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PROOF OF INSURANCE (2020) CLOSEDPage 1 of 2 DATE (MM/DD/Y" , `RL> CERTIFICATE OF LIABILITY INSURANCE 02/04/2020 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(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 this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Willis Towers Watson Certificate Center NAME: Willis Towers Watson Northeast, Inc. fka Willis of Pennsylvania, PHONE FAX -- Inc. 1-877-945-7378 1-888-.... 78 _Lka�G�NP�.�i(Ia:._......_.........., fAfC. Nolo................................ EMAIL certificates@willis.com C/o 26 Century Blvd ADDRESS; ,,,,,,,,,,,,,,,,,,,,,,,,,,, ._. P.O. Box 305191 INSURER(S) AFFORDING COVERAGE NAIC # Nashville, TN 372305191 USA INSURER A : Liberty Insurance Corporation 42404 INSURED INSURER B Henkels 6 McCoy, Inc. .., -.m......._......._ ..................... _..... .,.,............... � 985 Jolly Road INSURERC: Blue Bell, PA 19422 USA INSURER D ' QQ INSURER E R INSURER F: COVERAGES CERTIFICATE NUMBER: W15398938 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, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR AOOL »)V R LTR TYPE OF INSURANCE MAIL" POLICY NUMBER POLICY EFF POt,dCY EXP ........................ IMMIDDWYYI. WMIDDIYYYYI .-......m................ LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 5,000,000 .............. m CLAIMS -MADE %� OCCUR DAMAGE TO TED 1,000,000 PREMISES (Ea occurrence)$ A MED EXP (Any one person) $ 10,000 TB7-631-009002-919 10/01/2019 10/01/20205,000,000 PERSONAL &ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 10,000,000 L..:J PRO - POLICY Fx_1 LOC PRODUCTS - COMP/OP AGG $ 10,000,000.......... OTTIER: $ AUTOMOBILE LIABILITY .............. COMBINED SINGLE LIMIT $ 2,000,000 (Ea acoldent'I X ANY AUTO BODILY INJURY (Per person) $ A -....... OWNED SCHEDULED AS7-631-009002-909 10/01/2019 10/01/2020 BODILY INJURY (Per accident) $ AUTOS ONLY -x HIRED x AUTOS NON -OWNED P'ROPERT'Y DAMAGE $ AUTOS ONLY AUTOS ONLY _�.P.4^'..Ident ........... UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS -MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION X APER I DTH - STATUTE ER AND EMPLOYERS' LIABILITY YIN V ,,,,,,,,,,,,,,,, I $ 1,000,000 A ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUE No N/A WA7-63D-009002-929 E.L. EACH ACCIDENT 10/01/2019 10/01/2020 1,000,000 I (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE. $ If yes, describe under DESCRIPTION OF OPERATIONS below El DISEASE -POLICY LIMIT $ 1,000,000i A Workers Compensation WC7-631-009002-939 10/01/2019 10/01/2020 E.L. Each Accident $1,000,000 S Employers Liability E.L. Disease -Each End $1,000,000 (Work Comp: Per Statute E.L. Disease-Pol Lmt $1,000,000 DESCRIPTION OF OPERATIONS/ LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) BU #400052 Contract Reference No. Fiber Optic Vault Lid Replacement Project Project No.: PW 19-08; Replace 7 3x5 Fiber vault lids. Est Start/Finish Date: 2/17/2020-2/28/2020 C/O: n/a CERTIFICATE HOLDER CANCELLAT'IO'N SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. I City of El Segundo AUTHORIZED REPRESENTATIVE 320 Main Street+ El Segundo, CA 90245 ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD SR ID: 19213566 BATCH: 1560839 AGENCY CUSTOMER ID: LOC #: AC ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED Willis Towers Watson Northeast, Inc. fka Willis of Pennsylvania, Inc. Henkels S McCoy, Inc. 985 Jolly Road POLICY NUMBER Blue Bell, PA 19422 USA See Page 1 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 General Liability includes Contractual Liability. It is agreed that The City, its officers, officials, employees, agents, and volunteers are included as Additional Insureds as respects to General Liability, but solely in regards to work being performed by or on behalf of the Named Insured, as required by written contract. It is further agreed that such insurance as is afforded shall be Primary and Non-contributory with any other insurance in force for or which may be purchased by the Additional Insured as required by written contract. The City, its officers, officials, employees, agents, and volunteers are included as Additional Insureds as respects to Auto Liability, as required by written contract. Waiver of Subrogation applies in favor of City, its officers, officials, employees and volunteers with respects to General Liability and Auto Liability, as required by written contract. Waiver of Subrogation applies in favor of City, its officers, officials, employees and volunteers with respects to Workers Compensation, as required by written contract or agreement with the insured, executed prior to the accident or loss and as permitted by law. ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SR ID: 19213566 BATCH: 1560839 CERT: W15398938 Policy Number: TB7-631-009002-919 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) Location(s) Of Covered Operations Or Organizations): All persons or organizations as required by All locations as required by written contract or written contract or agreement prior to loss. agreement prior to loss. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section 11 -- 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) desig- nated above. B. With respect to the insurance afforded to these additional insureds, the following additional exclu- sions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equip- ment fumished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insureds) at the location of the covered operations has been completed; or CG 20 10 07 04 © ISO Properties, Inc., 2004 Page 1 of 2 2. That portion of "your work" out of which the injury or damage arises has been put to its in- tended use by any person or organization oth- er than another contractor or subcontractor engaged in performing operations for a princi- pal as a part of the same project. Page 2 of 2 0 ISO Properties, Inc., 2004 CG 2010 07 04 Policy Number: TB7-631-009002-919 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 Name Of Additional Insured Person(s) Or Organization(s): All persons or organizations as required by written contract or agreement prior to loss. SCHEDULE Location And Description Of Completed Opera- tions All locations as required by written contract or agreement prior to loss. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. 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". CG 20 37 07 04 0 ISO Properties, Inc., 2004 Page 1 of 1 Policy Number: TB7-631-009002-919 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: As required by written contract or agreement entered into prior to loss. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV — Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products - completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 1 POLICY NUMBER: AS7-631-009002-909 COMMERCIAL AUTO CA 20 48 '1013 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED FOR COVERED AUTOS LIABILITY COVERAGE This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement identifies person(s) or organizations) who are "insureds" for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. SCHEDULE Name Of Person(s) Or Organization(s): Any person or organization where the named insured has agreed by written contract to include such person or organization as a designated insured. Information required to complete this Schedule, if not shown above, will be shown In the Declarations. Each person or organization shown In the Schedule is an "Insured" for Covered Autos Liability Coverage, but only to the extentthat person or organization qualHies as an "insured" under the Who Is An Insured provision contained ih Paragraph A.1. of Section 11 , Covered Autos Liability Coverage In the Business Auto and Motor Carrier Coverage Forms and Paragraph D.2. of Sectlon I - Covered Autos Coverages of the Auto Dealers Coverage Form. CA 20 40 1013 0 Insurance Services Office, Inc., 2011 Page 1 of 1 POLICY NUMBER: AS7-631-009002-909 COMMERCIAL AUTO CA 04 4410 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respectto coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. SCHEDULE Name(s) Of Person(s) Or Organization(s): Any person or organization for whom you perform work under a written contract if the contract requires you to obtain this agreement from us, but only if the contract is executed prior to the injury or damage occurring. Premium: $ INCL Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The Transfer Of Rights Of Recovery Against Others To Us condition does not apply to the person(s) or organization(s) shown in the Schedule, but only to the extent that subrogation is waived prior to the "accident" or the 'loss" under a contract with that person or organization. CA 04 441013 0 Insurance Services Office, Inc., 2011 Page 1 of 1 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. Not applicable MN Wording: This waiver does not apply to any right to recover payments which the Minnesota Workers Compensation Reinsurance Association may have or pursue under M.S. 79.36. Schedule Any person or organization for which the employer has agreed by written contract, executed prior to loss, may execute a waiver of subrogation. However, for purposes of work performed by the employer In Missouri, this waiver of subrogation does not apply to any construction group of classifications as designated by the waiver of right to recover from others (subrogation) rule In our manual. Where required by contract or written agreement prior to loss and allowed by law. in the states of Alabama, Arizona, Arkansas, Colorado, Delaware, Dist. Of Col, Georgia, Idaho, Illinois„ Indiana, Kansas, Maine, Michigan, Mississippi, Missouri, Montana, New Mexico, Oklahoma, Pennsylvania, Rhode Island, West. Virginia, The premium charge Is 2.00% of the total manuai premium, .subject to a minimum premium of $100 per policy. in the states of Connecticut, Florida, Maryland, Oregon The -premium charge Is 1% of the total manual premium subject to a minimum premium of $250 per policy. In the state of Hawaii, The premium charge for this endorsement is 1.00% of the total manual premium, subject to a minimum premium of $250 per policy. In the state of Massachusetts, The premium charge is 1% of the total manual premium. In the state of Minnesota, The premium charge is 2.00% of the total manual premium, subject to a minimum premium of $100 per policy, In the state of New York & Tennessee, The premium charge Is 2.00% of the total manual premium, subject to a minimum premium of $250 per policy. In the state of Virginia, The premium charge is 5.00% of the total manual premium, subject to a minimum premium, of $250 per policy. Issued by Liberty Insurance Corporation 21814 For attachment to Policy No. WA7-63D-009002-929 Effective Date 10/112019 Premium $ Issued to Henkels & McCoy Group, Inc. WC 00 0313 ®1983 National Council on Compensation Insurance. Page 1 of 1 Fd. 04/01/1984 I 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 contract or written agreement prior to loss and allowed by law. In the state of Wisconsin, The premium charge Is 2% of the total manual premium, subject to a minimum premium of $50 per policy. Issued by Liberty Insurance Corporation 21814 For attachment to Policy No, WC7-631-009002-939 Effective Date 10/1/2019 Premium $ Issued to Henkels & McCoy, Inc. WC 00 0313 0 1983 National Council an Compensation Insurance. Page I of 1 Ed, 04J0I/1984