ........... - -- UMBRELLA LIAB OCCUR 'EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE $ DED RETENTION $ WORKERS COMPENSATION WC STATU- H- OT AND EMPLOYERS' LIABILITY Y / N ) _T'i " __ R " " "" .... "" " "..........." ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ N/A - ---- .............................................................. (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ Ifyes, describe under _. -.m_. _.. .............................. ............................... DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ A Professional Liability NE1141557.13 /19/2013 /19/2014 Per Claim $2,000,000 Errors & Omissions Aggregate $2,000,000 Claims Made Form Deductible $50,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) l:tK I IrIt;A I t MULUtK City of El Segundo Dir of Pub Wrks: Stephanie Katsouleas, P.E. 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 ©1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD NOVEMBER 1, 2012 CITY OF EL SEGUNDO 350 MAIN ST EL SEGUNDO CA 90245 -3813 IN REPLY REFER T0: CERTIFICATE OF WORKERS' COMPENSATION INSURANCE CANCELLATION WITHDRAWAL NOTICE RE: CERTIFICATE DATED SEPTEMBER 18, 2012 THE CANCELLATION HAS BEEN WITHDRAWN FOR THE WORKERS' COMPENSATION INSURANCE POLICY FOR THE EMPLOYER NAMED BELOW. THIS LETTER SUPERSEDES THE NOTICE OF CANCELLATION SENT TO YOU ON OCTOBER 31, 2012. THIS EMPLOYER'S WORKERS' COMPENSATION INSURANCE COVERAGE CONTINUED UNINTERRUPTED. EMPLOYER: APA ENGINEERING INC 9880 IRVINE CENTER DR IRVINE, CA 92618 POLICY 541- 0000587 -12 CUSTOMER SERVICE REPRESENTATIVE CUSTOMER SERVICE CENTER (877) 405 -4545 5860 Owens Dr Pleasanton, CA 94588-3900 Mailing Address: P.O. Box 8192 • Pleasanton, CA 94588 -9682 SCIF 19102 IN REPLY REFER T0: OCTOBER 31, 2012 CITY OF EL SEGUNDO PUBLIC WORKS 350 MAIN ST EL SEGUNDO CA 90245 -3813 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE CANCELLATION NOTICE RE: CERTIFICATE DATED JULY 11, 2012 THE WORKERS" COMPENSATION INSURANCE POLICY FOR THE EMPLOYER NAMED BELOW WILL BE CANCELLED EFFECTIVE DECEMBER 6, 2012 AT 12:01 A.M. IF YOU HAVE ANY QUESTIONS REGARDING THIS NOTICE, PLEASE CONTACT THE EMPLOYER NAMED BELOW EMPLOYER: APA ENGINEERING INC 9880 IRVINE CENTER DR IRVINE, CA 92618 POLICY 541 - 0000587 -12 CUSTOMER SERVICE REPRESENTATIVE CUSTOMER SERVICE CENTER (877) 405 -4545 5860 Owens Dr Pleasanton, CA 94588 -3900 Mailing Address: P.O. Box 8192 • Pleasanton, CA 94588 -9682 SCIF 19102 CERTHOLDER COPY P.O. BOX 8192, PLEASANTON, CA 94588 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 09 -18 -2012 CITY OF EL SEGUNDO SG 350 MAIN ST EL SEGUNDO CA 90245 -3813 GROUP: 000541 POLICY NUMBER: 0000587 -2012 CERTIFICATE ID: 63 CERTIFICATE EXPIRES: 07 -11 -2013 07 -11- 2012/07 -11 -2013 This is to certify that we have issued a valid Workers` Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 30 days advance written notice to the employer„ We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy. µ- Authorized Representative President and CEO EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT #0015 ENTITLED ADDITIONAL INSURED EMPLOYER EFFECTIVE 2012 -07 -11 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. NAME OF ADDITIONAL INSURED: CITY OF EL SEGUNDO ENDORSEMENT #1600 - ALI PAKZAD PRES,TRES - EXCLUDED. ENDORSEMENT #1600 - PAMELA PAKZAD SEC - EXCLUDED. ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EF U IVE 07 -11 -2012 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. EMPLOYER APA ENGINEERING, INC SG 9880 IRVINE CENTER DR IRVINE CA 92618 [NAM,CSj (REV. 1-2012) PRINTED : 09 -18 -2012 C<>R CERTIFICATE OF LIABILITY INSURANCE DATE(MM /DD/YYYY) 3126/2012 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 endorserent s „ PRODUCER NAME:_ Roba- H- ollow ,y ............. .. . ....... ............., Wood Gutmann & Bogart PHONE S 57 IZZ License Number 0679263 EMAIL 15901 Red Hill Ave., Suite 100 Tustin CA 92780 INSURERIS) AFFORDING COVERAGE '(""" -I mmmmmmNAIC # INSURED APAEN -1 APA Engineering, Inc. 9880 Irvine Center Drive Irvine CA 92618 COVERAGES CERTIFICATE NUMBER: grw'R,1't'LrwS%sn REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISPED 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 O PfLtlCY' Et F POLICY EXP LTR. TYPE OF INSURANCE ! R C1 POLICY NUMBER MMdDO1Y'YYY MM /DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ .. COMMERCIAL GENERAL t� ABILITY PREM SP SO aEOG�UrrPnCa) . CLAIMS -MADE OCCUR MED EX (Any one person m3 .. PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS- COMP /OPAGG $ POLICY PRO LOC AUTOMOBILE LIABILITY (Ea accident) .