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PROOF OF INSURANCE (2021 - 2021) CLOSEDDATE (MMIDD/YYYY) A� R"' CERTIFICATE OF LIABILITY INSURANCE 5/8/2020 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 CONTACT Dealey, Renton & Associates i PHOMarie Swaney NE dPAX 790 E Colorado Blvd #460 tA/.p- No. Ea tl: (AJC. Nol; Pasadena, CA 91101 AI DRIIESS: mswanev@deatevrenton.com INSURER(S) AFFORDING COVERAGE NAIC# License# 0020739 INSURER A: Crum & Forster Specialty Insurance Company 44520 INSURED GALEASS-01 INSURER B : Gale/Jordan Associates, Inc. 3858 Carson Street, Suite 200 INSURERC: Torrance, CA 90503-5613 310-316-4377 INSURERD..._.._.._.._.._.._._.._.._.._.._.._......._.._.._.._...._..............._.._.._.._.--_--._.._..—_.._.._. INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 1554869975 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. ..IIV51t .................,AiSC $UBR.— POLICY EFF POLICYE7(P—.—..�. LTR TYPE OF INSURANCE INsn Wvn POLICY NUMBER IMM/DD/YYYY) (MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY Y Y EPK130876 4/28/2020 4/28/2021 EACH OCCURRENCE $10,000,000 . 7CLAIMS X -MADE OCCUR PREMISES We occurrence) $ 100,000 X Contractual Liab MED EXP (Any one person) $ 5,000 X XCU Included PERSONAL & ADV INJURY $ 3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $10,000,000 ff] PRO. IPOLICY LOC PRODUCTS -COMP/OP AGG $ 10,000.000 X OTHER: Conlra=rs PrAl Cony. Poll. Liab. $ 3,000,000 A AUTOMOBILE LIABILITY Y EPK130876 4/28/2020 4/28/2021 ................ COMBINED SINGLE LIMIT tEa eacddentl $1,000,000 ANY AUTO BODILY INJURY (Per person) $ . OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS HIRED F NON-OWNED PROP'ERT'Y DAMAGE $ ..X... AUTOS ONLY AUTOS ONLY _.CF?gLl;� rn�'wwr u._ ............................................ X NoOwned Auto $ UMBRELLA LIAB OCCUR EXCESS LIAB CLAIMS -MADE .................................................... ......... ........ DED RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANYPROP R I ETO R/PARTN E R/EXEC UTI V E OFFICERIMEMBEREXCLUDED? ❑ NIA (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below A Professional Liability EPK130876 EACH, OCCURRENCE AGGREGATE PER I ERH E.L EACH ACCIDENT $ I ELL. DISEASE - EA EMPLOYEE $ E . DISEASE -POLICY LIMIT $ 4/28/2020 4/28/2021 Per Claim $3,000,000 AnnualAggr $3,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Auto Liability is follow -form to the General Liability. RE: All Operations — City of EI Segundo, its officers, agents and employees are named as additional insured as respects general and auto liability as required per written contract or agreement. CERTIFICATE HOLDER CANCELLATION 30 Day Notice will be sent to holder 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, Public Works Dept. 350 Main Street EI Segundo CA 90245 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Policy # EPK130876 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NON-CONTRIBUTORY ADDITIONAL INSURED WITH WAIVER OF SUBROGATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART CONTRACTORS POLLUTION LIABILITY COVERAGE PART ERRORS AND OMISSIONS LIABILITY COVERAGE PART THIRD PARTY POLLUTION LIABILITY COVERAGE PART SCHEDULE Name of Additional Insured Person(s) or Organization(s) Blanket when specifically required in a written contract with the named insured A. SECTION III — WHO IS AN INSURED within the Common Provisions is amended to include as an additional insured the person(s) or organization(s) indicated in the Schedule shown above, but solely with respect to "claims" caused in whole or in part, by "your work" for that person or organization performed by you, or by those acting on your behalf. This insurance shall be primary and non-contributory, but only in the event of a named insured's sole negligence. B. We waive any right of recovery we may have against the person(s) or organization(s) indicated in the Schedule shown above because of payments we make for "damages" arising out of "your work" performed under a designated project or contract with that person(s) or organization(s). C. This Endorsement does not reinstate or increase the Limits of Insurance applicable to any "claim" to which the coverage afforded by this Endorsement applies. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. EN0118-0211 Page 1 of 1 Policy # EPK130876 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 SCHEDULE Name of Additional Person(s) or Location And Description Of Completed Organization (s): I Operations Blanket when specifically required in a written contract with the named insured.. Information required to complete this Schedule, if not shown above, will be shown in the Declarations A. Section III — Who Is An Insured within the Common Provisions is amended to include as an 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". EN0320-0211 Page 1 of 1 CERTIFICATE OF LIABILITY INSURANCE j °W� �°'YYY"' PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION EJMS Services ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P.O. Box 33289 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. (CA1994) Los Gatos CA 95031 INSURERS AFFORDING COVERAGE NAIC 0 INSURED INSURER A Chubb 10053 gale/jordan associates, inc. INSURER e 3958 Carson St. INSURER C: Suite 200 INSURER 0 Torrance I CA 90503 INSURER E COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR'AD POLICY EFFECTIVE 'POLICY EaCPIRATb'ON ^yi !^yam POLICY NUMBER qWORM='DATEthSM10D�lYYY'Y'f LIMITS GENERAL LIABIUTY COMMERCIAL GENERAL LIABILITY CLAIMS MADE F OCCUR ii GEHI'L AGGREGATE LIMIT APPLIES PER: POLICY PRD I LOC AUTOMOBILE WWILITY ANY AUTO V ALL OWNED AUTOS SCHEOULEO AUTOS V HIRED AUTOS NON -OWNED AUTOS GARAGE LUUSILITY ANY AUTO EXCESS I UMBRELLA LIABILITY OCCUR 0 CLAIMS MADE DEDUCTIBLE RETENTION 'S A WORKERS COMPENSATION Y 21 7178 54-83 AND EMPLOYERS" LIABILITY YIN ( ) ANY PROPRIETORIPARTNERIEXECUTIVE ❑ OFFICERIMEMBER EXCLUOED7 (Mandatory In NH) d . dexnbo wwar SPEYCIAL, PROVISIONS balaw OTHER I EACH OCCURRENCE 1 UAMAUt IUKt:NIkU „MSS t'Ea occoarancel S MED EXP (Arty one person) S PERSONAL 8 ADV INJURY S GENERAL AGGREGATE S PRODUCTS - COMPIOP AGG S COMBINED SINGLE LIMIT S (Ea accident) BODILY INJURY S (Per person) BODILY INJURY S (Per accident) PROPERTY DAMAGE s IPeraccident) AUTO ONLY - EA ACCIDENT S OTHER THAN EA ACC S AUTO ONLY: AGG 5,,,,,, EACH OCCURRENCE S I+, AGGREGATE b $ I 3 y `V N y 2/1/!020 2/1/!021 I T 1 IM?.S I I0FR E L. EACH ACCIDENT Q S 1,000.000 E L DISEASE -EA EMPLOYEEi S 1,000.000 E L DISEASE-POLICYLIMR IS 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Christopher K. Gate, President - Excluded Thomas A. Jordan, Secretary Treasurer - Excluded CERTIFICATE HOLDER City of EI Segundo, Public Warks Dept 350 Main St. El Segundo. CA 90245.3813 I ACORD 25 (2009101) CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER 7 AGENTS OR REPRESENTATIVES. m rr"" AUTHORIZED REPRESEN'TA' Genie/ J. Cloud ®1988-2008 AACC,P D CORPORATION. All rights reserved. The ACORD name and logo are registered marks of AC D Workers' Compensation and Employers' Liability Policy Named Insured I Endorsement Number GALEMORDAN ASSOCIATES, INC Policy Number Symbol: Number: (21) 7176&54-63 Policy Period Effective Date of Endorsement 0210112o2o TO 021ov2o21 ( 0210112020 Issued By (Name of Insurance Company) Chubb National Insuranoe Com a otted only when this endorsement is issued subsequent to the orenaration of the ooll�i I he rem6lnd ner bt the information Ya lo be rrgme„ „ . CALIFORNIA WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement applies only to the insurance provided by the policy because California 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. You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. Schedule Specific Waiver Name of person or organization: ( X ) Blanket Waiver Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. 2. Operations: 3. Premium: Tne premium charge for this endorsement shall be 1% percent of the California premium developed on payroll in connection with work performed for the above person(s) or organization(s) arising out of the operations described. 4. Minimum Premium: WC 90 03 75 (05118) InsurW Copy Authorized Representative