Loading...
PROOF OF INSURANCE (2018) CLOSED lu:r,ull �.I»�»II�IAL,Q.,IQr,a, CERTIFICATE OF LIABILITY INSURANCE /2T/2o17 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 certlflcate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER ¢r➢�tl'+1.,1' rrrMa�t. HELEN SHERLOCK TRI WORLD INSURANCE AGENCY INC PHONE ' G No.Ext).(.949)756,0863 AI(:,N Zw(9149)1156-1356, 4000 Birch Street, Ste 2018 �''�uw��rr'':SS h)Mlerllo!(.k(d mk'ruw or°l(.iins.com Newport Beach, CA 92660 JAMES RIVER INSURANCE CO. A � 11111c,INSURER(S) AFFORDING COVERAGE 800-617-8428 INSURER A 7A IX 12604 MARX BROS. FIRE EXTINGUISHER CO. INSURER e RSUI INDEMNITY CO. A XII 22314 & COOK FIRE EXTINGUISHER INSURER c SECURITY NATIONAL INS CO. A XIV 19879 1159 S. SOTO STREET IN:>lrF ER I) LOS ANGELES, CA 90023 1?SUHFR C INSURER F,,,, COVERAGES CERTIFICATE NUMBER: 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 lrvs 0 6rll"NLU'd,'t0. VAIR IOY IINSUY"ANi pN4r3 MP ���. � �. . wst^ ibR I PT I I(;'YJIYtlQ§Q I& I Rlf0I ICDYkV1IT (Pr)I I," Q'rl• I rwr Err+NCH (.,r�°u lYa r:NC;I $ L000,000 ., u �.,X„ ¢�OYu81`AI'�l�r,U1��u�4VIWr4Q tQ71NC.Yto6Uw..11.1�6..I�C"I.UIN'. PREMISES ILQZ {4 Cdkrl'�.rt¢nu� �niN�.r¢oiUd AMAGr TO a FIPI Trn S s x 141 5 Y Y?, )C $5000 Ded/C)4,:,c Y 000525085 03/26/17 03/26/18 e��I N(�QaAIA rke�ug»Iao�rTTYa_� $ 2, ,000 A 000, 0 0 GE N'11. ODUCrs COIMIIrO GG $ ?,000,000 (-Y�ruul AC(,R[ u.11 i.:Y� P'Ira � , ItiI.0 I nrl(o-u(II .uF PRO ilJ"! I X S u.a`rl': Il°EuT°.... ANYAUT7 Y.300ILY IIN,U171RY(Pu, peg'unr)1 S i AU CJVVNw'I.) Rl1�Tun,O�YNw!I..Y P'I'kt V IL,II¢Ild�i.lf-t��I a:,.i,u;roi' 0 P ” Al.l1'l.9'J I FhI.PUt"lu Ildlllld'ICQ. AI,Yl0S i r ¢Irrrht, M. _ ..... ... ----® / UNIBRI,liI 4I,I"'M nrxuo-( NHA242177 03/26/17 03/26 18 EACH OCCURRLNC'. $ 4,000,000 B FXCT;ns uIAH auwl.r•u .u dwGGRLGAlu_ $ 4,000,000 , u E.D IalQ;uu NT PRODUCTF51OPS $,4 r VC, i I' aao.aao �vruaa$PR XCOMPENSATION iln� l u ua SWC1142015 02/18/17 02/18/18 Q::u.. (�r�CH l�ACCIDENT I IIII H UH uL,z N10Areu..AWUSER II.XCAUUF07 (" ° YdN P'u.cvYE'I s 1x000�.�Q)I,.b C N Y EA MI Vtl l���,ps fiYllV:�'VI�bo C,1¢k"IVJ�7I UF�1-A('r l)NS rhAI,1W '...__ E ry IXDbl:51F..A,°'S V_-N'C7N..IC.Y',0."IM1fl I'➢ $ 1,000,00,0„ as i DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101 Additional Remarks Schedule,if more space is required) ALL OPERATIONS - SERVICE AGREEMENT CITY OF EL SEGUNDO, ITS EMPLOYEES, REPRESENTATIVES, OFFICERS AND AGENTS ARE ADDITIONAL INSURED PER ATTACHED ENDORSEMENTS. WORKERS COMPENSATION WAIVER OF SUBROGATION ENDORSEMENT ATTACHED. TI (30) DAYS NOC APPLIES TO ALL LISTED POLICIES. CERTIFICATE HOLDER CANCELLATION CITY OF EL SEGUNDO, DEPT OF SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE PARKS & RECREATION-SO, AGENCY THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 360 W. EL SEGUNDO BLVD. ACCORDANCE WITH THE POLICY PROVISIONS, LOS ANGELES, CA 90061-1130 AUTHORIZED REPRESENTATIVE n ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD25(2010/05) The ACORD name and logo are registered marks of ACORD JAMES RIVER INSURANCE CO. CONVAERCIA11 GENERAL 11 1AB111 ITY CG 20 37 07 04 p'11 US :..�,N[.)ORSEEIMENT 0 1ANGIES F1 IE POI' ICY., PLIE.ASE RiE'AD IT CAIRE.:�FULLY, ADDITIONAL INSURED - OWNERS, LEASEES OR CONTRACTORS - COMPLETED OPERATIONS rNs eridoi seimeint modifies insurarice rwovided undei the folllomiliing:: C0114MERCIA11 GIENIBRAl TABU rFY COVERAGE IPAIRT SCII 11EIDU11 JE Name of Person oi� 0i garilzation: CI f Y OF •. I•- SEGUNDO, ITS EMPLOYEES, RIEmIi')S, OFFICER .IND AGE-NI S R: E-� ALI 01P1::.::lRAT101NS (Elf, no en" al.)pears above, ii information irequlred to cornlDlete tNs erodorseirneilit M1111 be sll'wwn o n the Declairatbins as apIpficable to this eilidoirseirrent,) S I ecdon IT - Who iis An Insured is arriended, to ku-Aude as ar-i 6irisured the 1::)erson or oi gairkzabon(s) sho i, iin the SchedLde, IhauUn only with respect to HaIL)iHty f0r "t)ocilly injury` or operity daimage"' caused, iin Whole or Nn part, by "your woirk" at the Ilocatiion destlginated and described dii the schedule of this eiridorserneirift pei forimed for that ad6bi•::)iroal wsured and included un the"I..)iroducts completed operatioros hazard". P-11RIMAIRY INSURAINCE "1 AUSE: To the extent that this insuirance is afforded to any add tioinal insured i.mder U'us poky, SUch hrnsurai ice sl,ialll ap-.)p y as prhmary and r)ot cointril::)utirng wi y insuiraince carried by such addKlona insured, as irequllred 1:.)y written coritiract. CG 0 37 07 04 Q ISO Pro.:)ert.les, Inc, 2000 IPage I of .1. JAMES RIVER INSURANCE CO' COMMERCIAL. GENERAL OABlLDTY CG 20 10 0704 THIS EwDOuH,u1EmTCW,mGE�n*[ POLICY, pILFASE READ/rCAREFULLY ����K'�X����l[ INSURED _ �������� Kl���l�l�� K�l� ^��^^^� � �~^�`^��� ��`^^~'�~'�^"^ �^ ,, ^`�����, ����=`^����^, ~,�~ ������� ������� � ���������� ������� ��� ~~^^^" � �~^^~~ " ~^�~^^ `�~~��^�"°~^�����^ � "�"~^^~^^� ~^�~ ��l����������'��K�Y� ���������`����� "��^^` This endorsement modifies inSuronce provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHM DUIX NAME OF PERSON OR ORGANIZATION: CITY OF ELSEGUMQO ITS EMPLOYEES, REPS, DFF{CERS AND AGENTS RE: ALL OPERATIONS A. Section 11 —Wuhm is An Insured is amended to include as an insured any person(s) ororQanization(s) shown in the Schedule, but only with respect to liability for "bodily in]ury", ''property damage" or "personal and advertising injury^ caused, im whole orin part by: l Your acts or omissions; or Z. The acts or omissions of those acting on your beha|f� In the performance of your ongoing operations for the additional insured(s)at the |ocation(s) designated above. 13� With respect no the insurance afforded to these additional Insureds, the following additional exclusions applies: This insurance does not apply to "bodily in]urypor "property damage"occurring after: I. All work, including materials, parts or equipment fu/n)shed in connection with such work, mn 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 Z, That portion of"your work"out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor mr subcontractor engaged in performing operations for a principal asa part of the same project. PRIMARY INSURANCE CLAUSE: To the extent that this insurance is afforded to any additional insured under this policy, such insurance shall apply as primary and nun contributory with any insurance carried by such additional insured, as required by written contract. CG 20 10 07 04 OcISO Properties, Inc., 2004 Page 1 of I WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 06 34 (Ed. 8-00) WAIVER OF OUR RIGHT TO RECOVERY FROM OTHERS ENDORSEMENT—BLANKET 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 form us). The additional premium for this endorsement shall be 3% of the total California Workers' Compensation premium otherwise due. SCHEDULE Pe,rson,,,,or, 0„rganizatiwon J,a b,I escri Pt on Any person or organization when required All California Operations by written contract. Policy Number: SWC1142015 Insured: MARX BROS FIRE EXTINGUISHER CO. Coverage Provided by: SECURITY NATIONAL INSURANCE COMPANY WC 99 06 34 (Ed.8-00) " D FLBLTY I SU INSURANCE 05/25/207 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 g n PHONE n�6Gc Williams Bryce Mckell, Agent PHON ��: � .........................................................................�I�c.N�� s��� �m7�5 413 E Foothill Blvd Ste 102 try t� Y tt .r .brrlcel _................................. MME R F a 9.oa�'nn pglat 1�1'�'/'n San Dimas, CA 91773 ..... ..... ................w.... - FORDING COVERAGE NAIC.......... E _ INSURERS AF INSURER A:State Farm Mutual Company al,Automobile Insurance Com_an _....m .... 251711.. INSURED Marx Brothers Fire Extinguisher Co Inc iwsuRER..B...�.................................................................. ......... .............................. 1159 S Soto St INSURER C: Los Angeles, CA 90023-2198 INSURER D: INSURER E: ............................................................................................... INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 2013-2014 RENEWAL 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. ..i .S.................................................... V ADOL S 'PO'CY FF POLICYEXP TYPE OF INSURANCE INSR W D POLICY NUMBER YNMJ fI IY^tYY ......................._w.,.