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PROOF OF INSURANCE (2020 - 2021) CLOSEDDATE (MMfDDMYYY) ACCOR CERTIFICATE OF LIABILITY INSURANCE 3/z/2o2o 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 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). I ruuawe ul PRODUCER Jill ie Rybak Kellogg & Moreland Agency, Inc. DBA fPHON E tr (909) 792-8950 I FAX 1909)792-2030 Pc' IL LAIC. Noy, Arroyo Insurance Services ADDRES'S':julier@arroyoins.com 1654 Plum Lane ( INSURER(S) AFFORDING COVERAGE NAIC N Redlands CA 92374-4532 INSURER A: Berkley Assurance Comte 39462 INSUREDII INSUPERB:United Financial Casualty Cc 11770 California Street Lighting, A California Corp IINSURER C:State Compensation Ins Fund 35076 3200 Guasti Road #100 INSURER D; I INSURER E Ontario CA 91761 „I, INSURER F COVERAGES CERTIFICATE NUM11 BER: REVIS ION 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. iINSR ADOL'SUBR V P&UCY OF POLICY EXP( LIMITS LTR TYPE OF INSURANCE ,� POLICv NUMBER p gMMVDDd'VYY°YI pMM�900t'P'�Wvl X COMMERCIAL GENERAL LIABILITY A =CLAIMS -MADE rX OCCUR X Y I VUMB0162532 "City El Segundo, its officials, and employees are additionaleinsureds fe required) OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may bemore space Cit of per attached forme NCG2033 & #CG2037" Such insurance is primary per attached form NVCAS2035. Waiver of Subrogation applies per attached forms $CG2404 & 1110217. 30 days written notice of cancellation applies. CERTIFICATE HOLDER CANCELLATION 1,000,000 100,000 Excluded 1,000,000 2,000,000 2,000,000 1,000,000 2,000,000 2,000,000 1,000,000 1,000,000 1,000,000 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of E1 Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City Clerk ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street, Room 5 EAUTHORIZED REPRESENTATIVE El Segundo, CA 90245-3813 (Julie Rybak/JULIE OW N 1980-2014 ACORD CORPORATION. All rights reserved. ACORD 26 (2014101) The ACORD name and logo are registered marks of ACORD INS025 (201401) GEN'L AGGREGATE LIMIT APPLIES PER: $ ri DAMAGE TO R'E.NIEU C PRE'MISrs fEa occurrencet,„, S POLICY JET LOC 12/1/2020 MED EXP fAny one person) S OTHER $ AUTOMOBILE LIABILITY S B X ANY AUTO S ALL OWNED SCHEDULED 06586638-1 .... AUTOS AUTOS IF” accidaft X X NON -OWNED 2/23/2020 2/23/2021 HIREDAUTOS S AUTOS PROPERTY DAMAGE UMBRELLA LIAB OCCUR A X EXCESS LIAR R ' CLAIMS -MADE DEC) I (RETENTION S VUM0162552 WORKERS COMPENSA TION AND EMPLOYERLIABILITY S' Y I N ANY Pal'OPRIE'%OWPAR')NERIEXECUTIVE AGGREGATE S OFFICERdMCMOER EXCLUDED? E]NIA 1 C (Mandatary in NH) -„,...,.,. y 9222151 19 If yes, describe under DESCRIPTION OF OPERATIONS balaw "City El Segundo, its officials, and employees are additionaleinsureds fe required) OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may bemore space Cit of per attached forme NCG2033 & #CG2037" Such insurance is primary per attached form NVCAS2035. Waiver of Subrogation applies per attached forms $CG2404 & 1110217. 30 days written notice of cancellation applies. CERTIFICATE HOLDER CANCELLATION 1,000,000 100,000 Excluded 1,000,000 2,000,000 2,000,000 1,000,000 2,000,000 2,000,000 1,000,000 1,000,000 1,000,000 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of E1 Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City Clerk ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street, Room 5 EAUTHORIZED REPRESENTATIVE El Segundo, CA 90245-3813 (Julie Rybak/JULIE OW N 1980-2014 ACORD CORPORATION. All rights reserved. ACORD 26 (2014101) The ACORD name and logo are registered marks of ACORD INS025 (201401) EACH OCCURRENCE $ ri DAMAGE TO R'E.NIEU C PRE'MISrs fEa occurrencet,„, S 12/1/2019 12/1/2020 MED EXP fAny one person) S PERSONAL &ADV INJURY $ GENERAL AGGREGATE S PRODUCTS - COMP/OP AGG S S .... (OMT( NED 8INGLL OMIT IF” accidaft BODILY INJURY (Per person) S 2/23/2020 2/23/2021 BODILY INJURY (Per accident) S PROPERTY DAMAGE S Wer $ EACH OCCURRENCE $ AGGREGATE S 12/1/2019 12/1/2020 IS X I I STATUTE I ERH is I E.L. EACH ACCIDENT 12/1/2019 12/1/2020 E.L DISEASE - EA EMPLOYEE II V S E.L. DISEASE - POLICY LIMIT Is "City El Segundo, its officials, and employees are additionaleinsureds fe required) OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may bemore space Cit of per attached forme NCG2033 & #CG2037" Such insurance is primary per attached form NVCAS2035. Waiver of Subrogation applies per attached forms $CG2404 & 1110217. 30 days written notice of cancellation applies. CERTIFICATE HOLDER CANCELLATION 1,000,000 100,000 Excluded 1,000,000 2,000,000 2,000,000 1,000,000 2,000,000 2,000,000 1,000,000 1,000,000 1,000,000 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of E1 Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City Clerk ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street, Room 5 EAUTHORIZED REPRESENTATIVE El Segundo, CA 90245-3813 (Julie Rybak/JULIE OW N 1980-2014 ACORD CORPORATION. All rights reserved. ACORD 26 (2014101) The ACORD name and logo are registered marks of ACORD INS025 (201401) COMMERCIAL GENERAL LIABILITY CG 20 33 4413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section 11 — Who Is An Insured is amended to include as an additional insured any person or organization for whom you are performing operations when you and such person or organization have agreed In writing in a contract or agreement that such person or organization be added as an additional Insured on your policy. Such person or organization is an additional insured 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. However, the insurance afforded to such additional insured: 1. Only applies to the extent permitted by law; and 2. Will not be broader than that which you are required by the contract or agreement to provide for such additional insured. A person's or organization's status as an additional insured under this endorsement ends when your operations for that additional insured are completed. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to: 1. "Bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of, or the failure to render, any professional architectural, engineering or surveying services, Including: a. The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports,, surveys, field orders, change orders or drawings and specifications; or b. Supervisory, inspection, architectural or engineering activities. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence"" which caused the "bodily injury" or "property damage", or the offense which caused the "personal and advertising Injury", involved the rendering of or the failure to render any professional architectural, engineering or surveying services, CG 20 33 04 13 @Insurance Services Office, Inc., 2012 Page 1 of 2 2. 'Bodily injury" or "property damage" occurring after: a. 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 b. That portuon 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. 1lVith respect to the insurance afforded to these additional insureds,the following is added to Section III — Limits Of Insurance: The most we will pay on behalf of the additional Insured is the amount of insurance: 1. Required by the contract or agreement you have entered into with the additional insured; 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 0 Insurance Services Office, Inc., 2012 CG 20 33 04 13 POLICY NUMBER: COMMERCIAL GENERAL LIABILITY CG 20 37 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. IM' - 0- A 9: :4 - site] Z ""+ ! 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 Organizations) I Location And Description Of Completed Operations As required by written contract executed prior to the date of occurrence but only to the extent permitted by law and the insurance afforded to such additional I insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. Construction project sites at which you performed work for such additional insured. I 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. CG 20 37 0413 © Insurance Services Office, Inc., 2012 Page 1 of 1 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 0413 0 Insurance Services Office, Inc., 2012 Page 2 of 2 E3 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRI ARY ANCA NONCONTRIBUTORY WORDING This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE With respect to coverage provided to an additional insured via attachment of an Additional Insured endorsement to this policy, such coverage is primary insurance and we will not seek contribution from any other insurance available to that additional insured. ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED VCAS2035 11 10 Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: To any person or organization provided you entered into the contract with that person or organization prior to any claim or loss to which this insurance applies. (if no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) The TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Condition (Section IV— COMMERCIAL GENERAL LIABILITY CONDITIONS) is amended by the addition of the following: 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 10 93 Copyright, Insurance Services Office, Inc., 1992 Page 1 of 1 13 STATE ENDORSEMENT AGREEMENT BROKER COPY WAIVER OF SUBROGATION M BLANKET BASIS 9222151-19 FUNRENEWAL SP HOME OFFICE 9-60-18-14 SAN FRANCISCO EFFECTIVE DECEMBER 1, 2019 AT 12.01 A.M. PAGE 1 OF 1 ALLEFFECTIVE DATESARE AND EXPIRING DECEMBER 11 2020 AT 12.01 A.M. AT IZ OI AM PACIFIC STANDARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME CALIFORNIA STREET LIGHTING 3200 E GUASTI RD STE 100 ONTARIO, CA 91761 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 2.00% OF THE TOTAL POLICY PREMIUM. SCHEDULE PERSON OR ORGANIZATION JOB DESCRIPTION ANY PERSON OR ORGANIZATION BLANKET WAIVER OF FOR WHOM THE NAMED INSURED SUBROGATION HAS AGREED BY WRITTEN CONTRACT TO FURNISH THIS WAIVER NOTHIM13 IN THIS ENDORSEMENT CONTAINED SHALL BE HELD TO VARY, ALTER, WAIVE OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS POLICY OTHER THAN AS STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE HELD TO VARY, ALTER, WAIVE. OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR LIMITATIONS OF THIS ENDORSEMENT. COUNTERSIGNED AND ISSUED AT SAN FRANCISCO., NOVEMBER 15, 2019 AUTHORIZED REPRE XNT IVF PRESIDENT AND CEO 2572 SCIF FORM 10217 MV.7.2014I OLD OP 217