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PROOF OF INSURANCE (2013) CLOSEDA� " CERTIFICATE OF LIABILITY INSURANCE DATE 10 /30IDD/Y3 10/30/2013 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. 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 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 1- 818 - 539 -2300 CONTACT CBS Certificate Processing g Arthur J. Gallagher & Co. Insurance Brokers of California, Inc. License #0726293 PHONE FAX a/ No Ext: 877 - 790 -8155 A/C No:818- 539 -1693 E -MAIL Jg• com CBS Certificates@ajg.com 505 North Brand Boulevard, Suite 600 INSURERS AFFORDING COVERAGE NAIC# Glendale, CA 91203-3944 INSURERA: TRAVELERS PROP CAS CO OF AMER 25674 CBS_ Certificates @ajg.com INSURED INSURER B: ST PAUL FIRE & MARINE INS CO 24767 CBS Corporation 12/31/13 DAMAGETORENTED PREMISES Ea occurrence CBS Outdoor, Inc. INSURER C: CLAIMS -MADE 1XI OCCUR INSURER D: 405 Lexington Ave INSURER E: New York, NY 10174 $ PERSONAL &ADV INJURY $ 5,000,000 INSURER F: CnVFRAnFS CERTIFICATE NUMBER: 36687856 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, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE INSR ADDLSUBR POLICY NUMBER MM/ DY EFF MM/DD/YYYY LIMITS A GENERAL LIABILITY TC2JGLSA121D6189TIL12 (US ) 12/31/1 12/31/13 EACHOCCURRENCE $ 5,000,000 B X COMMERCIAL GENERAL LIABILITY 234D0647(Canada) 12/31/1 12/31/13 DAMAGETORENTED PREMISES Ea occurrence $ 5,000,000 CLAIMS -MADE 1XI OCCUR MED EXP (Any one person) $ PERSONAL &ADV INJURY $ 5,000,000 GENERAL AGGREGATE $ 15,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 5,000,000 $ X POLICY PRO- F—] LOC A B AUTOMOBILE LIABILITY X ANY AUTO TC2JCAP121D6190TIL12 (USA 231D6266(Canada) 12/31/12 12/31/1 12/31/13 12/31/13 COMBINED SINGLE LIMIT Ea accident 5,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ X ALL OWNED SCHEDULED AUTOS PROPERTY DAMAGE Per accident $ X X NON OWNED HIRED AUTOS AUTOS $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y! N ANY PROPRIETOR/PARTNER/EXECUTIVE WC STATU- OTH- TORY IMIT R E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? NIA (Mandatory in NH) t. L. UISEASE - EA EMPLOYE E.L. DISEASE - POLICY LIMIT $ If yes, describe under DESCRIPTION OF OPERATIONS below A Auto Physical Damage TC2JCAP121D6190TIL12(USA 12/31/1 12/31/13 Comprehensive Ded. 0 B Auto Physical Damage 231D6266(Canada) 12/31/1 12/31/13 Collision Ded. 0 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CITY, its officials, volunteers, and employees are deemed Additional Insured as required by written or verbal contract. Please refer to attached General Liability endorsement (CG TS 31) for scope of Additional Insured status. Named Insured is a Qualified Self Insurer in the State of New York for Workers, Compensation. CFRTIFICATF HOI nFR ,\ CANCELLATION Ai"; SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of El Segundo, THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. t� 350 Main Street kkk10 AUTHORIZED REPRESENTATIVE �s El Segundo, CA 90245 USA ACORD 25 (2010/05) sugiglen occo^,occ ©1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD TC2JGLSA- 121D618- 9- TIL -12 COMMERCIAL GENERAL LIABILITY 4. CONDITIONS As a condition of coverage provided to the additional insured by this endorsement: + YV a) The additional insured must give us written notice as soon as practicable of an "occurrence" or offense which may give rise to a claim. To the extent possible, such notice should include:' L How, when and where the "occurrence" or offense took place; ✓ ii. The names and addresses of any injured persons and witnesses; and t� iii. The nature and location of any injury or