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PROOF OF INSURANCE (2024 - 2025)----- LCREART-01 -PER�l, '`� CERTIFICATE OF LIABILITY INSURANCEDATE(MMIDD/YYYY) 8/22/2024 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. themmm olic les must have ADDITIONAL INSURED provisions or IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, p y(' ) p 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 INSURICA 2420 Springer Dr, Suite 105 Norman, OK 73069 310-1583 217-0311 _INSURER A: Ohio SecunY Z4Ut$Z INSURED INSURER B : Markel American Insurance Company 28932 LCR Earthwork & Engineering, Corp. .INsuRER c Navi ators S ecialt Insurance Com any 36056 3200 E. Guasti Road, 100 INSURER D : Ontario, CA 91761 It.Sk .._.SURER R INSURER F t. ..........�.,._........-. .... ....,-. ...... ......__�.W........ .... ................�.. COVERAGES CERTIFICATE NUMBER: ............ _REVISION NUMBER .m,,,,, 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, DUCED INSR•, COMMERCIAL GENERAL LIABILITY �• •••••••• ^^^^ PAID S 1i"�l0pii EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN RE POLICY E BY P POLICY FSRm� - TYPE OF INSURANCE POLICY NUMBER LIMITS A X _ I EACH OCCURRENCE CLAIMS -MADE � OCCUR X X �BKS59172059 10/3/2023 10/3/2024 00 AREMISAGE TO -9 ED 500,000 000 MED EXP An one ersonJ 15" PERSL(?NAL INJURY $ 1,000,000 'E.N'L AGGREGATE LIMITAP.FLIES PER: GENERAL AGGREGATE $ 2,000,000, . ' � 2000,000 POLICY jE�g " LOC PRODUGTS COMP/QPAGG $ _!IT,,,, A... • dz oHER: _ d OMBSNErJ BUNGLE LIMIT 1,000,000 AUTOMOBILE LIABILITY X ANY AUTO X iBAS66323456 10/3/2023 10/3/2024 BODILY INJURY (Per arson OWNEDSCHEDULED BODILY IN .. - AUTOS ONLY AUTOS JURY Per accident $ R�I4 %�yy PROPEI:t"IY AMAr'"imE m---�, AIIRfG�S ONLY ........ ALIT4?S9^kELDY mf,PeR sCCrrlenl ...... $ .._ ........_.. ..........._..........�.- _.. ... ........_. ..... ply dry �yy�._y _.._..... 3,000,000 UMBRELLA LIAB X OCCUR EACH OCCURRENCE 5 ......, X EXCESS LIAB CLAIMS -MADE X X MKLM4EUE101254 1013/2023 10/3/2024 ArGREGATE .......... $. $ 00fir01001 ....... DED RETENTION $ ......_..�.,.�......�.. - W.....,_. ........._.. .... $ .__�. mm.��............... .. -.... ............... RS COMPENSATION PER OTH WORKS .3T.T41TFrR AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ E L. EACH ACCIDENT $ If'FIGERIM MBER EXCLUDED? N / A E L,� DISEASE - E4 EMPLOYEE'. $ yes cart' n NH) If yes, describe under DESCRIPTION OF OPERATIONS below E L DISEASE POLICY LIMIT S W, 0 C Pollution Liability CH24ECPR00557NC 7/13/2024 7/1312025 Each Incident 1,000,000 ................... _......... .... The CI DESCRIPTION OF OPERATIONS ILOCATION VEHICLES (ACORD 101, Adtid1ldnnal Remarks Schedule may be attache peCce required) arising out of � I1 more sP a Is requGrerT City, its officers, officials, employees, agents, and volunteers will be covered' as Insureds as res liability g activities performed by or on behalf of the Contractor; products and completed operations of the Contractor, promises owned, occupied or used by the Contractor; or automobiles owned, leased, hired or borrowed by the Contractor. The coverage will contain no special limitations on the scope or protection afforded to the City, Its officers„ officials, employees, agents, or volunteers. The Contractor's insurance coverage will be primary insurance as respects the City, its officers, officials,, employees, agents, and volunteers, Any insurance or self-insurance maintained by the City, its officers, officials, employees, agents, and volunteers will be excess of the Contractor's insurance and will not SEE ATTACHED ACORD 101 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 El Segundo CA 90245_'"""" AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: LCREART-01 DTERLIZZI C"R �ADDITIONAL REMARKS SCHEDULE Page 1 of 1 .__ _ .... _.. ....... ....... ........� AGENCY NAMED INSURED LCR Earthwork & Engineering, Corp. PoINSURICA 200 E. Guasti Road 100 u .....------- -- _.. ..mm."' Ontario, CA 81761 ' CY NUMBER SEE PAGE 1 - �._._.__... ��...... CARRIER NAIC CODE EE PAGE 1 SEE P 1 EWiCTHI E,E PA... �m._ _.... .em E DATE: GE 1 .......... _._..... ADDITIONAL REMARKS ADDITIONALTHIS REMARKS FORM IS A SCHEDULE TO ACORD FORM FORM NUMBER: D FORM TITLE Certificate of Liability. nsuran>ae ..... Description of Operations/Locations/Vehicles: contribute with it. The Insurer will agree in wanting to waive all rights of subrogation against the City, its officers, officials, employees and volunteers for losses arising from work performed by the Contractor for the City. Any failure to comply with repo1iing provisions of the policies will not affect coverage provided to the City, its officers, officials, employees, agents and volunteers. The Contractor's insurance will apply separately to each insured against whom claim is made or suit is brought, except with respect to the limits of the insurer's liability. Each insurance policy required by this subsection will be endorsed to state that coverage will not be suspended, voided, cancelled by either party, reduced in coverage or in limits except after thirty (30) days written notice by certified mail, return receipt requested, has been given to: CITY CLERK City of El Segundo 350 Main Street El Segundo, CA 90245 .......... ACORD 101 (200.8/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABILITY CG88100413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. COMMERCIAL GENERAL LIABILITY EXTENSION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART INDEX SUBJECT PAGE NON -OWNED