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PROOF OF INSURANCE (2015) CLOSEDNEXLI -1 OP ID: J1 DATE (MMIDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 03/17/2015 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 CONTACT Placer Insurance Agency NAME, LicenseOC66701 9 y IP,vc,NNo,,_Ext)' _ P. O. Box 619052 E -MAIL Roseville, CA 95661 -9052 ADDRESS Dirk Klndelt INSURER(S) AFFORDING COVERAGE INSURER A: Travelers ProDerty Casualtv Co 125674 INSURED Nexlevel Information INSURER B: j Technology, Inc. ...... 6829 Fair Oaks Blvd Ste 100 wsuRERC: Carmichael, CA 95608 INSURERD: ...... . . —__ I INSURER E: 1 INSURER F : r!nVFPAr.F9 r"-FRTIPIr.ATF N1IMRPPl RFviginN NIIMRFR• 1 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, . . ,,.. ,. .... E` E� . ...__r OY IEXIP -.� .. ........ -E PICN POLICY NUMBER POLICY /Y) I IMM /DDIYYYI a TYPE OF INSURANCE ... ....._ wVD LIMITS GENERAL LIABILITY EACH OCCURRENCE S 1,000,00 COMMERCIAL GENE L LIABILITY X ZLP13N222951415 05/0112014 05/01/2015 r7AMAUE Ti7 RENTED— PR MIC 4 ( a err pnrel S 500,000 CLAIMS -MADE X] OCCUR MED EXP (Anv one person) 1i S 10,00 INJURY 1,000,000 _ GENERALAGGREGA E 1 S 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: COMP/OP AGG I S 2,000,000 mm POLICY , ,X Lac { _PRODUCTS- Em Ben. .........�............. . � ............ ... 1,000,00 AUTOMOBILE LIABILITY r„ YMkT1NEO �eINGLE LIWT .._1,000,00 A ANY AUTO BA8141X98814TEC 05/0112014 05101/2015 BODILY INJURY (Per person) l S ALLOWNED 'SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) —.. �S X NON -OWNED HIRED AUTOS X AUTOS PROPERTY DAMAGE (P'EP ACCIq�N� � -- - -- UMBRELLA A6 X . OCCUR OCCUR OCCURRENCE 1,000,000 A ERCESS pg 111 CLAIMS MADE 05/01/2014 05/01/2015 .E AGGREGATE 1,000,000 DED RETENTIONS �ZUP13N223381415 m I WORKERS COMPENSATION 1HJUB7615XO0314 WCSTAfU IOTH -Y A AND EMPLOYERS' LIABILITY YIN N ANY PROPRIETOR/PARTNER/EXECUTIVE X 05/01/2014 05/01/2015 _X QRY I IMITC FR E L EACH ACCIDENT mm j$ 1,000,00e OF FIC N / A „ (Mandatory in NH) ION E L DISEASE - EA EMPLOYEE' 1,000,000 S 1 If es, describe under DESCR PT OF OPERATIONS below _ E.L DISEASE - POLICY LIMIT S.,,.1 000.000 A ,Professional Liab IZPL14R360811415 0510112014 0510112015 Limit 2,000,00 I Deduct 10,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) The City, its Officials and employees are additional insured and insurance is primary per CGD2480805 and CGD4250708 attached. Waiver of Subrogation per WC990376AO01 ULK I IFII:A I t_ CITYOEL City of El Segundo Department of Engine and Building Services 350 Main Street, 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 ° Ty © 1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD PIFA M pa COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANCES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED (CONTRACTORS OPERATIONS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 1. WHO IS AN INSURED - (Section 11) is amended to include any person or or- ganization that you agree in a "written contract. re+qulrin Insurance" to include as an additional insured on this Coverage Part. but: (a) Only with respect to liability for "bodily injury ", "property damage" or "personal injury "; and 3. (b) If, and only to the extent that, the injury or damage is caused by acts or omissions of you or your subcon- tractor in the performance of "your work" to which the "written contract requiring insurance" applies. The per- son or organization does not qualify as an additional insured with respect to the independent acts or omissions of such person or organization. 2. The insurance provided to the additional insured by this endorsement is limited as follows: (a) In the event that the Limits of Insur- ance of this Coverage Part shown In the Declarations exceed the limits of liability required by the "written con- tract requiring insurance ", the insur- ance provided to the additional in- sured shall be limited to the limits of liability required by that "written con- tract requiring insurance ". This en- dorsement shall not increase the lim- its of insurance described in Section III - Limits Of Insurance. (b) The insurance provided to the addi- tional insured does not apply to "bodily injury ", "property damage" or "personal injury" arising out