Loading...
PROOF OF INSURANCE (2016) CLOSEDCERTIFICATE OF LIABILITY INSURANCE DATE(MWDDNYYY) 8/"31/2015 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 prJlicy(les) must be endorsed. tl SUBROGATION 15 WVAIVED, sutJject 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 endorsements). PRODUCER c A� CSIS insurance Services CSIS Insurance Services PHONE (888)501-2i-47 `888) 50 . .. ��. ..�0 ..�514._ _e, el A "& cer tes@csiso n ne com �..m. 3315 Old Conejo Road IN utl R AFFORDWOCOVERAG NAICS Thousand Oaks CA 91320 R.._ y -... _w _...., w .,..... Ott INSURED •� —�••� �� �NSUR . _•.• msuRek a - Mercer Insurance OT a an I11IrURERC TorussfdaaLZar�aulno'y �._ rit Creative Contractors, Corp. �suran +Cor wan 25496 PO Box 80784 INBURERD: INSURE E _._._ .,....., ...�,.......�_.�,�,... ... ._. . Rancho Santa CA 92688 �RF: COVERAGES CERTIFICATE NUMBER:14aster 2015 -16 REVISION NUMBER: CERTIFICATE ED. MNOTWITHSTANDING OR MAREQUIIRE NE THE INSURANCE CE AFFORD i. BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS ED 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. SIO .. e�.'Abb BOOR � PuOLtCYN�uMSFR .,_... W..�. ....._...�, �....�..4.. ...,_. ,,.. TYPE OF INSURANCE POLICY IE — pd1Fc -YCx I ..�. ,.. UMlT6 X COMMERCIAL GENERAL LIABRJTY EACH OCC4JRRENCE $ 1,000,000 �,.w. .9.,.w.M ...�.,,,.,.. A... _ CLAIMS-MADE OCCUR n S 100, 000 / / �earrers .,i ...... CP52181709 S18/2015 5/18/2016 MED EXP (j1n. one 'S 5,000 m _ ._..... ..,_. , PERSONAL & ADW INJURY S 1,000,000 GENIAGGREGATE LIMIT APPLIES PER: AGGREGATE � S 2,000,000 X POLICY � GENERAL AGta�m JECT LOC m PROOUCTS • COMPIOP AGG S 2, 000 000 :: Pr �•.......... _...»..._ , OT. HER ' oPa ..RY damage •single moil S .AUTOMOBILE LIABILITY BODILY INJURY (Per person) P ANY AUTO �, ) S ALL OWNED SCHEDULED ._�.�.... .._ (Per _• de ... , _.....,....n... , ..._... HIRED AUTOS ane aaril S �.. BODILY INJURY AUTOS .�........... NONO- OSWNED B'FtOPER7M X UMBRELLA LIAB X OCCUR ) CE S DED REiCHTtONS _s ..,..,. 04i ,. EXCESS LIAR _ _ PMS•IIIVADE EACH OCCURRENCE ......_.. S 1 B EXC c �. AGGREGATE �� � 1 00,��000 . 0� WORKERS COMPENSATION YIN PER ER 27303567 5 /18 /2015 5/18/2016 ANY p AND C MP EMPLOYERS' LIABILITY ED ECl7TltiE L.... NIA 6L. , EACH ACCIDENT $ 0 x i11 C l O M eod In Nlj er 720150136 6/30/2015 6/30/2016 E.L. DISEASE EA EMPLOYE S 1,000 000 %& Sdoac �go undaHIPTIOH OF OPERATIONS bMawr E.L. DISEASE - POLICY LIMIT $ t 000 )100 DESCRIPTION OF OPERATIONS! LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached If more span it required) The City of El Segundo, its Officers, officials, employees, agents, and volunteers are named additional insured as respects general liability and this insurance is primary and noncontributory with any other insurance of the additional insured; and waiver of subrogation applies as respects workers compensation as required by written contract,. r.F PTIGIf%.ATi0 IWr%l rlca .... «. ,. .. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City Of El Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVEREO IN 350 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. El Segundo, CA 90245 AUTHORIM REPRESENTATIVE Ialnara Epping /ELENAP�Q ®1988.2014 ACORD CORPORATiONI. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD INS025 r7Illenll COMMERCIAL GENERAL LIABILITY CG 20 33 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR 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 11 - Who Is An Insured is amended to include as an additional insured any person or or- ganization for whom you are performing opera- tions 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 additional insured only with re- spect to liability for "bodily injury ", "property dam- age" 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 re- quired 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 ad- ditional insureds, the following additional exclu- sions apply: This insurance does not apply to: 1. "Bodily injury", "property damage" or "personal and advertising injury" arising out of the ren- dering of, or the failure to render, any profes- sional architectural; engineering or surveying services, including: a. The preparing, approving, or failing to prepare or approve, maps, shop draw- ings, opinions, reports, surveys, field or- ders, 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 wrongdoing in the supervision„ hiring, employment, training or monitoring