AIRCRAFT 2 NON -OWNED WATERCRAFT 2 PROPERTY DAMAGE LIABILITY -ELEVATORS 2 EXTENDED DAMAGE TO PROPERTY RENTED TO YOU (Tenant's Property Damage) MEDICAL PAYMENTS EXTENSION 3 EXTENSION OF SUPPLEMENTARY PAYMENTS - COVERAGES A AND B 3 " ADDITIONAL INSUREDS - BY CONTRACT, AGREEMENT OR PERMIT 3 PRIMARY AND NON-CONTRIBUTORY- ADDITIONAL INSURED EXTENSION 5 ADDITIONAL INSUREDS - EXTENDED PROTECTION OF YOUR "LIMITS OF INSURANCE" 6 WHO IS AN INSURED - INCIDENTAL MEDICAL ERRORS/MALPRACTICE AND WHO IS AN INSURED - FELLOW EMPLOYEE EXTENSION - MANAGEMENT EMPLOYEES 6 NEWLY FORMED OR ADDITIONALLY ACQUIRED ENTITIES 7 FAILURE TO DISCLOSE HAZARDS AND PRIOR OCCURRENCES 7 r KNOWLEDGE OF OCCURRENCE, OFFENSE, CLAIM OR SUIT 7 LIBERALIZATION CLAUSE 7 BODILY INJURY REDEFINED 7 EXTENDED PROPERTY DAMAGE 8 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US - 8 WHEN REQUIRED IN A CONTRACT OR AGREEMENT WITH YOU © 2013 Liberty Mutual Insurance CG 88 10 04 13 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 8 With respect to coverage afforded by this endorsement, the provisions of the policy apply unless modified by the endorsement. A. NON -OWNED AIRCRAFT Under Paragraph 2. Exclusions of Section I - Coverage A - Bodily Injury And Property Damage Liability, exclusion g. Aircraft, Auto Or Watercraft does not apply to an aircraft provided: 1. It is not owned by any insured; 2. It is hired, chartered or loaned with a trained paid crew; 3. The pilot in command holds a currently effective certificate, issued by the duly constituted authority of the United States of America or Canada, designating her or him a commercial or airline pilot; and 4. It is not being used to carry persons or property for a charge. However, the insurance afforded by this provision does not apply if there is available to the insured other valid and collectible insurance, whether primary, excess (other than insurance written to apply specifically in excess of this policy), contingent or on any other basis, that would also apply to the loss covered under this provision. B. NON -OWNED WATERCRAFT Under Paragraph 2. Exclusions of Section I - Coverage A - Bodily Injury And Property Damage Liability, Subparagraph (2) of exclusion g. Aircraft, Auto Or Watercraft is replaced by the following: This exclusion does not apply to: (2) A watercraft you do not own that is: (a) Less than 52 feet long; and (b) Not being used to carry persons or property for a charge. C. PROPERTY DAMAGE LIABILITY -ELEVATORS 1. Under Paragraph 2. Exclusions of Section I - Coverage A - Bodily Injury And Property Damage Liabil- ity, Subparagraphs (3), (4) and (6) of exclusion j. Damage To Property do not apply if such "property damage" results from the use of elevators. For the purpose of this provision, elevators do not include vehicle lifts. Vehicle lifts are lifts or hoists used in automobile service or repair operations. 2. The following is added to Section IV - Commercial General Liability Conditions, Condition 4. Other Insurance, Paragraph b. Excess Insurance: The insurance afforded by this provision of this endorsement is excess over any property insurance, whether primary, excess, contingent or on any other basis. D. EXTENDED DAMAGE TO PROPERTY RENTED TO YOU (Tenant's Property Damage) If Damage To Premises Rented To You is not otherwise excluded from this Coverage Part: 1. Under Paragraph 2. Exclusions of Section I - Coverage A - Bodily Injury and Property Damage Liability: a. The fourth from the last paragraph of exclusion j. Damage To Property is replaced by the follow- ing: Paragraphs (1), (3) and (4) of this exclusion do not apply to "property damage" (other than damage by fire, lightning, explosion, smoke, or leakage from an automatic fire protection system) to: (i) Premises rented to you for a period of 7 or fewer consecutive days; or (ii) Contents that you rent or lease as part of a premises rental or lease agreement for a period of more than 7 days. Paragraphs (1), (3) and (4) of this exclusion do not apply to "property damage" to contents of premises rented to you for a period of 7 or fewer consecutive days. A separate limit of insurance applies to this coverage as described in Section III - Limits of Insurance. © 2013 Liberty Mutual Insurance CG 88 10 04 13 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 2 of 8 b. The last paragraph of subsection 2. Exclusions is replaced by the following: Exclusions c. through n. do not apply to damage by fire, lightning, explosion, smoke or leakage from automatic fire protection systems to premises while rented to you or temporarily occupied by you with permission of the owner. A separate limit of insurance applies to Damage To Premises Rented To You as described in Section III - Limits Of Insurance. 2. Paragraph 6. under Section III - Limits Of Insurance is replaced by the following: 6. Subject to Paragraph 5. above, the Damage To Premises Rented To You Limit is the most we will pay under Coverage A for damages because of "property damage" to: a. Any one premise: (1) While rented to you; or (2) While rented to you or temporarily occupied by you with permission of the owner for damage by fire, lightning, explosion, smoke or leakage from automatic protection sys- tems; or b. Contents that you rent or lease as part of a premises rental or lease agreement. 