AgdaPkt 2019-01-28 Joint SA PFA - Laserfiche WebLink

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6.D. - Page 101 of 170 Request for Qualifications: General Park Building Construction, Retrofit, Maintenance, and/or Repairs Form A �►� CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYY() PRODUCER ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: INSURER B: INSURER C: INSURER D: INSURER E: ..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 CONTRACTOR 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR ADDL INSR TYPEOFINSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MM/DDIYY POLICY EXPIRATION DATE MIDDIYY LIMITS REPRESENTATIVES. GENERAL LIABILITY COMMERCIAL GENERAL LABILITY AUTHORIZED REPRESENTATIVE CC) EACH OCCURRENCE S cel S PREMISES O-REoNccTEteDn MED EXP (Any one person) 3 CLAIMS MADE F-1 OCCUR PERSONAL &ADV INJURY ; GENERAL AGGREGATE $ GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS- COMPIOP AGG ; $ POLICY 1ECT LOC AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT $ (Ea accident) BODILY INJURY $ (Per person) ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY S (Per accident) HIREDAUTOS NON -OWNED AUTOS PROPERTYDAMAGE S (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT S OTHER THAN EA ACC S ANY AUTO AUTOONLY: AGG S EXCESSAIMBRELLALIABILITY EACH OCCURRENCE S AGGREGATE S OCCUR ❑ CLAIMS MADE S S DEDUCTIBLE 3 C STATU- OTH- TOWRY LIMITSI I ER RETENTION S WORKERS COMPENSATION AND E.L. EACH ACCIDENT 3 EMPLOYERS' LIABILITY ANY PROPRIETOWPARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE -POLICY LIMIT 13 If yes, describe under SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS The City of Los Angeles is an additional insured by blanket endorsement. y„ City of Los Angeles SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Office of the City Administrative Officer, Risk Management DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS WRITTEN 200 North Main Street, Room '1240 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL Los Angeles, CA 90012 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE CC) ACUKU LO VUUT/UVJ IMPORTANT — RESPONDERS MUST SUBMIT ALL REQUIRED FORMS (COMPLETELY FILLED OUT) BY RFQ SUBMITTAL DEADLINE. 184 Page 95 of 103