Loading...
PROOF OF INSURANCE (2019 - 2020) CLOSEDAC 0 CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 3/27/2019 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 on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 'CONTACT Stilton & C01Tipanyy NAME: 3475 E. EoQttlill Blvd., Suite 100 PHONE 626 799-7000 A/C.Nolt „ (6�6t 583-2117 Pasadena, CA 91107 E.MAiL A_04R sga................................................ — S) AFFORDING COVERAGE NAIC # INSURER( .................................... ................_............. ........................... www.boltonco.com 0008309 INSURER A: Viqilant Insurance Company 20397 12800 Atkinson, Aer lson, Drive app & ROmO wsuRER^c..S....Federal Insurance Company ............... _. _...................2 .2.8.1,,,,, _......— INSURED Cerritos CA 90703 INSURER D : INSURER E : INSURER F: COVERAGES CERTIFICATE NUMBER: 47756464 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. MSR ............. PE OF INSURANCE ...... .Abbl. tusk .. POLICY ......., i ............................................................................__,. LTR IN$D WVD POLICY NUMBER IMMID fYYYY"1... TY......... .......... ... EFF M�DOYIY"ECYYi LIMITS A COMMERCIAL GENERAL LIABILITY35344557 4/1/2019 4/1/2020 EACH OCCURRENCE $1,000,000 CLAIMS -MADE Y OCCUR ✓ PREMISE d oHc a -nc ,.. .,.$1 000,000 .........................� L......I MED EXP (Any one person) $10,000 GEHL AGGREGATE LIMIT APPLIES PER: $1,000,000 GENERAL AGGREGATE $2,000,000 ❑ jE° ® s.,................. InClUded POLICY LOC $.... O,OOt) s 1.,00........... BODILY INJURY (Per person) $ _........,,.......................�. L.. OTHER: R P�FAGE DA ..$ B AUTOMOBILE LIABILITY 73508514 4/1/2019 4/1/2020 ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS _u HIREDNON-OWNED J' " AUTOS ONLY AUTOS ONLY B UMBRELLA LIAB OCCUR 79757104 4/1/2019 4/1/2020 EXCESS LIAB b CLAIMS -MADE D RETENTION $ B WORKERS COMPENSATION ✓ 71732870 4/1/2019 4/1/2020 AND EMPLOYERS' LIABILITY y I N ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? NIA (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below PERSONAL E ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 .R..............S-COMP/OPAGG P,,, ODUCT s.,................. InClUded COMBINED ., ...tl�eSINGLEIJMIT' ..(€�_��._.....�!.D $.... O,OOt) s 1.,00........... BODILY INJURY (Per person) $ _........,,.......................�. -.1.111 ................... --- -_ JU Y (Per accident) BODILY INJURY R P�FAGE DA ..$ PROa ...................... EACH OCCURRENCE ,AGGREGAT,E STA_TUTE....L........ GERH PER s 15000.01.000 15,,, 00,000 E.L EACH ACCIDENT $ 1,000,000 E L DISEASE -, EA _�LQ(a.OQ.(................................. E.L. DISEASE -POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: Client No. 0845 The firm does not own any autos and auto liatillity applies to hired and non -owned autos only. Additional Insured: The City of EI Segundo, Its elected or appointed officers, officials,, employyees and volunteers Additional Insured(s) named additional insured respecting general liability per the attached tOrm 80-02-2367 (Rev. 5-07) CERTIFICATE HOLDER Client No. 0845 City Clerk, City of EI Segundo 350 Main Street EI Segundo CA 90245 ACORD 25 (2016/03) 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 WilliarnA, Lewis ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 47756464 1 AALRR 119-20 Master Certificate I Matthew Nobriga 13/27/2019 11:27:45 AM (PDT) I Page 1 of 4 C H U B B° Liability Insurance Endorsement Policy Period Effective Date Policy Number Insured Name of Company Date Issued This Endorsement applies to the following forms: GENERAL LIABILITY Who Is An Insured Additional Insured - Scheduled Person Or Organization Liability Insurance Form 80-02-2387 (Rev. 5-07) 04/01/2019 3534-45-57 WUC ATKINSON ANDELSON LOYA RUUD & ROMO VIGILANT INSURANCE COMPANY Under Who Is An Insured, the following provision is added. Persons or organizations shown in the Schedule are insureds; but they are insureds only if you are obligated pursuant to a contract or agreement to provide them with such insurance as is afforded by this policy. However, the person or organization is an insured only: • if and then only to the extent the person or organization is described in the Schedule; • to the extent such contractor agreement requires the person or organization to be afforded status as an insured; • for activities that did not occur, in whole or in part, before the execution of the contract or agreement; and • with respect to damages, loss, cost or expense for injury or damage to which this insurance applies. No person or organization is an insured under this provision: • that is more specifically identified under any other provision of the Who Is An Insured section (regardless of any limitation applicable thereto). • with respect to any assumption of liability (of another person or organization) by them in a contract or agreement. This limitation does not apply to the liability for damages, loss, cost or expense for injury or damage, to which this insurance applies, that the person or organization would have in the absence of such contractor agreement. Addidional Insured - Scheduled Person Or Organization Endorsement 4775646A I AALRR 1 19-20 Master Certificate ( Matthew Ptohriga 1 3/27/2019 11:27:95 AM (2DT) I Page 2 of 4 continued Page 1 CHUBS® Liability Endorsement (continued) Under Conditions, the following provision is added to the condition titled Other Insurance. Conditions Other Insurance — If you are obligated, pursuant to a contract or agreement, to provide the person or organization Primary, Noncontributory shown in the Schedule with primary insurance such as is afforded by this policy, then in such case Insurance — Scheduled this insurance is primary and we will not seek contribution from insurance available to such person Person Or Organization or organization. Schedule PERSONS OR ORGANIZATIONS THAT YOU ARE OBLIGATED, PURSUANT TO WRITTEN CONTRACT OR AGREEMENT BETWEEN YOU AND SUCH PERSON OR ORGANIZATION, TO PROVIDE WITH SUCH INSURANCE AS IS AFFORDED BY THIS POLICY; BUT THEY ARE "INSUREDS" ONLY IF AND TO THE MIN]MUM EXTENT THAT SUCH CONTRACT OR AGREEMENT REQUIRES THE PERSON OR ORGANIZATION TO BE AFFORDED STATUS AS AN "INSURED". HOWEVER, NO PERSON OR ORGANIZATION IS AN "INSURED" UNDER THIS PROVISION WHO IS MORE SPECIF'IC'ALLY DESCRIBED UNDER ANY OTHER PROVISION OF THE WHO IS AN INSURED SECTION OF THIS POLICY (REGARDLESS OF ANY L] IITATION APPLICABLE THERETO). All other terms and conditions remain unchanged. Authorized Representative Q- Liability Insurance Additional Insured - Scheduled Person Or Organization Form 80-02-2387 (Rev. 5-07) Endorsement 47756464 1 AALRR 119-20 MasterCertificate I Matthew mobriga 1 3/27/2019 11:27:45 AM (PDT) I Page 3 of 4 last page Page 2 WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY INSURANCE POLICY WC 99 03 04 (Ed. 7-08) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA 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 on 04/01/2019 at 12:01 A. M. standard time, forms a part of (DATE) Policy No. 71732870 of the Federal Insurance Company (NAME OF INSURANCE COMPANY) Issued to Atkinson, Andelson, Loya, Ruud & Romo Endorsement No. Authorized Representative 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. The additional premium for the blanket waiver offered by this endorsement shall be 1.00% of total California premium. Schedule Person or Organization BLANKET WAIVER - ANY PERSON OR ORGANIZATION FOR WHOM THE NAMED INSURED HAS AGREED BY WRITTEN CONTRACT TO FURNISH THIS WAIVER WC 99 03 04 (Ed. 7-08) Job Description ALL CALIFORNIA OPERATIONS 47756464 1 AALRR 1 19-20 Master Certificate I Matthew Hobriga 1 3/27/2019 11:27:45 AM POT) I Page 4 of 4 0 DATE (MM/DD/YYYY) CCOL► CERTIFICATE OF LIABILITY'" INSURANCE O 08/06/2018 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 polic'y('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 1.847-385-6800 CONTACT Rob HercherN E Integro Insurance Brokers PHONE -3e-680 0847 _ 'sAr N — 111 West Campbell 4th Floor Arlington Heights, IL 60005 INSURED Atkinson, Andelson, Loya, Ruud & Romo, PC 12800 Center Court Drive Suite 300 Cerritos, CA 90703 COVERAGES CERTIFICATE NUMBER: 53616266 REVISION N'UMBE'R: 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, PAID CLAIMS, INSXCLUSIONSTMPD CONDITIONS alrOicE OF SUCH Aai POLICIES, LIMITS SHPOWc NUMBER BEEN REDUCED —_ LIMITS , SR ppm CfJPIMIODNYVYI i���i�WDD EXP IL,T'R IN. 17' � IMMIDDIYYYY's � „ GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY OCCUR CLAIMS -MADE GEN'L AGGREGATE LIMIT APPLIES PER: 7 POLICY I V J'ALO,T V LOC AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS --AUTOS ' NON -OWNED HIRED AUTOS AUTOS UMBRELLA LIAB � -11 io EXCESS LIAB ,,,,........DED ( RETENTIONS WORKERS CLAIMS"MA,C�„E,,, WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I N ANY P'nOi PRIE'FOfRIPARTNErV'EY''EC:UTUVE ❑ N I A OrHCERiMUABER E,XOLUDED"i (Mandatory in NH) UId yyes. dosenito unow DESCRIPTION OF OPERATIONS Wow A Professional Liability EACH OCCURRENCE $ K1_AiG$"T'OREAT'EU MED EXP (,Axono person) u - ...., PERSONAL & ADV (INJURY S GENERAL AGGREGATE S rr ..PRODUCTS -COM ................ ----. .. �f0PAGG S . COMBINED SINGLE LIMI,r BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ P'RC9PEF� PRLCOC�R:TT DAMAGE $ T'f $ EACH OCCURRENCE II AGGREGATE E.L. EACH ..A�gP,ENT ..'..........._.---�.............-, -- E.L. DISEASE - EA EMPLOYEE„ S DISEASE ...C---- . LWS0000639 08/08/lE 08/08/Each 19-8•yOLIYI.J9IhT $ Claim 1,000,000 Aggregate 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Client No. 0845 CERTIFICATE HOLDER City Clerk, City of E1 Segundo I 350 Main Street E1 Segundo, CA 90245 USA 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 U4 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD Patty.Baxendale@integrogroup.com LEM 53616266