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HomeMy WebLinkAboutInsurance Certificates 2019/20 Convergint Technologies^ l Page 1 of 2 Pt DATE (MM/DDIYYYY) `4�� n CERTIFICATE OF LIABILITY INSURANCE 02/03/2020 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 CONTACTNAM>=: Willis Towers Watson Certificate Center Willis Towers Watson Midwest, Inc. fka Willis of Illinois, Inc. PHONE 1-877-945-7378 Fox 1-888-467-2378 c/o 26 Century Blvd Ar-No. Ext): IR[C. Nei: P.O. Box 305191 ADDRESS: certificates@willis.com Nashville. TN 3723n5191 TTRA INSURED Convergint Technologies LLC #601 Location #601 One Commerce Drive Schaumburg, IL 60173 INSURER(S) AFFORDING COVERAGE NAIC# _ INSURER A: XL Insurance America Inc 24554 INSURER B : Navigators Insurance Company 42307 INSURERC: Indian Harbor Insurance Company 36940 COVERAGES CERTIFICATE NUMRER- W15367414 RFVISIcfN NIIMRFR- 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. IOLICY EXP LTR TYPE OF INSURANCE INSD WVD A[IDLSMBR POLICY NUMBER MM/DD/YYYY POLICY EFF PM/DD/YYYY LIMITS x COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE 1 " OCCUR DAMAGE TO R PREMISES c� ocrrsnce $ 300,000 MED EXP (Any one person) $ 10,000 A y CGS 7409054 07 03/01/2019 03/01/2020 PERSONAL BADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPOM FER: POLICY JE0 � LOC GENERAL AGGREGATE $ 21000,000 PRODUCTS-COMP/OPAGG S 2,000,000 $ OTHER AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea ..idenl $ 1,000,000 BODILY INJURY (Per person) $ )( ANY AUTO A OWNED SCHEDULED AUTOS ONLY AUTOS CAH 7400024 08 03/01/2019 03/01/2020 $ BODILY INJURY (Per accident) HIRED NON -OWNED AUTOS ONLY AUTOS ONLY HX PROP E DAMAGE tPar a dsn! $ B UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 10 , 000 , 000 AGGREGATE )( EXCESSLIAB CLAIMS -MADE CH19EXC704521IV 03/01/2019 03/01/2020 $ 10,000,000 E.I I RETENTION $ r $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED7 No (Mandatory In NH) NIA y CWG 7400022 08 03/Ol/2019 03/Ol/2020 x IPER OTH- STATUTE ER E.L EACH ACCIDENT $ 1,000,00 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E,L. DISEASE - POLICY LIMIT $ 1,000,000 C Professional Liability CE0744682203 03/01/2019 03/01/2020 Each Claim $2,000,000 .Aggregate $2,000,000 Retention J$100,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) This Voids and Replaces Previously Issued Certificate Dated 01/24/2020 WITH ID: W15308923. SEE ATTACHED CERTIFICATE HOLDER CANCFI I ATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of La Quinta AUTHORIZED REPRESENTATIVE 78495 Calla Tampico �� n La Quints,, CA 92253 1 ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD SR ID: 19206075 EATcH: 1558513 AGENCY CUSTOMER ID: _ LOC #-. ,ate n� ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED Willis Towers Watson Midwest, Inc. £ka Willis of Illinois, Inc- Convergint Technologies LLC #601 Location #601 POLICY NUMBER One Commerce Drive See Page 1 Schaumburg, IL 60173 CARRIER NAIC CODE See Page 1 See Page 1 EFFECTIVE DATE: See Page 1 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance Job Project Location: Public Safety Camera System (PSCS) 601SNJ8045 - City of La Quints. Citywide Surveillance. City of La Quints and its officers and its employees are included as Additional Insureds as respects to General Liability, as required by written contract. It is further agreed that such insurance as is afforded shall be Primary and Non -Contributory as respects to General Liability with any other insurance in force for or which may be purchased by Additional Insureds as required by writ contract. A Waiver of Subrogation in favor of Additional Insureds applies to the Workers Compensation where required by written contract as permitted by law. INSURER AFFORDING COVERAGE: Indian Harbor Insurance Company POLICY NUMBER: MTP 9030905 05 EFF DATE: 03/01/2019 EXP DATE: 03/01/2020 TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT: Cyber Aggregate $5,000,000 Occurrence $5,000,000 NAIC#: 36940 ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SR ID: 19206075 BATCH: 1558513 CERT: W15367414 POLICY NUMBER: CGS7409054 07 COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location(s) Of Covered Operations 1.Any Person or Organization with whom you have VARIOUS AS REQUIRED PER WRITTEN agreed through written contract, agreement or permit, CONTRACT. executed prior to loss, to provide Additional Insured coverage. 2.Any other Person or Organization you are required to add as an Additional Insured under the contract or agreement described in Paragraph 1. above. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability 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 location(s) designated above. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equipment 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 intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. CG 20 10 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 2 C. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. Page 2 of 2 © Insurance Services Office, Inc., 2012 CG 20 10 04 13 POLICY NUMBER: CGS7409054 07 COMMERCIAL GENERAL LIABILITY CG 20 37 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Or anization(s) Location And Description Of Completed Operations 1.Any Person or Organization with whom you have VARIOUS AS REQUIRED PER WRITTEN agreed through written contract, agreement or permit, CONTRACT. executed prior to loss, to provide Additional Insured coverage. 2.Any other Person or Organization you are required to add as an Additional Insured under the contract or agreement described in Paragraph 1. above. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the Schedule of this endorsement performed for that additional insured and included in the "products -completed operations hazard". However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 37 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13 (Ed. 4-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT 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.) This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule WHERE REQUIRED BY WRITTEN AGREEMENT SIGNED PRIOR TO LOSS. 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.) Endorsement Effective March 1, 2019 Policy No. CWG7400022 08 Countersigned by WC 00 03 13 (Ed. 4-84) i - - 0 1983 National Council on Compensation Insurance. ENDORSEMENT This endorsement, effective 12:01 a.m., March 1, 2019, forms a part of Policy No. CGS7409054 07 issued to CONVERGINT TECHNOLOGIES, LLC by XL Insurance America, Inc. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY PRIMARY INSURANCE CLAUSE ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS COVERAGE PART It is agreed that to the extent that insurance is afforded to any Additional Insured under this policy, this insurance shall apply as primary and not contributing with any insurance carried by such Additional Insured, as required by written contract. All other terms and conditions of this policy remain unchanged. XI L 424 0605 ©, 2005, XL America, Inc.