PROOF OF INSURANCE (2024) CLOSEDACCORD® CERTIFICATE OF LIABILITY INSURANCE
DATE(MM/DD/YYYY)
3/30/2023
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
Greyling Ins. Brokerage/EPIC
3780 Mansell Road, Suite 370
GA 30022
CONTACT
NAME: Carly Samuel
PHONE FAX
A/C No Ext : 770.670.5324 A/C, No): 770.670.5324
E-MAlpharetta
ADDRESS: greylingcerts@greyling.com
INSURER(S) AFFORDING COVERAGE
NAIC #
INSURERA: National Union Fire Ins Co of Pittsburg
19445
INSURED GEOSCON
Geosyntec Consultants, Inc.
900 Broken Sound Parkway NW, Suite 200
INSURERB: Everest National Insurance Company
10120
INSURERC: Allied World Assurance Co (U.S.) Inc.
19489
INSURERD: New Hampshire Insurance Company
23841
Boca Raton, FL 33487-0000
INSURER E :
INSURER F :
COVERAGES CERTIFICATE NUMBER:812438520 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
LTR
TYPE OF INSURANCE
ADDL
INSD
SUBR
WVD
POLICYNUMBER
POLICY EFF
MM/DD
POLICY EXP
MM/DD
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
GL5268179
4/1/2023
4/1/2024
EACH OCCURRENCE
$2,000,000
CLAIMS -MADE OCCUR
DAMAGE TO RENTED
PREMISES Ea occurrence
$ 500,000
MED EXP (Any one person)
$ 25,000
PERSONAL & ADV INJURY
$ 2,000,000
GEN'L
AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$ 4,000,000
POLICY � ECT � LOC
PRODUCTS - COMP/OP AGG
$ 4,000,000
$
OTHER:
A
A
AUTOMOBILE
LIABILITY
ANY AUTO
CA4489673 (AOS)
CA4489674 (MA)
4/1/2023
4/1/2023
4/1/2024
4/1/2024
COMBINED SINGLE LIMIT
Ea accident
$2,000,000
X
BODILY INJURY (Per person)
$
OWNED SCHEDULED
AUTOS ONLY AUTOS
BODILY INJURY (Per accident)
$
X
PROPERTY DAMAGE
Per accident
$
HIRED X NON -OWNED
AUTOS ONLY AUTOS ONLY
B
X
UMBRELLALIAB
X
OCCUR
XC3EX00336231
4/1/2023
4/1/2024
EACH OCCURRENCE
$ 10,000,000
X
AGGREGATE
$ 10,000,000
EXCESS LAB
CLAIMS -MADE
DED X RETENTION $ 1 n nnn
$
D
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
WC015893709(AOS)
WC015893710 (CA)
4/1/2023
4/1/2023
4/1/2024
4/1/2024
X PER OTH-
STATUTE ER
ANYPROPRIETOR/PARTNER/EXECUTIVE
E.L. EACH ACCIDENT
$ 1,000,000
OFFICER/MEMBER EXCLUDED? FN]
N/A
E.L. DISEASE - EA EMPLOYEE
$ 1,000,000
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
$ 1,000,000
C
Professional Liability (PL)/
03122723
4/1/2023
4/1/2024
Each Act
8,000,000
Contractors Pollution Liab (CPL)
Aggregate
10,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required)
Re: Stormwater Permit Implementation Assistance; August 13/2016. THe City of El Segundo, its officers & employees are named as Additional Insureds with
respects to General & Automobile Liability where required by written contract. The above referenced liability policies with the exception of professional liability
are primary & non-contributory where required by written contract. Waiver of Subrogation is applicable where required by written contract & allowed by law.
CERTIFICATE HOLDER 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.
City of El Segundo Public Works
350 Main Street
AUTHORIZED REPRESENTATIVE
El Segundo CA 90245-3813
@ 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
POLICY NUMBER: 526-81 -79 COMMERCIAL GENERAL LIABILITY
CG20101219
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 WHOM YOU
PER THE CONTRACT OR AGREEMENT.
BECOME OBLIGATED TO INCLUDE AS AN
ADDITIONAL INSURED AS A RESULT OF ANY
CONTRACT OR AGREEMENT YOU HAVE ENTERED
INTO.
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
CG 20 10 12 19 0 Insurance Services Office, Inc., 2018 Page 1 of 2 ❑
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, 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 above.
However:
1. The insurance afforded to such additional
insured only applies to the extent permitted
by law; and
2. If coverage provided to the additional
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 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.
C. With respect to the insurance afforded to these
additional insureds, the following is added to
Section III - Limits Of Insurance:
If coverage provided to the additional insured is
required by a contract or agreement, the most
we will pay on behalf of the additional insured
is the amount of insurance:
1. Required by the contract or agreement; or
2. Available under the applicable limits of
insurance;
whichever is less.
This endorsement shall not increase the
applicable limits of insurance.
Page 2 of 2 0 Insurance Services Office, Inc., 2018 CG 20 10 12 19
POLICY NUMBER: 526-81 -79 COMMERCIAL GENERAL LIABILITY
CG 20 37 12 19
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
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person(s)
Or Organization(s)
Location And Description Of Completed Operations
ANY PERSON OR ORGANIZATION WHOM YOU
PER THE CONTRACT OR AGREEMENT.
BECOME OBLIGATED TO INCLUDE AS AN
ADDITIONAL INSURED AS A RESULT OF ANY
CONTRACT OR AGREEMENT YOU HAVE ENTERED
INTO.
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
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, 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".
However:
1. The insurance afforded to such additional
insured only applies to the extent permitted
by law; and
2. If coverage provided to the additional
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 III — Limits Of Insurance:
If coverage provided to the additional insured is
required by a contract or agreement, the most
we will pay on behalf of the additional insured
is the amount of insurance:
1. Required by the contract or agreement; or
2. Available under the applicable limits of
insurance;
whichever is less.
This endorsement shall not increase the
applicable limits of insurance.
CG 20 37 12 19 0 Insurance Services Office, Inc., 2018 Page 1 of 1
POLICY NUMBER: 526-81 -79 COMMERCIAL GENERAL LIABILITY
CG 20 01 12 19
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
LIQUOR LIABILITY COVERAGE PART
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
The following is added to the Other Insurance
Condition and supersedes any provision to the
contrary:
Primary And Noncontributory Insurance
This insurance is primary to and will not seek
contribution from any other insurance available
to an additional insured under your policy
provided that:
(1)The additional insured is a Named Insured
under such other insurance; and
(2) You have agreed in writing in a contract or
agreement that this insurance would be
primary and would not seek contribution
from any other insurance available to the
additional insured.
CG 20 01 12 19 0 Insurance Services Office, Inc., 2018 Page 1 of 1
BLANKET WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT
This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different
date is indicated below.
(The following "attaching clause" need be completed only when this endorsement is issued subsequent to preparation of the policy).
This endorsement, effective 12:01 AM 04 / 01 / 2023
Issued to GEOSYNTEC CONSULTANTS, INC.
forms a part of Policy No. WC 015893710
By NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA.
We have a right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce
our right against any person or organization with whom you have a written contract that requires you to obtain this
agreement from us, as regards any work you perform for such person or organization.
The additional premium for this endorsement shall be 2.00 % of the total estimated workers compensation premium
for this policy.
WC040361 Countersigned by047� Akv�
______________________________
(Ed. 11/90)
Authorized Representative