damage arising out of the "occurrence" or offense. b) If a claim is made or "suit" is brought against the additional insured, the additional insured, must: Immediately record the specifics of the claim or "suit" and the date received; Notify us as soon as practicable; and iii. See to it that we receive written notice of the claim or "suit" as soon as practicable. c) The additional insured must immediately send us copies of all legal papers received in connection with the claim or "suit ", cooperate with us in the investigation or settlement of the claim or defense against the "suit ", and otherwise comply with all policy conditions. d) The additional insured must tender the defense and indemnity of any claim or "suit" to any provider of other insurance simultaneously which would cover the additional insured for a loss we cover under this endorsement. However, this condition does not affect whether the insurance provided to the additional insured by this endorsement is primary to other insurance available to the additional insured which covers that person or organization as a named insured as described in paragraph 3. above. 5. SEPARATION OF INSUREDS Except with respect to the Limits of Insurance, and any rights or duties specifically assigned in this Coverage Part to the First Named Insured, this insurance applies: a) As if each Named Insured were the only Named Insured; and b) Separately to each insured against whom claim is made or "suit" is brought. 6. DEFINITIONS The following definition is added to SECTION V. — DEFINITIONS: "Written contract requiring insurance" means that part of any written contract or agreement under which you are required to include a person or organization as an additional insured on this Coverage Part, provided that the "bodily injury" and "property damage" occurs and the "personal injury" is caused by an offense committed: a) After the signing and execution of the contract or agreement by you; b) While that part of the contract or agreement is in effect; and c) Before the end of the policy period. CG T8 31 12/31/12 - 12/31/13 06('11-Is J\ November 1 L 2013 Cite of El Segundo Department of Public Works 350 Main Street El Segundo, CA 90216 a �. 'l'o Whom It May Concern= ' ly x Subject: CBS Decaux Street Furniture LLC The purpose of this letter to supplement the information already provided regarding CBS C- orporations insurance program. CBS Corporation has the right to recover our payments from anyone liable for an injury covered by California Workers Compensation law. We will not enforce our rights against The City gf El Segundo, its City Council, officers•, gfficials, agents, employees, and volunteers as they now, or as they may hereafter be constituted, singly, jointly, or severally; or any other entity where we have agreed by written contract to w rive our rights of recovery. If there are any questions, or you require additional information please feel free to contact me by calling (212) 975-8971, or emailing Steahanie.(.ros bem,,?cbs.coni. Sincerely, Stephanie A. Grossberg Director - Risk Management C13S Corporation Cc Eugene J. Mellevold — CBS (NY) O U U O bA CC 03 O Ski al Q) C� U U z O H w a� Q �U r� w W F F� zW wF Fw a W A tit w a O� rl i• a d w O r Q Q F V z z 0 zn z 0 F x x d' ►_� • On -O y U C G. E U C N U . cGJ ro � U G � o � aGi ai o o U c w � � O � � N 4 U bn u M, a� cv G y c ... y 72 G L '� 2� N ro � U :C13 G .