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PROOF OF INSURANCE (2021 - 2021) CLOSEDV DATE (MMIDDNWY) CERTIFICATE OF LIABILITY INSURANCE I 11/10/2020 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, theolid p y(ies) must 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 ............. ............. .Tessicaporretta 1 ...................... NAME: Shaw Moses Mendenhall s Associates Ins. Agency PHONE I. (626)799-7813 sAX ,Not: (111)799-8784 License #OD94511 E-MAIL ADDxanh@smmainsurance.com 625 Fair Oaks, Suite 158 I INSURER(S) AFFORDING COVERAGE NAIC N South Pasadena CA 91030 IINSURERA: Ohio Security 24082 INSURED IN SURER B: Travelers Cas and Surety Perttula And Associates, Inc. INSURER C:: DBA: Tavi Design Group INSURER 0: 2341 27th Street INSURER E: Santa Monica CA 90405 INSURER F: COVERAGES CERTIFICATE NUMBER:CL2092508708 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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. INSR ADDL'SUBR POLICY EFF ' POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER IMMIDDIYYY'YM 1MM0DrYY'YY1 X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 A CLAIMS -MADE lil OCCUR DAMAGE TO RENTED ...... PREMISES (EaoccurrencMl 0 $ 300,000 X BZS56380079 10/23/2020 10/23/2021 II MED EXP (Any one person) $ 15,000 PERSONAL & ADV INJURY $ 2,000,000 4,000,000 GEN'I"AGGREGATELIMIT APPLIES PER: GENERAL AGGREGATE $ X POLICY PRO" 7 LOC PRODUCTS -COMPIOPAGG $ 4,000,000 OTHEP. Employee Dishonesty $ 25,000 AUTOMOBILE LIABILITY (,,UMBINED SIINGL.E LIMIT tEa accldoni) -BODILY $ 2 , 000, 000 ANY AUTO INJURY (Per person) $ A ALL OWNED SCHEDULED X BZS56380079 10/23/2020 10/23/2021 BODILY INJURY (Per accident) $ AUTOS AUTOS NON -OWNED P'ROP'ERd'1"OAMAOE' $„ x HIREDAUTOS x AUTOS tP" a'midb it U UMBRELLA LIAB OCCUR EACH OCCURRENCE S --...,. EXCESS LIAR HCLAIMS-MADE AGGREGATE $ DED I RETENTION $ WORKERS COMPENSATION g$ M STAR.TUTE P B ERH AND EMPLOYERS' LIABILITY Y d N ANY PROPRIETORIPARTNER/EXECUTIVE EL EACH ACCIDENT S OFFIiCEMM'EMBER EXCLUDED? �I N IA (Mandatory in NH) EL DISEASE - EA EMPLOYEE $ If yes dossv5be under DESCRIPTION OF OPERAT'ION'S below EL DISEASE - POLICY LIMIT S B Professional Liab. 106186656 C 10/23/2020 10/23/2021 $1,000,000 per occ DESCRIPTION OF OPERATIONS I LOCATIONS/ VEHICLES (ACORD 101, Additional Roma rks Schedule, maybe attached If more space Is required) When required by written contract, agreement or permit, The City of E1 Segundo, its officers, officials, employees and volunteers are named as an Additional Insured as regards to General Liability and those usual to the Insured's Operations. Digitally signed by Joseph Lillio DN: cn=Joseph Lillio, o=City of EI Joseph Lillio Segundo, ou=DIrector of Finance, email=jlillio@0segundo.org, c=US Date: 2020.12.20 22:13:32 -08'00' CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of El Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 350 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. El Segundo, CA 90245-3895 AUTHORIZED REPRESENTATIVE Xanh (Sand) Tran/XTT 9 © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS025 (201401) JL BUSINESSOWNERS BP 79 96 09 16 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY,. BUSINESSOWNERS LIABILITY EXTENSION ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAQE FORM Below is a summarization of the coverages provided by this endorsement. No coverages are given by this summary. Actual coverage descriptions are within this endorsement. >r yt SECTION SUBJECT A. Supplementary Payments Bail Bonds Loss Of Earnings B. Broadened Coverage For Damage To Premises Rented To You C. Incidental Medical Malpractice Injury D. Mobile Equipment E. Blanket Additional Insured (Owners, Contractors Or Lessors) F. Newly Formed Or Acquired Organizations G_ Aggregate Limits H. Duties In The Event Of Occurrence, Offense, Claim Or Suit I. Liability And Medical Expenses Definitions Bodily Injury Insured Contract Personal And Advertising Injury Section II - Liability is amended as follows: A. Supplementary Payments Section A.1. Business Liability is modified as follows: 1. The $250 limit shown in Paragraph A.1.f.(1)(b) Coverage Extension -Supplementary Payments for the cost of bail bonds is replaced by a $3,000 limit. 2. The $250 limit shown in Paragraph A.1.f.