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PROOF OF INSURANCE (2019) CLOSED GVPVE-1 0-M
CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY)12!10!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.
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 916-773-3800 CONTACT Dianne Nielsen
ISU/Francis-Pinney Ins. PHONE Ext}:916-773-3800 (AIX,Nc}:916-77,3-4484 '
2266 Lava Ridge Court Ste 200 IAIC.
P.O. Box 619050 'I.CMss'
Roseville, CA9 5661-9050 INSURER A:Philadel phiasInsurance Com pan 18058I .t .
Bruce WinninAFFORDING Ca��FIR GE NAC
INSURED GVP Ventures Inc., INSURER B: � IT3 m
Hartford Insurance Group
DBA: Bob Murray&Associates INSURER c:
Roseville, CA 95 61INSURER Sentinel Insurance Company Ltd 11000..........•.........
1544 Eureka
Ste.280
Road, ER D
INSURER E:
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.
!NSR TYPE OF INSURANCE ADDLISUBR7 POLICY NUMBER POLICY EFF POLICY EXP
r.TR INSD NND fMM1DDIYYYYI IMMODIYYYYb LIMITS
A X COMMERCIAL GENERAL LIABILITY EACH ,000RREIdCE 1; 2,000,000
C „X I • _LAnv)S-IAal X Y Y 578BP SD1B 3791 07/10/2018 07/10/2019 r1 1,000'000
rofessional E&O 10,
00
Claims Made PEF'SC,i1AL f' ADV IN,lj;'v' g 2,000,000
EIJL �- ...- ...... 4000,000
- i, E S
F JE�_T r, L_EC Prof Liab F^,FaTF A,.= ; 1,000,000
X r '00
'CLI
OI BIKED SIN,=LE LIMIT
B AUTOMOBILE LIABILITY (Ea accident),,,
AUTO OfJLi A.UTEDULEC 57SBABG7707 06/16/2018 06116/20191°EuDIL`r'IIJJUF.'1'iFel,n rsnnl 1: 2'000'000
WIJED j -r accident)
.X_ Y ..............._........................mm..
.HJP_�OIJL'v' ^^X„ IJQ Id-_,VflI EG OP.......)'EiAI�IA,=E
— AIITO AUTO'_ IDLY PROPERT)'......................... g
g'
UMBRELLA
OCCUR
.. H rnT rI,IRF•FbJ ATE 3 ,............................
EXCESS L ABIAB LAI!IS_MADE I �,ti
DED RETENTION g l TE,,,,,,,,, „,,,, •,,,,
REC-A
F
WORKERS X PER
MPLOYERSY r LIABILM YIN NIA 57WBCGG0320 06/16/2018 06116/2019 TH ACCIDENT FF g, 1,000000
IH
1 + E-UTNE ❑ E L EACH 000,000
A14D C
¢,MandvIory In NHI E L DISEASE-EA EI,.1FLC,rEEI T 1,000,000
_,Ir....'Y 1,,11,-.1-,c•Inw 1=1 TtlSEA3F....Gn.l..lr.\'...I...L ..,.,.,..
IT g 1,000,000'
DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required}
IRE: Executive recruitment for City Mana er
The City of.El Segundo its Officials and �mployees are included as
additional wnsured(s)as required by wvritten contract per the attached
enldorsement(s').Coveraye is primary and waiver of subrogation applies per
attached end'orsement(s
CER'T'IFICATE HOLDER CANCELLATION
ELSEG-1
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
City of EI Segundo
Attn: City Attorney's Office
350 Main Street AUTHORIZED REPRESENTATIVE
EI Segundo, CA 90245
ACORD 25(2016103) ©1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
POLIGYNUMBER-. 57SBABG7707 COMMERCIAL. GENERAL LIABILITY
THIS ENDORSEMENTCHANGES THE POLICY. PLEASE READ ITCAREFULLY.
ADDITIONAL INSURED - DESIGNATED PERSON OR
ORGANMATION
This endorsement modifies Insurance provided under the fotlowlag:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
$CHiDIiLB
Name d Person or Organization
The City of EI Segoundo its Officials and Employees
RE: Executive recruitment for City Manager
{If no entryappears above,Infonnallon required to complete this endoreernent will be shown in the Declarations as applicable to this endorsement.)
WHO IS AN INSURED(Secflan Iq Is emended to Include as an Insured the person or organization shown In the Scheduls at an Insured but only Vdth
respect to IIabLRty arising out of your operations o r premises owned by or rented to you.
CG 20 2011 85 Copyright,Insurance jervices Oflcs, Inc. 1984
POLICY NUMBER: 57SBABG7707 COMMERCIAL GENERAL LIABILITY
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
PRIMARY ADDITIONAL1 U
AMENDMENT
This endorsement modifies Insurance provided under the following:
GOMMERCIA,L GENERAL LIABILITY COVERAGE PART
SCHEDULE
Nana of Person or Organization:
The City of EI Segoundo its Officials and Employees
RE: Executive recruitment for City Manager
(If no entry appears above, Information required to complete this endorsement will be shown in the Declarations
as applicable to this endorsement.
With respect to insurance provided th the person or (1) That is Fire, Extended Coverage,
organization shown In the Schedule of this Builderls Risk, Installation Rlsk or similar
Endorsement, Condition 4. Other Insurance is coverage for"your work;"
replaced by the following: (2) That is Fire Insurance for premises rented
to you;or
4. Other Insurance. (3) If the loss arises out of the maintenance
If other valid and collectible insurance is available or use of aircraft, "autos" or watercratt to
for a loss we cover under Coverages A and B of the extent not subject to Exclusion C. of
this Coverage Part, our obligations are limited as Coverage A(Section 1).
follows: When this insurance is excess, we will have
a. Primary Insurance no duty under Coverage A or B to defend any
This Insurance Is primary and we will not seek claim or "suis" that any other insurer has a
contribution from other Insurance available-to duty to defend. If no other insurer defends,
the person or organization shown in the we will undertake to do so, but we will be
Schedule of this endorsement except when b. entitled Oa the insured's rights against all
below appiies. those other insurers.
b. Excess Insurance When this Insuranoe is excess over other
This insurance is excess over any of the other insurance, we will pay only our share of the
insurance whether primary, excess,
amount of the loss, I any, that exceeds the
sum of:
contingent or on any other tmis:
Form HC 24 08 11 94 Page 1 of 2
® 1995 The Hartford Insurance Group
(includes copyrighted materiel of Insurance Services Office
c. (Method of Sharing
(1) The total amount that all such other If all of the other insurance permits
insurance would pay for the loss in the contribution by equal shares, we will follow
absence of this insurance;and this method also_ Under this approach each
(2) The total of all deduotible and self-insured insurer contributes equal amounts until R has
amounts under all that other insurance, paid its applicable limit of insurance or none
We will share the remaining loss, if any, with of the loss remains,whichever comes first.
any other Insurance that Is not described in If arty of the other insurance does not permit
the Excess Insurance provislons and was not contribution by equal shares, we will
bought specifically to apply in excess of the contribute by limits. Under this method, each
Limits of Insurance shown in the Declarations insurer's share is based on the ratio of its
ofthle Coverage Part. applicable limit of insurance to the total
applicable limits of insurance of all insurers.
Page 2 of 2 Foran HC 24 08 11 94
57S BG7707
lir
THIS ENDORSEIVENT CHANGM THE KWJCY. PLEASE READ IT CARERXLY.
WAIVMOFSUBROGAIION
This endarsernent modes issuance provided under the fnllawirg:
M waive any rW of recovery we may have against
1. Any person or orgarization shown in to Declarations,or
2. Any person w arganWon with whom you have a oar t mt that requires such waiver.
FamSS12150300 paw 1 of 1
0 20M,The Halford
578BABG7707
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
NOTICE OF CANCELLATION TO CERTIFICATEHOLDER(S)
This policy is subject to the following additional Conditions:
A. If this policy Is cancelled by 1he Gompany, other If notice Is mailed, proof of mailing to the last known
than for non-payment of premium, notice of such mailing address of the certificate holder(s) on file with
cancellation will be provided at least thirty (30) days the agent of record or the Company will be sufficient
in advance of the cancellation effective date to the proof of notice.
certificate holder(s) with mailing addresses on file Any notification rights provided by this endorsement
with the agent of record or the Company. apply only to active certificate holder(s) who were Issued
B. If this policy is cancelled by the company for non- a certificate of insurance applicable to this policy's term.
payment of premium, or by the insured, notice of Failure to provide such noticeto the certificate holder(s)
such cancellation will be provided within ten (10) will not amend or extend the date the cancellation
days of the cancellation effective date to the becomes effective, nor will it negate cancellation of the
certificate holders) with mailing addresses on file policy. Failure to send notice shall Impose no liability of
with the agent of record or the Company. any kind upon the Company or its agents or
representatives.
Form SS 12 23 0611 Page 1 of t
0 2011,The Hartford
it'
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
NOTICE OF CANCELLATION TO CERTIFICATE HOLDER(S)
Policy Number: 57 WBC GG0320 Endorsement Number:
Effective Date: 06/16/18 Effective hour is the same as stated on the Information Page of the policy
Named Insured and Address: GVP VENTURES INC.,
1544 EUREKA RD STE 280
ROSEVILLE CA 95661
This policy is subject to the following additional If notice is mailed, proof of mailing to the last known
Conditions: mailing address of the certificate holder(s) on file with
A. If this policy is cancelled by the Company, other than the agent of record or the Company will be sufficient
for non-payment of premium, notice of such proof of notice.
cancellation will be provided at least thirty (30) days Any notification rights provided by this endorsement
in advance of the cancellation effective date to the apply only to active certificate holder(s) who were issued
certificate holder(s) with mailing addresses on file a certificate of insurance applicable to this policy's term
with the agent of record or the Company. Failure to provide such notice to the certificate holder(s)
B. If this policy is cancelled by the Company for will not amend or extend the date the cancellation
non-payment of premium, or by the insured, notice becomes effective, nor will it negate cancellation of the
of such cancellation will be provided within ten (10) policy Failure to send notice shall impose no liability of
days of the cancellation effective date to the any kind upon the Company or its agents or
certificate holder(s) with mailing addresses on file representatives.
with the agent of record or the Company
Form WC 99 03 94 Printed in U S A.
Process Date: 05/07/18 Policy Expiration Date: 06/16/19
©2011, The Hartford
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
WAIVER OF OUR RIGHT TO RECOVER FROM
OTHERS ENDORSEMENT - CALIFORNIA
Policy Number: 57 WBC GG0320 Endorsement Number:
Effective Date: 06/16/18 Effective hour is the same as stated on the Information Page of the policy
Named Insured and Address: GVP VENTURES INC ,
1544 EUREKA RD STE 280
ROSEVILLE CA 95661
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: 05/07/18 Policy Expiration Date: 06/16/19