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PROOF OF INSURANCE (2016) CLOSEDDATE (MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE r ,W 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 Arthur J. Gallagher Risk Management Services, Inc. 1 W. 4th Street, Suite 1300 Cincinnati OH 45202 INSURED I INSURER B : Landrum & Brown, Inc. INSURER C: c/o Dennis Peters INSURER D: 11279 Cornell Park Drive INSURER E Cincinnati OH 45242 �...••....�------------ ----••. INSURER F: COVERAGES CERTIFICATE NUMBER: 1195313279 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, ...................... �... mTYPEmOFINSURANCE .. .�.,. ^ _i .., .._._,... ..,.E _...�.LIC _.. .... . ..,.,...... LIMITS . ............................. NNSR I(L. R POL4'CY EFF POLICY EXP LTR !NSR. WVD POL,IC, NUMBER. MM(DD(''MY MMIDDrMY) ,4 GENERAL LIABILITY Y 35786142 1/23/2015 /2312016 49ACH OCCURRENCE $1.000.000 I ERALLIOCCUR i'r'nc'�-Titlrr „ rxriirrfnrel $1 ODO 000 TCLAIMS-MADE X ((Fa Any one person) MEDEXPS,,,,, ... $10.000 _ ........, ,,,......................................... ............. X Ohio Stop Gap L & ADV INJURY PERSONA .... ..... .....�.., $1.000.000 ...... _...... ................................. _... GENERAL AGGREGATE .................... .... $2.000.000 .......... _................. ............................................. --------- — GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG ''.. $2.000.000 i ,,,. POLICY X JECT ', LOC .............. ...... Employee Benefits ,........ -- - ----- `------- -- $1 000,000 A AUTOMOBILE _ .X LIABILITY Y 74968374 1/23/2015 1/23/2016 CO accident 1 $1.000,000 BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ ,,.,�.. NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE (Per accident) $ A X UMBRELLA LIAB X OCCUR Y 79839506 1/23/2015 1/23/2016 EACH OCCURRENCE $9,000,000 X AGGREGATE $9,000,000 EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ A WORKERS COMPENSATION 71709699 112312015 1I23I2016 X rnrzv i nnrUrc OFa AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR /PARTNER /EXECUTIVE ''.. OFFICER/MEMEER EXCLUDED? E] NIA E,L., EACH ACCIDENT $1,000,000 _____..,,,......._ .... __ (Mandatory in NH) E,L. DISEASE_- EA EMPLOYEE $1,000,000 If Y DFSCRIPTION OF OPERATIONS below E L, DISEASE - POLICY LIMIT $m �.�m mm.. .._ 1,000,000 B Professional Liability V11CU315PNPM 1/23/2015 1/23/2016 Limit 5,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) *Additional Insured for General Liability applies per policy form #80 -02 -2367 05/07 where required by law" The City of El Segundo is named as aditional insured on a primary and non- contributory basis. CERTIFICATE HOLDER The City of El Segundo 350 Main Street El Segundo CA 93010 USA q Y1k �d ACORD 25 (2010/05) CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE F''���7/ ©1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD CHUME3 Liability Insurance Endorsement This appliel to �hc' folloMng lbrnjs� GENEIRAV HABILFTY I �ndcr Who Is An Illnsured, dic following pirovkion k added, Who 1.9 Art Insured Liability Insurance Additional Insured, - Scheduled Person Or Organization conto 80 02-2367 (Rev- 5-07) Endorsement Pace i orm such insurance as is afforded by (his policy. All other terms and conditions remain unchanged, Authorized Representative Liability Insurance Addolional Insured - *Scheduled Person Or Organization Form 80-02-2367 (Rev. 5-07) Endorsement M2 w WORKERS' COMPENSATION AND EMPLOYERS' LIABILMY INSURANCE POLICY WC 124 (4 -84) WC 00 03 13 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT 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. (rhe following "attaching clause" need be completed only when this endorsement is issued subsequent to preparation of the poky.) This endorsement, effective on 01/23/15 at 12:01 A. M. standard time, forms a part of (DATE) Policy No. (16)7170 -96 -99 of the FEDERAL INSURANCE COMPANY (NAME OF INSURANCE COMPANY) issued to LANDRUM & BROWN INC Endorsement No, Authorized Representative 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 any one not named in the Schedule. Schedule N1111".1 PER SCHEDULE ON FILE WITH COMPANY AND ANY WRITTEN CONTRACT OR AGREEMENT THAT IS AN INSURED CONTRACT, PROVIDED THE BODILY INJURY OR PROPERTY DAMAGE, TO WHICH THIS INSURANCE APPLIES, OCCURS AFTER THE EXECUTION OF SUCH CONTRACT OR AGREEMENT. WC 124 (4 -84) WC 00 03 13 Copyright 1983 National Council on Compensation Insurance, Page 1 of 1 cHUrata Name & Mailing Address of the Insured LANDRUM & BROWN INC 11279 CORNELL PARK DR CINCINNATI OH 45242 FEIN 311095645 Name & Address of the Producer Attached to and Forming Part of Policy Number (16)7170 -96 -99 Policy Period 01/23/15 to 01/23/16 Effective Date 01/23/15 ARTHUR J GALLAGHER RISK MANAGEMENT SERV Name of Company 1 WEST FOURTH ST., #1300 FEDERAL INSURANCE COMPANY CINCINNATI OH 45202 Endorsement Number Producer Number 6 -48828 999 EXTENSION OF INFORMATION PAGE ITEM 3.A. COVERED STATES It is agreed that Item 3.A of the Workers Compensation and Employers Liability Policy Information Page includes the following states; State Risk I.D. State I.D. No. CALIFORNIA 917615608 FLORIDA 917615608 ILLINOIS 917615608 INDIANA 917615608 KENTUCKY 917615608 MASSACHUSETTS 917615608 NEW MEXICO 917615608 NEW YORK 917615608 TEXAS 917615608 VIRGINIA 917615608 All Other Terms and Conditions Remain Unchanged L.., dLk' Authorized R,epr esen atiwe Issue Date 01/29115 CIN CLD WC 00 00 01 A (Rev. 5 -88) Sandoval', Liil'i From: Garcia, Angelina Sent: Thursday, April 30, 2015 1:29 PM To: Sandoval, Lili Subject: FW: City of El Segundo & L &B Attachments: Landrum & Brown.pdf Angelina Garcia From: O'Neill, James Sent: Thursday, April 30, 2015 11:22 AM To: Garcia, Angelina Subject: FW: City of El Segundo & L &B - James From: Tricia M. Rollins II o® t Ulit l n_ _m -ht nMco Sent: Thursday, April 30, 2015 11:10 AM To: O'Neill, James Subject: FW: City of El Segundo & L &B Hi James — fingers crossed on this one. Let me know if this is not sufficient. Thanks Trish From: Joyce Lieske rinailtojoyce Lieske0aig.coml Sent: Thursday, April 30, 2015 1:21 PM To: Tricia M. Rollins Subject: RE: City of El Segundo & L &B Tricia, I have attached an updated state schedule showing the Risk ID # and agent signature. There is defiantly workers compensation coverage in CA. The carrier just left off the Risk ID. Hopefully they will be ok with this one, if not I will be happy to talk to them, if that will help. Thank you.. Joyce Lieske, ACSR, CISR Client Service Manager Senior Joyce lieske@,gg.com Arthur J Gallagher & Co, �f 1 W. 4th Street, Ste 1300 1 Cincinnati, OH 45202 P: 513.977.31161 F: 513.977.4752 www-ajg,cpM I www.aigrms.com/cincinnati Arthur J. Gallagher Risk Management Services, Inc. Formerly Schiff, Kreidler -Shell Insurance Inc. From: Tricia M. Rollins [mailto:trollins@ ndrt.im -brot n.cogm] Sent: Thursday, April 30, 2015 9:07 AM To: Joyce Lieske Subject: FW: City of El Segundo & L &B Good morning Joyce — seems this waiver is not going to do it. Can you please check into the items James indicated in his email below and the corresponding attachment.. Thank you Trish From: O'Neill, James [ ailt :J N' _ ill else undo.or !] Sent: Wednesday, April 29, 2015 8:56 PM To: Tricia M. Rollins Subject: RE: City of El Segundo & L &B Trish — The waiver actually seems to indicate that L &B does not have insurance in the state of California. See attached. There is no Risk I.D. listed for California. Additionally, the form is unsigned James From: Tricia M. Rollins [mailto:trolli la r m- brown.com] Sent: Tuesday, April 28, 2015 12:18 PM To: O'Neill, James Subject: FW: City of El Segundo & L &B Hi James — let me know if this is not sufficient. Trish From: Joyce Lieske [mailto:Jo ce. Lies e" , ] Sent: Tuesday, April 28, 2015 3:13 PM To: Tricia M. Rollins Subject: RE: City of El Segundo & L &B Tricia, Here is the page from the policy that shows the states covered. It does show California, does this work for the proof. Let me know if the City wants anything else. Thank you. Joyce Lieske, ACSR, CISR Client Service Manager Senior Joyce ligs orrt Arthur J. Gallagher & Co. X 4 1, `,) `,qv l , ".0 S 416 , "1" V 4 <,'1 1 T R A F R 111' P1 n .,.. 1 W. 4th Street, Ste 1300 1 Cincinnati, OH 45202 P: 513.977.31161 F: 513.977.4752 www.ajg.com I www.a" ris_cora�incinnt Arthur J. Gallagher Risk Management Services, Inc. Formerly Schiff, Kreidler -Shell Insurance Inc. From: Tricia M. Rollins [mail o:froltlins I n r m- r wn,.c ] Sent: Tuesday, April 28, 2015 1:25 PM To: Joyce Lieske Subject: RE: City of El Segundo & L &B Hi Joyce — see snipit below. "Can you provide evidence that the Workers' comp is for the state of California ?" Can you help me on this? Trish From: I :O'Neill, James <JON . @1dse undo.or > To: IN T'rida M. Rollins Cc: Subject: Fes': L &6 - contract/ March billings m , , 2 , . N , I p , , , 4 , , . n . , , , , . � , . . .6.. Trish — From: Garcia, Angelina Sent Monday, April 27, 2015 4:44 PM To: O'Neill, James Cc: Nguyen, Trang Subject: RE: L &B - contract/March billings Angelina Garcia From: Joyce Lieske [mail o. o e Li ske a` m, Sent: Monday, April 27, 2015 2:34 PM To: Tricia M. Rollins Subject: RE: City of El Segundo & L &B 3 Hi Tricia, I have attached the forms requested. Please let me know if you need anything else at this time. Thank you. Joyce Lieske, ACSR, CISR Client Service Manager Senior Jo . e lieske a aia..com Arthur J. Gaaher Co. „d 4fi','r!5 CHf11i4 I,,fP1,Ailf:� 1 W. 4th Street, Ste 1300 l Cincinnati, OH 45202 P: 513.977.31161 F: 513.977.4752 M8"_,dLqS.om 1 w .a' rrns.00m1cincinnati Arthur J. Gallagher Risk Management Services, Inc. Formerly Schiff, Kreidler -Shell Insurance Inc. From: Tricia M. Rollins [ma!Ito:tr!olli+n a rum r wn. ] Sent: Monday, April 27, 2015 2:08 PM To: Joyce Lieske Subject: City of El Segundo & L &B Hi Joyce! Welcome to the L &B account. The City of El Segundo has come back and said we need the highlighted below in regards to the insurance. He has attached samples of what they are looking for. I've attached correspondence between Tricia K and I for reference and the contract. Can you please look into this? Thanks so much! Trish Trish M. Rollins I Landrum & Brown 11279 Cornell Park Drive Cincinnati, OH 45242 P: 513.530.1247 1 F: 513.530.2247 