Loading...
PROOF OF INSURANCE (2015) CLOSEDAVEW -01 OP ID: CT DATE (MWDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 0712712015 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 The J. Morey Co., Inc. License #: 0655907 184 Jackson Street San Jose, CA 95112 Mary Jo Gleaves INSURED William Avery & Associates,lnc 3 112 N. Santa Cruz Ave, #A Los Gatos, CA 95030 COVERAGES CERTIFICATE NUMBER: 408 - 280 -0551 AFFORDING COVERAGE INSURERA:The Hartford _ INSURER B: Landmark. American Ins Co INSURER C : INSURER D INSURER E: INSURER F : REVISION NUMBER: 408 - 280 -1368 NAIC * 138 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. RW......... _._ ................. ILTR TYPE OF INSURANCE cDn WM POLICYNUMBER Mi17D MFrAT LIMITS A COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,00 CLAIMS -MADE OCCUR X 57SBABH7425 11l0212D14 11102!2015 pREMISE_S (Ea occurrence) $ 1,000,_00 .. Business Owners �www_ _M .._ MED EXP (Anv one person) $... 10,00 _--- _- mm................... _ PERSONAL & ADV INJURY $ ,000,00 GERL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,00 X.. POLICY JECT LOC ❑ PRO- PRODUCTS -m COMP /OPAGG $ 4,000,00 AUTOMOBILE ._ LIABILITY COMBINED: h °IVv7�T (Etr accidenh $ 1,000 , 00 A ANY AUTO 57SBABH1425 11!0212014 11/0212015 BODILY INJURY (Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) X X NON -OWNED HIRED AUTOS AUTOS Per accidenR) $..... _... .._..... UMBRELLA LIAR OCCUR EACH OCCURRENCE .. _ $ EXCESS LIAB CLAIMS -MADE AGGREGATE $ .. ...... .- DED RETENTION $ $ WORKERS COMPENSATdON PER 0TH - AND EMPLOYERS' LIABILITY YIN 57WECPHO745 06!30!2015 STAT! ITE FR A AWPnOPRIErORPARTNERtF- XECtJIIVE OFFICE �1dEtl4MF,kER B:OL4JDLC7� II FFICEt^ary' N /A 06!3012016 E.L EACHACCIDENT $ 1,000,00 � In N'H) "° ° ° ° °° ' E.L. DISEASE - EA EMPLOYEE' $ 1,000,00 If fires, dese dbe under DESCRIPTION OF OPERAT*NS below E.L. DISEASE - POLICY LIMIT $ 1,000,00 B 'Errors & Omissions LHR826199 04!04!2015 04!0412016 Claims 1,000,00 Made 10,000 ded'' DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached If more space Is required) City of El Segundo to be named as additional insured per form #SS00080405, Prima /noncontributing ltd Waiver of Subrogation form#SS00080405, form#SS00051008 cance7ation clause attached. City of El Segundo 150 Illinois St. El Segundo, CA 90245 ACORD 25 (2014101) ELSCI01 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 Ae,4-1% O 1988 -2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ✓"", M P0 nvl;��111, COMMON POLICY CONDITION i S rw All coverages of this policy are subject to the following conditions. a� A Cancellation 1. The first Named Insured shown in the Declarations may cancel this policy by mailing or delivering to us advance written notice of cancellation. 2. We may cancel this policy by mailing or delivering to the first Named Insured written notice of cancellation at least: a. 5 days before the effective date of cancellation if any one of the following conditions exists at any building that is Covered Property in this policy: (1) The building has been vacant or unoccupied 60 or more consecutive days. This does not apply to: (a) Seasonal unoccupancy, or (b) Buildings in the course of construction, renovation or addition. Buildings with 65% or more of the rental units or floor area vacant or unoccupied are considered unoccupied under this provision. (2) After damage by a Covered Cause of Loss, permanent repairs to the building: (a) Have not started; and (b) Have not been contracted for, within 30 days of initial payment of loss. (3) The building has: (a) An outstanding order to vacate; (b) An outstanding demolition order; or (c) Been declared unsafe by governmental authority. (4) Fixed and salvageable items have been or are being removed from the building and are not being replaced. This does not apply to such removal that is necessary or incidental to any renovation or remodeling. Form SS 00 05 10 08 (5) Failure to: (a) Furnish necessary heat, water, sewer service or electricity for 30 consecutive days or more, except during a period of seasonal unoccupancy, or (b) Pay property taxes that are owing and have been outstanding for more than one year following the date due, except that this provision will not apply where you are in a bona fide dispute with the taxing authority regarding payment of such taxes. b. 10 days before the effective date of cancellation if we cancel for nonpayment of premium. c. 30 days before the effective date of cancellation if 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. 5. If this policy is canceled, we will send the first Named Insured any premium refund due. Such refund will be pro rata. If the first Named Insured cancels, the refund may be less than pro rata. The cancellation will be effective even if we have not made or offered a refund. 6. If notice is mailed, proof of mailing will be sufficient 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 policy's terms can be amended or waived only by endorsement issued by us and made a part of this policy. © 2008, The Hartford (Includes copyrighted material of Insurance Services Office, Inc. with its permission) Page 1 of 3 COMMON POLICY CONDITIONS C. Concealment, Misrepresentation Or Fraud due from that other insurance, whether you can This policy is void in any case of fraud by you as it collect on it or not. But we will not pay more than relates to this policy at any time. It is also void if you the applicable Limit of Insurance. or any other insured, at anytime, intentionally conceal I. Premiums or misrepresent a material fad concerning: 1. The first Named Insured shown in the 1. This policy; Declarations: 2. The Covered Property; a. Is responsible