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PROOF OF INSURANCE (2015) CLOSED0 �,. CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DD/YYYY) 5115!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 Adamson & McGoldrick Insurance Solutions 1800 E. Lambert Rd., Ste 225 Brea, CA 92821 NAME: Maaaie Ho PHONE FAX �c No. Ext1: 714- 257 -9644 Arc No : 714 - 257 -9833 E -MAIL ADDRESS: mho snainS.Com INSURERS AFFORDING COVERAGE I NAIC # VTC2J- CO- 93228094 -14 OC &P & XCU INCLUDE INSURER A: Travelers Prop Cas Co ofAmr 1 25674 www.snains.com INSURED Morrow - Meadows Corporation 231 Benton Court INSURER B: Travelers Ind Co of Conn 1 25682 INSURER C: INSURER D: City of Industry CA 91789 INSURER E : GEN'L AGGREGATE LIMIT APPLIES PER: —j � POLICY JECT LOC ✓ i OTHER: $50,000 Deductible INSURER F : s COVERAGES CERTIFICATE NUMBER: 24700941 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. ILTR TYPE OF INSURANCE INSO VD POLICY NUMBER MOMILDIDY/YYYY MM DDIYYYY LIMITS A �/ ✓ ( COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ❑ OCCUR Blanket Cont.L ✓ I ' VTC2J- CO- 93228094 -14 OC &P & XCU INCLUDE 7/1/2014 ! 7/1!2015 j C ! I EACH OCCURRENCE Is 1,000,000 DAMA TO RENTED PREMISES (Ea occurcence) 5 300 +000 MED EXP (Any one person) is 5,000 ✓ BFPD;CrossLia PERSONAL AN &L ADVINJURY 5 1,000,000 GEL AGGREGATE Is 2 +000+000 GEN'L AGGREGATE LIMIT APPLIES PER: —j � POLICY JECT LOC ✓ i OTHER: $50,000 Deductible PRODUCTS - COMP /OP AGG , S 2,000,000 s B AUTOMOBILE ✓ LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIREDAUTOS ✓� AUTOS VTECAP9322B125 14 7/1/2014 ( 1711/2015 COMBINED SINGLE LIMIT , $ (Ea accident) 1,000,000 BODILY INJURY Per person) 11 BODILY INJURY (Per accident)! S ✓ _ PROPERTY DAMAGE S Per- accident) i5 G--� UMBRELLA LIAR EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE5 AGGREGATES I DED 11 RETENTIONS I � I ( is A � � �OF WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/ N � ANY PROPRIETOR/PARTNER/EXECUTIVE FICER/MEMBER EXCLUDED? N (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below I NIA ✓ ( I VTC2JUB9494A622 -14 7/1/2014 '7/1/2015 ! I SPER T OTH- ✓ ( TA UTE ER ! E.L. EACH ACCIDENT S 1,000,000 E.L. DISEASE - EA EMPLOYE � 5 1,000,000 E.L. DISEASE - POLICY LIMIT ' $ 1,000,000 i i DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: Job #215507, El Segundo Instrumentation & SCADA Services, 350 Main Street, El Segundo, CA 90245 -3813. City of El Segundo, its officials and employees are additional insured to General Liability policy per the attached endorsement. Primary wording applies to General Liability policy per the attached endorsement. Waiver of subrogation applies to Worker's Compensation policy per the attached endorsement *10 days notice of cancellation for non - payment of premium. %,am I Iris m I C r7SJLuam City of El Segundo /Public Works SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Y 9 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Attn: Lifan Xu ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street El Segundo, CA 90245 -3813 AUTHORIZED REPRESENTATIVE J Ted Adamson / �(`-- •�[�+ci:.L� -� `fir ©1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD 24700941 1 MOP.RO -1 1 14/15 GL AU WC UMB $514 1 Maggie Ho 1 5/15/2015 11:07:52 AM (PDT) I Page 1 of 4 VTC2J- CO- 93226094 -14 7/1/2014 7/1/2015 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 1. WHO IS AN INSURED — (Section II) is amended to include any person or organization that you agree in a "written contract requiring insurance" to include as an additional insured on this Cover- age Part, but: a) Only with respect to liability for "bodily injury", "property damage" or "personal injury"; and b) If, and only to the extent that, the injury or damage is caused by acts or omissions of you or your subcontractor in the performance of "your work" to which the "written contract requiring insurance" applies. The person or organization does not qualify as an additional insured with respect to the independent acts or omissions of such person or organization. 