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PROOF OF INSURANCE (2021 - 2022) CLOSEDDATE (MMIDD/YYYY) ` "RlDf CERTIFICATE OF LIABILITY INSURANCE 5/8/2020 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 NAME Marie Swaney Dealey, Renton & Associates PHVNI — FAX sE Colorado B#460 — E-MAIL _SwanPaadena CA 9101 RRss_I ey@dealeyr 4olo2m .... INSURED Gale/Jordan Associates, Inc. 3858 Carson Street, Suite 200 Torrance, CA 90503-5613 310-316-4377 INSURER A: Crum & Forster GALEASS-01 INSURER B INSURER C INSUR„R,,,,,,..,a. INSURER E INSURER F f`n\/CDAf=CC !`FRTIPIr ATF NI IMRFR• 1FFd5%RQQ7F REVISION NUMBER: NAIL # 44520 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. ...... ........... .. ...... o.LIC ,..�ADDG,ISW tF�- _-_ .. I Y EXP" ILT R ..... ..... POLICY NUMBER_.... TYPE OF INSURANCE--- IT IMMIDDfYYYY MM D LIMITS INSDI D A X COMMERCIAL GENERAL LIABILITY Y Y EPK130876 4/28/2020 4/28/2021 EACH OCCURRENCE 4$10 000 000 I X]OCCUR CLAIMS -MADE OCCUR �..X..] PRf PW$ESffar a ;;alnrrrlegp _... $ 1 D 0 000 X Contractual Liab EXP (Any one person) I $ 5, 000 PERSONAL ..... APPLIES PER: GEN L AGGREGATE LIMIT,,,,,,,,,,,,,,,,,,, GENERAL AGGREGATE $ 10,000,000 ,.. .. POLICY X I __I LOC PRODUCTS - COMP/OP AGG $1 000.000 X O"tHER:: C`ontraEOrsPoU Contr, Poll.,Liab......... $ 30 ,000 000 A AUTOMOBILE LIABILITY Y EPK130876 4/28/2020 4126/2021 I 'SOat1 INGI E I IM T $ 1, 000 000 ANY AUTO BODILY INJURY Per person) ( $ SCHEDULED OWNEDUTOS BODILY INJURY (Per accident) $ ONLY X.... HIRED AUTOS AX... NON -OWNED _ ......,_ PROPO.RT'V OA,4AGE .... $ .......... AUTOS ONLY AUTOS ONLY (Ppr,f!ggl,)....... .. ....... ...._- X NoOwned Auto $ UMBRELLA LAB OCCUR EACH OCCURRENCE $_- rr.. I EXCESSLIAB CLAIMS $ .,.. ,MADE ........ ----' �. .. ,AGGREGATE ...... ......� DED RETENTION $ $ WORKERS CMPENSATN PER TF ORH STATU AND EMPLOYERS' LIABILITY Y / N 'ANYPROPR _ E LEACH ACCIDENT ( $ EOTOR PARTNIEOR/EXECUTIVE OFFICER/MEMBEREXCLUDED? ❑ NIA I (Mandatory in NH) E L DISEASE EA EMPLOYEE_$_ --- --------- If yes, describe under DESCRIPTION OF OPERATIONS below E L DISEASE - POLICY LIMIT $ A Professional Liability EPK130876 4128/21121) 4128/2121 Per Claim $3.000,000 Annual Aggr $3,000.000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached it more space is required) Auto Liability is follow -form to the General Liability. RE: All Operations -- City of El Segundo, its officers, agents and employees are named as additional insured as respects general and auto liability as required per written contract or agreement. CERTIFICATE HOLDER CANCELLATION 30 tray Notice will be sent to holder 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, Public Works Dept. 350 Main Street AUTHORIZED REPRESENTATIVE El Segundo CA 90245 r ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Policy # EPK130876 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NON-CONTRIBUTORY ADDITIONAL INSURED WITH WAIVER OF SUBROGATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART CONTRACTORS POLLUTION LIABILITY COVERAGE PART ERRORS AND OMISSIONS LIABILITY COVERAGE PART THIRD PARTY POLLUTION LIABILITY COVERAGE PART SCHEDULE Name of Additional Insured Person(s) or Organization Blanket when specifically required in a written contract with the named insured A. SECTION III — WHO IS AN INSURED within the Common Provisions is amended to include as an additional insured the person(s) or organization(s) indicated in the Schedule shown above, but solely with respect to "claims" caused in whole or in part, by "your work" for that person or organization performed by you, or by those acting on your behalf. This insurance shall be primary and non-contributory, but only in the event of a named insured's sole negligence. B. We waive any right of recovery we may have against the person(s) or organization(s) indicated in the Schedule shown above because of payments we make for "damages" arising out of "your work" performed under a designated project or contract with that person(s) or organization(s). C. This Endorsement does not reinstate or increase the Limits of Insurance applicable to any "claim" to which the coverage afforded by this Endorsement applies. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. EN0118-0211 Page 1 of 1 Policy # EPK130876 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Additional Person(s) or Location And Description Of Completed Organization(s): I Operations nformation Blanket when specifically required in a written contract with the named insured. red to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section III — Who Is An Insured within the Common Provisions is amended to include as an 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". EN0320-0211 Page 1 of 1 DATE IMMID L CERTIFICATE OF LIABILITY INSURANCE 02/15/2021DmYY► 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()es) 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 CONTACT EJMS Insurance Services PHONE .,ttaltlw _ ........ �,,___.....f.Hp1.._�.................. PO Box 33289 E-MAIL AODRESS: Los Gatos„ CA 95031 -_ _ _ INSURER(,_), .:... .. mm:_ COVERA. NAIC.N......,..m, S AFFORDING OE INSURER A: Chubb National Insurance Company 10052 INSURED INSURER B - gale/jordan associates _.._........... �......,.... a._ ....... . ...................... ..:: SURER C 3585 W. Carson Street, Suite 200 IN � _ _ ..:.. _.:.. .. ...: INSURER D : Torrance, CA 90503 ------ INCIIQFQ F COVERAGES CERTIFICATE NUMBER: 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 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. INTO �... _ . ... TYPE OF INSURANCE ... ... mL POLICY NU ...• LICY EF'F POLICY P MBER IMMIDG1YYYY1 IMMIDDFYYYYt LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL RLIABILITY P .. ... CLAIMS•MAOE �_.XXX Y�� OCCUR. ED E(P (My one person) $ PERSONAL & ADV INJURY $ ---..... __ _ GENERAL AGGREGATE $ ....... .......mm ..... . _ . C GEN'L AGGREGATE LIMIT APPLIES PER. PRODUCTS - COMP/OP AGG $ PRow __ POLICY LOC —_....... AUTOMOBILE LIABILITY ....e of INona SINGLELIMITA .m ... ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED (Per accident) BODILY INJURYAUTOS $ .e.. ... HIRED AUTOS o � A11T0& p $ UMBRELLA LIAR OCCUR ..w. �.__ EACH OCCURRENCE m..... �.�..,.,,...�� $ __. EXCESS LIAB '.... CLAIMS -MADE AGGREGATE $ QED RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS LIABILITY ( 22 7178-54-63 2/01/2021 2/O1 /2022 WC STATU X ....! TDJRy LltA T_ _ ...... OT _— .............. ............ YIN ANY PR PRIETOR/PARTNERIEXECUTIVE E, L: EACH ACCIDENT $ ]-OOO.00O EXCLUDED? I NIA �. _— (Mandatory NH) E L, DISEASE - EA E_MPL_OYEE.. $ 1..000.000 If d sr yy DE.s 0 �Oba under SCRIPT ON OF OPERATIONS below a mEmI I. DISEASE- POLICY LIMIT $ 1,000,0OO.Wm. ...._ DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) Christopher K Gale - President: Excluded / Thomas A Jordan - Secretary / Treasurer: Excluded City of El Segundo, Public Works Dept. 350 Main St. El Segundo, CA 90245-3813 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. AUTHORIZED .m Daniel J. Cloud 01988-2010 ACC, D� "ORIP'ORATION. 11 rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACOR Workers' Compensation and Employers' Liability Policy Named Insured Endorsement Number GALEMORDAN ASSOCIATES, INC. Policy Number Number 22 7178.54a63 Poilcy Period _§OnW., Effective Dale of Endorsement 02l01r2021 TO 0 11r2022 02101/2021 Issued By (Name R Insuranoe Gernpany) Chubb Nallar^�aI I Cam rniAerl flea fwmbot, The remainder of the mfoonadon is to be cam otorl on when this qndwssytiemt is iss ed swbsa went to ft oropmton ofth e CALIFORNIA WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement applies only to the insurance provided by the policy because California is shown in Item 3.A. of the Information Page. 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, but this waiver applies only with respect to bodily injury arising out of the operations described in the Schedule, where you are required by a written contract to obtain this waiver from us. You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. Schedule Specific Waiver Name of person or organization: ( X ) Blanket Waiver Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. 2. Operations: 3. Premium: The premium charge for this endorsement shall be 1%_ percent of the California premium developed on payroll in connection with work performed for the above person(s) or organization(s) arising out of the operations described. 4. Minimum Premium: WC 90 03 75 (05118) InwK Cwy Authorized Representative