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PROOF OF INSURANCE (2017) CLOSED CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY)
10/25/2016
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: 0 the corti'fic'ato holder is an ADDITIONAL INSURED, the policy(les) 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 endorsoment(s).
PRODUCER CONTACT Diana Chau
_NAME:
SelectSolutions Insurance Services PHONEr xt). (866)500-6359 �FAX,N ]:(925)951-0077
IM0N 1350 Carlback Avenue ADDRESS„dianac @ppibselect.com
Suite 100 INSURERIS)AFFORDING COVERAGE NAIC#
NaWalnut Creek CA 94596 025674
.... -- IINSURERB:Cr Property Casualty INSURER B Cont nental Casualty Compan 20443 _
INSURED
Denn Engineers INSURER C:
3914 Del Amo Boulevard INSURER D:
Suite 920 INSURER E
Torrance CA 90503 I INSURER F
COVERAGES CERTIFICATE NUMBER:16/17 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
ILTR TYPE OF INSURANCE IX�WVD POLICY NUMBER .(POLICY DIYYYY) (MM DD[YYYYI LIMITS
X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
IJAI&OE 1'0
A _ __—_CLAIMS-MADE 5W OCCUR PRPMj3ES(F(acccurrenue) „„$ 1,000,000
X 6801H8819461647 9/1/2016 9/1/2017 MED EXP(Any one person) $ 5,000
PERSONAL&ADV INJURY $ 1,000,000
GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
POLICY[-_I P, �p LOG PRODUCTS-COMP/OP AGG $ 2,000,000
OTHER, $
AUTOMOBILE LIABILITY N/A COMBINEr`U S INGLE l "LIMIY $
__. S .
ANY AUTO BODILY INJURY(Per person) $
ALL OWNED SCHEDULED BODILY INJURY(Per accident) $
AUTOS AUTOS
NON-OWNED j ROF EEC"I'Y I AMAGE $
HIRED AUTOS Far,gc. dtm"
UMBRELLA LIAB O N/A OCCURRENCE $
EXCESS LIAB CLAIMS-MADE AGGREGATE $
DED I A
RETENTION$ $
WORKERS COMPENSATION N/A ;"iTr'F')"U'T'E 111H-
AND ND EMPLOYERS'LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE YIN I E ,EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED? ❑ N/A
(Mandatory in NH) I E L DISEASE-EA EMPLOYEE $
If yes,describe under
DESCRIPTION OF OPERATIONS below E .DISEASE-POLICY LIMIT $
B PROFESSIONAL LIABILITY AEH113984368 11/7/2016 11/7/2017 PER CLAIM $1,000,000
AGGREGATE $1,000,000
I b
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
Re: As Per Contract or Agreement on File with the Insured. City of E1 Segundo, its officials, and
employees are named as additional insured on General Liability policy if required by written contract per
the attached endorsement.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City of E1 Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Public Works Department ACCORDANCE WITH THE POLICY PROVISIONS.
Attn: Floriza Rivera
350 Main St. AUTHORIZED REPRESENTATIVE
E1 Segundo, CA 90245
L Trevino/CHADII ..,,Ylrf:::a i".. d,, b;i ,.p� r.•� .,f"...,,
©1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
INS025/?m4ni)
POLICY NO.: 6801H8819461647 COMMERCIAL GENERAL LIABILITY
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
BLANKET ADDITIONAL INSURED
(ARCHITECTS, ENGINEERS AND SURVEYORS)
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
A. The following is added to WHO IS AN B. The following is added to Paragraph a. of 4.
INSURED(Section II): Other Insurance in COMMERCIAL
GENERAL LIABILITY CONDITIONS (Section
Any person or organization that you agree in a IV):
"contract or agreement requiring insurance" to
include as an additional insured on this However, if you specifically agree in a"contract
Coverage Part, but only with respect to liability or agreement requiring insurance" that the
for "bodily injury', "property damage" or insurance provided to an additional insured
"personal injury" caused, in whole or in part, by under this Coverage Part must apply on a
your acts or omissions or the acts or omissions primary basis, or a primary and non-
of those acting on your behalf: contributory basis, this insurance is primary to
other insurance that is available to such
a. In the performance of your ongoing additional insured which covers such additional
operations; insured as a named insured, and we will not
b. In connection with premises owned by or share with the other insurance, provided that:
rented to you;or
c. In connection with "your work" and (1) The "bodily injury" or "property damage"
included within the "products-completed for which coverage is sought occurs;and
operations hazard".
