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PROOF OF INSURANCE (2020 - 2021) CLOSEDOP ID: YC D /Y)CERTIFICATE OF LIABILITY INSURANCE 03/24/2020 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. (PORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to ,e 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 LISA Sanchez NAME: Narver Associates Ins Agcy PHONE 626-943-2200 FAX (am.;....... P.O. Box 1509 l�slcaA% Ext); L..(6 , San Gabriel, CA 91778-1509 kDaAss: IsanCllenlrver.eorn Wesley G. Hampton PRODUCER WOODR-1 __1IJ5TP nE(;,sD.a: COVERAGES CER'TIF'IC'AT'E NUMBER: 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 DERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH DOLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS :LTR TYPE OF INSURANCE . AN R_nSUBRPOLICY NUMBER . $M DDPYE1'4"YI WMIODr YYYd . .... LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 DAMA, D REQ tl"ED..., CLAIMS -MADE PlRrMt E' �(Ca,gguyarare). .$.................................. '010,000 A X COMMERCIAL GENERAL L 0,000 � OCCUR X 72SBAUW7027 04/12/2020 04/12/2021 'MED EXP (Any one person) $ 1 PERSONAL & ADV INJURY $ 2,000,000 ...... .................... _ ....................... DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) City of E1 Segundo, its officials and employees are additional insured as respects attached General Liability endorsement SS 4170, as required by contract. Such insurance is primary and non-contributory with respect 1�o any insurance available to the additional insured as per attached General Liability form SS 00 08. Waiver of subrogation applies as per attached CER'TIFIC'ATE HOLDER CANCELLATION CITYELS 1,000,000 1,000,000 1,000,000 5,000,000 5,000,000 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Ci of EI Se THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City Segundo ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street EI Segundo, CA 90245 AUTHORIZED REPRESENTATIVE ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD GENERAL AGGREGATE $ 4,000,000 GENTAGGREGATE LIMIT APPLIES PER: $ PRODUCTS -COMP/OP AGG $ 4,000,000 )(... P)RO �.............. 1 POLICY I 1 . 1 L.00 NSATION $ B AAND EMPLOYERS' LIABILITY Y /.N.. "7175-0587 r X TQRy b INU�TS_1„ 1 FR,., 04/01/2020 04/01/2021 ACC AUTOMOBILE LIABILITY NOYR RO PROKERS PRIETOR/PARTNER/EXECUTIVE ) COMBINED SINGLE LIMIT $ 2,000,000 OFFICER/MEMBER EXCLUDED? ll.� N/A X (Ea accident) ANY AUTO (Mandatory in NH) BODILY INJURY (Per person) $ ALL OWNED AUTOS -- - yes, describe uner BODILY DILY INJURY (Per accident) $ __ SCHEDULED AUTOS DESCRIPTION OF OPERATIONS below PROPERTY DAMAGE $ $ A X HIRED AUTOS 72SBAUW7027 04/12/2020 04/12/2021 (PER ACCIDENT) $ A X NON -OWNED AUTOS 72SBAUW7027 04/12/2020 04/12/2021 $ f X UMBRELLA LIAB X .. _ OCCUR EACH OCCURRENCE .. .. $ 4,000,000 A EXCESS LAB CLAIMS -MADE 72SBAUW7027 04/12/2020 04/12/202 1 AGGREGATE •••• 000 $ 4 ,000 •• • • --- DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) City of E1 Segundo, its officials and employees are additional insured as respects attached General Liability endorsement SS 4170, as required by contract. Such insurance is primary and non-contributory with respect 1�o any insurance available to the additional insured as per attached General Liability form SS 00 08. Waiver of subrogation applies as per attached CER'TIFIC'ATE HOLDER CANCELLATION CITYELS 1,000,000 1,000,000 1,000,000 5,000,000 5,000,000 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Ci of EI Se THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City Segundo ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street EI Segundo, CA 90245 AUTHORIZED REPRESENTATIVE ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD 4 _ DEDUCTIBLE $ X RETENTION $ 10,000 ( $ NSATION WC 0TH- B AAND EMPLOYERS' LIABILITY Y /.N.. "7175-0587 r X TQRy b INU�TS_1„ 1 FR,., 04/01/2020 04/01/2021 ACC NOYR RO PROKERS PRIETOR/PARTNER/EXECUTIVE ) E L, EACH DENT $ OFFICER/MEMBER EXCLUDED? ll.� N/A X (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE: $ yes, describe uner .. DESCRIPTION OF OPERATIONS below OLICY LIMIT E L DISEASE POLICY $ $ C Professional LROOlEH19 11/01/2019 11/01/2020 PER CLAIM Liability AGGREGATE DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) City of E1 Segundo, its officials and employees are additional insured as respects attached General Liability endorsement SS 4170, as required by contract. Such insurance is primary and non-contributory with respect 1�o any insurance available to the additional insured as per attached General Liability form SS 00 08. Waiver of subrogation applies as per attached CER'TIFIC'ATE HOLDER CANCELLATION CITYELS 1,000,000 1,000,000 1,000,000 5,000,000 5,000,000 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Ci of EI Se THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City Segundo ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street EI Segundo, CA 90245 AUTHORIZED REPRESENTATIVE ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD NOTEPAD. HOLDER CODE CITYELS WOODR-1 PAGE 2 INSURED'S NAME Woodruff, Spradlin & Smart, OP ID: YC Date 03/24/2020 Workers Compensation endorsement WC 90 03 75„ 30 day notice of cancellation POLICY NUMBER: 72SBAUV 7027 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:BUSINESS LIABILITY COVERAGE FORM SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): City of EI Segundo, its officials and employees 350 Main Street, EI Segundo, CA 90245 Location(s) Of Covered Operations: Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section C. — 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) designated above. Form SS 41 70 06 11 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. © 2011, The Hartford (Includes copyrighted material of Insurance Services Office, Inc., with its permission) Page 1 of 1 (6) When You Are Added As An Additional Insured To Other Insurance That is other insurance available to you covering liability for damages arising out of the premises or operations, or products and completed operations, for which you have been added as an additional insured by that insurance; or (7) When You Add Others As An Additional Insured To This Insurance That is other insurance available to an additional insured. However, the following provisions apply to other insurance available to any person or organization who is an additional insured under this Coverage Part: (a) Primary Insurance When Required By Contract This insurance is primary if you have agreed in a written contract, written agreement or permit that this insurance be primary. If other insurance is also primary, we will share with all that other insurance by the method described in c. below. (b) ',Primary And Non -Contributory 'To Other Insurance When Required By Contract If you have agreed in a written contract, written agreement or permit that this insurance is primary and non-contributory with the additional insured's own insurance, this insurance is primary and we will not seek contribution from that other insurance. Paragraphs (a) and (b) do not apply to other insurance to which the additional insured has been added as an additional insured. When this insurance is excess, we will have no duty under this Coverage Part to defend the insured against any "suit" if any other insurer has a duty to defend the insured against that "suit". If no other insurer defends, we will undertake to do so, but we will be entitled to the insured's rights against all those other insurers. Form SS 00 08 04 05 Policy Number: 72SBAUW7027 BUSINESS LIABILITY COVERAGE FORM When this insurance is excess over other insurance, we will pay only our share of the amount of the loss, if any, that exceeds the sum of: (1) The total amount that all such other insurance woi ild nay for the loss in the absence of this insurance; and (2) The total of all deductible and self- insured amounts under all that other insurance. We will share the remaining loss, if any, with any other insurance that is not described in this Excess Insurance provision and was not bought specifically to apply in excess of the Limits of Insurance shown in the Declarations of this Coverage Part. c. Method Of Sharing If all the other insurance permits contribution by equal shares, we will follow this method also. Under this approach, each insurer contributes equal amounts until it has paid its applicable limit of insurance or none of the loss remains, whichever comes first. If any of the other insurance does not permit contribution by equal shares, we will contribute by limits. Under this method, each insurer's share is based on the ratio of its applicable limit of insurance to the total applicable limits of insurance of all insurers. 8. Transfer Of Rights Of Recovery Against Others To Us a. Transfer Of Rights Of Recovery If the insured has rights to recover all or part of any payment, including Supplementary Payments, we have made under this Coverage Part, those rights are transferred to us. The insured must do nothing after loss to impair them. At our request, the insured will bring "suit" or transfer those rights to us and help us enforce them. This condition does not apply to Medical Expenses Coverage. Waiver Of Rights Of Recovery (Waiver Of Subrogation) If the insured has waived any rights of recovery against any person or organization for all or part of any payment, including Supplementary Payments, we have made under this Coverage Part, we also waive that right, provided the insured waived their rights of recovery against such person or organization in a contract, agreement or permit that was executed prior to the injury or damage. Workers' Compensation and Employers' Liability Policy Named Insured Endorsement Number WOODRUFF SPRADLIN & SMART, APC Policy Number Symbol: Number: (21) 7175-05-87 Policy Period Effective Date of Endorsement 04/01/202o TO 04/01/2021 04/0112020 Issued By (Name of Insurance Company) Federal Insurance Company _ Insert the 0olicy number„ The rern,alnder of the infofrnation is to be completed only when this endorsement +s issued subsequent to the preparatuon of the policy. 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 1. (❑) Specific Waiver Name of person or organization THE CITY OF IRVINE AND ITS EMPLOYERS, REPRESENTATIVES, OFFICERS AND AGENTS 1 CIVIC CENTER PLAZA IRVINE, CA 92606 ([X) Blanket Waiver Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver, 2. Operations: ALL CALIFORNIA OPERATIONS Premium: The premium charge for this endorsement shall be 1 % 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; WC 90 03 75 (05/18) Insured Copy Authorized Representative