3. As regards coverage provided by this provision D. EXTENDED DAMAGE TO PROPERTY RENTED TO YOU (Tenant's Property Damage) - Paragraph 9.a. of Definitions is replaced with the following: 9.a. A contract for a lease of premises. However, that portion of the contract for a lease of premises ® that indemnifies any person or organization for damage by fire, lightning, explosion, smoke, or leakage from automatic fire protection systems to premises while rented to you or temporarily occupied by you with the permission of the owner, or for damage to contents of such premises that are included in your premises rental or lease agreement, is not an "insured contract'. E. MEDICAL PAYMENTS EXTENSION ry If Coverage C Medical Payments is not otherwise excluded, the Medical Payments provided by this policy are amended as follows: Under Paragraph 1. Insuring Agreement of Section 1 - Coverage C - Medical Payments, Subparagraph (b) of Paragraph a. is replaced by the following: (b) The expenses are incurred and reported within three years of the date of the accident; and F. EXTENSION OF SUPPLEMENTARY PAYMENTS - COVERAGES A AND B 1. Under Supplementary Payments - Coverages A and B, Paragraph 1.b. is replaced by the following: b. Up to $3,000 for cost of bail bonds required because of accidents or traffic law violations arising out of the use of any vehicle to which the Bodily Injury Liability Coverage applies. We do not have to furnish these bonds. 2. Paragraph 1.d. is replaced by the following: ° d. All reasonable expenses incurred by the insured at our request to assist us in the investigation or defense of the claim or "suit", including actual loss of earnings up to $500 a day because of time off from work. G. ADDITIONAL INSUREDS -BY CONTRACT, AGREEMENT OR PERMIT 1. Paragraph 2. under Section II - Who Is An Insured is amended to include as an insured any person or organization whom you have agreed to add as an additional insured in a written contract, written agreement or permit. Such person or organization is an additional insured but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused in whole or in part by: a. Your acts or omissions, or the acts or omissions of those acting on your behalf, in the performance of your on going operations for the additional insured that are the subject of the written contract or written agreement provided that the "bodily injury" or "property damage" occurs, or the "per- sonal and advertising injury" is committed, subsequent to the signing of such written contract or written agreement; or © 2013 Liberty Mutual Insurance CG 88 10 04 13 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 3 of 8 b. Premises or facilities rented by you or used by you; or c. The maintenance, operation or use by you of equipment rented or leased to you by such person or organization; or d. Operations performed by you or on your behalf for which the state or political subdivision has issued a permit subject to the following additional provisions: (1) This insurance does not apply to "bodily injury", "property damage", or "personal and ad- vertising injury" arising out of the operations performed for the state or political subdivision; (2) This insurance does not apply to "bodily injury" or "property damage" included within the "completed operations hazard". (3) Insurance applies to premises you own, rent, or control but only with respect to the following hazards: (a) The existence, maintenance, repair, construction, erection, or removal of advertising signs, awnings, canopies, cellar entrances, coal holes, driveways, manholes, marquees, hoist away openings, sidewalk vaults, street banners, or decorations and similar expo- sures; or (b) The construction, erection, or removal of elevators; or (c) The ownership, maintenance, or use of any elevators covered by this insurance. 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 insur- ance 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. With respect to Paragraph 1.a. above, a person's or organization's status as an additional insured under this endorsement ends when: (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. With respect to Paragraph 1.b. above, a person's or organization's status as an additional insured under this endorsement ends when their written contract or written agreement with you for such premises or facilities ends. With respects to Paragraph 1.c. above, this insurance does not apply to any "occurrence" which takes place after the equipment rental or lease agreement has expired or you have returned such equipment to the lessor. The insurance provided by this endorsement applies only if the written contract or written agreement is signed prior to the "bodily injury" or "property damage". We have no duty to defend an additional insured under this endorsement until we receive written notice of a "suit" by the additional insured as required in Paragraph b. of Condition 2. Duties In the Event Of Occurrence, Offense, Claim Or Suit under Section IV - Commercial General Liability Condi- tions. © 2013 Liberty Mutual Insurance CG 88 10 04 13 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 4 of 8 2. With respect to the insurance provided by this endorsement, the following are added to Paragraph 2. Exclusions under Section I - Coverage A - Bodily Injury And Property Damage Liability: This insurance does not apply to: a. "Bodily injury" or "property damage" arising from the sole negligence of the additional insured. b. "Bodily injury" or "property damage" that occurs prior to you commencing operations at the location where such "bodily injury" or "property damage" occurs. c. "Bodily injury", "property damage" or "personal and advertising injury" arising out of the render- ing of, or the failure to render, any professional architectural, engineering or surveying services, including: (1) The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or (2) Supervisory, inspection, architectural or engineering activities. 