-.�,..��,.�. LIMITS G ENERAL LIABILITY E F EACH OCCURRENCE _ ­ COMMERCIAL GENE LIABILITY $ RAL L DAMAGE TO RENTED � � PREMISES(Ea occurrencel $ -MADE OCCUR MED CLAIMS X P(Any one person) $ PERSONAL 8 ADV INJURY $ GENERAL AGGREGATE s GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ -1 POLICY _ I PRO 1-1 LOC w w $ - AUTOMOBILE LIABILITY COMBINED ide1tSINGLE'&.IMII$ A 022 5740-822-75H 02/2212017 0$/22/2017 w(FseoGden#D a _ ANY AUTO 041 1832-B22-75F 02/22/2017 08/2212017 BODILY INJURY(Per person) $ 1,000,000 SCHEDULED ALL OWNED X- NON-OWNED 404 5720-D19-75T 04/19/2017 10/19/2017 BODILY INJURYM(APerr accident) ..........1,000,000 H RED AUTOS AUTOS 454 0524-E08-75A 05/08/2017 11/08/2017 -(Per accident) a mm„ 1,000,000 ,,,,,,,,,,,,,, EACH CU _ a UMBRELLA LIAR OCCUR EIF EXCESS LI IIAB CLAIMS-MADE AGGREGATERRENCE a ....................... DED RETENTION$ II s................................................. WORKERS COMPENSATION TORY L M)IT.S l._.......� R...m......m........................................................... OFFICE/ME BER EXCL UDED?XECUTIVE Y YIN NIA E L.DISEASE CEA E_MP E.L LOYEE...a...........................................................rrrr.�._ If es,describe under IPa - ..DISEASE-POLICY LIMIT .a........................... Y A EMPLOYERS NON-OWNED/HIRED AUTO Y W23 4999-E25-75Y 05/25/2017 11/25/2017 BODILY INJURY(Per person) $1,000,000 LIABILITY L. BODILY INJURY(Per accident) $1,00"000 PROPERTY DAMAGE(Per accident) $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required) Automobile Liability Section:State Farm provides certification for Scheduled Autos only,described as all vehicles insured by State Farm,under the Producer named above, This includes Employers Non-owned/Hired Auto Liability. Additional Scheduled Auto:Policy No 474 1500-F21-75A(Eff 12/21/2016 to 06/21/2017) This insurance is primary and non-contributory with respects to claims arising out of the operation of the described vehicle. Additional Insured to be named on all policies:'the City,its officials,and employees'.Endorsement 6028BU attached. Cancellation Clause to include 30 days written notice to the Certificate Holder listed below. CERTIFICATE HOLDER CANCELLATION City f El Segundo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Ty g un THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Attn: City Clerk ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street AUTHORIZED REPRESENTATIVE El Segundo, CA 90245-0989 Digitally signed by Janiece Williams- LSA5 I ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 1001466 132849.8 01-23-2013 6028BU ADDITIONAL INSURED (Prior Notice of Termination) This endorsement is a part of the policy. Except for the changes this endorsement makes, all other provisions of the policy remain the same and apply to this endorsement. 1. A person or organization shown on the Declarations Page as an Additional Insured is provided Liability Coverage, but only to the extent that person or organization qualifies as an insured as defined in Liability Coverage. 2. An Additional Insured has the same right of recovery under Liability Coverage as if they had not been shown on the Declarations Page as an Additional Insured. 3. If Liability Coverage is changed or terminated as to the interest of the Additional Insured, unless another number of days notice is shown on the Declarations Page, we will provide the Additional Insured: a. 10 days notice of such change or termination if the policy is nonrenewed or the cancellation is for nonpayment of premium; and b. 20 days notice of such change or termination if the cancellation is for any reason other than nonpayment of premium. Additional Insured: 'the City,its officials,and employees' Page 1 of 1 6028BU C,Copyright, State Farm Mutual Automobile Insurance Company,2011