Loading...
PROOF OF INSURANCE (2016) CLOSEDClient #: 1514175 306ALLCITYM ACORM CERTIFICATE OF LIABILITY INSURANCE DATEro1/20/YYVY) oalrzol5 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()ios • 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 NAM , Nysa Gallegos BB &T- Knight Insurance Services PHN FAk` (� PhtNGelie o bbandt.c 1Adc, Nop. 877 -297 9262 535 N. Brand Blvd. 10th Floor E-MAIL -1-616 662 -4234 Om Glendale, CA 91203 Ao °P,..,a.nm ._ .... „, ..,,, -- - -. INSURER(31 AFFORDING 818 662 -4200 INSURER A: 1 Tokio Marine Specialty InsurancE 238501Gf �. m_ . ................... „ .........., ..........., .. ....., _ City g Ins Co of P 19445 INSURED All Ci Management Services Inc INSURER c p na nion Fire INSURER B at Depositors Insurance Company 42587 De 10440 Pioneer Blvd # 5 Santa Fe Springs, CA 90670 INSURER D ; ,.,, .., �. INSURER F: COVERAGES 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 CONTRACTOR 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. MIR - ADDL)SUBR PRiLtlCY F NrOuIcy EkP _ GENERAL LIABILITY ®® I MP I EACH OCCUR LIMITS A TYPE OF X X PPK1316352 4/01/2015 04/01/201 E $1,000,000 TR pN Vkvn POLICY NUMBER IM OOdYY`NY MN i4V YYYY RENCE 77 X COMMERCIAL GENERAL LIABILITY PREMISFSO RENTED $1 OO.000 _ CLAIMS MADE X� OCCUR MED EXP (Any one person) Is Excluded _ ERSONAL & ADV INJUR - -Y . ($1, P 000 000...,.. q GENERAL AGGREGATE `$2 00O 000 .. . , ....... ....... .... 'd........- . —_ .. ...1 ....µ.. ,,. DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Akach ACORD 101, Additional Remarks Schedule, If more space is required) As respects General Liability and required by written contract; Certificate Holder is named as additional insured. Insurance is Primary & Non - Contributory. Waiver of Subrogation applicable. TE HOLDER CANCELLATION El Segundo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Deborah Cullen, Finance Director ACCORDANCE WITH THE POLICY PROVISIONS, 350 Main Street El Segundo, CA 90245 AUTHORIZED REPRESENTATIVE ©1988 -2010 ACORD CORPORATION. All rights reserved, ACORD 25 (2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S13973834/M13973666 NNGON PRODUCTS- COMP /OPAGG s2,000,000 POLICY LOC p" pp $ C AUTOMOBILE LIABILITY X AC"'....., P7825954504 12121/2014 12/21/2015 Ea— daofSINGLE UMiT $1,000,000 X ANY AUTO "BODILY INJURY (Per person) $ ""• ALL OWNED SCHEDULED AUTOS BODILY INJURY (Per accident) $ X. HIRED AUTOS AUTOS X AUTOS ........... .... "$ "" . .. .. OPERTY DAMAGE $ leer ecadentl. , ...... ... ,eeee,...m... ... -.. ®, Po _ �$ B Xw,OCCUR X UMBRELLA LIAB BE06 5159478 4/01/2015 04/0112016 5 E OCCURRENCE $8,l)OO.. ­ EXCESS LIAB CLAIM &MADE IDED AACH GGREGATE, $8.000.000 X5 RETENTION SO 1$ WORKERS COMPENSATION Not Applicable 1WC STATU �OTH• Tnav Ir.niTC cn AND EMIPLOYERS'LIABILITY YIN ", ANY I�4� OWHIL ft)kR PARTNER/EXECUTIVE EXCLUDED? NIA E LEACH ACCIDENT I $ ., 1Mandalax y In NH) E.. T .L DISEASE EA EMPLOYEE:I If yes, describe under nF- CRIPT!ON OF OPERATIONS Wow . .,.,,,,,,., .. ...... .... .......... E.L. DISEASE - POLICY LIMIT $ Not Applicable .,. ,...,,..�...:,,,�.,.....,,.... .....LIMIT u .. DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Akach ACORD 101, Additional Remarks Schedule, If more space is required) As respects General Liability and required by written contract; Certificate Holder is named as additional insured. Insurance is Primary & Non - Contributory. Waiver of Subrogation applicable. TE HOLDER CANCELLATION El Segundo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Deborah Cullen, Finance Director ACCORDANCE WITH THE POLICY PROVISIONS, 350 Main Street El Segundo, CA 90245 AUTHORIZED REPRESENTATIVE ©1988 -2010 ACORD CORPORATION. All rights reserved, ACORD 25 (2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S13973834/M13973666 NNGON PRIMARY AND NON - CONTRIBUTORY WORDING POLICY NUMBER: PPK1316352 NAMED INSURED: All City Management Services Inc. COMMERCIAL GENERAL LIABILITY EFFECTIVE: 04/01/15-04/01/16 CG 20 26 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following; COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) As required by written contract ............ Information required to complete this Schedule, if not shown above, will be shown in the Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: A. In the performance of your ongoing operations; `or B. In connection with your premises owned by or rented to you Section IV Commercial General Liability Conditions, 4. Other Insurance, a. Primary Insurance is with replaced with the following for this Additional Insured only: This insurance is primary except when it is excess as provided under part b., below. When this insurance is primary, we will not seek contribution from other insurance available to the person or organization shown in the schedule of this endorsement except for the gross negligence and or willful or wanton misconduct of the person or organization shown in the schedule of this endorsement. All other terms and conditions remain the same. CG 20 26 07 04 © ISO Properties, Inc., 2004 14 -15 GL Al Primary POLICY NUMBER: PPK1316352 COMMERCIAL GENERAL LIABILITY NAMED INSURED: ALL CITY MANAGEMENT SERVICES INC. CG 24 04 05 09 EFFECTIVE: 04/01/15 - 04101/16 WAIVER OF 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 SCHEDULE Name Of Person Or Organization: AS REQUIRED BY WRITTEN CONTRACT Information reouired to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV — Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products - completed operations hazard ". This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 1 ❑ CERTIFICATE OF LIABILITY INSURANCE [::4121:2015 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 CONTACT am Trend Certificate Coordinator PHONE (214) 553 -5525 ROBERTS & CROW INC . r rare u,. �,,,�• (214) 553 -5505 ,oX 12221 Merit Drive E-MAIL Suite 300 INSURER(S) AFFORDING COVERAGE NAIC # nw ....____.....,., - -.,-„ .,._...,...... Dallas TX 75251 INSURERA:Technologv Insurance Co. , Inc. 42376 INSURED INSURER B: Trendsetter HR, LLC INSURER C: �ITmmm ........... L /C /F All City Management Services, Inc. INSURER D: ._..._....._ 2701 Sunset Ridge Drive, Suite 500 INSURER E: Rockwall TX 75032 INSURER F: COVERAGES CERTIFICATE N11IVI'RFR ^All Citv Manacrizmcrnt RFVIRICIN NI IMRFR- 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, Tagwr .... ,......__....... °" POLICY EFF POLICDY Ep ...................... .............._.....w.w..,,.... i TR TYPE OF INSURANCE n co nn 3 POLICY NUMBER (MMIDD /YYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY RRE1.11nnc�R�c. CLAIMS -MADE F—] OCCUR MED EXP (Any one person) $ ..... .--.. PERSONAL &ADVINJURY . .................. $ .�........ GENERAL AGGREGATE $ _ GE:NI AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ PRO• V..00 POLICY .. ....._ ... ..... .. ............. _' ''... $ AUTOMOBILE LIABILITY I I9+i.:.5 E A GL Ltl 17 i__ .................... ANY AUTO BODILY INJURY (Per person) $ ALL OWNED ...,_. SCHEDULED AUTOS AUTOS .... " ... BODILY INJURY Peraccide NON - OWNED ,PROPERTY DAMAGE ITITIT. -. - .................... .. ... $ HIRED AUTOS AUTOS .... (Per __.,.....�......._........_ ................ $ UMBRELLA LIAB '.. OCCUR EACH OCCURRENCE $ EXCESS LIAB '.. CLAIMS -MADE ................... ...... ............................... AGGREGATE $ DED RETENTION $ i' ..................., _....... / $ A WORKERS COMPENSATION WC STATLI OTH AND EMPLOYERS' LIABILITY YINy ANY PROPRIETOR /PARTNER/EXECUTIVE V__ TORY Ih%1.." ER OFFICER /MEMBER EXCLUDED? (Mandatory in NH) N/A C3474680 ;4/1/2015 4/1/2016 EACH ACCIDENT _ $ 1,000,000 ..._ E DISEASE - EA EMPLOYE F $ 1.000.000 If yes, describe under ,--- ,,,,,m.�.........._.... .... _ .. ,. DESCRIPTION OF OPERATIONS belaw E . DISEASE - POLICY LIMIT $ 1.000.000 Location Coverage Period:4 /1/2015 /1/2016 Client #331371 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) Coverage is provided for only those employees leased to but not subcontractors of All City Management Services, Inc. CERTIFICATE HOLDER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of E1 Segundo ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street El Segundo, CA 90245 AUTHORIZED REPRESENTATIVE Barry Crow /JRS ACORD 25 (2010/05) ©1988 -2010 ACORD CORPORATION. All rights reserved. INSn25 ontnnm m The Arf1Rr1 name onrl Innn are mmicfereri marka of Af (1011 WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY INSURANCE POLICY WC 124 (4 -84) WC 00 03 13 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different date is indicated below. (The following "attaching clause" need be completed only when this endorsement is issued subsequent to preparation of the policy) This endorsement, effective on 4/1/2015 at 12:01 A. M. standard time forms a part of DATE Policy No. TWC3474680 of the Issued to Trendsetter HR, LLC Premium $ All City Management Services, Inc. TECHNOLOGY INSURANCE COMPANY ` NAME OF INSURANCE COMPANY Authorized Representative 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. This agreement shall not operate directly or indirectly to benefit any one not named in the Schedule. City of El Segundo 350 Main Street El Segundo, CA 90245 WC 124 (4 -84) WC 00 03 13 Copyright 1983 National Council on Compensation Insurance Page 1 of 1