ACORD® DATE (MM/DD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE
11/14/2022
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 INSURERS), 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 endorsements).
PRODUCER NAMEACT Esther Campos NAME:
Rene Williams Agency PAC. No. Ext: 310-317-4433 PHONE FAC. NO):
22837 Pacific Coast Hwy Ste D E-MAIL [email protected] ADDRESS:
INSURERS) AFFORDING COVERAGE NAIC #
Malibu CA 90265-5841 INSURERA: Lloyds of London
INSURED INSURER B: FARMERS INSURANCE COMPANY
PACIFIC ARCHITECTURE AND ENGINEERING INC. INSURER C :
730 Arizona Ave
INSURER D:
INSURER E:
Santa Monica CA 90401 INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
HIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOI NDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THI
ERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERN ‹CLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIN
INSR TYPE OF INSURANCE ADDL SUBR LIMITS
LTR INSD | WVD POLICY NUMBER
X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE Is 2,000,000
X OCCUR DAMAGE TO RENTED
CLAIMS-MADE PREMISES (Ea occurrence) $ 250,000
MED EXP (Any one person) $ 5,000
Y PSK0734644899 11/19/2022|11/19/2023 PERSONAL & ADV INJURY _s 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 RO
POLICY | I LOC PRODUCTS COMPOP AGG $ 2.000.000
OTHER:
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 2,000,000
(Ea accident)
| ANY AUTO BODILY INJURY (Per person)
A OWNED SCHEDULED 11/19/2022|11/19/2023 BODILY INJURY (Per accident) S PSK0734644899
AUTOS ONLY AUTOS
HIRED NON-OWNED PROPERTY DAMAG
- AUTOS ONLY AUTOS ONLY Per accident
UMBRELLA LIAB OCCUR EACH OCCURRENCE
EXCESS LIAB CLAIMS-MADE AGGREGATE
DED RETENTIONS
WORKERS COMPENSATION TATUTE T TERH
AND EMPLOYERS LIABILITY Y / N
B OFFICER MEMBER DECEIVE E.L. EACH ACCIDENT $ 1,000,000 N/ A Y B09478570 11/19/2022 11/19/2023
(Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 1,000,000 escribe unde
ESCRIPTION OF OPERATIONS belo EL. DISEASE - POLICY LIMIT $ 1,000,000
PROFFESSIONAL LIABILITY
A PSK0734644899 11/19/2022 11/19/2023 CLAIMS MADE 1,000,000 DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER AND ADDITIONAL INSURED UNDER POLICY PSK0734644899
CITY OF REDONDO BEACH THEIR OFFICER EMPLOYEES VOLUNTEERS, AND AGENTS 415 DIAMOND STREET
REDONDO BEACH, CA 90277
SHOULD ANY OF THE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE, THE ISSUING INSURER WILL MAIL A WRITTEN NOTICE 30 DAYS IN ADVANCE.
CERTIFICATE HOLDER CANCELLATION
CITY OF REDONDO BEACH THEIR OFFICER EMPLOYEES SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE THEREOF, NOTICE WILL BE DELIVERED IN
VOLUNTEERS, AND AGENTS ACCORDANCE WITH THE POLICY PROVISIONS. 415 DIAMOND STREET
REDONDO BEACH, CA 90277 AUTHORIZED REPRESENTATIVE
Kene Wiliang
-
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ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD • cfc
ADDITIONAL INSURED CLAUSE (SPECIFIED THIRD PARTY)
ATTACHING TO POLICY PSL0839562914
NUMBER:
THE INSURED: Pacific Architecture & Engineering
WITH EFFECT FROM: 19 Nov 2022
It is understood and agreed that the following amendments are made to this Policy:
1. The following DEFINITION is added:
"Additional insured" means:
The City of Thousand Oaks (Effective From: 19 Feb 2020) The City, its elected officials, officers, agents, employees, and volunteers
2100 Thousand Oaks Blvd
Thousand Oaks
City of Santa Monica (Effective From: 19 Feb 2020)
The City, its elected officials, officers, agents, employees, and 1685 Main St
Santa Monica
CA, 90401
The City of Rolling Hills (Effective From: 19 Feb 2020) The City, its elected I officials, officers, agents, employees, and volunteers
2 Portugese Bend
Rolling Hills
City of South Gate and their appointed officials employees, agents,or volunteers (Effective From: 05 Jun 2020)
8650 California Avenue
South Gate
CA, 90280
SUCity of Redondo Beach, their officers, (Effective From: 21 Dec 2015) employees, volunteers and agents
415 Diamond St
St. Redondo Beach
CA, 90277
City of Rancho Palos Verdes (Effective From: 21 Dec 2015) 30940 Hawthorne Blvd
Rancho Palos Verdes
CA, 90272
Unique Market Reference No. B087522C9N5051. B087522C9N5053| cfc
El Segundo (Effective From: 23 Dec 2015)
City of El Monte and their elected & appointed (Effective From: 27 Apr 2016) officials, officers, employees, agents or volunteers 11333 Valley Boulevard
El Monte
CA, 91731
The Costa Mesa Sanitary District, its elected and appointed officials, agents, officers, volunteers and employees (Effective From: 15 Feb 2018)
290 Paularino Ave
Costa Mesa
CA, 92626
THE CITY OF CARLSBAD, ITS OFFICERS, EMPLOYEES, VOLUNTEERS AND AGENTS (Effective From: 06 Apr 2017)
c/o EXIGIS Insurance Compliance Services
P.O. Box 947
Murrieta
CA, 92564
SUCity of Redondo Beach, their officers employees, volunteers and agents (Effective From: 21 Dec 2015)
415 Diamond St
St. Redondo Beach
CA, 90277
City of Rancho Palos Verdes (Effective From: 21 Dec 2015) 30940 Hawthorne Blvd
St. Redondo Beach
Rancho Palos Verdes
CA, 90272
City of El Monte and their elected & appointed officials, officers, employees, agents or volunteers (Effective From: 27 Apr 2016 1333 Valley Boulevarc
El Monte
CA, 91731
2. In respect of the "Additional insureds" CONDITION, additional insureds are included as a third party.
3. The following CONDITION is added:
Notice of cancelation to additional insureds
If we give you notice of cancelation in accordance with the "Cancelation" CONDITION, we will endeavor to provide the same notice of cancelation to the additional insureds; however, not doing so will not place any additional liability upon us.
SUBJECT OTHERWISE TO THE TERMS AND CONDITIONS OF THE
POLICY
Unique Market Reference No. B087522C9N5051. B087522C9N5053|