Loading...
PROOF OF INSURANCE (2017) CLOSED a DATE(MMIDD/YYYY) � CERTIFICATE OF LIABILITY INSURANCE 3/30/2017 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). CONTACT' .. ......,,, PRODUCER NAMF: Carrie Allen Robert Harris Insurance Agency, Inc. PHONE (714)619-4480 FAX (r1a>61s-seal (AIC,No,.Exley, (AIC,Naafi: Lic. #0216736 EMAIL Carrie @reharris.com oa.al�rtES$,r, 3150 Bristol St. , Suite 200 INSURERS)AFFORDING COVERAGE NAIC# Costa Mesa CA 92626 INiSURE'R'A:Travelers Cas Ins Co of America. 19046 INSURED INSURER B:Hartford Accident & Indemnity 22357 Complete Pa erless Solutions LLC SRERC:Lloyds of London/S&C P P !N...U 4025 E. La Palma Ave #204 INSURER D: Anaheim, CA 92807 INSURER E: INSURER F COVERAGES CERTIFICATE NUIMBER: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 AIN Dw 3 D P'OLKCY NUMBER IMIOLICY EFF POLICY EXP TYPE OF INSURANCE POLICY P POLICY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 A CLAIMS-MADE X I OCCUR DAMAGE 70 RENTED 300,000 PREMISES(Ea occurrence) X 6808BB47614 6/23/2016 6/23/2017 MED EXP(Any one person) $ 10,000 PERSONAL BADVINJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 X POLICY JEC' .I LOC PRODUCTS-COMraK I)AGG $ 4,000,000 [°GyT OTHER $ AUTOMOBILE LIABILITY COMBINED NED SINGL,E LIM11 $ 1,000,000 (re:a accidtntp ANY ALL OWNED I SCHEDULED arson) $ A AUTOS TO INJURY(Per AUTO 68OBB647614 6/23/2016 6/23/2017 INJURY(Per accident) $ X HIRED AUTOS X I NON-OWNED PROPER AUTOS (Peraraident) i$ 1 $ UMBRELLA IAB I C NEN ;K:? d $ EXCESS B CLAIMS-MADE AGGREGATE $ DED RETENTION$' $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE """" EL EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? Y N/A B (Mandatory in NH) 72WECZX9262 6/23/2016 6/23/2017 EL D$EASE-EA E'mr,i,a',yr.E,� $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below EL DISEASE°POLICY LIMIT' $ 11000,000 C Professional Liability ESF03232782 1/11/2017 1/11/2018 Coverage Limit $1,000,000 Claims Made form Maximum Limit per policy. $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) The City, its officials and employees are added as Additional Insured as their interest may appear as respects operations of the Named Insured (see blanket policy form #CGD105 0494 attached) . Coverage provided is Primary over any other insurance maintained by the Additional Insured on all coverages, except Professional Liability. All Members/Owners are excluded from Workers Compensation coverage. A Waiver of Subrogation endorsement, issued on behalf of the Additional insured, as respects Workers Compensation, is attached. Policies are subject to 10-days Notice of Cancellation in the event of non-payment of premium. CERTIFICATE HOLDER CANCELLATION cschott @cps247.com SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of E1 Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 350 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. E1 Segundo, CA 90245 AUTHORIZED REPRESENTATIVE Carrie Allen/CALLEN ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401) COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURE OWNERS, LESSEES OR CONTRACTORS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PROVISIONS: 1. WHO IS AN INSURED (SECTION II) is amended in a written contract for this insurance to to include as an insured any person or organiza- apply on a primary or contributory basis. tion (called hereafter "additional insured") whom 3. This insurance does not apply: you have agreed in a written contract, executed prior to loss, to name as additional insured, but a. on any basis to any person or organization only with respect to liability arising out of "your for whom you have purchased an Owners work" or your ongoing operations for that addi- and Contractors Protective policy. tional insured performed by you or for you. b. to "bodily injury," "property damage," "per- 2. With respect to the insurance afforded to Addi- sonal injury," or "advertising injury" arising tional Insureds the following conditions apply: out of the rendering of or the failure to render any professional services by or for you, in- a. Limits of Insurance — The following limits of cluding: liability apply: 1. The limits which you agreed to provide; 1. The preparing, approving or failing to prepare or approve maps, drawings, or opinions, reports, surveys, change or- 2. The limits shown on the declarations, ders, designs or specifications; and whichever is less. 2. Supervisory, inspection or engineering b. This insurance is excess over any valid and services. collectible insurance unless you have agreed CG D1 05 04 94 Copyright, The Travelers Indemnity Company, 1994. Page 1 of 1 Includes Copyrighted Material from Insurance Services Office, Inc. 41" THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA Policy Number: 72 WEC Z%9262 Endorsement Number: 01 Effective Date: 06/23/16 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address: COMPLETE PAPERLESS SOLUTIONS LLC 4025 E LA PALMA AVE STE 201 ANAHEIM, CA 92807 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 ANY PERSON OR ORGANIZATION BLANKET OPERATIONS FROM WHOM YOU ARE REQUIRED BY WRITTEN CONTRACT OR AGREEMENT TO OBTAIN THIS WAIVER OF RIGHTS FROM US. Countersigned by Authorized Representative Form WC 04 03 06 (1) Printed in U.S.A. Process Date: 05/19/16 Policy Expiration Date: 06/23/17