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PROOF OF INSURANCE (2021 - 2022) CLOSEDC01AIR" CERTIFICATE OF LIABILITY INSURANCE DATE(MMIOOmYY) 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, the policy(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 NA E; Jessica Porretta Shaw Moses Mendenhall & Associates Ins. Agency PHONE (626)749-7813 FAx aze>rse-a,sa A6C No :, E-MAILss:xanh@smmainsurance.com ADDA License #OD94511 625 Fair Oaks, Suite 158 INSURE 5 AFFORDING COVERAGE NAIC # INSURERA:Ohio Security 24082 South Pasadena CA 91030 INSURED INSURER B : Travelers Cas and Surety INSURERC: Perttula And Associates, Inc. INSURER0: DBA: Tavi Design Group INSURERE: 2341 27th Street INSURER F: Santa Monica CA 90405 COVERAGES CERTIFICATE NUMBER:CL20925OB708 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. INSR LTR TYPE OF INSURANCE L SUOR POLICY LICY'EFF MMd00,fY'YYY POLICY EXp MA4tID0 Y.. LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 A CLAIMS -MADE t -- a OCCUR AMA PREMISES Ea occurrence) '. $ 300,000 MED EXP (Any one person) $ 15,000 X BZS56380079 10/23/2020 ''.. 10/23/2021 PERSONAL $ADVINJURY S 2,000,000 GENIAGGREGtATELIMITAPPLIESPER: PRO- X POLICY PRO" ❑ LOC GENERALAGGREGATE $ 4,000,000 PRODUCTS •COMPIOPAGG $ 4,000,000 OTHER Employee Dishonesty $ 25,000 AUTOMOBILE LIABILITY OMBI NIn den4'. s"" M Y (EaA $ 2,000,000 BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED . AUTOS AUTOS X BZSS6380079 10/23/2020 10/23/2021 BODILY INJURY (Per accident) $ x NON -OWNED HIRED AUTOS x AUTOS 6 R PEf M' DAMA `E Etr ect:ldtawul •............. $ $ UMBRELLA LIAR OCCUR EACH OCCURRENCE S AGGREGATE $ EXCESS LIAR CLAIMS -MADE OED I I RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE �I OFFICERlMEMBER EXCLUDED? N/A STATUTE RH E.L. EACH ACCIDENT $ EL DISEASE - EA EMPLOYEE $ (Mandatary In NH) If yes, describe under DESCRIPTION OF OPERATIONS below E..L. DISEASE - POLICY LIMIT $ H Professional Liab, 106186656 10/23/2020 10/23/2021 S1,000,000 per occ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) When required by written contract, agreement or permit, The City of El 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 I ON: cn Joseph Lillio, o=City of El Joseph Segundo ou=Director of Finance, email=)Illlio@eisegundo.org, c=U!5 Date: 2020.12.20 22:13:32-08'00' CERTIFICATE HOLDER CANCELLATION City of El Segundo 350 Main Street E1 Segundo, CA 90245-3995 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 rirl (Sarld) Tian/XTT ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS025 (201401) LA BuSmsoaoWNsma THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESSOWNERS LIABILITY EXTENSION ENDORSEMENT This endorsement modifies insurance provided under the following: 8U8|NEGSOVVNERS OOVERAGEFORM Below is o summarization of the coverages provided by this endorsement. No coverages are given by this summary. Actual coverage descriptions anowdmn this endorsement. W SECTION SUBJECT A. Supplementary Payments Bail Bonds S Lnaa Of Earnings 0 B. Broadened Coverage For Damage To Premises Rented To You C. Incidental Medical Malpractice Injury D. Mobile Equipment 1�e E. Blanket Additional Insured (Owners. Contractors Or Lessors) F. Newly Formed OrAcquired 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 U `Liability is amended as follows: � A. Supplementary Payments Section A.I. Business Liability is modified oomUowo: c 1. The $25Ulimit shown in Paragraph A.1.[(1)(b) Coverage Extension Supplementary Payments for the cost of bail bonds is replaced by a$3.00O limit. u. The $250 limit shown in Panooxopn A1z(1)(d) Coverage Extension -Supp(ementan/ Payments for reasonable expenses and |nes of earnings is replaced by o$soO limit. B. Broadened Coverage For Damage To Premises Rented To You 1. The last paragraph of Section B.I. Exclusions -Ap»Ucamr 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 thepormis- sion of the owner, Exclusions c., d,, e.� g,, h., k., L, m,, n. and o. do not apply to "property damage", @ 20`suberlyMutual Insurance BP7uoGUS1O |nuvuoncopyrighted material orInsurance Services Office, |nu.with Its permission, Page 1of4 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 or the owner is the Limit of Insurance shown in the Declarations. 