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PROOF OF INSURANCE (2013) CLOSEDACORD TIM e (MM/DD/Y CERTIFICATE OF LIABILITY INSU Dat9 RANCE F /17/2012 R) THIS 5ff'R_T1F_1C4ffIS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HoLuffR"T' HIS 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 lhe certificate holder isle an ADDITIONAL lNSURED, the poliFY(ios)—musti�r-15orsed, If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain poles require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement s' PRODUCER CONTACT Sherry Young Heffernan Professional Practice Insurance Brokers NAME. License No. 0564249 PHONE (A/C,No,Ext): 714-361-7700 FAX (AIC,No): 714-361-7701 . .. .......... 6 Hutton Centre Dr., Suite 500 EMAIL sherryy@heffins.com Santa Ana, CA 92707 ADDRESS: INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: Travelers Property CasnaltX Co. of Am. 25674 .......... Denn Engineers INSURER B: Continental Casualty0i. 20443 3914 Del Arno Blvd., Ste 921 INSURER C:. Torrance, CA 90503 INSURER D: INSURER E; I_NSUAFR F., COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TOGERTIFY THAT POLICIES OF INSURANCE usTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD ]NYC —ATff'5"— 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, LIMIT'S SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INSH TYPE: OF INSURANCE —WbDL SUER POLICY NUMBER POLICY EFF' POLICY EXP LIMITS LTR INSR WvD MM/DD/YY _LMM22njM_ GENERAL L LIABILITY EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES (Ea occurrence) $1,000,000 A CLAIMS-MADE OCCUR X 6804878L957TIL12 09/01/12 09/01/13 MED EXP (Any one person) $10,000 Fx� PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000.000 GEN'L. AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP /OP AGG $2,000,000 POLICY 5fl PROJECT E] LOC .... . .... ............. . . . . .. ...... $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY (Per person) $ SCHEDULED ALL OWNED AUTOS AUTOS BODILY INJURY Per accident $ . ............ HIRED AUTOS NON-OWNED PROPERTY DAMAGE AUTOS (Per accident) $ ............ . . . ..... ............ ....... . . . ........... . . . . . ........... UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ :�EFIETENTION ._._$ $ . . ..... ............................... . WORKERS COMPENSATION WC S A'r U_ Or AND EMPLOYERS' LIABILITY YIN TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE/ E,L, EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in N H.) 1:1 E . DISEASE - EA EMPLOYEE $ 11 yes, describe under DESCRIPTION OF E L DISEASE - POLICY LIMIT $ OPERATIONS below I= B PROFESSIONAL LIABILITY LSH1 13984368 11/07/11 11/07/12 Per Claim $1,000.000 Aggregate $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES tAtloob ACORD 101, Additional Remarks Schedule, It more space Is required) Projects as on file with the insured. The City of El Segundo, its officers, agents and employees are named as additional insureds and primary/non-contributory clause applies to the general liability policy-see attached endorsement. Severability of interest clause is included in the policy form. A 30-day notice of cancellation provision in favor of the Cil)L2f"El Sol-, udo is attached; . ............ .... CERTIFICATE HOLDER CANCELLATION -- - - -------- . . .. . ............. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH City of El Segundo THE POLICY PROVISIONS. 350 Main Street A_U-i�HORIZEO —REPRES2NTATtVE ....... ...... El Segundo, CA 90245-3813 ACORD 25 (2010)05) @11-8-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NO.: 6804878L957TIL12 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED (ARCHITECTS, ENGINEERS AND SURVEYORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. The following is added to WHO IS AN INSURED (Section II): Any person or organization that you agree in a "contract or agreement requiring insurance" to include as an additional insured on this Coverage Part, but only with respect to liability for "bodily injury ", "property damage" or "personal injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: a. In the performance of your ongoing operations; b. In connection with premises owned by or rented to you; or c. In connection with "your work" and included within the "products- completed operations hazard ". Such person or organization does not qualify as an additional insured for "bodily injury ", "property damage" or "personal injury" for which that person or organization has assumed liability in a contract or agreement. The insurance provided to such additional insured is limited as follows: d. This insurance does not apply on any basis to any person or organization for which coverage as an additional insured specifically is added by another endorsement to this Coverage Part. e. This insurance does not apply to the rendering of or failure to render any "professional services ". f. The limits of insurance afforded to the additional insured shall be the limits which you agreed in that "contract or agreement requiring insurance" to provide for that additional insured, or the limits shown in the Declarations for this Coverage Part, whichever are less. This endorsement does not increase the limits of insurance stated in the LIMITS OF INSURANCE (Section III) for this Coverage Part. B. The following is added to Paragraph a. of 4. Other Insurance in COMMERCIAL GENERAL LIABILITY CONDITIONS (Section IV): However, if you specifically agree in a "contract or agreement requiring insurance" that the insurance provided to an additional insured under this Coverage Part must apply on a primary basis, or a primary and non- contributory basis, this insurance is primary to other insurance that is available to such additional insured which covers such additional insured as a named insured, and we will not share with the other insurance, provided that: (1) The "bodily injury" or "property damage" for which coverage is sought occurs; and (2) The "personal injury" for which coverage is sought arises out of an offense committed; after you have entered into that 'contract or agreement requiring insurance ". But this insurance still is excess over valid and collectible other insurance, whether primary, excess, contingent or on any other basis, that is available to the insured when the insured is an additional insured under any other insurance. C. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us in COMMERCIAL GENERAL LIABILITY CONDITIONS (Section IV): We waive any rights of recovery we may have against any person or organization because of payments we make for "bodily injury ", "property damage" or "personal injury" arising out of "your work" performed by you, or on your behalf, under a "contract or agreement requiring insurance" with that person or organization. We waive these rights only where you have agreed to do so as part of the "contract or agreement requiring insurance" with such person or organization entered into CG D3 81 09 07 © 2007 The Travelers Companies, Inc. Page 1 of 2 Includes copyrighted material of Insurance Services Office, Inc., with its permission. ill by you before, and in effect when, the "bodily injury" or "property damage" occurs, or the "personal injury" offense is committed. The following definition is added to DEFINITIONS (Section V): "Contract or agreement requiring insurance" means that part of any contract or agreement under which you are required to include a person or organization as an additional insured on this Coverage Part, provided that the "bodily injury" and "property damage" occurs, and the "personal injury" is caused by an offense committed: a. After you have entered into that contract or agreement; b. While that part of the contract or agreement is in effect; and c. Before the end of the policy period. CG D3 81 09 07 © 2007 The Travelers Companies, Inc. Page 2 of 2 Includes copyrighted material of Insurance Services Office, Inc., with its permission. POLICY NUMBER: 6804878L957TIL12 ISSUE DATE: 06/28/12 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED ENTITY - NOTICE OF CANCELLATION PROVIDED BY US This endorsement modifies insurance provided under the following: ALL COVERAGE PARTS INCLUDED IN THIS POLICY SCHEDULE NUMBER OF DAYS NOTICE OF CANCELLATION: 30 PERSON OR ORGANIZATION: City of El Segundo, 350 Main St., Ell Segundo, CA 90245 -3813 Any person or organization to whom you have agreed in a written contract that notice of cancellation of this policy will be given, but only if: 1. You send us a written request to provide such notice, including the name and address of such person or or- ganization, after the first Named Insured shown in the Declarations receives notice from us of the cancellation of this policy; and 2. We receive such written request at least 14 days before the beginning of the applicable number of days shown in this Schedule. ADDRESS: The