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PROOF OF INSURANCE (2013) CLOSED CERTIFICATE OF LIABILITY INSURANCE 3/21/2013 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 pollcy(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 CONTACT Jerry Noyola AAL- Greyling Insurance Brokerage PHONE (770)552-4225 fAX (866)550-4082 450 Northridge Parkway MAIL jerry.noyola @g,:�eYlang.com Suite 102 INSURER(S)AFFORDING COVERAGE N.A.IC r! Atlanta GA 30350 INSURERA Commerce & Industry Insurance 19410 INSURED INSURER B-Chartls Specialty Insurance Co. 26883 Geosyntec Consultants, Inc. INSURER C:Ins. Co. of the State of PA 19429 . ............ .... 900 Broken Sound Parkway NW INAIIRFR,O; Suite 200 IN_St1RE_R E_ Boca Raton FL 33487 INSURER F: COVERAGES CERTIFICATE NUMBER:12-13 (Geosyntec Main) 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. TNSR POLICY EFF POLICY EXP 17R TYPE OF INSURANCE INCR wvn POLICY NUMBER lM MIr1rTIWW1 1nn,n11nn1Yvyvt LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,00 OOO' COMMERCIAL-GENERAL LIABILITY PRP-NiSpC $ 11000,000 A CLAIMS-MADE OCCUR 3L 417-86-18 9/1/2012 9/1/2013 MED EXP(Any one person) $ 25,000 X Contractual Liability PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE S 21,000!000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2 000,000 POI.CCY PRO- - d OC _. __ _.. . __ .$ X AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT !Fa rodenlY % 1.000.000 A Ix ANY AUTO BODILYINJURY(Perperson) $ ALLOWNED SCHEDULED :A 505-39-37 (AOS) '9/1/2012 9/1/2013 BODILY INJURY(Per accident) $ A AUTOS X NON-OWNED 195-54-51 (NA) 9/1/2012 9/1/2013 PROPERTY DAMAGE HIRED AUTOS AUTOS !?° ^°^�� $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 10,000,000 B EXCESS LIAB CLAIMS-MADE AGGREGATE $ 10,000,000 nFn RETFNTIfNR 8085625 3/1/2012 9/1/2013 $ WORKERS COMPENSATION T RV C 035896456 (ADS) 9/1/2012 9/1/2013 WC STATU 0TH- , C EMPLOYERS'LIABILITY X AND E I.AIT 1 FR .11,11 NI I C 035896457 (CA) E.L EACH ACCIDENT $ 1.000.00 ANY PROPRIETOR/PARTNER/EXECUTIVE (Mandatory NH)EXCLUDED? NIA 19/1/2012 ,9/1/2013 E � (Mandatory in NH) EL,.DISEASE-EA EMPLOYEE $ If es,describe under DESCRIPTION OF OPERATIONS below E.L,DISEASE-POLICY LIMIT $ 1.000.000 _ �I, � B Professional Liability COPS 1951904 /1/2012 9/1/2013 Per Claim $8,000,000 Contractors Poll. Liab. Aggregate $10,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space is required) Re: PSA - Stormwater Permit Compliance. The City of El Segundo, its officials & employees are named as Additional Insureds on the above referenced liability policies with the exception of workers compensation & professional liability where required by written contract. The above referenced liability policies with the exception of professional liability are primary & non-contributory where required by written contract. Should any of the above described policies be cancelled by the issuing insurer before the expiration date thereof, we will endeavor to provide 30 days' written notice (except 10 days for nonpayment of premium) to the Certificate Holder named below. 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 - .Pub c W ACCORDANCE WITH THE POLICY PROVISIONS. Stephanie Katsouleas 350 Main Street AUTHORIZED REPRESENTATIVE E1 Segundo, CA 9024 Matias Ormaza/JERRY ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025 onlnnsl n1 Tho Arf1Rr1 nama and Innn ara ranictararl marks of Arn ll POLICY NUMBER. GL 417-86-18 COMMERCIAL GENERAL LIABILITY CG 2010 07 04 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 Of Additional Inured Person(s) Or Or nizationls);,---1 Locations) Of Covered Operations BLANKET AS REQUIRED WRITTEN CONTRACT Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II - Who Is An Insured is amended to 1. All work, including materials, parts or equip- include as an additional insured the person(s) or ment furnished in connection with such organizations) shown in the Schedule, but only work, on the project (other than service, with respect to liability for "bodily injury' maintenance or repairs) to be performed by ""property damage" or 'personal and advertising or on behalf of the additional insured(s) at injury" caused, in whole or in part, by. the location of the covered operations has 1. Your acts or omissions; or been completed; or 2. The acts or omissions of those acting on 2. That portion of "your work" out of which your behalf; the injury or damage arises has been put to its intended use by any person or organ- in the por'forrnance of your ongoing operations ization other than another contractor or sub- for [tie additional insured(s) at the locations) contractor engaged in performing oper- designated'a'bove', ations for a principal as a part of the same B. With respect to the insurance afforded to these project. additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" -or "property damage" occurring after: CG 20 10 07 04 0 ISO Properties, Inc.,2004 Page 1 of 1 0 POLICY NUMBER:CA 505-39-37 COMMERCIAL AUTO 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 modi- fied by this endorsement. This endorsement identifies person(s) or organization(s)who are"insureds" under the Who Is An Insured Provi- sion 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 indi- cated below. Endorsement Effective:.09 0 1712 Countersigned By: Named Insured: t9.A444 GI=OSYNTEC CONSULTANTS (Authorized Representative) SCHEDULE Name of Person(s)or Organlzation(s): BLANKET WHERE REQUIRED BY WRITTEN CONTRACT (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 t O BLANKET WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement changes the policy to which it Is attached effective on the Inception date of the policy unless a different date Is indicated below. {The fokming'attaching clause' need be compleW only when Ns andorownent Is Issued subsequent to preparation of the pokyi. This endorsement,effective 12 : O 1 AM 0 9/01/12 forms a part of Policy No. WC 0 3 5 8 9 6 4 5 7 Issued to GEOSYNTEC CONSULTANTS. INC. By THE INSURANCE COMPANY OF THE STATE OF PENNSYLVAN We have a right to recover our payments from anyone liable for an inyu red by this policy. We will not enforce our right against any person or organization with whom you have a wri an contract that requires you to obtain this agreement from us, as regards any work you perform for such person or organization. The additional premium for this endorsement shall be 2% of the total estimated workers compensation premium for this policy. WC 04 03 Gi Countersigned by (Ed. 11190) Authorized Representative