No preview available
PROOF OF INSURANCE (2016) CLOSED„. DATE (M IY MIDDYYY) �r C40�,0 1?” CERTIFICATE OF LIABILITY INSURANCE 1/26/2016 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 endorsements). PRODUCER NAME: T Gizelda Parr Poms & Associates Insurance Brokers PHONE ho Eat)t (800) 578 -8802 -INC, No): (B1B)449 -9321 CA License #0814733 AQORE gparropomsassoc.com ADDR'�E(i _. ,....... a ., 5700 Canoga Ave. #400 INSURER(S) AFFORDINGCOVERAGE NAICp INSURED and Hills CA 91367 RERA:Colon Insurance Co .......... LNSLI - INSURERS Nat ,4Onal. Union Piro _Ins Co of PA Specialty Doors & Automation, Inc. urity National Insurance I±WSUR�,R C Bat" ,.. 2372 E. Pacifica Place INSURER 91:: INSURER E ;. Rancho Dominguez CA 90220 INSURFRF; COVERAGES CERTIFICATE NUMBER:15 -16 Master REVIStON 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. ...�. ._.._.._._. _ ....._ pAb'DUSUBRI'-- ., ..a. .. _ a POLICY E.'FF Pi'" .ICY E5(P ._ ,.... ,,,. INS R TYPr OF INSURANCE POLICY NUM It O OIYYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 000,000 ...� DAMAGE TO RENTED .... 1'' ... ..__...._ 100 A CLAIMS -MADE X ! OCCUR - PREMISES JEe occurrence $ 000 X Y 103GL000406805 5/11/2015 5/11/2016 MED EXP(Any one person) $ 5,000 I PERSONAIL4,ADVINJU k$ 11000,000 1 INJURY X'L AGGREGATE LIMIT APPLIES PER' �;'R09„Ci'a $2,000,000 E r E T L Employee Benefits AT .AG.G ,.. $ ._ 1, U -,. G R POLICY I� LOC 00, 000 OTHER: 000,000 ..... t M LE VM4T $ AUTOMOBILE LIABILITY (Ea _ dorl). . „, ANY A BOD3LY INJURY (Pea person) ' $ Ty" , SCHEDULED a �° P,.,�rrCDA14bf'C,' )� -$ ... AUTOS T B ALL OWNED � AUTOS � NON-OWNED � � I � Bs�,O1LY INJURY PV.r wldeLnn $ i HIRED AUTOS AUTOS s - -" „�- -- EXCESS LIALI q EACH OCCURRENCE $ 4,000,000 X � UMBRELLA LIAR X v OCCUR S -MADE' r AGGREGATE Iy$ 4,000,000'.. L7E0 RI«TENrION$. ' BE019714007 5/11/2015 5/11/2016 $ WORKERS COMPENSATION X STAT41;;fE H- p AND EMPLOYERS' LIABILnY V, I N ANY PROPRIETORIPARTNERIEXECUTIVE „', f ' E L. EACH ACCIDENT $ 1, 000, 000 OrFBCERfflV 0EREXCLUDED? NIA- ........ _ ._. C (ManlataryInNH) y SWC1075112 5/11/2015 5/11/2016 EL.DISEASE- EAEMPLOYEE $ 1,000,000 fld qq4s,. dounbo 4uncled „ - -- O &:5 IPTI N F FLRA10NS"tlrofoaw E I. DISEASE • POLICY LIMIT $� l 000 000 k u DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: HR Entrance Doors - Closer Replacement The City fo E1 Segundo, its officals, officers, agents and employees are named as an additional insured as respects to general liability. Primary non - contributory wording and waivers of subrogation apply per the attached endorsements. 30 Day notice of cancellation, except 10 day for non - payment of premium, will be mailed to the certificate holder. Umbrella policy is follow form to underlying general liability, and Employers Liability policies. CERTIFICATE HOLDER CANCELLAT'I'ON SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City Of El Segundo Q THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Attn: Floriza Rivera, PW Dept. ACCORDANCE WITH THE POLICY PROVISIONS. � °° 350 Main St El Segundo, CA 90245 „i AUTHORIZED REPRESENTATIVE Gizelda Parr /SGONZA ©1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD IN S025 (201401) 40 CERTIFICATE OF LIABILITY THIS CERTIFICATE 13 ISSUED AS A MATTER OF INFORMATION ONLY AND C( CERTIFICATE DOES NOT .AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND BELOW. THIS CERTIFICATE OF INSURANCE DO" NOT CONSTITUTE A Col REPRESENTATIVE OR PRODUCER, AND THE CERT11SCATE HOLDEP, policy(w, the terms and tonditimm of the pulicy, certain policies may require an orkdwsonli tort Cate holder in Lieu of such endorsunwrit(s). 