Loading...
PROOF OF INSURANCE (2014) CLOSEDA CERTIFICATE OF LIABILITY INSURAI CE F4/25/2013 DATE (MM /ffYYY) 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 NAME,. T Judy Dempsey Walter Mortensen Insurance / INSURICA PHONE (760) 379 -4651 TAR ( ?eo) 3 ?s -e ?22 N CA License #OD44424 E-MAIL jdempsey @insurica.com Amcn 5520 G4 Isabella B1, POBx 2663 AFFORDING COVE-RAGE NAIC# Lake Isabella CA 93240 --- INSURERS AFFORDING � ° ° °° ° • •° INSURER A: nduranc Am r1.C� _ an Specialty _ INSURED Rite Inc., DBA: The Perfect Field INSURER C: " " "• RE ._ 2075 Corte del Nogal �---- -- INSURBR D _" Suite X �....... ..... INSURER E: Carlsbad CA 92011 INSURER P: COVERAGES CERTIFICATE NUMBER:13 -14 GL 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. N "rfSR POLICY NUMBER ......... M "_ ..... ... ...... 9 ICY EXP LTR GENERAL LIABILITY INSURANCE PO4NCY EFF i'i7 /DO LIMITS EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY –" "" 000 �^:aoa;cr rr:noe) $ 100, A CLAIMS -MADE ;ro''''py OCCUR POg0000021901 4/23/2013 4/23/2014 PRBNgIS'�jE " °' MED EXP (Any one per, eo p PERSONAL & ADV INJURY $ 11000,000 GENERALAGGRrGAf "E $ ".. 2 000,000 GEN'LAGGREGATELIMITAPPLI LOC PRODUCTS - COMP /OPAGG $ 2,000,000 G ... ._ X POLICY PRO" LOC $ AUTOMOBILE LIABILITY MBI EO SIN La IMVT (Fn,eca ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED •.... AUTOS AUTOS BODILY INJURY (Per accident) $ NON -OWNED –– — . HIRED AUTOS AUTOS PROPLRCY DAMAGE Per aecldea f $ UMBRELLA LIAB OCCUR EACfI OCCURRENCE $ EXCESS LIAB – CLAIMS- MADE AGGREGATE $ _�. DIED RE I ENTCOGf $ $ WORKERS COMPENSATION Y / N Va� "�TATU OI'h ;. AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE - OFFICERIMEMBEREXCLUDED? N/A ILL EACt "I ACCIDENT $ �..t,�]L.. L'I� (Mandatory in NH) E.L. DISEASE EA EMh LOYd ���� y ..' describe ondrer IT,_, ...M... H RIPTION' OF OPERATIONS below E,L. DMEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Addililonal Remarks Schedule, if more space is required) The City of El Segundo, its officers, officials, employees, agents & volunteers are added to the General Liability policy as Additional Insureds,, per form CG 20 37 7/04 attached, subject to the terms, conditions and exclusions of the policy. Insurance is primary and non contributory per form EGL905 (06/06). A written contract is required for the additional insured and primary & non contributory to be valid. Cancellation provisions per attached form IL 00 17 (11/98), CERTIFICATE HOLDER. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of E1 Segundo ACCORDANCE WITH THE POLICY PROVISIONS. its officials & employees Attention: City Clerk AUTHORIZED REPRESENTATIVE 350 Main Street E1 Segundo, CA 90245 Ron Burcham /JDEMPS 1�51_7 r ACORD 26 (2010/05) ©1988 -2010 ACORD CORPORATION. All rights reserved. INS025 (201005).01 The ACORD name and logo are registered marks of ACORD POLICY NUMBER: AP000000021901 COMMERCIAL GENERAL LIABILITY CG 20 37 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Or- anization Location And Description Of Completed Operations City of El Segundo, its officials & employees Various Attention: City Clerk 350 Main Street El Segundo, CA 90245 Information re uired to com late this Schedule„ if not shown above„ will be shown in the Declarations. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage " caused', in whole or in part, by "your work "" at the location designated and described in the schedule of this endorsement performed for that additional insured and included in the "products - completed operations hazard" CG 20 37 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 11 POLICY NUMBER: AP000000021901 COMMON POLICY CONDITIONS S All Coverage Parts included in this policy are subject to the following conditions. A. Cancellation 1. The first Named Insured shown in the Declarations may cancel this policy by mailing or delivering to us advance written notice of cancellation. 2. We may cancel this policy by mailing or delivering to the first Named Insured written notice of cancellation at least: a. 10 days before the effective date of cancellation if we cancel for nonpayment of premium; or b. 30 days before the effective date of cancellation if we cancel for any other reason. 3. We will mail or deliver our notice to the first Named Insured's last mailing address known to us. 4. Notice of cancellation will state the effective date of cancellation. The policy period will end on that date. 5. If this policy is cancelled, we will send the first Named Insured any premium refund due. If we cancel, the refund will be pro rata. If the first Named Insured cancels, the refund may be less than pro rata. The cancellation will be effective even if we have not made or offered a refund. 