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PROOF OF INSURANCE (2014) CLOSEDGale Jordan Associates, Inc. ( Aco CERTIFICATE OF LIABILITY INSURANCE DATE(MMI ° °"""' 9/ 1 t201i 3 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(les) 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). j PRODUCER aAr 1J.- F01- Mar Swanay ... Deale , Renton & Associates_ PHONE FAX 6 199 S Los Robles #540aL Pasadena, CA 91101 � INSURER rSEc k,,. ADq�(tlA�4� HtiSr`�lan�y4f2 "( IS) AFFORDING COVERAGE i NAIC q INSURED INSURER B: Gale /Jordan Associates, Inc, INSURERc 3858 Carson Street, Suite 200 INSURER D: Torrance, CA 90503 -5613 _." m�........_ 310- 316 -4377 INSURER E e INSURER F : COVERAGES CERTIFICATE NUMBER: 2018196736 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. . m..... L�MeDD r _ AT GENERAL LIABILITY Y R Y 24391656001 /20/2013 POLICYEXP EACH OCCURRENCE INSR TYPE OF I �rus;R � POLICY' L IMMI�DfYYYVI LIMITS R � INSURANCE INS Wool POLICY V NIIMBER _,m � �F /2012014 $3,000,000 UANYAG T6 AffNtt ,.. �.. _ COMMERCIAL GENERAL LIABILITY PREMISES (go y);, gmrvgwpy CLAIMS -MADE F-1 OCCUR MED E (Anv one person) $5.000 X Contractor PERSONAL & ADV INJURY $2,000.000 Pollution Llab GENERAL AGGREGATE $4.000.000 GFNLAG{"t EGhTE LIMIT APPLIES PER: PRODUC'T4 COMPIOP AGG $4,000,000 Contr Pol. Liab $2,000,000 A AUTOMOBILE F-1 z10 LIABILITY l Off. _ r =Ott kGY T'I G24391656001 /2812013 11128120114 Coo i77 y)ty 0iLn ANY AUTO BODILY INJURY (Per person) $ ALL OWNED .... ,.,, SCHEDULED AUTOS AUTOS X BODILY INJURY (Psraccident) $ NON -OWNED @ {TLt6 a R tY tIAC AGF $ " ^..... NIREDAUTOS nx_.., AUTOS X NO OwnedAuto $ UMBRELLA LIAB OCCUR EACH OCCURRENCE S . R EXCESS LIA E $ ' -_„ -�.. .. , i CLAIMS MAD AGGREGATE DED RETENTION S $ WORKERS COMPENSATION WC STATU OTH AND EMPLOYERS' LIABILITY YIN TnaY LMIT3 ." ®, T ANY PROPRIETOR /PARTNERIEXECUTIVE 0 NIA E L EACH ACCIDENT S - OFFICER /MEMBER EXCLUDED? ..,.,_ (Mandatory In NH) E L. DISEASE EA EMPLOYE $ Ifyes describe under - - •...... - - ., .... ..,,,, ,m, ,. 0F,5CRIPTION OF OPERATIONS below E.L DISEASE -POLICY LIMIT $ A Professional Liability G24391656001 /28/2013 /28/2014 $2,000,000 Per Claim Claims made Form $2,000,000 Annual Aggr DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 10i, Additional Remarks Schedule, If more space Is required) General Liability policy excludes claims arising out of the performance of professional services. Contractors Polution & Professional Liability Endorsement: Fungi, Mold, or Microbial Matter Coverage limit $1,000,000 each claim /$1,000,000 Fungi Aggregate Limit (included in the General Liability Aggregate)deductible $10,000 each claim, retro date: 04128/2006. General Liability: XCU included. Auto Limit is included in GL Limit. City of El Segundo, its officers, agents and employees are named as additional insured as respects general liability for claims arising from the operations of the named insured as required per contract or agreement. "NOTE: CERTIFICATE HOLDER ANCELLA TION 3U Lys 1IU uay for Non -Pa rant of i rem qrJ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE e THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of El Segundo, Public Works Dept. i R ACCORDANCE WITH THE POLICY PROVISIONS. El Es undo CA 90245 350 M Street gain THORIZED REPRESENTATIVE Cyr © 1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD i Insert the policy number. The remainder of the Information Is to be compleled only when this endorsement la Issued subsequent to the preparation of the policy. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. o """ P, ADDITIONAL INSURED ENDORSEMENT - OWNERS, LESSEES OR CONTRACTORS (PRIMARY AND NON- CONTRIBUTORY) y� This endorsement modifies insurance provided under the following: I�p' "7" COMMERCIAL_ GENERAL LIABILITY COVERAGE CONTRACTOR'S POLLUTION LIABILITY COVERAGE SCHEDULE: Name of Person or Organization: Any person or organization that is an owner of real property or personal property on which you are performing operations, or a contractor on whose behalf you are performing operations, and only at the specific written request of such person or organization to you, wherein such request is made prior to commencement of operations. ((f no entry appears above, information required to complete this endorsement wilf be shown In the Declarations as applicable to this endorsement.) SECTION 11- WHO 1S AN INSURED is amended to include: A. SECTION II - WHO IS AN INSURED is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of your ongoing operations performed for that insured. B. With respect to the insurance afforded to these additional insureds, the following exclusion is added: 2. Exclusions This insurance does not apply to bodily injury or property damage occurring after_ (1) All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the site of the covered operations has been completed, or (2) That portion of your work out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. C. The coverage provided hereunder shall be primary and not contributing with any other insurance available to those designated above under any other third party liability policy. ENV -3141 (08 -04) Includes copyrighted material of Insurance Services Office, Inc. with its permission Page 1 of 1 Insert the policy number. The remainder of the Informatlan Is to be completed only when this endorsement Is issued subsequent to the preparation of Iho popsy, THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART CONTRACTORS POLLUTION LIABILITY COVERAGE PART SCHEDULE �yq,0 �p d6 I` Name of Person or Organization: Any person or organization that is an owner of real property or personal property on which you are performing operations, or a contractor on whose behalf you are performing operations, and only at the specific written request of such person or organization to you, wherein such request is made prior to commencement of operations. ktr no amry appears aoove, Inrormauan requires io compiew tnis ancorsement will De snown in the Declarations as applicable to this endorsement.) The TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Condition is amended by the addition of the following: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or your work done under a contract with that person or organization and included in the products - completed operations hazard. This waiver applies only to the person or organization shown in the Schedule above. All other terns and conditions remain the same, ENV -3143 (03 -05) Includes copyrighted material of Insurance Services Office, Inc. with its permission Page 1 of 1 Fax From StreemCenter Page 3 of 3 Feb 03 14 11:16a Cloud, Minturn & Flssociat 310 -543 -0013 P.3 POLICYHOLDER COPY P.O. BOX 8192, PLEASANTON, CA 94588 MEMENNEMM CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: C2-03 -2014 GROUP: POLICY NUMBER: 1118442 -2014 CERTIFICATE ID-. 328 CERTIFICATE EXPIRES: 02- 01.2015 02 -01- 2014/02-01-2015 THIS CERTIFICATE SUPERSEDES AND CORRECTS CERTIFICATE N 317 DATED 02 -01 -2014 CITY OF EL SEGUNDO, PUBLIC WORKS DEPT. SC 350 MAIN ST EL SEGUNDO CA 90245 -3813 This is to certify that we have Issued a valid Workers' Compensanon insurance policy in a form approved by the California Insuran --e Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 30 days advance written notice to the employer, We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration. Timis certificate of insurance is no, an insurance policy and does not amend, extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document With respocl to which this certificate of insurance may be issued or to which it may pertain, the insurance afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy_ Authorized Representative/ President and CEO EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT V1000 - CHRISTOPHER K. GALE, PRESIDENT - EXCLUDED. ENDORSEMENT .