Loading...
PROOF OF INSURANCE (2019) CLOSED ENVISCI-05 MC9RAW'M CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY(02/11/2019 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 an this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER License#OE67768 CONTACT Ali Smith AME; IDA Insurance Services PHONE FAX Ext):(619)788-5795 50206 Alc.Nei,(619)574-6288 4'370 La Jolla Village Drive M I Suite 600 MSs,,Ali,Smith(Rioausa.com San Diego,CA 92122 -- _. i, , NAIC# INSUR.ERSt AFFORDINGCOVERAGE, .1NSURERA:RLI Insurance Company .13056 INSURED INSURER,B,z.Mt Hawlev Insurance Company '37974 Environmental Science Associates INSURER,c:Greenwich Insurance Company 22322 5309 Shilshole Ave.NW#200 INSURER D: Seattle,WA 98107 RE INSURE.. ..., ...., ,, RF: COVERAGES .......................................... (MI TI I_CATE 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. TYPE OF INSURANCE ADDU 'SUBRI POLICY EFF POLICY EXP LIMITS . 1 POLICY NUMBER ABILITY DAMAGE,O CU RENTED $„ 2,000,000 INSR I�.w�ia.:.> � CJ I 1 TR AL A X COMMERCIAL A Ms-MADEERX IoccuR X X PSB0007416 12/01/2018 12/01/2019 DA fwMGE$(F RE mcn'�nzef � 1,000,000 X Cont Liab/Sev of Int MED EXP(Any one person) 5 10,000 � PERSONAL„s ADV INJURY S 2,000,000 EIWPOLICFdF',AT P ❑ Loc PRODUCTS $ 45000,000 G' E,LIMIT APPLIES PER GENERAL AGGREGATE „$,,,,,, Pouov l X 4,000,000 .................w.. ...................._ ....................................... Deductible............................ ............� 0 A ClT�IiBIL ......... .. ....... COMBI:NEDtSINGLE LIMIT 1,000,000 AUTOMOBILE LIABILITY $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY X X INJURY „ 1 INJURV(Perperson) $ RY(Per accident) $ X ANY AUTO PSA0002468 12/01/2018 12/01/2019 1 BODILY AH i i ONLY a IT E t r�P Perac,cit)AMAGE $ PROPERTY. .. ................. _ OCCURRENCEUR EACH .$„ 0 X Xi XI occoD B X UMBRELLA LIAB I� �.. � .. ...... ...... ..... 3,000,000 i � 0 EXCESS LIAB CLAIMS MADE �PSE0003196 12/0112018 12/0112019 AGGREGATE 0 3,0 DED I X I RETENTION$ 10,0001 .........�... � PER .. AND ERMPL E ER� P TIO W .XECUTIVE YIN❑ NIA X y. E(L EACH ACCIDENTE., I ORH S ,000,000 WWA w ...P..............RTLI PSW0004135 12/0112018 12/01/2019 UTE1 Tr4E ov s' CE'R 1 ,000 andatory in kIR) EL DISEASE-EA EMPLOYEEII T °,,,,,,,,,,,,,,,,,, If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT _S C Prof Liab/Ded.$50K PECO01336816 12/01/2018 12/01/2019 Per Claim/Aggregate 5,000,000 C Poll Liab/Ded.$50K PECO01336816 12/01/2018 12/01/2019 Occurrence/Aggregate 5,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required( Re:All Operations City of EI Segundo is Additional Insured with respect to General and Auto Liability per the attached endorsements as required by written contract.Insurance is Primary and Non-Contributory.Waiver of Subrogation applies to General Liability,Auto Liability and Workers'Compensation. 30 Days Notice of Cancellation with 10 Days Notice for Non-Payment of Premium in accordance with the policy provisions. CERTIFICATE HOLDER �. CANCELLATION.-.-.-.-.-.---..- SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE City of EI Segundo -T- ,/ 1 l�JrVi4& 350 Main Street oil d Seaundo.CA 90245-36..13..m._................. ........._......_..............._...................................... ......................_� ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Named Insured: Environmental Science Associates RLI Insurance Company Policy Number: PSB0007416 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. RLIPacke FOR PROFESSIONALS BLANKET ADDITIONAL INSURED ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM- SECTION 11—LIABILITY 1. C.WHO IS AN INSURED is amended to include as additional insured under this policy must apply an a an additional insured any person or organization that primary basis, or a primary and non-contributory you agree in a contract or agreement requiring basis, this insurance is primary to other insurance insurance to include as an additional insured on this that is available to such additional insured which policy, but only with respect to liability for "bodily covers such additional insured as a named insured, injury", "property damage" or "personal and and we will not share with that other insurance, advertising injury" caused in whole or in part by you provided that; or those acting on your behalf: a. The "bodily injury" or "property damage" for a. In the performance of your ongoing operations; which coverage is sought occurs after you have b. In connection with premises owned by or rented entered into that contract or agreement;or to you; or b. The "personal and advertising injury" for which c. In connection with "your work' and included coverage is sought arises out of an offensecommitted after you have entered into that within the "product-completed operations hazard". contract or agreement. 