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PROOF OF INSURANCE (2025)t DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 9/18/2024 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(fes) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). CONTACT PRODUCER I NAME:: .r. ... .... WTW MIDWEST INC 233 S WACKER DR,SUITE 2000 CHICAGO IL 60606 ... .. --- INSURED (888) 780-5381 t1, (66) 828-2424 Certificate@Hanover.com NG COVERAGE .MISURER(S)AFFORDI. _ �I--------- Citizens Ins Cc of America 31534 Hanover Insure..... �......__ nce Cc 22292 ... -� ...... Hanover ..Co ............ _ I H rAmencanns 36064 BUCKNAM INFRASTRUCTURE GROUP INC INSURER :. ....... ..,. m....r 3548 SEAGATE WAY STE 230 INSURER E _.... ..—m........,. OCEANSIDE CA 92056 INSURER F : I+GDTICl/�ATC srr ass rs« RFVISIAN N111MAFR! 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, OL�sIu�LIMITS SHOWN E BEEN REDUCEDDUCED BY PAID ICLAIMS _ .....-- . EXCLUSIONS AND CONDITIONS POLICIES... .N ................ POLICY ALrpp I vLAPrLIMITSINSR TYPE OF INSURANCE POLICY NUM 3ER MhDDtYY .__ 2 00000 0 $ COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE O'kAa TO RNTua $1 000 000 CLAIMS -MADE � OCCUR .IV.. ... MED EXP (Any one d3trrsca°a) $......-10 000 A Y N OBC A399956 10 09/16/2024 09116/2025 PERSONAL &ADV INJURY 2,000,000 .... _ „ GEN L AGGREGATE LIMIT APPLIES PER. GE tlERALAGGRE4,000,. 0.......... COMP/ POLICY LOC OP AGG $ 4 O00 000 PRO PRODUCTS„ _ .................... JECT OTHER ('O BIN861S INGLEUMIT $ 2,000,000 AUTOMOBILE LIABILITY ANY AUTO BODILY INJURY (Per person) . $ A _ OWNED SCHEDULED Y N OBC A399956 10 09/16/2024_ URY -- ( ident) $ AUTOS ONLY AUTOS mow' HIRED NON -OWNED 9r ' PeOP+ERTY DAMAGerEac (,„. rgcrJdernl ... .... $ „!�...- AUTOS ONLY ,____ AUTOS ONLY a-- $ UMBRELLA LIAB OCCUR EACH OCCURRENCE 3 ,000,000 MS MADE ..CLAL............... .. Y N OBC A399956 10 09/1612024 09/16/2025 AGGREGATE ..,._.___ w..... ......... $ 3,000,000 . ... .......... rAND -EXCESS�LrIAB.._ DED M' RETENT*N $ RKERS COMPENSATION tI PER p OSdP - �...0 FR .,.,.„.,, CPROPRIIETD EMPLOYERS' LIABILITY Y / N I'tNPARTNE�RFEXECUTIVIi N NIA Y WZC A399946 10 09/16/2024 09/16/2025 E.L„ EACH ACCIDENT ' $,,,„ 111111111.­ 000,000 �.. �„ E'FiEXC1.UULIED°� I"�J E.L DISEAS­11111E EMPLOYEE 000 1,000,000 (Mandatory in (Mandatrsay In NH) i t1 yyes, desedbe sunder DESCRIPTION OF OPERATIONS beIo E.t DISEASE POLICY LIMIT "� 1,000„000 B Architects & Engineers Prof Liab N N LHC H023717 05 09/16/2024 09/16/2025 Claims -Made: $2M Ea Claim/$2M Agg DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space 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. CERTIFICATE HOLDER L ANt r_LI.#1I IUM 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 AUTHORIZED REPRESENTATIVE 350 MAIN STREET EL SEGUNDO CA 90245 kV l`J8o-LU-la Ml.VRU {.rVRrVr%M1 rVa'l. Mu I W ILa 1wa1 vou. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 4 Hiinprr Insuirl P- THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, GENERAL LIABILITY SUPPLEMENTARY ENDORSEMENT This endorsement modifies insurance provided under the following: BUS|NESSOVVNERSCOVERAGE FORM A. Additional Insured byContract, Agreement or Permit The following is added to SECTION |U ' LIABILITY, C.Who \aAnInsured: Additional Insured byContract, Agreement or Permit a.Any person ororganization with whom you agreed in a written contract, written agreement or permit that such person or organization tuadd ms an additional insured on your policy is an additional insured only with respect to liability for "bodily injury", " damage", or "personal and advertising injury" caused, in whole or in part, by, Your acts oromissions, orthe acts wromissions ofthose acting on your behalf, but only with respect to: U\ "Your work" for the additional insured(s) designated in the 000t/act, agreement o, permit including ''bodNy injury" or or "::property damage"' included in the "pmoductm-conmpletedoperations hazard~ only 0this Coverage Part provides such coverage. (2) Premises you own, rent, lease oroccupy; or (3) Your maintenance, operation or use of equipment leased toyou. b. The insurance afforded to such additional insured described above: (1) Only applies tothe extent permitted by law; and (2) Will not bebroader than the insurance which you are required