Loading...
PROOF OF INSURANCE (2018 - 2019) CLOSED ��4 I DATE(MMIDWYYYY) CERTIFICATE OF LIABILITY INSURANCE u^ 4/202018 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 AODi'TIONAL I'NSU'RF'D, the policy(ies)must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certaln policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endoirsernent1s), PRODUCER CONTACT Julie RI:fa .„.................._..�,,..,_.� - Y.... .,,,, Kellogg & Moreland Agency, Inc. DBA PRONE (909)792-8950 (909)792-2030 N�I�aw Fl4X . _ Np Arroyo Insurance Services _ 111WE ,ulier@arroyo>ns.com „ 1659 Plum Lane INSURE .......... ” R(S)AFFORDING COVERAGEw ... ... .......... ...-,NAIC# ..""... Redlands CA 92374-4532 INSURERA Berkley Assurance„Com,p anv 394„62” INSURED INs,URfR,a,State Camp®n At"ion, Ins Fund _35076,,,,,,,,,",,,,, California Street Lighting, A California Corp INSURERC:United Financial Casualty Company.,, 11770 _....,. 3200 Guasti Road #100 Nrv,saakac,ta'; Ontario CA 91761 l.mm ..�....................... ...... ..... .......... ______..�.... ...,m. ... ..,,,._ .. MSURERFa .i COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: E B TINE IS TO CERTIFY THAT THE POLICIES OF INSURANCE I!Iia Eb BELOW HAV EEN ISSUED TO THE IN(YI'F�6';ti NAMED ABOVE FOR THE POLICY PER03 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. X... COMMERCIAL GENERAL LIABILITY ER EACH OCCURRENCE _.. _ EX ILT R TYPE OF(N'�SURANCE e"( L`W]oi'kr ...m,,.....POLICY NUMBE !,l ) 1 EFF POLICY EX 111 LIMITS LTR .... d1ytlRRdDrYkYg<YYl J"Il rrpiD4'll�''YYYI ..� � LlRRENCE 3 0 A CLAIMS-MADE X OCCUR I) IW' 1 100 000 l,o 11 ..... PRI P^(I�k4�:5�YE'�n wst.a;�r+ir�Av .. $...., Exclude...... X Y 0162530 12./1/2'017 12/1/2018 MEDEXP(Anvoneperson) '.S d „ ........ ........_...m.......,.....,,_..._..._� ...PERSONAL ADV 4NJURY'..... ..5................. .____.... .,.. 1,000,000 uN'LkGGREGAft`..,1.9MYTAPPLIES...... ,.....W............ .............._.... _..._ .... .. 2,000,0,00 GE _ PER. �GENERALAGGREGATE 3 P - PRODUCTS•CDMPrOP AGGry„ 21, 9.'.0.01.0.,. . � "�", JEOROT LOC POLICY 0"WEP. !(aIIIrvd a sry,iLasu. $ 1,000,000 „AUTOMOBILE LIABILITY TrS(P nl_...................... ..._.II_�.www,.,.,_,.......,w..,...._...,,,„.,,.,,,,.,.,.,,_w C ANY AUTO X 06588638-0 2!23/207 8 2/23/2019 ®O6IY Y ( person) S D BODILY INJURY Per P® ALL HIREOSAUTOS AUTOS g0yx .............. g, . OWNEDAUTOS 6ti R _X o INJURY Peraccd�t S . UMBRELLA LIAR X„�OCCUR .. .. . . EACH OCCURRENCE W IT S 2,000,000 A X EXCESS LIAR AGGREGATE _w_ S 2&_000,000, T7 RETENTIONS vUMB0162550 12/1/2017 12/1/2018 S - qq PER NN 07N- WOR.iCle1'(SCOtlJfPEPCSATION .... . X I STATIr7F V OI 1dBMJD EIMPLOYERnda'lory in SJIr5 ' LIAB ldC7rrk�+�C,',GPru^gym ?`Md NIA 9222151-17 12/1/2017 12/1d2018 E L"DISEASE EA EMPLOYEE.- . . ..1,000 000 N1 qay 1„descnbe under SCV114,'T'I!N C';dp"C;NG�C'Vde"t"Y'YCrvCdti d°iw°Lova E.L DISEASE;POLICY LIMIT 5 11000,000 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached If more apace Is required) "City of El Segundo, its officials, and employees are additional insureds per attached forms #CG2033 & #CG203711 Such insurance is primary per attached form #VCAS2035. Waiver of Subrogation applies per attached form #CG2404. 30 days written notice of cancellation applies. Mr✓' CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of El Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City Clerk ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street, Room 5 El Segundo, CA 90245-3813 AUTHORIZED REPRESENTATIVE Julie a. bak/JULIE O 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INS025(201401) COMMERCIAL GENERAL LIABILITY CG 20 33 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL 1 - OWNERS, LESSEES OR AUTOMATICCONTRACTORS - REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU This endorsement modifies insurance provided under the following COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section II — Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured any person or additional insureds, the following additional organization for whom you are performing exclusions apply: operations when you and such person or This insurance does not apply to: organization have agreed in writing in a contract or agreement that such