(1)(d) Coverage Extension - Supplementary Payments for reasonable expenses and loss of earnings is replaced by a $500 limit. B. Broadened Coverage For Damage To Premises Rented To You 1. The last paragraph of Section B.I. Exclusions - Applicable To Business Liability Coverage is replaced by the following: With respect to the premises which are rented to you or temporarily occupied by you with the permis- sion of the owner, Exclusions c., d., e., g„ h., k., I„ m„ n. and o. do not apply to "property damage". © 2016 Liberty Mutual Insurance BP 79 96 09 16 Includes copyrighted material of Insurance Services Office, Inc., with Its permission. Page 1 of 4 x 2. Paragraph D,2. Liability And Medical Expenses Limits Of Insurance is replaced by the following: The most we will pay under this endorsement for the sum of all damages because of all "property damage" to premises while rented to you or temporarily occupied by you with the permission of the owner is the Limit of Insurance shown in the Declarations, 3. Paragraph D.3. Liability And Medical Expenses Limits Of Insurance does not apply. C. Incidental Medical Malpractice Injury 1. Paragraph (4) under Paragraph 13.1.j. Exclusions - Applicable To Business Liability Coverage - Profes- sionalServices does not apply to "Incidental Medical Malpractice Injury" coverage. L 2. With respect to this endorsement, the following is added to Section F. Liability And Medical Expenses Definitions: a. "Incidental Medical Malpractice Injury" means bodily injury arising out of the rendering of or failure to render, during the policy period, the following services: (1) Medical, surgical, dental, x-ray or nursing service or treatment or the furnishing of food or beverages in connection therewith; or (2) The furnishing or dispensing of drugs or medical, dental or surgical supplies or appliances. b. This coverage does not apply to: (1) Expenses incurred by the insured for first-aid to others at the time of an accident and the Duties in the Event of Occurrence, Offense, Claim or Suit Condition is amended accordingly. (2) Any insured engaged in the business or occupation of providing any of the services described under a. above. (3) Injury caused by any indemnitee if such indemnitee is engaged in the business or occupation of providing any of the services described under a. above. D. Mobile Equipment Section C. Who Is An Insured is amended to include any person driving "mobile equipment" with your permission. E. Blanket Additional Insured (Owners, Contractors Or Lessors) 1. Section C. Who Is An Insured is amended to include as an insured any person or organization whom you are required to name as an additional insured on this policy under a written contract or written agreement The written contract or agreement must be: a, Currently in effect or becoming effective during the term of this policy; and b. Executed prior to the "bodily injury", "property damage", or "personal and advertising injury". 2. The insurance afforded to the additional insured is limited as follows: a. The person or organization is only an additional insured with respect to liability arising out of: (1) Real properly, as described in a written contract or written agreement, you own, rent, lease, maintain or occupy; and (2) Caused in whole or in part by your ongoing operations performed for that insured. b. The Limit of Insurance applicable to the additional insured are those specified in the written contract or written agreement or the limits available under this policy, as stated in the Declara- tions, whichever are less. These limits are inclusive of and not in addition to the Limit of Insurance available under this policy. C. The insurance afforded to the additional insured does not apply to: (1) Liability arising out of the sole negligence of the additional insured; (2) "Bodily injury", "property damage", "personal and advertising injury", or defense coverage under the Supplementary Payments section of the policy arising out of an architect's, en- gineer's or surveyor's rendering of or failure to render any professional services including: © 2016 Liberty Mutual Insurance BP 79 96 09 16 Includes copyrighted material of Insurance Services Office, Inc., with its permission Page 2 of 4 (a) The preparing or approving of maps, shop drawings, opinions, reports, surveys, field orders, change orders, or drawings and specifications; and (b) Supervisory, inspection, architectural or engineering activities. (3) Any "occurrence' that takes place after you cease to be a tenant in the premises described in the Declarations; or (4) Structural alterations, new construction or demolition operations performed by or for the person or organization designated in the Declarations. 