01M (*W0WrM) INSURANCE 01128r2016 FERS 40 RIGHTS UPON THE CERTIFICATE HOLMR, THIS A ALTER THE COVERAGE AFFORDED BY THE POLICIES RACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED most be endorsed. It SUBROGATION 15 WAIVLO, SUbfOct W L A stortarrient on this cartific4to does not cordw d" to the PRODWER fo;4x�MT� T Y VE, T rF-'1))`iU" WILSON RICH GOEDL, AGENT LIC# 0419456 73 1 4 529-31936 N01�714 529-4355 STATE FARM INSURANCE pvc, No, 90", Yvc, 904 E IMPERIAL.) WY, BREA CA 92821 PH 71 4 629-3936 FAX 714 52041355 pwe, Fam MuW Automoble fn5u,tarce company 29479 . . ....... . waupso SPEVALTY DOOR INC 2372 E PACIFICA PL COMPTON CA 90220-6214 INSURM r; 6Vi—RAGi—s— ­ " CERTIFICATE NUMBER,, RE-VISION NUMBEW I HIS * TO CEATIlf Y TED HE POLIC4ES Of JNSURANCE,� 01 D Rrit'Ovy HAVE BEEN I �, U., 70 'THE INSURED RA-7mr. D ABOVE. FOR THE POLICY PEA100 IND"'IE-0 NOTVATHSTANDING ANY RE0U)IAEMtNI, TtRM 1, CONUITON Of ANY CoNtRACT OR OTHER, 00QUMENT V,47H RE�ISPECTTQ vvHVCH THIS CERTIFICATE MAY BE ISSUED 00 MAY PCRJ`AJN THE' INSURANCE APFORI)ED BY TH! POLICIES DESCRIBED HEREIN IS SUBJECT TO AU THE TER IS. EXCLUSIONS AND CONDITIONS OF SUCf I POLIOES LIMIT 5 SHOWN MAY RAVE BEEN RLD ICED BY PAID CLAIM COMMERCUt GEN"At ILLAMM Iq A ANY AUTO ALL Oh"k."r, AUTaS TOS fk,,qFDAU-fS X *Oki I"Ar) VM E 1� OvIS UUMLLA LA" C i oc(304 WSSSUAD c'('A0j3'NAVE AND EunOYERS'LIAMUTY yjW ANY PR(Wft PDRA�ARINMI.X LICAJ r VAE I I �q � A txM14M, L-1 ju"dthwy ih N'") K 4 tp &RA)MOS 515 11.413401 A 5 520 62454301-75 2$8 3`170-8011-76 ENC`JL MSCRWMON OF Op#$tA7$offS 4 LOCA"NS n VeftMeS IACONO 101 , A4d4$wW ftmrla %dwdu*, M.y be ArQ&;IWYI uwTs �J#V*SE TO KNIPP RFAOI�VLS If'4 qmwfw'44 Mr ".A Exp IA n' M* swr'vlllu lmtf��VJNAL 6 K)V 01,ALRV 6 LNLPAL AGGREUAM GqXjj2D1fi f"1XL'f INIURY <PW r (IM112016 F-4o"O"Iry S FAC 0 ''MAJVM6 PICE C rACH ACCIDW F, i, DISEASE EA CAAPLG'yEE 6' DSLASE , VC10Gv LIM r'k 1r CITY OF SEGUNDO SHOD ANY Of THE ABOYT. WSCRISED POLICIES Of CANCELLED BEFORE 350 MAIN ST THE EXPIRATION DATE TKREOF, NOTICE WILL BE MWERED 04 EL SEGUNDO, CA 90245 ACCOR00CE WITH THE POLICY PROVISIONS. *v-o"u, ) Repoe iwok IrvE (0 t"8-2014 AC ORD CORPORATION, All rights reserved. ACORD 251;2014!011 The ACORD name and toga are register qd marks of ACORD 10014M 132849,9 02.04-2014 103 GL 0004068 -05 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - ONERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Additional Insured Person (s) or 6rganizat on(s) (Additional Insured): Location(s) of Covered Operations: All persons or organizations as required by written , As designated in written contract with the Named contract with the Named Insured Insured A. SECTION 11— WHO IS AN INSURED is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule for whom you are performing operations when you and such person or organization have agreed In writing in a contract or agreement that such person or organization be added as an additional insured on your policy. Such person or organization is an additional Insured 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 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. A person's or organization's status as an additional Insured under this endorsement ends when your operations for that additional insured are completed. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to: Additional Insured Contractual Liability "Bodily injury" or "property damage" for which the additional Insured(s) are obligated to pay damages by reason of the assumption of liability in a contract or agreement. Finished Operations at Work "Bodily injury" or "property damage" occurring after: 1. All work, including materials* parts or equipment furnished In connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or U156P -0310 Includes copyrighted material of ISO Properties, Inc., Page 1 of 2 with Its permission. 