person or organization be 1. "Bodily injury", "property damage" or"personal added as an additional insured on your policy. and advertising injury" arising out of the Such person or organization is an additional rendering of, or the failure to render, any insured only with respect to liability for "bodily professional architectural, engineering or injury", "property damage" or "personal and surveying services, including: advertising injury"caused, in whole or in part, by: a. The preparing, approving, or failing to 1. Your acts or omissions;or prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, 2. The acts or omissions of those acting on Your change orders or drawings and behalf; specifications; or in the performance of your ongoing operations for b. Supervisory, inspection, architectural or the additional insured. engineering activities. A person's or organization's status as an 2. "Bodily injury" or "property damage" occurring additional insured under this endorsement ends after.- when fter:when your operations for that additional insured are completed. a. All work, including materials, parts or equipment fumished 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 b. 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 or subcontractor engaged in performing operations for a principal as a part of the same project. CG 20 33 07 04 0 ISO Properties, Inc.,2004 Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL I - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Location And Description Of Com leted Operations As required by written contract executed prior Construction project sites at which you performed work to the date of occurrence but only to the extent for such additional insured. permitted by law and 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. Information required to complete this Schedule, if not shown above, will be shown m the Declarations. 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". CG 20 37 07 04 ©ISO Properties, Inc.,2004 Page 1 of 1 ❑ THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. PRIMARYI This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE With respect to coverage provided to an additional insured via attachment of an Additional Insured endorsement to this policy, such coverage is primary insurance and we will not seek contribution from any other insurance available to that additional insured. ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED VCAS2035 11 10 Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following.- COMMERCIAL ollowing:COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: To any person or organization provided you entered into the contract with that person or organization prior to any claim or loss to which this insurance applies. (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) The TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Condition (Section IV— COMMERCIAL GENERAL LIABILITY CONDITIONS) is amended by the addition of the following: 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 0410 93 Copyright, Insurance Services Office, Inc., 1992 Page 1 of 1 0 ENDORSEMENT AGREEMENT BROKER COPY WAIVER OF SUBROGATION BLANKET BASIS 9222151-17 NEW Sc HOME OFFICE SAN FRANCISCO EFFECTIVE DECEMBER 1, 2017 AT 12.01 A.M. PAGE 1 OF 1 ALLEFFECTIVE DATESARE AND EXPIRING DECEMBER 1, 2018 AT 12.01 A.M. AT 12:01 AM PACIFIC STANDARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME CALIFORNIA STREET LIGHTING 3200 E GUASTI RD, STE 100 ONTARIO, CA 91761 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. THE ADDITIONAL PREMIUM FOR THIS ENDORSEMENT SHALL BE 2.002 OF THE TOTAL POLICY PREMIUM. SCHEDULE PERSON OR ORGANIZATION .TOB DESCRIPTION ANY PERSON OR ORGANIZATION BLANKET WAIVER OF FOR WHOM THE NAMED INSURED SUBROGATION HAS AGREED BY WRITTEN CONTRACT TO FURNISH THIS WAIVER NOTHING IN THIS ENDORSEMENT CONTAINED SHALL BE HELD TO VARY, ALTER, WAIVE OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS POLICY OTHER THAN AS STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR LIMITATIONS OF THIS ENDORSEMENT, COUNTERSIGNED AND ISSUED AT SAN FRANCISCO: DECEMBER 19, 2017 2572 ; U7HORIZED AFPRESE Tlvr PRESIDENT AND CEO SCIF FORM 10217 IREV.7.20141 OLD OP 217