� c ro rn L uro, U N m C, y O a � iyL'�O o A . N x 0 6n .5 C ` ° �' p J c o vGi �,^ O C 7 •U v U ° ro L p e w c m U G O E O w U G U 4-. � •b �, G Cro w � ro •� E U O o0 S u C4 CIL * ° E Cd ° C, —o C v P a z O W z O U N O bA O m ON ao 0 z o1 V w OJ v i-i 0 Q 0 t~ c ° w � U FBI I � O N O W CCJ �1 H FH Q 1-4 A x O O y O W Q U M O 3 rc a O U U O bA CC 03 O Ski al Q) C� U U z O H w a� Q �U r� w W F F� zW wF Fw a W A tit w a O� rl i• a d w O r Q Q F V z z 0 zn z 0 F x x d' ►_� • On -O y U C G. E U C N U . cGJ ro � U G � o � aGi ai o o U c w � � O � � N 4 U bn u M, a� cv G y c ... y 72 G L '� 2� N ro � U :C13 G .� c ro rn L uro, U N m C, y O a � iyL'�O o A . N x 0 6n .5 C ` ° �' p J c o vGi �,^ O C 7 •U v U ° ro L p e w c m U G O E O w U G U 4-. � •b �, G Cro w � ro •� E U O o0 S u C4 CIL * ° E Cd ° C, —o C v P a z O W z O U N O bA O m ON ao 0 z o1 V w OJ v i-i 0 Q 0 t~ c ° w Shilling, Mona From: Garcia, Angelina Sent: Wednesday, November 13, 2013 8:06 AM To: Shilling, Mona Subject: FW: Insurance Viacom -CBS Attachments: 1893 CA CBS Operations, Inc..pdf, El Segundo Waiver of Subro.pdf, 0336687856.pdf Good to go. Angelina Garcia From: Johnson, James J (Outdoor) [mailto:james.johnson @cbsoutdoor.com] Sent: Tuesday, November 12, 2013 8:14 AM To: Katsouleas, Stephanie Cc: Garcia, Angelina Subject: RE: Insurance Viacom -CBS Hi Stephanie, Please see the attached forms and let me know if they will be sufficient. Thanks W& From: Katsouleas, Stephanie [ mailto :skatsouleas(a)elsegundo.oral Sent: Thursday, November 07, 2013 5:45 PM To: Johnson, James J (Outdoor) Cc: Garcia, Angelina Subject: RE: Insurance Viacom -CBS James, I apologize for the delay, but our Risk Manager has informed me that CBS also needs to submit workers comp and waiver of subrogation insurance. How soon can you provide that to us? The City is not open again until Tuesday (closed Fridays /Monday holiday). Please also cc Angie Garcia at agarcia _elsegundo.org. Thanks Stephanie Katsouleas, P.E. Director of Public Works 310-524-2356 310 -640 -0489 City Hall is closed on Fridays From: Johnson, James J (Outdoor) Finailto: james.johnson(a)cbsoutdoor.com] Sent: Monday, November 04, 2013 4:45 PM To: Katsouleas, Stephanie Subject: RE: Insurance Viacom -CBS Thank you so much for your help From: Katsouleas, Stephanie fmai Ito: skatsouleas elseoundo.o[g] Sent: Monday, November 04, 2013 4:44 PM To: Johnson, James J (Outdoor) Subject: RE: Insurance Viacom -CBS James, I have sent a request to the City Clerk asking when I can expect the executed document back. I'll let you know as soon as I have an answer. I have conveyed to them that this is needed to close escrow. Stephanie Katsouleas, P.E. Director of Public Works 310-524-2356 310 - 640 -0489 City Hall is closed on Fridays From: Johnson, James J (Outdoor) fmailto:james.johnson cbsoutdoor.com] Sent: Monday, November 04, 2013 11:06 AM To: Katsouleas, Stephanie Subject: FW: Insurance Viacom -CBS From: Johnson, James J (Outdoor) Sent: Wednesday, October 30, 2013 12:56 PM To: 'Katsouleas, Stephanie' Subject: RE: Insurance Viacom -CBS Hi Stephanie, I have attached a copy of an up to date insurance certificate. Iim From: Katsouleas, Stephanie (mailto:skatsouleas @ elsegundo.orq] Sent: Tuesday, October 29, 2013 6:14 PM To: Johnson, James J (Outdoor) Subject: FW: Insurance Viacom -CBS Hi James, I received confirmation that the insurance on file is expired. It will need to be up to date before the amendment will be processed. Do you have all the information you need for the renewal? Stephanie Katsouleas, P.E. Director of Public Works 310-524-2356 310 - 640 -0489 City Hall is closed on Fridays From: Domann, Cathy Sent: Tuesday, October 29, 2013 4:03 PM To: Katsouleas, Stephanie Subject: Insurance Viacom -CBS Hi Stephanie, The insurance we have on file expired in 2011. Cathy