3. Any coverage provided hereunder shall be excess over any other valid and collectible insurance avail- able to the additional insured whether primary, excess, contingent or on any other basis unless a contract specifically requires that this insurance be primary or you request that it apply on a primary basis. F. Newly Formed Or Acquired Organizations 53 0282101 The following is added to Section C. Who Is An Insured: Any business entity acquired by you or incorporated or organized by you under the laws of any individual state of the United States of America over which you maintain majority ownership interest exceeding fifty percent. Such acquired or newly formed organization will qualify as a Named Insured if there is no similar insurance available to that entity. However: s 1. Coverage under this provision is afforded only until the 18Dth day after the entity was acquired or incorporated or organized by you or the end of the policy period, whichever is earlier; 2. Section A.I. Business Liability does not apply to: a. 'Bodily injury" or "property damage' that occurred before the entity was acquired or incorporated or organized by you; and " b. "Personal and advertising injury" arising out of an offense committed before the entity was ac- quired or Incorporated or organized by you. 3. Records and descriptions of operations must be maintained by the first Named Insured. 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. G. Aggregate Limits The following is added to Paragraph DA. Aggregate Limits Liability and Medical Expenses Limits Of Insurance: 1. The Aggregate Limits apply separately to each of the "locations" owned by or rented to you or temporarily occupied by you with the permission of the owner. 2. The Aggregate Limits also apply separately to each of your projects away from premises owned by or rented to you. For the purpose of this endorsement only, 'location" means premises involving the same or connect- ing lots, or premises whose connection is interrupted only by a street, roadway, waterway or right- of-way of a railroad. H. Duties In The Event Of Occurrence, Offense, Claim Or Suit 1. Paragraph E.2 -a. Duties In The Event Of Occurrence, Offense, Claim Or Suit Liability And Medical Expenses General Condition applies only when the 'occurrence' is known to any insured listed in Paragraph C.1. Who Is An Insured or any "employee' authorized by you to give or receive notice of an "occurrence' or claim. 2. Paragraph E.2.b. Duties In The Event Of Occurrence, Offense, Claim Or Suit Liability And Medical Expenses General Condition will not be considered breached unless the breach occurs after such claim or "suit' is known to any insured listed under Paragraph C.1. Who Is An Insured or any "employee" authorized by you to give or receive notice of an 'occurrence" or claim © 20161-iberly Mutual Insurance BP 79 96 09 16 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 3 of 4 Section F. Liability And Medical Expenses Definitions is modified as follows: 1. Paragraph F.3. is replaced by the following: 3. 'Bodily Injury" means bodily injury, sickness, disease, or incidental medical malpractice injury sustained by a person, and includes mental anguish resulting from any of these; and including death resulting from any of these at any time. 2. Paragraph F.9. is replaced by the following: 9. 'Insured contract" means: a. A contract for a lease of premises. However, that portion of the contract for a lease of prem- ises that indemnifies any person or organization for damage by fire to premises while rented to you or temporarily occupied by you with permission of the owner is not an "insured contract' b. A sidetrack agreement; c. Any easement or license agreement, except in connection with construction or demolition operations on or within 50 feet of a railroad; d. An obligation, as required by ordinance, to indemnify a municipality, except in connection with work for a municipality; e. An elevator maintenance agreement; f. That part of any other contract or agreement pertaining to your business (including an indem- nification of a municipality in connection with work performed for a municipality) under which you assume the tort liability of another party to pay for "bodily injury" or "property damage" to a third person or organization, provided the "bodily injury" or "property damage" is caused, in whole or In part, by you or by those acting on your behalf. However, such part of a contract