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PROOF OF INSURANCE (2015) CLOSEDAC ' CERTIFIiCATE OF LIABILITY INSURANCE DATE (MMYYY " 6/12/ 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 NAME: Jerry Noyola Greyling Insurance Brokerage PHONE (770) 552 -4225 _o?( IeIc u,. c_,. .I (866)550 -4082 3780 Mansell Road &MI :jerry.noyolaCgre;ylizag,com Suite 370 INSLIIRFRtQ% arrnpin Nn rrIVFRar:c I Nalr }! GA 30022 '.INSURED INSURERB:Travelers Indemnity Company 5658 KPFF, Inc. INSURERC:Travelers Propertv Casualtv 5674 1601 5th Avenue INSURER D :Lloyd Is of London Suite 1600 INSURERE:Travelers Indemnity Co. of CT 25682 Seattle WA 98101 INSIIRFR F COVERAGES CERTIFICATE NUM13ER:14 -15 (LA Structural) 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, LTA TYPE OF INSURANCE !NSR wvD POLICY NUMBER IMMIDDN IMMIDDIYYYYI DI EXP LIMITS GENERAL LIABILITY OCCURRENCE $ 1 , 000 , 000 COMMERCIAL GENERAL I 3 CLAX IMS-MADE OCCUR 680- 1263L238 (AOS) 10/10/2014 0/10/2015 _EACH MED EXP (Any one mA m .. �jtt�S2NALA,�RVNIURY $ u10,000 „ _ X WA Stop Gap $ 1,000,000 E X Contractual Liability 680- 127OL580 (CA) 10/10/2014 10/10/2015 ..................... . GENERAL AGGREGATE ............ ...... .. $ 2,000,000 GEN L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 2,000,000 POLICY X F,E& LOC $ AUTOMOBILE LIABILITY COM BINED ' I aL "" LIMIT ' Ea accdent ¢ 1 000 - 000 - _ BODILY INJURY (Per person) T$ �ITIT B X ANY AUTO ALL OWNED X SCHEDULED - 1283L587 10/10/2014 10/10/2015 BODILY INJURY (Per accident) $ AUTOS AUTOS X X NON -OWNED HIREDAUTOS AUTOS PFtO' T2T'Y CSI/ �1rt E ���� -- rPP�a��I,�P . .................... ........ -...._ ..... ,$ ------------------------------- .............................. $...... X UMBRELLA LIAR ''. X OCCUR EACH OCCURRENCE $ 9,000,000 B ]..EXCESS LIAB CLAIMS -MADE I'AOGREGATE $ 9,000,000 'f)Fr1 ',, X RETFNTI(�N,A 10,00 PUP 10/10/2014 0/10/2015 $ C WORKERS COMPENSATION X TWC I - '.. PR R AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR /PARTNER /EXECUTIVE� OFFICER /MEMBER EXCLUDED? N/A E,L. EACH ACCIDENT $ 1. 000,00- 0 E,L. DISEASE - EA EMPLOYE, $ 1,000,000 d..�... 1. (Mandatory in NH) - 5836Y216 10/10/2014 0/10/2015 If yes, describe under DESCRIPTION OF OPFRATIONR haloes E,L, DISEASE - POLICY LIMIT $ 1,000,000 D 'Professional Liability/ 80146LDUSA1404384 10/10/2014 0/10/2015 Per Claim /Aggregate $10,000,000 Pollution Liability SIR $250,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Re: KPFF Job #115277 - E1 Segundo Fire Station No. 1 Seismic Evaluation & Retrofit. The City of E1 Segundo is named as an Additional Insured with respects to General & Automobile Liability where required by written contract. Waiver of Subrogation is applicable where required by written contract & allowed by law. Umbrella Follows Form with respects to General, Automobile & Employers Liability Policies. Should any of the above described policies be cancelled by the issuing insurer before the expiration date thereof, 30 days' written notice (except 10 days for nonpayment of premium) will be provided to the Certificate Holder. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of E1 Segundo ACCORDANCE WITH THE POLICY PROVISIONS. Floriza Rivera, PW Dept, 350 Main Street AUTHORIZED REPRESENTATIVE E1 Segundo, CA 90245 David Collings /JERRY ACORD 25 (2010/05) ©1988 -2010 ACORD CORPORATION. All rights reserved. INSn25 r9mnnFi m Thn ArOPn nmmn nnri Innn om — nia4nrnrl —ka of ArnRn COMMERCIAL GENERAL LIABILITY Policy Number: 680- 127OL580 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 in- clude as an additional insured on this Coverage Part, but only with respect to liability for "bodily in- jury", "property damage" or "personal injury" caused, in whole or in part, by your acts or omis- sions or the acts or omissions of those acting on your behalf: a. In the performance of your ongoing opera- tions; 