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PROOF OF INSURANCE (2021) CLOSED,acoR"' CERTIFICATE OF LIABILITY INSURANCEDATE(MM/DD/YYYY) II`� 12/1/2021 1 11/20/2020 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(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 Lockton CDrn anies NAM SAX 444 W. 47th �treet, Suite 900 (A/C, No. Ext): INCA Kansas Nr): (816) 9609 000 64112-1906 ADORE � II INSURER F COVERAGES L)EA1 401 - MAINCERTIFICATE NUMBER: 1677732.04 REVISION NUMBER: XX.;?(, X 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 PAID CLAIMS. (NSR AOOR SUStt POLICY FFF POLICY EX'P LIMITS LTR TYPE OF INSURANCE I Wy POLICY NUMBER PI�VMIDDIYGYYI, 7 Drrvyvl A X COMMERCIAL GENERAL LIABILITY y y GL09830389 12/1/2020 12/1/2021EyACH OCCURRENCE $ 1,000,000 CLAIMS -MADE® OCCUR IIIPREMMISE IOEnaT ur....eI,, $ 1,000,000 IMED EXP (Any one person) $ 10,000 _ pIPERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: (GENERAL AGGREGATE $ 2.000,000 POLICYPWC E LOC F (PRODUCTS - COMP/OPAGG $ 2,000,000 OTHER: D AUTOMOBILE LIABILITY ANY AUTO AUTOS ONLY SCHEDULED HIRED NON -OWNED AUTOS ONLY AUTOS ONLY B UMBRELLA LIABX OCCUR X EXCESS LIAB 1CLAIMS•MIADE DED u I RETENTION $ E WORKERS COMPENSATION Y Y BAP9830390 N N EXS0596384 AND EMPLOYERS LIABILITY YIN Y WC9336626 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? FN_1 N / A (Mandatory In NH) yes, describe under DESCRIPTION OF OPERATIONS below E L. DISEASE - POLICY LIMIT C 1 „000,000 C PROFESSIONAL N N AEH591924704 12/1/2020 12/1/2021 PER CLAIM $1,000,000 LIABILITY ANNUAL AGGREGATE $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: ELSG0000-0003 - PROJECT MANAGEMENT FOR EL SEGUNDO BLVD IMPROVEMENT PROJECT. CITY OF EL SEGUNDO, ITS OFFICIALS, AND EMPLOYEES ARE ADDITIONAL INSUREDS AS RESPECTS GENERAL LIABILITY AND AUTO LIABILITY, AND THESE COVERAGES ARE )RM OVER '['HE C. .NERAL Llr+BILI�FY,IAUTOILIABILITY �AND M LOYLRSILIABILITY UAmBILITY SUBJECTTOTHE POF IC, Ind'ERMS, CCL)NI11'TIO'NS AND EXCLUSIONS. NS. 12/1/2020 12/1/2021 Epacd E SI➢NGCI I.uMI"6' INSURER(S) AFFORDING COVERAGE MAIC # $ XXXXXXX INSURER A: Zurich American Insurance Company 16535 INSURED DAVID EVANS AND ASSOCIATES, INC. INSURER B: The Cincinnati Insurance Company 10677 1330770 2100 S RIVER PARKWAY, SUITE 100 INSURER C; Continental Casualty Company 20443 PORTLAND OR 97201 INSURER D: American Guarantee and Liab. Ins. Co. 26247 $XXXXXXX INSURER E; American Zurich Insurance Company 40142 II INSURER F COVERAGES L)EA1 401 - MAINCERTIFICATE NUMBER: 1677732.04 REVISION NUMBER: XX.;?(, X 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 PAID CLAIMS. (NSR AOOR SUStt POLICY FFF POLICY EX'P LIMITS LTR TYPE OF INSURANCE I Wy POLICY NUMBER PI�VMIDDIYGYYI, 7 Drrvyvl A X COMMERCIAL GENERAL LIABILITY y y GL09830389 12/1/2020 12/1/2021EyACH OCCURRENCE $ 1,000,000 CLAIMS -MADE® OCCUR IIIPREMMISE IOEnaT ur....eI,, $ 1,000,000 IMED EXP (Any one person) $ 10,000 _ pIPERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: (GENERAL AGGREGATE $ 2.000,000 POLICYPWC E LOC F (PRODUCTS - COMP/OPAGG $ 2,000,000 OTHER: D AUTOMOBILE LIABILITY ANY AUTO AUTOS ONLY SCHEDULED HIRED NON -OWNED AUTOS ONLY AUTOS ONLY B UMBRELLA LIABX OCCUR X EXCESS LIAB 1CLAIMS•MIADE DED u I RETENTION $ E WORKERS COMPENSATION Y Y BAP9830390 N N EXS0596384 AND EMPLOYERS LIABILITY YIN Y WC9336626 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? FN_1 N / A (Mandatory In NH) yes, describe under DESCRIPTION OF OPERATIONS below E L. DISEASE - POLICY LIMIT C 1 „000,000 C PROFESSIONAL N N AEH591924704 12/1/2020 12/1/2021 PER CLAIM $1,000,000 LIABILITY ANNUAL AGGREGATE $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: ELSG0000-0003 - PROJECT MANAGEMENT FOR EL SEGUNDO BLVD IMPROVEMENT PROJECT. CITY OF EL SEGUNDO, ITS OFFICIALS, AND EMPLOYEES ARE ADDITIONAL INSUREDS AS RESPECTS GENERAL LIABILITY