103 GL 0004066 -05 2. That portion of "your work" out of which the injury or damage arises has been put to its Intended use by any person or organization. Negligence of Additional Insured "Bodily injury" or "property damage" arising directly or indirectly out of the negligence of the additional insured(s). C. SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS, 4. Other Insurance is amended and the following added: The Insurance afforded by this Coverage Part for the additional insured shown In the Schedule is primary insurance and we will not seek contribution from any other Insurance available to that additional Insured. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. U156P -0310 includes copyrighted material of ISO Properties, Inc., Page 2 of 2 with Its permission. 103 GL 0004068.05 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION - COMPLETED OPERATIONS & ONGOING OPERATIONS AS SCHEDULED This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE - Or Or anrzation s : Location A Name Of Additional Insured persons p n Of Operations persons organizations as required by written As designated in wri tten contract scri too act with the Named contract with the Named Insured Insured for Commercial Projects and Apartment Projects Only A. Section II — )lllho Is An Insured is amended to include the person(s) or organization(s) shown in the Schedule (culled additional insured), but only with respect to: (1) Liability for "bodily injury" or "property damage" caused, in whole or in part, resulting from "your work" at the location designated and described in the schedule of this endorsement I performed for that additional insured and included in the "products - completed operations i hazard "' when you and such person(s) or organization(s) have agreed in writing in a con - tract or agreement that such person(s) or organization(s) be named as an additional in- sured on your policy. (2) Liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by resulting from: (a) Your acts or omissions; or (b)The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the loca- tion(s) designated above. B. Section IV — Commercial General Liability Conditions, 4. Other Insurance is amended and the following added: If you are required by written contract to provide primary insurance, the insurance afforded by this Coverage Part for the additional insured shown in the Schedule is primary insurance and we will not seek contribution from any other insurance available to that additional insured. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. U462 -0310 Includes copyrighted material of ISO Properties, Inc., 2004 Page 1 of 1 with its permission. 103 GL 0004066 -05 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following Is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV — Conditions: We waive any rights of recovery we may have against any person or organization because of payments we make for Injury or damage resulting from your ongoing operations or "your work" done under a contract with that person or organization and Included in the "products - completed operations hazard" if: a. you agreed to such waiver; b. the waiver Is included as part of a written contractor lease; and c. such written contract or lease was executed prior to any loss to which this insurance applies. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. Properties, Inc., Page 1 of 1 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSI]IRANCE POLICY WC 04 03 06 (Ed. 4-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA 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 2% of the Cal forwnia workers' compensation premium otherwise due on such remuneration. Schedule Any person or organization as required by written contract. This endorsement changes the policy to which it is attached and is a ectiv Endorsement Effective 5/1112015 Policy No. SWC10' 5,112 Insured Specialty Doors & Automation, Inc. (A insurance Company Security National Insurance Company on the date issued unless otherwise stated. Endorsement No. WC040306