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 "occur- rence" which caused the "bodily injury" or "property damage", or the offense which caused the "personal and advertising injury", involved the rendering of, or the failure to render, any professional architectural, engineering or surveying services. d. "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. e. Any person or organization specifically designated as an additional insured for ongoing operations by a separate ADDITIONAL INSURED -OWNERS, LESSEES OR CONTRACTORS endorsement is- sued by us and made a part of this policy. 3. 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: a. Required by the contract or agreement; or b. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declaratio ns. H. PRIMARY AND NON-CONTRIBUTORY ADDITIONAL INSURED EXTENSION This provision applies to any person or organization who qualifies as an additional insured under any form or endorsement under this policy. Condition 4. Other Insurance of SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS is amend- ed as follows: a. The following is added to Paragraph a. Primary Insurance: If an additional insured's policy has an Other Insurance provision making its policy excess, and you have agreed in a written contract or written agreement to provide the additional insured coverage on a primary and noncontributory basis, this policy shall be primary and we will not seek contribution from the additional insured's policy for damages we cover. © 2013 Liberty Mutual Insurance CG 88 10 04 13 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 5 of 8 b. The following is added to Paragraph b. Excess Insurance: When a written contract or written agreement, other than a premises lease, facilities rental contract or agreement, an equipment rental or lease contract or agreement, or permit issued by a state or political subdivision between you and an additional insured does not require this insurance to be primary or primary and non-contributory, this insurance is excess over any other insurance for which the addi- tional insured is designated as a Named Insured. Regardless of the written agreement between you and an additional insured, this insurance is excess over any other insurance whether primary, excess, contingent or on any other basis for which the additional insured has been added as an additional insured on other policies. I. ADDITIONAL INSUREDS -EXTENDED PROTECTION OF YOUR "LIMITS OF INSURANCE" This provision applies to any person or organization who qualifies as an additional insured under any form or endorsement under this policy. 1. The following is added to Condition 2. Duties In The Event Of Occurrence, Offense, Claim or Suit: An additional insured under this endorsement will as soon as practicable: a. Give written notice of an "occurrence" or an offense that may result in a claim or "suit" under this insurance to us; b. Tender the defense and indemnity of any claim or "suit" to all insurers whom also have insurance available to the additional insured; and c. Agree to make available any other insurance which the additional insured has for a loss we cover under this Coverage Part. d. We have no duty to defend or indemnify an additional insured under this endorsement until we receive written notice of a "suit" by the additional insured. 2. The limits of insurance applicable to the additional insured are those specified in a written contract or written agreement or the limits of insurance as stated in the Declarations of this policy and defined in Section III - Limits of Insurance of this policy, whichever are less. These limits are inclusive of and not in addition to the limits of insurance available under this policy. J. WHO IS AN INSURED -INCIDENTAL MEDICAL ERRORS / MALPRACTICE WHO IS AN INSURED - FELLOW EMPLOYEE EXTENSION - MANAGEMENT EMPLOYEES Paragraph 2.a.(1) of Section II - Who Is An Insured is replaced with the following: (1) "Bodily injury" or "personal and advertising injury": (a) To you, to your partners or members (if you are a partnership or joint venture), to your members (if you are a limited liability company), to a co -"employee" while in the course of his or her employ- ment or performing duties related to the conduct of your business, or to your other "volunteer workers" while performing duties related to the conduct of your business; (b) To the spouse, child, parent, brother or sister of that co -"employee" or "volunteer worker' as a consequence of Paragraph (1) (a) above; (c) For which there is any obligation to share damages with or repay someone else who must pay damages because of the injury described in Paragraphs (1) (a) or (b) above; or (d) Arising out of his or her providing or failing to provide professional health care services. However, if you are not in the business of providing professional health care services or providing profes- sional health care personnel to others, or if coverage for providing professional health care ser- vices is not otherwise excluded by separate endorsement, this provision (Paragraph (d)) does not apply. Paragraphs (a) and (b) above do not apply to "bodily injury" or "personal and advertising injury" caused