Loading...
PROOF OF INSURANCE (2016) CLOSED,. CW? DATE DI (MM,DYYYY) CERTIFICATE OF LIABILITY INSURANCE 7/1712015 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 pollcy(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 ondorsoment(s). ONTACT PRODUCER LOA Insurance Services NAME! Bettv Tran Aliso Viejo, CA 92656 �nnijh F. ....._.. 949-'297-596­2- 49 297 5962 Ip,c Nol 949-297-5960 ,r u ..... _ ..,w,. ArYlirkE A¢ bettv.tranle ioaus T corn COVERAGES CERTIFICATE INSURERISI AFFORDING COVERAGE NAIC # nww.ioausa,com CA License #OE67768 _� ...w .......�.......... THIS IS TO CERTIFY THAT THE POLICIES _ INSURER A, f2 „� ,�.......... , ,00,00,,.., L Insurance Comoanv 0000.. ,0000.,,,,_, ... ,,,,,. 13056 INSURED NAMED ABOVE FOR THE POLICY PERIOD INSURERS Navlaators Insurance Comoanv 42307 Consulting, Inc. PO OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, Box 9 55 THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES Chino Hills CA 91709 LIMITS SHOWN MAY HAVE BEEN INSURERD: PAID CLAIMS. INSR" 0000.- __ - -------- AIW S 'UDR INSURER E POLICY E FF POLICY ESOP LTR TYPE OF INSURANCE iMCn INSURER F : POLICY NUMBER IMMIDDIYYYYI IMMIDDIYYYYI COVERAGES CERTIFICATE NUMBER: 25629232 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. INSR" 0000.- __ - -------- AIW S 'UDR 0000... 0000.. 0000. '. POLICY E FF POLICY ESOP LTR TYPE OF INSURANCE iMCn wvn POLICY NUMBER IMMIDDIYYYYI IMMIDDIYYYYI LIMITS A t COMMERCIAL GENERAL LIABILITY PSB0002339 7/2212015 7/22/2016 EACH OCCURRENCE $ 2,000,000' CLAIMS -MADE OCCUR Scheduled Al Endt r'V. Ii�`RrNT'E't PRf MISTS fFa $ 1,000,000, Prim /NonCon #PPB3130212 nrrurrc�n(ec _ _ MED EXP,(Any one person) $ 10,000 - - - - - -- ----- - - - - -- - - - - - -- - - - - -- Professional Services Wvr of Subr - -_ -, ._w' ...-- - -- -- ---- -- - -- 0000._ performed by the Insured PERSONAL & ADV INJURY $ 2,000,000 .. 0 -- 0000. - -- - ------------------------------ GEN 'L AGGREGATE LIMIT APPLIES PE:R: are Excluded ''GE.NE.RAL.AGGREGATE $ 4,000,000 ............ 0000 0000.. POI -ICY I PRO ✓ .a LOG .. .. .,- PRODUCTS COMPIOPAGG $ 4000,000 ., 0000 . ... w OTHER �._ A AUTOMOBILE LIABILITY PSA0001537 7/22/2015 _ 7/22/2016 71, 'MLSINED I� N L $ tEa aradent 1 000.000 ANY AUTO Designated Insured Endt BODILY INJURY (Per person) S ALL OWNED sCIiEDU..ED #CA20481013; Prim /NonCon BODILY INJURY (Per accldenl) y AUTOS AUTOS and Blkt Wvr of Subr HIRED AUTOS ✓N ftIJOswavED Included on pg 2 of Form (Per <<aP r °AMA Prinm /NonCon ✓ Wvr of Subr #PPA3000313 $ UMBRELLA LIAR OCCUR .. .. _.. EACH OCCURRENCE $ . .. ..... 0000 ........ ., ... .. ... .............. EXCESS LIAB CLAIMS -MADE AGGREGATE $ ... ......... ............ DED RETENTION$ $ A WORKERS COMPENSATION � PSW0002073 7122/2015 7/22/2016 [PI R OOH ✓ AND EMPLOYERS' LIABILITY YIN Waiver Of Subrogation _ T61 T I Ire ............... _ ANY PRC)P RIEFORrPFg1�TY1 EN�fEXY' Ck: lG'Vl'),. El F.ACH ACCIDENT 1,000,000 N' OF ICERIMEMBER EXCLUDED? Y N/A Endt #WC0403060484 — .$ (Mandttnry to NN) E DISEASE - EA EMPLOYEE; $ 1,000,000 H ors desrsRbe under D6°SC X91" '9 "B4�IwE d; F OPE RAq" ONeS hpiktl�dd 0000. .0000. .:....... ._....... 0000.......__.. E.L. DISEASE POLICY I INnIT $ 1 ,000,000 B Professional Liability CM14DPLO278231V 7/22/2015 7122/20116 $1,000,000 Each Claim Claims -Made $1,000,000 Aggregate DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Certificate Holder is an Additional Insured with respect to General Liability (GL) and Automobile Liability but only when required by written contract with the Insured prior to an occurrence as per Endorsements noted above, GL includes Separation of Insureds and Contractual Liability per limitations in the BusinessOwners' Coverage form. A Workers' Compensation Waiver of Subrogation as noted above is included for the person or organization named in the Schedule that are parties to a contract requiring this Endorsement, provided that contract is executed before the loss. Coverage is subject to all policy terms, conditions, limitations and exclusions. 