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PROOF OF INSURANCE (2020) CLOSEDDATE (MMIDD/YYYY) A+7"R " CERTIFICATE OF LIABILITY INSURANCE 41l" 1 11/15/2019 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, 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 CONTACT.. ... ... .... NAME Marsh & McLennan 9850 N.W. 41 st Street ency LLC PHONE Ext) 305-591-0090 FAX Na) EMAIL Suite 100 ADDRESS, cerismiaiiii_@niaiia-it.com niaiia-ft.com Miami FL 33178 INSURER(S) AFFORDING COVERAGE NAIC# INSURERA: Liberty Mutual Fire Insurance Company 23035 INSURED WESTEI INSURER B: Berkshire Hathaway Homestate Ins Co 20044 Western State Design, Inc dba Western State Design Construction Company INSURERc: 2331 Tripaldi Way INSURER D Hayward CA 94545 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: 1870725610 REVISION NUMBER: THIS IS TOCERTIFY 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, INSR ILTR IN.SD ��SWVI? POLICY NUMBER (MMIDD/YUBR, POLICY EYYY) (MMD IFF POLICY EXP TYPE OF INSURANCE p/yyyy) LIMITS A COMMERCIAL GENERAL LIABILITY Y TB2Z61065325109 7/1/2019 7/1/2020 EACH OCCURRENCE 51000000 CLAIMS -MADE X OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: „POLICY X PRO- JECT X LOC OTHER' MED EXP (Any one person) A AUTOMOBILE LIABILITY AS2Z61065325029 X ANY AUTO GENERAL AGGREGATE OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED „ AUTOS ONLY AUTOS ONLY A X UMBRELLA LIAB X OCCUR TH7Z61065325069 EXCESS LAB CLAIMS -MADE DEQ RETENTION $ B WORKERS COMPENSATION WEWC011187 AND EMPLOYERS' LIABILITY Y I N ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? F_ NIA (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below DAMAGE '7'0 RLNt'ED $ 1,000,000 PREMISES „(Ea occu„rrence)$ 0 MED EXP (Any one person) $ 5,000 PERSONAL& ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OPAGG $,2,000,000 7/1/2019 7/1/2020 EACH OCCURRENCE $5,000,000 COMBINED SINGLE LIMIT 7/1/2019 7/1/2020acc (EaBODILY $ 1,000,000 INJURY (Per person) S BODILY INJURY (Per accident) S PIR0P'E RT Y 'G1AM AG!E (Pnr_a.pc,P.dgr1I) n$ 7/1/2019 7/1/2020 EACH OCCURRENCE $5,000,000 AGGREGATE $ 5,000,000 $ 7/1/2019 7/1/2020 X STPERUTE ER AT E. EACH ACCIDENT S1,000.000 E LDISEASE - EA EMPLOYEE $1,000,000 ELDISEASE- POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) RE: Fire Station #1 - 314 Main Street, EI Segundo CA 90245; Fire Station #2 - 2261 E. Mariposa Ave., EI Segundo, CA 90245 City of EI Segundo, its officials, and employees„ as Owner/Lessee/Contractor, are Additional Insured as respects General Liability (including Ongoing and Completed Operations) when required by written contract subject to the term, conditions and exclusions of the policy. General Liability is primary and non-contributory when required by written contract subject to the terms, conditions and exclusions of the policy. 30 Day notice of Cancellation in favor of Additional Insured as respects General Liability as required by written contract subject to the terms, conditions and exclusions of the p y. CERTIFICATE HOLDER; 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. City of EI Segundo 2261 E. Mariposa Avenue AUTHORIZED REPRESENTATIVE EI Segundo CA 90245 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD POLICY NUMBER:TB2-Z61-065325-109 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 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. Name Of Additional Insured Person(s) Or Organization(s): B. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: SCHEDULE All persons or organizations with whom you have entered into a written contract or agreement, prior to an "occurrence" or offense, to provide additional insured status. 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. Location And Description Of Completed Operations All locations as required by a written contract or agreement entered into prior to an 'occurrence" or offense. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. CG 20 37 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 POLICY NUMBER:TB2-Z61-065325-109 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 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: Name Of Additional Insured Person(s) Or Organization(s): lu 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. 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; SCHEDULE whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. Location(s) Of Covered Operations All persons or organizations with whom you have All locations as required by a written contract or entered into a written contract or agreement, prior to an agreement entered into prior to an "occurrence" or "occurrence" or offense, to provide additional insured offense. status. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. CG 20 10 04 13 0 Insurance Services Office, Inc., 2012 Page 1 of 1 Policy Number TB2-Z61-065325-109 Issued by Liberty Mutual Fire Insurance Co. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. OTHER INSURANCE AMENDMENT —SCHEDULED ADDITIONAL INSURED This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART If you are obligated under a written agreement to provide liability insurance on a primary, excess, contingent, or any other basis for any person(s) or organization(s) shown in the Schedule of this endorsement that qualifies as an additional insured on this Policy, this Policy will apply solely on the basis required by such written agreement and Paragraph 4. Other Insurance of Section IV — Conditions will not apply. Where the applicable written agreement does not specify on what basis the liability insurance will apply, the provisions of Paragraph 4. Other Insurance of Section IV — Conditions will apply. However, this insurance is excess over any other insurance available to the additional insured for which it is also covered as an additional insured for the same 'occurrence", claim or "suit". Schedule Name of Person(s) or Organization (s): All persons or organizations with whom you have entered into a written contract or agreement, prior to an "occurrence" of offense, to provide additional insured status. LC 24 20 11 18 © 2018 Liberty Mutual Insurance Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc., with its permission. WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 04 10 C (Ed. 01-19) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT -CALIFORNIA BLANKET BASIS 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 ) The additional premium for this endorsement shall be calculated by applying a factor of 2% to the total manual premium, with a minimum initial charge of $350, then applying all other pricing factors for the policy to this calculated charge to derive the final cost of this endorsement This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule Schedule Blanket Waiver Person/Organization Blanket Waiver — Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. Job Description Waiver Premium (prior to adjustments) All CA Operations 7046.00 IV 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: 07/01/2019 Policy No : WEWC011187 Endorsement No. .° Insured: Premium $ Insurance Company: Berkshire Hathaway Homestate Ins Co Countersigned by WC990410C (Ed. 01-19)