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PROOF OF INSURANCE (2024) CLOSEDC CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYY1� L —� 1 8/23/2023 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 pollcy(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). ONTAc PRODUCER C,,...�. PHU"� uww(888) 780-5381 b6 828-2424 WTW MIDWEST INC MArIL ADDRESS: CertdfiCate@Hanover.comes ............................... 233 S WACKER DR,SUITE 2000 INSURERS AFFORDING COVERAGE NAIC # CHICAGO IL 60606 ....,...... ,�........ .. .....:: ............. ,,,.,._. ,,,,,,.,...,..... „",,, ... .....,,,,,,,,,...- INSURER A a Citizens Ins Co of America .. .. -- .... """"""""". 31534 INSURED. VerlrlSura INSURER B : Insurance Co m _..._ ............ 22292 Hanover A... i INSURER C : can Ins Co 36064 BUCKNAM INFRASTRUCTURE GROUP INC INSU_RERD: 3548 SEAGATE WAY STE 230 INSURER E : OCEANSIDE CA 92056 INSURER F r nVFRAr.F'R r_FRTIFIrOTF NIIMRFR- RFVIBI0N 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 I TR AbbLO TYPE OF INSURANCE P3'FC, POLICY NUMBER POLICYE;FF MM POUCYEXP D LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 ----- ----. -MADE CLAIMS occuR PREMISES Ea occurrence ........ ��...._.--...� $ 1,000,000 MED EXP Any one person) A --------------------._._.----------------------_--------- Y N OBC A399956 09 09/16/2023 09/16/2024 PERSONAL & ADV INJURY �.$...10,000 $ 2,000,000 GFN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ 4,000,000 POLICY II JECT FILOC PRODUCTS-COMP/OPAGG $ 4,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea 00"401;' $ 2,000,000 ANY AUTO BODILY INJURY (Per person) $ A OWNED SCHEDULED Y N OBC A399956 09 09/16/2023 09/16/2024 BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS HIRED NON -OWNED PROPErEI'VDAMAG $ AUTOS ONLY AUTOS ONLY IPar ac 4$0a)... ---------------- $ UMBRELLALUIB OCCUR EACH OCCURRENCE $ 3,000,000 A EXCESS LIAB CLAIMS -MADE Y N OBC A399956 09 09/16/2023 09/16/2024 AGGREGATE $ 3,000,000 DE RETENTION $ $ WORKERS COMPENSATION EMPLOYERS'LIABILITYSTAT ANYPROPR ETTORIPARTNERIEXECUTIVE YIN , .— _ 000 C EXCLU D7 N N / A Y WZC A399946 09 09/16/2023 09/16/2024 E.L. EACH ACCIDENT ..... (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 1,000,000 UIf yyes, describe under DESCRIPTION' OF OPERATIONS below -"u""""" ""-- E.L. DISEASE -POLICY LIMIT $ 1,000,000 B Architects & Engineers Prof Liab N N LHC H023717 04 09/16/2023 09/16/2024 Claims -Made: $2M Ea Claim/$2M Agg DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more apace Is required) City of El Segundo are Additional Insured on the General Liability and Auto Liability pursuant to the terms and conditions by form 391-1586. Additional Insured is Primary and Noncontributory to the extent provided by form 391-1003 (pg 79 of 81). Waiver of Subrogation as provided by form WC040306. Excess/Umbrella to follow form. Cancellation Notice will be provided to the Certificate Holder pursuant to endorsement: 401-1235, 331-0342 and 921-1507. Such notice is solely for the purpose of informing the Certificate Holder of the effective date of cancellation and does not grant, alter, or extend any rights or obligations under this policy. CITY OF EL SEGUNDO 350 MAIN STREET ELSEGUNDO ACORD 25 (2016103) 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' CA 902451(t' S .) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD H§nInsura9Xi!r OBCA399956 1309570 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, GENERAL LIABILITY SUPPLEMENTARY ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM A. Additional Insured by Contract, Agreement or Permit The following is added to SECTION II - LIABILITY, C. Who Is An Insured: Additional Insured by Contract, Agreement or Permit a. Any person or organization with whom you agreed in a written contract, written agreement or permit that such person or organization to add as an additional insured on your policy is an additional insured only with respect to liability for "bodily injury", "property damage", or "personal and advertising injury" caused, in whole or in part, by your acts or omissions, or the acts or omissions of those acting on your behalf, but only with respect to: (1) "Your work" for the additional insured(s) designated in the contract, agreement or permit including "bodily injury" or "property damage" included in the "products -completed operations hazard" only if this Coverage Part provides such coverage. (2) Premises you own, rent, lease or occupy; or (3) Your maintenance, operation or use of equipment leased to you. b. The insurance afforded to such additional insured described above: (1) Only applies to the extent permitted by law; and (2) Will not be broader than the insurance which you are required by thecontract, agreement or permit to provide for such additional insured. (3) Applies on a primary basis if that is required by the written contract, written agreement or permit. (4) Will not be broader than coverage provided to any other insured. (5) Does not apply if the "bodily injury", "property damage" or "personal and advertising injury" is otherwise excluded from coverage under this Coverage Part, including any endorsements thereto. c. This provision does not apply: (1) Unless the written contract or written agreement was executed or permit was issued prior to the "bodily injury", "property damage", or "personal injury and advertising injury". (2) To any person or organization included as an insured by another endorsement issued by us and made part of this Coverage Part. (3) To any lessor of equipment: (a) After the equipment lease expires; or (b) If the "bodily injury", "property damage", or "personal and advertising injury" arises out of sole negligence of the lessor (4) To any: (a) Owners or other interests from whom land has been leasedif the "occurrence" or offense takes place or the offense is committed after the lease for the land expires; or (b) Managers or lessors of premises if: (1) The "occurrence" takes place or the offense is committed after you cease to be a tenant in that premises; or (ii) The "bodily injury" "property damage", "personal injury" or "advertising injury" arises out of structural alterations, new construction or demolition operations performed by or on behalf of the manager or lessor. (5) To "bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of or the failure to render any professional services. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence" which caused the "bodily injury" or "property damage" or the offense which caused the "personal and advertising injury" involved the rendering of or failure to render any professional services by or for you. d. With respect to the insurance afforded to these additional insureds, the following is added to SECTION II - LIABILITY, D. Liability and Medical Expense Limits of Insurance: The most we will pay on behalf of the additional insured for a covered claim is the lesser of the amount of insurance: 391-1586 08 16 Includes copyrighted material of Insurance Services Offices, Inc., with its permission. Page 1 of 2 1. Required by the contract, agreement or permit described in Paragraph a.; or 2. Available under the applicable Limits of Insurance shown in the Declarations. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations B. Aggregate Limits of Insurance per Project or per Location The following changes are made to SECTION II - LIABILITY: 1. The following is added to SECTION II - LIABILITY, D. Liability and Medical Expenses Limits of Insurance, paragraph 4: The Aggregate Limits of Insurance apply separately to each of "your projects" or each "location" listed in the Declarations. 2. For the purpose of coverage provided by this endorsement only, the following is added to SECTION II - LIABILITY, F. Liability And Medical Expenses Definitions: 1. "Your project" means: a. Any premises, site or "location" at, on, or in which "your work" is not yet completed; and b. Does not include any"location" listed in the Declarations. 2. "Location" means premises involving the same or connecting lots, or premises whose connection is interrupted only by a street, roadway, waterway or right-of-way of a railroad. ALL OTHER TERMS, CONDITIONS, AND EXCLUSIONS REMAIN UNCHANGED. 