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PROOF OF INSURANCE (2015) CLOSEDDATE (MMIDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 10/30/2014 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 Garrett/Mosier /Griffith /Sistrunk C' NTACT AME _ Risk Management &Insurance Services PHONE "�" Irvine CA 92620 12 Truman mn Xll (949)559- 6700 1It Nc) (949)559-6703 ADD RE :' ........ www.gmgs.com OB84519 INSURED EEC Environmental One City Boulevard West, Suite 1800 Orange CA 92868 NAIC n Insurance Company Ra�E.... AFFORDING COVE .......... 25224 Trance Comoanv 24198 Comoanv P 17370 COVERAGES CFRTIFICATF NIIIVIRPR• la,sd,^riltq PPVIQInIJ lull Hmr r-o 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. - -(_ S(li'BiY.... .m..m'F'(7LIC'1'IEFFNOLNCY EXP' PTR TYPE OF INSURANCE _ _ ..... ....................� I POLICY NUMBER MMIDDIYYYY ) tMM0DDryYyyI LIMITS A ," COMMERCIAL GENERAL LIABILITY GLP2006942 -12 10/31/2014 10/31/2015 EACH OCCURRENCE $ 5,000,0 CLAIMS -MADE �/ 1 OCCUR U RRFMVS& + 5" CECN ._ ..... .... - :: SdH ................ ....... ..,,,,..... , ..�ww .... 100,000 �. a._ � ......................................................_.,,.,. .. ..........................,. MED EXP (Any one person) .- . . ..-$....... $ 5,000' .........................wwww.. PERSONAL & ADV INJURY _ -$ 5,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 5,000,000 POLICY �� JEftQ E LOC _ PRODUCTS -- COMP /OP AGG$� - - 5,000,000 OTHER: $ AUTOMOBILE LIABILITY CBP8977390 10/31/2014 10/31/2015 COMBINED SINGLE LIMIT ......... 1 „000,00 ANY AUTO BODILY INJURY (Per person) ''. $ _.....- ALL OWNED ......., SCHEDULED AUTOS AUTOS - BODILY INJURY (Per accident) $ - - -- NON -OWNED HIRED AUTOS AUTOS PROPERTI' 5'AgKG —Emm.. PeracoGdertt) ..... „v- w. e... .____ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS - MADE'. AGGREGATE „ ............. .. $ .,......., DE D RETENTION $ $ A WCA2008815 -11 5/24/2014 5/24/2015 ER" AND EMPLOYERS' L LIABILITY YIN _✓ STAT�I,TE;., „_ EXCLUDED? ECUTIVE ❑ NIA _ m _,.,n,,,..m......1..,'000,000 (MandatR/M in NH) E.L,� DISEASEC A EMPLOYEE $ If -$ ..... .......................�.�.�.�1 DESCRIPTION OF OPERATIONS below EL, DISEASE-POLICY LIMIT ,000,000 D Pollution Liability CCP2006941 -12 10/31/2014 10/31/2015 Each Poll Occurrence $5,000,000 Professional Liability Each Prof Liab Claim $5,000,000 General Aggregate: $5,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: Sewer System Management Plan As respects General Liability coverage„ City of Ell Segundo, its officials and employees are added as AddRional Insureds and this insurance is primary per EN 2154 -A0906 attached. As respects Automobile Coverage, Business Auto Coverage Form CA 00 01 10 01 applies. As respects Workers' Compensation coverage,, a'Waiver of Subrogation is hereby Included per + C040306 attached. As respects General Liability coverage, 30 -day written notice of cancellation (10 days for non - payment of premium) applies per IL00171198 attached. k.r-K I Ir`P.A I t: MULUIZK.. C:ANI:tLLA I TUN Sewer System Management Plan City of El Segundo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE y g THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Public Works ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street El Segundo CA 90245 AUTHORIZED REPRESENTATIVE;rT7CM,✓ Griff Griffith ©1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD CERT NO.: 221'75133 Marissa Romo 10/30/2014 3:56:29 PM (PDT) Page 1 of 4 ..p"'1. w EEC Environmental COMMON POLICY CONDITION All Coverage Parts included in this policy are subject to the following conditions. A. Cancetlatlon 1. The first Named Insured shown In the Dealara- tlons may cancel this policy by mailing or deliv- ering to us advance written notice of cancella- tion. 2. We may cancel this policy by mailing or deliver - Ing to the first Named Insured written notice of cancellation at least: a. 10 days before the effective date of cancel- lation if we cancel for nonpayment of pre- mium; or b. 30 days before the effective date of cancel - Mon if we cancel for any other reason. 8. We will mail or deliver our notice to the first Named Insured's last, mailing address known to us. 4. Notice of cancellation will state the effective date of cancellation. The policy period will end on that date. 5. If this policy Is cancelled, we will send the first Named Insured any premium refund due. If we cancel, the refund will be pro rata. If the first Named Insured cancels, the refund may be less than pro rata. The cancellation will be ef- fective even if we have not made or offered a refund. 6. If notice Is mailed, proof of mailing will be suifi- clent proof of notice. B. Changes This policy contains all the agreements between You and us concerning the Insurance afforded. The first Named Insured shown In the Declarations Is authorized to make changes in the terms of this policy with our consent. This policy's terms can be amended or waived only by endorsement Issued by us and made a part of this policy. C. Examination Of Your Books And Records We may examine and audit your books and re- cords as they relate to this policy at any time dur- ing the policy period and up to three years after- word. D. Inspections And Surreys 1. We have the right to: a. Make inspections and surveys at any time; IL 00171148 IL 00 17 11 98 b. Give you reports on the conditions we find; and e. Recommend changes. 