of the rendering of, or failure to render, any professional architectural, engineering or surveying services, including: I. The preparing, approving, or fail- ing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders or change orders, or the preparing, approv- ing, or failing to prepare or ap- prove, drawings and specifications; and ii. Supervisory, inspection, architec- tural or engineering activities. (C) The insurance provided to the addi- tional insured does not apply to "bodily injury" or "property damage" caused by "your work" and included in the "products- completed operations hazard ". The insurance provided to the additional insured by this endorsement is excess over any valid and collectible "other in- surance", whether primary, excess, con- tingent or on any other basis, that is available to the additional insured for a loss we cover under this endorsement. However, if the "written contract requir- ing insurance" specifically requires that this insurance apply on a primary basis or a primary and non - contributory basis, this insurance is primary to "other insur- ance" available to the additional insured which covers that person or organization as a named insured for such loss, and we will not share with that "other insur- ance". But the insurance provided to the additional insured by this endorsement still is excess over any valid and col- lectible "other insurance ", whether pri- mary, excess, contingent or on any other basis, that is available to the additional insured when that person or organization is an additional insured under such "other insurance ". 4. As a condition of coverage provided to the additional insured by this endorse- ment: (a) The additional insured must give us written notice as soon as practicable of an "occurrence" or an offense which may result in a claim. To the extent possible, such notice should include: I. How, when and where the "occur- rence" or offense took place; ill. The names and addresses of any injured persons and witnesses; and CG D2 48 08 05 0 2005 The Travelers Indemnity Company. All rights reserved. Page 1 of 2 COMMERCIAL GENERAL LIABILITY iii. The nature and location of any in- jury or damage arising out of the "occurrence" or offense. (b) If a claim is made or "suit" is brought against the additional insured, the additional insured must: i. Immediately record the specifics of the claim or "suit" and the date received; and ii. Notify us as soon as practicable. 5. The additional insured must see to it that we receive written notice of the claim or "suit" as soon as practica- ble. (c) The additional insured must immedi- ately send us copies of all legal pa- pers received in connection with the claim or "suit ", cooperate with us in the investigation or settlement of the claim or defense against the "suit ", and otherwise comply with all policy conditions. (d) The additional insured must tender the defense and indemnity of any claim or "suit" to any provider of "other insurance" which would cover the additional insured for a loss we cover under this endorsement. How- ever, this condition does not affect whether the insurance provided to the ;additional Insured by this endorse - ment is primary to "other insurance" available to the additional insured which covers that person or organiza- tion as a named insured as described in paragraph 3. above. The fallowing definition is added to SECTION V. - DEFINITIONS: "Written contract requiring insurance" means that part of any written contract or agreement under which you are re- quired to include a person or organiza- tion 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 the signing and execution of the contract or agreement by you; IL While that part of the contract or agreement is in effect; and C. Before the end of the policy period. Page 2 of 2 0 2DD5 The Travelers Indemnity Company. All rights reserved. CG D2 48 08 05 M ca m n iy COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. is OTHER INSURANCE - ADDITIONAL INSUREDS PRIMARY AND NON- CONTRIBUTORY WITH RESPECT TO CERTAIN OTHER INSURANCE r$ b O O H 0 n M w N z c� 0 a V !E This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART The following is added to Paragraph 4. a, Primary