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PROOF OF INSURANCE (2017) CLOSEDClient#: 25320 KIMLHORN ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE(MM /DD/YYYY) 3/28/2016 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 CertlfNCatf� holder is an ADDITIONAL INSURED, t _...w .. .. _ he 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 Jer N'oyola Gre lin Ins. Brokers a /EPIC r�' ry ftONE -- -- -._ �.....,.m.m., Alpharetta, GA 30022uite 370 fns gin, L say 770,552-4225 i :N� 866 550 -4082 Grey ling 9 Road, I q�RE $ferry noyola@greyling.comi INSURI DIORAGE - NAI- C # ER(SAORNG CVE 908-5619 N 4.1. I U' .....URED --- - .... �m...� .. Flre Ins Co 19445 INSURED INSURED Comm rce & ... INSURER B; Commerce gr Industry Ins Co. IN ­­- 19410 KImIe......Horn a. Associates, Inc. Y- INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE New H fNSURERc; Hampshire Ins Co. INDICATED. 23841 P.O. Box 33068... I1-° ...�.� �. ,..,. ... NSURER D : Lloyds of London ... 0.85202 Raleigh, NC 27636 _ n._.-- - - --.. _ . ........ _ THE INSURANCE AFFORDED BY THE INSURER E: DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, COVERAGES CERTIFICATE NUMBER: 16 -17 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.. ���,, LTA - -...... . __., AOLISUBR TYPE OF INSURANCE � ...w .. ,i "� —..- POLICY NUMBER POLICY EFF .. (MMIDD/YYYY) POLICY EXP - . -. -.- -LIMITS MMIDD/YYYY) ......._ . .....,,. A '^ COMMERCIAL GENERAL LIABILITY 5268169 4/01/2016 04/01/2017 EACHOCCURRENCE $1,000,000 CLAIMS X. DAMAGE TO RENTED -MADE OCCUR PREMISES (Ea ocryuep!yO, $m5OO 000' X Contractual Llab. -....- 1. MED EXP (Any one parson) $25,.000 .. ------ ' PERSONAL 8 ADV INJURY $1,000, OOO GEN'L AGGREGATE LIMIT APPLIES PER: I PRO- F POLICY � J CTT X LOC PRODUCTS�COMP /OPAGG ,,.,.... ............�.........._.. $2000,000 ? , ', $ A AUTOMOBILE LIABILITY .....SCHEDULED .� .4489663. .�.._, � ... •4/01/2016 ..,.. 04/01/201 EahABtlp+tED SINGLE LIMIT ��'ma��,id ®np) _ X1,000,000 BODILY INJURY (Per person) � $ OWNED AUTOS AUTOS ILY INJURY (P. eI r accident) $ X HIRED AUTOS X AVON -OWNED P10 ��DPERTY DAMAGE - accd n tll,........... $ X X OCCUR BE013778306 4/01/2016 04 /01/ _ OCCURRENCE 201 EACH OCCURRENCE $S,O;OOtOOO EXCESS LIABAB CLAIMS -MADE ..NT AGGREGATE $5 00100 1) X �..�. R. RETENTION ETENTIO ...... C WO KERS{C PENSATION 15893685 (AOS)N 4/01/201.... 6 04/01/201 )( PERoTH LIABILITY Y/ N ...�ST�TE... ., ANY PROPRIETORIPARTNER/EXECUTIVE OFFICERWEMSER EXCLUDED? � N/A E L. EACH ACCIDENT .1,000 $ 000 _._ A (Mandalwy In NH) 15893686 (CA) 4/01/2016 04/011201 E.L. DISEASE - EA EMPLOYEE $1,000,000 If yes describe under ...-..,,...._ ION OF OPERATIONS DESCRIPT y, .. , ...,.,m,.,...., .. .. ''.., _E.L. DISEASE - POLICY LIMIT `1,LO�IO�,OOO� ... .�. D Professional Liab P070831600 4/01/2016 04/01/2017 Per Claim $2,000,000 Aggregte $2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS/ VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) Re: 2015 -2016 On Call Services; Serine Ciandella. THe City of El Segundo, its officials & employees are named as Additional Insureds with respects to General Liability where required by written contract. The above referenced liability policies with the exception of professional liability are primary & non - contributory where required by written contract. City of El Segundo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 350 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. El Segundo, CA 90245 AUTHORIZED REPRESENTATIVE ©1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) 1 of 1 The ACORD name and logo are registered marks of ACORD #S461823/M461305 CUND1 POLICY NUMBER: 5268169 COMMERCIAL GENERAL LIABILITY CG 20 33 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES O CONTRACTORS - AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section II - Who Is An Insured is amended to include as an additional insured any person or organization 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 addi- tional 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. However, the insurance afforded to such additional insured: 1. Only applies to the extent permitted by law; and 2. Will not be broader than that which you are required by the contract or agreement to provide for such additional insured. A person's or organization's status as an addi- tional 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 ex- clusions apply: This insurance does not apply to: 1. "Bodily injury ", "property damage" or "personal and advertising injury" arising out C of the rendering of, or the failure to render, any professional architectural, engineering or surveying services, including: YII�11.