No preview available
PROOF OF INSURANCE (2016) CLOSEDNEXLINF -01 LRODEN ACORO' . _. .DA..T�E . ._(_ MM / °DYY Y) C E RTI F I ATE F LIABILITY INSURANCE 511 /2/2015 ..... __...._ _.......................... .�...._._............ _ 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 NA1/!E„ " Premier Agency, Inc. y 5 Sierra Gate Plaza 2nd FI PHONE FAX 916 784 -1008 �A Ne), (916) 4^l�� /'( - - -- ) 784 -8116 Roseville, CA 95678 A MAIL ADDRESS;. --------- INSURE.R(S)AFFO'RDING COVERAGE'.. NAIC p '.., INSURERA- Travelers Property Casualty Company of America .25674 ''. INSURED INSURER B : Nexlevel Information Technology, Inc. INSURER C: Technology, Inc. 6829 Fair Oaks Blvd Ste 100 „INSURER D ^ Carmichael, CA 95608 wsuRER E INSURER F : COVERAGE'S CERTIFICATE NUMBER: ...................... REVISION NUMBER: 1 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, LTR .,.. ,,.,.. ,,.,..._.. ,.,., . TYPE OF INSURANCE 1lbDL' D Welk --- ---........ POLICY NUMBER POLICYEFF MMIDD/YYYY) POLICY Edit *...... - --- ------------ ------ -.- ......--- MM /DDIYYYY' LIMITS .,.,- A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000, CLAIMS -MADE f OCCUR X ZLP13N222951515 05/01/2015 05/01/2016 DAUNGE O- AERTED PREMISES ES $ 500, .. - MED EXP (Any one person) $ 10,000 PERSONAL &ADV INJURY _ $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY LOC JECT PRODUCTS COMP /OP AGG $ 2,000,000 41iBiER Em Ben $ 1 000,00 0 AUTOMOBILE --- --- LIABILITY (Ea acI dent). NGLE L1MII (Ea acCldot:l) $ 1,000,000 A ANY AUTO BA8141X98815TEC 05101/2015 05/01/2016 BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident) $ X .... XAUTOS OWNED �AMA � $ HIREDAUTOS (per OcC lr $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 /1, EXCESS LIAB CLAIMS -MADE ZUP13N223381515 05/01/2015 05101/2016 AGGREGATE m ®.n $ 1,000,000 DED. -. X RETENTION $,�� 0 $ WORKERS COMPENSATION X PER OIH- STATUTE ER AND EMPLOYERS' LIABILITY YIN A ANY PROPRIETOR /PARTNER /EXECUTIVE X HJUB7615XO0315 05/01/2015 05/01/2016 EL EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? ❑''.. (Mandatory in NH) NIA E, L DISEASE - EA EMPLOYE ' $ 1,000,000 DESCRIPTION OF OPERATIONS below w ............................. E L DISEASE POLICY LIMIT $ 1,000,000 A Professional Liab ZPL14R360811515 05/01/2015 05/01/2016 Limit 2,000,000 '.. DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may mm mmmmmmmmm mmm a �mmmmmmmmmmITmmmmmmqui .... .. ��� WWW � �.�.�.. edule, may be attached ff more apace Is required) .�....._�.... ��������� The City, its Officials and employees are additional insured and insurance is primary per CGD2480805 and CGD4250708 attached. Waiver of Subrogation per WC990376AO01 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of El Segundo Department of Engineering THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. and Building Services 350 Main Street, El Segundo„ CA 90245 AUTHORIZED REPRESENTATIVE © 1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ID I A This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 1. WHO IS AN INSURED - (Section II) is amended to include any person or or- ganization that you agree in a "written contract requiring Insurance" to include as an additional insured on this Coverage Part, but: (a) Only with respect to liability for "bodily injury ", "property damage" or "personal injury "; and (h) If, and only to the extent that, the injury or damage is caused by acts or omissions of you or your subcon- tractor in the performance of "your work" to which the "written contract requiring insurance" applies. The per- son or organization does not qualify as an additional insured with respect to the independent acts or omissions of such person or organization. 2. The insurance provided to the additional insured by this endorsement is limited as follows: (a) In the event that the Limits of Insur- ance of this Coverage Part shown in the Declarations exceed the limits of liability required by the "written con- tract requiring insurance ", the insur- ance provided to the additional in- sured shall be limited to the limits of liability required by that "written con- tract requiring insurance ". This en- dorsement shall not increase the lim- its of insurance described in Section III - Limits Of Insurance. (h) The insurance provided to the addi- tional insured does not apply to "bodily injury", "property damage" or "personal injury" arising out of the rendering of, or failure to render, any professional architectural, engineering or surveying services, including: i. The preparing, approving, or fail- ing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders or change orders, or the preparing, approv- ing, or failing to prepare or ap- prove, drawings and specifications; and ii. Supervisory, inspection, architec- tural or engineering activities. (C) The insurance provided to the addi- tional insured does not apply to "bodily injury" or "property damage" caused by "your work" and included in the "products- completed operations hazard ". 3. The insurance provided to the additional insured by this endorsement is excess over any valid and collectible "other in- surance", whether primary, excess, con- tingent or on any other basis, that is available to the additional insured for a loss we cover under this endorsement. However, if the "written contract requir- ing insurance" specifically requires that this insurance apply on a primary basis or a primary and non - contributory basis, this insurance is primary to "other insur- ance" available to the additional insured which covers that person or organization as a named insured for such loss, and we will not share with that "other insur- ance". But the insurance provided to the additional insured by this endorsement still is excess over any valid and col- lectible "other insurance ", whether pri- mary, excess, contingent or on any other basis, that is available to the additional insured when that person or organization Is an additional insured under such "other insurance ". 4. As a condition of coverage provided to the additional insured by this endorse- ment: (a) The additional insured must give us written notice as soon as practicable of an "occurrence" or an offense which may result in a claim. To the extent possible, such notice should include: L How, when and where the "occur- rence" or offense took place; ii. The names and addresses of any injured persons and witnesses; and CG D2 48 08 05 0 2005 The Travelers Indemnity Company. All rights reserved. Page 1 of 2 TRVEER5 ONE TOWER SQUARE HARTFORD, CT 06183 WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY ENDORSEMENT WC"03 761 A) - DOI WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA (BLANKET WAIVER) We have the right to recover our payments from anyone Ilable for an injury covered by thls policy. We will not enforce our right against the person or organization named in the Schedule, The additional premium for this endorsement shall be 07.000 % of the Califomia workers' compensation pre- mium. Schedule Person or Organization Job Description ANY PERSON OR ORGANIZATION FOR WHICH THE INSURED HAS AGREED BY WRITTEN CONTRACT EXECUTED PRIOR TO LOSS TO FURNISH, THIS WAIVER. m� a n� This endorsement changes the policy to which it is attached and Is effective on the date issued unless otherwise stated. (The Infamation below is required only when this endorsement Is issued subsequent to preparation of the policy.) Endorsement Effective Policy No. Endorsement No. Insured Premium Insurance Company Countersigned by 5T ASSIGN: Page 1 of I 04475 00 W 0 u U 51 N 0 n m N W CD N N N Z C9 SV O a U 0 Y COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. OTHER INSURANCE ADDITIONAL INSUREDS - PRIMARY AND NONI- CONTRIBUTORY WITH RESPECT TO CERTAIN OTHER INSURANCE This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART The following is added to Paragraph 4. a, Pr are Insurance, of SECTIDN IV - - A R IAL GENERAL LL481LITY CONDITIONS: However, if you specifically agree in a writ- ten contract or agreement that the Insurance afforded to an additional insured under this Coverage Part must apply on a primary ba- sis, or a primary and non- contributory basis, this insurance is primary to other insurance that is available to such additional Insured which covers such additional insured as a CG D4 25 07 08 named insured, and we will not share with that other insurance, provided that: (1) The "bodily injury" or "property damage" for which coverage is sought is caused by an "occurrence ` that takes place, and (2) The "personal injury" or "advertising in- jury" for which coverage is sought arises out of an offense that is committed; subsequent to the signing and execution of that contract or agreement by you. 0 2008 The Travelers Companies, Inc. Page 1 of 1