No preview available
PROOF OF INSURANCE (2019 - 2020) CLOSED�="�''RV CERTIFICATE OF LIABILITY INSURANCE 11 Dom) �► DATE /2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS e., 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 certificate policy, isannDIOSUR hP y(ies) must be endorsed If SUBROGATION IS WAIVED„ subject to the and of the PTICes may require endot. A statement on this certificate does not confer rights to the certificate holder in Ileu of such endorserns nt(s). PRODServices E Rala 15) 957J -0e CER 0"""" " " o Jas MOCUI Insurance Sere P1T(7N', (415)957-0600 FAILNot (415)957-0577 License No. 0589960 ' AReSS t hcallejas@mocins.com 101 Montgomery St., Suite 800 San Francisco CA 94104 LSURERA-'MaSsalchusetts URERIS) AFFORDNNG COVERAGE NANC $INBay Ins. Co. 223016 INSURED INSURER BrAllmerlca Financial Benefit Co. 41840 Keyser Marston Associates, Inc. IIINSURER C:Hanover Insurance Company 22292 1299 4th Sreet Suite 408 p INSURER D. �I V INSURER E r .., ... .,,. San Rafael CA 94901 �, INSURER F FICATE COVERAGES THIS IS TO ERTIFY THAT THE. POLNCIESEOF IINSURANCE LIMB D BELOW HAVE BEEN ISSUED TO THE INSURED DOCUMENT BOVERES Ef E TO HICH THIS ^ I BER POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, D CLAIMS. 4P9R TYPEOFINS'URANCIE.... ry POLICIES. CAYUMBEIB fM'�MIDDl1"YYY,1'POLICYEX�P.. LIMITS .. AODL'81JO PL L° Y BY I. LTREXCLUSIONS AND CONDITIONS OF SUCH POL BLIMITS SHOWN N HAVE BEEN RED MaMN)DNA"r^�'Y) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $. 1,000,0005. IJAhtAtuaL'(C9RENTED 500,000 A CLAIMS -MADE FOOCCUR PRE141SES IEa occurenceli $ X ZDFA49104904 12/1/2018 12/1/2019 ,MED EXP (Arty' one persr l 5 10, 000 No Deductible Applies PERSONAL $ AOV INJURY $ 1,000,000 MWIL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PR0. PR POLICY JECT DUCTS-COMO P/OP AGG $ Included OTHER .... ., ...,,, —. Lo OL`IMiawl"aIN(nk.ELimit $ AUT 1,000,000 X AUTOMOBILE LIABILITY I We aceldonll ANY AUTO BODILY INJURY (Per person) $ B ALL OWNED SCHEDULED _AT4FA490049 12/1/2016 12/1/2019 I BODILY INJURY (Par accident) $ AUTOS AUTOS X I 'PROPERTY DAMAGE X Y. HIRED AUTOS Nx "OTOSWNEDBluer accidentilX Comp $500 Call $500 Uninsured, motorist combined single $ 1,000,000 EXCESS LIA rd C UMBRELLA BAB EACH OCCURRENCE I $ 4,000,.000 OCCUR X CLIJMS�MADE AGGR'Er°xA'fl'E $ 40000„000 DED J X I RETENTION $ 0 X I UHFA49117104 12/1/2018 12/1/2019 0$ WORKERS COMPENSATION I STATUTE ' ERFIERH AND EMPLOYERS' LIABILITY 'Y 1 N ANY PROPRIETORIPARTNERIEXECUTIVE kEL EACH ACCIDENT $ OFFICERIMEMBER� EXCLUDED? Li N / A (Mandatory In NH) E.L DCSEASE - EA EMPLOYEE $,,,,,, Ifos, describe unE L DISEASE - POLICY LIMIT $ PISCRIPTION OF rofessionalpLiabilityNS a ..� LHED42616501 12/1/2018 12/1/2019 u1 Each Wrongful Act $1,000 C �i ,000 Retention $25,000 Retro Date: 11/11/1976 Aggregate Umd $2,000,000 DESCRIPTION OF OPERATIONS ILOCATIONS I VEHICLES (ACORD 101, Addltional Remarks Schedule, may be attached If more space is required) The City of E1 Segundo, its officers, officials and employees are Additional Insured as respects their interest appears per written contract. Insurance is primary and non-contributory. I 30 day notice of cancellation/10 day for non-payment of premium. l CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of E1 Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street El Segundo, CA 90245-3813 AUTHORIZED REPRESENTATIVE J+ Ha,lidee Callejas/HCA Ala. 01988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD INS025 (201401) COMMERCIAL GENERAL LIABILITY CG 2010 07 04 POLICY NUMBER: ZDFA49104904 Effective Date: 12/01/2018 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. i # !Me - As This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Additional insured Person(s) �I or Organization(s): Location(s) of Covered Operations City of El Segundo, its officers, officials and employees It is understood and agreed that this insurance is primary and any other insurance maintained by the Additional Insured shall be excess only and not contributing with this insurance in regards to all operations as pertains to the named insured. Information required to complete this Schedule, if not shown above, will be shown in the Declarations, A. Section 11 — Who Is An Insured is amended to include as an additional insured the person(s) or organizations) shown in the Schedule, but only with respect to I'iability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the locations) desig- nated above. B. With respect to the insurance afforded to these additional insureds, the following additional