3. Paragraph 113.3. Liability And Medical Expenses Limits Of Insurance does not apply. C. Incidental Medical Malpractice Injury 1. Paragraph (4) under Paragraph B.1.j. Exclusions - Applicable To Business Liability Coverage - Profes- sional Services 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 a. The person or organization is only an additional insured with respect to liability arising out of: (1) Real property, 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 or mapy, y*ov drawinga, opimona, epmnm. uvrvayo. field ordem, change orders, or drawings and apeoifiooUnna; and (b) Supeninory, inapecUun, architectural or engineering activities. (3) Any "occurrence" that takes place after you cease to beatenant in the premises described in the Declarations; or pQ Structural alterationa, new construction or demolition opoox|une performed by or for the person or organization designated in the Dau|onaUona. 3. Any coverage provided hereunder shall beexcess over any other ,eUd and oo||auUb|e insurance avail- able to the additional insured whether phmmry, exreoa, contingent or on any other basis unless a contract specifically requires that this insurance be primary or you request that it apply on aprimory basis. F^ mevv)y Fu,medor4cqui,ed Organizations = The following is added to Section C. Who |axnInsured: � Any business entity oo4uina4 by you o, 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 o, newly formed organization will qualify aeuNamed Insured if there is no similar � insurance available to that entity, However: Q 1. Coverage under this provision is afforded only until the 1e0th day after the entity was acquired or incorporated or organized by you or the and of the policy per/od, whichever is earlier; 2. Section A1.Business Liability does not apply to: a. "Bodily injury" or "property damaon" 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 an- qu|nad or Incorporated or organized by you. 3. Records and descriptions of operations must be maintained by the hm| 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 oseNamed Insured in the Declarations. G. Aggregate Limits The following in added to Paragraph oA. Aggregate Limits Uouimy and Medical Expenses Limits Of Insurance: 1. The Aggregate Limits apply separately to each of the '1oco§ona^ owned by or rented to you or temporarily occupied by YOU with the permission of the owner. � 2. The Aeumgava Limits also apply separately to each of your projects away from premises owned by or � rented to you. Forme purpose of this endorsement only, ''|ocaUun^ means premises involving the same orconnoot- /ng |ma, or premises whose connection is interrupted only by a otnae,, modway, waterway o, right- of-way ofarailroad. H. Duties In The Event Of Occurrence, Offense, Claim Or Suit 1. Paragraph E.2.a. Duties In The Event Of nrcmr,enpe, mnenap. Claim O, m"u 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 ',onnvnenoo" or claim, u. pansOmph E,o.u. Duties In The Event mrOccurrence, Offense. cm/m Or Suit Liability And Medical Expenses General Condition will not be considered breached un|oee the breach occurs after such claim of "suit" is mmwn to any insured listed under Paragraph C1. Who Is An Insured or any "employee" authorized by you to give or receive notice of an "occurrence"or claim. @ 20161-iue,/yw"wv/ Insurance epre 96 09 15 Includes copyrighted material orInsurance Services Office, mc,with its permission Page 3o/4 I |. Section puaumity And Medical Expenses Definitions is modified as follows: 1. Paragraph F.3. is replaced by the following: :. "Bodily Injury" means bodily injvry, aioknesa, diseasu, or incidental medical me|p/wcUoe injury ovolaioud by m porson, and inowuna mental anguish resulting from any of maea; and including 0ooN resulting from any of these at any time. 2. Paragraph Fg. is replaced bythe following: 9. "Insured contract" means.