From: O'Neill, James [inailfo° N ill Is undo.or ] Sent: Monday, April 27, 2015 12:44 PM To: Tricia M. Rollins Subject: FW: L &B - contract /March billings Trish — Sorry for the delay, as our Risk Manager was out of the office last week. Attached are samples of the needed endorsement for Commercial General Liability and Waiver of Subrogation for workers' comp forms. - James From: Tricia M. Rollins mailt :trollins landrummm wn. n3 Sent: Tuesday, April 21, 2015 10:32 AM To: O'Neill, James Cc: Alan Hass Subject: RE: L &B - contract /March billings James — is this what you need? Trish From: O'Neill, James n "il o JO et@ 15 un orcfl Sent: Tuesday, April 21, 2015 1:28 PM To: Tricia M. Rollins Cc: Alan Hass Subject: RE: L &B - contract /March billings The City needs the endorsement for Commercial General Liability and Waiver of Subrogation for workers' comp to execute the contract. Please provide a scanned copy as soon as possible to help expedite the process. Thank you. - James From: Tricia M. Rollins [mail : r llins landru , r vary. mtt] Sent: Monday, April 20, 2015 2:21 PM To: O'Neill, James Cc: Alan Hass Subject: RE: L &B - contract /March billings Hi James — I am hoping this invoice sent to you on 04/15/15 was ok and you've received the information from Alan to correspond. I have included this invoice on our books unless I hear otherwise. Thank you, Trish Trish M. Rollins 1 Landrum & Brown 11279 Cornell Park Drive Cincinnati, OH 45242 P: 513.530.1247 1 F: 513.530.2247 From: Tricia M. Rollins Sent: Wednesday, April 15, 2015 2:58 PM To: 'O'Neill, James' Cc: Alan Hass Subject: RE: L &B - contract /March billings Hi James — attached is the invoice billing for Landrum & Brown that I would like your approval on beings this is the first one. Alan will have the March 301h reports to you by the end of the week. This invoice takes into account those reports. Let me know your thoughts. Trish Trish M. Rollins I Landrum & Brown 11279 Cornell Park Drive Cincinnati, OH 45242 P: 513.530.1247 1 F: 513.530.2247 From: O'Neill, James [m it . ON ill else un t_, ] Sent: Monday, April 13, 2015 8:37 PM To: Tricia M. Rollins Cc: Alan Hass Subject: RE: L &B - contract /March billings For billing, please invoice according to the cost schedule provided by Alan. Please include a list of homes tested for each of the weeks of testing performed. If you would like me to look at a sample, I'd be happy to look at it and provide more detailed feedback if that is necessary. - James From: Tricia M. Rollins [mailto:trollins o)l ndrum- brown.com] Sent: Thursday, April 09, 2015 2:54 PM To: O'Neill, James Cc: Alan Hass Subject: L &B - contract /March billings Hi James — wanted to do a follow up on the contract between L &B and the City to see if there is a signed copy in the works and on its way back to Alan and I here at L &B? We also have some charges in March for Alan Hass, Eric Seavey, & Michael Holritz. Would you like me to go ahead and invoice those labor and expense charges for Acoustical Testing Services and Analysis & Documentation? Is there a special way you would like us to provide that invoice? I am not seeing any special instructions with the paperwork that I have so if you prefer us to bill in a specific format, pass that along. I will wait to hear from you. Thank you, Trish Trish M. Rollins I Landrum & Brown 11279 Cornell Park Drive Cincinnati, OH 45242 P: 513.530.1247 1 F: 513.530.2247