__ $ ANY AUTO ''. BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident)', $ AUTOS AUTOS _J L NON -OWNED $ HIREDAUTOS AUTOS (Peraccident) __ 1 $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ .................................................................... EXCESS LIAB CLAIMS -MADE AGGREGATE DECD RETENTION $ $ WORKERS COMPENSATION WCSTA7U- I OTH- AND EMPLOYERS' LIABILITY Y / N - . TQRY _LLM).T.$_a_... ANY PROPRIETOR /PARTNER /EXECUTIVE E L EACH ACCIDENT $ OFFICER /MEMBER EXCLUDED? ❑ N NIA ......... ....... - -- (Mandatory in NH) EL DISEASE -EA EMPLOYEE $ If y �. ,.......... ....... �.. ...._......... -.. DESCRIPTION OF OPERATIONS below E L DISEASE ASE - POLICY LIMIT $ A Professional Liability NE114155712 /19/2012 /19/2013 Per Claim $2,000,000 Errors & Omissions / Aggregate $2,000,000 Claims Made Form Deductible $50,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) City of El Segundo Dir of Pub Wrks: S' 350 Main Street El Segundo CA 90; P. E. 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 V 1W SU -20U AGUKU GUKPURATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD eill a DATE (MMIDD/YYYY) AC40 CERTIFICATE OF LIABILITY INSURANCE 09/20/2012 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). Richard Don Agent PHONE to smitn PRODUCER 77 a Del La go, Suite 20 - T Ch(949)855-1310 FAX Net. (949')855 -0217 N 91 9 27772 Vista 1Irit 1 0_n .m.smdh Ittld s AOD},ESS @ ....... Om ..... atefarm o A Mission Viejo, CA 92692 PRODUCER � f Il4""Md1uvc 111 ll« 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 .........-__ - -' -TYPE OF INSURANCE .............. AOL'a'Hl''Orf' POLICY NUMBER- ....,,,.._ "POLICY EFF POLICY EXP......... ....... LIMITS. .. ,...�...... LTR. M ID.D MMIDDM(YY A GENERA X COMMERCIAL GENERAL LIABILITY MCLAIMIS- ADE X OCCUR 92- BQ- FO64 -9 06/1912012 06/1912013 EACH OCCURRENCE TA�Id�1ADE 70-RENTED . PfkMf9 .a, F,ngc aloeatn a� , MED EXP {Any one person) 1 000 000 . 3 300 000' $� . ... ............... $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 _ _— GEN LAGGREGATE LIMIT APPLIES PER: - PRODUCTS - COMPIOP AGG $ 2,000,000 POLICY PRm LOC B AUTOMOBILE LIABILITY ........,. ANY AUTO El 321 4094- F05 -75 06/05/2012 06/05/2013 CO aBINED) INGLE LIMIT (Ea BODILY INJURY (Per person) $ 1,000,000 $ ALL OWNED AUTOS t) BODILY INJURY (Per accident) ...._.... $ X SCHEDULED AUTOS HIRED AUTOS PROPERTY DAMAGE (Per accident) .................,. ... ....�. .... .................... .._- NON -OWNED AUTOS .............. $ ...$......... ......... .. .... ,�............,�.........._. UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB LAIMS MADE AGGREGATE $ DEDUCTIBLE RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNER/EXECUTIVE ❑ OFFICER /MEMBER EXCLUDED? d.M &nCEakoYy n NH) ryes dosct150U der' NIA �W�C STAI U- OTH- E.L. EACH ACCIDENT EMPLOYE E L DISEASE EA E..... O E.L. DISEASE - POLICY LIMIT $ S .... . $ F][11 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, it more space is required) 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 Richard Dong ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD 1001486 132849.4 02 -11 -2010 PONV Policy No.: 92- BQ- FO64 -9 FE -6609 r�rzpk a�w.r,w ', SECTION II ADDITIONAL INSURED ENDORSEMENT Policy No.: 92- BQ- FO64 -9 Named Insured: APA ENGINEERING 9880 IRVINE CENTER DR IRVINE CA 92618 -4353 Additional Insured (include address): THE CITY OF EL SEGUNDO, ITS OFFICERS, OFFICIALS, EMPLOYEES, AGENTS AND VOLUNTEERS 350 MAIN ST EL SEGUNDO CA 90245 -3895 WHO IS AN INSURED, under SECTION II DESIGNATION OF INSURED, is amended to include as an insured the Additional Insured shown above, but only to the extent that liability is imposed on that Additional Insured solely because of your work performed for that Additional Insured shown above. Any insurance provided to the Additional Insured shall only apply with respect to a claim made or a suit brought for damages for which you are provided coverage. The Primary Insurance coverage below applies only when there is an "X" in the box. ® Primary Insurance. The insurance provided to the Additional Insured shown above shall be primary insurance. Any insurance carried by the Additional Insured shall be noncontributory with respect to coverage provided to you. All other policy provisions apply. FE -6609 Printed in U.S.A.