exclu- sions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equip- ment furnished 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 2. That portion of "your work" out of which the injury or damage arises has been put to its in- tended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a princi- pal as a part of the same project. CG 2010 07 04 0 ISO Properties, Inc., 2004 Page 1 of 1 0 Keyser Marston Associates, Inc Policy No: AWFA490049 COMMERCIALAUTO CA 00 0103 06 BUSINESS AUT® COVERAGE FORM Various provisions in this policy restrict coverage. Read the entire policy carefully to determine rights, duties and what is and is not covered. Throughout this policy the words "you" and "your" refer to the Named Insured shown in the Declarations. The words "we", "us" and "our" refer to the Company pro- viding this insurance. Other words and phrases that appear in quotation marks have special meaning. Refer to Section V — Definitions. Symbol 7 Any "Auto" 2 Owned "Autos" Only 3 Owned Private Passenger "Autos" Only 4 Owned "Autos" Other Than Pri- vate Passenger "Autos" Only 5 Owned "Autos" Subject To No - Fault 6 Owned "Autos" Subject To A 'Compulsory Un- insured Motor- ists Law 7 Specifically De- scribed "Autos" Hired "Autos" Only 9 Nonowned "Autos" Only SECTION I — COVERED AUTOS Item Two of the Declarations shows the "autos" that are covered "autos" for each of your coverages. The following numerical symbols describe the "autos"' that may be covered "autos". The symbols entered next to a coverage on (lie Declarations designate the only "autos" that are covered "autos"_ A. Description Of Covered Auto Designation Symbols Description Of Covered' Auto Designation Svmbols Only those "autos" you own (and for Liability Coverage any "trailers" you don't own while attached to power units you own). This includes those "autos" you acquire ownership of after the ,policespins. Only the private passenger "autos" you own. This Includes those private passenger ""autos" you acquire ownership of after the policy begins. Only those "autos"" you own that are not of the private passenger type (and for Li- ability Coverage any"trallers" you dont own while attached to power units you ower). This includes those "autos" not of the private passenger type you acquire ownership of ager the policy berains. Only those "autos" you own that are required to have No -Fault benefits in the state where they are licensed or principally garaged, This includes those "autos" you ac- quire ownership of after the policy begins provided they are required to have No - Fault benefits In the state where they are licensed or 2rin�ci ail para ed. Only those "autos" you own that because of the law in the state where they are li- censed or principally garaged are required to have and cannot reject Uninsured Motorists Coverage. This includes those "autos" you acquire ownership of after the policy begins provided they are subject to the same state uninsured motorists re- quirement. Only those "autos" described in Item Three of the Declarations for which a pre- mium charge is shown (and for Liability Coverage any "trailers"' you don't own while attached to any power unit described In Item Three). Only eirrtlhire, rent yborrow. This y youeasehe,enorborrow from any of YouemploYees", partners (If Yoo area partnership), members (if you are a limited liability company) or members of their households. Only those "autos" you do not own, lease, hire, rent or borrow that are used in con- nection with your business. This includes "autos" owned by your "employees", part- ners (if you are a partnership)", members (if you are a limited liability company), or members of their households but only while used in your business or your personal affairs. CA 00 0103 06 0 ISO Properties, Inc., 2005 Page 1 of 12 19 Mobile Equip- Only those "autos" that are land vehicles and that would qualify under the definition ment Subject To of "mobile equipment" under this policy if they were not subject to a compulsory or Compulsory Or financial responsibility law or other motor vehicle insurance law where they are li- Financial Re- censed or principally garaged. sponsibility Or Other Motor Ve- hicle Insurance Law Only B. Owned Autos You Acquire After The Policy Begins 1. If Symbols 1, 2, 3, 4, 5, 6 or 19 are entered next to a coverage in Item Two of the Declara- tions, then you have coverage for "autos" that you acquire of the type described for the re- mainder of the policy perrod. 2. But, If Symbol 7 is entered next to a coverage in Item Two of the Declarations, an "auto" you acquire will be a covered "auto" for that cover- age only if: a. We already cover all "autos" that you own for that coverage or it replaces an "auto' you. previously owned that had that cover- age; and b. You tell us within 30 days after you acquire it that you want us to cover it for that cover- age. C. Certain Trailers, Mobile Equipment And Temporary Substitute Autos If Liability Coverage is provided by this Coverage Form, the following types of vehicles are also cov- ered "autos" for Liability Coverage: 1. 'Trailers" with a load capacity of 2,000 pounds or less designed primarily for travel on public roads. 2. "Mobile.. equipmenf' white being carried or towed by a covered "auto". 3. Any "auto"' you do not own while used with the permission of Its owner as a temporary substi- tute for a covered "auto" you own that is out of service because of its: a. Breakdown; b. Repair; c. Servicing; d. "Loss"'; or e.. Destruction. SECTION 11— LIABILITY COVERAGE A. Coverage We will pay all sums an "insured" legally rnust pay as damages because of"bodily Injury"" or "'property damage" to which this insurance applies" caused by an "accidentf' and resulting from the ownership, maintenance or use of a covered "auto". We will also pay all sums an "insured" legally must pay as a "covered pollution cost or expense" to which this insurance applies, caused by an "acci- dent" and resulting from the ownership, mainte- nance or use of covered "autos". However, we will only pay for the "covered pollution cost or ex-' pense" if there is either "bodily injury" or "property damage" to which' this, Insurance applies that Is caused by the same "accident". We have the right and duty to defend any"Insured" against a "suit" asking for such damages or a "covered pollution cost or expense". However, we have no duty to defend any "insured" against a ""suit" seeking damages for "bodily injure++'" or "prop- erty damage" or a "covered pollution cost or ex- pense" xpense" to which this insurance does not apply. We may investigate and settle any claim or "suit" as we consider appropriate. Our duty to defend or settle ends when the Liability Coverage Limit of Insur- ance has been exhausted by payment of judg- ments or settlements. 1. Who Is An Insured The following are "insureds": a. You for any covered "auto". b. Anyone else while using with your permis- sion a covered "auto"' you own, hire or bor- row except: (1) The owner or anyone else from whom you hire or borrow a covered "auto"". This exception does not apply if the covered "auto"' is a "trailer" connected to a cov- ered "auto" you own. Page 2 of 12 0 ISO Properties, Inc., 2005 CA 00 0103 06 Cl (2) Your "employee!' if the covered "auto" is owned by that "employee" or a member of his or her household. (3) Someone using a covered "auto", while he. or she Is working in a business of selling, servicing, repairing, 'parking or storing '"autos" unless that business is yours, (4) Anyone other than your "employees", partners, (if you are a partnership), members• (if you are a limited liability company), or a lessee or borrower or any of their "employees", white moving property to or from a covered "auto"". A partner (if you are a partnership), or a member (if you are a limited liability company) for a covered "auto"' owned' by him or her or a member of his or her household. c. Anyone liable for the conduct of an 'in - wed". described above but only to the ex- tent of that liability. 2. Coverage Extensions a. Supplementary Payments We will pay for the "insured": (1) All expenses we incur. (2) Up to $2,000 for cost of bail bonds (in- cluding bonds for related traffic law vio- lations) required because of an '!acci- dent' we cover. We do not have to fur- nish these bonds. (3) The cost of bonds to, release attach- ments In any "'snit"" against the "Insured" we defend, but only for bond amounts Within our Limit of Insurance. (4) All reasonable expenses Incurred by the "Insured" at our request, including actual loss of earnings up to $760 a day be- cause of time off from work. (6) All costs taxed against the "Insured" in any "sult" against the "insured" we de- fend,. (6) PJI Interest on the full amount of any judgment that accrues after entry of the judgment In any ",sult" against the "in- sured" we defend, but our duty to pay in- terest ends when we have paid, offered to pay or deposited in court the part of the, judgment that is within our Limit of Insurance. These payments will not reduce the Limit of Insurance. b. Out -Of -State Coverage Extensions While a covered "auto" Is away from the state where it is licensed we will: (1) Increase