by an "employee" who is acting in a supervisory capacity for you. Supervisory capacity as used herein means the "employee's" job responsibilities assigned by you, includes the direct supervision of other "employ- ees" of yours. However, none of these "employees" are insureds for "bodily injury" or "personal and © 2013 Liberty Mutual Insurance CG 88 10 04 13 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 6 of 8 advertising injury" arising out of their willful conduct, which is defined as the purposeful or willful intent to cause "bodily injury" or "personal and advertising injury", or caused in whole or in part by their intoxica- tion by liquor or controlled substances. The coverage provided by provision J. is excess over any other valid and collectable insurance available to your "employee". K. NEWLY FORMED OR ADDITIONALLY ACQUIRED ENTITIES Paragraph 3. of Section II -Who Is An Insured is replaced by the following: 3. Any organization you newly acquire or form and over which you maintain ownership or majority interest, will qualify as a Named Insured if there is no other similar insurance available to that organization. However: a. Coverage under this provision is afforded only until the expiration of the policy period in which the entity was acquired or formed by you; b. Coverage A does not apply to "bodily injury" or "property acquired or formed the organization; and c. Coverage B does not apply to "personal and advertising committed before you acquired or formed the organization. d. Records and descriptions of operations must be maintained damage" that occurred before you injury" arising out of an offense by the first 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 as a Named Insured in the Declarations or qualifies as an insured under this provision. L. FAILURE TO DISCLOSE HAZARDS AND PRIOR OCCURRENCES Under Section IV - Commercial General Liability Conditions, the following is added to Condition 6. Repre- sentations: Your failure to disclose all hazards or prior 'occurrences" existing as of the inception date of the policy shall not prejudice the coverage afforded by this policy provided such failure to disclose all hazards or prior 'occurrences" is not intentional. M. KNOWLEDGE OF OCCURRENCE, OFFENSE, CLAIM OR SUIT Under Section IV - Commercial General Liability Conditions, the following is added to Condition 2. Duties In The Event of Occurrence, Offense, Claim Or Suit: Knowledge of an 'occurrence", offense, claim or "suit" by an agent, servant or "employee" of any insured shall not in itself constitute knowledge of the insured unless an insured listed under Paragraph 1. of Section II - Who Is An Insured or a person who has been designated by them to receive reports of "occurrences", offenses, claims or "suits" shall have received such notice from the agent, servant or "employee". N. LIBERALIZATION CLAUSE If we revise this Commercial General Liability Extension Endorsement to provide more coverage without additional premium charge, your policy will automatically provide the coverage as of the day the revision is effective in your state. O. BODILY INJURY REDEFINED Under Section V - Definitions, Definition 3. is replaced by the following: 3. 'Bodily Injury" means physical injury, sickness or disease sustained by a person. This includes mental anguish, mental injury, shock, fright or death that results from such physical injury, sick- ness or disease. © 2013 Liberty Mutual Insurance CG 88 10 04 13 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 7 of 8 P. EXTENDED PROPERTY DAMAGE Exclusion a. of COVERAGE A. BODILY INJURY AND PROPERTY DAMAGE LIABILITY is replaced by the following: a. Expected Or Intended Injury "Bodily injury" or "property damage" expected or intended from the standpoint of the insured. This exclusion does not apply to "bodily injury" or "property damage" resulting from the use of reasonable force to protect persons or property. Q. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US - WHEN REQUIRED IN A CONTRACT OR AGREEMENT WITH YOU Under Section IV - Commercial General Liability Conditions, the following is added to Condition 8. Trans- fer Of Rights Of Recovery Against Others To Us: We waive any right of recovery we may have against a person or organization 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" provided: 1. You and that person or organization have agreed in writing in a contract or agreement that you waive such rights against that person or organization; and 2. The injury or damage occurs subsequent to the execution of the written contract or written agree- ment. © 2013 Liberty Mutual Insurance CG 88 10 04 13 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 8 of 8 AAIS This endorsement changes CL 0162 01 19 the policy Pacie 1 of 3 -- PLEASE READ THIS CAREFULLY -- AMENDATORY ENDORSEMENT CALIFORNIA t. Under Common Policy Conditions, Cancella- 3) there has been a discovery of fraud tion is deleted and replaced by the following: or material misrepresentation com- mitted by: Cancellation And Nonrenewal a) a person insured under this cov- a. "You" may cancel this policy by returning erage or his or her representative the policy to "us" or by giving "us" writ- in obtaining this insurance; or ten notice and stating at what future date coverage is to stop. b) "you" or "your" representative in pursuing a claim under this b. "We" may cancel or not renew this policy policy; by delivering or mailing written notice to the producer of record and to "you" at 4) there has been a discovery of willful "your" mailing address last known to or grossly negligent acts or omis- Q "us". "Our' notice will state the reason sions, or of violations of state laws or for the cancellation or nonrenewal. Proof regulations establishing safety stan- of delivery or mailing is sufficient proof of dards by "you" or "your" representa- notice. tive, that materially increase a hazard insured against; c. If this policy has been in effect for 60 days or less, "we" may cancel for any reason. 