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PROOF OF INSURANCE (2026)HAZE&SA-01 = CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYrY) -. 1 3/26/2025 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 endorsements . PRODUCER Ames & Gough 8300 Greensboro Drive Suite 980 McLean, VA 22102 827-2277 827-2279 ................................ INSURED INSURER ,8 mmNational Fire Insurance Company of Hartford A(XV) 20478 Hazen and Sawyer INSURER c Continental Insurance Com an SXV „ 352 498 Seventh Avenue RePA A INSURER p American Casual Co of ad n 20427 New York, NY 10018 INSURERE : �.��,._..-_.................................m,,,,...._ .,........................................,-,— INSURER F ; rwti.rconr_cc r:9:0Ticar ATP NUMBER' REVISION NUMBER, THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN„ THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, CONDITIONS OF SUCH POLICIES. LIMITS SHOWN HAVE BEEN REDUCEDBY PAIDCLAIMS. RXCLUSIONSTMPDCO oLICYF Po CEXPwsJJIL.OPOLICY NUMBERLIMITS A X COMMERCIAL GENERAL LIABILITY EAOH pCGU $ 1,000,000RRENCE , CLAIMS -MADE [ X � OCCUR 7036845683 3/29/2025 3/29/2026 m TO ED .gLX 1,OOS 060 Contractual Liab. EXPAng�p son) 000n �....__ .. EFSOAD.INJ,UR 1,000,000 '�_2,000,000 ¢E 'e. 'X ..�_ LACGREmATELIMIT APPIES PER E $ POLICY JPET LLOC UCG ,PRODTSCOMP/OPAGG 2OOQ000 $ m. OTHER, mCOMUINED $ B SINGLE. LIMIT 1 000 000 ' AUTOMOBILE LIABILITY {Et3,.0 j.d1l7,I,','I••••rI'„ ....,..., .m�- X ANY Auro 7036845635 3129/2025 312912026 eow?u.x wJURY_ gEpt on . _.O .. „ _.,,_ .1_ .... ......... OWNED --- SCHEDULED AUTOS ONLY AUTOS accident) )•-- - �I vuIy .. App.AMAGE A"r0 ONY II. ..$ .m UR"O� ONLY -w,....,,,, ,Comp./Coll. Ded 1,000 X UMBRELLA LU\B X OCCUR EACH OCOURRENCE S1,000,000 EXCESS UI CLAIMS-MADEOOQ 7036845649 3/29/2025 3/29/2026 GGREGATEE 1,000,000 $ ,LB DED X RETENTION $ 1 Q D IONILIT PE. ldT..E ER YERS'LIABILITY AND EMPLOYERS' LIABILITY AND EMPLOYERS' m 0 �. 7036845666 3/29/2025 3/29/2026 .WX $ � ANY PROPRIETORIPARTNER/EXECUTIVE [ ._ EACH ACCIDENT $rFICERd'M MBER EXCLUDED? N N / A 1�������� W� atadatoryn NH) E lDISEASE - EA EMPLOYEE $ � Ifyes, describe under 1,000,000 DESCRIPTION OF OPERATIONS below E I, DISEASE -POLICY LIMIT A Professional Liab. AEH008231489 3/29/2025 3/2912026 Per Claim/Aggregate 1,000,000 DESCRIPTION OF OPERATIONS I LOCATION'S i VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: Professional Services Agreement for Design Services City of EI Segundo, its officials, and employees are Included as additional Insured with respect to General Liability, Automobile Liability and Umbrella Llability 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 insurers 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 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 I 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 ITITITITIT�� ......'.....New 488 Seventh Avenue .......................� POLICY NUMBER York, NY 10018 SEE PAGE 1 _................ ....... ................ . CARRIER NAIC CODE �SEEPAGE`I SEE P 1 EFFECTIVE DATE: SEE PAG 1 AUUI I IUNAL t( 14f1,AKKZ5 THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: A929 25 FORM TITLE Certificate of Liabili 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. f1VVKU 1U1 (LUU8/U1) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD CNA 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: 03/29/2025 Copyright CNA All Rights Reserved. CN 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: 03/29/2025 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 Part, 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: 03/29/2025 copyright CNA All Rights Reserved. CNA 1 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 NAMED INSURED HAS AGREED IN WRITING IN A CONTRACT OR AGREEMENT TO WAIVE SUCH RIGHTS OF RECOVERY, BUT ONLY IF SUCH CONTRACT OR AGREEMENT: 1.IS IN EFFECT OR BECOMES EFFECTIVE DURING THE TERM OF THIS COVERAGE PART; AND EXECUTED PRIOR TO THE BODILY INJURY, PROPERTY DAMAGE OR PERSONAL AND �2.WAS 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: 7n-16845683 Page 1 of 1 Endorsement #: American Casualty Company of Reading, PA Effective Date: 0 3 / 2 9 / 2 0 2 5 Insured Name: Hazen and Sawyer D.P.C. Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission. CNA Business Auto Policy Policy 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) Endorsement Effective Date: Endorsement No: Underwriting Company: National Fire Insurance Of Hartford Policy No: 7036845635 Policy Effective Date: 3/29/25 Policy Page: 7036845635 0 Copyright CNA All Rights Reserved. Workers Compensation And Employers Liability Insurance CNRPolicy Endorsement 1 r% 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. 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 4,li lll"""^ s arllo,'W'thle �. i poNraliIId;Nlin date NS 0'1101A/iin N.IIoN , Form No: G-19160-B (11-1997) Policy No: 7036845666 Endorsement Effective Date: Endorsement Expiration Date: Policy Effective Date: 3/29/25 Endorsement No: 2; Page: 1 of 1 Policy Page: Underwriting Company: Valley Forge Insurance Company 0 Copyright CNA All Rights Reserved.