AND AUTO LIABILITY, AND THESE COVERAGES ARE )RM OVER '['HE C. .NERAL Llr+BILI�FY,IAUTOILIABILITY �AND M LOYLRSILIABILITY UAmBILITY SUBJECTTOTHE POF IC, Ind'ERMS, CCL)NI11'TIO'NS AND EXCLUSIONS. NS. 12/1/2020 12/1/2021 Epacd E SI➢NGCI I.uMI"6' $ 1,000,000 BODILY INJURY (Per person) $ XXXXXXX BODILY INJURY (Per accident $ X)CXXXXX PROPERTY DAMAGE Por accidenO $ XXXXXXX $XXXXXXX 12/1/2020 12/1/2021 EACH OCCURRENCE $ 1,000,000 (AGGREGATE $ 1,000.000 $XXXXXXX 12/1/2020 12/1/2021 X (aTATUTE I IFR IE L EACH ACCIDENT $ 1,000,000 EL DISEASE - EA EMPLOYEE $ 1,000.000 CERTIFICATE HOLDER CANCELLATION See Attachnients SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 16773204 AUTHORIZED REPRESENTATIVE CITY OF EL SEGUNDO ATTN: CHERYL EBERT 350 MAIN STREET EL SEGUNDO CA 90245 ACORD 25 (2016/03) ©108-20'15 ACORD CORPORATION. All rights reserved The ACORD name and logo are registered marks of ACORD Miscellaneous Attachment: M503337 Certificate ID: 16773204 Additional Insured — Owners, Lessees Or Contractors — Scheduled person Or Organization THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Y Policy No. GLO 9830389 Effective Date: 12/01/2020 This endorsement modifies insurance provided under the: Commercial General Liability Coverage Part Name Of Additional Insured Person(s) Or Organization(s): Any person or organization you are required to add as an additional insured in a written contract or written agreement. SCHEDULE Location(s) Of Covered Operations Any Location where you have agreed, through a written contract, agreement or permit, to provide Additional insured coverage except where such Contract or agreement is prohibited by law. 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 of this endorsement, 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 in such Schedule. 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. All other terms, conditions, provisions and exclusions of this policy remain the same. U -GL -2169-A CW (02/19) Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Miscellaneous Attachment : M503356 Certificate ID : 16773204 Additional Insured — Owners, Lessees Or Contractors — Completed Operations THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Policy No. GLO 9830389 1 Effective Date: 12/01/2020 This endorsement modifies insurance provided under the: Commercial General Liability Coverage Part SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Any person or organization you are required to add as an additional insured under a written contract or written agreement. Location And Description Of Completed Operations Any location or project where you are required to provide additional insured status in a written contract or written agreement, except where such contract or agreement is prohibited by law. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule of this endorsement, 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 such Schedule, performed for that additional insured and included in the "products -completed operations hazard". All other terms, conditions, provisions and exclusions of this policy remain the same. U -GL -2168-A CW (02/19) Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Miscellaneous Attachment: M503490 Certificate ID : 16773204 POLICY NUMBER: GLO 9830389 Other Insurance Amendment - Primary And Non -Contributory This endorsement modifies insurance provided under the: Commercial General Liability Coverage Part 1. The following paragraph is added to the Other Insurance Condition of Section IV - Commercial General Liability Conditions: This insurance is primary insurance 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. You are required by a written contract or written agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. 