Loading...
PROOF OF INSURANCE (2016 - 2017) CLOSED=o(9m/28'/2oD1/y6 YYY) CERTIFICATE OF LIABILITY INSURANCE 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(es) must have ADDITIONAL INSURED provisions or 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 CONTACT NAME: (866) 283 7122 ,. (8 Aon Risk Insurance Services West, Inc„ -- — " 00) 363 0105 Los An el es CA office Ext) 1 N 707 Wi shire Boulevard E-MAIL Suite 2600 ADDRESS: Los Angeles CA 90017 -0460 USA INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURER A: North American Elite Insurance company 29700 ACCO Enqineered Systems, Inc. INSURE _...._." PLA.TO_..... ,,,,,,,,,,_ RB: XL Insurance America Inc 24554 6265 San Fernando Road INSURER C: Greenwich Insurance company WWW WWWWW "22322 Glendale CA 91201 USA _ INSURER D: Indian Harbor Insurance Company 36940 INSURER E: Berkley Assurance Company 39462.................. INSURER F: COVERAGES CERTIFICATE NUMBER: 570063902915 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. Limits shown are as requested' I..TI TYPE OF INSURANCE lNSiP WVD POLICY NUMBER mm orvyyyy MMrowyYYY. LIMITS X COMMERCIAL GENERAL LIABILITY t RGD EACH OCCURRENCE $1,000,000 I.. CLAIMS -MADE I I X I OCCUR PREMISES (Ea occutrgnce $300,000 MED EXP (Any one person) $5,000 �..._,.".._ ................ PERSONAL 8 ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT A.pPL.IIES PER: GENERAL AGGREGATE $2,000,000 PRO - POLICY X ��� �.., JECT Y... k LOC PRODUCTS - COMP /OP AGG $2,000,000 OTHER: .,.,..,.._ .,_,m........._...._......_. ............._., " " ".",",w C AUTOMOBILE LIABILITY Y Y RAD500014909 10/01/201610/01 /2017 COMBINED SINGLE LIMIT $2,000,000 (EpLeccident) X ANY AUTO BODILY INJURY ( Per person) OWNED " "" SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) HIREDAUTOS NON -OWNED PROPERTY DAMAGE .. ONLY AUTOS ONLY (Per accident).. A X UMBRELLA LIAB X OCCUR Y Y UMB2 O 00 10/01/2016 12/30/2016 EACH OCCURRENCE -$4,000,000 EXCESS LIAB CLAIMS -MADE AGGREGATE $4,000,060 DED I X IRETENTION 325,000 B WORKERS COMPENSATION . AND Y RWD500014809 1D 01/2016 1D /01 /LOI.7 X..u. 3TAi0TE OTH- ANY PROPRIETOR / PARTNER / EXECUTIVE ° " "/" E.L. EACH ACCIDENT $1,000,000 oPFICtP)WMeER E:XCLUDF177 YN NIA (Mandatory In NH) �• E,L.DISEASE -EA EMPLOYEE $1,000,000 If yyes,, describe under DESCRIPTION OF OPERATIONS below E.L DISEASE - POLICY LIMIT $1,000,000 E Env Contr Prof PCADB50012831016 10/01/2016 10/01/2017 Aggregate /Each LOSS $1,000,000 Claims Made Prof Agg SIR $600,000 SIR applies per policy ter ''IS & condi'ions Prof Each Claim SIR $200,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached it more space is required) [Re: service, All operations at the City of El Segundo] [AI: City of El Segundo, its officials, officers, agents, and employees] are included as Additional Insured with respect to the General Liability, Automobile Liability and Umbrella Liability policies; granted a Waiver of Subrogation for General Liability, Automobile Liability, umbrella Liability and Workers' Compensation policies; and the General Liability policy evidenced herein is Primary and Non- Contributory to other insurance available, as required by written contract, but limited to the operations of the Insured under said contract. umbrella Liability follows form over General Liability, Automobile Liability and Employers' Liability. CERTIFICATE HOLDER 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. City of El Segundo AUTHORIZED REPRESENTATIVE its officials, officers, agents and employees Public Works Department 350 Main Street, E1 Segundo CA 90245 USA ©1988 -2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD a AGENCY CUSTOMER ID: 10021564 LOC #: ADDITIONAL REMARKS SCHEDULE Page _ of _ AGENCY NAMED INSURED Aon Risk Insurance services West, Inc. ACCO Engineered systems, Inc. POLICY NUMBER see certificate Number: 570063902915 CARRIER NAIC CODE see certificate Number: 570063902915 EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance ADDITIONAL POLICIES If a policy below does not include limit information, refer to the corresponding policy on the ACORD certificate form for policy limits. ACORD 101 (2008101) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: RGD5000150 -09 COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON O ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) ........................................................................................... ............................... Locations Of Covered Operations Any person or organization for whom the Named Insured All leased premises has agreed to provide insurance prior to loss as provided by this policy but only to the limit and scope of insurance agreed to by the Named insured. City of El Segundo, its officials, officers, agents, and Service, All operations at the City of El Segundo employees Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. 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 ", "property damage" 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(s) at the location(s) designated above. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or However: 2. That portion of "your work" out of which the injury or damage arises has been put to its 1. The insurance afforded to such additional intended use by any person or organization insured only applies to the extent permitted by other than another contractor or subcontractor law; and engaged in performing operations for a 2. If coverage provided to the additional insured is principal as a part of the same project. required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. CG 20 10 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 2 C. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance 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 © Insurance Services Office, Inc., 2012 CG 20 10 04 13 POLICY NUMBER: RGD5000150 -09 COMMERCIAL GENERAL LIABILITY CG 20 37 04 13 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 PRODUCTS /COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations Any person or organization for whom the Named All locations Insured has agreed to provide insurance prior to loss as provided by this policy but only to the limit and scope of insurance agreed to by the Named Insured. City of El Segundo, its officials, officers, agents, and Service, All operations at the City of El Segundo employees Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. 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 ". However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. CG 20 37 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 2 B. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance 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 © ISO Properties, Inc., 2004 CG 20 37 04 13 13 ENDORSEMENT # This endorsement, effective 12:01 a.m., 10 -01- 2016, forms a part of Policy No. RGD5000150 -09 issued to Acco Engineered Systems, Inc. by Greenwich Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY INSURANCE CLAUSE ENDORSEMENT This endorsement modifies insurance provided under the following:. COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS /COMPLETED OPERATIONS COVERAGE PART It is agreed that to the extent that insurance is afforded to any Additional Insured under this policy, this insurance shall apply as primary and not contributing with any insurance carried by such Additional Insured, as required by written contract. All other terms and conditions of this policy remain unchanged. XIL 424 0605 ©, 2005, XL America, Inc. POLICY NUMBER: RAD500014909 COMMERCIAL AUTO CA 04 44 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US ('WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: ACCO ENGINEERED SYSTEMS, INC. Endorsement Effective Date: October 1, 2016 SCHEDULE Name(s) Of Person(s) Or Organization(s): Where required by written contract or agreement executed prior to loss (except where not permitted by law) City of El Segundo, its officials, officers, agents, and employees Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The Transfer Of Rights Of Recovery Against Others To Us condition does not apply to the person(s) or organization(s) shown in the Schedule, but only to the extent that subrogation is waived prior to the "accident' or the 'loss" under a contract with that person or organization. CA 04 44 10 13 © Insurance Services Office, Inc., 2011 Page 1 of 1 POLICY NUMBER: RAD500014909 COMMERCIAL AUTO CA 20 48 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED FOR COVERED AUTOS LIABILITY COVERAGE This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: ACCO ENGINEERED SYSTEMS, INC. Endorsement Effective Date: October 1, 2016 SCHEDULE Name Of Person(s) Or Organization(s): City of El Segundo, its officials, officers, agents, and employees Where required by written contract executed prior to loss Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Each person or organization shown in the Schedule is an "insured" for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Paragraph A.I. of Section II — Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms and Paragraph D.2. of Section I — Covered Autos Coverages of the Auto Dealers Coverage Form. CA 20 48 10 13 © Insurance Services Office, Inc., 2011 Page 1 of 1 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 04 -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 Where required by written agreement signed prior to loss All California Operations City of El Segundo, its officials, officers, agents, and employees Service, All operations at the City of El Segundo This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 10 -01 -2016 Policy No. RWD5000148 -09 Endorsement No. Insured Acco Engineered Systems, Inc. Insurance Company XL Insurance America, Inc. Countersigned By WC 04 03 06 Page 1 of 2 (Ed. 04 -84) Copyright 1984 Workers' Compensation Insurance Rating Bureau of California. All Rights Reserved. WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 04 -84) WC 04 03 06 Page 2 of 2 (Ed. 04 -84) Copyright 1984 Workers' Compensation Insurance Rating Bureau of California. All Rights Reserved. POLICY NUMBER: RGD5000150 -09 COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS /COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: City of El Segundo, its officials, officers, agents, and employees Where required by written contract or agreement executed prior to loss (except where not permitted by law) Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV — Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products - completed operations hazard ". This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 1