� °M a. The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or b. Supervisory, inspection, architectural or engineering activities. This exclusion applies even if the claims against any insured allege negligence or other wrong- doing in the supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence" which caused the "bodily in- jury" or "property damage ", or the offense which caused the "personal and advertising injury ", involved the rendering of or the failure to render any professional architectural, engineering or surveying services. 2. "Bodily injury" or "property damage" occurring after: a. 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 b. 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 other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. With respect to the insurance afforded to these additional insureds, the following is added to Section III - Limits Of Insurance: The most we will pay on behalf of the additional insured is the amount of insurance: CG 20 33 04 13 ® Insurance Services Office, Inc., 2012 Page 1 of 2 0 1. Required by the contract or agreement you have entered into with the additional insured; or 2. Available under the applicable Limits of whichever is less. This endorsement applicable Limits of Declarations. shall not increase the Insurance shown in t" Page 2 of 2 0 Insurance Services Office, Inc., 2012 CG 20 33 04 13 1 POLICY NUMBER: 5268169 COMMERCIAL GENERAL LIABILITY CO2Q37O4 13 This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(ij ............... . ..... Location And Description Of Completed Operations Or Organization(s) ANY PERSON OR ORGAN17-ATION PER THE CONTRACT OR AGREEMENT, 14HOIM YOU BECOME OBLIGATED TO INCLUDE AS AN ADDITIONAL INSURED AS A RESULT OF ANY CONTRACT OR AGREEMENT YOU HAVE ENTERED INTO. Information required to complete this Schedule, if not shown above, will be shown in the Declarations, A . Section U ' Who Is An Insured is amended to which you are required by the contract or include as an additional insured the person(s) or agreement to provide for such additional organization(s) shown in the Schedule, but only insured. with respect to liability for "bodily injury" or B. With respect to the insurance afforded to these "property damage" caused, in whole urin part' additional insureds, the following is added to by "your work" at the location designated and Section U| ' Limits Of Insurance: described in the Schedule ofthis endorsement If coverage provided tothe additional insured is performed for that additional insured and required by a contract or agreement, the most included in the ^produotw'oomp|atmdoporatiuna we will pay on behalf of the additional insured hazard". is the amount nfinsurance: However: T. Required by the contract oragreement; or 1. The insurance afforded to such additional 2' Available under the applicable Limits of |nwu' innu,ed only applies to the extent permitted rwnoo shown in the O*c|mreduny; by law; and whichever is |aoo. 2. If coverage provided to the additional insured is required by a contract or eQn:e' This endorsement shall not innromno the appU' menx, the insurance afforded to such oddi' cable Limits of Insurance ahuvxn in the Dec|e' dnna| insured will not be broader than that rathzno ' CO20 37 0413 0 Insurance Services Office, inc,2O12 Page 1 of 1 El BLANKET 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 12:01 AM 4/1/2016 forms a part of Policy No. 15893686 Issued to KIM LEY -HORN AND ASSOCIATES, INC. By NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA. We have a right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against any person or organization with whom you have a written contract that requires you to obtain this agreement from us, as regards any work you perform for such person or organization. The additional premium for this endorsement shall be 2.00 % of the total estimated workers compensation premium for this policy. q��' WC 04 03 61 Countersigned by _. X21 _. _ (Ed. 11190) Authorized Representative