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PROOF OF INSURANCE (2021 - 2022) CLOSEDDATE (MM/DDIYYYY) ACAOR" CERTIFICATE OF LIABILITY INSURANCE 02/18/2021 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 DNAME:anae Lobbenmeier IQ Risk Insurance Services, LLC PHONE' 949 679-3700 FAX 949 679-3701 225 N Bush Street �, dlobbenmeier@igrisk.com INSURER(S) AFFORDING COVERAGE NAIC # Santa Ana CA 92701 INSURERA: Allied World Assurance Company 012525 .��....... �. INSURED INSURER B : Capitol Specialty Insurance Corporation � _.... 10328 CC LAYNE & SONS INC. INSURER C : Falls Lake Fire and Casualty Company 15884 INSURER D,° " 216 Standard Street INSURER E INSURER F f ElSegundo CA 90245 COVERAGES CERTIFICATE NUMBER: CL2082606705 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 SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OF INSURANCE IN ID yyyp POLICY NUMBER '.. MM/DD/YYYY MM DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000.000 rA 15�100,000 CLAIMS -MADE OCCUR PREMISES Ea occurrence 5 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY 5 11000,000 a Y 5057-5035 08/10/2020 08/10/2021 G,Er I'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY ❑ JECT LOC PRODUCTS $ 2,000000 $ OTHER: AUTOMOBILE LIABILITY _ C.OMBIr4F-D S!IgGJ.E t.IMIT Ea docident. 5.... ANYAUTO BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS HIRED NON -OWNED PROPERTY DAMAGE: ,m 5 AUTOS ONLY AUTOS ONLY Per a bdenl ............... _...... 5 X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 2,000,OOD B EXCESS LIAB CLAIMS -MADE XS20032343 08/10/2020 08/10/2021 _. AGGREGATE $ 2,000,006 ..... DED RETENTION 5 5 WORKERS COMPENSATION PTE GTH _ STATUTE E'R _• AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE C NIA FLA008293-03 02/01/2021 02/01/2022 E.L. EACH ACCIDENT _ •••, S 1,000,000 OFFICER/MEMBER EXCLUDED? 1,000,000 (Mandatory inNH) E,L• DISEASE- EA EMPLOYEE $ If yes, describe under If 1,000,000 OF OPERATIONS below E.L. DISEASE- POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLE m__w• _--- _ S (ACORD 109, Additional Remarks Schedule, may be attached if more spaceis required) •.•._.�, *10 Days Notice of Cancellation for Non -Payment of Premium. RE: Covered CA Operations Performed By Or On Behalf of the Named Insured. The City of El Segundo, its officers, officials, employees, agents, and volunteers are named additional insured as respects general liability and this insurance is primary and noncontributory with any other insurance of the additional insured; and waiver of subrogation applies as respects workers compensation as required by written contract, per endorsements attached. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of El Segundo ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street AUTHORIZED REPRESENTATIVE ElSegundo CA 90245� ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 26 (2016/03) The ACORD name and logo are registered marks of ACORD DATE (MMIDDNYYY) ACRV CERTIFICATE OF LIABILITY INSURANCE 03/10/2021 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 StateFann Jeff Lowe 214 Standard Street, Suite B "" El Segundo, CA 90245 INSURED C C Layne & Sons Inc 216 Standard Street El Segundo, CA 90245 Jeff Lowe 310-322-5840 State Farm Mutual Automobile Insurance Com 1^OVFRAC`FA (:FRT1FIrATFNIIMRFR• RFVI.glinN NIIMRFR•. 310-322-0831 25178 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. 1�169,,,,.,.._ POLkCYNUMBER... _. -..... WMpYEY I PpOA9LDD EXP.. TYPE OF INSURANCE ...., ....__ LIMITS._,_...,.,,.,_.-. ........—, COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ _ 4d4biAGa1C I(7T _. CLAIMS -MADE ..,,,,.. OCCUR (P(I aE ('u ncccarre n .... _- —. PERSONAL. & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY � ".� JECOT LOG PRODUCTS ,QOMPpOP AGG m OTHER. AUTOMOBILE LIABILITY X X 696 9333-808-75 02/OS/2021 08J08/2021 COMBINED SINGLE LIMIT / 15ridar,(t $ ANY nuTo 696 9334-808-75 02/08/2021 - 08/08/2021 BODILY INJURY (Per person) �.,.. _.._._.... $ 1 QQQ 000 A SCHEDULED INJURYOWNED BODILY ( accident) $ 1,000,000 HIRED AUTOS NON-OWNED OON-AUToN 696 9335-BO8-75 02/08/2021 08/08/2021 oa�EFtrr cwAGE' . $ 1,000,000 AUTOS ONLY ONLY UMBRELLA LIAB OCCUR �.. EACH OCCURRENCE $ EXCESS LIAR .. CLAIMS MADE, .,..... LIED RE"rENTkONS 1.AGGREGATE S WORKERS COMPENSATION ' PER 0714. AND EMPLOYERS' LIABILITY YIN '...... .....,„,„ER ANY PROPRIETOR/PARTNER/EXECUTIVE E L EACH ACCIDEt'dT S OFFICER/MEMBER EXCLUDED? NIA 1(Mandatory in NH) E L DISEASE EA EMPLOYEE $ lC es, describe under _..... ._� 0 SCRIPTiON OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 'S DESCRIPTION OF OPERATIONS t LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Additional Insured: The City of El Segundo, its officers, officials, employees, agents, and volunteers. City of El Segundo 350 Main St El Segundo 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 Completed by an authorized State Farm representative. If signature is required, please contact a State Farm agent. ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 1001486 132649.13 04-22-2020 POLICY NUMBER: 5O57-5O35 COMMERCIAL GENERAL LIABILITY CG2O1OO413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location(s) Of Covered Operations Any person or organization to whom the Named Insured Where specified by fully executed written contract, has agreed by a fully executed written contract that such person or organization be added as an Additional Insured, but only with respect to operations performed by or on behalf of the Named Insured and only with respect to occurrences subsequent to the making of such fully executed written contract otherwise covered by this insurance. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section U — Who Is An Insured in amended to include aeonadditional insured the paroon(o)or organization(o)shown inthe Schedule, but only with naapaot to liability for "bodily injury", "property damage" or "personal and advertising injury" cauoed, in whole or in part. by: 1. Your acts or omissions; or 2. The acts oromissions of those acting on your behalf, - in 8e performance of your ongoing operations for the additional insured(s) at the location(s) designated above. However 1. The insurance afforded to such additional insured only applies to the extent permitted by law-, and 3. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded tosuch additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect tothe insurance afforded tothese additional inoureds, the following additional exclusions apply: This insurance does not apply to"bodily injury" or ^pnopertydamage" occurring after: 1. All mmrk, including ma0eho|e, parts or equipment furnished in connection with such wmrk, on the project (other than oawioe, maintenance nrrepairs) 0obeperformed byor on behalf ofthe additional insured(s) at the location of the covered operations has been comp|eded� or CG 20 10 04 13 @ Insurance Services Office, Inc., 2012 Page 1 of 2 POLICY NUMBER: 5O57-5O35 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 o port of the same project. C. With respect to the insurance afforded to these additional inounads, the following is added to Section U|—L|nnbs Of Insurance: If coverage provided to the additional insured is required by o contract or agreement, the most we will pay on behalf ofthe additional insured is the amount nfinsurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown inthe Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG2010 0412 @|nouronceServices Office, |nc,2012 Page 2of2 POLICY NUMBER: 5O57'5O35 COMMERCIAL GENERAL LIABILITY CG20 370413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PROD UCTS/COM PLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Des,-ription Of Completed Operations Any person or organization to whom the Named Where specified by fully executed written contract, Insured has agreed by a fully executed written contract that such person or organization be added as an Additional Insured for Completed Operations Coverage, but only with respect to operations performed by or on behalf of the Named Insured and only with respect to occurrences subsequent to the making of such fully executed written contract otherwise covered by this insurance. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section H — Who Is An Insured in amended to include aeanadditional insured the peroon(s) or organization(s) shown in the Suhedu|a, but only with respect to liability for "bodily injury" or "property damage" caused, inwhole orinpart, 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". i. The insurance afforded to such additional insured only applies to the extent permitted bylaw; and 2. If coverage providedtoth dditiono| insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following is added to Section Ul—Limdo Of Insurance: If coverage provided to the additional insured is required bymcontract oragreement, the most we will pay on behalf ufthe additional insured is the amount ofinsurance: 1. Required bythe contract oragreement; or 2. Available under the applicable Limits of Insurance shown inthe Declarations; whichever ialess. This endorsement applicable Limits of Declarations. shall not increase the Insurance shown in the CG 20 37 04 13 @ Insurance Services Office, Inc., 2012 Page 1 of 1 POLICY NUMBER: 5057-5035 COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS 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 against whom you have agreed to waive your right of recovery in a written contract or written agreement, provided such contract or agreement was executed prior to the date of loss, in.;. njor damaoe. Information required to complete this Schedule, if not shown 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. will be shown in the Declarations. CG 24 04 06 09 © Insurance Services Office, Inc., 2008 Page 1 of 1 0 This endorsement, effective: O8V1O/2O2O (at 12:01 A.M. standard time at the address of the Named |OSUnad as showing in the [>eC|@[@tionS) forms gpart OfPolicy No: 5057-5035 |ssUedh}-CCLaVDe & Sons Inc. By: Allied World Surplus Lines Insurance Company THUS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY / NON-CONTRIBUTORY INSURANCE ENDORSEMENT (BLANKET) Any person or organization f6'—whom the Named Insured Where specified by fully executed written contract that was has agreed by a written contract that was fully executed fully executed prior to an "occurrence". prior to an "occurrence" that such person or organization be added as an additional insured under this policy on a primary and noncontributory basis, but only with respect to operations performed by or on behalf of the Named Insured and only with respect to "occurrences" subsequent to the making of such fully executed written contract otherwise covered qyt Effective Date: 08/10/2020 bisagreed that this policy isamended ssfollows: Notwithstanding any other provision of this policy to the mzntrary, the insurance afforded to the person or organization named in the above Schedule shall be primary to, and non-contributory with, any other insurance available to such person or organizadon, but only as respects liability resulting from "your work" performed by the Named Insured at the project designated inthe Schedule above for the person ororganization named inthe Schedule above. This endorsement applies only to "bodily injury" or "property damage" caused by an "occurrence" under Coverage A and not otherwise excluded in the policy. All other terms, conditions and exclusions under the policy are applicable to this endorsement and remain unchanged. CSGLOO233OOOD1G Includes copyrighted material of Page of WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 Ed. 4-84 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 22.5% of the California workers' compensation premium otherwise due on such remuneration. Schedule Person or Organization Job Description Blanket Waiver of Subrogation As respects to all CA jobs performed by the named insured during the policy period where by written contract a waiver of subrogation is required prior to the commencement of work. 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 02-01-2021 Policy No. FLA008293-03. Endorsement No, Insured Insurance Company CC Layne & Sons, Inc (a Corp) Falls Lake Fire & Casualty Company Countersigned By ©1998 by the Workers' Compensation Insurance Rating Bureau of California. All rights reserved,