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PROOF OF INSURANCE (2016) CLOSED
LL- DA / 1� - I 08 /11 /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 CONEA ROBERT B RICE, JR, 0181288 (P/ F.t,I (818) 561 -2600 ! NIa), (818) 436 -5988 SARGEANT INSURANCE AGENCY, LLC. E-MAIL sa robert@sargeantinsurance.com — INSURER(S) AFFORDING COVERAGE .................................. ................. ...... - .WW. ..NAIC............W.. 7740 PAINTER AVENUE, SUITE 210 WHITTIER CA 90602 -2477 INSURER A: AMERICAN STATES INSURANCE COMPANY 19704 ... ........ .. ..... ....__ ........ -------------------------- _...___________- 1.111..,....... ..... .. INSURED INSURER B .AMTRUST / TECHNOLOGY INSURANCE CO. 42376 _ --- _ --------------- _ ------------ ..._m _.m.._, ........ BARTEL- ASSOCIATES, LLC INSURER C: INDIAN HARBOR INSURANCE COMPANY 36940 .. � ............................ ......................... . . . . .. - -- — _ 411 BOREL AVENUE INSURER D SUITE 101 INSURER E . SAN MATEO CA 94402 -3525 INSURER F COVER GE$ CERTIFICATE NUMBER: 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. -I'D- -- 1111..- ..----- .. .. ... .. .. . .._.. ---.-.....-..._.--,..............,...,............................................................................................................. ............................... 'INSR A LS�t��. POLICY EFF POLICY EXP LTR TYPE OF INSURANCE lNSR WVn POLICY NUMBER (MMILNI,=) (MM/DD /YYYYI LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 X COMMERCIAL CLAIMS -MADE � OCCUR MED EXP (Any one Ders n) $ 1,000,000 00 A X 25 -CC- 124429 -0 09/01/2015 09/01/2016 pERSONAL &ADVINJURY $ 2,000,000 GENERAL AGGREGATE ......... $ 4,000,000.... ..._ „_ _..___ ___- _._._....4,000,000.... GEN'L AS GREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ ._ --- - - - - -� ...m._.m.�... .............. .... .................... .. .... . PRtfi.. POLICY LOC ' $ AUTOMOBILE LIABILITY COM8INED SINGLE LI I $ 1,000,000 ANY AUTO BODILY INJURY (Per person) $ -- — 1111 .. ... ................. .. .. .._ .....--.-..-...._.-_.... ------------------- ._..... ..... .. A// ALL OS OWNED SCHEDULED X 25- CC- 124429 -0 09/01/2015 09/01/2016 BODILY INJURY (Per accident) $ ALT /gym HIRED AUTOS X AUTOS NON -OWNED PROPERTY DAMAGE $ .. AUTOS (Pr�rc acr„4d¢rnk) -- - ................ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE $ nEn RETENTION $ $ WORKERS COMPENSATION X1 WC STATU- 0TH- AND EMPLOYERS' LIABILITY TORY I IIM TR FR .- Y 1 N.t ANY PROPRIETOR/PARTNER/EXECUTIVE E L EACH ACCIDENT $ 1,090,090 B OFFICER /MEMBER EXCLUDED? El N/A X TWC3494759 09/01/2015 09/01/2016 (Mandatory In NH) E,L., DISEASE EA EMPLOYEE $ 1,000,000 IY yyes, describe under 0 RIPTION 01,, OPERATIONS Wow E L. DISEASE- POLICY LIMIT $ 1,000,000 C MISC. PROFESSIONAL LIABILITY MPP001715211 09/01/2015 09/01/2016 $2,000,000 PER CLAIM $4,000,000 ANNUAL AGGREGATE DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CERTIFICATE HOLDER IS HEREBY NAMED AS AN ADDITIONAL INSURED ON POLICY #25 -CC- 124429 -0 AS RESPECTS TO OPERATIONS OF THE NAMED INSURED ONLY, SEE ATTACHED FORMS CG2010. COVERAGE UNDER POLICY #25 -CC- 124429 -0 IS PRIMARY AND NON - CONTRIBUTORY ABOVE ANY OTHER INSURANCE THE CERTIFICATE HOLDER(S) MAY CARRY. 30 DAY NOTICE OF CANCELLATION. A%4 or= �.�, _ I� e : %A f � I �- roc I , ^m ». CERTIFICATE HOLDER CANC LI_AT1 P' SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITY OF EL SEGUNDO '' THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ATTN: DEBORAH CULLEN, DIRECTOR OF FINANCE ACCORDANCE WITH THE POLICY PROVISIONS. 350 MAIN STREET - AUTHORIZED REPRESENTATIVE EL SEGUNDO CA 90245 ROBERT B. RICE, JR.�{'ii- Ria-) Jr. ACORD 25 (2010/05) ©1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD BARTEL - ASSOCIATES, LLC CG 86 72 10 02 POLICY NUMBER: 25 -CC- 124429 -0 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED — OWNERS, LESSEES OR CONTRACTORS —COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: City of El Segundo Location and Description of Completed Operations: All operations of the Named Insured Additional Premium: Included (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) SECTION II — WHO IS AN INSURED is amended to include as an insured the person or organization shown in the Schedule, but only to the extent you are held liable due to "your work" at the location designated and described in the schedule of this endorsement for that insured and included in the "product- completed operations hazard ".