(2) The "personal injury' for which coverage
Such person or organization does not qualify is sought arises out of an offense
as an additional insured for "bodily injury", committed;
"property damage" or "personal injury" for
which that person or organization has after you have entered into that "contract or
assumed liability in a contract or agreement. agreement requiring insurance". But this
insurance still is excess over valid and
The insurance provided to such additional collectible other insurance, whether primary,
insured is limited as follows: excess, contingent or on any other basis, that
is available to the insured when the insured is
d. This insurance does not apply on any an additional insured under any other
basis to any person or organization for insurance.
which coverage as an additional insured
specifically is added by another C. The following is added to Paragraph 8.
endorsement to this Coverage Part. Transfer Of Rights Of Recovery Against
Others To Us in COMMERCIAL GENERAL
e. This insurance does not apply to the LIABILITY CONDITIONS(Section IV):
rendering of or failure to render any
"professional services". We waive any rights of recovery we may have
against any person or organization because of
f.. The limits of insurance afforded to the payments we make for "bodily injury",
additional insured shall be the limits which "property damage" or "personal injury" arising
you agreed in that"contract or agreement out of"your work"performed by you, or on your
requiring insurance" to provide for that behalf, under a "contract or agreement
additional insured, or the limits shown in requiring insurance" with that person or
the Declarations for this Coverage Part, organization. We waive these rights only
whichever are less. This endorsement where you have agreed to do so as part of the
does not increase the limits of insurance "contract or agreement requiring insurance"
stated in the LIMITS OF INSURANCE with such person or organization entered into
(Section III)for this Coverage Part. by you before, and in effect when, the "bodily
CG D3 81 09 07 ©2007 The Travelers Companies, Inc. Page 1 of 2
Includes copyrighted material of Insurance Services Office,Inc.,with its permission,
injury" or "property damage" occurs, or the "personal injury" is caused by an offense
"personal injury"offense is committed. committed:
D. The following definition is added to a. After you have entered into that contract or
DEFINITIONS(Section V): agreement;
"Contract or agreement requiring insurance" b. While that part of the contract or
means that part of any contract or agreement agreement is in effect;and
under which you are required to include a
person or organization as an additional insured c. Before the end of the policy period.
on this Coverage Part, provided that the"bodily
injury" and "property damage" occurs, and the
CG D3 81 09 07 ©2007 The Travelers Companies, Inc. Page 2 of 2
Includes copyrighted material of Insurance Services Office, Inc.,with its permission.
N C E
4. / ► DATE,MM/DDIYYYY)
INSURANCE
1/11/2017
THIS CERTIFICATE IS ISSUED AS A MAATTE� I
R OF INFORMATION MATTION ONLLY�A'D 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 ollc, Ios must be.
p y( � 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
u of such ondorsement(s).
PRODUCER ate holdor in I'I„e CONTACT'Blanca De La Hoz
Danmar Insurance Services Inc. L (951)509-0509 �; No) (951)509-0515
O.GICk➢,..
License # OD36873 ADDRESS,,
RERI i#4F C7 Gfi0dlGC 1dERAGE NAIC0
9899 Indiana Avenue Ste INSta„
CA 92503 INSPiRERA:Hart 'or, Apci.dent TmC1t,�_ n psR't�1i�'y. o
Riverside .... . .
INSURED rINSURERB:TechnOlocry ,Insurance .C,Ompany 42376
Dann 39 4 DallAmor Blvdc INSURER C:Ste 921 INS
�... _
U RER D
INSURER E:_
Torrance CA 90503 INSURER F
COVERAGES CERTIFICATE NUMBER.CL2711105282 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 ppPOLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
I INSURANCE p r POLICY NUMBER IMMIDOY FF R POLICY'EX"
PC�LI��CY EFI'. NtMIOONYEXY
I'LTI� LIMITS
I TYPE OF �0
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $
CLAIMS-MADE _.w. OCCUR PR�SE$( srrccxa�rpn ,),„ ,..,
0
. $
MED EXP(My cne person) $
PERSONAL 8 ADV INJURY S
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S
PRO.ET �LOC
PRODUCTS-
OTHER:
AUTOMOBILE LIABILITY COMBINED SINGLE P LIMIT
1,000,000
O NJURY( person) S
A X ANY AUTO
ALL OWNED AUTOS SCHEDULED O BODILY INJURY
„
(Per
72UECKC2774 7/17/2016 7/17/2017 BODILY INJURY accident)
HIRED SAUTOS AUTOS X 4._sr0-kienl)„....,. _
NON-OWNED ._,N.. ...$
Underinsured motorist S 1,000,000
UMBRELLA LIAB OCCUR EACH OCCURRENCE S
EXCESS ,.(CESS LIAR �� AGGREGATE S
OED]7 RETENTIONS pp $ -
WORXERSCOMPENSATIONI ANY C ROPH IMBER EXCLUDED?AEIVE ECUTIVE YIN NIA E 1_� T CI D... 1 HRH_ e__ s o _
AND EMPLOYERS LIABILITY Ip
B (Mae ato In.NH) ”' TWC3605817 2/1/2017 2/1/2018 EL.DISEASE-.. 1 AEM LIMIT $ 1,000x000
(Mandatory
If yye dasor be under
DES CRIPTION OF OPERATIONS Wk- --...,..
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES ACORD 101 .,
( ,Additional Remarks Schedule,may be attached H more space Is required)
The City, its officers, elected and appointed officials, employees and volunteers are to be covered as
insureds with respect to liability arising out of automobiles owned, leased, hired or borrowed by or on
behalf of the Consultant per attached RA9916 0312 endorsment.
Waiver of Subrogation Endorsement in favor of the Workers Compensation Policy Included Endorsement
WC040306 to follow
CERTIFICATE HOLDER CANCELLATION'
frivera @elsegundo.org
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City of E1 Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Public Works Department ACCORDANCE WITH THE POLICY PROVISIONS.
Floriza Rivera
350 Main Street AUTHORIZED REPRESENTATIVE
E1 Segundo, CA 90245 fyr
B De La Hoz/BLANCA �—
01988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD
INS025 pouo1)
COMMERCIAL AUTOMOBILE
HA 9916 0312
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
COMMERCIAL AUTOMOBILE, BROAD
ENDORSEMENT
This endorsement modifies insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
To the extent that the provisions of this endorsement provide broader benefits to the "insured" than other
provisions of the Coverage Form,the provisions of this endorsement apply.
1. BROAD FORM INSURED d. Any "employee" of yours while using a
A. Subsidiaries and Newly Acquired or covered "auto" you don't own, hire or
Formed Organizations borrow in your business or your
The Named Insured shown in the personal affairs.
Declarations is amended to include: C. Lessors as Insureds
(1) Any legal business entity other than a Paragraph A.1. -WHO IS AN INSURED -of
partnership or joint venture,formed as a Section II - Liability Coverage is amended to
subsidiary in which you have an add:
ownership interest of more than 50%on e. The lessor of a covered "auto"while the
the effective date of the Coverage Form. "auto" is leased to you under a written
However, the Named Insured does not agreement if:
include any subsidiary that is an (1) The agreement requires you to
"insured" under any other automobile
policy or would be an "insured" under provide direct primary insurance for
the lessor and
such a policy but for its termination or
the exhaustion of its Limit of Insurance. (2) The "auto"is leased without a driver.
