PROOF OF INSURANCE (2021) CLOSEDCERTIFICATE OF LIABILITY INSURANCE a OATE(MM/DDrYYYY)
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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 CN,ONTACT' „..,...
Aon Risk Services central, Inc, PHONE (866) 283-7122 FAX (800) 363-0105
Pittsburgh PA office INC No.
EaB: rA c, No,t:
EQT Plaza - Suite 2700 E-MAIL
625 Liberty Avenue ADDRESS:
Pittsburgh PA 15222-3110 USA
INSURERS) AFFORDING COVERAGE NMC k
INSURED INSURER A: American casualty Co. of Reading PA 120427
Michael Baker International, Inc INSURER B; Transportation Insurance co. 120494
5 Hutton Centre Drive
Suite 500 INSURER C: Continental Casualty Company 120443
Santa Ana CA 92707 USA INSURER o: Allied world National Assurance company 110690
INSURER E: Allied world Surplus Lines Insurance Co 124319
INSURER F: 1'
COVERAGE'S CE'RT'IFICATE NUMBER: 570083666229 REVISIONNUMBER:
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 I
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, 1
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Limits shown are as requested:
105R ADDLISUeR POLICY "F POLICY kXP
LTR TYPE OF INSURANCE Ouse WW POLICY NUMBER JMMJo,pdj"}"'Y �{POLW YYYY1 LIMITS
C X COMMERCIAL GENERAL LIABILnY 6078988730 UC/7UJfU 11 Utilsu/'1UI1 EACH OCCURRENCE $2,000,OOOj
("� General Liability UAMA4it ILr Ktar, I k0
B CLAIMS -MADE occuR 6079257181 08/30/2020 08/30/2021 PR. 1JI s "000 $100,000:
20-21 Stop Gap (US) MED EXP (Any one person) 510,000°
UPERSONAL&ADV INJURY $2,000,000'
GEN't AG ATE LIMITAPPILIES PER: 1 GENERAL AGGREGATE $4,000,000,
POLICY
GRE GATE
JECT
OTHER:LOC PRODUCTS - COMPIOP AGG $4,000,000
C G AUTOMOBILE LIABILITY
X ANYAUTO
- OWNED SCHEDULED
�- AUTOS ONLY AUTOS
HIREDAUTOS NON -OWNED
........ ONLY AUTOS ONLY
D X UMBRELLALIAB OCCUR
EXCESS LIAR Fd CLAIMS -MADE
DED [ X 1R'ETEN'1ICN S10,000
A WORKERS COMPENSATION AND ...
E LOYE S' L
MP R (ABILITY Y' '
/N
AN YF OPRIETORl PARTNER1EXECUTIVE /N
B OFFICERIMEMBER EXCLUDED? N I A
(Mandalory In NH)
11 yes. doscAbe Under
BUA 6078988680
03124809
We6678J88713
AOS
wc6078988727
wI
08/30/202008/30/2021 COMBINED SINGLE LIMIT $2,000,000
„rEa acnldRml
BODILY INJURY ( Per person)
V BODILY INJURY (Per accident) V
YPROPERTY DAMAGE
ID (Par accident)
08/30/2026 08/30/'2021�EACH OCCURRENCE $10,000,000
AGGREGATE _w$10,000,000
08130)MIS U8/JO/2O21 11PER STATUTE
08/30/2020 08/30/2021E.L. y EACH ACCIDENT
OR ^1 $1,000,00
II 0
pp 0
E L. DISEASE -EA EMPLOYEE p $1,000,000,
D SCRIPTION OF OPERATIONS below E.L DISEASE -POLICY LIMIT rr '3.1, 000, 000 _=
E E&O-PL-Primary 03124806 08/30/2020 08/30/2021 Per Claim $5,000,0001—
claims Made Aggregate $5,000,000
SIR applies per policy terns & condii1ons
DESCRIPTION OF OPERATIONS r LOCATIONS r VEHICLES (ACORD 101, Addlllonal Remarks Schedule, may be attached II more space Is required) ;Icy
For Named insuredonly: Attn: Kim Hartsfield. RE: Project: All Operations, 1N 152457. City of E1 Segundo its officials
and employees are included as Additional Insured in accordance with the policy provisions of the General Liability policy.
