The URL can be used to link to this page

PROOF OF INSURANCE (2017) CLOSEDClient #: 131038 DAVIFAR DATE (MMIDD/YYYY) ACORD,. CERTIFICATE OF LIABILITY INSURANCE 5/26/2016 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. IMPORTAN . If the certificate holder an ADDITIONAL INSURED, the policy(ies) must be endorsed. ................................................................. ..................._"__.u.... "" T• orsed. 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 Lani Stanbery CBIZ Insurance Svcs. Inc. (LA) PHONE 310 268 -2.- FAX C!-M E-MAIL , lstaber cbix.c....,,,,� Lic. # OB17100 �LZ�D %ass "�� 111 om 10474 Santa Monica Blvd, #200 �,......" -- iNSURER(s)� AFFORDING COVERAGE NAIC # Los Angeles, CA 90025 INSURERA..T ... .... ............._-_r "-r----- -- ----- - ...__.. Travelers Casualty Ins. Co. of 19046 INSURED " " INSURER B: Travelers Property Casualty Co Davis INSURER C .....,,...,.,.,.,.,...., 25. ".� 674 DavisFarr LLP " " " " " " " " " " " "" — -- ............................................................ ............................... 2301 Dupont Drive Suite 200.-._ .........................................._.-_." �.. ". " " " ",. " ".�... ". " " " " ".... ". ._ Irvine, CA 92612 INSURER D . " "" INSURER E: 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. ...... .. INSR WVD ... POLICY NUMBER LIf1R ..... .............. INSURANCE - ADDL.SUBR.. __.... ---...... ...... ............._..... ,....... LIMIT MMlDL)IYYXX MMIDDIYYYX .... ............................. ", ( POLICY EFF� � POLICY EXP,I A COMMERCIAL GENERAL LIABILITY 680OH933685 ......... 05121/2016 05/21/201 EACH OCCURRENCE m. $ 1 -X --- _ 1 CLAIMS -MADE XJ OCCUR I, ppq;Mp�}}qq E fl "p C " Ri'MI S I -a cu ran2N. rOOO,O00 ,$300,000 .. ....... .._, MED EXP (Any one person) S5000 PERSONAL 8 ADV INJURY $199 00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,_000 ,,...._X. POLICY D JEC PRO "f El L.00 PRODUCTS COMP /OPAGG $2,,000,000 OTHER: $ Au A roMOBILEUnelurY - - ._ - BA2H007452 _ 5121/2016 05 /21I201µCC7MBINEDI)SINGLELIMIT Ea aced... -,,,,,. ..1.,000,... 000 ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS .,' ... BODILY INJURY Per ( ,cadent) ,...... . . . . ......... ......... $ . NON -OWNED X HIRED AUTOS X,,,, AUTOS .. - -.._ '. Pf �3PLF TY rPfl *.'E (P(ar[kadcGC� $ B X X occuR CUP1H416250 5/2112016 05121/201 EACHOCCURRENC E $1 OOOOOO EXCESSLABIAB [-CLAIMS-MADE nG�SEATIJT ..... B WORKER��ENSATON�1O000 IJUB9H41646A X PT 5/21/2016 05/21/201 .� AND EMPLOYERS LIABILITY ITY Y I N —��T" ANY 1�FiOPRIErCNRMAR 'k,'�fiNEWE��.XECUTIVE E L EACH ACCIDENT $1,000,000 OFFtCER/MEMBLR EXCLUDED'? � N/A (Mandatory In NH) E.L. DISEASE - EA EMPLOYEE $1,000,000 Ifyes, describe under .... .... DESCRIPTION OF OPERATIONS below E., L. DISEASE POLICY LIMIT- .... .... .... ...... .- �"- ."....._ .......... ... $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: RFP #08 -16. City of El Segundo, its officers, officials, employees, agents and volunteers are considered as additional insureds on the General Liability policy. This applies only to the operations performed by the named insured as required and agreed to by contract or agreement. CERTIFICATE HOLDER CANCELLATION 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 -0989 AUTHORIZED REPRESENTATIVE CBIZ Insurance Services, Inc. ©1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) 1 of 1 The ACORD name and logo are registered marks of ACORD #S1305972/M1305542 OPJS COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PROVISIONS: 1. WHO IS AN INSURED (SECTION II) is amended to include as an insured any person or organiza- tion (called hereafter "additional insured ") whom you have agreed in a written contract, executed prior to loss, to name as additional insured, but only with respect to liability arising out of "your work" or your ongoing operations for that addi- tional insured performed by you or for you. 2. With respect to the insurance afforded to Addi- tional Insureds the following conditions apply: a. Limits of Insurance — The following limits of liability apply: 1. The limits which you agreed to provide; or 2. The limits shown on the declarations, whichever is less. b. This insurance is excess over any valid and collectible insurance unless you have agreed in a written contract for this insurance to apply on a primary or contributory basis. 