the Limit of Insurance for Li- ability, Coverage to: meet the limils sped- fled by a compulsory or financial re- sponsibillty law of the jurisdiction where the covered '%Uld' Is being used. This extension does not apply to, the limit or limits specined by any law governing motor carriers of passengers or prop- erty. (2) Provide the minimum amounts and types of other coverages, such as no- fault, required of out-of-state vehicles by the jurisdiction where the covered "auto" is being used. We Will not pay anyone more than once for the same elements of loss because of these extensions. B. Exclusions This insurance does not apply to any of the follow- ing: 1. Expected Or Intended Injury "Bodily injury' or "property damage" expected or intended from the standpoint of the ""in- sured". 2. Contractual Liability assumed under any contract or agree- ment. But this exclusion does not apply to liability for damages: a.. Assumed in a contract or agreement that is an "Insured contract" provided the "bodily In- jury" or "property damage"" occurs subse- quent to the: execution of the contract or agreement; or b. That the 'Insured" would have In the ab- sence of the contract or agreement, 3. Workers' Compensation Any obligation for which the 'Insured' or the "Insured's" insurer may be held liable under any workers' compensation, disability benefits or un,employment,compensation law or any similar law. 4. Employee Indemnification And Employees Liability "Bodily injury" to: a. An "employee" of the "Insured" arising out of and in, the course of. (1) Employment bythe "Insured", or CA 00 0103 06 0 ISO Properties, Inc., 2005 Page 3 of 12 13 0 DATE ItIIMa'D"YYY) CERTIFICATE I II INSURANCE 06/05/19 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 I IMPORTANT- Ifthe certificate PRODUCER, TE holder i an ADDITIONAL INSURED, the olio ie's must have AD ITIONAL INSURED p y( ) D provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A to the certificate holder in lieu of such endorsement(s). AR tR Uemenuthis c Services, Inc of Florida certificate does not confer rights I TACT ,on Risk Services, Inc of Florida n sk ODUCER CONT AIC No, Ext): 8;G i FAX __ 1001 Bnckell Bay Drive, Suite #1100 PHONE�?is 80(1_x27.7514 Miami, FL 33131-4937 10 743 6100 IEMAIL ADDRESS. ADP.00I Cenler@Aon.com y INSURER(S) AFFORDING COVERAGE I NAIC # INSURER A: American Home Assurance Co. 19380 INSURED N INSURER B ADP TotalSource DE IV, Inc, 10200 Sunset Drive INSURER C .' Miami, FL 33173 L/CIF I INSURER D: Keyser Marston Associates, Inc INSURER E: 1299 Fourth Street, Suite 408, San Rafael, CA 94901 INSURER F: COVERAGES REQUIREMENT, R MREVISION.. MB THIS IS TOCERTIFY THAT PINSURANCE LISTED BEEN ISSUED TO THE INSURED NAMED AS POLICY PERIOD INDICATED, NOTWITHSTANDING ERMOR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WIHRE 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. LI'NUT'.;`?' :"; fd F,:ab: ,u;' i"-QIJEST D INSR TYPE OF INSURANCE ADDLI POLICY NUMBER 'SUBRPOLICY EFF POLICY EXP LIMITS LTR INSR WVO(MMIDDIYYYY) (MM/DD/YYYY) ` I EACH OCCURRENCE I $ C,OMMERCNA(.GENERAL LIABILITY CLA'IMS•MADE', 1-1 OCCUR DAMAGE TO RENTED 1PREP.41scs CLo rxuurroncoJ $ MED EXP (Any one person) $ w..... pI G PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 0 EJ I PRODUCTS - COMP OP AGG $ .. POLICY PROJECT LOC OTHER �. ��� v LIM't"I. AU"OMOBILE LIABILITY yC:OG�"'�F:i1NE'D'.�9NtaLL. REa accidenl, $ 9 BODILY INJURY(Per person) I $ ANY AUTO OWNED SCHEDULED BODILY INJURY (Per I $ AUTOS ONLY AUTOS accident) HIRED NON -OWNED PROPERTY DAMAGE I $ AUTOS ONLY AUTOS ONLY (Per accident) D EACH OCCURRENCE $ UMBRELLA LIAB OCCUR I AGGREGATE $ EXCESS LIAB CLAIMS -MADE DEC RETENTION $ y I WORKERS COMPENSATION X PER OTH- STATUTE ER I AND EMPLOYERS' LIABILITY Y / N U $ 2,000,000 A ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? NIA WC 080375758 CA 7/1/2019 7/1/2020 E.L. EACH ACCIDENT In NH) Y E.L. DISEASE - EA EMPLOYEE) $ 2,000,000 (Mandatory If yes, descnbe under LIMIT 1 $ 2,000,000 DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) All worksite employees working for KEYSER MARSTON ASSOCIATES, INC., paid under ADP TOTALSOURCE, INC's payroll, are covered under the above stated policy. CERTIFICATE HOLDER CANCELLATION City „ . of EI Segundo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Attn: Risk Manager 350 Main Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN EI Segundo, CA 90245 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE aqon rRah04 qaa a f ef&,tida ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD IlUiiv'i nn`f".'„n i. 1 lii 1085348