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PROOF OF INSURANCE (2020) CLOSEDAC CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 12/1/2020 I 5/28/2020 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(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 Lockton Companies CONTACT NAME: 444 W. 47th Street, Suite 900 PHONE FAX IAJ�L. NO. FarrIA/C. No): Kansas City MO 64112-1906 E-MAIL (816) 960-9000 ADDRESS: DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) RE: ELSGOOOO-0003 - PROJECT MANAGEMENT` FOR EL SEGUNDO BLVD IMPROVEMENT PROJECT. CITY OF EL SEGUNDO, ITS OFFICIALS, AND EMPLOYEES ARE ADDITIONAL INSUREDS AS RESPECTS GENERAL LIABILITY AND AUTO LIABILITY, AND THESE COVERAGES ARE PRIMARY IF REQUIRED BY WRITTEN CONTRACT, THE EXCESS LIABILITY IS CONSIDERED FOLLOW FORM OVER THE GENERAL LIABILITY, AUTO LIABILITY AND EMPLOYERS LIABILITY SUBJECT TO THE POLICY TERMS, CONDITIONS AND EXCLUSIONS. & 6. 23 -,:As ),rj CERTIFICATE HOLDER CANCELLATION See Attachments 1 16773204 CITY OF EL SEGUNDO SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ATTN: CHERYL EBERT THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 350 MAIN STREET ACCORDANCE WITH THE POLICY PROVISIONS. EL SEGUNDO CA 90245 AUTHORIZED REPRESENTA @1 9881 ORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD INSURER(S) AFFORDING COVERAGE MAIC # INSURER A: Zurich American insurance Company 16535 INSURED DAVID EVANS AND ASSOCIATES, INC. INSURERS; Travelers Property Casualty Co of America 25674 1330770 2100 SW RIVER PARKWAY INSURER C :Continental Casualty Company 20443 PORTLAND OR 97201 INSURER D: American Guarantee and Liab. In's. Co. 26247 INSURER E: American Zurich Insurance Company 40142 INSURER F: COVERAGES DEAINOI - MAIN CERTIFICATE NUMBER: 16773204 REVISION NUMBER: xxxxxxx 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. INADDLSUSR LTSRR TYPE OF INSURANCE INSO WVD POLICY POLICY EFF POLICY EXP" I NUMBER iMMIDDfYYY1MMIDDIYYYY1 LIMITS A X COMMERCIAL GENERAL LIABILITY Y Y GL09830389 12/1/2019 12/1/2020 I EACH OCCURRENCE s $1.000.000 CLAIMS -MADE Fx-1OCCUR DAMAGESRENTED PREMISES (Ea occurrencO s $300.000 MED EXP (Any one person) s $10.000 PERSONAL& ADV INJURY s $1.000.000 AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE s $2.000,000 --GEN'L 7 IRI - POLICY 7X 0 JECT LOC I PRODUCTS -COMPIOPAGG s $2.000.000 OTHER: $ D AUTOMOBILE LIABILITY y y BAP9830390 12/1/2019 12/1/2020 COMBINED SINGLE LIMIT (Ea accident) $ $1.000,000 x ANY AUTO BODILY INJURY (Per person) S xxxxxxx OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) S xxxxxxx X HIRED NON -OWNED AUTOS ONLY AUTOS ONLY R ..PROPERTY DAMAGE— (Per accident! $ xxxxxxx s xxxxxxx B — UMBRELLA LIAB x OCCUR N N ZUP-51NO7076 I 12/1/2019 12/1/2020 EACH OCCURRENCE s $1.000.000 X EXCESS LAB CLAIMS -MADE I AGGREGATE S $1.000.000 I I I DEO RETENTIONS $ XXXXXXX WORKERS COMPENSATION E Y X I PER I OTH. STATUTE AND EMPLOYERS' LIABILITY YIN WC 9 336626 12/l/2019 12/1/2020 S I IER ANY PROPRIETORIPARTNERIEXECUTIVE FN—] E.L. EACH ACCIDENT $ 1.000.000 OFFICERIMEMBER EXCLUDED? N/A (Mandatory In NH) E.L. DISEASE - EA EMPLOYEES 1.000.000 lVes, describe under D DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1.000.000 C PROFESSIONAL N N AEH591924704 12/1/2019 12/1/2020 PER CLAIM S1,000,000 LIABILITY ANNUAL AGGREGATE S 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) RE: ELSGOOOO-0003 - PROJECT MANAGEMENT` FOR EL SEGUNDO BLVD IMPROVEMENT PROJECT. CITY OF EL SEGUNDO, ITS OFFICIALS, AND EMPLOYEES ARE ADDITIONAL INSUREDS AS RESPECTS GENERAL LIABILITY AND AUTO LIABILITY, AND THESE COVERAGES ARE PRIMARY IF REQUIRED BY WRITTEN CONTRACT, THE EXCESS LIABILITY IS CONSIDERED FOLLOW FORM OVER THE GENERAL LIABILITY, AUTO LIABILITY AND EMPLOYERS LIABILITY SUBJECT TO THE POLICY TERMS, CONDITIONS AND EXCLUSIONS. & 6. 23 -,:As ),rj CERTIFICATE HOLDER CANCELLATION See Attachments 1 16773204 CITY OF EL SEGUNDO SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ATTN: CHERYL EBERT THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 350 MAIN STREET ACCORDANCE WITH THE POLICY PROVISIONS. EL SEGUNDO CA 90245 AUTHORIZED REPRESENTA @1 9881 ORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD Miscellaneous Attachnicnt: M503337 Certificate ID: 16773204 POLICY NUMBER: GLO 9830389 COMMERCIAL GENERAL LIABILITY CG 2010 07 04 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) Or Organization(s): Location(s) Of Covered Operations ANY PERSON OR ORGANIZATION YOU ARE REQUIRED TO ADD Any location where you have agreed, through AS AN ADDITIONAL INSURED UNDER WRITTEN CONTRACT OR written contract, agreement of permit, to AGREEMENT EXECUTED PRIOR TO A LOSS. provide additional insured coverage, except where such contract or agreement is prohibited by law. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section 11 - Wbo 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", 11property 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, 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: 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. Miscellaneous Attachment: M503356 Certificate 1D: 16773204 POLICY NUMBER: GLO 9830389 COMMERCIAL GENERAL LIABILITY CG 20 37 07 04 - THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADM M OR CONTRACTORS OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): ANY PERSON OR ORGANIZATION YOU ARE REQUIRED TO ADD AS AN ADDITIONAL INSURED UNDER WRITTEN CONTRACT OR AGREEMENT EXECUTED PRIOR TO A LOSS. Location And Description Of Completed Operations Any location where you have agreed, through written contract, agreement or permit, to provide additional insured coverage for completed operations, except where such contract or agreement is prohibited by laws. 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 or- ganizations} 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". Miscellaneous Attachment: M503490 Certificate ID: 16773204 POLICY NUMBER: GLO983O389 OtherInsurance Amendment —Primary And Non -Contributory This endorsement modifies insurance provided under the: Commercial General Liability Coverage Part 1, The following paragraph is added to the Other Insurance Condition of Section IV ~ Commercial General Liability Conditions: This insurance is primary insurance to and will not seek contribution from any other insurance available hmenadditional insured under this policy provided that: a. The additional insured |maNamed Insured under such other insurance; and b. You are required byewritten contract orwritten agreement that this insurance would beprimary and would not seek contribution from any other insurance available to the additional insured. 2. The following paragraph is added to Paragraph 4.6. of the Other Insurance Condition of Section IV ' Commercial General Liability Conditions: This insurance is excess over: Any ofthe other insurance, whether primary, excess, contingent or on any other basis, available to an additional insured, in which the additional insured on our policy is also covered as an additional insured on another policy providing coverage for the same °ocoumance", ufenuo, claim or "suit". This provision does not apply b»any policy inwhich the additional insured iaa Named Insured mnsuch other policy and where our policy is required by written contract orwritten agreement to provide coverage to the additional insured on a primary and non-contributory basis. All other terms and conditions afthis policy remain unchanged. U -GL -1 327-A CW A A Mwixefffn I LN Pat 0 0 L COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART Name Of Person Or Organization: Any person or organization that requires you to waive your rights of recovery, in a written contract or agreement with the Named Insured, 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 Page 1 of 1 Miscellaneous Attachment: M460257 Certificate ID: 16773204 Miscellaneous Attachment: M5D3359Certificate ID: 16773204 POLICY NUMBER: BAP 9880390 COMMERCIAL AUTO CA 20 48 10 13 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 bythis endorsement, #heprovo|onmofdheCoveregeFwnnapphun|ees modified bythis endorsement. This endorsement identifies s)ororganization(s) 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 inthe Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated Name CePenaon(s)C)r Organization (s): ANY PERSON OR ORGANIZATION YOU ARE REQUIRED TO ADD AS AN ADDITIONAL INSURED UNDER WRITTEN ]0NTRAC7ORAGREEMENT EXECUTED PRIOR TDALOSS. Information required tocomplete this Schedule, ifnot shown above, will bmshown inthe Declarations. Each person or organization shown in the Schedule is an "insured" for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Paragraph A.I. of Section 11 — Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms and Paragraph D.2. of Section I - Covered Autos Coverages of the Auto Dealers Coverage Form. CA 20481013 @/nsmnynce Services Office, |no,2O11 Page 1nf1 Attachment Code: D465278 Certificate ID: 16773204 POLICY NUMBER: BAP 9830390 COMMERCIAL AUTO CA 04 44 10 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 respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: DAVID EVANS AND ASSOCIATES, INC. Endorsement Effective Date: 6110101411111,4 Name(s) Of Person(s) Or Organization(s): ANY PERSON OR ORGANIZATION THAT REQUIRES YOU TO WAIVE YOUR RIGHTS OF RECOVERY IN A WRITTEN CONTRACT OR AGREEMENT WITH THE NAMED INSURED. 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 44 10 13 @ Insurance Services Office, Inc., 2011 Page 3 of 6 Lj Miscellaneous Attachment: M460261 Certificate ID: 16773204 WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY WC 00 03 13 (Ed. 04-84) POLICY NUMBER: WC9336626 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 required you to obtain this agreement from us.) This agreement shall not operate directly or indirectly to benefit any one not named in the Schedule. SCHEDULE Any person or organization that requires you to waive your rights of recovery in a written contract or agreement with the Named Insured. 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.)