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PROOF OF INSURANCE (2021 - 2021) CLOSEDV CERTIFICATE OF LIABILITY INSURANCE °ATE`MM'°°'""YY' 11/05/2020 i 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 CMI cT Blanca De La Hoz Danmar Insurance Services Inc. ARION' � � a: (951) 509-0509 � FAX N� X51) 509-0515 License # OD36873 Ad�D�Lss; blancad@danmarins.com 9899 Indiana Avenue, Ste 101 INSURER(S) AFFORDING COVERAGE 9 MAIC p Riverside CA 92503 INS.RERA Travelers Property Casualty Cc of America 1 25674 INSURED Denn Engineers, Inc. 3914 Del Amo BI., Ste 921 INSURER B : Preferred Employers Insurance Company INSURER c : OBE North America Insurance Group INSURER D: I INSURER E Torrance CA 90503 1 INSURER F' COVERAGES CERTIFICATE NUMBER: CL2011409461 REVISION NUMBER: I 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 SUBJECTTO ALL THE TERMS„ EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. i'INSR :AUUL'SUBRPOLICY EFF POLICY EXP 10900 LTR TYPE OF INSURANCE :INSO I WvO POLICY NUMBER IMWDDPYYYY) IMIWOWYYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE I, $ 1,000,000 CLAIMS � UAAAGf; ruREN1 1,000,000 -MADE OCCUR PREW$ES IEe occurrence) I $ I MED EXP IAnY one person) $ 5,000 A Y 680-9N963609-20-47 09/01/2020 09/01/2021 PERSONAL& ADV INJURY $ 1,000,000 GE.N'LA+GGREGAIELIMIT APPLIES PER: I GENERALAGGREGATE , $ 2,000,000 E PRO- F19 2,000,000 POLICY ,gECT LOC PRODUCTS - COkSP/OP Ar„ais S OTHER I Employee dishonesty $ 75,000 AUTOMOBILE LIABILITY COMBINED $IINIGLE LIMIT $ BE',a accidentt ANYAUTO BODILY INJURY (Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident) $ HIRED NON -OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Wor aaccddantl $ (I$ UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLralta4S-MADE AC;ORIrG',ATE. $ DED � RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY PER OTH- STATU'Tw. ER YIN ANY'PR'OPRIETORIPARTN'ERIEXIECUTIV'E B OFFICERIMEMBEREXCLUDED' =,vNIA Y WKN165362-3 J 02/01/2020 02/01/2021 E,L EACH $ 1,000,000 (Mandatary In NH) a E 1.. DISEASE - EA EMPLOYEE $ 1,000,000 If Yea, deserioe under DESCRIPTION OF OPERANkONS below E L. DISEASE - POLICY LIMIT ( $ 1,000,000 Professional Liability Each Claim $1,000,000 C ANE40469-01 I 11/07/2020 11/07/2021 Aggregate $1,000,000 a DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may I be attached if more space Is required) Re: As per Contract orAgreement on file with the insured. City of EI Segundo Public Works Department, its officers elected and appointed officials employees and volunteers are included as additional insured on the General Liability policy CGD381 0915 endorsement attached. Workers Compensation Waiver of Subrogation endorsement PE1104 05/01/98. CERTIFICATE HOLDER City of EI Segundo, Public Works DepartmentAttn: Floriza Rivera 350 Main Street EI Segundo I CA 90245 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE mm 07 1 988-201 5 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED (ARCHITECTS, ENGINEERS AND SURVEYORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 1. The following is added to SECTION II — WHO IS AN INSURED: Any person or organization that you agree in a "written contract requiring insurance" to include as an additional insured on this Coverage Part, but: a. Only with respect to liability for 'bodily injury", "property damage" or "personal injury": and b. If, and only to the extent that, the injury or damage is caused by acts or omissions of you or your subcontractor in the performance of "your work" to which the "written contract requiring insurance" applies, or in connection with premises owned by or rented to you. The person or organization does not qualify as an additional insured: c. With respect to the independent acts or omissions of such person or organization; or d. For "bodily injury", "property damage" or "personal injury" for which such person or organization has assumed liability in a contract or agreement. The insurance provided to such additional insured is limited as follows: e. This insurance does not apply on any basis to any person or organization for which coverage as an additional insured specifically is added by another endorsement to this Coverage Part. C This insurance does not apply to the rendering of or failure to render any "professional services". g. In the event that the Limits of Insurance of the Coverage Part shown in the Declarations exceed the limits of liability required by the "written contract requiring insurance", the insurance provided to the additional insured shall be limited to the limits of liability required by that "written contract requiring insurance". This endorsement does not increase the limits of insurance described in Section 111 — Limits Of Insurance. h. This insurance does not apply to "bodily injury" or "property damage" caused by "your work" and included in the "products - completed operations hazard" unless the "written contract requiring insurance" specifically requires you to provide such coverage for that additional insured, and then the insurance provided to the additional insured applies only to such 'bodily injury" or "property damage" that occurs before the end of the period of time for which the "written contract requiring insurance" requires you to provide such coverage or the end of the policy period. whichever is earlier. 2. The following is added to Paragraph 4.a. of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: The insurance provided to the additional insured is excess over any valid and collectible other insurance, whether primary, excess, contingent or on any other basis, that is available to the additional insured for a loss we cover. However, if you specifically agree in the "written contract requiring insurance" that this insurance provided to the additional insured under this Coverage Part must apply on a primary basis or a primary and non-contributory basis, this insurance is primary to other insurance available to the additional insured which covers that person or organizations as a named insured for such loss, and we will not share with the other insurance, provided that: (1) The "bodily injury" or "property damage" for which coverage is sought occurs; and (2) The "personal injury" for which coverage is sought arises out of an offense committed; after you have signed that "written contract requiring insurance". But this insurance provided to the additional insured still is excess over valid and collectible other insurance, whether primary, excess, contingent or on any other basis, that is available to the additional insured when that person or organization is an additional insured under any other insurance. CG D3 8109 1S 0 2015 The Travelers Indemnify Company, All rights reserved. Page 1 of 2 Includes the copyrighted material of Insurance services Office, Inc,, with Ifs permission COMMERCIAL GENERAL LIABILITY 3. The following is added to Paragraph 8.. Transfer Of Rights Of Recovery Against Others To Us, of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: We waive any right of recovery we may have against any person or organization because of payments we make for "bodily injury", "property damage" or "personal injury" arising out of 'your work" performed by you, or on your behalf, done under a "written contract requiring insurance" with that person or organization. We waive this right only where you have agreed to do so as part of the "written contract requiring insurance" with such person or organization signed by you before, and in effect when, the "bodily injury" or "property damage" occurs, or the "personal injury" offense is committed. 4. The following definition is added to the DEFINITIONS Section: "Written contract requiring insurance" means that part of any written contract under which you are required to include a person or organization as an additional insured on this Coverage Part, provided that the "bodily injury" and "property damage" occurs and the "personal injury" is caused by an offense committed: a. After you have signed that written contract; b. While that part of the written contract is in effect; and c. Before the end of the policy period. Page 2 of 2 ® 2015 The Travelers Indemnity Company. All rights reserved. CG D3 8109 15 Includes the copyrighted material of Insurance Services Office, Inc., with Its permission C>R& ., INSURANCE . DATE 121120 /YYYY) �-- CERTIFICATE OLIABILITY,__ os/21/2020 THIS CERTIFICATE IS ISSUED ASA MATTER OF AMEND, EXTENDORA TERHECO ERAGEAFFORDEDBY HE POLICIESBEN ONLY AND FLOW.THSCFERS NO IGHTS ERTIFICATEOF _ E CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. p y(ies)musthaveADDITIONALINSUREDprovisionsorbeendorsed.IfSUBROGATIONISWAIVED,sub IMPORTANT:If[hecertlficateholderisanADDITIONALINSURED,the alit ject to the terms and conditions ofthe pndorsement. A statement on this certificate does notconfer rights to the certificate holder in lieu of such endorsement(s). olicy, certain policies may require an e..-, PRODUCER CONTACT NAME: MI,chaelP Delaney NAMES FAX Michael Delaney(2958C5T) PHON-.- 6 Plaza2340 Del Amo Ste 200 (A/c, No, EXT): 311782-858 (A/C. No): 310-787-00390 , V E-MAIL Torrance CA 90501-3453 ADDRESS: mdelane farmersa ent.com INSUREY@ 9 i . . . - .. .. AFFORDING OVERAGE INSURED INSURERA TruckIsuranceExchan e2170 . . 21709 ............... Farmers Insurance- Exchange 21652 DENN ENGINEER INC 3914 DEL AMO BLVD STE 921 I INSURERC ­Mid ,e _ nlLr Insurance Company, 21687 INSURER D. _ E. TORRANCE CA 90503 INSURE INSURER F: � COVERAGES CERTIFICATE NUMBER: REV ISION NUMBER: THIS ISTOCERTIFY THATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUEDTOTHE INSURED HTH ITTS INDICATED. NOTWITHSTANDI NG A NY REQUREMENT,TERM OR ONDRIONOFANYCONTRACTOROTH RDC ESS MISHOWN HAVE BEEN EDUCED BY PA DECINAINIS. CE AFFORDED BYTHE POLICIES DESCRIBED HEREIN ISSUBJECT TOALL THE TERMS, EXCLUSIONSANIT OWHICH DCONTO CONDITIONS INSR ADDTLSUBR I POLICY EFF (M%Lt1/L LTR TYPEOFINSURANGE INSD WVD POLICY NUMBER (MM/DD/YYYY) DD/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY f IEACH OCCURRENCE $ CLAIMS-MADE �I OCCUR DAMAGE TO RENTED PREMISES (Ea Occurrence) �a MED EXP (Anyone person) �$ PERSONALE ADV INJURY S GENE.... ' GEN'LAGGREGATE LIMITAPPUES PER: RAL AGGREGATE S POLICYI,„ PROJECT LOC PRODUCTS -COMP/OPALG S S OTHER: IT AUTOMOBILE ( BODIBident)ANYAUTOY(PeEpenrson) $- 1,000,OOgi AU �6066650117 COONNEDAUTOS X SCHEDULED AUTOS BODILYINJURY (Per X NON-OWNED AUTOS ONLY Y 09/13/2020 09/13/2021 HIRED AUTOS PROPERTY DAMAGE ccidenU S ONLY (Per accident) S UMBRELLA LIAB jOCCUR EACH OCCURRENCE - S i EXCDESS LIAB IMS-MADE I AGGREGATE RETENTION 5 iS S. ,.,. ' WORKERS COMPENSATION PER OTHER S AND EMPLOYERS' LIABILITY STATUTE DISEASE . ANY PROPRIETOR/PARTNER/ Y/N EACH ACCIDENT EY,ECUTIVEOFFICERIMEMBER N/A (Mandatory I 5 OPERATIONS belowato DESCRIPTION OF ^I E.L. DISEASE - POLICY LIMIT T� If yes, describe under DE DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) The City of EI 'Segundo, its officers, elected and appointed officials, employees and volunteers named as Additional Insured With respect to liability arisint� out of autornabiles owned, leased. hired or borrowed by or on behalf of the consullant Denn Engineers, Inc. See attached Additional Insured Endorsement CA30480299 - CERTIFICATE HOLDER CANCELLATION City of ElSerbund6PlublcWoart rks06 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BECANCELLEDBEFORE THE EXPIRATION P rrlF�nl 350 Mein Street DATE HEREOF, NOTICE WILLBE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ... d g E I7Wdr�ttrSre FUIOndOB RCABra90245 AUTHORIZED REPRESENTATIV ACORD 25 (2016/03) @1988-2015 ACORD CORPORATION. All Rights Reserved 31-1769 11-15 The ACORD name and logo are registered marks of ACORD POLICY NUMBER: 60666-50-17 Policy Period 9/13/20 to 9/13/21 CO III ►TiERC1AL AUTO CA 20 48 02 99 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless mod ified by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds' under the Who Is An Insured Provi- sion of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indi- cated below. Endorsement Effective: 09/13/2020 Named Insured: Countersigned By: DENN ENGINEER INC (Authorized RepresentativeL SCHEDULE Name of Person(s) or Organization(s): City of EI Segundo Public'Works Department, 350 Main Street, EI Segundo, CA 90245 (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to the endorsement.) Each person or organization shown in the Schedule is an "insured" for Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured Provision contained in Section II of the Coverage Form. The City of EI Segundo, its officers, elected and appointed officials, employees and volunteers named as Additional Insured with respect to liability arising out of automobiles owned, leased, hired or borrowed by or on behalf of the consultant Denn Engineers, Inc. CA 20 48 02 99 Copyright, Insurance Services Office, Inc., 1998 Page 1 of 1 Workers Compensation and Employers Liability Preferred Erlaygrs Insurance Policy t N S tS 'ff A N C E C 0 M P A N Y Waiver of Our Right to Recover from Others Endorsement — California 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 determined by multiplying the California workers' compensation premium due on such remuneration by the factor 0.050. Schedule Person or Oroanization City of EI Segundo Public Works Department 350 Main Street EI Segundo, CA 90245 Job Description RE: Engineering work This endorsement is subject to a minimum premium charge of $200 Nothing in this endorsement shall vary, alter, waive or extend any of the terms, conditions or limitations of this policy other than as stated above. Nothing elsewhere in this policy shall be held to vary, alter, waive or limit the terms, conditions, agreements or limitations of this endorsement. This Endorsement when attached to Policy Number: WKN 165362-3 issued to DENN ENGINEERS, INC. shall be valid and shall form part of referenced policy. The effective date of this endorsement is 02/01/20 at 12:01 A.M. Endorsement No.: 19 Producer Number: 12886 Agency Name: DANMAR INSURANCE SERVICES PE1104 05/01198 Date Issued: 12/30/19 Refer To Signature Page Authorized Representative