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PROOF OF INSURANCE (2021 - 2021) CLOSEDCERTIFICATE OF LIABILITY INSURANCE I DAT0401/200YYY) 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) roust 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 I CONTACT Ann Risk insurance services west, Inc. NAME: PHONE(866) 263_7122 FAX LOS An el es CA office A10. No. Ext): INC. No.): 800-363-0105 707 Wilshire Boulevard E-MAIL Suite 2600 ADDRESS. Los Angeles CA 90017-0460 USA INSURER(S) AFFORDING., COVERAGE I NAIC # INSURED INSURER A: Zurich American Ins c0 ;16535 595 Engineers 3900 Kilroy Airport INSURER B: steadfast Insurance Company 26387 Long Beach CA 90806 -Way, Suite 100 6816 USA�INSURERC; INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570081267968 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. Limits shown are as requested ICT ADUL SUBR' POLICY EFF POLICY EXP TYPE OF INSURANCE INSD WVD POLICY NUMBER (MWDDIYYYYj fMI&DD/YYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY GLO011277805-03/31/LOLU 03/31/2021 EACH OCCURRENCE ' $1,000,0001 CLAIMS -MADE MOCCUR DAMAGE1 EaaocurREN I Eencs) $1,000,0001 PREMMED EXP (Any one person) $25,0001 PERSONAL& ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE ( $10,000,000 POLICY X PRO- X LOC �JECT (PRODUCTS - COMP/OPAGG I $10,000,000 OTHER; AUTOMOBILE LIABILITY X ANYAUTO __.-.. OWNED SCHEDULED ---- AUTOS ONLYAUTOS HIRED AUTOS NON -OWNED ....�... ONLY AUTOS ONLY UMBRELLA LIAR II OCCUR EXCESS LIAR CLAIMS -MADE DED I (RETENTION WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR / PARTNERI EXECUTIVE �""� OFFICER/MEMBER EXCLUDED? I "" (NIA (Mandatory In NH) L..� If yes, describe under BAP 0112780-05 04/01/2020 04/01/2021( COMBINED SINGLE LIMIT (Ea accideI $1,000,000 nt) BODILY INJURY ( Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accideni) EACH OCCURRENCE (AGGREGATE WC011277905 04/01/2020 04/01/20211X I PERSTATI.6TE '"" ERarH- E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE -EA EMPLOYEE $1,000,000 D SCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT I $1,000,000 - B Env Prof (E&O) IPR379235303 03/31/2020 03/31/2023 Per Claim $1,000,000 -- Prof Liab - Claims Made I Aggregate I $1,000,000 DESCRIPTION OF OPERATIONS d LOCATIONS! VEWICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) -. RE: SC5 Job N0. 01217299.00, solid waste Consulting Services. City of E1 Segundo, its officials and employees are included as Additional insured with respect to the General Liability policy; granted a Waiver of subrogation for workers' Compensation policy; and the General Liability policy evidenced herein is thePrimInsured underand osaidbcontract,other insurance available, as required by written contract, but limited to the operations of y._, h N cc 0 r� u7 0 Z rU W U CERTIFICATE HOLDER City of E1 Segundo Attn: Ken Beckman Public works, 350 Main street El Segundo CA 90245 USA CANCELLATION 054 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION PATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 2-:1 AUTHORIZED REPRESENTATIVE 4f ta� J4 x� @1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 0 ZURICH"' Additional Insured —Automatic — Owners, Lessees Or Contractors �� n��^^��n,rs �—T | | | pPolicyBI Da�Pot.— Exp._Date of "�°� / E�D�e of Enm._ Producer |� �8��P�m Return / . | | | G | | | | |U]O11 � O3/31/282O D�/�1/2O2O |O3/31/�O21 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ KCAREFULLY. Named Insured: Stearns, Conrad and Schmidt, Consulting Engineers, Inc. Address (including ZIP Code): 3900 Kilroy Airport Way, Ste. 100, Long Beach, CA 90806 This endorsement modifies insurance provided under the: Commercial General Liability Coverage Part A. SectmnU—VVhoks An Insured is amended to include as an additional insured any person or organization whom you are required to add as an additional insured on this policy under vvhthan contract or written agreement. 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 oromissions; or 2. The acts or omissions of those acting on your behalf, in the performance of your ongoing operations or "your work" as included in the "prod ucts-comp|ehad operations hozmrd"^which iathe subject ofthe written contract orwritten agreement. However, the insurance afforded tosuch additional insured: 1. Only applies tothe extent permitted bylaw; and 2^ Will not be broader than that which you are required by the written contract or written agreement to provide for such additional insured, B. With respect to the insurance afforded to these additional insureds, the following additional exclusion applies: This insurance does not apply to: "Bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of, or failure to render, any professional architectural, engineering orsurveying serviceainduding: o. The prepohng, approving or failing to prepare or approve maps, shop drawings, opiniono, reports, surveym. field orders, change orders ordrawings and specifications; or b. Supervisory, inspection, architectural orengineering 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 damaOe", 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. u^sL-1175-Fnvv(04/13 Page I of 2 Includes copyrighted material of Insurance Services Office, Inc., with its permission. C. The following is added toParagraph 2.Duties |nThe Event Of Occurrence, Offense, Claim OrSuit ofSgction|V— The additional insured must see toit the 1. VVeare notified as soon aspracticable ofan"000urnence'oroffense that may result inaclaim; 2. VVereceive written notice ofaclaim or"suit"amsoon aepracticable; and 3. A request for defense and indemnity of the claim or "suit" will promptly be brought against any policy issued by another insurer under which the additional insured may be an insured in any capacity, This provision does not apply to insurance on which the additional insured is a Named Insured if the written contract or written agreement requires that this coverage be primary and non-contributory. D. For the purposes ofthe coverage provided bvthis endorsement: 1. The following is added to the Other Insurance Condition of Section PV — Commercial General Liability Primary and Noncontributory insurance This insurance is primary to and will not seek contribution from any other insurance available to an additional insured provided that: a. The additional insured kaaNamed Insured under such other insurance; and b. You are required by vvh8en contract or written agreement that this insurance be primary and not seek contribution from any other insurance available to the additional insured. 2. The following paragraph is added to Paragraph 4.b. of the Other Insurance Condition of Section IV — Commercial General Liability Conditions: This insurance is excess over: Any of the other insurance, whether primary, excues, contingent or on any other basis, available to an additional iosured, inwhich the additional insured on our policy im also covered as an additional insured on another policy providing coverage for the same "nocu/rence^.offense, claim or"muit' This provision does not apply toany policy in which the additional insured is a Named Insured on such other policy and vvhoos our policy is required by written contract or written agreement to provide coverage to the additional insured on m primary and non- contributory basis. E. This endorsement does not apply to an additional insured which has been added to this policy by an endorsement showing the additional insured in a Schedule of additional insureds, and which endorsement applies specifically to that identified additional insured. F. With respect imthe insurance afforded to the additional insureds under this endmnaement, the following is added to Section III — Limits Of Insurance: The most wewill pay onbehalf ofthe additional insured ksthe amount ofinsurance: 1. Required bvthe written contract orwritten agreement referenced inParagraph A.ofthis endorsement; or 2. Available under the applicable Limits of Insurance shown in the Declarations, whichever isless. This endorsement shall not increase the applicable Limits ofInsurance shown |nthe Declarations. All other terms and conditions of this policy remain unchanged. V -GL -1175-F CW (04 3) Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page aorc WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY VUCM0O313 (Ed. 04-84) -' �� o�� UU�� U��T ��"�"��.��. ��.��~.. �� '�. �� OTHERS ENDORSEMENT '��' We have the ht 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 performwork under a written contract that requires you toobtain this agreement from us.) This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule ALL PERSONS AND/OR ORGANIZATIONS THAT ARE REQUIRED BY WRITTEN CONTRACT OR AGREEMENT WITH THE INSURED, EXECUTED PRIOR TO THE ACCIDENT OR LOGS, THAT WAIVER OF SUBROGATION BE PROVIDED UNDER THIS POLICY FOR WORK PERFORMED BYYOU FOR THAT PERSON AND/OR ORGANIZATION 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: 0401/2020 Policy No. WC 0112779-05 Insured: Stearns, Conrad and Schmidt, Consulting Engineers, Inc. Insurance Company: Zurich American Insurance Company Endorsement No. Premium $ yyCPage 1uf1 WC 00 03 13 Copyright 1y8oNational Council onCompensation Insurance, Inc. Uniform Form STM WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 4-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different date is indicated below. (The following "attaching clause" need be completed only when this endorsement is issued subsequent to preparation of the policy.) This endorsement, effective on: 04/01/2020 at 12:01 A.M. standard time, forms a part of Policy No. WC 0112779-05 Endorsement No. of the: Zurich American Insurance Company issued to: Stearns, Conrad and Schmidt, Consulting Engineers, Inc, Premium (if any) $ 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 % of the California workers' compensation pre- mium otherwise due on such remuneration. �IIMITIV Person or Organization Job Description ALL PERSONS AND/OR ORGANIZATIONS THAT ARE REQUIRED BY WRITTEN CONTRACT OR AGREEMENT WITH THE INSURED, EXECUTED PRIOR TO THE ACCIDENT OR LOSS, THAT WAIVER OF SUBROGATION BE PROVIDED UNDER THIS POLICY FOR WORK PERFORMED BY YOU FOR THAT PERSON AND/OR ORGANIZATION WC 252 (4-84) WC 04 03 06 (Ed. 4-84) Page 1 of 1 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE WC 42 03 04 B Policy Number: WC01 12779-05 (Ed. 6-14) TEXAS WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement applies only to the insurance provided by the policy because Texas is shown in Item 3.A. of the Information Page 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, but this waiver applies only with respect to bodily injury arising out of the operations described in the Schedule where you are required by a written contract to obtain this waiver from us. This endorsement shall not operate directly or indirectly to benefit anyone not named in the Schedule. The premium for this endorsement is shown in the Schedule. Schedule 1. (E1) Specific Waiver Name of person or organization ALL PERSONS AND/OR ORGANIZATIONS THAT ARE REQUIRED BY WRITTEN CONTRACT OR AGREEMENT WITH THE INSURED, EXECUTED PRIOR TO THE ACCIDENT OR LOSS, THAT WAIVER OF SUBROGATION BE PROVIDED UNDER THIS POLICY FOR WORK PERFORMED BY YOU FOR THAT PERSON AND/OR ORGANIZATION (Z) Blanket Waiver Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. 2. Operations: 3. Premium: The premium charge for this endorsement shall be 2 percent of the premium developed on payroll in connection with work performed for the above person(s) or organization(s) arising out of the operations described, 4. Advance Premium: INCL WC 4203048 (Ed. 6-14) @ Copyright 2014 National Council on Compensation Insurance, Inc. All Rights Reserved.