(2) Any organization that is acquired or Such a leased "auto" will be considered a
formed by you and over which you covered "auto" you own and not a covered
maintain majority ownership. However, "auto"you hire.
the Named Insured does not include any D. Additional Insured if Required by Contract
newly formed or acquired organization: (1) Paragraph A.I. -WHO IS AN INSURED
(a) That is a partnership or joint - of Section It - Liability Coverage is
venture, amended to add:
(b) That is an "insured" under any other f. When you have agreed, in a written
policy, contract or written agreement,that a
(c) That has exhausted its Limit of person or organization be added as
Insurance under any other policy,or an additional insured on your
(d) 180 days or more after its business auto policy, such person or
acquisition or formation by you, organization is an"insured",but only
unless you have given us notice of to the extent such person or
the acquisition or formation. organization is liable for "bodily
Coverage does not apply to "bodily injury" or "property damage" caused
injury" or "property damage"that results by the conduct of an"insured"under
from an "accident" that occurred before paragraphs a. or b. of Who Is An
you formed or acquired the organization. Insured with regard to the
B. Employees as Insureds ownership, maintenance or use of a
Paragraph A.1. -WHO IS AN INSURED -of covered auto.
SECTION II - LIABILITY COVERAGE is
amended to add:
O 2011,The Hartford(Includes copyrighted material
Form HA 99 16 0312 of ISO Properties, Inc.,with its permission.) Page 1 of 5
The insurance afforded to any such E. Primary and Non-Contributory if
additional insured applies only if the Required by Contract
"bodily injury" or "property damage" Only with respect to insurance provided to
occurs: an additional insured in 1.D. - Additional
(1) During the policy period,and Insured If Required by Contract, the
(2) Subsequent to the execution of such following provisions apply:
written contract,and (3) Primary Insurance When Required By
(3) Prior to the expiration of the period Contract
of time that the written contract This insurance is primary if you have
requires such insurance be provided agreed in a written contract or written
to the additional insured. agreement that this insurance be
(2) How Limits Apply primary. If other insurance is also
If you have agreed in a written contract primary, we will share with all that other
Y 9 insurance by the method described in
or written agreement that another Other Insurance 5.d.
person or organization be added as an
additional insured on your policy, the (4) Primary And Non-Contributory To Other
most we will pay on behalf of such Insurance When Required By Contract
additional insured is the lesser of: If you have agreed in a written contract
(a) The limits of insurance specified in or written agreement that this insurance
the written contract or written is primary and non-contributory with the
agreement;or additional insured's own insurance, this
b The Limits of Insurance shown in insurance is primary and we will not
( ) seek contribution from that other
the Declarations. insurance.
Such amount shall be a part of and not Paragraphs (3) and (4) do not apply to other
in addition to Limits of Insurance shown insurance to which the additional insured
in the Declarations and described in this has been added as an additional insured.
Section.
(3) Additional Insureds Other Insurance When this insurance is excess, we will have no
duty to defend the insured against any suit if
If we cover a claim or "suit" under this any other insurer has a duty to defend the
Coverage Part that may also be covered insured against that "suit". If no other insurer
by other insurance available to an defends, we will undertake to do so, but we will
additional insured, such additional be entitled to the insured's rights against all
Insured must submit such claim or"suit" those other insurers.
to the other insurer for defense and When this insurance is excess over other
indemnity. insurance, we will pay only our share of the
However, this provision does not apply amount of the loss, if any, that exceeds the sum
to the extent that you have agreed in a of:
written contract or written agreement (1) The total amount that all such other
that this insurance is primary and non- insurance would pay for the loss in the
contributory with the additional insured's absence of this insurance;and
own insurance.
(2) The total of all deductible and self-insured
(4) Duties in The Event Of Accident, Claim,
Suitor Loss amounts under all that other insurance.
If you have agreed in a written contract We will share the remaining loss, if any, by the
or written agreement that another method described in Other Insurance 5.d.
person or organization be added as an 2. AUTOS RENTED BY EMPLOYEES
additional insured on your policy, the Any "auto" hired or rented by your "employee"
additional insured shall be required to on your behalf and at your direction will be
comply with the provisions in LOSS considered an"auto"you hire.
CONDITIONS 2. - DUTIES IN THE The OTHER INSURANCE Condition is amended
EVENT OF ACCIDENT, CLAIM , SUIT by adding the following:
OR LOSS — OF SECTION IV —
BUSINESS AUTO CONDITIONS, in the
same manner as the Named Insured.
