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PROOF OF INSURANCE (2021) CLOSED' 7 0 DATE (MMIDDIYYYY) ARV CERTIFICATE OF LIABILITY INSURANCE 5/1/2021 11/2/2020 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(les) 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). ACT PRODUCER Lockton Companies NAME; 3280 Peachtree Road NE, Suite #250 PHONE Atlanta GA 30305 glc. No. Extlw.... ................................. ....... rale rra�= MAIL (404)460-3600 ADDRESS" COVERAGES Irvine CERTIFICATE NUMBER: 17105237 REVISION NUMBER: XX XXX.X 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 iPAID CLAIMS. INSR TYPE OF INSURANCE........ ADDL'0ff l�---_..... POLICY NUMBER dMOdDD Y'YYYi i'06 16Y E1d......,............................................... .............. p .P I LTR INSD Wvo DD/YYYYY , LIMITS AX COMMERCIAL GENERAL LIABILITY Y N 6057040530 5/l/2020 5/1/2021 EACH OCCURRENCE $ 1,000,000 DAMAGE '16"RENTEo CLAIMS -MADE Fx� OCCUR PREMISES (Ea occurrence) $ 1.000.000 XContIactu,al ,Liab MED EXP (Any one person) $ 15 000 .............- ......... _— X Cross Liab Inc] PERSONAL & ADV INJURY $ 1.000,000 INSURER(S),AFFORDING COVERAGE NAIC # CANCELLATION INSURER A : t%al.1.e ._FS?r e... %jrance Company 20.5.0.8...._. INSURED 1484342 N ani 20443. 3 T chnolo Drive gy INSURER C : The Continen al Insurance Co m�a� 35289 Suite 100 INSURER D: National Fire Insurance Co of Hartford 20478 Irvine CA 92618 ................................. INSURER E : Berkley Insurance,...Comn.....a.. . ................ ..... .... 3. .. 260 B INSURER F: Y N 6057040575 COVERAGES Irvine CERTIFICATE NUMBER: 17105237 REVISION NUMBER: XX XXX.X 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 iPAID CLAIMS. INSR TYPE OF INSURANCE........ ADDL'0ff l�---_..... POLICY NUMBER dMOdDD Y'YYYi i'06 16Y E1d......,............................................... .............. p .P I LTR INSD Wvo DD/YYYYY , LIMITS AX COMMERCIAL GENERAL LIABILITY Y N 6057040530 5/l/2020 5/1/2021 EACH OCCURRENCE $ 1,000,000 DAMAGE '16"RENTEo CLAIMS -MADE Fx� OCCUR PREMISES (Ea occurrence) $ 1.000.000 XContIactu,al ,Liab MED EXP (Any one person) $ 15 000 .............- ......... _— X Cross Liab Inc] PERSONAL & ADV INJURY $ 1.000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) PW 20-04, El Segundo Water Main Improvements Project on Indiana Street City of El Segundo, its officials, and employees are included as an additional insured as respects General Liability and Automobile Liability on a primary basis as per written contract, subject to terms, conditions and exclusions of policy(s). GEN'L AGGREGATE LIMIT APPLIES PER: CERTIFICATE HOLDER ..... CANCELLATION �, GENERAL AGGREGATE $ 2,000,000 City of EI Segundo RO- ^,X.11 POLICY FX_1 JECT III LOC Lifan Xu, Ci Engineer g THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PRODUCTS - COMP/OP AGG $ 2,000.000 El Segundo CA 90245 OTHER:$ 1 B AUTOMOBILE LIABILITY Y N 6057040575 /2021 5/1/2020 5/1/2 .. COMBINED SINGLE ...LiMff $ 1.000,000 ...,. ANY AUTO BODILY INJURY (Per person) $ XXXX3= OWNED SCHEDULED LY INJURY (Per accident) $'X AUTOS ONLY AUTOS ED ....... DAM'AGF 6TO n P Eff l._.... 0 $ = ATOS ONLY AUTOS ONEDY ... m...)...... ............................ .. $ XXXXXXX C UMBRELLA AB OCCUREACH x N N CUE6076054554 5/1/2020 5/1/2021 OCCURRENCE s 20,000.000 EXCESS ABLAIMS-MADE AGGREGATE $ 20..:......___.._I -DED.RE....... X TE NTION $ $0 $ XXXXXXX D WORKERS COMPENSATION N WC657040558(CA) 5/1/2020 5/1/2021 OTH- ILITY YN ANFDIPROPRIIETORE E1. EA EACH CIIENI,,,,,,,,R„ 1,QO(.1,000 CB pRIXECUTIVE ❑ N/A (Mandatory In NH) E SE - EA EMPLOYE E $ 1 .000,000 .:.... ... If Oyes, de TION un OPERATIONS below E L DISC E - POLICY LIMIT S s IT $ 1,000.000 E Professional Liability N N AEC903639504 5/1/2020 5/1/2021 Each Claim: $I OM Aggregate: $20M Valuable Papers Limit:$100,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) PW 20-04, El Segundo Water Main Improvements Project on Indiana Street City of El Segundo, its officials, and employees are included as an additional insured as respects General Liability and Automobile Liability on a primary basis as per written contract, subject to terms, conditions and exclusions of policy(s). CERTIFICATE HOLDER ..... CANCELLATION 17105237 City of EI Segundo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Lifan Xu, Ci Engineer g THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 350 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. El Segundo CA 90245 AUTHORIZED REPRESENTA'ItyE I r :,, ©'1588-2' a ACORD CORPOFI riION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Blanket Additional Insured - Owners, Lessees or Contractors -with Products -Completed Operations Coverage Endorsement This endorsement modifies insurance provided under the following; COMMERCIAL GENERAL LIABILITY COVERAGE PART It is understood and agreed as follows: 0- 1. WHO IS AN INSURED is amended to include as an Insured any person or organization whom you are required by written contract to add as an additional insured on this coverage part, 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 subject to such written contract; or B. in the performance of your work subject to such written contract, but only with respect to bodily injury or property damage included in the products -completed operations hazard, and only if: 1. the written contract requires you to provide the additional insured such coverage; and 2. this coverage part provides such coverage. II. But if the written contract requires: A. additional insured coverage under the 11-85 edition, 10-93 edition, or 10-01 edition of CG2010, or under the 10-01 edition of CG2037; or B. additional insured coverage with "arising out of language; or C. additional insured coverage to the greatest extent permissible by law; then paragraph I. above is deleted in its entirety and replaced by the following: WHO IS AN INSURED is amended to include as an Insured any person or organization whom you are required by written contract to add as an additional insured on this coverage part, but only with respect to liability for bodily injury, property damage or personal and advertising injury arising out of your work that is subject to such written contract. Ill. Subject always to the terms and conditions of this policy, including the limits of insurance, the Insurer will not provide such additional insured with: A. coverage broader than required by the written contract; or B. a higher limit of insurance than required by the written contract. IV. The insurance granted by this endorsement to the additional insured does not apply to bodily injury, property damage, or personal and advertising injury arising out of: A. the rendering of, or the failure to render, any professional architectural, engineering, or surveying services, including: 1. the preparing, approving, or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; and 2. supervisory, inspection, architectural or engineering activities; or B. any premises or work for which the additional insured is specifically listed as an additional insured on another endorsement attached to this coverage part. V. Under COMMERCIAL GENERAL LIABILITY CONDITIONS, the Condition entitled Other Insurance is amended to add the following, which supersedes any provision to the contrary in this Condition or elsewhere in this coverage part: Primary and Noncontributory Insurance CNA75079XX (10-16) Policy No: 6057040530 Page 1 of 2 Effective Date: 05/01/2020 Insured Name: Nv5 Global, Inc Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission. Blanket Additional Insured - Owners, Lessees or Contractors -with Products -Completed Operations Coverage Endorsement With respect to other insurance available to the additional insured under which the additional insured is a named insured, this insurance is primary to and will not seek contribution from such other insurance, provided that a written contract requires the insurance provided by this policy to be: 1. primary and non-contributing with other insurance available to the additional insured; or 2. primary and to not seek contribution from any other insurance available to the additional insured. But except as specified above, this insurance will be excess of all other insurance available to the additional insured. VI. Solely with respect to the insurance granted by this endorsement, the section entitled COMMERCIAL GENERAL LIABILITY CONDITIONS is amended as follows: The Condition entitled Duties In The Event of Occurrence, Offense, Claim or Suit is amended with the addition of the following: Any additional insured pursuant to this endorsement will as soon as practicable: 1. give the Insurer written notice of any claim, or any occurrence or offense which may result in a claim; 2. send the Insurer copies of all legal papers received, and otherwise cooperate with the Insurer in the investigation, defense, or settlement of the claim; and 3. make available any other insurance, and tender the defense and indemnity of any claim to any other insurer or self -insurer, whose policy or program applies to a loss that the Insurer covers under this coverage part. However, if the written contract requires this insurance to be primary and non-contributory, this paragraph 3. does not apply to insurance on which the additional insured is a named insured. The Insurer has no duty to defend or indemnify an additional insured under this endorsement until the Insurer receives written notice of a claim from the additional insured. VII. Solely with respect to the insurance granted by this endorsement, the section entitled DEFINITIONS is amended to add the following definition: Written contract means a written contract or written agreement that requires you to make a person or organization an additional insured on this coverage part, provided the contract or agreement: A. is currently in effect or becomes effective during the term of this policy; and B. was executed prior to: 1. the bodily injury or property damage; or 2. the offense that caused the personal and advertising injury; for which the additional insured seeks coverage. Any coverage granted by this endorsement shall apply solely to the extent permissible by law. 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. CNA75079XX (10-16) Policy No: 6057040530 Page 2 of 2 Effective Date: 05/01/2020 Insured Name: NV5 Global, Inc. Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission. P CN CNA (Ed. 10/12) ADDITIONAL INSURED - PRIMARY AND NON-CONTRIBUTORY It is understood and agreed that this endorsement amends the BUSINESS AUTO COVERAGE FORM as follows: SCHEDULE Name of Additional Insured Persons Or Organizations 1. In conformance with paragraph A.1.c. of Who Is An Insured of Section II — LIABILITY COVERAGE, the person or organization scheduled above is an insured under this policy. 2. The insurance afforded to the additional insured under this policy will apply on a primary and non-contributory basis if you have committed it to be so in a written contract or written agreement executed prior to the date of the "accident" for which the additional insured seeks coverage under this policy. All other terms and conditions of the Policy remain unchanged. CNA71527XX (10/12) Page 1 of 1 Insured Name: NV5 GLOBAL, INC. Copyright CNA All Rights Reserved. Policy No: 6057040575 Endorsement No: Effective Date: 05/01/2020