General Liability policy evidenced herein is Primary and Non -Contributory to other insurance available to Additional Insured,
but only in accordance with the policy's provisions. A waiver of Subrogation is granted in favor of certificate Holder in
accordance with the policy provisions of the workers' Compensation policy. 1�
CERTIFICATE HOLDER 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 El Segundo AUTHORIZED REPRESENTATIVE
350 main Street
E1 Segundo CA 90245 USA
01988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
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AGENCY CUSTOMER ID: 570000027699
LOC #:
ADDITIONAL REMARKS SCHEDULE
Page _ of _
AGENCY NAMED INSURED
Aon Risk services Central, Inc. Michael Baker International, Inc
POLICY NUMBER
see Certificate Number: 570083686229
CARRIER NAIC CODE U
see Certificate Number. 570083686229 I EFFECTIVE DATE:
ADDITIONAL REMARKS
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance
INSURER(S) AFFORDING COVERAGE NAIC #
INSURER
INSURER
INSURER
INSURER
ADDITIONAL POLICIES If a policy below does not include limit information, refer to the corresponding policy on the ACORD
certificate form for policy limits.
POLICY '1°OLICY
I�tiSIt AVUL S'tl'1'IR POLICYNUMBERLIMITS
DATTEE DATE 4 LTR TYPEOFINSURANCE INSD WVD EFFEEXPIRATION
(MMIDD/YYYY) (MMfDWVY'YY)
I WORKERS COMPENSATION
A
ACORD 101 (2008101)
N/A wvc6078988694
CA
08/30/2020 08/30/2021
I
The ACORD name and logo are registered marks of ACORD
® 2008 ACORD CORPORATION. All rights reserved.
CNA CNA PARAMOUNT
Additional Insured - Owners, Lessees or Contractors -
Scheduled Person or Organization Endorsement
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person(s) Location(s) Of Covered Operations
Or Organization(s)
All persons or organizations with which you have entered into a written All locations as requested by a written contract or agreement entered into
contract or agreement, prior to an "occurrence" or offense, to provide prior to an 'occurrence" or offense.
additional insured status
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
It is understood and agreed as follows:
A. Section II — 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.
However:
1. The insurance afforded to such additional insured only applies to the extent permitted by law; and
2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to
such additional insured will not be broader than that which you are required by the contract or agreement to
provide for such additional insured.
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.
C. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of
Insurance:
If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of
the additional insured is the amount of insurance:
1. Required by the contract or agreement; or
2. Available under the applicable Limits of Insurance shown in the Declarations;
whichever is less.
This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations.
CG 20 10 (04-13) Policy No: 6078988730
Page 1 of 1 Endorsement No:
Continental Casualty Company Effective Date: 8/30/2020
Insured Name: Michael Baker International, LLC
Copyright Insurance Services Office, Inc., 2012
CNACNA PARAMOUNT
Primary and Noncontributory - Other Insurance
Condition Endorsement
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
It is understood and agreed that the condition entitled Other Insurance is amended to add the following:
Primary And Noncontributory Insurance
Notwithstanding anything to the contrary, this insurance is primary to and will not seek contribution from any other
insurance available to an additional insured under this policy provided that:
a. the additional insured is a named insured under such other insurance; and
b. the Named Insured has agreed in writing in a contract or agreement that this insurance would be primary and
would not seek contribution from any other insurance available to the additional insured.
All other terms and conditions of the Policy remain unchanged.
This endorsement, which forms a part of and is for attachment to the Policy issued by the designated Insurers, takes
effect on the effective date of said Policy at the hour stated in said Policy, unless another effective date is shown below,
and expires concurrently, with said Policy.
CNA74987XX (1-15) Policy No: 6078988730
Page 1 of 1 Endorsement No:
Continental Casualty Company Effective Date: 8/30/2020
Insured Name: MICHAEL BAKER INTERNATIONAL, LLC
Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission.
