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PROOF OF INSURANCE (2015) CLOSED (2)Client#: 974 AKMCONSUL [ E ACORD. CERTIFICATE OF LIABILITY INSURANCE DAT13 /20DIYYYY) 4/1312015 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. mq�NgCiTANT, Vf certificate holder is an ADDITIONAL INSURED, the policy(iesµ) µmust be endorsed. If SUBROGATION .— — — B ATION 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 NA E Nancy Ferrlck _ Dealey, Renton & Associates PHONE 510 465 3090 FAX 510 452 -2193 A/C, No Ext) WC No): P. O. Box 12675 -b -'MME" ML dra com Oakland, CA 94604 -2675 _._.. s nferrir-k@insdra.com 465 -3090 I I L C E 71000 c # S t SURER(S) AFFORDING TDVERA G ............................ ........................... ...................... .............. INSURERA: en ne nsurance o. ----.- ,.,_,_ INSU RED - ................ INSURER B: American Automobile Ins. Co. 21849 AKM Consulting Engineers, Inc. �'" Travelers Casual ......................... INSURERC Casualty & Surety Co. 31194 553 Wald Street Irvine, CA 92618 -4627 INSURERD INSURER E: INSURER 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 CONTRACTOR 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. . L R ....... .,......_ TYPE OF INSURANCE IMCa ...,._.., SU n ............. .. POLICY NUMBER POLICY YY IMM /DDIYYYYI ...� , u PMIDDY YXI IMMIDD /YYYYI LIMITS ., A GENERAL LIABILITY X X 57SBWLU8719 9/20/2014 09/20/2015 EACH OCCURRENCE $2.000.000 X. COMMERCIAL GENERAL LIABILITY PREML ESO(F2 oocurrDencel............ $1 OOO.O....... ,. 00 .. „m, .... CLAIMS -MADE X OCCUR . ED EXP (A,ny one person) M $.10.000 PERSONAL & ADV INJURY $ 2.000.000 ------ --------- ......... -------- ,,,,,,- - - -__, GENERAL AGGREG AT.E .................. 1..$.4' U. O. U'. 6. 0. 0....... ............................... GEN'L AGGREGATE LIMIT APPLIES PER, PRODUCTS - COMP /OP AGG $4,000,000 POLICY X PPTO LOC J. $....� ..... A .,.. .._...� ..... AUTOMOBILE LIABILITY X X 57SBWLU8719 9/20/2014 .... 09/201201 COMBINED SINGLE LIMIT II=I acuddeul $2,000,000 ANY AUTO BODILY INJURY (Per person) _ .............. $ _ A O SCHEDULED AUU TOS S AUTOS BODILY INJURY (Per accident) $ NON -OWNED X X PROPERTY DAMAGE .., -.,,. $ ....., . HIRED AUTOS AUTOS (PPrarndan }� . A �( , UMBRELLA LIAB X OCCUR X X 57SBWLU871.9 ... -�- - ... 9/20/2014 09/20/201 EACH OCCURRENCE ... $1.000.000 EXCESS LIAB CLAIMS-MADE . MS MADE........... .. . .. . ............._...... ............................,.1 AGGREGATE______. $1 OQO OOp - - DED N $ $ B .... .... N WORKERS COMPENSATION .............. X ....... - WZP81021314 ---- -- 9/20/2014 - -_......... 09/20/201 ,.�..�. X Rv IAM TR °R ".,...... AND EMPLOYERS LIABILITY..,.,..,. /N ...I ANY PROPRIETOR /PARTNER /EXECUTIVEY EL EACH ACCIDENT $1,000,000 L' YFFICERFMEM1BER EXCLUDED? � NIA -----"` --- (Mandatory In NH) : E L. DISEASE - EA EMPLOYEE $1.000.000 If yes, descdbe under DESCRIPTION OF OPERATIONS below ......... ......... ..... --....._.._ _..._.....,. E L DISEASE POLICY LIMIT ... r ............ .,..,_ $1.000.000 C Professional 105344511 9120/2014 09/20/201 $2,000,000 per Claim Liability 1 $2,000,000 Annl Aggr, DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) General Liability Policy excludes claims arising out of the performance of professional services. Ref: El Segundo Fiber Optic Network Expansion Project/ Proposal No 04- 00218. (See Attached Descriptions) ') City of El Segundo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 350 Main Street, "` ACCORDANCE WITH THE POLICY PROVISIONS. El Segundo, CA 90245 -3 AUTHORIZED REPRESENTATIVE ©1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) 1 of 2 The ACORD name and logo are registered marks of ACORD #S1296099/M1104314 NMF SAGITTA 25.3 (2010/05) 2 of 2 #S1296099/M1104314 Insured: AKM Consulting Engineers, Inc.. Insurer: Sentinel Insurance Co, LTD Policy Number: 57SBWLU8719 Policy Effective Date: 09/20/2014 City of El Segundo, its officers, officials, employees and volunteers„ Additional