30 Day Notice of Cancellation /10 Days for Non - Payment in accordance with policy provisions. CERTIFICATE HOLDER CANCELLATION tnglneermg ana ueslgn support services Ti City of El Segundo, its officers o #ficlals and employees 350 Main street El Segundo CA 90245 ACORD 25 (2014101) 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 4 i (AVC) Alicia K. Iciram © 1988 -2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 25629232 1 7/15 -16 GL, AUTO, WC & PL I (AVC) Betty Tran 1 7/17/2015 2:54:10 PM (PDT) I Page 1 of 5 9mr-MAM Name of Person(s) or Organ ization(s) City of El Se undo, its officers, oyfficials and employees z6'2923?.. 1 // P, 16 G L, A09 U, WC & P I, I (AVC) ty Tx— � '?/ 1, 1/201.5 2: 54 m PM (PUT) � Pay, 2 of 5 POLICY NUMBER: PSA0001537 COMMERCIAL AUTO CA 20 48 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, DESIGNATED INSURED FOR COVERED AUTOS LIABILITY COVERAGE 1!M , 0111,0111101,0101 411P. 111 PIS 047 FR. 4111, "Fly Named Insured: Ornnis Consulting, Inc. Endorsement Effective Date: 7/22/2015 . . . .. .................... - SCHEDULE Name Of Person(s) Or Organization (s): City of El Se undo, its officers, Mcials and employees ,��Ilkl @ Insurance Services Office, Inc,, 2011 25629232 1 7(15 -1.6 GL, AUTO, WC & PL I (AVC) b.tty T— 1 7/17/2015 2: F4: 10 PM (PDT) I Page 3 of 1.5 Page 1 of I 3 11:,� 11,410 1 11, 1 1 001 10,TJ The following is added to the SECTION 11 — COVERED AUTOS LIABILITY COVERAGE, Para- graph A.1. Who Is An Insured Provision-, Any "employee" of yours is an "insured" while using a covered "auto" you don't own, hire or borrow in your business or your personal affairs, T M. The insurance provided to the additional insured will be on a primary and non-contributory basis to the additional insured's own business auto coverage if you are required to do so in a contract ♦ agreement that is executed by you before the "bodily injury" or "property damage" occurs The following is added to the SECTION IV — BUSI- NESS AUTO CONDITIONS, A. Loss Conditions, 5. Transfer Of Rights Of Recovery Against Others To Us: 1 N' "loss provided that the "accident" or "loss" arises The waiver applies only to the person or organization designated in such contract. amw=��� P�Mmm•naytvwrm. L*s� 1211111111111012-011MI SUM= ?ECTION 11 — CO'T_5R,5P_AJT_M_S__1JAB1Lff_T COVERAGE, Exclusion B.5. does not apply if you have workers compensation insurance in-force covering all of your employees. The amount paid under the PHYSICAL DAMAGE COVERAGE section • the policy; and a. Overdue lease/loan payments at the time of the "loss"; 2�,629242 1 71h5 1.6 GL, ALIT0, WC PL, �, (AVC) Betty'T­11. 1 �/17/201.5 2 PM I P.q­l of , WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE 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 California workers' compensation premium otherwise due on such remuneration. Person or Organization City of El Segundo, its officers, officials and employees Schedule Job Description Jobs performed for any person or organization that you have agreed with in a written contract to provide this agreement. ID 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 7/22/2015 Policy No.PSW0002073 Endorsement No. Insured Insurance Company omnis Consulting, Inc. RLI Insurance Company , Countersigned By 01998 by the Workers' Compensation Insurance Rating Bureau of California. All rights reserved. ,6292 2 1 Gl.o, AUTO, WC & P1, 0 fkNCr Dekty Tran 1 7/17 /20Pr 2:,A :10 1:.1iw (1.470 1 Paa3. , cr. s