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 per- son or organization has assumed liability in a con- tract 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 cover- age as an additional insured specifically is added by another endorsement to this Cover- age Part. e. This insurance does not apply to the render- ing of or failure to render any "professional services ". f. The limits of insurance afforded to the addi- tional insured shall be the limits which you agreed in that "contract or agreement requir- ing insurance" to provide for that additional insured, or the limits shown in the Declara- tions for this Coverage Part, whichever are less. This endorsement does not increase the limits of insurance stated in the LIMITS OF INSURANCE (Section 111) 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 Cov- erage 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 addi- tional 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 insur- ance 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 CON- DITIONS (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 insur- ance" with such person or organization entered into by you before, and in effect when, the "bodily CG D3 8109 07 © 2007 The Travelers Companies, Inc. Page 1 of 2 Includes the cocvriahted material of Insurance Services Office. Inc., with its oermission e COMMERCIAL GENERAL LIABILITY injury" or "property damage" occurs, or the "per- sonal injury" offense is committed. D. The following definition is added to DEFINITIONS (Section V): "Contract or agreement requiring insurance" means that part of any contract or agreement un- der which you are required to include a person or organization as an additional insured on this Cov- erage Part, provided that the "bodily injury" and "property damage" occurs, and the "personal in- jury" 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. Page 2 of 2 © 2007 The Travelers Companies, Inc. CG D3 81 09 07 Includes the coovriahted material of Insurance Services Office. Inc.. with its permission m— 0 0 0 o� r o= o� J 000979 COMMERCIAL AUTO Policy Number: BA- 1283L587 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AUTO COVERAGE PLUS ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modi- fied by the endorsement. GENERAL DESCRIPTION OF COVERAGE - This endorsement broadens coverage. However, coverage for any injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsement to the Coverage Part, and these coverage broadening provisions do not apply to the extent that coverage is excluded or limited by such an endorsement. The following listing is a general cover- age description only. Limitations and exclusions may apply to these coverages. Read all the provisions of this en- dorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered. A. BLANKET ADDITIONAL INSURED H. AUDIO, VISUAL AND DATA ELECTRONIC B. EMPLOYEE HIRED AUTO EQUIPMENT - INCREASED LIMIT C. EMPLOYEES AS INSURED D. SUPPLEMENTARY PAYMENTS - INCREASED LIMITS E. TRAILERS - INCREASED LOAD CAPACITY F. HIRED AUTO PHYSICAL DAMAGE G. PHYSICAL DAMAGE - TRANSPORTATION EXPENSES - INCREASED LIMIT A. BLANKET ADDITIONAL INSURED The following is added to Paragraph A.1., Who Is An Insured, of SECTION II - LIABILITY COV- ERAGE: Any person or organization who is required under a written contract or agreement between you and that person or organization, that is signed and executed by you before the "bodily injury" or "property damage" occurs and that is in effect during the policy period, to be named as an addi- tional insured is an "insured" for Liability Cover- age, but only for damages to which this insurance applies and only to the extent that person or or- ganization qualifies as an "insured" under the Who Is An Insured provision contained in Section II. B. EMPLOYEE HIRED AUTO I. WAIVER OF DEDUCTIBLE - GLASS J. PERSONAL EFFECTS K. AIRBAGS L. AUTO LOAN LEASE GAP M. BLANKET WAIVER OF SUBROGATION performing duties related to the conduct of your business. 