Loading...
PROOF OF INSURANCE (2015) CLOSEDDATE (MM /DD/YYYY) , CbR CERTIFICATE OF LIABILITY INSURANCE 5/22/2015 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). CONTACT PRODUCER Garrett/Mosier /Griffith /Sistrunk NAME. FAX �,. Risk Management & Insurance Services _F (9as 559 s7oo ��� ���� —� FAX W�). (949)559-6703 12 Truman EMAIL ��`� pp Irvine, CA 92620 ADDRESS_...... I ISI AFFORDING CO � AIC # F COVERAGE N www.gmgs.com OB84519 . .............................._ INSURER A : Great ..............lf INSURED INSURER B: PeerOne Environmental t M lOD�PY'Y'YY MMLICY TR TYPE OF INSURANCE INS unin POLICY NUMBER DI LIMITS City Boulevard Su I 800 INSURE R C RE Orange CA 92868 INSURERD: Nautll GLP2006942 -12 INSURER E: rnv00Ar_Ce f CGTICI!`ATI= Kit IMRr-R- na-rni7MA RFVICInN1 NIIMRFR• 241 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, — - -� IN SR R PMIDDI EFF PO FX " "..,..,..,._ X Dn yyY M lOD�PY'Y'YY MMLICY TR TYPE OF INSURANCE INS unin POLICY NUMBER DI LIMITS A ✓ COMMERCIAL LIABILITY GLP2006942 -12 10/31/2014 10/31/2015 EACH OCCURRENCE $ 5,000,000 tSAr�iAO�rtfr CLAIMS -MADEGENERAL OCCUR w�R sn M JFAgC ltkw a p. $ MED EXP (Any one person) ` _................... $ 5,000 ...... PERSONAL & ADV INJURY $ 5,000,000 -� -�_ GENE L AGGREGATE LIMIT APPLIES PER: _ ............... ....� ........ --- _ ...... GENERAL AGGREGATE $ 5,000,000 POLICY ✓ PRO- LOC PRODUCTS - COMP /OP AGG —__ $ 5,000,000 OTHER; B AUTOMOBILE LIABILITY ... CBP8977390 10/31/2014 10/31/2015 COMBINED SINGLE LIMIT _,(_Ep gpd�ID.t) . ................ $ 1,000,000 .eemmm. ANY AUTO rson).. BODILY INJURY (Per person) --- .... $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS ...,.. NON -OWNED PROPERTY DAMAGE $ HIREDAUTOS AUTOS UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS -MADE AGGREGATE $ DED RETENTION $ $ A WORKERS COMPENSATION WCA2008815 -12 5/24/2015 5/24/2016 / gTATl1TE ERH D Y EACH ACCIDENT ANY PROPRIETOR /PARBINER/EXECUTIVE OFFICER /MEMBER EXCLUDED? (Mandatory In NH) N I A „E L E L DISEASE EA EMPLOYEE '.. $1,000,000 describe under DESCRIPTION OF OPERATIONS below E,L DISEASE -POLICY LIMIT $ 1,000,000 D Pollution Liability CCP2006941 -12 10131/2014 10/31/2015 Each Poll Occurrence $5,000,000 Professional Liability Each Prof Liab Claim $5,000,000 General Aggregate: $5,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: Sewer System Management Plan As respects General Liability coverage, City of El Segundo, its officials and employyee( are added as Additional Insureds and this insurance is pninary per ENV2154AO906 attached, As respects AutomobiNe Coverage„ Business Auto Coverage Form CA 00 01 10 01 applies. As respects Wormers' Compensation coverage, a Waiver of Subrogation Is hereby included per WC040306 attached. As respects General Liability coverage, 30 -day written notice of cancellation (10 days for non - payment of premium) applies per IL00171198 attached. CERTIFICATE HOLDER CANCELLATION Sewer System Management Plan SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Ci%�(/ of El Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PuIIc Works ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street El Segundo CA 90245 AUTHORIZED REPRESENTATIVE - r7M222z9 Griff Griffith "" ' ' ` ©1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD 24791764 1 14 -15 G /A /UMB /POLL /E &O; 15 -16 WC I Marissa Romo 1 5/22/2015 9:28:24 AM (PDT) I Page 1 of 4 GLP2006942 -12 EEC Environmental ENDORSEMENT This endorsement forms a part of the policy to which it is attached. Please read it carefully. ADDITIONAL INSURED - BLANKET - OWNERS, LESSEES OR CONTRACTORS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Who is An Insured (Section ll) is amended to include as an insured any person(s) or organizations, for whom you are performing operations under a written contract or agreement, which is in effect prior to the performance of your work which is the subject of such written contract or agreement, that such person(s) or organization(s) be added as an additional insured on your policy, but Only with respect to liability for bodily injury, property damage or personal and advertising injury caused, in whole or in part, by: 1. Your acts or omissions, or the acts or omissions of those acting on your behalf, in the performance of your ongoing operations for the additional insured; or 2. Your work performed for such person(s) or organizations (s) and included in the products - completed operations hazard, only when required by the written contract or written agreement. With respect to damages caused by your work, as described above, the coverage provided hereunder shall be primary and not contributing with any other insurance available to those designated above, but only when required by written contract or agreement. © 2006 by Berkley Specialty Underwriting Managers LLC, an affiliate of Nautilus Insurance Company and Great Divide Insurance Company. All rights reserved. ©1985 -2006 by Insurance Services Office, Inc., material used by permission. ENV 2154 A 09 06 Page 1 of 1 24791764 1 14 -15 G /A /UMB /POLL /E &O; 15 -16 WC I Marissa Romo 1 5/22/2015 9:28:24 AM (PDT) I Page 2 of 4 EEC Environmental GLP2006942 -12 All Coverage Parts Included in this policy are subject to the following conditions. A. Cancellation 1. The first Named Insured shown In the Deolara- tions may cancel this policy by mailing or deliv- ering to us advance written notice of cancella- tion. 2. We may cancel this policy by mailing or deliver- Ing to the first Named Insured written notice of cancellation at least: a. 10 days before the effective date of cancel- lation if we cancel for nonpayment of pre- mium; or b. 30 days before the effective date of cancel- lation it we cancel for any other reason. 3. We will mail or deliver our notice to the first Named Insured's last.mailing address known to us. 4. Notice of cancellation will state the effective date of cancellation. The policy period will end on that date. S. If this policy is cancelled, we will send the first Named Insured any premium refund due. If we cancel, the refund will be pro rata. If the first Named Insured cancels, the refund may be less than pro rata. The cancellation will be ef- fective even it we have not made or offered a refund. 6. If notice Is mailed, proof of mailing will be suffi- clent proof of notice. B. Changes This policy contains all the agreements between You and us concerning the Insurance afforded. The first Named Insured shown In the Declarations Is authorized to make changes in the terms of this policy with our consent. This pollcy`s terms can be amended or waived only by endorsement Issued by us and made a part of this policy. C. Examination Of Your Books And Records We may examine and audit your books and re- cords as they relate to this policy at any time dur- Ing the policy period and up to three years after- ward. D. inspections And Surveys 1. We have the right to; a. Make inspections and surveys at any time; IL 00 17 1198 IL 00 171196 b. Give you reports on the conditions we find; and c. Recommend changes. 2. We are not obligated to make any Inspections, surveys, reports or recommendations and any such actions we do undertake relate only to in- surablllty and the premiums to be charged. We do not make safety Inspeotions. We do not un- dertake to perform the duty of any person or organization to provide for the health or safety of workers or the public. And we do not warrant that conditions; a. Are safe or healthful; or b. Comply with laws, regulations, codes or standards. 3. Paragraphs 1. and 2, of this condition apply not only to us, but also to any rating„ advisory, rate service or similar organization which makes In- suranoe Inspections, surveys, reports or rec- ommendations. 4. Paragraph 2. of this condition does not apply to any inspections, surveys, reports or recom mendations we may make relative to certifica- tion, under state or municipal statutes, ordl` nances or regulations, of boilers, pressure ves- sels or elevators. E. Premiums The first Named Insured shown in the Declara- tions, 1. Is responsible for the payment of all premiums; and 2. Will be the payee for any return premiums we pay- F. Transfer Of Your Rights And Duties Under This Policy Your rights and duties under this policy may not be transferred without our written consent except In the case of death of an individual named insured. If you d'ie, your rights and duties wilt be transferred to your legal representative but onty while acting within the scope of duties as your legal represents- live, until your legal representative Is appointed, anyone having proper temporary custody of your property will have your rights and duties but only with respect to that property. Copyright, insurance Services Office, Inc., 1998 24791764 1 14 -15 G /A/UMB /POLL /$ &O; 15 -16 PAC". I Marissa Rom I 5/22/2075 9:28:24 AM (PDT) I Page 3 of 4 Page 1 of 1 0 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 04 84 ATEA I W A Oki W &oM :4 1 Z 4 M. MR k a I Is] ki - 9 � DO _: U A. a ZOI. i VA. to I � 911 -4. a 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 0.00% of the California workers' compensation premium otherwise due on such remuneration. Schedule Person or Organization As required by written contract This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy) Endorsement Effective Policy No, WCA2008815 -12 Endorsement No. 5/24/2015 Insured Premium EEC Environmental Insurance Company: Countersigned by Great Divide Insurance Company WC 04 03 06 04 84 1998 by the Workers' Compensation Insurance Rating Bureau of California. Page 7 of 1 All rights reserved. From the WCIRB's California Workers' Compensation Insurance Forms Manual 2001. 24791764 1 14 -15 G /A /UMB /POLL /E &O; 15 -16 WC I Marissa Romo 1 5/22/2015 9:28:24 AM (PDT) I Page 4 of 4