2. The insurance provided to the additional insured by 4. The following is added to SECTION III K. 2. this endorsement is limited as follows: Transfer of Rights of Recovery Against Others to Us — COMMON POLICY CONDITIONS (BUT a. This insurance does not apply on any basis to APPLICABLE TO ONLY TO SECTION II — any person or organization for which coverage LIABILITY) as an additional insured specifically is added by We waive any rights of recovery we may have another endorsement to this policy. against any person or organization because of b. This insurance does not apply to the rendering payments we make for "bodily injury", "property of or failure to, render any "professional damage" or "personal and advertising injury" arising services". out of "your work" performed by you, or on your c. This endorsement does not increase any of the behalf, under a contract or agreement with that limits of insurance stated in D. Liability And person or organization, We waive these rights only Medical Expenses Limits of Insurance. where you have agreed to do so as part of a contract or agreement with such person or 3. The following is added to SECTION III H.2. Other organization entered into by you before the "bodily Insurance — COMMON POLICY CONDITIONS injury" or"property damage" occurs, or the"personal (BUT APPLICABLE ONLY TO SECTION II -- and advertising injury"offense is committed. LIABILITY) However, if you specifically agree in a contract or agreement that the insurance provided to an ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED. PPB 304 02 12 Page 1 of 1 Named Insured: Environmental Science Associates Policy Number: PSA000246B BUSINESS AUTO COVERAGE FORM A. Broad Form Named Insured of the operations contemplated by such contract. The The following is added to the SECTION II — waiver applies only to the person or organization COVERED AUTOS LIABILITY COVERAGE, Para- designated in such contract. graph A1,Who Is An Insured Provision; E. Employee Hired Autos Any business entity newly acquired or formed by you 1, The following is added to the SECTION II — during the policy period, provided you own fifty COVERED AUTOS LIABILITY COVERAGE, percent(50%)or more of the business entity and the Paragraph A.1.Who Is An Insured Provision: business entity is not separately insured for Bus-iness An 'employee" of yours is an "insured" while Auto Coverage, Coverage is extended up to a operating an "auto" hired or rented under a maximum of one hundred eighty(180)days following contract or agreement in that"employee's"name, the acquisition or formation of the business entity. with your permission, while performing duties This provision does not apply to any person or related to the conduct of your business. organization for which coverage is excluded by 2. Changes In General Conditions: endorsement. B. Employees As Insureds Paragraph 5.b. of the Other Insurance Con- dition in the BUSINESS AUTO CONDITIONS is The following is added to the SECTION II -- deleted and replaced with the following: COVERED AUTOS LIABILITY COVERAGE, Para- b. For Hired Auto Physical Damage Coverage, graph A.1.Who Is An Insured Provision: the following are deemed to be covered Any"employee"of yours is an"insured"while using a "autos"you own: covered "auto" you don't own, hire or borrow in your (1) Any covered "auto" you lease, hire, rent business or your personal affairs. or borrow; and C. Blanket Additional Insured (2) Any covered "auto" hired or rented by The following is added to the SECTION II — your`employee" under a contract in that COVERED AUTOS LIABILITY COVERAGE, Para- individual "employee's" name, with your graph A.1.Who Is An Insured Provision: permission, while performing duties related to the conduct of your business, Any person or organization that you are required to However,any"auto"that is leased,hired, include as an additional insured on this coverage form rented or borrowed with a driver is not a in a contract or agreement that is executed by you covered"auto before the"bodily injury"or"property damage"occurs is an "insured" for liability coverage, but only for F. Fellow Employee Coverage damages to which this insurance applies and only to SECTION II — COVERED AUTOS LIABILITY the extent that person or organization qualifies as an COVERAGE, Exclusion B.S. does not app I if you "insured" under the Who Is An Insured provision contained in SECTION II — COVERED AUTOS have workers compensation insurance in-force LIABILITY COVERAGE. covering all of your employees. The insurance provided to the additional insured will G. Auto Loan Lease Gap Coverage be on a primary and non-contributory basis to the SECTION III — PHYSICAL DAMAGE COVERAGE, additional insured's own business auto coverage if C.Limit Of Insurance, is amended by the addition of you are required to do so in a contract or agreement the following: that is executed by you before the "bodily injury" or "property damage"occurs. In the event of a total"loss"to a covered"auto"shown in the Schedule of Declarations, we will pay any D. Blanket Waiver Of Subrogation unpaid amount due on the lease or loan for a covered auto", less: The following is added to the SECTION IV— BUSI- 1. The amount paid under the PHYSICAL NESS AUTO CONDITIONS,A. Loss Conditions, 5. DAMAGE COVERAGE section of the policy;and Transfer Of Rights Of Recovery Against Others To Us: 2. Any: We waive any right of recovery we may have against a. Overdue lease/loan payments at the time of any person or organization to the extent required of the"loss"; You by a contract executed prior to any"accident" or "loss",provided that the"accident"or"loss"arises out PPA 300 03 13 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 p3 46 (Ed.4-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT—CALIFORNIA 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 All persons or organizations that are party to a contract that Jobs performed for any person or organization that you requires you to obtain this agreement,provided you executed have agreed with in a written contract to provide this the contract before the loss. agreement. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The Information below is required only when this endorsement Is Issued subsequent to preparation of the policy.) Named Insured: Environmental Science Associates Policy Number: PSWO004135 Insurance Company: RLI Insurance Company Countersigned By Q1998 by the Workers'Compensation Insurance Rating Bureau of California,All rights reserved.