PROOF OF INSURANCE (2014) CLOSED" CERTIFICATE OF LIABILITY INSURANCE Dat'Im.f�I
�� 10/21DDfY/2013 R)
TMMS CERTIIFICATECDOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, OR ALTER THE COVERAGE AFFORDED BY E HOLDER• THIS
MATTER OF NNFORMTIONIIaIL CERTIFICAT
« 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.
WPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the polloy(les) must be endorsed. If SUBROGATION IS WAIVED„ .subject to the terms )VC and conditions of the policy, certain policies require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of
such end'orsemarut s' .
_PROOUCLR COINTACT Sherry Young
Risk Strategies Company NAME:
2040 Main Street, Suite 580 PHONE w 949.242.9240 N® 949.596.0866
Irvine, CA 92614 EMAIL
lac. #OF06675 ADDRESS: eyoung@rlsk-strategion.com
INSURERS AFFORDING COVERAGE NAIC #
INSURED 1NSURERA: Citizens insurance Co. of America 31534
Pacific Municipal Consultants INSURER B: Hanover American Insurance Co. 36034
DBA: PMC INSURER Q Massachusetts BM Insurance Co. 22306
2729 Prospect Park Dr., Ste 220 1 INSURER D: Continental Casualty Co. 20443
Rancho Cordova CA 95670 INSURER E'
� INSURER F:
COVEIAIE$ CERTIFICATE NUMBER; RN;VISION NUNIiIB�IR:
T141S IS TO CERTIFYTHA.f POLICIES OF INSURANCE LISTED BELOW HAVE BEAN ISSUED 7 THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,
NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECTTO 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,
N SR TYPE OF INSURANCE CY E PgLICY
k:T'R rusR B POLICY NUMBER M '.. M'bRYDDlYY'i�'Y. LIMITS
GENERAL L LIABILITY EACH OCCURRENCE $2,000,000
A X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED
$1,000,000
CLAIMS-MADE X.. OCCUR X PRENtlSEB(EaaeaWar4moe.
OB3914666102 07/01/13 07/01/14 MED EXP (Any one person) ;$4,0W,000 0,000
PERSONAL d ADV INJURY $,000,000
GENERAL AGGREGATE ,000,000
GEN'L AGGREGATE Lr14rrAPPLIES PER PRODUCTS - COMP/OP AGO
POLICY X PROJECT LOC $
AUTOMOBILE LIABILITY COMBINED SINGLE. LWIT $?,000,000
La acoddenq
A ANYAUTO BODILY INJURY (Per person) ,.5
ALLOWNEDAUTOS Ar SCHEDULED
UTOS OB3914WO102 07/01 /13 07/01/14 BODILY INJURY (Per aoddlM) 5
AOS
NOW
X HIREDAuros X OWNED PROPERTY DAMAGE
AUTOS (Pera0dent) $
$
X UMBRELLALL4B X OCCUR
EACH OCCURRENCE $2.000,000
A EXCESSUAS CLAIMS- OB3914666102 07/01/13 07/01/14 AGGREGATE $2AO0,a00
offi.
OED X RETENTION $10,000
$
WORKERS COMPENSATION A 04H-
B AND rd1PL0YERB'LIABILITY YM X LTOR' ER
ANY PRCPRIETOR/PARTNERiFMCU7rVE/ WZ3912749003 (CA, AZ 07/01/13 07/01/14 -
I
OA 10ElZMEA(BER EXCLUDED? Y WA % E.L. EACH ACCIDENT $1,olxl
C (MandatorynN.H.) WZ3912749f302(OR) 07101113 07101!14 EL, E -EA
Nye%dkerlbe under DESCRIPTION OF EMPLOYEE $1AO0.00o
OPERATIONS below E.L,DISEASE- POLICY LIMIT $1,000,000
D PROFESSIONAL LIABILITY MCH288307507 07/01/13 07/01/14 Per Claim $2.000,000
Aggregate $3,000.000
F OPERATN NB P LOCATIONS I'VEH1CLES (AR;; AC6IRO t0 a Addlatlrrel e e e d „ II more epees Ae rerl re11
Projects as on file with the insured including but not limited to Contract Planning Assistance. City of El Segundo, its officials and employees are named as
additional insureds on the general liability policy and a waiver of subrogation applies to the work comp policy -see attached endorsement. "The above
policies Contain a 30 -day notice provision for non - renewal and cancellation except for cancellation due to non - payment of premium, In which a 10 -day notice
CERTIFICATE HOLDER r.Awn t r e1Tnu
City of El Segundo
Planning & Building Safety; 1
350 Main St.
El Segundo, CA 90245 -3813
Mgr
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH
THE POLICY PROVISIONS.