or agreement shall only be considered an "insured contract" to the extent your assumption of the tort liability is permitted by law. Tort liability means a liability that would be imposed by law in the absence of any contract or agreement. Paragraph f. does not include that part of any contract or agreement: (1) That indemnifies a railroad for "bodily injury" or "property damage" arising out of con- struction or demolition operations, within 50 feet of any railroad property and affecting any railroad bridge or trestle, tracks, road -beds, tunnel, underpass or crossing; (2) That indemnifies an architect, engineer or surveyor for injury or damage arising out of: (a) Preparing, approving, or failing to prepare or approve, maps, shop drawings, opin- ions, reports, surveys, field orders, change orders or drawings and specifications; or (b) Giving directions or instructions, or failing to give them, if that is the primary cause of the injury or damage; or (3) Under which the insured, if an architect, engineer or surveyor, assumes liability for an injury or damage arising out of the insured's rendering or failure to render professional services, including those listed in (2) above and supervisory, inspection, architectural or engineering activities. 3. Paragraph F.14.b. Personal And Advertising Injury is replaced by the following: b. Malicious prosecution or abuse of process; ® 2016 Liberty Mutual Insurance BP 79 96 09 16 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 4 of 4 ' 0 DATE (MMIDD/YYYY) C40R�''" CERTIFICATE OF LIABILITY INSURANCE 11/04/2020 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 Automatic Data Processing Insurance Agency, Inc. Automatic Data Processing Insurance Agency, Inc. PHONE e E' t): 1-800-524-7024 CAx, Na} ADDRESS 1 Adp Boulevard INSURER(S) AFFORDING COVERAGE NAIC # Roseland NJ 07068 INSURERA: AmGUARD Insurance Company 42390 INSURED Perttula and Associates INSURER B: INSURER C : DBA: Tavi Design Group INSURER D: 12794 W Washington Blvd INSURER E: Los Angeles CA 90066 INSURER F: COVERAGES CERTIFICATE NUMBER: 1722275 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOWHAVE 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, INSRLICY EFF POLICY CXP LTR TYPE OF INSURANCE ",�yN5D 'SWVD POLICY NUMBER UOA', fMi�N' DDYYYY6 xMMMDY YY I LIMITS ERCIAL RAL LIABILITY CA H OCCURRENCE $ EACH .,,COMMLAIMS-MADEEI MAGE T'Ci'kLN'i'ED� .. OCCUR PREMISES,(Ea occurrence) $ „ MED EXP (Any one person) $ PERSONAL 8 ADV INJURY $ GEN'LAGGREGATE LIMIT APPLIES .,,P I I PER` GENERAL AGGREGATE $ L..... �_1 Itl POLICY L LOC PRODUCTS - COMP/OPAGG EC $ OTHER„ . $ AUTOMOBILE LIABILITY (E"a accc,aevrlCOMeINEb p pRJ'Gkk' LINuAat $ . ANY AUTO I BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS .I HIRED j NON -OWNED PROPERTY DAWAG5 AUTOS ONLY AUTOS ONLY (Pr v g ru rjerl) $ U OCCR $ ,UMBRELLA LIAB EACH OCCURRENCE EXCESS LIAB CLAIMS -MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION PER OIH AND EMPLOYERS' LIABILITY „/\ STATUTE ERANY PROPRIETOR/1 ,000,000 A OFFICER/MEMBER EXCLUDED Y N/ A I Y PEWC121198 03/13/2020 03/13/2021 1 000 00 (Mandatory in NH PARTNER/EXECUTIVE E L: DISEASE -L EACH EAE EMPLOYEE, $ If yes, desribe under EL DISEASE -POLICY LIMIT 1,000,000 DESCRIPTION OF OPERATIONS below g I II I DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (P 1101, Additional Remarks Schedule, may be attached if more space is required) This certificate of insurance includes a Waiver of Subrogation in favor of the certificate holder. Digitally signed by Joseph Lillio ON: im.:.Joseph 0111o, co=Cd'y of LI Joseph L i l l i o Segundo, ou"Dara:ooi of Finance, maYl4:)Il0106'Pis °guindoorg, c -US Date: 2020 12.20 22:14:37 -06'00' CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of EI Segundo ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street AUTHORIZED REPRESENTATIVE 1I <1 EI Segundo CA 90245 © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 4-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT—CALIFORNIA VL 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 1.05 % of the California workers' compensation premium otherwise due on such remuneration. Person or Organization The City of El Segundo Schedule Job Description Landscape Design 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.) Endorsement Effective Policy No. PEWC121198 Endorsement No. Insured Insurance Company Countersigned By ©1998 by the Workers' Compensation Insurance Rating Bureau of California. All rights reserved.