Loading...
PROOF OF INSURANCE (2013) CLOSEDACORP. CERTIFICATE OF LIABILITY INSURANCE f DATE(MMfflDIYYYY) 1 10/11/2012 THIS CERTIFICATE IS ISSUED ASA 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 asLowL THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE onPRODUCER, AND THE CERTIFICATE HOLDER. WPORTANT� If the certificate holder is an ADDITtONAL INSURED, lhe p0cy(Ioo must be endorsed �fSUBROGATIONISWAIVED.Subjoclto the terms and conditions m the policy, certain policies may require anendorsement. A statement on this certificate does not confer rights mthe certificate holder m lieu m such unuo,m,mvnKs), Pridemark-Everest Insurance Services, Inc. PHONE FU... (714)569-2720 14)784-3999 A Leavitt Group Co #OF13098 E-MAIL 1920 E. First Street, Ste SOO .QUAWNER IRK. NSURED INSURERA: Sentinel Ins. Co. #11000 Compressed Air Specialties, Inc. INSU�RER B: 1340 Simpson Circle INSURER C: Anaheim, CA 92806-SS31 INSURER F: COVERAGES CERTIFICATE NUMBER: 12- 13 GL-AUTO REVISION NUMBER: THIS IS TO CERTIFY THAI 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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 UMITS GENERALLIABILITY 72SBARB4627S( 1111512012 11/1612013 EACH OCCURRENCE I OOOA( COMMERCIAL GENERAL LIABILITY $ 1.00019� CLAIMS-MADE A j OCCUR MED EXP (Any one person) $ 10,0( GENIL AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG S 2,000,01 ANY AUTO ALL OWNED AUTOS A SCHEDULED AUTOS HIRED AUTOS '%i NON-OWNED AUTOS UMBRELLAuAB ) |OCCUR EXCESS LIAB CLAIMS MADE oeoocnmLE RETENTION S AND EMPmYER=LLAmLITY YIN ANY PROPRIETORfPARTNER/EXEGUTIVEF-I OFFICER/MEMBER EXCLUDED? N/A (Mandatory In NH) I� vi*, dwwo3 under (Ea accident) 1,000 EACH OCCURRENCE $ AGGREGATE $ E L EACH ACCIDENT As re4uired by written contract. )Emcm,nowvp OPERATIONS / LOCATIONS / VEHICLES (Attach ^oox ,o`^^mvon" Remarks Schedule, nmore space *required) E: Repair & Maintenance of Fire Department's Breathing Air Compressor ertificate Holder is Additional Insured as respects General Liability per S5 OO 08 04 05 {PGS, 18-20} od IH12001185. ,ERTIFICATE HOLDER CANCELLATION City of B Segundo 950 Main St El,Segundo, CA 90245 SHOULD ANY oF THE ABOVE DESCRIBED POLICIES as CANCELLED BEFORE THE sxpn*now oxTs THEREOF, WILL BE osovsnso IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 0«988-20u9 ACORD CORPORATION. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD BUSINESS LIABILITY COVERAGE FORM F. OPTIONAL ADDITIONAL INSURED COVERAGES If listed or shown as applicable in the Declarations, one or more of the following Optional Additional Insured Coverages also apply. When any of these Optional Additional Insured Coverages apply, Paragraph 6. (Additional Insureds When Required by Written Contract, Written Agreement or Permit) of Section C., Who Is An Insured, does not apply to the person or organization shown in the Declarations. These coverages are subject to the terms and conditions applicable to Business Liability Coverage in this policy, except as provided below: 1. Additional Insured - Designated Person Or Organization WHO IS AN INSURED under Section C. is amended to include as an additional insured the person(s) or organization(s) shown in the Declarations, 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: a. In the performance of your ongoing operations; or b. In connection with your premises owned by or rented to you. 2. Additional Insured - Managers Or Lessors Of Premises a. WHO IS AN INSURED under Section C. is amended to include as an additional insured the person(s) or organizations) shown in the Declarations as an Additional Insured - Designated Person Or Organization; but only with respect to liability arising out of the ownership, maintenance or use of that part of the premises leased to you and shown in the Declarations. b. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to: (1) Any 'occurrence" which takes place after you cease to be a tenant in that premises; or (2) Structural alterations, new construction or demolition operations performed by or on behalf of such person or organization. 