- a. A contract for a lease of premises. However, that portion of the contract for aleoue of prem- ises that indamfiUns 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 Asidetrack agreement; u. Any easement or license agreement, except in connection with oonntmoUnn or demolition operations onorwithin 5Ofeet uf aei|mad; d� An obligation, as required by ondinanca, to indemnify a municipa|ity, except in connection with work for amunicipality; o. An elevator maintenance agreement; t That pert of any other contract or agreement pertaining to your business (including an indom- nifivation cfamunicipality /n connection with work performed for umunicipa|ity) under vvh|oh 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 couoed, in whole or In pod, by you or by those acting on your behalf. However, ouox port of contract o, agreement shall only be considered on "Insured contract" to the extent your assumption of the hart liability is permitted by law. Tort liability means o|iobUity that would be imposed by law in the mbaonno of any contract or agreement. Paragraph ,. does not include that part of any contract or agreement: (i) That indemnifies m railroad for "bodily injury" o, "properly damage" arising out of con- struction o, demolition operations, within 50*ec« of any railroad property and affecting any noi|mod bridge or trestle, bauks, mod'bads, mnno/, underpass o, crossing; (z) That indemnifies an architect, engineer or surveyor for injury or damage arising out of: (o) Preparing, appmwng, or failing to prepare or appmve, m*po, shop drawinga, opin- iuna, vuponts, a"rvevn, field onde,s, change orders or drawings and specifications; o, (b) Giving m,ecUo^e or insoncUuns, o, failing to give /hom, if that is the primary muvae of the injury or damage; or (3) Under which the inoured, if an orchiteot, engineer or aumayo/. assumes liability for an injury or damage arising out of the mounmd'u rendering or failure to render professional mew,oes, including moue |ia,md in (2) above and svporviaory, inapeohon, architectural or engineering activities. 3. Paragraph F.14.h. Personal And Advertising Injury is replaced by the following: b, Malicious prosecution or abuse of process; m201eubertyMutual Insurance o DATE (MM/DDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 04/08/2021 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). CONTACT PRODUCER NAME. Automatic Data Processing Insurance Agency, Inc. Automatic Data Processing Insurance Agency, Inc. Air N -Eyt,. 1-800-524-7024 Na1:- 1 Ad Boulevard R S AFFORDING COVERAGE „ „ p„NAIC # p _ _... ........... INSURE..�.i� �...�.��,��--�.��...�_....-_ Roseland NJ 07068 INSURER A : AmGUARD Insurance Company 42390 _.._ .,.. _------- ,--- _ .. ..a ...._. _._.. _ ...................... _ _.. - . ....._...._ INSURED Perttula and Associates INSURER B : INSURER C DBA: Tavl Design Group iNSURER�....._..._......-__......�............_._.�-_.-.�-.... ._...._.... �...._.�.............�.�.........___. 9 p - ................... _ ..._ .. .. 12794 W Washington Blvd INSURER E : Los Angeles CA 90066 INSURER F COVERAGES CERTIFICATE NUMBER: 1919176 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. ................ INSR-......._.,,. ...w.....µ....._..._. ............ -.,3AdoL ,'it,i'B,. ..... ...e,,,,.m.._._..... __ ..... ., .,..."ChtG�'".E''',_.. ...,,,,,..ww.,,.,....._.�._......_. .........., ....�.....�. LTR TYPE OF INSURANCE POLICY NUMBER '.. MMIDDIYYYYI (MMIDDfYYYYI LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS -MADE �........OCCUR .fvTX I i0RE TT ......... _,_ PR , MISEB Ea 9!cgy _......... . .,..,, MED EXP (Any one person) $ _.. ....._ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY ❑ PRO- LOC PRODUCTS COMPIOPAGG ''. $ OTHER: $-_ AUTOMOBILE LIABILITY ...CO INNE,0 IN LE LIMIT f $ ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ HIRED NON -OWNED 1�11 i i5tlroTl= _ $ AUTOS ONLY _ AUTOS ONLVeaycdaNe+a.,,, _..... .... UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIABCLA{MS-MADE ........... . ..._. AGGREGATE _ ......w.,,, $ _. DED RETENTION $ $ WORKERS COMPENSATION 'AND STATTH- UTE ER EMPLOYERS' LIABILITY 'ANY PROPRIETORIPARTNER/EXECUTIVE Y 7 N ._ 1,000,000 000 A OFFICER/MEMBER EXCLUDED? Y N / A N PEWC267352 03/13/2021 03/13/2022—- E.L. EACH ACCIDENT ------�- - $ •� - ---- (Mandatory in NH) E.L. DISEASE - EA EMPLOYE - $ 1.000,000 If yes, describe under DESCRIPTION OF OPERATIONS below _��—ICY LIMIT E.L. DISEASE - POLICYI � � -��� ..... . .... . � 1,000,000 I DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) 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 El Segundo CA 90245 �t....•'.,.r y�{ 01908-2015 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 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 )L.ps._% 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 Insured Policy No. PEWC267352 Insurance Company Countersigned By Endorsement No. 01998 by the Workers' Compensation Insurance Rating Bureau of California. All rights reserved.