bythemomtraut. agreement mrpermit tmpruv|dehmrsuch additional insured. (3) Applies on a primary basis if that is required bythe written contract, written agreemenrorpermit. NQ Will not be broader than coverage provided tnany other insured. (5) Boas not apply if the "bodily ' 'mny°, '' d mage^' or "penaowa| and advertising injury" is otherwise excluded from coverage under this Coverage Port, including any endorsements thereto. c. This provision does not apply: (1) Unless the written contract or written agreement was executed orpermitwas issued prior to the "bodily injury",personal 'property damage", or 1 injury and advertising injury". Toany person or organization included as an insured by another endorsement issued by um and made part of this Coverage Part. (3) Toany lessor ofequipment: (m) After the equipment |eomu expires; or (b) If the "bodily"property damage", or "personal and advertising injury" arises out of sole negligence ofthe lessor (4) To any: (a) Owners or other interests from whom land has been leased if the ^000unnnoe^ or offense takes place ortho offense in committed after the lease for the land expires; or (t) Managers orlessors ofpremises it (i) The "000urronoa"takes place or the offense is committed after you cease to be u tenant in that premises; or (ii) The "bodilyinjury", "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 orlessor. (5) To "bodily injury", "property damage" or Hpersonaland advertising mya ng out of the rendering of or the failure to render any professional services. This exclusion applies even ifthe claims against any insured allege negligence or other ron d i 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 or the offense which caused the "personal advertising �����m|nQ injury" involved the rendering of or failure to render any professional services bYorfor you. d. With respect to the insurance afforded to these additional insureds, the following is added to SECTION || ' LIABILITY, D. Liability and Medical Expense Limits ofInsurance: The most we will pay on behalf of the additional insured fora covered claim is the lesser ufthe amount ufinsurance: 391'158608 16 Includes copyrighted material of Insurance Services Offices, Inc., with its ponn/oo/on. Page 1 of 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 I I -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 08 16 Includes copyrighted material of Insurance Services Offices, Inc., with its permission. Page 2 of 2 1. if two or more of However, if you agree in a written this coverage part's coverages to contract, written agreement', or the same loss or dwe will not 'pay written permit that the insurance more than the actual amount of the |omm or provided to any person or damage. organization /mc/uoeo as an 2 SECTION >| L|��BXL�T� i� is our stated ' / - ' Additional |mour�� un�er this ��v� Part is primary and ' intent that the various Coverage Parts, -contributory, we vvi|| not seek ''~^' ~~^^^^ formsendorsements or policies issued ' contribution from any other the named insured by uo, or any company inoumaoce available to that Additional affiliated with us, do not provide any Insured which covers the Additional or overlap ofcoverage for the |nounm� a��N�med Insured except: same claim, "suit", ^ouuurrence", offense, 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 ordamage. (2) When the Additional Insured in If this Coverage Part and any other an Additional Insured under Coverage Part, fornn, endorsement or another liability policy. policy issued to the named insured by us, b. 2wxoass Insurance orany company affiliated with us, apply to This insurance imexcess over: the -same claim,"suit", occurrence, offenma, accident, "wrongful act" or loss, (1) Any of the other inouranoe, the maximum Limit of Insurance under all whether pr|mmry' exoaaa. such Coverage Parta, fmrms, contingent oronany other basis: endorsements or policies combined shall (a) That is Fire Extended not exceed the highest applicable Limit of Coverage, Builder's F�|�� ' Insurance under any one Coverage Part, ' Installation Risk or similar form, endorsement orpolicy. coverage for "your vvork"; This condition does not apply to any (b) That is Property Insurance for Excess or Umbrella Policy issued by us i o rented to you or specifically to apply as excess insurance '--'''-- tampurari|y occupied by you over this policy. with permission of the owner; G. Liberalization (o) That is insurance purchased If we adopt any revision that would broaden by you to cover your liability the coverage under this olicy without as a tenant for "property additional premium within 45Jaye prior to or damage" to premises rented during the policy period, the broadened to you or temporarily coverage will immediately apply tmthis policy. occupied by you with H. Other Insurance permission ufthe owner; or 1 GG�T|0� | '��������' (d) If the |noo arises out of the ' maintenance or use of If there is other |nsura�noa covering the aircraft, "autos" or watercraft same |ono or donmagm, we will pay only for to the extent not oubj�eot to the amount of covered |oao or damage in SECTION Xy ' L|AB|LITY, excess of the amount due from that other Exclusion g. Ainoraft. Auto or imomnamce, whether you can collect on it or Watercraft; and not But, e wiU| not pay more than the applicable—' -'^ w/0 i�C�\neunonoeof���7���h0| (2) primary other �r��ry insurance -PROPERTY. available avmMab|etmyou covering liability ' ^-~^ �'^' '' for damages arising out of the �) 2. SECTN|[-LIABILITY premises or op�eraons, or the If other valid and collectible insurance is products and completed available to the insured for a loss we operaUone, for which you have cover under SECTION /1 ' LIABILITY, our been added as an additional obligations are limited anfollows: insured by attachment of on o. Primary Insurance endorsement. This insurance is primary except when When this insurance ioexcess, vvewill have nnduty under SECTION [| ' paragraph b. below applies. |f this LIABILITY to defend the insured LIABILITY insurance is primary, our obligations any "suit" if any other are not affected unless any of the insurer has duty to defend the other insurance is also primary. Then. insured against �ha� ^oui�" |fno other we will share with all that other �� insurer "==..da.vva vvi||unde�okuto insurance by the method described in do so, but we wi|| boentiUad�u the paragraph c.ba|ovv. 39140030816 Includes copyrighted material mInsurance Services Office, Inc., with its permission. Page TSof81 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 9 tY 9 Days Notice CITY OF EL SEGUNDO 30 350 MAIN STREET EL SEGUNDO CA 90245 I (Information required to complete this Schedule, if not shorn 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 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. 401-12351214 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 1 ninover 4 NOTICE 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 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 vvhMan notice of such cancellation to the n�Entity(s) E in the Schedule. Such ncdk:e u be delivered or sent by any means choosing. The notice to the Designated EnUty(n)vvi|| state the effective date nfcancel- lation. Unless otherwise noted in the Schedule above, such notice will be provided to the Designated )nu more than the number of days in advance of the effective date of cancellation that we are required to pro- videtotheNamed|nouredforouuhoonoe||aUon. Such notice of cancellation is solely for the purpose of informing the Designated Entity(e) 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. Wrc-A3eee4e-10 Endorsement No. mourou Premium Insurance Company THE sAmovmaAmERzCxm zmooaAmoE oomrAmr Countersigned By 331-0342 (09 11) Includes copyrighted materials from ISO, Inc. 2003 Page 1 of 1 13 _ I11Sr NMIC (400P Endorsement Coverage: Architects and Engineers Liability Endorsement Number: 11 Issued To: BUCKNAM INFRASTRUCTURE GROUP INC Policy Number: LHC-H023717-05 Issued By: The Hanover Insurance Company Effective Date: 09/16/2024 M OM 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. IMEMEMMEHIMMEMa 921 1507 01/18 Page 1 of 1 4 H al"n over Insurance Croup. W; CA30,00 6 1309570 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 tinder a written contract that regunres 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 endorsernent is issued subsequent to preparation of the policy.) Endorsement Effective Policy No. WZ C-A3 9 9 9 4 6 -10 Endorsement No. Insured Insurance CompanyTHE HANOVER AMERICAN INSURANCE COMPANY Countersigned By WC 04 03 06 (Ed 04-84)