3. Additional Insured - Grantor Of Franchise WHO IS AN INSURED under Section C. is amended to include as an additional insured the person(s) or organization(s) shown in the Declarations as an Additional Insured - Grantor Of Franchise, but only with respect to their liability as grantor of franchise to you. 4. Additional Insured - Lessor Of Leased Equipment a. WHO IS AN INSURED under Section C. is amended to include as an additional insured the person(s) or organization(s) shown in the Declarations as an Additional Insured — Lessor of Leased Equipment, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your maintenance, operation or use of equipment leased to you by such person(s) or organization(s). b. With respect to the insurance afforded to these additional insureds, this insurance does not apply to any 'occurrence" which takes place after you cease to lease that equipment. 5. Additional Insured - Owners Or Other Interests From Whom Land Was Been Leased a. WHO IS AN INSURED under Section C. is amended to include as an additional insured the person(s) or organization(s) shown in the Declarations as an Additional Insured — Owners Or Other Interests From Whom Land Has Been Leased, but only with respect to liability arising out of the ownership, maintenance or use of that part of the land leased to you and shown in the Declarations. b. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to: (1) Any 'occurrence" that takes place after you cease to lease that land; or (2) Structural alterations, new construction or demolition operations performed by or on behalf of such person or organization. 6. Additional Insured - State Or Political Subdivision — Permits a. WHO IS AN INSURED under Section C. is amended to include as an additional insured the state or political subdivision shown in the Declarations as an Additional Page 18 of 24 Form SS 00 Oa 04 05 BUSINESS LIABILITY COVERAGE FORM Insured — State Or Political Subdivision - (e) Any failure to make such Permits, but only with respect to inspections, adjustments, tests or operations performed by you or on your servicing as the vendor has agreed behalf for which the state or political to make or normally undertakes to subdivision has issued a permit. make in the usual course of b. With respect to the insurance afforded to business, in connection with the these additional insureds, the following distribution or sale of the products; additional exclusions apply: (f) Demonstration, installation, This insurance does not apply to: servicing or repair operations, except such operations performed (1) "Bodily injury", "property damage" or at the vendor's premises in "personal and advertising injury" connection with the sale of the arising out of operations performed for product; the state or municipality; or (g) Products which, after distribution (2) "Bodily injury" or "property damage" or sale by you, have been labeled included in the "product- completed or relabeled or used as a operations" hazard. container, part or ingredient of any 7. Additional Insured —Vendors other thing or substance by or for a. WHO IS AN INSURED under Section C. is the vendor; or amended to include as an additional (h) "Bodily injury" or "property insured the person(s) or organization(s) damage" arising out of the sole (referred to below as vendor) shown in the negligence of the vendor for its Declarations as an Additional Insured - own acts or omissions or those of Vendor, but only with respect to "bodily its employees or anyone else injury" or "property damage" arising out of acting on its behalf. However, this "your products" which are distributed or exclusion does not apply to: sold in the regular course of the vendor's (i) The exceptions contained in business and only if this Coverage Part Subparagraphs (d) or (f); or provides coverage for "bodily injury" or (ii) Such inspections, "property damage" included within the ". adjustments, tests or servicing "products- completed operations hazard as the vendor has agreed to b. The insurance afforded to the vendor is make or normally undertakes subject to the following additional exclusions: to make in the usual course of (1) This insurance does not apply to: business, in connection with (a) "Bodily injury" or "property the distribution or sale of the damage" for which the vendor is products. obligated to pay damages by (2) This insurance does not apply to any reason of the assumption of insured person or organization from liability in a contract or agreement. whom you have acquired such This exclusion does not apply to products, or any ingredient, part or liability for damages that the container, entering into, vendor would have in the absence accompanying or containing such of the contract or agreement; products. (b) Any express warranty 8. Additional Insured — Controlling Interest unauthorized by you; WHO IS AN INSURED under Section C. is (c) Any physical or chemical change amended to include as an additional insured in the product made intentionally the person(s) or organization(s) shown in the by the vendor; Declarations as an Additional Insured — (d) Repackaging, unless unpacked Controlling Interest, but only with respect to solely for the purpose of inspection, their liability arising out of: demonstration, testing, or the a. Their financial control of you; or substitution of parts under b. Premises they own, maintain or control instructions from the manufacturer, while you lease or occupy these premises. and then repackaged in the original container; Form SS 00 08 04 05 Page 19 of 24 BUSINESS LIABILITY COVERAGE FORM This insurance does not apply to structural The limits of insurance that apply to additional alterations, new construction and demolition insureds are described in Section D. — Limits Of operations performed by or for that person or Insurance. organization. How this insurance applies when other insurance 9. Additional Insured — Owners, Lessees Or is available to an additional insured is described in Contractors — Scheduled Person Or the Other Insurance Condition in Section E. — Organization Liability And Medical Expenses General a. WHO IS AN INSURED under Section C. is Conditions. amended to include as an additional G. LIABILITY AND MEDICAL EXPENSES insured the person(s) or organization(s) DEFINITIONS shown in the Declarations as an Additional Insured — Owner, Lessees Or Contractors, 1. "Advertisement" means the widespread public but only with respect to liability for "bodily dissemination of information or images that injury", "property damage" or "personal has the purpose of inducing the sale of goods, and advertising injury" caused, in whole or products or services through: in part, by your acts or omissions or the a. (1) Radio; acts or omissions of those acting on your (2) Television; behalf: (3) Billboard; (1) In the performance of your ongoing (4) Magazine; operations for the additional i nsured(s); or (5) Newspaper; (2) in connection with "your work" b. The Internet, but only that part of a web performed for that additional insured site that is about goods, products or and included within the "products- services for the purposes of inducing the completed operations hazard ", but sale of goods, products or services; or only if this Coverage Part provides c. Any other publication that is given coverage for "bodily injury" or widespread public distribution, "property damage" included within the However, "advertisement" does not include: "products - completed operations a. The design, printed material, information hazard ", or images contained in, on or upon the b. With respect to the insurance afforded to packaging or labeling of any goods or these additional insureds, this insurance products; or does not apply to "bodily injury ", "property b. An interactive conversation between or damage" or "personal an advertising among persons through a computer network. injury" arising out of the rendering of, or the failure to render, any professional 2. "Advertising idea" means any idea for an architectural, engineering or surveying "advertisement ". services, including: 3. "Asbestos hazard" means an exposure or (1) The preparing, approving, or failure to threat of exposure to the actual or alleged prepare or approve, maps, shop properties of asbestos and includes the mere drawings, opinions, reports, surveys, presence of asbestos in any form. field orders, change orders, designs or 4, "Auto" means a land motor vehicle, trailer or drawings and specifications; or semi - trailer designed for travel on public (2) Supervisory, inspection, architectural roads, including any attached machinery or or engineering activities. equipment. But "auto" does not include 10. Additional Insured — Co -Owner Of insured "mobile equipment', Premises 5. "Bodily injury" means physical: WHO IS AN INSURED under Section C. is a. Injury; amended to include as an additional insured b. Sickness; or the person(s) or Organization(s) shown in the c. Disease Declarations as an Additional insured — Co- Owner Of Insured Premises, but only with sustained by a person and, if arising out of the respect to their liability as co -owner of the above, mental anguish or death at any time, premises shown in the Declarations. 6. "Coverage territory" means: Page 20 of 24 Form SS 00 08 04 05 POLICYHOLDER COPY SP STATE P.O. BOX 8192, PLEASANTON, CA 94588 INSURANCP FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 12 -31 -2012 GROUP: POLICY NUMBER: 9033103 -2012 CERTIFICATE ID: 28 CERTIFICATE EXPIRES: 12 -31 -2013 12- 31- 2012/12 -31 -2013 CITY OF EL SEGUNDO SP JOB:FIRE DEPARTMENT 350 MAIN ST EL SEGUNDO CA 90245 -3813 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 after 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. Authorized Representative President and CEO EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT #1600 - TOWNSEND, CHARLES PRESIDENT - EXCLUDED. ENDORSEMENT #1600 - TOWNSEND, SHAWN VICEPRES - EXCLUDED. ENDORSEMENT #1600 - TOWNSEND, CONNIE SECRETARY TREASURER - EXCLUDED. ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 12 -31 -2012 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. EMPLOYER COMPRESSED AIR SPECIALTIES, INC SP 1340 S SIMPSON CIR ANAHEIM CA 92806 [Pi 6.SPj Ev.l -2ot2) PRINTED : 12 -31 -2012 Kmm POLICY NUMBER: 72 SBA RB4627 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - STATE /POLITICAL SUBDIVISION CITY OF BURBANK 275 EAST OLIVE AVE. BURBANK, CA 91510 - 6459 CITY OF EL SEGUND 350 MAIN ST. EL SEGUNDO, CA 90245 CITY OF FULLERTON 303 W. COMMONWEALTH AVE. FULLERTON, CA 92632 CITY OF ONTARIO 425 E. B STREET ONTARIO, CA 91764 -4194 CITY OF SAN DIEGO PURCHASING DIVISION 1200 THIRD AVE., SUITE 200 SAN DIEGO, CA 92101 -4195 CITY OF SANTA ANA 20 CIVIC CENTER PLAZA SANTA ANA, CA 92701 CITY OF SANTA BARBARA FIRE OPERATIONS 121 WEST CARRILLO ST SANTA BARBARA, CA 93101 CITY OF TORRANCE PURCHASING DIVISION ATTN: BARBARA KASS 3031 TORRANCE BLVD. TORRANCE, CA 90503 CITY OF VERNON ATTN: RISK MANAGEMENT 4305 SANTA FE AVE. VERNON, CA 90058 Form IH 12 00 11 86 T SEQ. NO. 005 Printed In U.S.A. Page 001 Process Date: 08 /29/12 Expiration Date: 11/15/13 ENDORSEMENT AGREEMENT STATE WAIVER OF SUBROGATION NSURANCE 9033103 -12 RENEWAL SP HOME OFFICE 1- 30 -30 -42 SAN FRANCISCO PAGE 1 OF 1 ALL EFFECTIVE DATES ARE AT 12:01 AM PACIFIC EFFECTIVE MAY 22, 2013 AT 12.01 A.M. STANDARD TIME OR THE TIME INDICATED AT AND EXPIRING DECEMBER 31, 2013 AT 12.01 A.M. PACIFIC STANDARD TIME COMPRESSED AIR SPECIALTIES 1340 S SIMPSON CI ANAHEIM, CA 9280' ANYTHING IN THIS POLICY TO THE CONTRARY NOTWITHSTANDING, IT IS AGREED THAT THE STATE COMPENSATION INSURANCE FUND WAIVES ANY RIGHT OF SUBROGATION AGAINST, CITY OF EL SEGUNDO WHICH MIGHT ARISE BY REASON OF ANY PAYMENT UNDER THIS POLICY IN CONNECTION WITH WORK PERFORMED BY, COMPRESSED AIR SPECIALTIES IT IS FURTHER AGREED THAT THE INSURED SHALL MAINTAIN PAYROLL RECORDS ACCURATELY SEGREGATING THE REMUNERATION OF EMPLOYEES WHILE ENGAGED IN WORK FOR THE ABOVE EMPLOYER, IT IS FURTHER AGREED THAT PREMIUM ON THE EARNINGS OF SUCH EMPLOYEES SHALL BE INCREASED BY 03 %. NOTHING IN THIS ENDORSEMENT CONTAINED SHALL BE HELD TO VARY, ALTER, WAIVE OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS POLICY OTHER THAN AS STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR LIMITATIONS OF THIS ENDORSEMENT, COUNTERSIGNED AND ISSUED AT SAN FRANCISCO: MAY 24, 2011 2570 AUTHORIZED REPRESENTA IVE PRESIDENT AND CEO SCIF FORM 10217 (REV.1-2012) OLD DP 217