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PROOF OF INSURANCE (2015) CLOSEDA "R" CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DD1 /YYYY) 0/23/2014 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 COIfTACT Jerr NO ola Greyling Insurance Brokerage PHONE (770)552 -4225 jALq�qo- __L(866)550 -4082 450 Northridge Parkway ��' ,jerry,noyola @greyl,ing.com Suite 102 INSURER(S) AFFORDING COVERAGE NAIC # ................ ............................... Atlanta GA 30350 INSURERANa ............. _. INSURED INSURER B :COmmerce & Industry Insurance 19410 Kimley -Horn and Associates, Inc. INSURER C .New ITITHampshITireITITITInsurance Company 23841 P.O. Box 33068 INSURER D:Llovd I s of London 085202 Raleigh NC 27636 INSURER F: COVERAGES CERTIFICATE NUMBER:14 -15 (Kimlev Janice) 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. ) T ...... _... TY.... ..... ........ ... ....� ..,K .L A .._. __. ............._.- .,...._._.._.- ...POLICY EFF POLICY EXP ---.....,.............................. .............................. PE OF INSURANCE POLICY NUMBER MMIDDIYYYY MM /DDIYYYY LIMITS GENERAL LIABILITY ` 8�w THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN EACH OCCURRENCE $ 1,000,000 I X COMMERCIAL GENERAL LIABILITY Cit Of El Se ndo Y gu I Insurance Administrator µ '4 q " 0 RENTED PREMISE$ (Fa occu ranr $ _ 500, 0^00 A CLAIMS -MADE � OCCUR L 9645227 4/1/2014 4/1/2015 MED EXP (Any one person) $ _ 25,000 PERSONAL & ADV INJURY $ 1,000,000 X Contractual Liability GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 2, 000, 000 POLICY 5XI M . X LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident) $ 000 000 1 t...---- X BODILY INJURY (Per person) � $ A ANY AUTO — ALL OWNED SCHEDULED CA 4982985 4/1/2014 4/1/2015 BODILY INJURY (Per accident) $ AUTOS _,...... AUTOS X HIRED AUTOS X NON -OWNED .............. AUTOS PROPERTY DAMAGE ''.... Per accident. $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 ­­- B ]: EXCESS EXCESSLIAB CLAIMS-MADE .x. uµµµµ — ......10,00µW ­D` AGGREGATE -_$ $mmITIT ITIT5,IT000,000 — ED RETENTION $ E58430948 /1/2014 4/1/2015 C WORKERS COMPENSATION WC 018112556 (AOS) 4/1/2014 /1/2015 X WCSTATU pTH- AND EMPLOYERS' LIABILITY Y / N 105 . ............. ECUTIVE /EXCLUDED? NIA ... EL, EACH ACCIDENT $ 000, 000 A OFF ICEOPRIEBOER 1 I� (Mandatory in NH) � C 018112557 (CA) 4/1/2014 4/1/2015 E,L DISEASE - EA EMPLOYE ..._._..la. 1,000,000 If yes, describe under J_$ E.L.. DISEASE - POLICY LIMIT $ 1 000 , 000 ��......._, DES CRIPTION OF OPERATIONS below .— __._ ._ .. _ _............ . ...... ..... ..... _- D (,,Professional Liability 0879P070831401 4/1/2014 4/1/2015 Per Claim $2,000,000 Aggregate $2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Re: Peer Review Plaza 6th DA Amendment; Serine Ciandella. Ashdon Development, E1 Toro Inc. & The City of E1 Segundo is named as an Additional Insured with respects to General 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, 30 days' written notice (except 10 days for nonpayment of premium) will be provided to the Certificate Holder named below. (;tK I WIL;A I t -IOLUtK GANGELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ` 8�w THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN I ACCORDANCE WITH THE POLICY PROVISIONS. Cit Of El Se ndo Y gu I Insurance Administrator µ '4 q " AUTHORIZED REPRESENTATIVE y 350 Main Street E1 Segundo, CA 90245 David Collings /JERRY - �✓��^'�� y — ACORD 25 (2010/05) ©1988 -2010 ACORD CORPORATION. All rights reserved. INSn2517ntnns) n1 Thn A(`r)Pn nnma nnrl Innn nrn rnniefnrarl mnrlre of ,&rr1Rrl POLICY NUMBER: GL 9645227 COMMERCIAL GENERAL LIABILITY CG 20 37 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Location And Description Of Completed O erations AS REQUIRED BY WRITTEN CONTRACT AS REQUIRED BY WRITTEN CONTRACT Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section II - Who Is An Insured is amended to designated and described in the schedule of this include as an additional insured the person(s) or endorsement performed for that additional insured organization(s) shown in the Schedule, but only and included in the "products-completed operations with respect to liability for "bodily injury" or hazard." "property damage" caused, in whole or in part, by "your work" at the location CG 20 37 07 04 0 ISO Properties, Inc.,2004 Page 1 of 1 ❑ Policy Number: GL 9645227 COMMERCIAL GENERAL LIABILITY CG 20 33 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -- OWNERS, LESSEES OR CONTRACTORS -- AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION AGREEMENT WITH This endorsement modifies insurance provided under the following. COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section 11 — Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured any person or or- additional insureds, the following additional exclu- ganization for whom you are performing operations sions apply: when you and such person or organization have This insurance does not apply to: agreed in writing in a contract or agreement that such person or organization be added as an addi- 1. "Bodily injury", "property damage" or "personal tional insured on your policy. Such person or or- and advertising injury"arising out of the render- ganization is an additional insured only with re- ing of, or the failure to render, any professional spect to liability for "bodily injury", "property architectural, engineering or surveying ser- damage" or "personal and advertising injury" vices, including: caused, in whole or in part, by: a. The preparing, approving, or failing to pre- 1. Your acts or omissions; or pare or approve, maps, shop drawings, 2. The acts or omissions of those acting on your opinions, reports, surveys, field orders, change orders or drawings and specifica- tions; or in the performance of your ongoing operations for b. Supervisory, inspection, architectural or the additional insured. engineering activities. A person's or organization's status as an additional 2. "Bodily injury' or "property damage" occurring insured under this endorsement ends when your after: operations for that additional insured are com- pleted. a. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than ser- vice, maintenance or repairs) to be per- formed by or on behalf of the additional in- sureds) at the location of the covered operations has been completed; or b. 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 subcontrac- tor engaged in performing operations for a principal as a part of the same project. CG 20 33 07 04 0 130 Properties, Inc., 2004 Page 1 of 1 ❑