Insured: EXCERPTS FROM: Hartford Form SS 00 08 04 05 BUSINESS LIABILITY COVERAGE FORM C. WHO IS AN INSURED 6. Additional Insureds When Required By Written Contract, Written Agreement Or Permit The person(s) or organization(s) identified in Paragraphs a. through f. below are additional insureds when you have agreed, in a written contract, written agreement or because of a permit issued by a state or political subdivision, that such person or organization be added as an additional insured on your policy, provided the injury or damage occurs subsequent to the execution of the contract or agreement, or the issuance of the permit. A person or organization is an additional insured under this provision only for that period of time required by the contract, agreement or permit. f. Any Other Party (1) Any other person or organization who is not an insured under Paragraphs a. through e, above, but only with respect to liability for "bodily injury, "property damage" or "personal and advertising 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 your premises owned by or rented to you; or (c) In connection with "your work" and included within the "products- completed operations hazard, but only if (i) The written contract or written agreement requires you to provide such coverage to such additional insured; and (ii) This Coverage Part provides coverage for "bodily injury" or "property damage" included within the "products- completed operations hazard. (2) With respect to the insurance afforded to these additional insureds, this insurance does not apply to: "Bodily injury, "property damage" or "personal and advertising injury" arising out of the rendering of, or the failure to render, any professional architectural, engineering or surveying services, including: inspection, or engineering E.B. Separation of Insureds Except with respect to the Limits of Insurance, and any rights or duties specifically assigned in this policy to the first Named Insured, this insurance applies: a. As if each Named Insured were the only Named Insured; and b. Separately to each insured against whom a claim is made or "suit" is brought. E.7.b.(7).(b) Primary And Non - Contributory To Other Insurance When Required By Contract If you have agreed in a written contract, written agreement or permit that this insurance is primary and non- contributory with the additional insured's own insurance, this insurance is primary and we will not seek contribution from that other insurance. E.8.b. Waiver Of Rights Of Recovery (Waiver Of Subrogation) If the insured has waived any rights of recovery against any person or organization for all or part of any payment, including Supplementary Payments, we have made under this Coverage Part, we also waive that right, provided the insured waived their rights of recovery against such person or organization in a contract, agreement or permit that was executed prior to the injury or damage. EXCERPT FROM Hartford Form SS 04 38 06 01 HIRED AUTO AND NON -OWNED AUTO B. With respect to the operation of a "non -owned auto ", WHO IS AN INSURED is replaced by the following: The following are "insureds ": d. Anyone liable for the conduct of an "insured ", but only to the extent of that liability. Insured: AKM Consulting Engineers, Inc. Policy Number: WZP81021314 Effective Date: 09/20/2014 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. 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 % of the California workers' compensation premium otherwise due on such remuneration. Person or Organization City of El Segundo 350 Main Street El Segundo, CA 90245 -3895 SCHEDULE Job Description Ref: El Segundo Fiber Optic Network Expansion Project/ Proposal No 04- 00218. SCHEDULE CONTINUED: A Waiver of Subrogation applies in favor of the City of El Segundo, its officers, officials, employees and volunteers Countersigned bye"'""' Authorized Representative Form WC 04 03 06 (1) Printed in U.S.A. Process Date: Policy Expiration Date: