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PROOF OF INSURANCE (2015) CLOSEDCERTIFICATE OF LIABILITY INSURANCE ­" .. " " " " " " "'' 09/04/2014 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 PATRICK MCRAE INSURANCE SERVICES 1290 N. HANCOCK ST., SUITE 210 ANAHEIM HILLS, CA 92807 INSURED ........ ......... ....... _..... BIG WEST CONSTRUCTION 15331 NORMANDIE Irvine COVERAGES CA APGe,,(y. (714) 779 -6999 No), (714p 779 -6903 DD IES$; p.mcrae @sbcglobal.net I : SURERIS)AFFORDING COVERAGE NAIC # INSURER A MT. H A WLEY INSURANCE COMPANY 37974 INSURER B;. GOLDEN EAGLE INSURANCE CORPORATION 10836 INSURER C : INSURER D INSURER E. ... ... -. .._ 92604 INSURER F . CERTIFICATE NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. JSR . ADI�LISUBR _ - POLICY EPF YEXP I A X COMMERCIAL GENERAL LIABILITY X I MGLO180690 104/30/2014 04/30/201 TO RENTED LIMITS ,TR I TYPE OF INSURANCE POLIO POLICY NUMBER M D11fYYYY MMID /2015 DAMAGE CURRENCE_ ) 6 I L��b� bl b I (( ((� ^ ^ [_ I J CLAIMS -MADE ( XI OCCUR PREMISE$ (Fa e wrrwhcscel P 50,000 GENT AGGREGATE LIMIT APPLIES PER POLICY I X &I+ rl LOC B AUTOMOBILE LIABILITY $ X �. X '- ANY AUTO 2,000,000 ALL OWNED SCHEDULED $ 1000,00 AUTOS AUTOS , - — X HIRED AUTOS X ( NON -OWNED BODILY INJURY (Per accident) $ 0ROP F RTY DAw AGr AUTOS _. (Pat arcldonl)� UMBRELLA LIAR 1 OCCUR EXCESS LIAB } CLAIMS -MADE $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y$ N, ANY PROPRIETOR /PARTNER /EXECUTIVE OFFICER /MEMBER EXCLUDED? - NIA? (Mandatory in NH) If ves. describe under MED EXP iAny one person) $ EXCLUDED PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000 „000 PRODUCTS - COMP /OPAGG $ 2,000,000 COMBINED 9INGI E LIMI °G $ 1000,00 (Ea accidenlp - , - — BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ 0ROP F RTY DAw AGr $ _. (Pat arcldonl)� .. EACH OCCURRENCE $ AGGREGATE I$ EL EACH ACCIDENT $ E,L DISEASE - EA EMPLOYEF $ E.L DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) THE CITY OF EL SEGUNDO, ALONG WITH THEIR OFFICERS, OFFICIALS, AGENTS, EMPLOYEES AND VOLUNTEERS ARE NAMED AS ADDITIONAL INSURED WITH RESPECTS TO THE ABOVE MENTIONED POLICIES PER ATTACHED ENDORSEMENT(S). COVERAGE IS PRIMARY & NON - CONTRIBUTORY AS REQUIRED BY WRITTEN CONTRACT, PER ATTACHED ENDORSEMENT FORMS. WAIVER OF SUBROGATION APPLIES, IF REQUIRED BY WRITTEN CONTRACT. . SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, A 30 DAY WRITTEN NOTICE WILL BE ISSUED, SHOULD ANY OF THE ABOVE POLICIES BE CANCELLED FOR NON - PAYMENT, A 10 DAY WRITTEN NOTICE WILL BE ISSUED. RE: GROUP 55 PROJECT CERTIFICATE HOLDER "" CANCE THE CITY OF EL SEGUNI 350 MAIN ST. EL SEGUNDO CA JI ��^yy�p�^� �y , I"5 X AUTHORIZED REPRESENTATIVE @ 1988 -2013 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ACORD 25 (2013/04) Policy Number: MGLO178121 Mt. Hawley Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. SECTION II — WHO IS AN INSURED is amended to include as an additional insured any person or organization for whom you are performing operations when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy. Such person or organization is an additional insured only with respect to liability for "bodily injury," "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongog- operations for the additional insured. A person's or organization's status as an additional insured under this endorsement ends when your operations for that additional insured are completed. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to; 1. "Bodily injury," "property damage" or "personal and advertising injury" arising out of the rendering of, or the failure to render, any professional architectural, engineering or surveying services, including: a. The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or b. Supervisory, inspection, architectural or engi- neering activities. 2. "Bodily injury" or "property damage" occurring after: a. 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 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 subcontractor engaged in performing operations for a principal as a part of the same project. CG 20 33 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 Insured Policy Number: MGLO180690 Mt. Hawley Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS (FORM C) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART (If no entry appears below, information required to complete this endorsement will be shown in the Declarations as appli- cable to this endorsement.) WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in the Sched- ule, but only with respect to liability arising out of "yon u" for that insured by or for you. To the extent required under contract, this policy will apply as primary insurance to additional insureds scheduled below and other insurance which may be available to such additional insureds will be non - contributory. Section IV., Condition 4., of this policy is amended accordingly. SCHEDULE Name of Person or Organization: All persons or organizations where required by written contract. CGL 216 (04/98) ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED. Insured Page 1 of 1 Policy Number: MGLO180690 Mt. Hawley Insurance Company 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 SCHEDULE Name Of Person Or Organization: All persons or organizations where required by written contract. (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as appli- cable to this endorsement.) The Transfer Of Rights Of Recovery Against Others To Us Condition (SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS) 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. CG 24 04 10 93 Copyright, Insurance Services Office, Inc., 1992 Page 1 of 1 Insured BIGWE4 OP ID: KL DATE(MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE F 0910512014 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 WANED, 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 Phone: 949-756-4100 A" INVENSURE Insurance Brokers Fax: 949 - 756 -4199 PHONE " 17991 Cowan RE'VIS'ION NUMBER: NPANQ' M; Irvine, CA 92614 -6025 IS TO CERTIFY THAT THE POLICIES APPR §$ ` . Richard M. Sherman, CIC LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE INSURER(S) AFFORDING COVERAGE INDICATED. NOTWITHSTANDING ANY REQUIREMENT, INSURERA:State Comp. Insurance Fund INSURED Big West Construction Corp. TERM OR CONDITION OF ANY IN B _ 15331 Normandie Ave DOCUMENT WITH RESPECT TO WHICH THIS Irvine, CA 92604 MAY BE ISSUED OR MAY 11 INSURER C: THE INSURANCE AFFORDED BY INSURER D DESCRIBED HEREIN IS SUBJECT TO INSURER E COVERAGES CERTIFICATE NUMBER: RE'VIS'ION 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. �ADDLSUBPS ,.,,_�,... —. .,,.,.PbUdYEFF P01aCYEXP LIMITS TYPE OF INSURANCE POLICY NUMBER GENERAL LIABILITY EACH OCCURRENCE $ °OAMAGETO RENTED COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence) $ �$ CLAIMS -MADE Z OCCUR -„ MED EXP (Any p one Person) PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ POLICY Pit �' - Lac $ COMBINED SIN= LIMIT AUTOMOBILE LIABILITYEaacoident) _ $ BODILY INJURY Per person) $ ANY AUTO ALLOWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS NON-OWNED pi1 RTY i)AMAOE IA mo $ HIRED AUTOS AUTOS accidant) UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE $ DED J RETENTION $ $ WORKERS COMPENSATION X WCSTATU OR TQRX (,HITS, ER A AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER /EXECUTIVE Y❑ X '91026$6 -74 06/01/2014 06/01/2015 E L EACH ACCIDENT $ 1,000,00 OFFICER /MEMBER EXCLUDE[ (Mandatory In NH) N / A. E L DISEASE - EA EMPLOYEE „ $ 1,000,00 ®. ,, If yyes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT J $ 1,000,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Waiver of Subrogation applies per attached endorsement. City of El Segundo 350 Main Street El Segundo, CA 90 ACORD 25 (2010105) ELSEG -1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ,g-w 0.;P�� ©1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD &MLOW or-1Y1G1Y 1 A1711GG1Y1G1111 WAIVER OF SUBROGATION 9102636 -14 NEW SP PAGE 1 HOME OFFICE SAN FRANCISCO EFFECTIVE SEPTEMBER 4, 2014 AT 12.01 A.M. ALL EFFECTIVE DATES ARE AND EXPIRING JUNE 1, 2015 AT 12.01 A.M. AT 12:01 AM PACIFIC STANDARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME BIG WEST CONSTRUCTION CORP 15331 NORMANDIE AVE IRVINE, CA 92604 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` WHICH MIGHT ARISE BY REASON OF ANY PAYMENT UNDER THIS POLICY IN CONNECTION WITH WORK PERFORMED BY, BIG WEST CONSTRUCTION CORP 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: SEPTEMBER 8, 2014 2570 AUTHORIZED REPRESENT • IVE PRESIDENT AND CEO