2. The following paragraph is added to Paragraph 4.b. of the Other Insurance Condition of Section IV - Commercial General Liability Conditions: This insurance is excess over: Any of the other insurance, whether primary, excess, contingent or on any other basis, available to an additional insured, in which the additional insured on our policy is also covered as an additional insured on another policy providing coverage for the same 'occurrence", offense, claim or "suit'. This provision does not apply to any policy in which the additional insured is a Named Insured on such other policy and where our policy is required by written contract or written agreement to provide coverage to the additional insured on a primary and non-contributory basis. All other terms and conditions of this policy remain unchanged. U -GL -1327-A CW POLICY NUMBER: GLO 9830389 WAIVER OF TRANSFER RECOVERY AGAINST OTHERS COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 OF RIGHTS OF TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: Any person or organization that requires you to waive your rights of recovery, in a written contract or agreement with the Named Insured. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV - Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products -completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 05 09 Page 1 of 1 Miscellaneous Attachment: M460257 Certificate ID : 16773204 Miscellaneous Attachment: M503359 Certificate ID : 16773204 POLICY NUMBER: BAP 9830390 COMMERCIAL AUTO CA 20 48 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED FOR COVERED ALTOS LIABILITY COVERAGE This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" for Covered Autos Liability Coverage under the Who Is An Insured provision 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 indicated below. SCHEDULE Name Of Person(s) Or Organization(s): 4NY PERSON OR ORGANIZATION YOU ARE REQUIRED TO ADD AS AN ADDITIONAL INSURED UNDER WRITTEN :ONTRACT OR WRITTEN AGREEMENT. Information required to complete this Schedule, if not shown above, will be shown in the Declarations Each person or organization shown in the Schedule is an "insured" for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Paragraph A.1. of Section II — Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms and Paragraph D.2. of Section — Covered Autos Coverages of the Auto Dealers Coverage Form. CA 20 48 10 13 © Insurance Services Office, Inc., 2011 Page 1 of 1 Attachment Code : D465278 Certificate ID : 16773204 POLICY NUMBER: BAP 9830390 COMMERCIAL AUTO CA 04 44 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: DAVID EVANS AND ASSOCIATES, INC. Endorsement Effective Date: SCHEDULE Name(s) Of Person(s) Or Organization(s): ANY PERSON OR ORGANIZATION THAT REQUIRES YOU TO WAIVE YOUR RIGHTS OF RECOVERY IN A WRITTEN CONTRACT OR WRITTEN AGREEMENT WITH THE NAMED INSURED. I Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The Transfer Of Rights Of Recovery Against Others To Us condition does not apply to the person(s) or organization(s) shown in the Schedule, but only to the extent that subrogation is waived prior to the "accident' or the "loss" under a contract with that person or organization. CA 04 44 10 13 © Insurance Services Office, Inc., 2011 Page 3 of 6 `J Miscellaneous Attachment: M460261 Certificate ID : 16773204 WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY WC 00 03 13 (Ed. 04-84) POLICY NUMBER: WC9336626 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT 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 required you to obtain this agreement from us.) This agreement shall not operate directly or indirectly to benefit any one not named in the Schedule. SCHEDULE Any person or organization that requires you to waive your rights of recovery in a written contract or agreement with the Named Insured. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.)