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PROOF OF INSURANCE (2020 - 2020) CLOSEDA�R03/29/20��1,,, . � CERTIFICATE OF LIABILITY INSURANCE DATE`MMIDD19 THIS CERTIFICATE IS ISSUED ASA 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(les) 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 g endorsement(s). PRODUCER rtlficate does not confer rights to the certificate holder in lieu of such � �' �� a Julie Wong IQ Risk Insurance Services, LLC PHONE (949) 679-370D fAM (9491 679-3701 . Ea> I'Aao, Nar. 38 Executive Park, Suite 320 NESS„ jwong@igrlsk corn Irvine, CA 92614 INSURER(S) AFFORDING COVERAGE I NAICk INSURERA: Kinsale Insurance Company 38920 INSURED I-IINSURERB: Falls Lake Fire and Casualty Company 15864 .......... CC LAYNE & SONS INC. I INSURER C: 216 Standard StreetINSURER D. EI Segundo, CA 90245 INSURER E: I INSURER F: ' COVERAGES CERTIFICATE NUMBER„ CL1913104485 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, EXCLUSIONSAND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. iN sk AUUL t.UOK POLICY EPFPOLICY EMP LIMITS LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MMIDWYYYY? I t MM$DOfY'M'YY) I X" COMMERCIAL GENERAL LIABILITY -, EACH OCCURRENCE S 1,000,000 -UAWR:at i%)HLiAoLu,a 100,000 CLAIMS -MADE 19 OCCUR PREMISES Me occurrenc l S I MED EXP (Any one Persons $ Excluded A Y Y 010061552-1 02/01/2019 02/01/2020 I PERSONAL&ADV INJURY s 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. I GENERAL AGGREGATE $ 2,000,000 POLICY D jEa D LOC OTHER AUTOMOBILE LIABILITY ANYAUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY X UMBRELLA LIAB OCCUR A �I EXCESSUAe HCLAIMS-MADE 0100061562-1 02/01/2019 02/01/2020 I DED [ RETENTION S WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE Y NIA FUa008293-01 02/01/2019 02/01/2020 PRODUCTS - COM PIOP AGG �0,1�11"LY %INE..5""4E LIMIT 4"'a"" INJURY(Per person) ILY INJURY (Per accident) PAOPFRTY DAMAGE I Per 4ts46nu I EACH OCCURRENCE I AGGREGATE $ 2,000,000 $ S 2,000,000 XI PLH STATUTE, JC ER" EL EACH ACCIDENT $ 1,000,000 B OFFICERIMEMBER EXCLUDED? Lij1,000,000 (Mandatory in NH) I E.L. DISEASE - EA EMPLOYFF S If yes, describe under1,000,000 I I DESCRIPTION OF OPERATIONS below E L DISEASE- POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) '10 Days Notice of Cancellation for Non -Payment of Premium. City of EI Segundo is named as Additional Insured with respect to General Liability policy. Blanket Additional Insured and Waiver of Subrogation Endorsement applied and attached. CERTIFICATE HOLDER City of EI Segundo 350 Main Street EI Segundo, CA 90245 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 REPRESS . NTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS SCHEDULED PERSON OR ORGANIZATION .. �and Forming Part of Policy ....�......w........................... icy Effective Date of Endorsement Named Insured 0100061552-1 D2/01/201912:01AM at the Named Insured C C Layne & Sons Inc address shown on the Declarations Additional Premium: Return Premium: A$O 50 _....... �, 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 Blanket, as required by written contract. Ii Information required to complete this Schedui'e, if not shown above„ will be shown in the Declarations, A. Section II — Who Is An Insured is amended to include B. With respect to the insurance afforded to these as an additional insured the person(s) or additional insureds, the following additional exclusions organization(s) shown in the Schedule, but only with apply: respect to liability for "bodily injury", "property This insurance does not apply to "bodily injury" or damage" or "personal and advertising injury" caused, "property damage" occurring after: in whole or in part, by: 1. All work, including materials, parts or equipment 1. Your acts or omissions; or furnished in connection with such work, on the 2. The acts or omissions of those acting on your project (other than service, maintenance or behalf; repairs) to be performed by or on behalf of the in the performance of your ongoing operations for the additional insured(s) at the location of the covered additional insured(s) at the location(s) designated operations has been completed; or above. 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. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. CG 20 10 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US -BLANKET Attached To and Forming Part of Policy 0100061552-1 Additional Premium: Effective Date of Endorsement Named insured 02/01/201912:01AM at the Named Insured C C Layne & Sons Inc address shown on the Declarations Return Premium: So This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE SECTION IV — CONDITIONS, S. Transfer of Rights of Recovery against Others to Us is amended by the addition of the following: We waive any right of recovery we may have against persons or organizations because of payments we make for injury or damage arising out of "your work" done under a written contract with that person or organization wherein you have agreed to provide this waiver. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. CAS4002 0110 Page 1 of 1 CERTIFICATE OF LIABILITY INSURANCE DATE fromOrr" 1 11115/2019 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, MEND 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 hoWer is an ADDITIONAL INSURED, the policy(ios) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the k4un and conditions of the policy, certain pollcles may require an endorsement- A statement on thIs certificate does not confer rights to the cartificate holder in lion of such andorsoment(s), PRODUCER CONTACt NAiftj I om Brie Tom Brundidge LicenNE se 0479986 PHODb�' (:31'(I) 322-WO-1 (310)322-0131.1 214 Standard St. Ste B AQMffS,,IoM@torr&und1dge.com Etre gundo CA 90245 INSUAI�RS) ArFORWOO COVERA61- NAIL A oto f arm Mutual Aulomot*,- Irssurance Company 25 1 Pii INSURED INSURER 0 C C LAYNE & SONS INC DOWER C 216 STANDARD ST EL SEGUNDO CA 90245 tNSURI5R E COVERAGE$CERTIFICATE NUMBER: REVISION NUMBER: THIS 13 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 THF POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAWS F )0" YYYJ� IL IR TYPE OF INSURANCE POLEY 'D00YY r UNITS COMMERCIAL GENERAL LIABILITY N(X -WOE , 455mto-'al OCCUR 5A,0VSNJURY POLICY TECOT ux PRODUCrb�.CAIPXAl, AP01- S GENL AGGREGATE UMRAPPUIE5 PER' 0, 1'"H(' 7-- AUTOMOBILE LIABILffy Y Y 639 1212-BM75 OWM019 0210 WOM 11 ANY AU10 I BODILY INJURY wwowun) $ 1'000.000 A OMED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per acddwtj $ 1,000,_000 MIRED NOWOWNED CIVIMA�xt s 1000 1 000 AUTOS ONLY AUTOS ONLY ,' UMOW" LIAB OCCUR .Gcl I OCCURRENCE I EXCESS LL49 .... . ...... WORnASCOMPIENSATION pltfi 91h, AND SIM PLOYERS'LIAOILrEY Y 114 1-n- F,L rACH AqCPCNT IN, F �CrrWchlut: R i KWOV F❑NIA luaivd4tovy in 4") L L D'.",l AISEA EfO4.0YI F I lt� w., d9itg mo umw L! 1,.CXW71r.*4 Or tlP�HATIONS Vokw, !i4SE.+St �Ii �1 Y LIMIT 5 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD ORD 10i, AddMooW Rmwk* Sdw&&, may D;.%.hd It WWM space I. Mq~ 2006 FORD F350 SD CREW CAB VIN I FTVWV31 P46EA08216 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of El Segundo ACCORDANCE VATH THE POLICY PROVISIONS. 350 Main St HORIWORETAES ZAIwt El Segundo CA 90245 AUTIV, TID 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD 10014LIG t3284912 03 10.2016 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 4-134) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT -CALIFORNIA 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.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 225% of the California workers' compensation premium otherwise due on such remuneration_ Schedule Person or Organization Job Description Blanket Waiver of Subrogation As respects to all CA jobs performed by the named insured during the policy period where by written contract a waiver of subrogation is required prior to the commencement of work. 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 02-01-2019 Policy No. FLA008293-01 Endorsement No. Insured Insurance Company CC Layne & Sons, Inc (A Corp) Falls Lake Fire & Casualty Company Countersigned By 94998 by the Workers' Compensation Insurance Rating Bureau of California. All rights reserved.