01 -8 -2010 ACORD CORPORATION. All right reserved.
POLICY NO.OB3914666102 INSURED: PACIFIC MUNICIPAL CONSULTANTS, DBA: PMC
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
GENERAL LIABILITY SUPPLEMENTARY ENDORSEMENT
This endorsement modifies insurance provided under the following:
BUSINESSOWNERS COVERAGE FORM
I. Additional Insured by Contract, Agreement or
(ii) The 'bodily injury", "property
Permit
damage" or "personal and
Under SECTION II — LIABILITY, C. Who Is An
advertising injury" arises out of
Insured, Paragraph 4. is added as follows:
structural alterations, new
a. Any person or organization for whom you are
construction or demolition
performing operations when you and such person
operations performed by or on
or organization have agreed In writing in a
behalf of the manager or lessor, or
contract, agreement or permit that such person or
(5) To "bodily injury", "property damage" or
organization be added as an additional insured
"personal and advertising injury" arising out
on your policy. Such person or organization is an
of the rendering of or the failure to render
additional Insured only with respect to liability for
any professional services. This includes but
"bodily injury", "property damage'" or "personal
is not limited to any professional services as
and advertising Injury" caused. In whole or in
an architect or engineer arising out of any
part, by:
construction agreement or activities under
(1) Your acts or omissions; or
which any insured or anyone acting on any
(2) The acts or omissions of those acting on
insureds behalf provides or provided
service, advice, expertise or work.
your behalf,
Construction Includes, but is not limited to,
but only with respect to.
the plan, conception, design, build,
(3) "Your work' for the additional insured(s) at
construct, assembly, development, safety"
erection, formation, reconstruct,
the location designated In the contract,
rehabilitation, repair, or any Improvement
agreement or permit; or
made to real property. Construction also
(4) Premises you own, rent, lease, control or
Includes the hiring, supervision or
occupy.
management of any of these activities.
This insurance applies on a
PP primary basis if that
However, this exclusion does not apply to
is required by the written contract, agreement or
liability arising out of an Insured "s presence
permit.
at a jobslte that was not caused by
b. This provision does not apply:
professional activities listed In the above
paragraph.
(1) Unless the written contract or written
c. Additional insured coverage provided by this
agreement has been executed or permit has
been issued prior to the "bodily injury',
provision will not be broader than coverage
*Property damage" or "personal and
provided to any other insured.
advertisin g Injury";
d. All other insuring agreements, exclusions, and
(2) any person or organization included as
conditions of the policy apply.
an
an insured a endorsement issued by us
II. Additional Insured by Contract, Agreement or
and made part of
f this Policy;
Permit — Primary and Non-contributory
(3) To any lessor of equipment
The following is added to SECTION III — COMMON
(a) After the equipment lease expires; or
POLICY CONDITIONS:
(b) If the "bodily injury", "property damage"
M. Other Insurance
or "personal and advertising injury"
1. Additional insureds
arises out of the sole negligence of the
N you agree In a written contract, written
lessor:
agreement or permit that the insurance
(4) To any:
provided to any person or organization
(a) Owners or other Interests from whom
included as an Additional Insured under SECTION II - LIABILITY, Part C —Who Is
land has been leased which takes place
after the lease for that land expires; or
An Insured, is primary and non - contributory,
the following applies:
(b) Managers or lessors of premises if
(1) The occurrence takes place after
you cease to be a tenant in that
premises; or
391 -1586 02 11 Includes copyrighted material of Insurance Services Offices, Inc., with its permission Page 1 of 3
391 -1586 02 11
If other valid and collectible insurance Is
When this Insurance is excess, we will have
available to the Additional Insured far a loss
no duty under SECTION H — LIABILITY,
we cover under SECTION 11 — LIABILITY,
Part A. Coverages, 1. Business Liability to
Part A. Coverages, Paragraph 1., Business
defend the insured against any "suit" if any
Liability our obligations are limited as
other Insurer has a duty to defend the
follows:
insured against that "suit". If no other insurer
a. Primary Insurance
defends, we will undertake to do so, but we
This insurance is primary to other
Will be entitled to the insured's rights against
insurance that is available to the
all those other insurers.