2. The insurance provided to the additional insured by this endorsement is limited as follows: a) In the event that the Limits of Insurance of this Coverage Part shown in the Declarations exceed the limits of liability required by the "written contract requiring insurance ", the in- surance provided to the additional insured shall be limited to the limits of liability re- quired by that "written contract requiring in- surance". This endorsement shall not in- crease the limits of insurance described in Section III — Limits Of Insurance. b) The insurance provided to the additional in- sured does not apply to "bodily injury", "prop- erty damage" or "personal injury" arising out of the rendering of, or failure to render, any professional architectural, engineering or sur- veying services, including: L The preparing, approving, or failing to prepare or approve, maps, shop draw- ings, opinions, reports, surveys, field or- ders or change orders, or the preparing, approving, or failing to prepare or ap- prove, drawings and specifications; and ii. Supervisory, inspection, architectural or engineering activities. CG D2 46 08 05 c) The insurance provided to the additional in- sured does not apply to "bodily injury" or "property damage" caused by "your work" and included in the "products- completed op- erations hazard" unless the "written contract requiring insurance" specifically requires you to provide such coverage for that additional insured, and then the insurance provided to the additional insured applies only to such "bodily injury" or "property damage" that oc- curs before the end of the period of time for which the "written contract requiring insur- ance" requires you to provide such coverage or the end of the policy period, whichever is earlier. 3. The insurance provided to the additional insured by this endorsement is excess over any valid and collectible 'other insurance ", whether primary, excess, contingent or on any other basis, that is available to the additional insured for a loss we cover under this endorsement. However, if the "written contract requiring insurance" specifically requires that this insurance apply on a primary basis or a primary and non - contributory basis, this insurance is primary to "other insurance" available to the additional insured which covers that person or organization as a named insured for such loss, and we will not share with that "other insurance ". But the insurance provided to the additional insured by this endorsement still is excess over any valid and collectible "other in- surance", whether primary, excess, contingent or on any other basis, that is available to the addi- tional insured when that person or organization is an additional insured under such "other insur- ance". 4. As a condition of coverage provided to the additional insured by this endorsement: a) The additional insured must give us written notice as soon as practicable of an "occur- rence" or an offense which may result in a claim. To the extent possible, such notice should include: O 2005 The St. Paul Travelers Companies, Inc. 24700941 1 MORRO -1 1 14/15 GL AU WC UMS $std I Maggie Ho 1 5/15/2015 11:07:52 A14 (PDT) I Page 2 of 4 Page 1 of 2 COMMERCIAL GENERAL LIABILITY L How, when and where the 'occurrence" or offense took place; iii. The names and addresses of any injured persons