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PROOF OF INSURANCE (2015) CLOSED (2)DATE (MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 01/08/2015 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 310-659-4950 - - -_ 310- 659 - 4950 .:. 8viichplle Nla... AX Nia Insurance Agency, Inc. LIC #01388707 PH ml nialnsura,ncea enc coD �e� 11041 Santa Monica Blvd #719 ADDRESS y m Los Angeles, CA 90025 INSURERS( AFFORDING COVERAGE INSURED INSURERS Progressive Uasualty insuranceL;o,l Spec Construction Co, Inc. INSURIERC 1870 S. Carlos Ave INSURERR,;, ....., _ Ontarioa, ca 91761 INSURER E , ..,,, . . ....... PERSONAL & ADV INJURY $ 1AOa,Q00 ....._. INSURER F: rn11C0At±042 f'=PT /CIr'ATP NI InnR1 =R• RFVISIC)N 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 CLAIM_ S. "...R TYPE OF INSURANCE .......– .�.�._POLICY NUMBER ..�.....� ".MMI IYYW d XYY'.. .............. 'INSR Af)l7t'�UBR POLICYEFF POLICYEXP ----- -- LIMITS TR COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ a0 t)O Q00 ...1 A CLAIMS -MADE OCCUR I?i±F FaEpcaorrnaN $ CGD00001202 04/26/2014 04/26/2015 MED EXP (Anyone person) $ 5 Q(aQ .... . ....... PERSONAL & ADV INJURY $ 1AOa,Q00 ....._. GENBIL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $,2,000,000 I!� PRODUCTS-COMP /OPAGG $ 2,00Or000 . POLICY JECT LOC OTHER_ $ ,...AUTOMOBILE LIABILITY / Y a a .ds01 INGd.E LLMgT........ $......1,000.1000 ............. B ANY AUTO BODILY INJURY (Per p person) $ _- — " ALL OWNED _....µ, . SCHEDULED BODILY INJURY (Per accident) $ M! y AUTOS AUTOS HIRED AUTOS NON-OWNED ED „ AUTOS 057559366 05/07/2014 05/07/2015 _V PEI DAMAG E $ UMBRELLA LIAB OCCUR LLIAB EACH OCCURRENCE $ EXCESS . _- CLAIMS MADE AGGREGATE $ „ DF,D RETENTION $ $ WORKERS COMPENSATION PER TH 518 ....... AND EMPLOYERS' LIABILITY YIN ""' " ",..,— .._....- ............ ANY PROPRIETOR /PARTNER /EXECUTIVE ACCIDENT _ __$ _ _ OFFICERIMEMBER EXCLUDED? (Mandatory in NH) NIA E L D SEA SE EA EMPLOYEE ........ __. $ — ......�.... If yes describe under DESCRIPTION OF OPERATIONS below E L DISEmmm ASE -POLICY LIMIT $ , DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) Additional Insured Endorsement USIC - CMGIA- 0301 -0412 , USIC -CMGIA -7900 0414, Waiver of Subrogation USIC -CMGIA 7830, Primary and Non - Contributory Wording, USIC -CMGIA including Products /Completed Operation are enclosed.Waiver of Subrogation is executed for Commercial Auto Liability. 30 Days Notice of Cancellation for Non - Payment of Premium. The City, its officers, officials, employees, agents will be covered as insured as respects, liability arising out of activities performed by or on behalf of the Contractor. Project No: RIS Group 65 ( 14 -23). Contract Number: 4715. CERTIFICATE HOLDER CANCELLATION /10 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of El Segundo �� �� THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Planning & Building Safety ACCORDANCE WITH THE POLICY PROVISIONS. 333 Main Street Unit a I AUTHORIZE DRE;RIESENTATIV ,,, 1 El Segundo, California 90245 -3814 U� pC N 014 ACOR O ORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered f ACO CERTIFICATE OF LIABILITY INSURANCE 11/21/2014DmrvY) 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 hotter in lieu of such endorsement (s . PRODUCER CONTACT Pay chex Insurance Agency Inc NAME PAY INSURANCE AGENCY INC. ONE FAX 150 S S DRIVE Nf EXT � 877 266 -6850 ( 585-3.8.9.-.74.26 ( H ROCHESTER, NY 14620 E-MAIL Certs@paychex.com Certs @paychex.com ... - INSURER(S) AFFORDING COVERAGE NAIC # . ... _...._ _ ..... ......... — — INSURER A: NorGUARD Insurance INSURED Company 31470 SPEC CONSTRUCTION CO INC INSURER B: 1870 S. CARLOS AVENUE ........ .. . . .- - - - - -- �., ,... ONTARIO, CA 91761 INSURER C: INSURER D: INSURER E. ,INSURE RER F: COVERAGES CERTIFICATE NUMBER: 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. NSR'. POLICY NUMBER POLICY EFF POLICY EXP LIMITS TYPE OF A DDL UBR LTR INSR D MM /DD/YYYY) MMIDD/YYYY GENERAL LIABILITY EACH OCCURRENCE $ qCOMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED III 6Ct.AIMS VCCN.PR.. PREC�4ISES ,4La cez �rrenttab- ...._._ $ u l.. .... -MADE MED EXP (Any one person) .....J $ ..-- ........ ........ ... PERSONAL & ADV INJURY $ __ .. GENERAL AGGREGATE $ "EN "t. AGGREGATE LIMIT APPLIES PER: PRODUCTS - COM P /OP AGG $ POLICY LO C ....�.��.......,...,_ ,..._- ------------- - -- $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) ANY AUTO _ BODILY INJURY ALL OWNED �.... CHEDULED (Per person) $ auras OWNED _ ............. ...