391.1586 0816 Includes copyrighted material of Insurance Services Offices, Inc., with its permission. Page 2 of 2 HAnover° Insurance Group.. OBCA399956 1309570 1. SECTION I - PROPERTY, if two or more of However, if you agree in a written this coverage part's coverages apply to contract, written agreement, or the same loss or damage, we will not pay written permit that the insurance more than the actual amount of the loss or provided to any person or damage. organization included as an 2. SECTION II - LIABILITY, it is our stated Additional Insured under this Coverage Part is primary and intent that the various Coverage Parts, non-contributory, we will not seek forms, endorsements or policies issued to contribution from any other the named insured by us, or any company affiliated with us, do not provide any insurance available to that Additional duplication or overlap of coverage for the Insured which covers the Additional same claim, "suit", "occurrence", offense, Insured as a Named Insured except: accident, "wrongful act" or loss. We will (1) For the sole negligence of the not pay more than the actual amount of Additional Insured; or the loss or damage. (2) When the Additional Insured is If this Coverage Part and any other an Additional Insured under Coverage Part, form, endorsement or another liability policy. policy issued to the named insured by us, b. Excess Insurance or any company affiliated with us, apply to the same claim, "suit", occurrence, This insurance is excess over: offense, accident, "wrongful act" or loss, (1) Any of the other insurance, the maximum Limit of Insurance under all whether primary, excess, such Coverage Parts, forms, contingent or on any other basis: endorsements or policies combined shall (a) That is Fire, Extended not exceed the highest applicable Limit of Coverage, Builder's Risk, Insurance under any one Coverage Part, Installation Risk similar form, endorsement or policy. f w coverage for your work"; This condition does not apply to any Excess or Umbrella Policy issued by us (b ) That is Property Insurance for specifically to apply as excess insurance premises rented to you or temporarily occupied by you over this policy. with permission of the owner; G. Liberalization (c) That is insurance purchased If we adopt an revision that would broaden P Y by you to cover your liability the coverage under this policy without as a tenant for "property additional premium within 45 days prior to or damage" to premises rented during the policy period, the broadened to you or temporarily coverage will immediately apply to this policy. occupied by you with H. Other Insurance permission of the owner; or 1. SECTION I - PROPERTY (d) If the loss arises out of the If there is other insurance covering the maintenance or use ofaircraft, "autos" or watercraft same loss or damage, we will pay only for to the extent not subject to the amount of covered loss or damage in SECTION II - LIABILITY, excess of the amount due from that other Exclusion g. Aircraft, Auto or insurance, whether you can collect on it or Watercraft; and not. But, we will not pay more than the applicable Limit of Insurance of SECTION 1 (2) Any other primary insurance - PROPERTY. available to you covering liability 2. SECTION II - LIABILITY for damages arising out of the premises or operations, or the If other valid and collectible insurance is products and completed available to the insured for a loss we operations, for which you have cover under SECTION II - LIABILITY, our been added as an additional obligations are limited as follows: insured by attachment of an a. Primary Insurance endorsement. This insurance is primary except when When this insurance is excess, we will have no duty under SECTION II - paragraph b. below applies. If this LIABILITY to defend the insured insurance is primary, our obligations against any suit if any other are not affected unless any of the insurer has a duty to defend the other insurance is also primary. Then, insured against that suit". If no other we will share with all that other insurance by the method described in insurer defends, we will undertake to paragraph c. below. do so, but we will be entitled to the 391-1003 08 16 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 79 of 81 HiinqyRr THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTICE OF CANCELLATION TO DESIGNATED ENTITY(S) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART COMMERCIAL LIABILITY UMBRELLA COVERAGE PART HANOVER COMMERCIAL FOLLOW FORM EXCESS AND UMBRELLA POLICY COMMERCIAL PROPERTY COVERAGE PART BUSINESS AUTO COVERAGE FORM BUSINESSOWNERS COVERAGE FORM SCHEDULE Name of Designated Entity Mailing Address or Email Address Number Days Notice CITY OF SEGUNDO 30 350 MAIN STREET EL SEGUNDO, CA 90245 (Information required to complete this Schedule, if not shown above, will be shown in the Declarations.) If we cancel this policy for any reason other than nonpayment of premium, we will give written notice of such cancellation to the Designated Entity(s) shown in the Schedule, Such notice may be delivered or sent by an � means of our choosing. The notice to the Designated Entity(s) will state the effective date of cancellation. Unless otherwise noted in the Schedule above, such notice will be provided to the Designated Entity(s) no more than the number of days in advance of the effective date of cancellation that we are required to provide to the Named Insured for such cancellation. Such notice of cancellation is solely for the purpose of informing the Designated Entity(s) of the effective date of cancellation and does not grant, alter, or extend any rights or obligations under this policy. ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED. 401-1235 12 14 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 1 ing r Insurance Group_ WZCA399946 1309570 N0110E OF CANCELLATION TO DESIGNATED ENTITY(S) This endorsement modifies insurance provided under the following: WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY INSURANCE POLICY SCHEDULE Name of Designated Entity Mailing Address or Email Address Number ............................. ............... _ Da s�N_otice CITY OF EL SEGUNDO 30 350 MAIN STREET EL SEGUNDO, CA 90245 .......... ....... . . . . ....... ..................... ...._ ..... Information required to complete this Schedule, if not shown above, will be shown in the Declarations. If we cancel this policy for any reason other than nonpayment of premium, we will give written notice of such cancellation to the Designated Entity(s) shown in the Schedule. Such notice may be delivered or sent by any means of our choosing. The notice to the Designated Entity(s) will state the effective date of cancel- lation. Unless otherwise noted in the Schedule above, such notice will be provided to the Designated Entity(s) no more than the number of days in advance of the effective date of cancellation that we are required to pro- vide to the Named Insured for such cancellation. Such notice of cancellation is solely for the purpose of informing the Designated Entity(s) of the effective date of cancellation and does not grant, alter, or extend any rights or obligations under this policy. ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED. 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 Policy No. W Z C —A3 9 9 9 4 6— 0 9 Endorsement No. Insured Premium Insurance Company THE HANOVER AMERICAN INSURANCE COMPANY Countersigned By 331-0342 (09 11) Includes copyrighted materials from ISO, Inc. 2003 Page 1 of 1 n 4 H% I =111149EIM93ma M Endorsement Coverage: Architects and Engineers Liability Endorsement Number: 12 Issued To: BUCKNAM INFRASTRUCTURE GROUP INC Policy Number: LHC-H023717-03 Issued By: The Hanover Insurance Company Effective Date: 09/16/2022 NOTICE OF CANCELLATION OR NON -RENEWAL TO DESIGNATED ENTITY In consideration of the premium charged it is agreed that: If We cancel or non -renew this Policy, We will provide 30 days, except 10 days for non-payment of premium, written notice of such termination or cancellation to the following: CITY OF EL SEGUNDO 350 MAIN ST EL SEGUNDO, CA 90245 Nothing herein contained shall be held to vary, alter, waive or extend any of the terms, conditions, agreements or limitations of the Policy other than as above stated. In the event cancellation or non -renewal is initiated by the Named Insured, We have no duty to provide such notice. All other terms and conditions remain unchanged. The title and any headings in this endorsement are solely for convenience and form no part of the terms and conditions of coverage. 921 1507 01/18 Page 1 of 1 over 44k r.lfouqnce Group- WZCA399946 13095:7# 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 2% % of the California workers' compensation premium otherwise due on such remuneration. Person or Organization Schedule Job Description BLANKET AS REQUIRED BY CONTRACT 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 Policy No. WZC-A3 9 9 9 4 6-0 9 Endorsement No. Insured Insurance CompanYTHE HANOVER AMERICAN INSURANCE COMPANY Countersigned By WC 04 03 06 (Ed 04-84)