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PROOF OF INSURANCE (2015) CLOSED�� �. DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 6/23/2014 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 CONTACT Risk Strategies Company NAME: Risk Strategies Compaq 2040 Main Street, Suite 450 PiioNE 949- 242 -92ao FAX �9 ,�� �� Irvine, CA 92614�(`tD' ° ~� E -MAIL m... www.risk - strategies.com CA DOI License No. OF06675 INSURER A : . SURE � PMC nicipal Consultants.'........ __......... _ ...�_ _._.. � ..mm..... _ _m� m... S INSURED INSURER B INSURER C 2729 Prospect Park Dr., Ste. 220 INSURER D: Rancho Cordova CA 95670 INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: I`IAnAn14 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. INSR ._._.......... .�._._.•....� .................. .............................. �.:�.. �....�.�..�...�., U POLICYYEFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER O MA LIMITS A c ✓ IOB3914666103 7/1/2014 7/1/2015 Y mmMMERCIALGENERALLIABILITY CLAIMS -MADE � / OCCUR AMA$ N •_ ........ pREM,IOSESUEaRaocu ence $ .,000.,000 $1 000 00 0 MED EXP (Any one person) $ $10,000 _ PERSONAL &ADV INJURY $ $2,000,000 0,O GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ $4,O 00, 00 PRO - POLICY ✓ LOC JECT ❑ P...... �. �.�.�.�.�.�..._. �.��..�.�......���.�.�� ..... ..._ ....... ..............._.... DUC A $ _..Ro.....�TS..: COMP /OP....GG . _. " " ".......... ". " "".__.00 $4,000,000 OTHER: $ A AUTOMOBILE LIABILITY OB3914666103 7/1/2014 7/1/2015 CpM6 °I "J'EDSBNGLEL °°M°T $ $2,000,Ot)0 ,ww�(�rmt) ANY AUTO BODILY INJURY (Per person) $ _...ALLOWNED SCHEDULED AUTOS AUTOS BODILYINJURY(Peraccident) $ PROPERTY DAMAGE . $ _�.�_�.� ,,,,,ITIT „_,_.,,. NON -OWNED * . •'' HIRED AUTOS ✓, AUTOS Per Fac ddent A '.. ✓ UMBRELLALIAa ,q/ _,' OCCUR 063914666103 7/1/2014 7/1/2015 EACH OCCURRENCEm .m.__ C „C S . ITITmmmITITIT m$ $2,000,000 _ _ m$2,000,000 EXCESSLIAB CLAIMS -MADE AGGREGATE DED ✓ RETENTION $10,000 s B WORK RS COMPENSATION ✓ WZ3912749004 (CA, AZ) 7/1/2014 7/1/2015 ✓ Pra OFTH- C AND EMPLOYERS' LIABILITY YIN VVD3912749603 (OR) 7/1/2014 7/1/2015 �,IT� __� ANY PRC1FIrtVE" GORa 'PAr( "9`INLRI�k�YtV'OtITIIVIm OF'FICER�Y EMSER EXCLUDED? N / A E L EACH ACCIDENT `_. . """" -" $ $1 ,000,000 (IM1nordatnry in NH) F I DISEASE -EA FMPI OYF $ $1,000 ;000 Ues, descrON un O EI ATIONS ISkAIo E _ .. ...;. . .I_.DISEASE- POLICY LIMIT $ $1,000,000 D Professional Liability MCH288307507 7/1/2014 7/1/2015 Per Claim: $2,000,000 Aggregate: $3,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Projects as on file with the insured including but not limited to Contract Planning Assistance. City of EI Segundo, its officials and employees are named as additional insureds on the general liability policy and a waiver of subrogation applies to the work comp policy -see attached endorsement. The above policies contain a 30 -day notice provision for non - renewal and cancellation, 10 -day notice for non - payment of premium. CERTIFICATE HOLDER CANCELLATION ° Clt of EI Se undo ti SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE y 9 /4, THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Planning & Building Safety (d'N\ � ) ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Planning Manager ✓s ^� El SegulndotCA 90245 -3813 AuTHORIZEDREPRESENraT1VE (BSTN) Mike Christian ©1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD CERT NO.: 20606014 (IRVN) Sherry Young 6/23/2014 11:18:01 AM (PDT) Page 1 o£ 5 POLICY NO.:063914666103 INSURED: Pacific Municipal Consultants, dba: PMC THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. GENERAL LIABILITY SUPPLEMENTARY ENDORSEMENT This endorsement modifies insurance provided under the following„ �0 �� BUSINESSOWNERS COVERAGE FORM � 1. Additional Insured by Contract, Agreement or (ii) The "bodily injury", "property Permit damage" or "personal and Under SECTION II — LIABILITY, C. Who Is An Insured, Paragraph 4. is added as follows: a. Any person or organization for whom you are performing operations when you and such person or organization have agreed in writing in a contract, agreement or permit 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, but only with respe�t to: - (3) "Your work' or the additional insured(s) at the location designated in the contract, agreement or permit; or (4) Premises you own, rent, lease, control or occupy. This insurance applies on a primary basis if that is required by the written contract, agreement or permit. b. This provision does not apply: (1) Unless the written contract or written agreement has been executed or permit has been issued prior to the "bodily injury", "property damage" or "personal and advertising injury"; (2) To any person or organization included as an insured by an endorsement issued by us and made part of this Policy; (3) To any lessor of equipment: (a) After the equipment lease expires; or (b) If the "bodily injury", "property damage" or "personal and advertising injury" arises out of the sole negligence of the lessor; (4) To any: (a) Owners or other interests from whom land has been leased which takes place after the lease for that land expires; or (b) Managers or lessors of premises if. (i) The occurrence takes place after you cease to be a tenant in that premises; or advertising injury" arises out of structural alterations, new constructio or demolition operations <performed by or on behalf of the manager or lessor; or (5) To "bodily injury", "property damage" or "personal and advertising injury' arising out of the rendering of or the failure to render any professional services. This includes but is not limited to any professional services as an architect or engineer arising out of any construction agreement or activities under which any insured or anyone acting on any insured's behalf provides or provided service, advice, expertise or work. Construction includes, but is not limited to, the plan, conception, design, build, construct, assembly, development, safety, erection, formation, reconstruct, rehabilitation, repair, or any improvement made to real property. Construction also includes the hiring, supervision or management of any of these activities. However, this exclusion does not apply to liability arising out of an insured's presence at a jobsite that was not caused by professional activities listed in the above paragraph. c. Additional insured coverage provided by this provision will not be broader than coverage provided to any other insured. d. All other insuring agreements, exclusions, and conditions of the policy apply. II. Additional Insured by Contract, Agreement or Permit — Primary and Non - contributory The following is added to SECTION III — COMMON POLICY CONDITIONS: M. Other Insurance 1. Additional Insureds If you agree in a written contract, written agreement or permit that the insurance provided to any person or organization included as an Additional Insured under SECTION II - LIABILITY, Part C — Who is An Insured, is primary and non - contributory, the following applies: 391 -1586 02 11 Includes copyrighted material of Insurance Services Offices, Inc., with its permission CERT NO.: 20606014 (IRVN) Sherry Young 6/23/2014 11:16:01 AM (PDT) Page 2 of 5 Page 1 of 3 If other valid and collectible insurance is When this insurance is excess, we will have available to the Additional Insured for a loss no duty under SECTION li — LIABILITY, we cover under SECTION II — LIABILITY, Part A. Coverages, 1. Business Liability to Part A. Coverages, Paragraph 1., Business defend the insured against any "suit" if any Liability our obligations are limited as other insurer has a duty to defend the follows: insured against that "suit ". If no other insurer a. Primary Insurance defends, we will undertake to do so, but we will be entitled to the insured's rights against This insurance is primary to other all those other insurers. insurance that is available to the Additional Insured which covers the When this insurance is excess over other Additional Insured as a Named Insured. insurance, we will pay only our share of the amount of the loss, if any, that exceeds the We will not seek contribution from any sum of: other insurance available to the Additional Insured except: (1) The total amount that all such other insurance would pay for the loss in the (1) For the sole negligence of the absence of this insurance; and Additional Insured; (2) The total of all deductible and self - (2) When the Additional Insured insured amounts under all that other Additional Insured under anothee r primary liability policy; or insurance. (3) When b.(2) below applies. We will share the remaining loss, if any, with any other insurance that is not described in If this insurance is primary, our this Excess Insurance provision and was not obligations are not affected unless bought specifically to apply in excess of the any of the other insurance is also Limits of Insurance shown in the primary. Then, we will share with all Declarations of this Coverage Part. that other insurance by the method described in b.(3) below. c. Method Of Sharing b. Excess Insurance If all of the other insurance permits contribution by equal shares, we will follow this method also. This insurance is excess over: Under this approach each insurer contributes (1) Any of the other insurance, whether equal amounts until it has paid its applicable limit primary, excess, contingent or on of insurance or none of the loss remains, any other basis: whichever comes first. (a) That is Fire, Extended If any of the other insurance does not permit Coverage, Builder's Risk, contribution by equal shares, we will contribute Installation Risk or similar by limits. Under this method, each insurer's share coverage for "your work "; is based on the ratio of its applicable limit of (b) That is Fire insurance for insurance to the total applicable limits of premises rented to the insurance of all insurers. Additional Insured or III. Aggregate Limit of Insurance (Per Project) temporarily occupied by the __, a. For purposes of the coverage provided by this Additional insured with endorsement, D. Liability and Medical permission of the owner; Expenses Limits of Insurance under Section 11 (c) That is insurance purchased by — Liability is amended by adding the following: the Additional Insured to cover The General Aggregate Limit under D. Liability the Additional Insured's liability and Medical Expenses Limits of Insurance as a tenant for "property applies separately to each of "your projects" or damage" to premises rented to each location listed in the Declarations. the Additional Insured or temporarily occupied by the b. For purposes of the coverage provided by this Additional Insured with endorsement F. Liability And Medical permission of the owner; or Expenses Definitions under Section -11 - Liability is amended by adding the following: (d) If the loss arises out of the maintenance or use of aircraft, a. "Your project" means: "autos" or watercraft to the i. Any premises, site or location at, on, or extent not subject to Exclusion in which "your work" is not yet g. of SECTION 11 — LIABILITY, completed; and Part A. Coverages, 1. Business Liability. ii. Does not include any location listed in the Declarations. 391 -1586 02 11 Includes copyrighted material of Insurance Services Offices, Inc., with its permission Page 2 of 3 CERT NO.: 20606014 (SRVN) Sherry Young 6/23/2014 11:18:01 AM (PDT) Page 3 of 5 IV. Blanket Waiver of Subrogation Paragraph K. Transfer Of Rights Of Recovery Against Others To Us in Section III — Common Policy Conditions is amended by the addition of the following: We will waive any right of recovery we may have against any person or organization when you have agreed in a written contract, permit or agreement to waive any rights of recovery against such person or organization 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 ". 391 -1586 0211 Includes copyrighted material of Insurance Services Offices, Inc., with its permission Page 3 of 3 CERT NO- 20606014 (xxvcv) sherry Young 6(23(2014 11:18:01 AM (PDT) page 4 of 5 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT— CA , This endorsement changes the policy to which it is attached effective on the inception date of the policy unless otherwise stated. This endorsement effective on 7/12014 part of Policy No. WZ3912749004 (CA, AZ) of the Hanover American Insurance Co. issued to: Pacific Municipal Consultants, dba: PMC Premium if an $ at 12:01 am standard times forms a Authorized Representative 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. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 2.000% of the California workers' compensation premium otherwise due on such remuneration. Schedule Person or Organization ANY PERSON OR ORGANIZATION WITH WHOM YOU AGREE IN WRITING TO WAIVE YOUR RIGHT TO RECOVER AGAINST THEM. YOU MUST AGREE TO THIS WAIVER PRIOR TO THE DATE OF LOSS Job Description: Projects as on file with the insured WC 252 040 84 CERT NO.: 20606014 (IRVN) Sherry Young 6/23/2014 11:18 :01 AM (PDT) Page 5 of 5