of others by that insured, if the "occur- rence" which caused the "bodily injury" or "prop- erty damage ". or the offense which caused the "personal and advertising injury" involved the ren- dering of or the failure to render any professional architectural, engineering or surveying services. CO 20 33 04 13 Copyright, Insurance Services Office, Inc., 2012 Page 1 of 2 INSURED 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 serv- ice, maintenance or repairs) to be per- formed 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 or- ganization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. C. With respect to the insurance afforded to these additional insureds, the following is added to Sec- tion Ill - Limits Of Insurance: The most we will pay on behalf of the additional in- sured is the amount of insurance: 1. Required by the contract or agreement you have entered into with the additional insured; or 2. Available under the applicable Limits of Insur- ance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. Page 2 of 2 Copyright, Insurance Services Office, Inc., 2012 CO 20 33 04 13 C V CERTIFICATE OF LIABILITY INSURANCE DA 3ioz0016 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 WANED, 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 endorsemen s). PRODUCER r r A STATE FARM INSURANCE _ "...w. PHONE FAQ, 27101 ALISO CREEK RD t, '126 lAI I+UD MI�?I: ALISO VIEJO, CA 92656 F MAIL OFF 9419-362-3615-0 IN sURERIS)AFFORDINOCOyERAGE NAMCa' FAX 940.362 -3039 _...._. _... 1 INSURER A; Skale Fann General insurance CCTIn(rI1M)*f 26161 I INSURED ,...w.,�.,.,,..CRE'A. "IVE CONTRACT O 'S C O¢ F._ .,.... .- " INSURER 0 PO BOX 80784 INSURER C I INSURER rw INSURER G_ - tNSUR R COVERAGES CERTIFICATE NUMBER: REVISION NUMBER. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO TILE 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 A-D SUSR,,..e.m _.....�' bU qwr8I +OLK; OFINSURANCE POLICY NUMBER Y P YYJ .. ",,...._ „».,.,.,......„ LIMITS ,.......,., , .,,.. "�.,....._. COMMERCIAL GENERAL LIABILITY „.ACNOCCUNMRCNCE .,., $ JCLAIMS -MADE -- OCCUR pREp,4,Slluoacnrrrl.purr.,„__ S .-1 ..... .... _ .._.. MNM r11ilEXPlIw,Yanuwfwrku ^ op S , OVIIQUeMY ,. 5 ,....,. -.R "Crrdk'rF'.PI OITAPPLIES PER: CLA AA4. SA a PIER _ fiaClw. L ATaG PRO. LOC ry PRODUCT 9�'ahL +'�C t ~t�ul t49 L� 'S POLICY QA F tl _. OTHak S COIwM,PMOP ACTS , r AUTOMOBILE LIABILITY Y Y i P41 3872- F17 -75K 1211712015 1211772016 = S 2,000,000 ANY AUTO ryry {p I BODILY YIIN URY (Por person) 5 1 m " !AUTOS ED Al1TOSULED BODILY INJURY IPrx acc+deNy S.._. 5 1 00— I .,X.I HIRED AUTOS .+i AUTOS I pi §�Ia'�MtuL,rE .. 0.000 UMBRELLA UAB OCCUR 14ACI I OCCURR)''d+= ! 5 P EXCESS LU\B LAO)AE A rE"dd TOATF _..._....... ,_.." " ,.._.... ,.., -.„ DEPT ( RFTFNI101I * t P 5 !WORKERS COMPFNSATION 7ATUTF I „� FTi Cl�r4 u;MEanFt S LU1BILnY YIN AND EMPLOYE h"' Ri] PP' dNCTk "�F��pro,?aR'rPtl�?rEI,P".DJPMIIE k. L ;n ti%.')1 AW.96Lt9'P S ERU Ct.UDEDS NIA G — V'NIMlandaMOrydIINRM) ._ 1 'EL.MSSASE- EACIAPLOY99 S Ilyftro.vSoM��AE:e�cuatiU^�I II .._» ,. _ _ ^,k$'4R'IPTI N CF O F', TIONS LI Iom 1 k I E.L" DISEASE - PLil.CY LVJIr S ' I DESCRIPTION OF OPERATIONS I LOCATIONS f VEHICLES (ACORD 101, Addldonal Remarks SehadWo, may be attached K more space Is rcgWred) CERTIFICATE HOLDER CANCELLATION Additional Insured SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of El Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE OEUVERED IN 350 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. El Segundo, CA 90245 9488.2014 ACOqD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACCORD ' 1001486 132849.9 02.04 -2014 WC 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. Schedule Person or Organization Job Description Blanket Waiver of Subrogation As respects to all CA jobs performed by the named insured during the policy period where by written contract a waiver of subrogation is required prior to the commencement of work. This endorsement changes the policy to which it is attached and Is effective on the date issued unless otherwise stated. (Tare information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective: 06-30 -2015 Insured: Creative Contractors Corp. (A Corp) Policy No.: T20150136 Endorsement No.: Insurance Company: Torus National Insurance Company Countersigned By 01998 by the Workers' Compensation Insurance Rating Bureau of California. All rights reserved.