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PROOF OF INSURANCE (2021) CLOSEDA� ® CERTIFICATE OF LIABILITY INSURANCE I DAT9/(��/2o20YY> 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 Nancy Ferrick Dealey, Renton & Associates PHONE FAX P.O. Box 12675 I (A/C. No. Ext): 510-465-3090 (A/C, No): 510-452-2193 Oakland CA 94604-2675 I E-MAIL ADDRESS: ADDREss: nferrick renton.com y INSURER(S) AFFORDING COVERAGE NAIC # License#: 00207391 INSURER A: Sentinel Insurance Company 11000 INSURED AKMCONS-01 INSURER B: Travelers Casualty and Surety Co of America 31194 AKM Consulting Engineers, Inc. I 553 Wald Street INSURERC: Hartford Casualty Insurance Company 29424 Irvine CA 926184627 I INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 1218892794 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER (MM/DD/YYYYI IMM/DD/YYYYI A X COMMERCIAL GENERAL LIABILITY Y Y 57SBWLU8719 9/20/2020 9/20/2021 EACH OCCURRENCE $2000000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Umbrella Liability Policy is a follow -form underlying General Liability/Auto Liability/Employers Liability. Ref: PW 19-09 - Walnut Avenue Inspection Project. The City of EI Segundo, its officers, officials, employees and volunteers are named as Additional Insured for General and Auto Liability as required by written contract or agreement. General Liability is Primary/Non-Contributory per policy form wording. Auto Liability is primary per policy form. The Named Insured has no company owned autos. Insurance coverage includes waiver of subrogation per the attached endorsement(s). 30 Day Notice of Cancellation. CERTIFICATE HOLDER CANCELLATION 30 Days Notice of Cancellation 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 350 Main Street AUTHORIZED REPRESENTATIVE EI Segundo, CA 90245-3895 - © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD DAMAGE TO RENTED CLAIMS -MADE � OCCUR PREMISES (Ea occurrence) $ 1,000,000 X Contractual Liab MED EXP (Any one person) $ 10,000 Included PERSONAL & ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIE S PER: GENERAL AGGREGATE $4,000,000 POLICY � � LOC PRODUCTS COMP/OP AGG $ 4,000,000 ECT - OTHER: $ A AUTOMOBILE LIABILITY Y Y 57SBWLU8719 9/20/2020 9/20/2021 COMBINED SINGLE LIMIT $2,000,000 fEa accident) ANY AUTO BODILY INJURY (Per person) $ OWNEDSCHEDULED BODILY INJURY $ AUTOS ONLY AUTOS (Per accident) X HIRED I X I NON -OWNED PROPERTYDAMAGE $ AUTOS ONLY AUTOS ONLY fPer accident) A X UMBRELLALIAB OCCUR Y Y 57SBWLU8719 9/20/2020 9/20/2021 EACH OCCURRENCE $1,000,000 LAB LB CLAIMS -MADE H AGGREGATE $ 1,000,000 DED I X I RETENTION $ in nnn $ C WORKERS COMPENSATION Y 57WEGZS0250 9/20/2020 9/20/2021 X I SPER TATUTE EORH AND EMPLOYERS' LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE Y / N E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 B Professional Liability 105344511 9/20/2020 9/20/2021 Each Claim $2,000,000 Annual Aggregate $2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Umbrella Liability Policy is a follow -form underlying General Liability/Auto Liability/Employers Liability. Ref: PW 19-09 - Walnut Avenue Inspection Project. The City of EI Segundo, its officers, officials, employees and volunteers are named as Additional Insured for General and Auto Liability as required by written contract or agreement. General Liability is Primary/Non-Contributory per policy form wording. Auto Liability is primary per policy form. The Named Insured has no company owned autos. Insurance coverage includes waiver of subrogation per the attached endorsement(s). 30 Day Notice of Cancellation. CERTIFICATE HOLDER CANCELLATION 30 Days Notice of Cancellation 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 350 Main Street AUTHORIZED REPRESENTATIVE EI Segundo, CA 90245-3895 - © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: 57SBWLU8719 BUSINESS LIABILITY COVERAGE SS 00 08 04 ON ADDITIONAL COVERAGES BY WRITTEN CONTRACT, AGREEMENT OR PERMIT This is a summary of the coverage provided under the following form (complete form available): BUSINESS LIABILITY COVERAGE FORM SS 00 08 04 05 Additional Insured When Required by Written Contract, Written Agreement or Permit WHO IS AN INSURED under Section C. is amended to include as an additional insured, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: (a) In the performance of your ongoing operations; (b) In connection with your premises owned by or rented to you; or (c) In connection with "your work" and included within the "products completed operations hazard", but only if (i) The written contract or written agreement requires you to provide such coverage to such additional insured; and (ii) This Coverage Part provides coverage for "bodily injury" or "property damage" included within the "products completed operations hazard". The person(s) or organization(s) are additional insureds when you have agreed, in a written contract, written agreement or because of a permit issued by a state or political subdivision, that such person or organization be added as an additional insured on your policy, provided the injury or damage occurs subsequent to the execution of the contract or agreement, or the issuance of the permit. A person or organization is an additional insured under the provision only for that period of time required by the contract, agreement or permit. With respect to the insurance afforded to the additional insured, 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 or surveying services, including: (a) The preparing, approving, or failure to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders, designs or drawings and specification: or (b) Supervisory, inspection, architectural or engineering activities. The limits of insurance that apply to additional insureds are described in Section D. Limits Of Insurance. How this insurance applies when other insurance is available to an additional insured is described in the Other Insurance Condition in Section E. Liability And Medical Expenses General Conditions. No person or organization is an insured with respect to the conduct of any current or past partnership, joint venture or limited liability company that is not shown as a Named Insured in the Declarations. Other Insurance If other valid and collectible insurance is available for a loss we cover under this Coverage Part, our obligations are limited as follows: 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. Rev 5•.14 Page 1 of 2 BUSINESS LIABILITY COVERAGE FORM Summary SS 00 08 34 0 Paragraphs (a) and (b) do not apply to other insurance to which the additional insured has been added as an additional insured. 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. Waiver of Subrogation If you have 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 you waived your rights of recovery against such person or organization in a contract, agreement or permit that was executed prior to the injury or damage EXCERPT FROM Hartford Form SS 04 38 09 09 HIRED AUTO AND NON -OWNED AUTO B. With respect to the operation of a "non -owned auto", WHO IS AN INSURED is replaced by the following: The following are "insureds": d. Anyone liable for the conduct of an "insured", but only to the extent of that liability Rev 5.14 Page 2 of 2 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. • �•-ILI •- Policy Number: 57WEGZS0250 Endorsement Number: Effective Date: 09/20/2020 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address: AKM Consulting Engineers, Inc. 553 Wald Street Irvine. CA 92618-4627 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 2 % of the California workers' compensation premium otherwise due on such remuneration. SCHEDULE Person or Organization Job Description Any person or organization from whom you are required by written contract or agreement to obtain this waiver of rights from us Countersigned by Form WC 04 03 06 (1) Printed in U.S.A. Authorized Representative Policy Expiration Date: 09/20/2021