Loading...
PROOF OF INSURANCE (2018 - 2018) CLOSED Client#: 25181 PSOMAS ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) I 2/01/2018 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)frust 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 Jerry Noyola ,vc 770 552-422 5 Greyling Ins. Brokerage EPIC PHONE a^Ext): 5 ac No): 866 5 0-4082 3780 Mansell Road,Suite 370 E-M^I'- err no oIa[il re Im com AWREss: 1 y� y C'g y g• Alpharetta,GA 30022 INSURERfS) ... S)AFFORDING COVERAGE NAIC# INSURER A:Nasional Union Fire Ins.Co. 19445 I INSURED INSURER B: ' Psomas INSURER C 555 S. Flower Street ...... C Suite 4300 INSURER D .. .... .. ...... .... INSURER E: Los Angeles,CA 90071 INSURER F: COVERAGES _ CERTIFICATE NUMBER: 17-18 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 CONTRACTOR 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 POL CIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSkLTt„,", TYPE OF INSURANCE ... IMSR POLICY NUMBER u,(MMI RnYy ),(EFF POLICY MI IDY=,) .... LIMITS • X COMMERCIAL GENERAL LIABILITY I GL5268212 04/01/2017 04/01/2018 EACHOCCURRENCE $1,000,000 ❑ DAMAGE TO RENTED I CLAIMS-MADE X OCCUR PREMISES(Ea,-rurrence) $500,000 MED EXP(AnV one person) $25,000 PERSONAL&ADV INJURY $1,000,000 GEN'LAGGREGATE LIMIT APPLIESPER: GENERALAGGREGATE $2,000,000 POLICY�......X PROT C...X... LOC ...PRODUCTS. COMP/OP.AGG......$.2,000,000........................... OTHER: � ............................................................................................$.................................................................... ( BNdnn �G4eL°MirA AUTOMOBILE LIABILITY CA4489706 04/01/2017 04/01/2018 E,3at) 1,000,000 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED XSCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS _ HIRED AUTOS NON-OWNED PROPERTY 0-AMAGE $ _......_ _._.., AUTOS ,lPdyrnnr;a¢Iyult,V UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED I B RETENTION$ $ WORKERS AND ROPHIYMERS'EXCLUDER/E � NIA ( ) EACH ACCIDENT IFP $1,000, A ANDrN�$OPP�SYERSJPA BILITYEXECUTIVE WC015893764 AOS 04/01/2017 04/01/2018 XL PER 0TH ,000 OFFICERIME A If Dyes,de cdbe OF)OPERATIONS below 01589376504/01/2017 04/01/2018,,,E E.L DISEASE PO I iMandatory In $1,000,000 DISEASE-EAEMPLOYEE Dyes,describe under POLICY LIMIT $1,000,000...................... DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) 1AFBO10101; Project#PW 18-09-EI Segundo Blvd.Rehabilitation&Improvements Pre-Design Engineering Support Services.The City, its officials&employees are named as Additional Insureds with respects to General Liability where required by written contract.The above referenced liability policies with the exception of workers compensation are primary&non-contributory where required by written contract.Should any of the above described policies be cancelled by the issuing insurer before the expiration date mow, (See Attached Descriptions) L_ CERTIFICATE HOLDER CANCELLATION Cit of EI Segundo Public Works SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City gunTHE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Arianne Bola ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street EI Segundo,CA 90245 AUTHORIZED REPRESENTATIVE I ©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014/01) 1 of 2 The ACORD name and logo are registered marks of ACORD #S953616/M691546 J NOY1 DESCRIPTIONS (Continued from Page 1) thereof,30 days'written notice(except 10 days for nonpayment of premium)will be provided to the Certificate Holder.Waiver of Subrogation is applicable where required by written contract&allowed by law. i SAGITTA 25.3(2014101) 2 of 2 #S953616/M691546 POLICY NUMBER: GL5268212 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 s SCHEDULE Name Of Od Organization(s) Insured Personls) Location And Description Of Completed Operations A_ TI PER THE CONTRACT OR AGREEMENT G , f ;4 ANY,�:CONTRAL-T,--90RVWGREEMENT4'YOU HAVOYEVEREffe-33111 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 which you are required by the contract or include as an additional insured the person(s) or agreement to provide for such additional organizationis) shown in the Schedule, but only insured. with respect to liability for "bodily injury" or B. With respect to the insurance afforded to these "property damage" caused, in whole or in part, additional insureds, the following is added to by "your work" at the location designated and Section III - Limits Of Insurance: described in the Schedule of this endorsement If coverage provided to the additional insured is performed for that additional insured and required by a contract or agreement, the most included in the "products-completed operations we will pay on behalf of the additional insured hazard". is the amount of insurance: However: 1. Required by the contract or agreement; or 1. The insurance afforded to such additional 2. Available under the applicable Limits of Insu- insured only applies to the extent permitted rance shown in the Declarations; by law; and whichever is less. 2. If coverage provided to the additional insured is required by a contract or agree- This endorsement shall not increase the appli- ment, the insurance afforded to such addi- cable Limits of Insurance shown in the Decla- tional insured will not be broader than that rations. CG 20 37 04 13 a Insurance Services Office, Inc., 2012 Page 1 of 1 0 This page has been left blank intentionally. POLICY NUMBER: GL5268212 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 OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Personis) Or Organization(s) Location(s) Of Covered Operations ANY PERSON OR ORGANIZATION WHOM YOU PER THE CONTRACT OR AGREEMENT. BECOME OBLIGATED TO INCLUDE AS AN ADDITIONAL INSURED AS A RESULT OF ANY CONTRACT OR AGREEMENT YOU HAVE ENTERED INTO. 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 that which you are required by the contract include as an additional insured the personis) or or agreement to provide for such additional organization(s) shown in the Schedule, but only insured. with respect to liability for "bodily injury", B. With respect to the insurance afforded to these "property damage" or "personal and advertising additional insureds, the following additional injury" caused, in whole or in part, by: exclusions apply: 1. Your acts or omissions; or This insurance does not apply to "bodily injury" 2. The acts or omissions of those acting on or "property damage" occurring after: your behalf; 1. All work, including materials, parts or in the performance of your ongoing operations equipment furnished in connection with such for the additional insured(s) at the location(s) work, on the project (other than service, designated above. maintenance or repairs) to be performed by or on behalf of the additional insured(s) at However: the location of the covered operations has 1. The insurance afforded to such additional been completed; or insured only applies to the extent permitted 2. That portion of "your work" out of which by law; and the injury or damage arises has been put to 2. If coverage provided to the additional its intended use by any person or insured is required by a contract or organization other than another contractor or agreement, the insurance afforded to such subcontractor engaged in performing additional insured will not be broader than operations for a principal as a part of the same project. CG 20 10 04 13 0 Insurance Services Office, Inc., 2012 Page 1 of 2 0 C. With respect to the insurance afforded to these 2. Available under the applicable Limits of additional insureds, the following is added to Insurance shown in the Declarations-, Section III - Limits Of Insurance: ichever iless. If coverage provided to the additional insured is less. required by a contract or agreement, the most This endorsement shall not increase the we will pay on behalf of the additional insured applicable Limits of Insurance shown in the is the amount of insurance: Declarations. 1. Required by the contract oragreement; or Page 2 of 2 0 Insurance Services Office, Inc., 2012 CG 20 10 04 13 E3 BLANKET WAIVER OF DUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different date is indicated below. (The following"attaching clause" need be completed only when this endorsement is issued subsequent to preparation of the policy). This endorsement, effective 12:01 AM 4/1/2017 forms a part of Policy No. IWC015893765 Issued to PSOMAS By NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA. We have a right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against any person or organization with whom you have a written contract that requires you to obtain this agreement from us, as regards any work you perform for such person or organization. The additional premium for this endorsement shall be 2.00 % of the total estimated workers compensation premium for this policy. WC 04 03 61 Countersigned b -` (Ed. 11/90) Authorized Representative This page has been left blank intentionally, DATE(MM/DD/YYYY) 'C>R "" CERTIFICATE OF LIABILITY INSURANCE 1/24/2018 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 CONTACT NAME: Robin Lee Dealey, Renton&Associates PHONE I FAX LIC.#0020739 "V,Nq,_Extj;714-427-6810 (AIC,No,l:714-427-6818 IL P.O. Box 10550 ADDR' ss,_flee dealay renton,,com Santa Ana CA 92711-0550 II INSURERISl,AFFORDING COVERAGE NAIC# p INSURER A:XL Specialty Insurance Co. 37885 INSURED PSOMAS PSOMAS INSURER B 555 South Flower Street, Suite 4300 INSURER c Los Angeles CA 90071INSURER D INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: 1620682901 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 INSR AOS 9ULTR E OF INSURANCE --_--INS,—fflVD POLICY NUMBER (MMIDD/YYYY) (MMIDDIYYYY) TYPE BR POLICYEFF POLICY EXP LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ bAkk6E 10 kLNI LD ...I CLAIMS-MADE ....�OCCUR PREMISES Ea occurrence) ..$ .... ... MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER. _GENERAL AGGREGATE $ POLICY JECT PRO r LOC PRODUCTS-COMP/OPAGG $ PRO- -Www . C!1 M-eER $ AUTOMOBILE LIABILITY COMBINED S6NGLfc 1,I101,1 $ ....... (Ela pc5(de,nll. ............... ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULEDBODILY INJURY(Per accident) $ AUTOS O ...$ ....... .. ............ HIRED AUTOS �.. AOSWNED. eP ?AM�h(aF....................... $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ „ .... DED .�... .... RETENTION$ I$ WORKERS COMPENSATION IPER STATLITE ORH AND EMPLOYERS'LIABILITY Y/N IR ANY PROPRIETOR/PARTNER/EXECUTIVEE 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 DISEASE-POLICY LIMIT $ A Professional Liability DPR9917719 10/15/2017 10/15/2018 Per Claim $1,000,000 Claims Made Annual Aggregate $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) 1AF13010101,Project*PW 18-09,EI Segundo Blvd.Rehabilitation And Improvements Pre-Design Engineering Support Services.SEE CANCELLATION SECTION of Certificate for 30 Days Notice of Cancellation. CERTIFICATE HOLDER CANCELLATION 30 Day Notice of Cancellation SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of EI Segundo ACCORDANCE WITH THE POLICY PROVISIONS. Public Works Attn:Arianne Bola 350 Main Street AU HORIZED REPRESENTATIVE EI Segundo CA 90245 aAr koq P ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD