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PROOF OF INSURANCE (2013) CLOSED Client#:18530 NCMENGINEE ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 07/01/13 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Dealey, Renton&Associates ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE P.O.Box 10550 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Santa Ana,CA 92711-0550 714 427-6810 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Travelers Indemnity Co.of Conn 25682 NCM Engineering Corp. INSURER B: Travelers Property Casualty Co 25674 22362 Gilberto,Suite 125 INSURER C: XL Specialty Insurance Co. 37885 Rancho Santa Margarita,CA 92679 INSURER D: INSURER E: _ COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. AWL TYPE OF INSURANCE POLICY NUMBER 'POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR INSRC DATE IMM/OD/YY1 DATE IMM/DDIYYI A GENERAL LIABILITY 6806C263891 12/05/12 12/05/13 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY General Liab. DAMAGE TO RE c RENTED $1.000,000 1 CLAIMS MADE © OCCUR excludes claims MED EXP(Any one person) $10 000 X Contractual Liab. _ arising out of PERSONAL&ADV INJURY $1,000,000 the performance GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: of professional PRODUCTS-COMP/OP AGG $2,000,000 n POLICY Tit JEGT n LOC services. A AUTOMOBILE LIABILITY 6806C263891 12/05/12 12/05/13-- COMBINED SINGLE LIMIT _ ANY AUTO (Ea accident) $Included ALL OWNED AUTOS BODILY INJURY _ SCHEDULED AUTOS (Per person) $ X HIRED AUTOS BODILY INJURY X NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE $ (Per accident) , GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ nOCCUR n CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION 5 $ B WORKERS COMPENSATION AND UB4022T740 01/10/13 12/05/13 X ) V40 s n- I IOER` EMPLOYERS'LIABILITY TORY L!MlTS ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,001} OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 C OTHER Professional DPS9704404 12/05/12 12/05/13 $1,000,000 per clairt]- Liability $2,000,000 annl aggr. Claims made DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Re: Park Place Estension Project. City of El Segundo, its officers,employees or agents are additional insured on General Liability coverage as per written contract. Coverage afforded the additional insured is primary and non-contributory. Waiver of subrogation included in work comp. CERTIFICATE HOLDER CANCELLATION 10 Days for Non-Payment SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION City of El Segundo (DATE THEREOF,THE ISSUING INSURER WILL rigutygRigt MAIL 3n DAYS WRITTEN 350 Main Street • !NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,xxxnetkeopennneocoom El Segundo,CA 90245 144PAMOINZOIWIXIIMMXIMMOCIMIXXIMAUXXXRPAIKWICWAYAKOMOCCXX ARIMISXLMIWxgx AUTHORIZED REPRESENTATIVE (2001/08) 44.1.4+ �.. ACORD 25 )1 of 1 #S661997/M513835 THC © ACORD CORPORATION 1988 COMMERICAL GENERAL LIABILITY POLICY NUMBER: 6806C263891 ISSUE DATE: 12/05/12 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED (ARCHITECTS, ENGINEERS AND SURVEYORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE NAME OF PERSON(S)OR ORGANIZATION(S): City of El Segundo 350 Main Street El Segundo,CA 90245 PROJECT/LOCATION OF COVERED OPERATIONS: Re:Park Place Estension Project.City of El Segundo,its officers,employees or agents PROVISIONS A. The following is added to WHO IS AN INSURED The insurance provided to such additional insured (Section II): is limited as follows: The person or organization shown in the Sched- d. This insurance does not apply to the render- ule above is an additional insured on this Cover- ing of or failure to render any "professional age Part, but only with respect to liability for"bod- services". ily injury", "property damage" or "personal injury" e. The limits of insurance afforded to the addi- caused, in whole or in part, by your acts or omis- tional insured shall be the limits which you sions or the acts or omissions of those acting on agreed in that "contract or agreement requir- your behalf: ing insurance" to provide for that additional a. In the),.) rformance of your ongoing opera- insured, or the limits shown in the Declara- tions;. tions for this Coverage Part, whichever are b. In connection with premises owned by or less. This endorsement does not increase the rented to you; or limits of insurance statefrfn the LIMITS OF INSURANCE (Sectiorf III) for this Coverage c. In connection with "your work" and included Part. within the "products-completed operations hazard". B. The following is added to Paragraph a. of 4. Other Insurance in COMMERCIAL GENERAL Such person or organization does not qualify as LIABILITY CONDITIONS (Section IV): an additional insured for "bodily injury", "property damage" or "personal injury" for which that per- However, if you specifically agree in a "contract or son or organization has assumed liability in a con- agreement requiring insurance" that, for the addi- tract or agreement. tional insured shown in the Schedule, the insur- ance provided to that additional insured under this CG D3 82 09 07 ©2007 The Travelers Companies, Inc. Page 1 of 2 Includes the copyrighted material of Insurance Services Office, Inc.,with its permission COMMERICAL GENERAL LIABILITY Coverage Part must apply on a primary basis, or injury" arising out of"your work" on or for the pro- a primary and non-contributory basis, this insur- ject, or at the location, shown in the Schedule ance is primary to other insurance that is avail- above, performed by you, or on your behalf, un- able to such additional insured which covers such der a "contract or agreement requiring insurance" additional insured as a named insured, and we with that additional insured. We waive these will not share with the other insurance, provided rights only where you have agreed to do so as that: part of the "contract or agreement requiring insur- (1) The "bodily injury" or "property damage" for sou befol before, at anditional insured e entered into injury" which coverage is sought occurs; and you "bodily 1 y injury" which coverage is or "property damage" occurs, or the "personal in- (2) The "personal 1 ur Y 9 jury"offense is committed. sought arises out of an offense committed; D. The following definition is added to DEFINITIONS after you have entered into that "contract or (Section V): agreement requiring insurance" for such addi- tional insured. But this insurance still is excess "Contract or agreement requiring insurance" over valid and collectible other insurance, means that part of any contract or agreement un- whether primary, excess, contingent or on any der which you are required to include the person other basis, that is available to the additional in- or organization shown in the Schedule as an ad- sured when the additional insured is also an addi- ditional insured on this Coverage Part, provided tional insured under any other insurance. that the "bodily injury" and "property damage" oc- curs, and the "personal injury" is caused by an of- C. The following is added to Paragraph 8. Transfer fense committed: Of Rights Of Recovery Against Others To Us in COMMERCIAL GENERAL LIABILITY CON- a. After you have entered into that contract or DITIONS (Section IV): agreement; We waive any rights of recovery we may h b. While that part of the contract or agreement is against the additional insured shown in the in effect; and Schedule above because of payments we make c. Before the end of the policy period. for "bodily injury", "property damage" or "personal Page 2 of 2 ©2007 The Travelers Companies,Inc. CG D3 82 09 07 Includes the copyrighted material of Insurance Services Office, Inc.,with its permission NCM Engineering Corp. WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 99 03 76(00)-- POLICY NUMBER: UB4022T740 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA (BLANKET WAIVER) 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. 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 %of the California workers'compensation premium otherwise due on such remuneration. Schedule Person or Organization: Job Description: Re:Park Place Estension Project.City of El Segundo,its officers,employees or agents City of El Segundo 350 Main Street El Segundo,CA 90245 DATE OF ISSUE: 01/10/13