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PROOF OF INSURANCE (2015) CLOSEDACORD. CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) RDDUCCR THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION DENNIS COLLINS INSURANCE AGENCY ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 520 S. EL CAMINO REAL STE. 300 ALTER THE COVERAGE AFFORDED BY THE POLICIF.A Rr:1 nW SAN MATEO, CA 94402 !6 i0- 342 -6461 'SURE° The Dardanelle Group Inc. 106 S. Catalina Avenue Redondo Beach, CA 90277 INSURERS AFFORDING COVERAGE NAIC# INSURER A. I ",ar%uers Insurance EXCb e:. INSURER B: Western World Insurance Company �. INSURER C: INSURER D: INSURER E: THC POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PER60D INDICATIEDL NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CON-ITRAG "I" 08 OTHER DOCUMENT WITH, RESPECT I'D WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS :SUB.IEC'T TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID OLAIIWIS. a D ^L T POI ICY PFE .IVE POLICYEXPIRATICIN I ra NSRD TYPE aTr• INfiIi17iYASd"t= I and Iry w luaco a...r. .. GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMSMADE CI OCCUR 604327928 01/15/13 01/15/15 GEN"L AGGREGATE LIMIT APPLIES PER: PRO. POLICY I T LOC AUTOMOBILE LIABILITY ANYAUTO ALLOWNEDAUTOS _ SCHEDULED AUTOS HIREDAUTOS 604327928 01/15/13 01/15/15 NON- OWNEDAUTOS GARAGE LIABILITY �IANYAUTO EXCESSIUMBRELLA LIABILITY —I OCCUR D CLAIMSMADE DEDUCTIBLE RETENTION 5 WORKERS COMPENSATIONAND EMPLOYERS' LIABILITY ANY PROPMETOR.PARTNER /EMCUTNF OFF ICEWMEM,DER EXCLUDED? LIMITS EACH OCCURRENCE 5 DA"IGPA=- TO- PRMiSE*r IPwo oc+rnaaorlt.,gs1.... S MED EXP (Anyend p etson) $ PERSON AL &ADVINJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP /OPAGG 5 COMBINED SINGLE LIMIT (Ea accident) $ 1 , 000, 000 BODILYINJURY $ (Pot porsonJ BODILY) JURY g (Peraccident) PROPERTY DAMAGE g (Peraccident) AUTO ONLY - EA ACCIDENT S OTHERTHAN EAACC $ AUTOONLY AGG $ EACH OCCURRENCE g AGGREGATE $ 15 E.L, EACH ACCIDENT E,L. DISEASE - EA EMPLOYE OTHER E.L. DISEASE- POLICY LIMIT Professional Liability/ E &O BRL0007103 .07/13/14 07/13/15 1,000,000 3CRIPTION OF OPERATIONS) LOCATIONS I VEHICLES/ EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS ity of E1 Segundo , its officials and employees are listed as dditional Insureds City of El Segundo 350 Main Street"r °`° E1 Segundo, CA g SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3O DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL G'nOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR E'P RE SEN T ATWES. I `HORIZEO REPRESENTATIVE ORD25(2001/08) —" 4 ©ACORD CORPORATION 1988 POLICY NUMBER: 604327928 THIS ENDORSEMENT CHANGES THE POLICY. Well ADDITIONAL INSURED - DESIGNATED OR ORGANIZATIO%�- This endorsement modifies insurance Provided under the following: BUSINESSOWNERS POLICY SCHEDULE* Name Of Person Or Organization: CI-I-y 01,, 1---L SEGUNDO Its Officials and employees BUSINESSOWNERS BP 04 48 01 97 * Information required to complete this Schedule, if not shown on this endorsement, will be shown in the Decla- rations. The following is added to Paragraph C. Who Is An Insured in the Businessowrlers Liability Coverage Form: 4. Any person or Organization shown, in the Schedule is ' also an insured, but only with respect to liability ansing Out Of your ongoing operations or premises owned by or rented to you. BP 04 48 0197 CODvriaht. Insiirpnrn Cow r-N"a__ Shilling, Mona From: Hegvold, Julie Sent: Monday, December 08, 2014 5:00 PM To: Shilling, Mona Cc: Katsouleas, Stephanie Subject: Dardanelle - Consultant Contract Attachments: Dardanell Group - Park Place Agmt.CM.pdf, Dardanell Group - Park Place Ins.pdf Hi Mona, Attached is a signed, consultant contract with Dardanelle for the Park Place Project. I will drop off the hard copy of the contract to you today. Vendor contact: Kathleen Jackson k.iackson@dardanelleinc.com Please let me know if you need any additional information in order to finalize this contract. Thank you, W..f A Xr Ar H .I..r_Q...d IS CLOSED 'l..NN I RI.A...k�.P...'q.. A. IS �/) A' " From: Garcia, Angelina Sent: Tuesday, November 25, 2014 8:43 AM To: Hegvold, Julie' Subject: RE: Dardanelle - Consultant Contract You can just print this and attach it to the insurance packet. I will sign off.! µ.. �d Angelina Garcia From: Hegvold, Julie Sent: Tuesday, November 25, 2014 7:11 AM To: Garcia, Angelina Subject: Dardanelle - Consultant Contract Good Morning Angie, What do you need, if anything, in lieu of the Work Comp if there are no employees? C1lrPY IIIl lA Lt I'S CU) llifl) 011 li'llt,IDAYS Begin forwarded message: From: < Jac so (a) r a ellei c.co > Date: November 24, 2014 at 6:04:23 PM PST To: "Katsouleas, Stephanie" <ssoles(a,e Ise g door > Subject: RE: FW: Contract Corporation, no employees so I am not required to have Worker's Compensation. Kathleen Jackson The Dardanelle Group, Inc. Office: 310 - 379 -5316 Fax: 310 - 379 -2816 Cell: 310 - 663 -5764 http: / /thedardanellegroup.com -- - - - - -- Original Message -- - - - - -- Subject: FW: Contract From: "Katsouleas, Stephanie" <skatsouleas0 elsegundo.org> Date: Mon, November 24, 2014 4:35 pm To: " 'k.jackson(&dardanelleinc.com "' <k.jackson(@dardanelleinc.com> Are you sole proprietor, or do you have "employees ?" Stephanie Katsouleas, P.E, Director of Public Works City Hall is closed on Fridays From: Garcia, Angelina Sent: Monday, November 24, 2014 4:30 PM To: Hegvold, Julie Subject: RE: Consultant Contract This works. However, we will need also Workers' Comp and waiver of subrogation.