2. We are not obligated to make any Inspeotions, surveys, reports or recommendations and any such actions we do undertake relate only to In- surability and the premiums to be charged. We do not make safety Inspections. We do not un- dertake to perform the duty of any person or organization to provide for the health or safety of workers or the public. And we do not warrant that conditions: a. Are safe or healthful; or b. Comply with laws, regulations, codes or standards. 9. Paragraphs 1. and 2, of this oondition apply not only to us, but also to any rating, advisory, rate service or similar organization which makes in- suranoe Inspections, surveys, reports or rec- ommendations. 4. Paragraph 2. of this condition does not apply to any inspections, surveys, reports or recom- mendations we may make relative to certifica- tion, under state or municipal statutes, ordi- nances or regulations, of boilers, pressure ves- sels or elevators. E. Premiums The first Named Insured shown in the Declara- tions: 1. Is responsible for the payment of all premiums; and 2. Will be the payee for any return premiums we pay - F. Transfer Of Your Rights And Duties Under This Policy Your rights and duties under this policy may not be transferred without our written consent except In the case of death of an Individual named insured. If you die, your rights and duties wait be transferred to your legal representative but only while acting within the scope of duties as your legal represent&- tive. Until Your 16gall representative Is appointed, anyone having proper temporary custody of your property will have your rights and duties but only with respect to that property. Copyright, Insurance Services Office, Inc., 1898 CrRT NO.: 221.751.33 Mar.i.ssa RoYno 10(30(2074 3:56:29 PM (PDT) page 2 of 4 Page 1 of 1 D GLP2006942 -12 EEC Environmental ENDORSEMENT This endorsement forms a part of the policy to which it is attached. Please read it carefully, ADDITIONAL INSURED - BLANKET - OWNERS, LESSEES OR CONTRACTORS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Who is An Insured (Section II) is amended to include as an insured any person(s) or organizations, for whom you are performing operations under a written contract or agreement, which is in effect prior to the performance of your work which is the subject of such written contract or agreement, that such person(s) or organization(s) be added as an additional insured on your policy, but 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 the acts or omissions of those acting on your behalf, in the performance of your ongoing operations for the additional insured; or 2. Your work performed for such person(s) or organizations (s) and included in the products - completed operations hazard, only when required by the written contract or written agreement. With respect to damages caused by your work, as described above, the coverage provided hereunder shall be primary and not contributing with any other insurance available to those designated above, but only when required by written contract or agreement. © 2006 by Berkley Specialty Underwriting Managers LLC, an affiliate of Nautilus Insurance Company and Great Divide Insurance Company. All rights reserved. ©1985 -2006 by Insurance Services Office, Inc., material used by permission. ENV 2154 A 09 06 Page 1 of 1 CE:RT NO.: 22175133 Marissa Romo 10/30/2014 3:56:29 PM (PDT) Page 3 of 4 MIUMRS CKWENSATION A,ND IMLOYERS LIMILITY INWIMAITCM POLICY WC 04 03 06 (04-84) WMVER AWE' OEM, RIGHT TO SUCCOVER, FRCAd OTIIZRS ]P?;r)GRSnd:M2�T]w -"CRI,ILPORNIA We have thlll:� �-i;011t �Cl vcr Our payments fri!!nrl alivl, n�- by s 0 Wt:l day not enfon�n, m�4i r. ti�E P�--'X'son 0z 0:ganizatjon naiiieid in thR ScIlhiectile,, (This agi:eeri)e�'l,t itrDpIlles laxtient that �Ilnlu pe�! form work umj"HL a v�� 1 tt&i contract that li,uz� you Lai d�)i� ai�% :1 t th L5 agre�:I�iilen nxn im, I Yoi.i inu,:zt maintain payro� � a��%'Ur atra lip "'A-C�i-egat � rig the �i, -1 !-xt' '�doul emp Loy:2,es, whille engaged in the �,x�!-Ir de scr�bied iT'i t�he Schie�ftule, iit.icrial prei'aluin foi!! thi s e�ilq!lcrsement Shal � be 0 00% of the CaLi!�<!"rnkB viorkons, atl'�exn,lise due <>n such renumexat�:,cjn, ,Sch odu I e Persm or OrganizatJ an Zrdb lll�Wesrarlptjan An required by written contracty(') TJ i i r endonsement changes tAle palicy to Yoffilch it js� atta�:"hed and is ef Erc jvE? 011 tjue date issued unless otlhera rise stat:ed (The infonmatlom, be law, is req'italred orily, °Q em 1!. I tils endorse-mimat I z Issued subsequent to pxeparation of the po I I icy,) Endorsenic! nt E f f q cl, i ve ':: i/24/2014 Po � i cy No. WCA20088 1,5-11 Endox,,soyivmt Pio, Insured IEC�������,�iviraii,�rneiiita� Insurance Company, Grealt Divide Insurance company Couatersj�:Picd by Cq)�Trjqlllt 1199q by the Wakens ImPArmce Rating &n:ieau olf All rjoits ronerrrA. CE'RT NO.: 22175133 Marissa Romo 10/30/2014 3:56:29 PM (PD'.I') P.9e 4 of 4