CNA PARAMOUNT
Additional Insured - Owners, Lessees or Contractors -
Completed Operations Endorsement
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person(s) Or Organization(s)
All persons or organizations with whom you have entered into a written contract or agreement, prior to an "occurrence" or offense, to provide
additional insured status.
Location And Description Of Completed Operations
All locations as required by a written contract or agreement entered into prior to an 'occurrence" or offense
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
It is understood and agreed as follows:
A. Section II — 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 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.
However:
1. The insurance afforded to such additional insured only applies to the extent permitted by law; and
2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded
to such additional insured will not be broader than that which you are required by the contract or agreement
to provide for such additional insured.
B. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits
Of Insurance:
If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on
behalf of the additional insured is the amount of insurance:
1. Required by the contract or agreement; or
2. Available under the applicable Limits of Insurance shown in the Declarations;
whichever is less.
This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations.
CG 20 37 (04-13) Policy No: 6078988730
Page 1 of 1 Endorsement No: 1
Insured Name: MICHAEL BAKER INTERNATIONAL, LLC Effective Date: 08/30/2020
Copyright Insurance Services Office, Inc., 2012
Workers Compensation
CNAI�i:1,l:cl �Vaivcro 0tir Right
Lo Recover l=ron, Ofliers
l
This endorsement changes the policy to which it is attached.
It is agreed that Part One - Workers' Compensation Insurance G. Recovery From Others and Part Two -
Employers' Liability Insurance H. Recovery From Others are amended by adding the following:
We will not enforce our right to recover against persons or organizations. (This agreement applies only to the
extent that you perform work under a written contract that requires you to obtain this agreement from us.)
PREMIUM CHARGE - Refer to the Schedule of Operations
The charge will be an amount to which you and we agree that is a percentage of the total standard
premium for California exposure. The amount is 2%.
All other terms and conditions of the policy remain unchanged.
This endorsement, which forms a part of and is for attachment to the policy issued by the designated Insurers,
takes effect on the Policy Effective date of said policy at the hour stated in said policy, unless another
effective date (the Endorsement Effective Date) is shown below, and expires concurrently with said policy
unless another expiration date is shown below.
Form No: G-1 9160-B 01-1997) Policy No: WC 6078988713 Policy
Endorsement Effective Date: 08/30/2020 Endorsement Expiration Date: 08/30/2021 Effective Date: 08/30/2020
Endorsement No: Page: 1 of 1 Policy Page:
Underwriting Company: American Casualty Company of Reading, PA
0 Copyright CNA All Rights Reserved.
CNA
Workers Compensation
i,lan):ct �Vai cr of `(.el' i;i ht
to Recce er From Others
This endorsement changes the policy to which it is attached.
It is agreed that Part One - Workers' Compensation Insurance G. Recovery From Others and Part Two -
Employers' Liability Insurance H. Recovery From Others are amended by adding the following:
We will not enforce our right to recover against persons or organizations. (This agreement applies only to the
extent that you perform work under a written contract that requires you to obtain this agreement from us.)
PREMIUM CHARGE - Refer to the Schedule of Operations
The charge will be an amount to which you and we agree that is a percentage of the total standard
premium for California exposure. The amount is 2%.
All other terms and conditions of the policy remain unchanged.
This endorsement, which forms a part of and is for attachment to the policy issued by the designated Insurers,
takes effect on the Policy Effective date of said policy at the hour stated in said policy, unless another
effective date (the Endorsement Effective Date) is shown below, and expires concurrently with said policy
unless another expiration date is shown below.
Form No: G-1 9160-B 01-1997)
Endorsement Effective Date: 08/30/2020 Endorsement Expiration Date: 08/30/2021
Endorsement No: Page: 1 of I
Underwriting Company: American Casualty Company of Reading, PA
0 Copyright CNA All Rights Reserved.
Policy No: WC 6078988694 Policy
Effective Date: 08/30/2020
Policy Page: