Loading...
PROOF OF INSURANCE (2013) CLOSED* DATE CERTIFICATE OF LIABILITY INSURANCE 10/10/2012YY' to /lo /zalz I 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 LIC #OE67768 1- 925- 660 -3514 CONTACT N AME. Gigi Yuen IOA Insurance Services PHONE. FAX (925) 416 7862 09/01/1 ( fq" ( P) 3875 Hopyard Road, Suite 240 .EAipI ss. gigi.yuenoioausa.com PRODUCER' Pleasanton, CA 94588 OUSTOIWV.FR i0, ........ ............. ...... G.lgi.,,, Yuen _ _ INSURER'('.t„)APAgRo!NGCOVERAGE NAIC #.,,,,,, INSURED INSURER A; TRAVELERS PROP CAS CO OF AMER ..............w....... 25674 Jl,ee Engineering Inc. m ,.... INSURER B: ACE AMER INS CO 22667 .............. _.. .... , .... 430 S. Garfield Avenue, Suite 301 INSURER C; Alhambra, CA 91801 INSVRERD: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 29631573 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. . . .. . .. ...... �. .. , , .... ................ ILTR A4ODL SUBR POLICY DFF POVC'GDIYYYX TYPE OF INSURANCE POLICY NUMBER WDO1YYYY MMM LIMITS • GENERAL LIABILITY AUTHORIZED REPRESENTATIVE , 680- 8855NS94 09/01/1 09/01/13 EACH OCCURRENCE $ 2,000,000 X COMMERCIAL GENERAL LIABILITY _J,4MAGE $O' R(`NTE'D PREMISES�kra,±pc'auvratrr;) . 1,000,000 $ .. CLAIMS -MADE I_X OCCUR MED EXP (Anyone person) $ _10 000 PERSONAL &ADV INJURY $ 2,000,000 GENERAL AGGREGATE $ 4,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OPAGG $ 4,000,000 POLICY X PRO LOC $ • AUTOMOBILE LIABILITY 680 - 8855N594 09/01/1, 09/01/13 COMBINED SINGLE LIMIT $ 2,000,000 (Ea accident) - ANY AUTO ---- BODILY INJURY (Per person) - ------- --------------- . $ ALL OWNED AUTOS --- _ ...... - -- BODILY INJURY (Per accident) - --- ------------------- -.,.--- $ - SCHEDULED AUTOS .- _._... PROPERTY DAMAGE _.- ...____ _.....___ -. .. -..., X HIRED AUTOS (Per accident) $ X NON -OWNED AUTOS $ UMBRELLA LIAB OCCUR . ....... _. — EACH OCCURRENCE ......._.... $ . ,.,.,. , , _ ,,...., , ..,.... EXCESS LIAR CLAIMS -MADE - AGGREGATE $ DEDUCTIBLE $ RETENTION $ _ $ p� WORKERS COMPENSATION IIB- 3290T632 09/01/1 09/01/13 X WCSTAIU- OTH TORY L(PII.T6 ER AND EMPLOYERS' LIABILITY Y / N — ANY ETOR/PARTNER/EXECUTIVE E LEACH ACCIDENT $ 1,000,000 CER /M EXCLUDED? N / A MandatoMEn NH ( rY ) E'�L DISEASE W EA.EMILOYEF. $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. -. LI LIMIT DISEASE - POLICY LIMIT ,. $ 1,000,000 • ProleSsIona.L L a 1 ity N00917977008 Per C alm , H Professional Liability N001917977008 11/02/1 11/02/12 Annual Aggregate 1,000,000 UE'SCRIPTfON OF OPERATIONS I LOCATIONS l VEHICLES (Attach ACORD 101, AddRional Remarks Schedulo, U' more space Is required) All Operations of the Named Insured. General Liability only: City of El Segundo, its officers, officials, employees, and authorized volunteers is named as Additional insured but only as respects liability arising out of the Named Insured's operations in Professional Services Agreement; such coverage is Primary and Non - Contributory as respects any insurance carried by the Additional Insured with respect to work performed by the Named Insured. Also, note that the aforementioned General Liability includes coverage for Hired & Non -Owned Auto Liability. Above policies include Waiver of Subrogation in favor of the aformentioned Additional Insured. CERTIFICATE HOLDER CANCELLATION City of E1 Segundo ,; d" SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Sam Lee, Building 350 Main Street El Segundo, CA 90245 Manager )� 7 ° I I AUTHORIZED REPRESENTATIVE , LTSA gyuenSFP © 1988 -2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD 29631573 POLICY NUMBER: 680- 885SN594 NAMED INSURED: TLee Engineering Inc. COMMERCIAL GENERAL LIABILITY DATE ISSUED: 10/10/2012 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED (ARCHITECTS, ENGINEERS AND SURVEYORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE NAME OF PERSON(S) OR ORGANIZATION(S): rq City of 81 Segundo Attn: Sam Lee, Building Manager 350 Main Street El Segundo, CA 90245 USA City of E1 Segundo, its officers, officials, employees, and authorized volunteers PROJECT /LOCATION OF COVERED OPERATIONS: All operations of the Named Insured PROVISIONS A. The following is added to WHO IS AN INSURED (Section II): The person or organization shown in the Schedule above is an additional insured on this Coverage Part, but only with respect to liability for "bodily injury", "property damage" or "personal 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; b. In connection with premises owned by or rented to you; or c. In connection with "your work" and included within the "products- completed operations hazard ". Such person or organization does not qualify as an additional insured for "bodily injury", "property damage" or "personal injury" for which that person or organization has assumed liability in a contract or agreement. The insurance provided to such additional insured is limited as follows: d. This insurance does not apply to the rendering of or failure to render any "professional services ". e. The limits of insurance afforded to the additional insured shall be the limits which you agreed in that "contract or agreement requiring insurance" to provide for that additional insured, or the limits shown in the Declarations for this Coverage Part, whichever are less. This endorsement does not increase the limits of insurance stated in the LIMITS OF INSURANCE (Section III) for this Coverage Part. CG D3 82 09 07 © 2007 The Travelers Companies, Inc. Page 1 of 2 Includes copyrighted material of Insurance Services Office, Inc., with its permission. B. The following is added to Paragraph a. of 4. Other Insurance in COMMERCIAL GENERAL LIABILITY CONDITIONS (Section IV): However, if you specifically agree in a "contract or agreement requiring insurance" that, for the additional insured shown in the Schedule, the insurance provided to that additional insured under this Coverage Part must apply on a primary basis, or a primary and non - contributory basis, this insurance is primary to other insurance that is available to such additional insured which covers such additional insured as a named insured, and we will not share with the other insurance, provided that: (1) The "bodily injury' or "property damage" for which coverage is sought occurs; and (2) The "personal injury' for which coverage is sought arises out of an offense committed; after you have entered into that "contract or agreement requiring insurance" for such additional insured. But this insurance still is excess over valid and collectible other insurance, whether primary, excess, contingent or on any other basis, that is available to the additional insured when the additional insured is also an additional insured under any other insurance. C. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us in COMMERCIAL GENERAL LIABILITY CONDITIONS (Section IV): We waive any rights of recovery we may have against the additional insured shown in the Schedule above because of payments we make for "bodily injury', "property damage" or "personal injury" arising out of "your work" on or for the project, or at the location, shown in the Schedule above, performed by you, or on your behalf, under a "contract or agreement requiring insurance" with that additional insured. We waive these rights only where you have agreed to do so as part of the "contract or agreement requiring insurance" with that additional insured entered into by you before, and in effect when, the "bodily injury" or "property damage" occurs, or the "personal injury' offense is committed. D. The following definition is added to DEFINITIONS (Section V): "Contract or agreement requiring insurance" means that part of any contract or agreement under which you are required to include the person or organization shown in the Schedule as an additional insured on this Coverage Part, provided that the "bodily injury' and "property damage" occurs, and the "personal injury' is caused by an offense committed: a. After you have entered into that contract or agreement; b. While that part of the contract or agreement is in effect; and c. Before the end of the policy period. CG D3 82 09 07 © 2007 The Travelers Companies, Inc. Page 2 of 2 Includes copyrighted material of Insurance Services Office, Inc., with its permission. YAM J WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - A' A ORNIA This endorsement changes the policy to which it is attached effective on inception date of the policy unless a different date is indicated below. (The following "attaching clause" need be completed only when this endorsement is issued subsequent to preparation of the policy,) This endorsement, effective 12:01 AM 09/01/12 Issued to: JLee Engineering Inc. By: TRAVELERS PROP CAS CO OF AMER Premium: INCL forms a part of Policy No. UB- 3290T632 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). 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 5% of the California workers' compensation premium otherwise due on such remuneration. Schedule Person or Organization City of El Segundo Attn: Sam Lee, Building Manager 350 Main Street E1 Segundo, CA 90245 Job Description All operations of the Named Insured Waiver of Subrogation is in favor of the aforementioned Additional Insured. WC 04 03 06 Countersigned by �_ (Ed. 4 -84 ) Representative _ Authorized