and witnesses; and iii. The nature and location of any injury or damage arising out of the 'occurrence" or offense. b) If a claim is made or "suit" is brought against the additional insured, the additional insured must: L Immediately record the specifics of the claim or "suit" and the date received; and ii. Notify us as soon as practicable. The additional insured must see to it that we receive written notice of the claim or "suit" as soon as practicable. c) The additional insured must immediately send us copies of all legal papers received in connection with the claim or "suit ", cooperate with us in the investigation or settlement of the claim or defense against the "suit ", and otherwise comply with all policy conditions. d) The additional insured must tender the de- fense and indemnity of any claim or "suit" to Page 2 of 2 any provider of "other insurance" which would cover the additional insured for a loss we cover under this endorsement. However, this condition does not affect whether the insur- ance provided to the additional insured by this endorsement is primary to 'other insur- ance" available to the additional insured which covers that person or organization as a named insured as described in paragraph 3. above. 5. The following definition is added to SECTION V. — DEFINITIONS: "Written contract requiring insurance" means that part of any written contract or agreement under which you are required to include a person or organization as an additional in- sured on this Coverage Part, provided that the "bodily injury" and "property damage" oc- curs and the "personal injury" is caused by an offense committed: a. After the signing and execution of the contract or agreement by you; b. While that part of the contract or agreement is in effect; and c. Before the end of the policy period. © 2005 The St. Paul Travelers Companies, Inc. ` A CG D2 46 08 05 24700941 1 MORRO -1 1 14/15 GL AU WC UMS $5M I Maggie Ho 1 5/15/2015 11:07:52 AM (PDT) I Page 3 of 4 A601k TRAVELERS WORKERS COMPENSATION AND ONE TOWER SQUARE HARTFORD, CT 06183 EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 00 03 13 (00)-01 POLICY NUMBER: VTC2JUB9494A622-14 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 DESIGNATED PERSON: Person or Organization: City of El Segundo Attn: PW Dept 350 Main St El Segundo, CA 90245 Job Description: City of El Segundo, its officials, officers, agents and employees re: Engineering Plan Check Svcs, City of El Segundo DESIGNATED ORGANIZATION: ANY PERSON OR ORGANIZATION FOR WHICH THE INSURED HAS AGREED BY WRITTEN CONTRACT EXECUTED PRIOR TO LOSS TO FURNISH THIS WAIVER. AT-1 24700941 1 MORRO-1 1 14/15 GL AD WC UMS $5M 1 Maggie Ho 1 5/15/2015 11:07:52 AM (PDT) 1 Page 4 of 4 �� 0 CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDNYYY) 3!24/2015 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 Adamson & McGoldrick Insurance Solutions 1800 E. Lambert Rd., Ste 225 Brea, CA 92821 NAME: Lynn Beimer PtiCNN Ext: 714- 257 -9644 FAX No: 714- 257 -9833 E -MAIL ADDRESS: Ibeimer snains.com INSURERS AFFORDING COVERAGE NAIC # EACH OCCURRENCE S �DAMA T RED PREMISES Ea occurrence I S__ INSURER A : Columbia Casualty Company _( www.snains.com INSURED Morrow- Meadows Corporation 231 Benton Court INSURERB: INSURER C: PERSONAL & ADV INJURY $ INSURER D: __ _ GENERAL AGGREGATE !s City of Industry CA 91789 INSURER E : I OTHER: INSURER F: COVERAGES CERTIFICATE NUMBER: 23929019 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. INSR TYPE OF INSURANCE iADDtDgUBR1- POLICY NUMBER P NOLICY EFF MM/DDYYY POLICY EXP MMIDDYYY N LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE EI OCCUR EACH OCCURRENCE S �DAMA T RED PREMISES Ea occurrence I S__ _ MED EXP (Any one person) S _( j ( i PERSONAL & ADV INJURY $ !GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- JECT El LOC __ _ GENERAL AGGREGATE !s PRODUCTS - COMP /OP AGG I S i S I OTHER: ! E AUTOMOBILE LIABILITY ! ANY AUTO ! I COMBINED SINGLE LIMIT s (Ea accident/ BODILY INJURY (Per person) S I ALL AUTOS OWNED AUTOS ( j j BODILY BODILY INJURY (Per accident)' $ �---� NON -OWNED HIRED AUTOS AUTOS j PROPERTY DAMAGE s fPeraccidenq UMBRELLA LIAB OCCUR ( EACH OCCURRENCE s AGGREGATE $ EXCESS LIAB CLAIMS -MADE DIED I RETENTION S j I Is ! WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER /EXECUTIVE OFFICER/MEMBER EXCLUDED? El 1(Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below ! N/A! � I ! ! ! I i j PER I OTH- I STATUTE I_ I ER E.L. EACH ACCIDENT : S -- E.L. DISEASE - EA EMPLOYEE S E.L. DISEASE - POLICY LIMIT ! $ A Professional liab. CE02076170260 1/21/2015 1/21/2016 I Limit: $5,000,000 Retention $150,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: Job #215507, El Segundo Instrumentation & SCADA Services, 350 Main Street, El Segundo, CA 90245 -3813. CERTIFICATE HOLDER CANCELLATION City of El Segundo / Public Works Attn: Lifan Xu 350 Main Street El Segundo, CA 90245 -3813 lklYll 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 Ted Adamson ©1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD CERT NO.: 23929019 CLIENT CODE: MORRO -1 Ram Kishore K 3/24/2015 2:18:25 PM (PDT) Page 1 of 1 Sandoval, Lili From: Nguyen, Trang Sent: Monday, May 18, 2015 9:08 AM To: Hegvold, Julie Cc: Xu, Lifan; Sandoval, Lili; Shilling, Mona Subject: RE: Morrow-Meadows Agmt Z•.. -- Thank you, Trang From: Hegvold, Julie Sent: Monday, May 18, 2015 7:26 AM To: Nguyen, Trang Cc: Xu, Lifan; Sandoval, Lili; Shilling, Mona Subject: Morrow-Meadows Agmt Good Morning Trang, Morrow-Meadows has forwarded their Work Comp waiver. Please let me know if their insurance is approved. Thanks, Julie Hegvold, Management Analyst CITY OF EL SEGUNDO I Public Works Dept. 350 Main Street, El Segundo, CA 90245 Tel. (310) 524-2365 1 ihegvold@elsegLindo.org CITY HALL IS CLOSED ON FRIDAYS From: Hegvold, Julie Sent: Wednesday, April 29, 2015 5:44 PM To: Nguyen, Trang Cc: Garcia, Angelina; Xu, Lifan Subject: RE: Morrow-Meadows Agmt Hi Trang, The Prof Liability was included (separate cert), but we will request the Work Comp Waiver. Thanks! Julie Hegvold, Management Analyst CITY OF EL SEGUNDO I Public Works Dept. 350 Main Street, El Segundo, CA 90245 Tel. (310) 524-2365 1 jhegvold@elseondo.org CITY HALL IS CLOSED ON FRIDAYS 1 , From: Nguyen, Trang Sent: Tuesday, April 2O,2U156:19PK8 To: HeQvn|d,Julie Cc: Garcia, Angelina Subject: RE: Morrow-Meadows Agmt Hi Julie, I reviewed the insurance and confirmed with Angie that we will need the Professional Liability and waiver for Worker's Comp, Please make sure that the Worker's Comp insurance is for the state of California, Thank you, Trang From: Garcia, Angelina Sent: Tuesday, April 28,]O15l1:4QAM To: Nguyen, Trang Subject: FW: Morrow-Meadows Agmt Angelina Garcia From: Hegvold, Julie Sent: Tuesday, April 28, 2015 11:43 AM To: Garcia, Angelina Cc: %u, LKan; Sandoval, UU; Shilling, Mona Subject: Morrow-Meadows Agmt Hi Angie, We're hoping that you'll review our contract insurances up until you leave. ;) Here's a consulting agreement with Morrow-Meadows and their insurance certs and endorsements for your review and initials. Please let us know if they are acceptable, and I will drop off the hard copies to your office. Thank you, Julie Hegvold, Managment Analyst CITY OF Ef. SEGUNDO I Public Works Dept, 350 Main Street, El Segundo, CA 90245 Tel, (310) 524-2365 1 ihcgvo1d((bc1scgundo.org CITY HALL IG CLOSED 0N FRIDAYS I