„ BODILY ..................... .. $ AUTOS HIRED AUTOS AUTOS ent)RY 4 PROPERTY DAMAGE $ (Per accident,) $ UMBRELLA LIAB q J OCCUR EACH OCCURRENCE .. ...�.. $ ........ EXCESS LIAB CLAIMS -MADE AGG EL RAT ........E ... .__ .... $ .... ............ .............. DED RETENTION $ $ WORKERS COMPENSATION AND SPWC583326 03/12/2014 03/12/2015 X WC STATU OTH- Lec. . EMPLOYERS' LIABILITY E.., EACH ACCIDENT 1 000,00 .00 ANY PROPRIETOR/PARTNER/EXECUTIVE YY E.L. DISEASE - EA EMPLOYEE $ 1,' OFFICERIMEMBER (Mandatory In NH) EXCLUDED? � a ! N/A X E1, DISEASE -POLICY LIMIT $ 1,000,000.00 If yes, describe under DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) Residential Sound Insulation Program - Group 65 Project No: RSI 14 -23 Waiver of Subrogation granted in favor of the certificate holder CERTIFICATE HOLDER CANCELLATION City of El Segundo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION 333 Main Street DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY Unit A PROVISIONS, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR El Segundo, CA 90245 " "•, LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE � ACORD 25 (2010/05) ©1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Policy Number Named Insured Effective Date CGD00001202 Spec Construction Co, Inc. 04/26/2014 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS (FORM B)` This endorsement modifies insurance provided under the following: " s� COMMERCIAL GENERAL LIABILITY COVERAGE PART The City, its officers, officials, employees and agents. The City of El Segundo. Planning & Building Safety 333 Main Street Unit A El Segundo, CA 90245 -3814 Project: RIS Group 65 (14 -23) Section 11- Who is An insured is amended to include as an additional insured only the perms (s) or organization (s) who have entered into a written contract with "you" prior to "your/ commencement of work for the person(s) or organization (s) with whom "you" have entered into a written contract and such written contract specifica?In' r uires that "you "A provide this coverage, but only with respect to liability for "bodily ry "" " "property damage`° caused in whole and exclusively by "you" performing "your wor on ompleted operations hazard'" binder the policy. This amendment does not apply to "your r, on any residential construction project. Terms in quotation marks are defined in the policy to which the endorsement is attached. U S I C -C MG IA -7810 Rev.9/25/2013 INSURED: SPEC CONSTRUCTION CO, INC. "' CARRIER: PROGRESSIVE CASUALTY INSURANCE COMPANY'' ATTACHED TO AND ENDORSEMENT EFFECTIVE DATE FORMING A PART OF (1R A.M. STANDARD TIME) ADDITIONAL INSURED ENDORSEMENT NO. POLICY NUMBER The City, its officers, officers, employees and agents. City of El Segundo. Planning & Building Safety. 333 Main Street 057559366 04/26/2014 Unit A El Segundo, CA 90245 -3814. Project: RIS Group 65 14- USIC- CMGIA- 23 1 0310 -0412 (The above information is required only when this endorsement is issued subsequent to preparation of the policy.) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED — OWNERS, LESSEES OR CONTRACTORS — AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU This endorsement modifies insurance provided under the following: COMMERCIAL AUTO LIABILITY COVERAGE PART A. Section II —Who Is An Insured is amended to in- of, or the failure to render, any professional clude as an additional insured any person or organi- architectural, engineering or surveying services, zation for whom you are performing operations when including: you and such person or organization have agreed in a. The preparing, approving, or failing to prepare writing, and executed such a contract or agreement or approve, maps, shop drawings, opinions, prior to the time of an occurrence giving rise to a reports, surveys, field orders, change orders claim, that such person or organization be added as or drawings and specifications; and an additional insured on your policy. Such person or organization is an additional insured only with respect b. Supervisory, inspection, architectural or engi- to liability for "bodily injury," "property damage" or neering activities. "personal and advertising injury" caused, in whole or in part, by: 2. "Bodily injury" or "property damage" occurring after: 1. Your acts or omissions; or a. All work, including materials, parts or equip - 2. The acts or omissions of those acting on your ment furnished in connection with such work, behalf; on the project (other than service, mainte- in the performance of your ongoing operations for the nance or repairs) to be performed by or on additional insured. behalf of the additional insured(s) at the site of the covered operations has been complet- B. With respect to the insurance afforded to these addi- ed; or tional insureds, the following additional exclusions b. That portion of "your work" out of which the in- apply: jury or damage arises has been put to its in- This insurance does not apply to: tended use by any person or organization 1. "Bodily injury," "property damage" or "personal other than another contractor or subcontrac- for engaged in performing operations for a and advertising injury" arising out of the rendering principal as a part of the same project. NIA INSURANCE AGENCY INC. 01/08/2015 AUTHORIZED REPRESENTATIVE DATE Includes copyrighted material of ISO Properties, Inc., with its permission. Copyright, ISO Properties, Inc., 2004 US IC -CMG IA- 0301 -0412 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY COMMERCIAL GENERAL LIABILITY POLICY NUMBER: CGD00001202 INSURED : Spec Construction Co, Inc. ADDITIONAL INSURED - PRIMARY AND NON - CONTRIBUTORY - OWNERS, LESSORS OR CONTRACTORS COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: The City, its Officers, Officials, Agents and Employees. City of El Segundo. Planning & Building Safety 333 Main Street Unit A El Segundo, CA 90245 -3814. Project No: RIS Group 65( 14 -23). Contract Number: 4715 Section II -In accordance with the terms, conditions, limitations and provisions of the policy to which this endorsement is attached, Section II -Who is an Insured is amended to include an Additional Insured The Person, organization or entity designated in this endorsement but only with respect to liability for bodily injury or property damage caused, in whole or in part, by your work at the designated construction project performed for the designated person, organization or entity and included in the ongoing operations hazard. This endorsement does not create or our part a duty to defend the designated person, organization or entity or contribute to or reimburse the designated person, organization or entity. This endorsement is only applicable it the designated person, organization or entity and the designated project sections are completed. With respect to the Insurance afforded to these Additional Insured , the following additional inclusions apply: This insurance applies to "Bodily Injury" or "Property Damage" occurring after: 1- All work, including materials, parts or equipment furnished in connection with such work, on the project other than service, maintenance or repairs to by performed by or on behalf of the Additional Insured. At the location of the covered operations has been completed ; or That portion of "Your Work" out of which the injury or damage has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for the principal as part of the same project. PRIMARY /NON- CONTRIBUTORY WORDING: It is agreed that this insurance is primary and non - contributory and that no insurance held or owned by the designated Additional Insured shall be called upon to cover a loss under said policy up to the limits of this policy if loss under this policy arises directly from work performed by Named Insured. All other terms, conditions and exclusions remain unchanged (OMINI 7 EFQA12 -11 -5- 1/12/1203051353) Form Edition 05/10/12 INSURED: Spec Construction Co, Inc. Carrier: Progressive Casualty Insurance Company ATTACHED TO AND FORMING A PART OF ENDORSEMENT EFFECTIVE DATE ADDITIONAL INSURED ENDORSEMENT NO. POLICY NUMBER (12:07 A.M. STANDARD TIME) The City, its officers, officials, employees and agents, City of El Segundo. Planning & Building Safety. 333 Main Street Unit 057559366 05/07/2014 A El Segundo, CA 90245 -3814. Project: RIS Group 65( 14- 1 USIC -CMGIA 23). 1 7830 (The above information is required only when this endorsement is issued subsequent to preparation of the policy.) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. LIMITED WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL AUTO LIABILITY COVERAGE PART The TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Condition (Section IV— COMMERCIAL GENERAL LIABILITY CONDITIONS) is amended by the addition of the following: We waive any right of recovery we may have against an additional insured shown on form USIC- CMGIA- 0310 -0412 but only with respect to liability for "bodily injury," "property damage" or "personal and advertis- ing injury" caused by: 1. The named insured's acts or omissions; or 2. The acts or omissions of those acting on the named insured's behalf; in the performance of the named insured's ongoing operations for the additional insured shown on form U S I C -C M G I A- 0310 -0412. . All other Terms and Conditions of this Policy remain unchanged. Includes copyrighted material of ISO Properties, Inc., with its permission. Copyright, ISO Properties, Inc., 1992, 2003 NIA INSURANCE AGENCY INC. 41/08/2015 USIC -CMGIA 7830 INSURED: Spec Construction Co, Inc. Carrier: United Specialty Insurance Company ATTACHED TO AND FORMING A PART OF ENDORSEMENT EFFECTIVE DATE (72:07 A.M. STANDARD TIME) ADDITIONAL INSURED ENDORSEMENT NO. POLICY NUMBER The City, its officers, officials, employees and agents, City of El Segundo. Planning & Building Safety. 