3. This insurance does not apply: a. on any basis to any person or organization for whom you have purchased an Owners and Contractors Protective policy. b. to "bodily injury," "property damage," "per- sonal injury," or "advertising injury" arising out of the rendering of or the failure to render any professional services by or for you, in- cluding: 1. The preparing, approving or failing to prepare or approve maps, drawings, opinions, reports, surveys, change or- ders, designs or specifications; and 2. Supervisory, inspection or engineering services. PERSON OR ORGANIZATION: City of El Segundo, its officers, officials, employees, agents and volunteers 350 Main Street El Segundo, CA 90245 -0989 CG D1 05 04 94 Copyright, The Travelers Indemnity Company, 1994. Page 1 of 1 Includes Copyrighted Material from Insurance Services Office, Inc. Ate"" CERTIFICATE OF LIABILITY INSURANCE °ATE`MM' ° °"""' 05/15/2016 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 endorsement(s). iCONTACY PRODUCER (847) 385 -6800 (847) 385 -6801 1 NA_�n,. Inte„ra� USA Inc Integro USA Inc. (HBO,.NR 0z_�847.385 680Q z C,nq. X847) 385-68,01 111 West Campbell Street E-MAIL „`ohn hecht Irate ro rou com ADr�s_�1 _._._.n �e.P 4th Floor INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURER 8: -- .______._..._. .,�..,�. .. .... .... .. _ ..... ...... .. Davis Farr LLP INSURERC: 2301 Dupont Drive, Suite 200 INSURERD: _ ... Irvine, CA 92612 INSURER E. 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 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 .... �.... ...m.........�....�..,� ........ ..........�........... ........... ........... I�,��L. 9�'k. �..., POLICY�EFF POLICYEXP LTR TYPE OF INSURANCE POLICY NUMBER IMMIDDffYYY) (MMIDDIYYYY) '.. LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY PREMISES(Eagccwencej M CLAIMS -MADE OCCUR MED EXP (Any one person) $ PERSONAL & ADV INJURY „..`G�. $ ............................... GENERAL AGGREGATE GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ .............. ............ PRO. POLICY LOC ---...........,.,................. ............................... $ AUTOMOBILE LIABILITY COMBINED SINGL.r qMl (Ea acci) ANY AUTO BODILY INJURY (Per person) $ YYeeW ALL OWNED ...... SCHEDULED ---- BODILY INJURY (Per accident) ---- -.. ........... ..............,.m $ AUTOS AUTOS NON -OWNED PRiJPERCYDAMGt A $ _ HIRED AUTOS AUTOS ---------. $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ [EXCESS LIAB CLAIMS -MADE AGGREGATE $ DED-_1 RETENTION$ $ WORKERS COMPENSATION WC STATU- O'T'H- AND EMPLOYERS' LIABILITY Y / N —. S�.RX..L)b1f.T..a�.. __...,...._...,.... m ................. ............................... ANY MBER EXCLUDED? PROPRIETOR/PARTNER/EXECUTIVE E] NIA �EA ....................................... ............................... (Mandatory In E.L DISEASE EMPLOYEE Ifyes, descidn under ____,� ....__ .................__- �m.._...................................... ............................... DESCRIPTION OF OPERATIONS below E L DISEASE - POLICY LIMIT $ A Professional Liability CH16APLOBAHYNNV 05/15/2016 05/15/2017 $1,000,000 Each Claim and Annual Aggregate DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CERTIFICATE HOLDER City of El Segundo City Clerk 350 Main Street El Segundo, CA 90245 ACORD 25 (2010/05) CANCELLATION 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 ©1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD TRA ELER V WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 04 03 06 (01) — POLICY NUMBER: IJUB- 1H41646A16 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 % OF THE CALIFORNIA WORKERS' COMPENSATION PREMIUM OTHERWISE DUE ON SUCH REMUNERATION. SCHEDULE PERSON OR ORGANIZATION JOB DESCRIPTION City of El Segundo, its officers, officials, employees, agents and volunteers 350 Main Street El Segundo, CA 90245 -0989 DATE OF ISSUE: - - ST ASSIGN: