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PROOF OF INSURANCE (2025)HAZE&SA-01 CERTIFICATE OF LIABILITY INSURANCE 0 FDATE {MMIDD/YYYY) i6/206 024 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 CONTACT Ames t/., Gough Drive PHONE _ IArcµr� cal 7tj 827 2277 Np 703 827-2279�^^f" 8300 Greensboro e ns oro b 80 lry^3 cow nINSURER" McLean, VA 22102 m..._� ._......�... e s At Fo „ "."- I DING COVERAGE .„� ,,,,,_„ NAIL _ ... ..... INSURER Casalt y Co ofReading, . (J 20427- INSURED aNSURERB: National Fire Insurance Company of Hartford A('9{V) 2047$ _._� - Hazen and Sawyer 111ry U9sURERc Continental) Insurance ance Compan�,r A XV 35289 498 Seventh Avenue INSuR& N�11y Fcrr a In l rltnce horn art ( XV 20508 New York, NY 10018 _A INSURER E Continental Casualty Compan CNA A XV 20443 INSURER F r':1"11t9pAngs CIPIP^TICir ATF INIt(WIFtFIr Dr-MIRInIN NItMRFR° 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. ^. TYPE OF INSURANCE ......^.^ L SUaR .. MMft ' E;FF POLICY EXP n .. ....„_, . Y EF IINSR A015 POLICY NUMBERLIMITS A X... LIABILITY CO.. 1,000,000 CLAIMS -MADE OCCUR R. , 7036846683 3/29/2024 3/29/202$ DAMAGE TORENTED ..I'l 1„000000 .... X Contractual Liab — MEL3mli&RA I?y 15,000 PERSON�VL $,AOV IN9�IRY 5 2,000,000 oE.000 _Ntl. AGGREGATE LIMIT APPLIES PER: C EIYE'RAI:.A_GC4g9 At"E S POLICY ❑ �3ref ❑ LOC , 18QQLrgT t:'I MFm MOP AGI S 2,000„000 B AUTOMOBILE LIABILITY COM_ ...I.F B E DS SINGLE "LIMIT .^ ..^^^ 1,000,000 ANY AUTO 7036845635 3/29/2024 3/29/2025 BODILY A 4JURY.'Per arsa .m ..m. _ ...... OWNED SCHEDULED AUTOSONLY........... AUTOS A0..I &ONLY NON -OWNED AUTOS ONLY P 1JU 2 DAMAGE...„ .. ., .�-,.,._� Coma 1C0oII. Ded 1,0 X.. MBRELLA �B X OCCUR q&(Zij EXCESSLIABRELLA CLAIMS - MADE -MADE 7036845649 3/29/2024 3129/2025 .ugaRRENOE S' ^^m 1,000 000. DED X RETENTION $ 10,000' D AND WORKERSIONX ERS'LIABILIITY ..r lui4:':f~' YIN ANY PROPRIETOR/PARTNER/EXECUTIVE 7036845666 3/29/2024 3/29/2025 ELEACH CCIP'r WT 1,000,00 S FICI RdM MBER EXCLUDED? N N /A 1,000,000 andata� n NH "� ) l L Dm1 r E EA9MFr 9YE,. 1m If es, describe under O 'SCR`WVON OF OPERAT(ONS b�ebw Y LI7tiI7T E L F71<SI:ASE - POLIL' _ 1,000,000 S E PlrofessionalLiab. AEH008231489 312912024 312912025 PerClaim/Aggregate 1,000,000 DESCRIPTION OF OPERATIONS I LOCATION'S / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: Professional Services Agreement for Design Services City of El Segundo, its officials, and employees are Included as additional insured with respect to General Liability, Automobile Liability and Umbrella Liability when required by written contract, General Liability„ Automobile Liability and Umbrella Liability are primary and non-contributory over any existing insurance and limited to liability arising out of the operations of the named insured and when required by written contract. General Liability, Automobile Liability, Umbrella Liability and Workers Compensation policies include a waiver of subrogation in favor of the additional insureds where permissible by state law and when required by written contract, 30-day Notice of Cancellation will be issued for the General Liability, Automobile Liability, Umbrella Liability, Workers SEE ATTACHED ACORD 101 City of El Segundo 350 Main Street El Segundo, CA 90245 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 „ram^ ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: HAZE&SA-01 KSUTTON LOC #: 0 __. ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY NAMED INSURED Ames & Gough Hazen and Sawyer - 488 Seventh Avenue POLICY NUMBER .................... __.. WW New York, NY 10018 EE PAGE 1 --- _ CARRIER I NAIC CODE EE PAGE 1 SEE P 1 P _ ........ ...... . _.....r._........ �.._... EFFECTIVE DATE SEE THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: A—CgR9,91 FORM TITLE Certificate of Liablllty. Insurance Description of Operations/Locations/Vehicles: Compensation and Professional Liability policies in accordance with policy terms and conditions. Umbrella Liability coverage sits excess over General Liability, Automobile Liability and Employers Liability coverage. Pollution Liability coverage is provided and included within the Professional Liability policy noted above. It shares the limits of the Professional Liability policy. r v,vr-u Iu I tcuo01u-I/ © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD CN CNA PARAMOUNT Blanket Additional Insured - Owners, Lessees or Contractors - with Products -Completed Operations Coverage Endorsement This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART It is understood and agreed as follows: I. WHO IS AN INSURED is amended to include as an Insured any person or organization whom you are required by written contract to add as an additional insured on this Coverage Part, but 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: A. In the performance of your ongoing operations subject to such written contract; or B. In the performance of your work subject to such written contract, but only with respect to bodily injury or property damage included in the products -completed operations hazard, and only if: 1. The written contract requires you to provide the additional insured such coverage; and 2. This Coverage Part provides such coverage; and C. Subject always to the terms and conditions of this policy, including the limits of insurance, the Insurer will not provide such additional insured with: 1. Coverage broader than what you are required to provide by the written contract; or 2. A higher limit of insurance than what you are required to provide by the written contract. Any coverage granted by this Paragraph I. shall apply solely to the extent permissible by law. II. If the written contract requires additional insured coverage under the 07-04 edition of CG2010 or CG2037, then paragraph I. above is deleted in its entirety and replaced by the following: WHO IS AN INSURED is amended to include as an Insured any person or organization whom you are required by written contract to add as an additional insured on this Coverage Part, but 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: A. In the performance of your ongoing operations subject to such written contract; or B. In the performance of your work subject to such written contract, but only with respect to bodily injury or property damage included in the products -completed operations hazard, and only if: 1. The written contract requires you to provide the additional insured such coverage; and 2. This Coverage Part provides such coverage. III. But if the written contract requires: A. Additional insured coverage under the 11-85 edition, 10-93 edition, or 10-01 edition of CG2010, or under the 10- 01 edition of CG2037; or B. Additional insured coverage with "arising out of language; then paragraph I. above is deleted in its entirety and replaced by the following: WHO IS AN INSURED is amended to include as an Insured any person or organization whom you are required by written contract to add as an additional insured on this Coverage Part, but only with, respect to liability for bodily injury, property damage or personal and advertising injury arising out of your work that is subject to such written contract. CNA75079XX (3-22) Page 1 of 3 American Casualty Company of Reading, P.A. Insured Name: Hazen and Sawyer D . P . C . Policy NO: 7036845683 Endorsement No: 16 Effective Date: 03/29/2024 Copyright CNA All Rights Reserved. CNA CNA PARAMOUNT Blanket Additional Insured - Owners, Lessees or Contractors - with Products -Completed Operations Coverage Endorsement IV. But if the written contract requires additional insured coverage to the greatest extent permissible by law, then paragraph I. above is deleted in its entirety and replaced by the following: WHO IS AN INSURED is amended to include as an Insured any person or organization whom you are required by written contract to add as an additional insured on this Coverage Part, but only with respect to liability for bodily injury, property damage or personal and advertising injury arising out of your work that is subject to such written contract. V. The insurance granted by this endorsement to the additional insured does not apply to bodily injury, property damage, or personal and advertising injury arising out of: A. The rendering 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; and 2. Supervisory, inspection, architectural or engineering activities; or B. Any premises or work for which the additional insured is specifically listed as an additional insured on another endorsement attached to this Coverage Part. VI. Under COMMERCIAL GENERAL LIABILITY CONDITIONS, the Condition entitled Other Insurance is amended to add the following, which supersedes any provision to the contrary in this Condition or elsewhere in this Coverage Part: Primary and Noncontributory Insurance With respect to other insurance available to the additional insured under which the additional insured is a named insured, this insurance is primary to and will not seek contribution from such other insurance, provided that a written contract requires the insurance provided by this policy to be: 1. Primary and non-contributing with other insurance available to the additional insured; or 2. Primary and to not seek contribution from any other insurance available to the additional insured. But except as specified above, this insurance will be excess of all other insurance available to the additional insured. VII. Solely with respect to the insurance granted by this endorsement, the section entitled COMMERCIAL GENERAL LIABILITY CONDITIONS is amended as follows: The Condition entitled Duties In The Event of Occurrence, Offense, Claim or Suit is amended with the addition of the following: Any additional insured pursuant to this endorsement will as soon as practicable: 1. Give the Insurer written notice of any claim, or any occurrence or offense which may result in a claim; 2. Send the Insurer copies of all legal papers received, and otherwise cooperate with the Insurer in the investigation, defense, or settlement of the claim; and 3. Make available any other insurance, and endeavor to tender the defense and indemnity of any claim to any other insurer or self -insurer, whose policy or program applies to a loss that the Insurer covers under this coverage part. However, if the written contract requires this insurance to be primary and non-contributory, this paragraph 3. does not apply to other insurance under which the additional insured is a named insured. The Insurer has no duty to defend or indemnify an additional insured under this endorsement until the Insurer receives written notice of a claim from the additional insured. CNA75079XX (3-22) Page 2 of 3 American Casualty Company of Reading, P.A. Insured Name: Hazen and Sawyer D.P.C. Policy No: 7036845683 Endorsement No: 16 Effective Date: 03/29/2024 Copyright CNA All Rights Reserved. CNA CNA PARAMOUNT Blanket Additional Insured - Owners, Lessees or Contractors - with Products -Completed Operations Coverage Endorsement Vill. Solely with respect to the insurance granted by this endorsement, the section entitled DEFINITIONS is amended to add the following definition: Written contract means a written contract or written agreement that requires you to make a person or organization an additional insured on this Coverage Fart, provided the contract or agreement: A. Was executed prior to: 1. The bodily injury or property damage; or 2. The offense that caused the personal and advertising injury; for which the additional insured seeks coverage; and B. Is still in effect at the time of the bodily injury or property damage occurrence or personal and advertising injury offense. All other terms and conditions of the Policy remain unchanged.. This endorsement, which forms a part of and is for attachment to the Policy issued by the designated Insurers, takes effect on the effective date of said Policy at the hour stated in said Policy, unless another effective date is shown below, and expires concurrently with said Policy,. CNA75079XX (3-22) Page 3 of 3 American Casualty Company of Reading, P.A. Insured Name: Hazen and Sawyer D.P.C. Policy No: 7036845683 Endorsement No: 16 Effective Date: 03/29/2024 Copyright CNA All Rights Reserved. CNA I CNA PARAMOUNT Waiver of Transfer of Rights of Recovery Against Others to the Insurer Endorsement This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: ANY PERSON OR ORGANIZATION WHOM THE CONTRACT OR AGREEMENT TO WAIVE SUCH CONTRACT OR AGREEMENT: NAMED INSURED HAS AGREED IN WRITING IN A RIGHTS OF RECOVERY, BUT ONLY IF SUCH l.IS IN EFFECT OR BECOMES EFFECTIVE DURING THE TERM OF THIS COVERAGE PART; AND 2.WAS EXECUTED PRIOR TO THE BODILY INJURY, PROPERTY DAMAGE OR PERSONAL AND ADVERTISING INJURY GIVING RISE TO THE CLAIM. (Information required to complete this Schedule, if not shown above, will be shown in the Declarations.) Under COMMERCIAL GENERAL LIABILITY CONDITIONS, it is understood and agreed that the condition entitled Transfer Of Rights Of Recovery Against Others To Us is amended by the addition of the following: With respect to the person or organization shown in the Schedule above, the Insurer waives any right of recovery the Insurer may have against such person or organization because of payments the Insurer makes for injury or damage arising out of the Named Insured's ongoing operations or your work included in the products -completed operations hazard. All other terms and conditions of the Policy remain unchanged. This endorsement, which forms a part of and is for attachment to the Policy issued by the designated Insurers, takes effect on the effective date of said Policy at the hour stated in said Policy, unless another effective date is shown below, and expires concurrently with said Policy. CNA75008XX (10-16) Policy No: 7036845683 Page 1 of 1 Endorsement #: American Casualty Company of Reading, PA Effective Date:03/29/2024 Insured Name: Hazen and Sawyer D.P.C. Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission. Business Auto Policy CNAPolicy Endorsement It is understood and agreed that this endorsement amends the BUSINESS AUTO COVERAGE FORM as follows; ANY PERSON OR ORGANIZATION THAT YOU ARE REQUIRED BY WRITTEN CONTRACT OR WRITTEN AGREEMENT TO NAME AS AN ADDITIONAL INSURED. 1. In conformance with paragraph A.1.c. of Who Is An Insured of Section II - LIABILITY COVERAGE, the person or organization scheduled above is an insured under this policy. 2. The insurance afforded to the additional insured under this policy will apply on a primary and non-contributory basis if you have committed it to be so in a written contract or written agreement executed prior to the date of the "accident" for which the additional insured seeks coverage under this policy. All other terms and conditions of the policy remain unchanged This endorsement, which forms a part of and is for attachment to the policy issued by the designated Insurers, takes effect on the Policy Effective date of said policy at the hour stated in said policy, unless another effective date (the Endorsement Effective Date) is shown below, and expires concurrently with said policy. Form No: CNA71527XX (10-2012) Policy No: 7036845635 Endorsement Effective Date: Policy Effective Date: 3/29/24 Endorsement No: Policy Page:7036845635 Underwriting Company: National Fire Insurance Of Hartford ® Copyright CNA All Rights Reserved. Workers Compensation And Employers Liability Insurance CNAPolicy Endorsement This endorsement changes the policy to which it is attached. It is agreed that Part One - Workers' Compensation Insurance G. Recovery From Others and Part Two - Employers' Liability Insurance H. Recovery From Others are amended by adding the following: We will not enforce our right to recover against persons or organizations. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) PREMIUM CHARGE - Refer to the Schedule of Operations The charge will be an amount to which you and we agree that is a percentage of the total standard premium for California exposure. The amount is 3%. All other terms and conditions of the policy remain unchanged. f IV° s ewudors rn�ent, which forms a part of and is for attachment to the policy issued by the designated Insurers, takes effect on the Policy Effective Date of said policy at the hour stated in said policy, unless another effective date (the Endorsement Effective Date) is shown below, and expires concurrently with said policy unless another expliration date is shown below. Form . . No: G�-1��9�1�60-B (11-1997) ���� �� Policy No: 7036845666 Endorsement Effective Date: Endorsement Expiration Date: Policy Effective Date: 3/29/24 Endorsement No: 2; Page: 1 of 1 Policy Page: Underwriting Company: Valley Forge Insurance Company ® Copyright CNA All Rights Reserved.