address for that person or organization included in such written request from you to us. PROVISIONS: A. If we cancel this policy for any statutorily permit- ted reason other than nonpayment of premium we will mail notice of cancellation to the person or or- ganization shown in the schedule above. We will mail such notice to the address shown in the schedule above at least the number of days shown for cancellation in the schedule above be- fore the effective date of cancellation. IL T4 00 12 09 © 2009 The Travelers Indemnity Company Page 1 of 1 ' " ' CERTIFICATE OF LIABILITY INSURANCE F8/13/2012 DA DDr PRODUCER (951) 509 -0509 FAX: (951) 509 -0515 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Danmar Insurance Services Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR License # OD36873 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 9899 Indiana Avenue, Ste 101 Riverside CA 92503 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURERA: Sentinel Insurance Compant, 11000 Denn Engineers, Inc. INSURERB;CQmIRerce and Industry 15 172 3914 Del Amo Bl . , Ste 921 INSURERC: CA 90503 INSURER E: 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 OFSUCH POLICIES, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. uSR D k ......... ,. .. L" ...... . .. —� POLICY NUMBER POLICY EFFECTIVE POLICYEX/PRIRATION ( _LIMITS I GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL AnaY n on eP, msesrca) $ .e. . °n) ....... PERSONAL &ADVINJURY $ GENERALAGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS COMP /OPAGG $ POLICY PRO I���_........� LOC _. ......... ...�.... AUTOMOBILE LIABILITY $ 1,000,000 COMBINED SINGLE LIMIT X ANY AUTO (Ea accident) A ALL OWNED AUTOS 72UECKC2774 7/17/2012 7/17/2013 BODILYINJURY '$ SCHEDULEDAUTOS (Per person) HIREDAUTOS BODILY NON-OWNED AUTOS (PerraccidenCRY $ GARAGE LIABILITY ANY AUTO EXCESS I UMBRELLA LIABILITY OCCUR CLAIMS MADE �DEDUCTBLE RE "rENTION S .. w.. �.....- ...�.� ............. _..._ B .......... WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIE TCR+PARTNIERIEXECUTIVE ❑ OFFICEWMEMBLR CXCLUOE07 (Mandatory in NH) WC001657966 U a s, describe under apew SL OTHERI.PROV1SIk0� /ir.,,m„ _.....,_.... PROPERTYDAMAGE $ (Per accident) AUTO ONLY - EA ACCIDENT ) $ OTHERTHAN EA,ACC $ AUTO ONLY: AGG I[ $ EACH OCCURRENCE J$ AGGREGATE $ S El, EACH ACCIDENT � $ 11 000199 9 2/1/2012 2/1/2013 EL DISEASE EAG „MPLCNE� $ _ 1,000,000, E L, DISEASE- POLICY LIMIT S 11000,000 DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS Job descriptions Topographic survey for construction of new storm drain system on Mariposa Street from Maryland to Center Street. Workers Compensation coverage includes Waiver of Subrogation per WC04 03 06 (04/84) attached, CERTIFICATE HOLDER k,I r4%ot:LLH I IVIV ABola @elsegundo.org SHOULD ANY OFTHEABOVE DESCRIBED POLICIES BECANCELLED SEFORETHE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL The City of E1 Segundo IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR its official and employees 350 Main Street REPRESENTATIVES. E1 Segundo, CA 90245 -3813 AUTHORIZED REPRESENTATIVE Norma Duvall /NORMAD ACORD 25 (2009/01) ©1988-2009 ACORD CORPORATION. All rights reserved, INS025 (200901)01 The ACORD name and logo are registered marks of ACORD IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER This Certificate of Insurance does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25 (2009/01) INS025 (200901}01 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT -- CALIFORNIA This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different date is indicated below. (The following "attaching clause" need be completed only when this endorsement is issued subsequent to preparation of the policy). This endorsement, effective 12:01 AM 07/17/2012 forms a part of Policy No. WC 001-65-7966 Issued to DENN ENG I NEER INC By COMMERCE AND INDUSTRY INSURANCE COMPANY Premium 250 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 otherwise due on such remuneration. Schedule Person or Oroanization THE CITY OF EL SEGUNDOITS OFFICIALS AND EMPLOYEE ITS OFFICIALS AND EMPLOYEES ELOSEGUNDOTCA 90245 "THE PREMIUM WILL BE 5% OF THE UNMODIFIED PREMIUM ARISING OUT OF THE WORK FOR WHICH THE WAIVER IS GRANTED. MINIMUM PREMIUM IS $250." % of the California workers' compensation premium Job Description WC 04 03 06 Countersigned by - _ - ®..._ _ .. .. .._ _ _ - _ v - _ (Ed. 04184) Authorized Representative