5) there has been a failure by "you" or "We" will give "you" notice at least 10 "your" representative to implement days before the cancellation is effective. reasonable loss control requirements "Our" notice will state the date on which to which "you" agreed as a condition the cancellation is effective. Such notice of the issuance of this policy, or may be delivered by electronic means if which were required in order to "you" have affirmatively consented to qualify for a particular rate or rating that method of delivery and have not plan, if the failure materially in - withdrawn such consent. creases a hazard insured against; d. If this policy has been in effect for more 6) the Insurance Commissioner has de - than 60 days, or if it is a renewal of a termined that loss of, or changes in, policy issued by "us", "we" may cancel "our' reinsurance would threaten only for one or more of the following rea- "our' financial integrity or solvency; r sons: 7) the Insurance Commissioner has de- l) nonpayment of premium; termined that a continuation of this policy would place "us" in violation 2) there has been a judgment by a court of the law or that continuation of cov- 31 or an administrative tribunal that erage would threaten "our" solven- "you" have violated a law of this cy; or state or the United States involving an act that materially increases a haz- 8) there has been a change made by and insured against; "you" or "your" representative in the activities or property which has re- sulted in a materially added, in- creased, or changed hazard that is not included in the policy. CL 0162 01 19 Copyright, American Association of Insurance Services, Inc., 2019 AAIS AAIS CL 0162 01 19 Page 2 of 3 If "we" cancel this policy for nonpayment 4) this policy was issued for a term of of premium or fraud, "we" will give 60 days or less and "you" were noti- "you" notice at least 10 days before the fied when the policy was issued that cancellation is effective. If "we" cancel it would not be renewed; this policy for any other reason, "we" will 5) "you" request a change in "terms" or give "you" notice at least 30 days before "Our' hazards covered within 60 days of cancellation is effective. notice will the end of the policy period; or state the date on which the cancellation is effective. Such notice may be delivered 6) in accordance with the requirements by electronic means if "you" have affir- of this condition, "we" have made a matively consented to that method of de- written offer to renew the policy with livery and have not withdrawn such con- changed "terms" or at a change to sent. the rate on which the premium is e. "Your" return premium, if any, will be based. calculated on a pro rata basis and will be g. If this policy covers a one- to four -family refunded at the time of cancellation or dwelling used predominantly for residen- within 80 business days of cancellation tial purposes, except in cases in which unless this policy is subject to audit. If "you" terminate the policy, "we" may not this policy is subject to audit, it will be cancel or not renew this policy solely: refunded to "you" within 80 business days of the date "you" provide all infor- 1) because "you" have accepted "our" mation needed to conduct an audit. Pay- offer of earthquake coverage; or ment or tender of the unearned premium 2) because of corrosive soil conditions, is not a condition of cancellation. if this policy contains an exclusion f. If we decide not to renew this policy, relating to that peril; or "we" will give "you" notice at least 60 3) because the dwelling is located in an days, but not more than 120 days, before area in which a wildfire has occurred the nonrenewal is effective. and a state of emergency, as defined However, notice of nonrenewal is not re- in Section 8558 of the Government quired if: Code of California, has been declared in response, but only to the extent 1) this policy is transferred to or re- such cancellation or nonrenewal is newed by another insurer in "our" in- prohibited by Section 675.1(b) of the surance group without changing California Insurance Code. policy "terms" or the rate on which r the premium is based; h. If this policy covers a one- to four -family ° dwelling used predominantly for residen- 2) the policy has been extended for 90 tial purposes and if, in accordance with days or less after notice was given in California law, "you" have designated an m accordance with the requirements of additional person to receive notice of the this condition; nonrenewal or cancellation of this policy 3) "you" have obtained replacement for nonpayment of premium, "we" will coverage or have agreed in writing to give notice to such person at least 10 obtain replacement coverage within days before the nonrenewal or cancella- 60 days of the termination of this tion is effective. Such notice will be sent policy; by first-class United States mail, postage prepaid, to the address provided by "you" within 10 days after the date on which the premium is due and unpaid. CL 0162 01 19 Copyright, American Association of Insurance Services, Inc., 2019 AAIS AAIS CL 0162 01 19 Pa e3of3 Except as provided above, no person des- ignated by "you" to receive notice of the nonrenewal or cancellation of this policy for nonpayment of premium has any rights, whether as an additional insured or otherwise, to any benefits under this policy. 