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PROOF OF INSURANCE (2014) CLOSEDJLEEENG -01 YUENG ACORO- CERTIFICATE OF LIABILITY INSURANCE 718/26/2014 E(MM/DD/YYYY) 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 4 . PRODUCER License # OE67768 AM E: r GI l Yuen IOA Insurance Services -SF PHONE 926 416 -7862 _.. FAX 826 416 -7869 3875 Hopyand Road Suite 240 � - -• - -.��N' - Pleasanton, CA 94560 n11nRimn. GII3I.Yuen0loausa.com INSURE S AFFORDING COVERAGE NAIC dr INSURER A: Travelers Property Casualty Company of America 25674 INSURED INSURER 9: Argonaut Insurance Company 19801 JLee Engineering, Inc. INSURER C: 430 S. Garfield Avenue, #301 INSURER 0: Alhambra, CA 91801 INSURER E: ._ . ............. _ ........... ... .......... ............................................... ............................._� ................� INSURER F COVERAGES CERTIFICATE NUMBER: 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. Ll TYPE OF INSURANCE .. -� POLICY NUMBER M/ DPYYY fY LIMITS A X COMMERCIAL GENERAL LIABILITY _ EACH OCCURRENCE $ CLAIMS -MADE IXw]OCCUR 6808855N594 09/01/2014 09/01/2015 PR MdF �a $ 11000,00 MED EXP (Anyone person) $ 10,00mm PERSONAL & ADV INJURY $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,00 POLICY E �.,,,- _�.._..- ._-- -....0 PRO- JECT LOC PRODUCTS - COMP /OP AGG $ 4,000,00 OTHE'R,t $ AUTOMOBILE LIABILITY BI REF) Eaaccident $ ... 2,000,00 A► ANY AUTO 8808855N594 09101/2014 09/01/2015 BODILY INJURY (Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ X HIRED AUTOS X NON-OWNED AUTOS accident 4 ­.... ._.. ......... _ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAS CLAIMS -MADE AGGREGATE $ .. ............ . ..... DED RETENTION $ WORKERS COMPENSATION X - AND EMPLOYERS' LIABILITY STATUTE _ER A ANY PROPRIETOR/PARTNER/EXECUTIVE Y/ N UB329OT632 09/01/2014 09/01/2015 E.L. EACH ACCIDENT $ 11000,00 OFFICERIMEMBER EXCLUDED? N/A - — _ ................... . (Myyandatory In NH) E.L. DISEASE - EA EMPLOYE $ 1,000,00 DESG�RIPT ON OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ 1,000,000 B Professional Liab. IAE1262601 11/02/2013 11/02/2014 Per Claim 1,000,00 B Professional Liab. JAE1252601 11102/2013 11/02/2014 Aggregate 1,000,00 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) All Operations of the Named Insured. General Liability only: City of El Segundo, Its officers, officials, employees, and authorized volunteers Is named as Additional Insured but only as respects liablllty arising out of the Named Insured's operations In Professional Services Agreement; such coverage Is Primary and Non - Contributory as respects any insurance carried by the Additional Insured with respect to work performed by the Named Insured. Also, note that the aforementioned General Liability Includes coverage for Hired & Non -Owned Auto Liability. Above policies Include Waiver of Subrogation In favor of the eformentioned Additional Insured. � 9 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE u,. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ! M;y AUTHORIZED REPRESENTATIVE City of El Segundo , z'' 350 Main Street 191 ftgundg. CA 907AG ®1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABILITY POLICY NUMBER: 680-8855N594-TIL-13 ISSUE DATE: 07-17-13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED (ARCHITECTS, ENGINEERS AND SURVEYORS) This endorsement modes insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE NAME OF PERSON(S)OR ORGANIZATION(S): �?�„ PER SCHEDULE ON FILE `.,X ;xo PROJECTILOCATION OF COVERED OPERATIONS: 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 performance 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 stated in the LIMITS OF INSURANCE (Section 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 COMMERCIAL 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 ance" with that additional insured entered Into by which coverage is sought occurs;and you before, and in effect when, the "bodily injury" (2) The "personal injury" for which coverage is or "property damage" occurs, or the "personal in- 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 have 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 TRAVELERS WORKERS COMPENSATION AND ONE TOWER SQUARE EMPLOYERS LIABILITY POLICY HARTFORD, CT 06183 ENDORSEMENT WC 99 03 76( A)— 001 POLICYNUMBER: (XJUB-3290T63-2-13) 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. The additional premium for this endorsement shall be 03.00 % of the California workers' compensation pre- mium. Schedule Person or Organization Job Description ANY PERSON OR ORGANIZATION FOR , .,.* WHICH THE INSURED HAS AGREED BY WRITTEN CONTRACT EXECUTED PRIOR TO LOSS TO FURNISH THIS ) WAIVER. , This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The Information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective Policy No. Endorsement No. Insured Premium Insurance Company Countersigned by DATE OF ISSUE: 07-16-13 ST ASSIGN: Page 1 of 1 -----Original Message----- From: Garcia, Angelina Sent:Tuesday, September 09, 2014 11:34 AM To: Stack, Rebecca Cc: Lee, Sam Subject: RE: Emailing: 2014 SEVENTH Amendment to J Lee Contract#3790, INSURANCE This looks good.Approved. Angelina Garcia -----Original Message----- From:Stack, Rebecca Sent:Tuesday,September 09, 2014 11:27 AM To: Garcia,Angelina Cc: Lee,Sam Subject: Emailing: 2014 SEVENTH Amendment to J Lee Contract#3790, INSURANCE Angie If this looks ok I will send to consultant for signature and forward to Clerk. Thanks The message is ready to be sent with the following file or link attachments: 2014 SEVENTH Amendment to J Lee Contract#3790 INSURANCE Note:To protect against computer viruses, e-mail programs may prevent sending or receiving certain types of file attachments. Check your e-mail security settings to determine how attachments are handled. 3