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PROOF OF INSURANCE (2015) CLOSEDL. DATE(MWDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 11112/2014 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 z BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED 0 REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. 0 IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the pollcy(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 w) certificate holder in lieu of such endorsement(s). c PRODUCER CONTACT NAME. m a Aon Risk Services Central, Inc. JA _ `y Pittsburgh PA office (AC. : (866) 263 -- 7- 1 22 , No.); (800 363 -0105 Dominion Tower, 10th Floor E -MAIL 625 Liberty Avenue ADDRESS: _ Pittsburgh PA 15222-3110 USA INSURER(S) AFFORDING COVERAGE NAIC# INSURED INSURER A: Liberty Mutual Fire Ins CO 123035 RBF COnsultinq INSURER B: Lloyd's Syndicate NO. 2623 AA1128623 PO BOX 57057 ._ ................. ..... Irvine CA 92619 -7057 USA INSURER C: Liberty Insurance Corporation 42404 INSURER D: National Union Fire Ins co of Pittsburgh ',19445 INSURER E: .._ ...............• .._. INSURER F: COVERAGES CERTIFICATE NUMBER; 570055841576 REVISION NUMBER~ THIS IS TO CERTIFY' THAT THE POLICIES OF INSURANCE LISTER BELOW HAVE BEEN ISSUED TO THE INSURED NAMED 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. Limits shown are as requested' WSR ADD ^p TYPE OF INSURANCE POLICY NUMBER O LIMITS X COMMERCIAL GENERAL LIABILITY TB EACHOCCURRENCE $2,000,000 .. ...._._ ­­- CLAIMS-MADE 1:x1 .00CUR $1 ,000,000 PREMISF4,(Ea or�cu,rrence X Contractual MED EXP (Any one person) $ 5 1000 X BFPD, XCU PERSONAL &ADV INJURY $2,000,000 GEN'LAGGREG-'A-T�E LIMIT APPLIES PER: GENERALAGGREGATE $4,000,000 - POLICY I X IJEa t. .....d LOC PRODUCTS - COMP /OPAGG $4,000,000 in OTHER: 4�d r* A AUTOMOBILE LIABILITY AS2- 681 - 004145 -724 06/30/2014 08/30/2015 COMB -e- IF,, COMBINED SINGLE LIMIT $1,000,000 X ANYAUTO BODILY INJURY ( Per person) 0 ALL OWNED SCHEDULED BODILY INJURY (Per accident) AUTOS AUTOS - .... X HIREDAUTOS X NON -OWNED PROPERTY DAMAGE AUTOS (Par accident) el, D X UMBRELLA LIAR X OCCUR BE018742918 08/30/2014 08/30/201S EACH OCCURRENCE $10,000,000' °"" EXCESS LIAB CLAIMS -MADE AGGREGATE _ $10,000,000'.. 'DED X RE"GEN" ", 410,000 C WORKERS COMPENSATION AND 'wA768D 04145694 06/ 3O 2014 777672= X I PER STATUTE OTH� C OFFICER E.MaERIEXCLUDED EXECUTIVE N INIA WCC7681004145704 06/30/2014 08/30/2015 E.L. DISEASE-EA F - $1,000,000 Mandatory inNlf EMPLOYEE $1,000,000 r eTdas- primary Professional &Pollution 06/30 /201408 /31/2015 Aggregate Perclim $5,000, 000 B E &O- PL- primary D SCRIPT'ION OF O'P'ERATIONS!heslow+ E.L. DISEASE - POLICY LIMIT $1,000,000 SIR a pp lies per polic y teats & conditions DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: MSIS Proposal No. 143495, 500 S Douglas Street IS /MND. y City f El Segundo and its officials and employees are included as Additional Insured in accordance with the policy provisions of the General Liability policy. General Libility evidenced herein is Primary and Non - Contributory to other insurance available to an Additional Insured, but only in accordance with the policy's provisions. A waiver of Subrogation is granted in favor of City of El Segundo and its officials and employees in accordance with the policy provisions of the workers' Compensation policy. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE HEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY wJ City Of El Segundo � � AUTHORIZED REPRESENTATIVE 350 Main Street E1 Segundo CA 90245 USA t�Xa�a i�GIdSG r�sbs�icCt4 �G�StLtaL e.Jna ©1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD 233201200144600065 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, BLANKET ADDITIONAL INSURED This endorsement modifies insurance provided under the following: i CONIINInKCIAL CENER -U, LIABILITY CO1r1l&3tGE FOlta�( Ayb SECTION 11 - WHO IS AN INSURED is amended to include as an insured any person or organization for whom you have agreed in writing to provide liability insuratim. But., The insurance provided by this amendment: L Applies only to "bodily injury" or "proper), damage" arising out.of (a) "your work" c r Qt) premises or other prope.ny owned by or rented to you; 2. Applies only to coverage and minimum limits of insurance required by die written agreement, but in no event exceeds either the scope of coverage or the limits of insurance pro%ided by this policy. and 3. Does not apply to any person or orgarwation for whom you have procured separate liability btsurauce while such insurance is in effect, regardless of whether the scope of coverage or limits of insurance of this policy exceed those of such othr,r insurance or whether such other insurance 6 valid and collectible. The following provisions also apply: 1. Where the applicable written agreement requires the insured to provide liability insurance on a primary, excess, contingent, or any other basis, this policy will apply solely on the basis required by such uTittcn agreement and Item 4. Other Insuranceof SECTION IV of this policy will not apply. 2. %V+ere the :applicable written agreement does not specify on what basis the liability insurance will apply, the provisions of Item 4, Other Insurance of SECTION IV of this policy will govern. 3 This endorsement shall not apply to any person or organization for any "bodily injury" or "property damage" if any other additionnl insured endorsement on this policy applies to that person or organization with regard to the "bodily injury" or "property damage". 4. if any other additional insured endorsement applies to any person or organization and you are obligated tinder a written agreement to provide liability insurance on n primary, excess, contingent, or any other basis for that additional insured, this policy will apply solely on the basis required by such written agreement and Item 4. Other Insunnce of SECTION IV of this policy will not apply, regardless of w heiher the person or organisation hss available other %-jEd and collectible insurance. If the applicable written agreement does not specif} on avhat basis the liability insurance will apply, the provisions of Items Other insurance of SECTION IV of this policy will govern. '111iv enJursrmtrt is mft-utcd by the LIBERTY MUTUAL Fl RE INSURANCE COMPANY Prrrrium S 13(fcctive 1)31r I Minricwt Untc 11wnttschmcm(ol0oticyNu. TB2- 681 - 004145 -714 Audit Hzia Issaco Tt) ill LN 20 Of 06 05 CAtafl(LM- tcJ b) .4k, t tffisec and Ni o. 1and.1.kTW Nn. 0142013003667OU001 P011cy Number TB2- 681 - 004145 -714 issued by LIBERTY 141LITUAL FIRE INSURAN'CE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, NOTICE OF CANCELLATION TO THIRD PARTIES This endorsement modifies Insurance provided under the following: BUSINESS AUTO COVERAGE PART MOTOR CARRIER COVERAGE PART GARAGE COVERAGE PART TRUCKERS COVERAGE PART EXCESS AUTOMOBILE LIABILITY INDEMNITY COVERAGE PART SELF- INSURED TRUCKER EXCESS LIABILITY COVERAGE PART COMMERCIAL GENERAL LIABILITY COVERAGE PART EXCESS COMME=RCIAL GENERAL LIABILITY COVERAGE PART PRODUCTSICOMPLETED OPERATIONS LIABILITY COVERAGk.PART LIQUOR LIABILITY COVERAGE PART COMMERCIAL LIABILITY— UMBRELLA COVERAGE FORM Schedule of Other Person(s) f Email Address or mailing) Number izationtsl: address: { "Per schedule an file with the com A. If we cancel this policy for any reason other than nonpayment of premium, we will notify the persons or organizations shown in the Schedule above. We will send notice to the email or mailing address listed above at least 10 days, or the number of days listed above, if any, before the cancelalion becomes effective. In no eventdoes the notice to the third party exceed the notice to the first named insured. B. This advance notification of a pending cancotlation of coverage is Intended as a courtesy only. Our failure to provide such advance notification will not extend 1hB policy cancellation date nor negate cancellation of the policy. All other terms and conditions of this policy remain unchanged. LIM 99 0105 11 012011 Liberty Mutual Group of Companies. All rights reserved. Page i of 1 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Policy Number: AS2- 681 - 004145 -724 Issued By: Liberty Mukual Eire insurance Co. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTICE OF CANCELLATION TO THIRD PARTIES This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE PART MOTOR CARRIER COVERAGE PART,, r c el GARAGE COVERAGE PART TRUCKERS COVERAGE PART EXCESS AUTOMOBILE LIABILITY INDEMNITY COVERAGE PART SELF-INSURED TRUCKER EXCESS LIABILITY COVERAGE PART COMMERCIAL GENERAL LIABILITY COVERAGE PART EXCESS COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS /COMPLETED OPERATIONS LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART Schedule Naome of Qth� er Person(s)l Email Address or mailing rganlzatilon(s): address: Per schedule on file with the company Days Notice: 30 A. If we cancel this policy for any reason other than nonpayment of premium, we will notify the persons or organizations shown in the Schedule above. We will send notice to the email or mailing address listed above at least 10 days, or the number of days listed above, if any, before the cancellation becomes effective. In no event does the notice to the third party exceed the notice to the first named insured. B. This advance notification of a pending cancellation of coverage Is intended as a courtesy only. Our failure to provide such advance notification will not extend the policy cancellation date nor negate cancellation of the policy. All other terms and conditions of this policy remain unchanged. LIM 99 0105 11 © 2011, Liberty Mutual Group of Companies. All rights reserved. Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc. with Its permission. WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT 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.) This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Not applicable in KY, NH and NJ � The waiver does not apply to any right to recover payments which the Minnesota Workers Compensation Reinsurance Association may have or pursue under M.S. 79.36. Schedule Where required by contract or written agreement prior to loss This endorsement is executed by the Liberty Insurance Corporation 21814 Premium $ Effective Date Expiration bate For attachment to Policy No. WA7 -68v- 004145 -694 WC 00 0313 ©1983 National Council on Compensation Insurance. Page 1 of 1 Ed. 4/11/1984 A. If we cancel this policy for any reason other than nonpayment of premium, we will notify the persons or organizations shown In the Schedule below. We will send notice to the email or mailing address listed below at least 10 days, or the number of days listed below, if any, before cancellation becomes effective. In no event does the notice to the third party exceed the notice to the first named insured. B. This advance notification of a pending cancellation of coverage is intended as a courtesy only. Our failure to , provide such advance notification will not extend the policy cancellation date nor negate cancellation of the policy. Schedule Name of Other Person(s) l Email Address or mailing address: Number Days Notice: Organization(s): Per schedule on file with the comparry All other terms and conditions of this policy remain unchanged. Issued by Liberty Insurance Corporation 21814 30 For attachment toPdicyNo. WA7- 68D- 004145 -694 Premium$ Issued to Michael Baker Corporation WM 9018 0611 ® 2011, Liberty Mutual Group. All Rights Reserved. Page t of 1 Ed. 06/01/2011 (1) Underwriters authorize Aon the ( "Certificate Issuer") to issue Cartifiaates of Insurance at the request or direction of the Assured. It is expressly understood and agreed that subject to Paragraph (2) below, any Certificate of Insurance so Issued shall not confer any rights upon the Certificate Holder, create any obligation on the part of the Underwriters, or purport to, or be construed to, alter, extend, modify, amend, or otherwise change the terms or conditions of this Policy In any manner whatsoever. In the case of any conflict between the description of the terms and conditions of this Policy contained In any Certificate of Insurance an the one hand, and the terms and conditions of this Policy as set forth herein on the other, the terms and conditions of this Policy as set forth herein shall control. (2) Notwithstanding Paragraph (1) above, such Certificates of Insurance as are authorized under this endorsement may provide that In the event the Underwriters cancel or non -renew this Policy or in the event of a Material Change to this Policy, Underwriters shall mail written notice of such cancellation, non - renewal, or Material Change to such Certificate Holder 30 days prior to the effective data of cancellation, non - renewal, or a Material Change, but 10 days prior to the effective date of cancellation in the event the Assured has failed to pay a premium when due. The Assured shall provide written notice to the Underwriters of all such Certificate Holders, if any, specified In each Certificate of Insurance (1) at Inception of this Policy, (ii) 80 days prior to expiration of this Policy, and (iii) within 10 days of receipt of a written request from Underwriters. Underwriters' obligation to mail notice of cancellation, non - renewal, or a Material Change as provided In this paragraph shall apply solely to those Certificate Holders with respect to whom the Assured has provided the foregoing written notice to the Underwriters. (3) It is further understood and agreed that Underwriters' authorization of the Certificate Issuer under this endorsement Is limited solely to the Issuance of Certificates of Insurance and does not authorize, empower, or appoint the Certificate Issuer to act as an agent for the Underwriters or bind the Underwriters for any other purpose. The C 6 icate Issuer shall be solely responsible for any errors or omissions in connection with the issuance of any Certificate of Insurance pursuant to the endorsement. (4) As used in this endorsement: (i) Certificate of Insurance means a document issued for informational purposes only as evidence of the existence and terms of this Policy in order to satisfy a contractual obligation of the Assured. (ii) Material Change means an endorsement to or amendment of this Policy after issuance of this Policy by the Underwriters that restricts the coverage afforded to the Assured. All other temps, clauses and conditions remain unchanged. Market Submission - Supplemental Page 38 of 54 OM Clauses