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PROOF OF INSURANCE (2014) CLOSEDAgreement No. 4605 Keyser Marston Associates, Inc. ACS CERTIFICATE OF LIABILITY INSURANCE O/24/ IDDIYYYY) .-W I 4/24r2o14 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). PRODUCER CONTACY Halidee Caile_jas MOC Insurance Services PHONE (415)9_57-0600 q° Ipy (415)957-0577 License No. 0589960 F-MAIL hcalle,jas @mocins.com 44 Montgomery St. , 17th Fl. INSURER(SI AFFORDING COVERAGE NAICIf San Francisco CA 94104 INSURERA:Golden Earle Insurance Coro• 10836 e_.... INSURED INSURERB:Republic Indemnity Companv _ 22179 Keyser Marston Associates, Inc. INSURER CEva_nston Insurance Co 35378 160 Pacific Avenue, Suite 204 INSURER D: - INSURER E Sari Francisco CA 94111 INSURER F: COVERAGES CERTIFICATE NUMBER34ASTER 2013-2014 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. __.._ NSR OLiCYEff POLIO EXrP LIMITS Iq,rR. TYPE OF INSURANCE �„��® �Rnm' POLICY NUMBER 1r PP GENERAL LIABILITY EACH OCCURRENCE $ 11000,000 OCCUR X B A CLAIMS-MADE P8932329 12/1/2013 12/1/2019 M A m L.".J $ 00,000 X COMMERCIAL GENERAL LIABILITY R ED EXP(Anv one eersonl 5 10,000 o Deductible applies PERSONAL BADVINJURY S 11000,000 GENERAL AGGREGATE _ $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG h$ 1,000,000 P'OLfCY X m LOC $ AUTOMOBILE LIABILITY L M I � Ll IF,a acCd ..._._ 1.000-000 X ANY AUTO BODILY INJURY(Per person) S A ALL OWNED SCHEDULED A 8932429 2/1/2013 12/1/2014 AUTOS AUTOS X BODILY INJURY(Per accident $ X_....HIREDAUTOS X AUTOS WNED NRIYNEI3P1".:A,Vr e $ o X CYrdtg55600 X Coll$500 Iln nsuredrnoPanaP,o bIn H $ 1.000.000 X UMBRELLA LIAB CC EACH OCCURRENCE $ 4,000,000 A EXCESS LIAB H()CLAIUR-MADE AGGREGATE $ 4,000,000 ..X RETENTIONS 10,00 X U 8932629 12/1/2013 12/1/2014 -•-••• $ 13 WORKERS COMPENSATION X rnavTneU- Oco AND EMPLOYERS'LIABILITY 2/1/2013 12/1/2014 E.L EACH AC ANY PROPRIETORIPARTNERIEXECUTIVE —] 03954619 E $ 1,000,000 OFFICER/MEMSER EXCLUDED? N I A _ ACCIDENT (Mandatory in NH) E.L.DISEASE MPLOYE- 5 1.000.000 If yos,describe under --m•-� '`' " DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1.000.000' C Professional Liability S0855446 2/1/2013 12/1/2014 Each Wrongful X , lAcl $1,000 OOO Retention: $25,000 etro Date: 11/11/1976 AGGREGATE LIMIT $2,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS 1 VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) The City of E1 Segundo, its officers, officials and employees are Additional Insured as respects their interest appears per written contract. Insurance is primary and non-contributory, 30 day notice of cancellation/10 day for non-payment of premium. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of E1 Segundo '"• ACCORDANCE WITH THE POLICY PROVISIONS. 350 90245-3 AUTHORIZED REPRESENTATIVE Halidee Callejas/HCA " " ACORD 25(2010/06) ©1988-2010 ACORD CORPORATION. All rights reserved. INSO25 onirnfil M Tho ARf1I7r1 nama and Innn ara ranictararl marlrc of At'_('114n COMMERCIAL GENERAL LIABILITY CG 20 10 07 04 POLICY NUMBER: CBP8932329 Effective Date: 12/01/2013 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name o.�.. W_..m__.. - __._.m __.__. f Additional Insured Persons) — Ww aeratin rations _Locationlsl of Covered 0 _ _w w. mm City El $ggqndo,JlL officers, offic is and employees it is understood and agreed that this insurance is primary and any other insurance maintained by the Additional Insured shall be excess only and not contributing with this insuranc `in regads to all operations as pertains# t ft npm d insured. Inform ti n—re-quir d to co, this Sct e up+e, if not sown above,will be shown ._..... _ ... ....._., gym._- �..— ` � in the Declarations. A. Section II — Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following additional exclu- organization(s) shown in the Schedule, but only sions apply: with respect to liability for"bodily injury", "property This insurance does not apply to "bodily injury" or damage" or "personal and advertising injury" pp y y caused,in whole or in part, by: "property damage' occurring after: 1. Your acts or omissions;or 1. All work, including materials, parts or equip- ment furnished in connection with such work, 2. The acts or omissions of those acting on your on the project (other than service, behalf; maintenance or repairs)to be performed by or in the performance of your ongoing operations for on behalf of the additional insured(s) at the the additional insured(s) at the location(s) desig- location of the covered operations has been nated above, completed;or 2. That portion of "your work" out of which the injury or damage arises has been put to its in- tended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a princi- pal as a part of the same project. CG 20 10 07 04 ©ISO Properties, Inc.,2004 Page 1 of 1 ❑ INSURANCE INDUSTRY CHANGE: COMMERCIAL GENERAL LIABILITY ADDITIONAL INSURED ENDORSEMENT Please be advised that the CG_ 20 10 10 01 Endorsement has been replaced with the CG 20 10 07 04 Additional Insured Endorsement. ON of El Segundo. its officers officials and emolovees are named as Additional Insured(s) on the Commercial General Liability policy. Keyser Marston Associates, Inc. provides professional services to; City of El Sepaundo, its officers, officials and employees therefore `completed operations' coverage would be addressed under the Professional Liability policy shown as "Insurer D" on the attached Certificate of Insurance. POLICY NUMBER: COMMERCIAL AUTO BA 8932429 CA 20 48 02 99 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s)or organization(s)who are"insureds" under the Who Is An Insured Provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Endorsement effective l2/01/13 Named Insured Countersigned by KEYSER MARSTON ASSOCIATES, INC. (Authorized Representative) SCHEDULE Name of Person(s)or Organization(s): CITY OF EL SEGUNDO ITS OFFICERS, OFFICIALS AND EMPLOYEES (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to the endorsement.) Each person or organization shown in the Schedule is an "insured"for Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured Provision contained in Section II of the Coverage Form. CA 20 48 02 99 Copyright, Insurance Services Office, Inc., 1998 Page 1 of 1