Loading...
PROOF OF INSURANCE (2018 - 2019) CLOSED C a DATE(MMIDDNYYY) CERTIFICATE OF LIABILITY INSURANCE I 9/4/2018 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 have ADDITIONAL INSURED provisions or be endorsed. i If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on j this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Fric Evans ..... .... NE Chrysalis ......................... c,No,Ext): 714-464-8080 gpJ..c No): 714-464-8070 Insurance *enc A H b AI 3001 Red Hill Ave.Suite,2-226 ADDRESS: eric(a)ciapro,net ................. INSURER(S)AFFORDING COVERAGE NAIC# Costa Mesa CA 92626 INSURER A: SENTINEL INS CO LTD _ 11000 ................... ........................ INSURED INSURER B: PROPERTY&CAS INS CO OF HARTFORD 34690 WESIPLEX.INC. INSURER C: ACE FIRE UNDERWRITERS INS CO 20702 ......................� 9 Corporate Park,Suite 240 INSURER D INSURER E .................... In'Ine CA 92606 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 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 POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ................... INSW .................... A1U U4.SeYdB'�' _ PULICY EFF PULICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MMIDDIYYYY) (MMIDD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 MED EXP An one person) ----••••••••••••••••••� S'F,w i°cel o r rir, l S 1.000,000 mv CLAIMS-MADE X OCCUR IPn%tC,Vt91,".wE,(,m Y Gp j •••••••••••• $ 10,000 A Y Y 72SBABA9522 11122/2017 11/22/2018 PERSONAL&ADV INJURY S 2,000,000 r__ ................... GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 4,000.000 ............................. PRO.POLICY „y RO. LOC PRODUCTS-COMP/OPAGG $ 4,000.000 X OTHER: $ ._.w._._................ _.......................... AUTOMOBILE LIABILITY LtaMmdRw�rvb�„l.J„y�rvwm. �I.,IMI a ; 2,000,000 (rraas.clrE91 ANY AUTO BODILY INJURY(Per person) S OWNED SCHEDULED -• A AUTOS ONLY AUTOS Y Y 72SBABA9522 11/22/2017 1 1/22/2018 BODILY INJURY(Per accident} $ .......... HIRED NON-OWNED Ta,71•'k�wliiY IJN'�ormA,�as�. X AUTOS ONLY X,AUTOS ONLY [Per„eircicCstntW $ ........... ......____................. ._.. ... ............ UMBRELLA LIABOCCUR EACH OCCURRENCE 5 EXCESS LIAB HCLAIMS-MADE AGGREGATE S DED V I RETENTION$ S XII S _ WORKERS COMPENSATION •.•., ............. I H- AND EMPLOYERS'LIABILITY PtK E Y I NR _ TATUTE I ANY PROPRIETOR/PARTNER/EXECUTIVE , E L EACH ACCIDENT $ 51,000,000 B OFFICER/MEMBEREXCLUDED? Y NIA Y 72WL-CAA9LAU 01/01/2018 01/01/2019 IMandatory in NH) EL DISEASE-EA EMPLOYEE S 51,000,000 DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT 5 51,000,000 EACH CLAIM $5,000,000 C TECHE&O AND CYBER EONCAF137939312 11/22/2017 11/22/2018 AGGREGATE $5,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Certificate Holder is named Additional Insured under blanket endorsement and Waiver of Subrogation applies. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN City of El Segundo ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street AUTHORIZED REPRESENTATIVE EI Segundo,CA 90245 0�� I o II O 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: 72SBABA9522 COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSENS OR CONTRACTORS - SCHEDULED PERSON O ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location(s)Of Covered Operations City of EI Segundo 350 Main Street EI Segundo, CA 9045 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 B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following additional organization(s) shown in the Schedule, but only exclusions apply: with respect to liability for "bodily injury", "property This insurance does not apply to "bodily injury" or damage" or "personal and advertising injury" "property damage"occurring after: caused, in whole or in part, by: 1. All work, including materials, parts or 1. Your acts or omissions; or equipment furnished in connection with such 2. The acts or omissions of those acting on your work, on the project (other than service, behalf; maintenance or repairs) to be performed by or in the performance of your ongoing operations for on behalf of the additional insured(s) at the the additional insured(s) at the location(s) location of the covered operations has been designated above. completed; or However: 2. That portion of "your work" out of which the injury or damage arises has been put to its 1. The insurance afforded to such additional intended use by any person or organization insured only applies to the extent permitted by other than another contractor or subcontractor law; and engaged in performing operations for a 2. If coverage provided to the additional insured is principal as a part of the same project. required by a contract or agreement, 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. CG 20 10 04 13 ©Insurance Services Office, Inc., 2012 Page 1 of 2 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: whichever is less. If coverage provided to the additional insured is This endorsement shall not increase the required by a contract or agreement, the most we applicable Limits of Insurance shown in the will pay on behalf of the additional insured is the Declarations. amount of insurance: 1. Required by the contract or agreement; or Page 2 of 2 0 Insurance Services Office, Inc., 2012 CG 20 10 0413 4e�,y THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA Policy Number: 72 WEC AA9ZAU Endorsement Number: 3 Effective Date: 01/01/18 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address: Webiplex, Inc. 9 CORPORATE PARK 240 IRVINE CA 92606 e�lt 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 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: 01/17/18 Policy Expiration Date: 01/01/19