Additional Insured which covers the
When this insurance is excess over other
Additional Insured as a Named Insured.
insurance, we will pay only our share of the
We will not seek contribution from any
amount of the loss, if any, that exceeds the
other insurance available to the
sum of:
Additional Insured except:
(1) The total amount that all such other
(1) For the sole negligence of the
insurance would pay for the loss in the
Additional Insured;
absence of this Insurance; and
(2) When the Additional Insured Is an
(2) The total of all deductible and self -
Additional Insured under another
insured amounts under all that other
primary liability policy; or
insurance.
(3) When b.(2) below applies.
We will share the remaining loss, If any, with
If this insurance Is primary, our
any other insurance that is not described in
obligations are not affianced unless
this Excess Insurance provision and was not
any of the other insurance is also
bought specifically to apply in excess of the
primary. Then, we will share with all
Limits of Insurance shown in the
Declarations of this Coverage Part.
that other insurance by the method
described In b.(3) below.
c. Method Of Sharing
b. Excess Insurance
If all of the other insurance penults contribution
This insurance is excess over:
by equal shares, we will follow this method also.
Under this approach each insurer contributes
(1) Any of the other Insurance, whether
equal amounts until it has paid Its applicable limit
Primary, excess, contingent or on
of Insurance or none of the loss remains,
any other basis:
whichever comes first.
(a) That is Fire, Extended
If any of the other insurance does not
Coverage, Builder's Risk,
permit
contribution by equal shares, we will contribute
Installation Risk or similar
by limits. Under this method, each insurer's share
coverage for "your work ";
Is based on the ratio of its applicable limit of
(b) That is Fire insurance for
insurance to the total applicable limits of
premises rented to the
insurance of all insurers.
Additional Insured or
III. Aggregate Limit of Insurance (Per Project)
temporarily occupied by the
Additional Insured with
a. For purposes of the coverage p rovided b this
permission of the owner;
endorsement, D. Liability and Medical
Expenses Limits of Insurance under Section II
(c) That is insurance purchased by
— Liability is amended by adding the following:
the Additional Insured to cover
e Additional Insured's liability
The General Aggregate ggregate Limit under D. Liability
as a tenant for "property
ty
and Medical Expenses Limits of Insurance
damage" to premises rented
applies separately to each of "your projects" or
the Additional Insured or
each location listed in the Declarations.
temporarily occupied by the
b. For purposes of the coverage provided by this
Additional Insured with
endorsement F. Liability And Medical
permission of the owner, or
Expenses Definitions under Section II -
(d) If the loss arises out of the
Liability Is amended by adding the following:
maintenance or use of aircraft,
a. "Your project" means:
"autos" or watercraft to the
1. Any premises, site or location at, on, or
extent not subject to Exclusion
in which "your work" is not yet
g. of SECTION II — LIABILITY,
completed; and
Part A. Coverages, 1.
Business Liability.
H. Does not include any location listed in
the Declarations.
IV. Blanket Waiver of Subrogation
Includes copyrighted materiel of Insurance Services Offices, Inc., with Its permission Page 2 of 3
.�r :w ♦ � NW � �
Conditions S amended by aaddition o a
right we will waive any of recovery we may have
against any person or organization when youi halve
agreed In a written contract permit or agreement to
waive any rights of recovery against such pemon or
•' qr . I N G i V, D •
work" done under a contract with that person or
organization and Included In the 'products-oomplated
operations y
391 -1586 0211 Includes Copyrighted material of Insurance Services Offices, Inc., with Its permission Page 3 of 3
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY
WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT— CA
This endorsement changes the policy to which it is attached effective on the
inception date of the policy unless otherwise stated.
This endorsement effective on 07/01/2013 at 12:01 am standard times forms a
part of Policy No. WZ3912749003
of the Hanover American Insurance Company
issued to: Pacific Municipal Consultants, DBA: PMC
Premium if an $
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)
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 2.000% of the California workers'
compensation premium otherwise due on such remuneration.
Schedule
Person or Organization
ANY PERSON OR ORGANIZATION WITH WHOM YOU AGREE IN WRITING TO WAIVE YOUR
RIGHT TO RECOVER AGAINST THEM. YOU MUST AGREE TO THIS WAIVER PRIOR TO THE
DATE OF LOSS
Job Description: Projects as on file with the insured
WC 252.040 84