#1000 - THOMAS A. JORDAN, SECRETARY TREASURER - EXCLUDED. ENDORSEMENT #2006 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 02- 01-2000 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. ENDORSEMENT #2870 ENTITLED WAIVER OF SUBROGATION EFFECTIVE 2014 -02-03 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. THIRD PARTY NAME: CITY OF EL SEGUNDO, PUBLIC WORKS DEPT. EMPLOYER GALE /JDRDAN ASSOCIATES, INCORPORATED 3858 W CARSON ST STE 200 TORRANCE CA 90503 SC IP1 Z,SC] [REV. 1-20121 PRINTED : 02- 03-2014 ENDORSEMENT AGREEMENT WAIVER OF SUBROGATION STATE 1118442 -14 RENEWAL INSURANCE SC FUND 2- 70 -70 -25 PAGE 1 HOME OFFICE SAN FRANCISCO EFFECTIVE FEBRUARY 3, 2014 AT 12.01 A.M. ALL EFFECTIVE DATES ARE AND EXPIRING FEBRUARY 1, 2015 AT 12.01 A.M.° "�' AT 12:01 AM PACIFIC STANDARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME �� r GALE / JORDAN ASSOCIATES, INC. !4 0 3858 W CARSON ST STE 200 TORRANCE, CA 90503 ANYTHING IN THIS POLICY TO THE CONTRARY NOTWITHSTANDING: IT IS AGREED THAT THE STATE COMPENSATION INSURANCE FUND WAIVES ANY RIGHT OF SUBROGATION AGAINST: CITY OF EL SEGUNDO, PUBLIC WORKS DEPT. WHICH MIGHT ARISE BY REASON OF ANY PAYMENT UNDER THIS POLICY IN CONNECTION WITH WORK PERFORMED BY, GALE /JORDAN ASSOCIATES, INC. IT IS FURTHER AGREED THAT THE INSURED SHALL MAINTAIN PAYROLL RECORDS ACCURATELY SEGREGATING THE REMUNERATION OF EMPLOYEES WHILE ENGAGED IN WORK FOR THE ABOVE EMPLOYER. IT IS FURTHER AGREED THAT PREMIUM ON THE EARNINGS OF SUCH EMPLOYEES SHALL BE INCREASED BY 03 %. NOTHING IN THIS ENDORSEMENT CONTAINED SHALL BE HELD TO VARY, ALTER, WAIVE OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS POLICY OTHER THAN AS STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR LIMITATIONS OF THIS ENDORSEMENT. COUNTERSIGNED AND ISSUED AT SAN FRANCISCO: FEBRUARY 5, 2014 2570 AUTHORIZED REPRESENTVIVE PRESIDENT AND CEO SCIF FORM 10217 (REV.1-2012) OLD OF 217 Shilling,, Mona From: Garcia, Angelina Sent: Monday, March 31, 2014 3:05 PM To: Hegvold, Julie Cc: Rivera, Floriza; Bola, Arianne; Shilling, Mona Subject: RE: Gale Jordan Agmt - City Hall Roof Hi Julie, Yes, all are in place. However, except for the workers' comp, they are set to expire 4/28/14. I'm available all day for signatures. Angelina Garcia From: Hegvold, Julie Sent: Monday, March 31, 2014 2:43 PM To: Garcia, Angelina Cc: Rivera, Floriza; Bola, Arianne Subject: Gale Jordan Agmt - City Hall Roof Good Afternoon Angie, Here is a second agreement with Gale Jordan for asbestos removal at City Hall, for your review and sign -off. The first agreement 4540 was approved earlier this year. All insurance certs and waivers should still be in place and current. Please let me know when I can bring this new Gale Jordan contract, as well as their contract below (for Water Division) by for your sign -off. Thanks! ("11"Y .IIA1.L I C'LOSPA) ON 11 1II I)AYS From: Hegvold, Julie Sent: Wednesday, March 12, 201411:27 AM To: Garcia, Angelina Cc: Rivera, Floriza Subject: Gale Jordan Agmt - Water Div Monitoring Hi Angie, Here is a professional services agreement with Gale Jordan Associates for asbestos monitoring in the Water Division for your review and sign -off. Their insurance certificates and waivers should be active and in place as they are currently conducting the asbestos removal and monitoring for the City Hall Roof Project. Please let me know if you need any additional information. Thanks! . . . . . . . . . . . . . . N, ► 350 Main Street, El Segundo, CA 90245 U&)&. UITY HA.I.A., IS CLOSED ON Ii'RIDAYS