©2011,The Hartford (Includes copyrighted material
Form HA 9916 0312 of ISO Properties, Inc.,with its permission.) Page 2 of 5
If an "employee's" personal Insurance also 5. PHYSICAL DAMAGE - ADDITIONAL
applies on an excess basis to a covered "auto" TEMPORARY TRANSPORTATION EXPENSE
hired or rented by your "employee" on your COVERAGE
behalf and at your direction, this insurance will Paragraph AA.a. of SECTION III - PHYSICAL
be primary to the "employee's" personal DAMAGE COVERAGE is amended to provide a
insurance. limit of $50 per day and a maximum limit of
3. AMENDED FELLOW EMPLOYEE EXCLUSION $1,000.
EXCLUSION 5. - FELLOW EMPLOYEE - of 6. LOAN/LEASE GAP COVERAGE
SECTION II - LIABILITY COVERAGE does not Under SECTION III - PHYSICAL DAMAGE
apply if you have workers' compensation COVERAGE, in the event of a total "loss" to a
insurance in-force covering all of your covered "auto", we will pay your additional legal
"employees". obligation for any difference between the actual
Coverage is excess over any other collectible cash value of the "auto" at the time of the"loss"
insurance. and the"outstanding balance"of the loan/lease.
4. HIRED AUTO PHYSICAL DAMAGE COVERAGE "Outstanding balance" means the amount you
If hired "autos" are covered "autos" for Liability owe on the loan/lease at the time of"loss" less
Coverage and if Comprehensive, Specified any amounts representing taxes; overdue
Causes of Loss, or Collision coverages are payments; penalties, interest or charges
provided under this Coverage Form for any resulting from overdue payments; additional
„auto you own, then the Physical Damage mileage charges; excess wear and tear charges;
Coverages provided are extended to"autos"you lease termination fees; security deposits not
hire or borrow, subject to the following limit. returned by the lessor; costs for extended
The most we will pay for "loss" to any hired warranties, credit life Insurance, health, accident
or disability insurance purchased with the loan or
"auto"is: lease; and carry-over balances from previous
(1) $100,000; loans or leases.
(2) The actual cash value of the damaged or 7. AIRBAG COVERAGE
stolen property at the time of the"loss';or Under Paragraph B. EXCLUSIONS - of
(3) The cost of repairing or replacing the SECTION III - PHYSICAL DAMAGE
damaged or stolen property, COVERAGE, the following is added:
whichever is smallest, minus a deductible. The The exclusion relating to mechanical breakdown
deductible will be equal to the largest deductible does not apply to the accidental discharge of an
applicable to any owned "auto" for that airbag.
coverage.No deductible applies to"loss"caused g, ELECTRONIC EQUIPMENT - BROADENED
by fire or lightning. Hired Auto Physical Damage COVERAGE
coverage is excess over any other collectible
insurance. Subject to the above limit, deductible a. The exceptions to Paragraphs B.4 -
and excess provisions, we will provide coverage EXCLUSIONS - of SECTION III - PHYSICAL
equal to the broadest coverage applicable to any DAMAGE COVERAGE are replaced by the
covered"auto"you own. following:
We will also cover loss of use of the hired"auto" Exclusions 4.c. and 4.d. do not apply to
if it results from an "accident", you are legally equipment designed to be operated solely
liable and the lessor Incurs an actual financial by use of the power from the "auto's"
loss, subject to a maximum of $1000 per electrical system that, at the time of"loss",
"accident". is:
This extension of coverage does not apply to (1) Permanently installed in or upon
any "auto" you hire or borrow from any of your the covered"auto";
"employees", partners (if you are a partnership), (2) Removable from a housing unit
members (if you are a limited liability company), which is permanently installed in
or members of their households. or upon the covered"auto";
(3) An integral part of the same unit
housing any electronic
equipment described in
Paragraphs(1)and (2)above;or
©2011,The Hartford(includes copyrighted material
Form HA 9916 0312 of ISO Properties, Inc.,with its permission.) Page 3 of 5
(4) Necessary for the normal If another Hartford Financial Services Group,
operation of the covered"auto"or Inc. company policy or coverage form that is not
the monitoring of the covered an automobile policy or coverage form applies to
"auto's"operating system. the same"accident",the following applies:
b.Section III — Version CA 00 01 03 10 of the (1) If the deductible under this Business Auto
Business Auto Coverage Form, Physical Coverage Form is the smaller (or smallest)
Damage Coverage, Limit of - Insurance, deductible, it will be waived;
Paragraph C.2 and Version CA 00 01 10 01 of (2) If the deductible under this Business Auto
the Business Auto Coverage Form, Physical Coverage Form is i not the smaller (or
Damage Coverage, Limit of Insurance, smallest) deductible,, it will be reduced by
Paragraph C are each amended to add the the amount of the' ,smaller (or smallest)
following: deductible.
$1,500 is the most we will pay for"loss" in 12. AMENDED DUTIES IN THE EVENT OF
any one "accident" to all electronic ACCIDENT, CLAIM, SUIT OR LOSS
equipment(other than equipment designed
The requirement in LOSS CONDITIONS 2.a. -
solely for the reproduction of sound, and
a DUTIES IN THE EVENT OF ACCIDENT,CLAIM,
accessories used with such equipment)
SUIT OR LOSS - of SECTION IV - BUSINESS
that reproduces, receives or transmits
AUTO CONDITIONS that you must notify us of
audio, visual or data signals which, at the
time of"loss", is: an "accident" applies only when the"accident"is
known to:
(1) Permanently installed in or upon
the covered "auto" in a housing, (1) You,if you are an individual;
opening or other location that is not (2) A partner,if you are a partnership;
normally used by the "auto" (3) A member, if you are a limited liability
manufacturer for the installation of company;or
such equipment; (4) An executive officer or insurance manager,if
(2) Removable from a permanently you are a corporation.
installed housing unit as described 13. UNINTENTIONAL FAILURE TO DISCLOSE
in Paragraph 2.a. above or is an HAZARDS
integral part of that equipment;or
(3)An integral part of such equipment. If you unintentionally fail to disclose any hazards
existing at the inception date of your policy, we
c.For each covered "auto", should loss be limited will not deny coverage under this Coverage
to electronic equipment only, our obligation to Form because of such failure.
pay for, repair, return or replace damaged or 14. HIRED AUTO-COVERAGE TERRITORY
stolen electronic equipment will be reduced by
the applicable deductible shown in the Paragraph e. of GENERAL CONDITIONS 7. -
Declarations, or $250, whichever deductible is POLICY PERIOD, COVERAGE TERRITORY -
less. of SECTION IV - BUSINESS AUTO
9. EXTRA EXPENSE - BROADENED CONDITIONS is replaced by the following:
COVERAGE e. For short-term hired "autos", the coverage
Under Paragraph A. -COVERAGE-of SECTION territory with respect to Liability Coverage is
III - PHYSICAL DAMAGE COVERAGE, we will anywhere in the world provided that if the
pay for the expense of returning a stolen covered "insured's" responsibility to pay damages for
"bodily injury" or "property damage" is
"auto"to you. determined in a"suit,"the"suit"is brought in
10. GLASS REPAIR-WAIVER OF DEDUCTIBLE the United States of America, the territories
Under Paragraph D.-DEDUCTIBLE-of SECTION and possessions of the United States of
III - PHYSICAL DAMAGE COVERAGE, the America, Puerto Rico or Canada or in a
following is added: settlement we agree to.
