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PROOF OF INSURANCE (2022) CLOSEDDATE (MMIDDrrm) ACC>R" CERTIFICATE OF LIABILITY INSURANCE 12/1/2022 11 /30/2021 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 INSURERS), 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). p CONTACT PRODUCER Lockton Companies NAME: 444 W. 47th Street, Suite 900 PHONE" FAX Kansas City MO 64112-1906 (E E-MAIL ExtD . (F, No): (816) 960-9000 ADDRESS:-— INSURERIS� AFFORDING COVERAGE NAIC # ,.,.. -........ .... ........... ..me,� , „n. „. ,., ®. ,� 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,: QQntinenta1 C4$A41ty,CQmp4ny 20443 PORTLAND OR 97201 INSURER D : American Guarantee and Liab. Ins. Co. 26247 „ . , INSURER E: American Zurich Insurance Company 40142 INSURER F COVERAGES DEA1N01 - MAIN CERTIFICATE NUMBER: 16773204 KhVI1151ION NIUMISUK: xx.Yr",,,7{xAA. 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 .. ...................�._�.INN� L. S� ...... _ - ., aR -- — POLICY �`'FF POLICY EXP LTR TYPE OF INSURANCE p POLICY NUMBER MMIOOM'VY,1„ (MM/OD/YYYVI,,, LIMITS LITY A X COMCLAI S MADEEX1IOCICUR Y Y GL09830389 12/1/2021 12l1/2022 EACH OCCURRENCE $ PREMisETb`R $ 1,000,000 dAINAGEEfJTED 000 MED EXP (Any one person) $ 10,000 mm '..... ,PERSONAL ,&ADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATEPRO . ee, POLICY X CT 0 LOC PRODUCTS - COMP/OP AGG $ 2,OO,Ow000. 07HERt i $ '- D mmmUTOMOBILELIABILITY A..., y y BAP9830390 12/1/2021 12/1/2022 COMSINEOSINGLE(,INIF $ (Ea accident.) ......1,000.000 ''. ANY AUTO BODILY INJURY (Per person) $ xxxxx"XX ., ,..e, . .,.�.......... OWNED SCHEDULED BODILY INJURY (Per accident) $ X�CXXXX HIRED ONLY HIRED 'NON -OWNED PROPERTY DAMAGE $ �' �� AUTOS ONLY AUTOS ONLY ( , ,Per accident) ,,,, ... B i�l UMBRELLALIAB ';�"' OCCUR N N EXS0596384 12/1/2021 12/1/2022 EACH OCCURRENCE $ 1,000,000 X EXCESS LIAB ,.,.,.,. CLAIMS MADE s, AGGREGATE . $ 1,000,,000 DED RETENTION $ ` $ XXXXXXX E WORKERS COMPENSATION y WC9336626 12/1/2021 12/1/2022 XPER sTATt� CRH AND EMPLOYERS' LIABILITY IN Y� ANY PROPRIET .IP TNERffiXECUTIVE E L EACH ACCIDENT $ 1 0OO O0O � '� OFFICEWMEMBERE�34CLUP.ED N (Mandatory In NH) NIA , $ 1W 000A, 000 E L, DISEASE EA EMPLOYEE",,..., ,... ,.,, .,. „s. v If yes, describe under '.. DESCRIPTION OF OPERATIONS below ._ E.L.. DISEASE -POLICY LIMIT $ 1,000,000 C 'PROFESSIONAL N N AEH591924704 12/1/2021 12/1/2022 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 PRIMARY IF REQUIRED BY WRITTEN CONTRACT. THE EXCESS LIABILITY IS CONSIDERED FOLLOW FORM OVER THE GENERAL LIABILITY, AUTO LIABILITY AND EMPLOYERS LIABILITY SUBJECT TO THE POLICY TERMS, CONDITIONS AND EXCLUSIONS. CERTIFICATE HOLDER CANCELI_A f EVIN ec At'CaGt° ITICnC5 16773204 CITY OF EL SEGUNDO SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ATTN: CHERYL EBERT THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 350 MAIN STREET EL SEGUNDO CA 90245 AUTHORIZED REPRESENTATIVE"' 01'88015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) 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 POLICY NO. GLO 9830389 This endorsement modifies insurance provided under the: Commercial General Liability Coverage Part SCHEDULE Name Of Additional Insured Person(s) Location(s) Of Covered Operations Or Organization(s): Any person or organization you are required to add Any Location where you have agreed, through a written contract, agreement or permit, to provide as an additional insured in a written contract or Additional insured coverage except where such written agreement. 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 POLICY NO. GLO 9830389 This endorsement modifies insurance provided under the: Commercial General Liability Coverage Part SCHEDULE ------------ Name Of Additional Insured Person(s) Or Organization(s): Location And Description Of Completed Operations Any location or project where you are required to provide Any person or organization you are required to add additional insured status in a written contract or written as an additional insured under a written contract or agreement, except where such contract or agreement is written agreement. 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 mrent - Primary And Non -Contributory This endorsement modifies insurance provided under the: Commercial General Liability Coverage Part ZURICH 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 Miscellaneous Attachment: M460257 Certificate ID: 16773204 POLICY NUMBER: GLO 9830389 COMMERCIAL GENERAL LIABILITY CG24041219 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY Y. AGAINST OTHERS TO US (WAIVER OF SU OG TN ) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART ELECTRONIC DATA LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART DESIGNATED SITES POLLUTION LIABILITY LIMITED COVERAGE PART DESIGNATED SITES PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART UNDERGROUND STORAGE TANK POLICY DESIGNATED TANKS SCHEDULE Name Of Person(s) Or Organization(s): 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_com lete 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 against the person(s) or organization(s) shown in the Schedule above because of payments we make under this Coverage Part. Such waiver by us applies only to the extent that the insured has waived its right of recovery against such person(s) or organization(s) prior to loss. This endorsement applies only to the person(s) or organization(s) shown in the Schedule above. Miscellaneous Attachment: M503359 Certificate ID: 16773204 POLICY NUMBER: BAP 9830390 COMMERCIAL AUTO CA20481013 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED FOR COVERED AUTOS 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): \NY 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. Ia 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 I — 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 CA04441013 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. 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. 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.)