333 Main Street Unit CGD00001202 04/26/2014 A El Segundo, CA 90245 -3814. Project: RIS Group 65( 14- USIC -CMGIA 1. 23). 1 7830 (The above information is required only when this endorsement is issued subsequent to preparation of the policy.) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. LIMITED WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART The TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Condition (Section IV— COMMERCIAL GENERAL LIABILITY CONDITIONS) is amended by the addition of the following: We waive any right of recovery we may have against an additional insured shown on form USIC- CMGIA- 0310 -0412 but only with respect to liability for "bodily injury," "property damage" or "personal and advertis- ing injury" caused by: 1. The named insured's acts or omissions; or 2. The acts or omissions of those acting on the named insured's behalf; in the performance of the named insured's ongoing operations for the additional insured shown on form USIC - CMGIA- 0310- 0412.. All other Terms and Conditions of this Policy remain unchanged. Includes copyrighted material of ISO Properties, Inc., with its permission. Copyright, ISO Properties, Inc., 1992, 2003 NIA INSURANCE AGENCY INC. 41/08/2015 USIC -CMGIA 7830 Policy Number: 057559366 Insured: Spec Construction Co, Inc. Insurance Carrier: Progressive Casualty Insurance Company CG 2010 00 (07-04) COMMERCIAL AUTO LIABILITY THIS ENODSREMENT CHANGES THE POLICY. ADDITIONAL INSURED- DESIGNATED PERSON OR ORGANIZATION This Endorsement modifies insurance provided under the following: COMMERCIAL AUTO LIABILITY COVERAGE PART. SCHEDULE NAME OF PERSON OR ORGANIZATION: City of El Segundo, its officers, employees, agents 333 Main Street Unit A El Segundo, CA 90245 Re: Project: RSI 14 -23 Residential Sound Insulation Program- (If no entry appears above, information required to complete this endorsement will be shown in the Declaration as applicable to this endorsement) WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in the schedule as an insured but only with respect to liability Arising out of your operations or premises owned by or rented to you. Copyright, Insurance Services Office, Inc. 2010 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 4-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT — CALIFORNIA 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 1.02 of the California workers' compensation premium otherwise due on such remuneration. Schedule Person or Organization Job Description Blanket Waiver -Any person or organization for whom the All CA Operations Named Insured has agreed by written contract to furnish this waiver. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The Information below Is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective Policy No. SPWC583326 Endorsement No. Insured Insurance Company Countersigned By M998 by the Workers' Compensation Insurance Rating Bureau of California. All rights reserved. Emportant l h tM SPEC Construction Co Inc 1870 S. Carlos Avenue Ontario, CA 91761 BERKSHIRE HATHAWAY INSURANCE GUARDCOMPANIES Agency PAYCHEX INSURANCE AGENCY 150 Sawgrass Drive Rochester, NY 14620 Changes to Your Workers' Compensation Policy with NlorGUARD Insurance Company Policy Number SPWC583326 Policy Period From March 12, 2014 to March 12, 2015, 12:01 AM, standard time at the insured's mailing address. Party Requesting the Change and Type of Endorsement The Agent - Added Blanket Waiver of Subrogation effective 03/12/2014 State: CA; New: 1.020 Premium change: $ 775.00 This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective See Above Insured SPEC Construction Co Inc Policy No. SPWC583326 Endorsement No. 2 Premium $775 Insurance Company NorGUARD Insurance CompanyCountersigned by Thank You Again for Choosing Berkshire Hathaway GUARD Insurance Companies! Call our Customer Service Hotline at 1- 800 - 673 -2465, Ext. 1300 with any questions. Endorsement WC 99 00 13