No deductible applies to glass damage if the 15. WAIVER OF SUBROGATION
glass is repaired rather than replaced. TRANSFER OF RIGHTS OF RECOVERY
11. TWO OR MORE DEDUCTIBLES AGAINST OTHERS TO iUS - of SECTION IV -
Under Paragraph D.-DEDUCTIBLE-of SECTION BUSINESS AUTO CONDITIONS is amended by
III - PHYSICAL DAMAGE COVERAGE, the adding the following:
following is added:
©2011,The Hartford(Includes copyrighted material
Form HA 9916 0312 of ISO Properties, Inc.,with its permission.) Page 4 of 5
i
We waive any right of recovery we may have c.Regardless of the number of autos deemed a
against any person or organization with whom total loss, the most we will pay under this
you have a written contract that requires such Hybrid, Electric, or Natural Gas Vehicle
waiver because of payments we make for Payment Coverage provision for any one
damages under this Coverage Form. "loss"is$10,000.
16. RESULTANT MENTAL ANGUISH COVERAGE For the purposes of the coverage provision,
The definition of "bodily injury" in SECTION V- a.A "non-hybrid" auto is defined as an auto that
DEFINITIONS is replaced by the following: uses only an internal combustion engine to
"Bodily injury" means bodily injury, sickness or move the auto but does not include autos
disease sustained by any person, including powered solely by electricity or natural gas.
mental anguish or death resulting from any of b.A "hybrid" auto is defined as an auto with an
these. internal combustion engine and one or more
17. EXTENDED CANCELLATION CONDITION electric motors; and that uses the internal
Paragraph 2. of the COMMON POLICY combustion engine and one or more electric
g p motors to move the auto, or the internal
CONDITIONS - CANCELLATION - applies combustion engine to charge one or more
except as follows: electric motors,which move the auto.
If we cancel for any reason other than 19. VEHICLE WRAP COVERAGE
nonpayment of premium, we will mail or deliver
to the first Named Insured written notice of In the event of a total loss to an "auto"for which
cancellation at least 60 days before the effective Comprehensive, Specified Causes of Loss, or
date of cancellation. Collision coverages are provided under this
18. HYBRID, ELECTRIC, OR NATURAL GAS Coverage Form, then such Physical Damage
VEHICLE PAYMENT COVERAGE Coverages are amended Ito add the following:
In the event of a total loss to a "non-hybrid" auto In addition to the actual cash value of the "auto",
for which Comprehensive, Specified Causes of we will pay up to $1,000 for vinyl vehicle wraps
which are displayed on the covered "auto" at the
Loss, or Collision coverages are provided under time of total loss. Regardless of the number of
this Coverage Form, then such Physical autos deemed a total loss, the most we will pay
Damage Coverages are amended as follows: under this Vehicle Wrap Coverage provision for
a.If the auto is replaced with a "hybrid" auto or any one "loss" is $5,000. For purposes of this
an auto powered solely by electricity or natural coverage provision, signs or other graphics
gas, we will pay an additional 10%, to a painted or magnetically affixed to the vehicle are
maximum of$2,500, of the "non-hybrid"auto's not considered vehicle wraps.
actual cash value or replacement cost,
whichever is less,
b.The auto must be replaced and a copy of a bill
of sale or new lease agreement received by us
within 60 calendar days of the date of"loss,"
©2011,The Hartford(Includes copyrighted material
Form HA 9916 03 12 of ISO Properties, Inc.,with its permission.) Page 5 of 5
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06
(Ed.01-84)
WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT CALIFORNIA
We have the right to recover our payments from anyone liable(or an Injury covered by this policy.We will not enforce our right
against the person or organization named in the Schedule.(This agreement applies only to the extent that you perform work under
a written contract that requires you to obtain this agreement from us.)
You must maintain payroll records accurately segregating the remuneration of your employees while engaged In the work
described in the Schedule.
The additional premium for this endorsement shall be 0%of the California workers'compensation premium otherwise due on such
remuneration.
Schedule
Person or Organization Job Description
City of El Segundo
Segundo,CA 90245 All CA Operations
This endorsement changes the policy to which it is attached and Is effective on the date issued unless otherwise stated,
(The Information below is required only when this endorsement Is Issued subsequent to preparation of the policy.)
Endorsement Effective 2/1/2017 Policy No. TWC3605817 Endorsement No. 1
Insured Donn Engineers,Inc. Premium$ 4431
Insurance Company Technology Insurance Company,Inc.
Countersigned by
WC 04 03 06
(Ed.01-84)