Insurance, of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: However, if you specifically agree in a writ- ten contract or agreement that the Insurance afforded to an additional insured under this Coverage fart must apply an a primary ba- sis, 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 that other insurance, provided that: (1) The "bodily injury" or "property damage" for which coverage is sought is caused by an "occurrence" that takes place; and (2) The "personal injury" or "advertising in- jury" for which coverage is sought arises out of an offense that is committed; subsequent to the signing and execution of that contract or agreement by you. CG 04 25 07 08 0 2008 The Travelers Companies, Inc. Page t of i WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA (BLANKET WAIVER) We have the right to recover our payments From anyone liable for an injury Covered by this policy. ',d',fe will not enforce our right against the person or organization named in the Schedule. The additional premium for this endorsement ,hall be 07.000 % of the California ,porkers' compensation pre- mium. Schedule Person or Organization Job Description ANY PERSON OR ORGANIZATION FOR WHICH THE INSURED HAS AGREED BY WRITTEN CONTRACT EXECUTED PRIOR TO LOSS TO FURNISH THIS WAIVER. m= of a= This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. m° (The information below is required Only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective Policy No. Endorsement No. Insured Premium Insurance Company Countersigned by DATE OF ISSUE: 03 -07 -14 ST ASSIGN:. 018076 Page 1 of t NEXLI -1 OP ID: J1 CERTIFICATE OF LIABILITY INSURANCE DATE 031'091201YY) a3ra912o15 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(les) 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 NCO lac. Agency N Placer Insurance A A E. 9 Y ,PHONE ASi ...... _._ ..... ._ Llce'nso010066701 IAIC N F n , ........... +APO N .._ ...., P. O. Box 619052 �NaANL Roseville, CA 95661- 9052roaDR s: r... ....... ...... __.... INSURER Travelers 25674 _ _ .............. INSURED NeXlevelInformation INSURER B: Technology, Inc. 6829 Fair Oaks Blvd Ste 100 iNsuRER c Carmichael, CA 95608 INSURER t) INSURER E INSURER F: r nV PAr.fLC. t1PP'T'IVfr1 .:ATF NI IMRFR• I'a MkfIS"fr'%KI RII 111N MM. 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. NSR 'll(IYYY.- . "d4dPVWdTJU'JYYY ......._._._... -. ..._____ NS TYPE OF INSURANCE o ,� POLICYNUMBER POIAiCy"ixX.y LIMITS GENERAL LIABILITY EACH OCCURRENCE ....� It 1,000,00 C4wr,lMamROALGENERALLIA131LITY - -- X ZLP13N222951415 05/0112014 0510112015 D"Ag PER PRIMk�aE,�(�4lj�ylxgleryc� $ 5oa,00a CLAIMS -MADE OCCUR MEO EXP (Anv one person} S 10,000 PERSONAL &ADVINJURY .. ............................. S 1,000,000 -- -- GENERAL AGGRE GATE $ 2,000,000 O E N'LP'4iaOREGTFLiMITAPPI.IrSPER: PRODUCTS- COMPJOPAGG S 2,000,000 Poa.fCY X l LOC E-mp Ben. $ 1,000,000 AUTOMOBILE LIABILITY "U Ms IJ, INGLE MMIT 1,000,000 A ANY AUTO BA8141X98814TEC 05/01/2014 05101/2015 ,n ......... ... BODILY INJURY (Per person) ............. $ AU OS AUTOS AUTOS AUTOS BODILY INJURY (Per accident) 3 X NON -OWNED HX PHOPFII'4' I'lA Afz °(m. HIREDAUiOS AUTOS mJ1 Ftl1 gnpfgn ITmmmm mmmm .$ . $ X UMBRELLALIAB X ,OCCUR EACHOCCURRENCE $ 1,000,000 A ExcessuAe CLAIMS -MADE ZUP13N223381415 05101/2014 05101/2015 AGGREGATE $ 1,000,000 DED RETENTIONS $ H- X AND EMPLOYERS' LIABILITY YIN LT(1R F Lla�l�...., R ... ............ . ...... ACCT A o RROPRIETORIPAcxuERo?ECUTIVE ❑ NIA HJUB7616XO0314 05/01/2014 05/01/2015 E.L. f� ENT $ 1,000,101D ...G ... - (Mandatory in NH) E L DISEASE EA EMPLOYEF $ 1 000 0 n es,%9V$I IUN under .............Y .............. .O.a E.L. DISEASE ICY LIMIT S 1,000,000 A Professional Liab ZPL14R360811415 05/01/2014 05/01/2015 Limit 2,000,000 Deduct 10,000 DESCRIPTION OF OPERATIONS I LOCATIDNS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) The City, its Officials and employees are additional insured and insurance is primary per CGD2480805 and CGD4250708 attached. E City of El Segundo Department of Engineering and Building Services 350 Main Street, ACORD 26 (2010105) CITYOEL 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 pti � Q o ©1988 -2010 ACORD CORPORATION. All rights reserved, The ACORD name and logo are registered marks of ACORD