6. If notice is mailed, proof of mailing will be sufficient proof of notice. B. Changes This policy contains all the agreements between you and us concerning the insurance afforded. The first Named Insured shown in the Declarations is authorized to make changes in the terms of this policy with our consent. This policy's terms can be amended or waived only by endorsement issued by us and made a part of this policy, C. Examination Of Your Books And Records We may examine and audit your books and records as they relate to this policy at any time during the policy period and up to three years afterward. D. Inspections And Surveys 1. We have the right to: a. Make inspections and surveys at any time; IL 00 17 1198 b. Give you reports on the conditions we find; and c. Recommend changes. 2. We are not obligated to make any inspections, surveys, reports or recommendations and any such actions we do undertake relate only to insurability and the premiums to be charged. We do not make safety inspections. We do not undertake to perfdrrn the duty of any person or organization to provide for the health or safety of workers or the public. And we do not warrant that conditions: a. Are safe or healthful; or b. Comply with laws, regulations, codes or standards. 3. Paragraphs 1, and 2. of this condition apply not only to us, but also to any rating, advisory„ rate service or similar organization which makes insurance inspections, surveys, reports or recommendations, 4. Paragraph 2. of this condition does not apply to any inspections, surveys„ reports or recommendations we may make relative to certification, under state or municipal statutes, ordinances or regulations, of boilers, pressure vessels or elevators. E. Premiums The first Named Insured shown in the Declarations: 1. Is responsible for the payment of all premiums; and 2. Will be the payee for any return premiums we pay. F. Transfer Of Your Rights And Duties Under This Policy Your rights and duties under this policy may not be transferred without our written consent except in the case of death of an individual named insured. If you die, your rights and duties will be transferred to your legal representative but only while acting within the scope of duties as your legal representative. Until your legal representative is appointed, anyone having proper temporary custody of your property will have your rights and duties but only with respect to that property. IL 00 17 11 98 Copyright, Insurance Services Office, Inc., 1998 Page 1 of 1 ❑ " AC" '" CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 4/5/2013 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 CON. T—ACT Jud7 .._. .... . Dempsey _...m.n._.r Walter Mortensen Insurance / INSURICA PHONE (760)379 -4651 F (760)379 -8722 CA License #OD44424 E -MM Ji dempsey@ insurica.c:It 5520 G4 Isabella Ell, POBX 2663 INSURER(8 AFFORDING COVERAGE NAIC# Lake Isabella CA 93240 INSURERA:Peerless Insurance ComiDanv INSURED INSURER B: Rite, Inc. INSURER C: dba The Perfect Field INSURER D: 2075 Corte del Nogal Suite X INSURER Carlsbad CA 92011 INSURER F: COVERAGES CERTIFICATE NUMBER:13 -14 BA 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. POLICY EFF POLICY EXP ,I7q TYPE OF INSURANCE A L POLICY NUMBER MM/ D M .._...... LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY PREMISE Ea occurrence $ E' CLAIMS -MADE OCCUR MED EXP (An one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE ''..$ GEN'L AGGREGATE LIMIT APPLIES PER: PROD IJI T - G MPIOf> A00 $ POLICY LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Eaaca• rodent 1,000,000 ANY AUTO A BODILY INJURY (Per person) $ ALL OWNED SCHEDULED AA1039385 /16/2013 /16/2014 X BODILY INJURY (Per accident) $ AUTOS AUTOS X X NON -OWNED ''. f'ECOP'ER'1 "'Y DAMAGE $ HIRED AUTOS AUTOS JPer accident. Underinsured motorist $ 500 000 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION WC STATU - OTH -'.. AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR /PARTNER /EXECUTIVE E.L.. EACH ACCIDENT $ OFFICER /MEMBER EXCLUDED? N/A • ° °° -° (Mandatory in NH) E L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E L DISEASE POLICY LIMIT $ DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of E1 Segundo ACCORDANCE WITH THE POLICY PROVISIONS. its officials & employees c/o City Clerk AUTHORIZED REPRESENTATIVE 350 Main Street, Room #5 E1 Segundo, CA 90245 -3813 Ron Burcham /JDEMPS e ACORD 25 (2010/05) ©1988 -2010 ACORD CORPORATION. All rights reserved. INS025 (201005) 01 The ACORD name and logo are registered marks of ACORD