for the payment of all 3. Your interest in the Covered Property; or premiums; and 4. A claim under this policy. b. Will be the payee for any return premiums D. Examination Of Your Books And Records we pay. We may examine and audit your books and 2. The premium shown in the Declarations was computed based on rates in effect at the time records as they relate to the policy at any time the policy was issued. If applicable, on each during the policy period and up to three years renewal, continuation or anniversary of the afterward. effective date of this policy, we will compute E. Inspections And Surveys the premium in accordance with our rates and 1. We have the right but are not obligated to: rules then in effect. a. Make inspections and surveys at anytime; 3• With our consent, you may continue this policy in force by paying a continuation premium for b. Give you reports on the conditions we find; each successive one -year period. The and premium must be: c. Recommend changes. a. Paid to us prior to the anniversary date; and 2. Any inspections, surveys, reports or b. Determined in accordance with Paragraph recommendations will relate only to insurability 2. above. and the premiums to be charged. We do not make safety inspections. We do not Our forms then in effect will apply. If you do undertake to perform the duty of any person or not pay the continuation premium, this policy organization to provide for the health or safety will expire on the first anniversary date that we of any person. We do not represent or warrant have not received the premium. that conditions: 4. Changes in exposures or changes in your a. Are safe or healthful; or business operation, acquisition or use of locations that are not shown in the Declarations b. Comply with laws, regulations, codes or may occur during the policy period. If so, we may standards. require an additional premium. That premium will 3. This condition applies not only to us, but also be determined in accordance with our rates and to any rating, advisory, rate service or similar rules then in effect. organization which makes insurance J. Transfer Of Rights Of Recovery Against Others inspections, surveys, reports or To Us recommendations on our behalf. Applicable to Property Coverage: F. Insurance Under Two Or More Coverages If any person or organization to or for whom we If two or more of this policy's coverages apply to make payment under this policy has rights to the same loss or damage, we will not pay more recover damages from another, those rights are than the actual amount of the loss or damage. transferred to us to the extent of our payment. G. Liberalization That person or organization must do everything If we adopt any revision that would broaden the necessary to secure our rights and must do coverage under this policy without additional nothing after loss to impair them. But you may premium within 45 days prior to, or at any time waive your rights against another party in writing: during, the policy period, the broadened coverage 1. Prior to a loss to your Covered Property, or will immediately apply to this policy. 2. After a loss to your Covered Property only if, at H. Other Insurance - Property Coverage time of loss, that party is one of the following: If there is other insurance covering the same loss or damage, we will pay only for the amount of covered loss or damage in excess of the amount Page 2 of 3 Form SS 00 0510 08 a. Someone insured by this insurance; b. A business firm: (1) Owned or controlled by you; or (2) That owns or controls you; or c. Your tenant. You may also accept the usual bills of lading or shipping receipts limiting the liability of carriers. This will not restrict your insurance. K. 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 die, your rights and duties will be transferred to your legal representative but only while acting within the scope of duties as your legal representative. Until your legal representative is COMMON POLICY CONDITIONS appointed, anyone having proper temporary custody of your property will have your rights and duties but only with respect to that property. L. Premium Audit a. We will compute all premiums for this policy in accordance with our rules and rates. b. The premium amount shown in the Declarations is a deposit premium only. At the close of each audit period we will compute the earned premium for that period. Any additional premium found to be due as a result of the audit are due and payable on notice to the first Named Insured. If the deposit premium paid for the policy term is greater than the earned premium, we will return the excess to the first Named Insured. c. The first Named Insured must maintain all records related to the coverage provided by this policy and necessary to finalize the premium audit, and send us copies of the same upon our request. Our President and Secretary have signed this policy. Where required by law, the Declarations page has also been countersigned by our duly authorized representative. Terence Shields, Secretary A,4�1 x• A0 IV21. Mdrd A. Nap h, Fresident Form SS 00 05 10 08 Page 3 of 3 (6) When You Are Added As An Additional Insured To Other Insurance That is other insurance available to you covering liability for damages arising ouV of the premises or operations or products and completed operations, for which you have been added as an additional insured by that insurance; or (7) When You Add Others As An Additional Insured To This Insurance That is other insurance available to an additional insured. However, the following provisions apply to other insurance available to any person or organization who is an additional insured under this Coverage Part: (a) Primary Insurance/ When Required By Contract✓ This insurance is primary if you have agreed in a written contract, written agreement or permit that this insurance be primary. If other insurance is also primary, we will share with all that other insurance by the method described in c. below. (b) Primary And Non - Contributory To Other Insurance When Required By Contract If you have agreed in a written contract, written agreement or permit that this insurance is primary and non - contributory with the additional insured's own insurance, this insurance is primary and we will not seek contribution from that other insurance. Paragraphs (a) and (b) do not apply to other insurance to which the additional insured has been added as an additional insured. When this insurance is excess, we will have no duty under this Coverage Part to defend the insured against any "suit" if any other insurer has a duty to defend the insured against that "suit ". If no other insurer defends, we will undertake to do so, but we will be entitled to the insured's rights against all those other insurers. Form SS 00 08 04 05 BUSINESS LIABILITY COVERAGE FORM When this insurance is excess over other insurance, we will pay only our share of the amount of the loss, if any, that exceeds the sum of: (1) The total amount that all such other insurance would pay for the loss in the absence of this insurance; and (2) The total of all deductible and self - insured amounts under all that other insurance. We will share the remaining loss, if any, with any other insurance that is not described in this Excess Insurance provision and was not bought specifically to apply in excess of the Limits of Insurance shown in the Declarations of this Coverage Part. c. Method Of Sharing If all the other insurance permits contribution by equal shares, we will follow this method also. Under this approach, each insurer contributes equal amounts until it has paid its applicable limit of insurance or none of the loss remains, whichever comes first. If any of the other insurance does not permit contribution by equal shares, we will contribute by limits. Under this method, each insurer's share is based on the ratio of its applicable limit of insurance to the total applicable limits of insurance of all insurers. 8. Transfer Of Rights Of Recovery Against Others To Us a. Transfer Of Rights Of Recovery If the insured has rights to recover all or part of any payment, including Supplementary Payments, we have made under this Coverage Part, those rights are transferred to us. The insured must do nothing after loss to impair them. At our request, the insured will bring "suit" or transfer those rights to us and help us enforce them. This condition does not apply to Medical Expenses Coverage. b. Waiver Of Rights Of Recovery (Waiver Of Subrogation) If the insured has waived any rights of recovery against any person or organization for all or part of any payment, including Supplementary Payments, we have made under this Coverage Part, we also waive that right, provided the insured waived their rights of recovery against such person or organization in a contract, agreement or permit that was executed prior to the injury or damage. Page 17 of 24 BUSINESS LIABILITY COVERAGE FORM 2. Applicable To Medical Expenses Coverage We will not pay expenses for "bodily injury ": a. Any Insured To any insured, except "volunteer workers ". b. Hired Person To a person hired to do work for or on behalf of any insured or a tenant of any insured. c. Injury On Normally Occupied Premises To a person injured on that part of premises you own or rent that the person normally occupies. d. Workers' Compensation And Similar Laws To a person, whether or not an "employee" of any insured, if benefits for the "bodily injury" are payable or must be provided under a workers' compensation or disability benefits law or a similar law. e. Athletics Activities To a person injured while practicing, instructing or participating in any physical exercises or games, sports or athletic contests. f. Products - Completed Operations Hazard Included with the "products- completed operations hazard ". g. Business Liability Exclusions Excluded under Business Liability Coverage. C. WHO IS AN INSURED 1. If you are designated in the Declarations as: a. An individual, you and your spouse are insureds, but only with respect to the of which you are the sole owner. b. A partnership or joint venture, you are an insured. Your members, your partners, and their spouses are also insureds, but only with respect to the c. A limited liability company, you are an insured. Your members are also insureds, but only with respect to the r bus i ess. Your managers are insureds, but only with respect to their duties as your managers. d. An organization other than a partnership, joint venture or limited liability company, you are an insured. Your "executive officers" and directors are insureds, but only with respect to their duties as your officers or directors. Your stockholders are also insureds, but only with respect to their liability as stockholders. e. A trust, you are an insured. Your trustees are also insureds, but only with respect to their duties as trustees. 2. Each of the following is also an insured: a. Employees And Volunteer Workers Your "volunteer workers" only while performing duties related to the o uct of �, or your "employees ", other than either your "executive officers" (if you are an organization other than a partnership, joint venture or limited liability company) or your managers (if you are a limited liability company), but only for acts within the scope of their employment by you or while performing duties related to the onduct o our business However, none of these "employees" or "volunteer workers" are insureds for: (1) "Bodily injury" or "personal and advertising injury": (a) To you, to your partners or members (if you are a partnership or joint venture), to your members (if you are a limited liability company), or to a co- "employee" while in the course of his or her employment or performing duties related to the conduct of your business, or to your other "volunteer workers" while performing duties related to the onduct of our bus` (b) To the spouse, child, parent, brother or sister of that co- "employee" or that "volunteer worker" as a consequence of Paragraph (1)(a) above; (c) For which there is any obligation to share damages with or repay someone else who must pay damages because of the injury described in Paragraphs (1)(a) or (b) above; or (d) Arising out of his or her providing or failing to provide professional health care services. If you are not in the business of providing professional health care services, Paragraph (d) does not apply to any nurse, emergency medical technician or paramedic employed by you to provide such services. (2) "Property damage" to property: (a) Owned, occupied or used by, Form SS 00 08 04 05 BUSINESS LIABILITY COVERAGE FORM contract, written agreement or because of a (e) Any failure to make such permit issued by a state or political inspections, adjustments, tests or subdivision, that such person or organization servicing as the vendor has be added as an additional insured on your agreed to make or normally policy, provided the injury or damage occurs undertakes to make in the usual subsequent to the execution of the contract or course of business, in connection agreement, or the issuance of the permit. with the distribution or sale of the A person or organization is an additional products; insured under this provision only for that (fl Demonstration, installation, period of time required by the contract, servicing or repair operations, agreement or permit. except such on erformed However, no such person or organization is an at the vendors premises in additional insured under this provision if such connection with the sale of the person or organization is included as an product; additional insured by an endorsement issued (g) Products which, after distribution by us and made a part of this Coverage Part, or sale by you, have been labeled including all persons or organizations added or relabeled or used as a as additional insureds under the specific container, part or ingredient of any additional insured coverage grants in Section other thing or substance by or for F. — Optional Additional Insured Coverages. the vendor; or a. Vendors (h) "Bodily injury" or "property Any person(s) or organization(s) (referred to damage" arising out of the sole below as vendor), but only with respect to negligence of the vendor for its "bodily injury" or "property damage" arising own acts or omissions or those of out of " our ducts "" which are distributed its employees or anyone else or sold in time regular purse of the vendor's acting on its behalf. However, this business and only if this Coverage Part exclusion does not apply to: provides coverage for, "bodily injury" or (1) The exceptions contained in "property damage" included within the Subparagraphs (d) or (f); or "products-completed operations hazard ". (ii) Such inspections, adjustments, (1) The insurance afforded to the vendor tests or servicing as the vendor is subject to the following additional has agreed to make or normally exclusions: undertakes to make in the usual This insurance does nQt apply to: • in connection with the distribution (a) "Bodily injury" or "property or sale of the products. damage" for which the vendor is (2) This insurance does not apply to any obligated to pay damages by insured person or organization from reason of the assumption of whom you have acquired such products, liability in a contract or agreement. or any ingredient, part or container, This exclusion does not apply to entering into, accompanying or liability for damages that the containing such products. vendor would have in the absence of the contract or agreement; b. Lessors Of Equipment (b) Any express warranty (1) Any person or organization from unauthorized by you; whom you lease equipment; but only (c) Any physical or chemical change with respect to their liability for "bodily "property in the product made intentionally injury", damage" or "personal by the vendor; and advertising injury" caused, in whole or in part, by your (d) Repackaging, except when maintenance, operation or use of unpacked solely for the purpose of equipment leased to you by such inspection, demonstration, testing, person or organization. or the substitution of parts under instructions from the manufacturer, and then repackaged in the original container; Form SS 00 08 04 05 Sandoval, Lili From: Shilling, Mona Sent: Monday, August 10, 2015 3:21 PM To: Dijkstra, Martha; DeZiel, Julie Cc: King, David; Dijkstra, Martha; Nguyen, Trang; Sandoval, Lili,h Subject: FW: Avery Associates - PSA Julie, Could you please give Lili the agreement and we will complete the signature process and provide you a completion email and executed agreement. Thank you, Mona S From: Dijkstra, Martha Sent: Monday, August 10, 2015 3:03 PM To: Shilling, Mona Cc: DeZiel, Julie; King, David Subject: Avery Associates - PSA Mona, The City Manager has approved moving forward with the PSA for Avery Associates without a Waiver of Workers' Compensation. Please let Julie DeZiel or me know if you need anything further so we can expedite this Agreement. Thank you, Martha