2. Under Common Policy Conditions, the follow- ing condition is added: ® Conditional Renewal - If "we" condition the renewal of this policy upon: a. a reduction in 'limits"; b. an elimination of coverage; c. an increase in deductibles; or d. a rate increase of more than 25%; "we" will deliver or mail written notice to the producer of record and to "you", at the mail- ing address shown in the policy, at least 60 days, but not more than 120 days, before the end of the policy period. Such notice may be delivered by electronic means if "you" have affirmatively consented to that method of de- livery and have not withdrawn such consent. Proof of delivery or mailing is sufficient proof of notice. CL 0162 01 19 CL 0162 01 19 Copyright, American Association of Insurance Services, Inc., 2019 AAIS REINFORCEMENTS IN COVERAGE • Blanket Additional Insured The designated person or organization is included as an insured for the operation, maintenance or use of a covered auto. Coverage for bodily injury or property damage applies if the accident occurs after the contract, agreement or permit is issued and applies for the duration of the contract, permit or agreement. • Amended Fellow Employee Exclusion This coverage now requires you have workers compensation in force for all your employees in order for coverage to apply. Additionally, the coverage is now excess over any other collectible insurance (i.e. the employee's personal auto policy). If there is no coverage, other than workers compensation, available, this coverage will be primary. • Audio, Visual and Data Electronic Equipment Coverage Changes in format to make the coverage easier to read. • Accidental Airbag Deployment This insurance is excess over any other collectible insurance or reimbursement from a manufacturer's warranty. However, we will pay any deductible applicable to that other coverage or warranty. REDUCTION IN COVERAGE • Extra Expense — Broadened Coverage The amount we pay to return your stolen covered auto to you is $1000. This may be considered a reduction in your limit. • Personal Effects Coverage This coverage applies to personal effects up to $600 stolen with your covered auto and is excess over any other collectible insurance. Personal effects are defined as tangible property that is worn or carried by an insured. Personal effects do not include tools, equipment, jewelry, money or securities. • New Vehicle Replacement Cost New Vehicle purchase price cost is not included as part of your new policy. • Newly Formed or Acquired Subsidiaries This coverage now includes limited liability company's (LLC's) which represents a broadening in language. However, coverage is now limited to only newly acquired or formed entities for a period of ninety (90) days after formation. When the insured purchases or forms a new entity, the entity should be disclosed to Liberty Mutual within ninety (90) days. • Additional Insured by Contract, Agreement or Permit The coverage now specifies that a written contract or written agreement must be in place for additional insured status to be granted. It also requires the insured to submit a claim to the additional insured's insurer if the insured has not agreed in writing to be primary and non-contributing. Waiver of Transfer of Rights of Recovery Against Others to Us This coverage now requires the insured to have expressly waived the right to subrogation in a written contract or written agreement. • Extended Cancellation Condition The extended cancellation condition is being removed — Please contact your agent for information on adding this condition on your policy. • Broad Form Insured This coverage is now limited to newly acquired or formed entities, other than partnerships orjoin ventures, for a period of 90 days after acquisition or formation. CNA 04 01 06 18 © 2018 Liberty Mutual Insurance Page 3 of 4 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 08119/2024 66323456 POLSVCS HC Insured Copy „— -70 DATE (MM/DD/YYYY) '"”" CERTIFICATE OF LIABILITY INSURANCE 09/03/2024 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("es) 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 JESSICA CASILLAS "ImS��I�' Mrm EFFEREM SANCHEZ 9.N t 562)803 9777 - 56 803 0308 STATE FARM INSURANCE AGENCY EMAIL JESSiCA@TE'AMSANCHEZ N!T vm..a --- ..,.,...---.. _ . 12327 WOODRUFF ,..I ..., RAGE ,,INSURER�S)AFFORDINGCOVE NAIC #- EY, CA 90241 INSURER A : State Farm Mutual Automobile Insurance Company �m..__ 25178 —... ----- ...,..,.,mDOWN------__- INSURED _ INSURER 8 : State Farm Mutual Automobile Insurance Company LCR EARTHWORK & ENGINEERING CORP ..._....� INSURERC: .... ., ......., 4791 MOUNT RAINIER ST INSURER D: RIVERSIDE, CA 92509-5440 INSURER E ..,...... ...,,...._ _ .............. INSURER F : — .......,.— 1-..—---- ..... r•xvar=MAw-00 !`COTICUTATC Nirliltit:at:0. RFVLwfC'1NNUMRFR-, 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. ..- .. m. W__Ably"MAV 'p" MM22 p ' �LTR PE OF INSURANCE INS WVD POLICY NUMBER M/DD'P;1Y M/00 LIMITS TYPE COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ — _ _ bAMAb TO RENSED .....___� CLAIMS -MADE ....1 OCCUR ... $I- hS, ;"s'-.( ti 9 p"GA10. «,)-['$.,...__ ..-......, MED EXP (Any one person) .... ...........-........— $ .........,..� .......,...,...,.._. ........... ........................„w.....-- --......................... PERSONAL & ADV INJURY_ $ GEN'L ... .-- AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ C f PRO- LOC POLICY 1 .�..._.,I JECT PRODUCTS COMP/O ..,�...,___ ......,,,� OTHER' $ AUTOMOBILE LIABILITY 6277942-004-75B COMBINED SINGLE LM)I �bat'clltent�W. .r.-.. S 1000,000 _....... .... - ANY AUTO 2019 FORD F450 UTIL TRK 07/12/2024 07/12/2025 (Perperson) BODILY INJURY P $ A AUTOS ONLY SCHEDULED AUTOS Y cadent) BODILY INJURY (Per accident) $ � . r,..�_. HIRED NON -OWNED VINA FDOW4GT2KEG17892 +'^"* AUTOS ONLY AUTOS ONLY L ....tY�pr rT, 091). ......... - ,,w.®,. ...... DEDUCTIBLE $ 1,000 UMBRELLALIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS -MADE ,..A,G,G,R,E,G,ATE,....,...__..._-....$ .......................................................m.m..___-. DED RETENTION $ $ WORKERS COMPENSATION PER OTH- $ ANDRS' LIABILITY ANY PROPRIEEOR/PARTNER/EXECUTIVE Y.�..N E.L. EATCH ACCIDENTS OFFICER/MEMBER EXCLUDED? N / A (Mandatory in NH)"' " E.L. DISEASE - EA EMPLOYE • _ $ If yes,, describe underE DESCRIPTION ' OF OPERATIONS below E.L. DISEASE Y...._� -POLIO LIMIT $ B ENOL Y 656 9467-E12-75 12/18/2023 12/18/2024 ENOL 1,000,000 Additional may attached 6I more space is required) LOCATIONSra Awilll ���to, as respects! lsi cut of on p 9(ability airlSlsvgy caul of ao�HVPtIas performed by or on hshaff of the Contractor; products and cornplsrt+ed operation The Cd lal off officers, officials, emple , and volunteers beep ers the Contractor, premises owned„ ocoupged or used by the Contractor: or automobiles owned, leased„ hired or borrowed by tree Corrhactm The coverage will contain no special ilm4awns, on the scope or protection afforded to the Cltyu Its officers, of4blals, employees, agents,, or volunteers. "the Contractor's Insurance coverage W111 be primary Insurance as respect$ the City, Its offBtcere, officials, employees, agents, and volunteers. Any insurance or self -Insurance maintained by the City, its officers, official employees„ agents, and volunteers wHll be excess of the Contractor's insurance and will not contribule vallh It The Insurst wfII agree in wrC4ng to, waive alli rights of submgalion against the City, its ors, olficials, employees and votunteers for tosses aideing Irvin wo* performed by the Conlradorfor The City, Any failure to comply with mpolHng pmVlstons of the policies will not of i ad coverage provided to the City Its officers, officiate enuptoyess. agents and volunteers. The Contractor's insurance well apply separately to each Insured against whom rdakn Is made or, sari is brought„ except width rasped to the Imi s of the insurer's liability.. Each Insurance policy required by this subsection Will be endorsed to state that ooverage will not be suspended, wonted, oanoaeled by either party, reduced in coverage or in limits except after thirty (30) days written notice bycarutgfied snail„ return receipt requested, has been given Io: CITY CLERK City of Et Segundo 36CI Maln StroalEt S undo. CA 9024Ca CITY OF EL SEGUNDO 350 MAIN STREET EL SEGUNDO, CA 90245 LIANLICL .A%11Vry 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 signatu ©19813-2015 ACORD CORPORA I IUIV. All rignts reservea. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 1001486 132849.14 04-13-2022 of FE-6609 SECTION II ADDITIONAL INSURED ENDORSEMENT N Policy No.: 627 7942-004-75B Named Insured: LCR EARTHWORKS & ENGINEERING CORP 4791 MOUNT RAINIER ST RIVERSIDE, CA 92509-5440 Additional Insured (include address): CITY OF EL SEGUNDO 350 MAIN STREET EL SEGUNDO, CA 90245 WHO IS AN INSURED, under SECTION II DESIGNATION OF INSURED, is amended to include as an insured the Additional Insured shown above, but only to the extent that liability is imposed on that Additional Insured solely because of your work performed for that Additional Insured shown above. Any insurance provided to the Additional Insured shall only apply with respect to a claim made or a suit brought for damages for which you are provided coverage. The Primary Insurance coverage below applies only when there is an "X" in the box. ® Primary Insurance. The insurance provided to the Additional Insured shown above shall be primary insurance. Any insurance carried by the Additional Insured shall be noncontributory with respect to coverage provided to you. All other policy provisions apply. FE-6609 Printed in U.S.A. POLICYHOLDER COPY SP P.O. BOX 8192, PLEASANTON, CA 94588 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 09-03-2024 CITY OF EL SEGUNDO 350 MAIN ST EL SEGUNDO CA 90245-3813 GROUP: POLICY NUMBER: 9246887-2024 CERTIFICATE ID: 147 CERTIFICATE EXPIRES: 03-08-2025 03-06-2024/03-06-2025 SP JOB:PW24-08: FY 24-25 PAVEMENT REHABILITATION VARIOUS LOCATIONS EL SEGUNDO CA 90245 This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 30 days advance written notice to the employer, We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy. Authorized Representative President and CEO EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 03-06-2024 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. ENDORSEMENT #1651 - JENNIFER MENDOZA P,S,T - EXCLUDED. ENDORSEMENT #1651 - JORGE MENDOZA DIR - EXCLUDED. EMPLOYER LCR EARTHWORK & ENGINEERING, CORP 4791 MOUNT RAINIER ST JURUPA VALLEY CA 92509 SP [P16,HO] (REV.7-2014) PRINTED : 09-03-2024