2. The following replaces Paragraph b. in B.S., Other Insurance, of SECTION IV - BUSI- NESS AUTO CONDITIONS: b. For Hired Auto Physical Damage Cover- age, the following are deemed to be cov- ered "autos" you own: (1) Any covered "auto" you lease, hire, rent or borrow; and (2) Any covered "auto" hired or rented by your "employee" under a contract in that individual "employee's" name, with your permission, while perform- ing duties related to the conduct of your business. 1. The following is added to Paragraph A.1., However, any "auto" that is leased, hired, rented or borrowed with a driver is not a Who Is An Insured, of SECTION II - Lk ABILITY COVERAGE: covered "auto". An "employee" of yours is an "insured" while C. EMPLOYEES AS INSURED operating a covered "auto" hired or rented The following is added to Paragraph A.1., Who Is under a contract or agreement in that "em- An Insured, of SECTION II - LIABILITY COV- ployee's" name, with your permission, while ERAGE: CA T4 20 07 10 © 2010 The Travelers Indemnity Company. All rights reserved. Page 1 of 3 Includes copyrighted material of Insurance Services Office, Inc. with its permission. COMMERCIAL AUTO Any "employee" of yours is an "insured" while us- ing a covered "auto" you don't own, hire or borrow in your business or your personal affairs. D. SUPPLEMENTARY PAYMENTS — INCREASED LIMITS 1. The following replaces Paragraph A.2.a.(2) of SECTION II — LIABILITY COVERAGE: (2) Up to $3,000 for cost of bail bonds (in- cluding bonds for related traffic law viola- tions) required because of an "accident" we cover. We do not have to furnish these bonds. 2. The following replaces Paragraph A.2.a.(4) of SECTION II — LIABILITY COVERAGE: (4) All reasonable expenses incurred by the "insured" at our request, including actual loss of earnings up to $500 a day be- cause of time off from work. E. TRAILERS — INCREASED LOAD CAPACITY The following replaces Paragraph C.1. of SEC- TION I — COVERED AUTOS: 1. "Trailers" with a load capacity of 3,000 pounds or less designed primarily for travel on public roads. F. HIRED AUTO PHYSICAL DAMAGE The following is added to Paragraph A.4., Cover- age Extensions, of SECTION III — PHYSICAL DAMAGE COVERAGE: Hired Auto Physical Damage Coverage If hired "autos" are covered "autos" for Liability Coverage but not covered "autos" for Physical Damage Coverage, and this policy also provides Physical Damage Coverage for an owned "auto ", then the Physical Damage Coverage is extended to "autos" that you hire, rent or borrow subject to the following: (1) The most we will pay for "loss" in any one "accident" to a hired, rented or borrowed "auto" is the lesser of: (a) $50,000; (b) The actual cash value of the damaged or stolen property as of the time of the "loss "; or (c) The cost of repairing or replacing the damaged or stolen property with other property of like kind and quality. (2) An adjustment for depreciation and physical condition will be made in determining actual cash value in the event of a total "loss ". (3) If a repair or replacement results in better than like kind or quality, we will not pay for the amount of betterment, (4) A deductible equal to the highest Physical Damage deductible applicable to any owned covered "auto ". (5) This Coverage Extension does not apply to: (a) Any "auto" that is hired, rented or bor- rowed with a driver; or (b) Any "auto" that is hired, rented or bor- rowed from your "employee ". G. PHYSICAL DAMAGE — TRANSPORTATION EXPENSES —INCREASED LIMIT The following replaces the first sentence in Para- graph A.4.a., Transportation Expenses, of SECTION III — PHYSICAL DAMAGE COVER- AGE: We will pay up to $50 per day to a maximum of $1,500 for temporary transportation expense in- curred by you because of the total theft of a cov- ered "auto" of the private passenger type. H. AUDIO, VISUAL AND DATA ELECTRONIC EQUIPMENT — INCREASED LIMIT Paragraph C.2.. Limit Of Insurance, of SEC- TION III — PHYSICAL DAMAGE COVERAGE is deleted. I. WAIVER OF DEDUCTIBLE — GLASS The following is added to Paragraph D., Deducti- ble, of SECTION III — PHYSICAL DAMAGE COVERAGE: No deductible for a covered "auto" will apply to glass damage if the glass is repaired rather than replaced. J. PERSONAL EFFECTS The following is added to Paragraph A.4., Cover- age Extensions, of SECTION III — PHYSICAL DAMAGE COVERAGE: Personal Effects Coverage We will pay up to $400 for "loss" to wearing ap- parel and other personal effects which are: (1) Owned by an "insured "; and (2) In or on your covered "auto ". This coverage only applies in the event of a total theft of your covered "auto ". No deductibles apply to Personal Effects cover- age. Page 2 of 3 © 2010 The Travelers Indemnity Company. All rights reserved. CA T4 20 07 10 Includes copyrighted material of Insurance Services Office, Inc. with its permission. K. AIRBAGS The following is added to Paragraph B.3., Exclu- sions, of SECTION III – PHYSICAL DAMAGE COVERAGE: Exclusion 3.a. does not apply to 'loss" to one or more airbags in a covered "auto" you own that in- flate due to a cause other than a cause of 'loss" set forth in Paragraphs A.1.b. and A.1.c., but only: a. If that "auto" is a covered "auto" for Compre- hensive Coverage under this policy; b. The airbags are not covered under any war- ranty; and c. The airbags were not intentionally inflated. We will pay up to a maximum of $1,000 for any one 'loss ". L. AUTO LOAN LEASE GAP The following is added to Paragraph A.4., Cover- age Extensions, of SECTION III – PHYSICAL DAMAGE COVERAGE: Auto Loan Lease Gap Coverage for Private Passenger Type Vehicles In the event of a total 'loss" to a covered "auto" of the private passenger type shown in the Schedule or Declarations for which Physical Damage Cov- erage is provided, we will pay any unpaid amount due on the lease or loan for such covered "auto" less the following: �— (1) The amount paid under the Physical Damage Coverage Section of the policy for that "auto "; and o= o= o= o= U= a= u� AE - CA T4 20 07 10 000880 COMMERCIAL AUTO (2) Any: (a) Overdue lease or loan payments at the time of the 'loss "; (b) Financial penalties imposed under a lease for excessive use, abnormal wear and tear or high mileage; (c) Security deposits not returned by the les- sor; (d) Costs for extended warranties, Credit Life Insurance, Health, Accident or Disability Insurance purchased with the loan or lease;and (e) Carry-over balances from previous loans or leases. M. BLANKET WAIVER OF SUBROGATION The following replaces Paragraph A.5., Transfer Of Rights Of Recovery Against Others To Us, of SECTION IV – BUSINESS AUTO CONDI- TIONS: 5. Transfer Of Rights Of Recovery Against Others To Us We waive any right of recovery we may have against any person or organization to the ex- tent required of you by a written contract exe- cuted prior to any "accident" or 'loss ", pro- vided that the "accident" or "loss" arises out of the operations contemplated by such con- tract. The waiver applies only to the person or organization designated in such contract. © 2010 The Travelers Indemnity Company. All rights reserved. Page '3 of 3 Includes copyrighted material of Insurance Services Office, Inc. with its permission. -0 TRAVEL RS J WORKERS COMPENSATION ONE TOWER SQUARE AND HARTFORD, CT 06183 EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 00 03 13 (00) -01 POLICY NUMBER: UB- 5836Y216 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT 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 Scheduie. (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: DESIGNATED ORGANIZATION: ANY PERSON OR ORGANIZATION FOR WHICH THE INSURED HAS AGREED IN A WRITTEN CONTRACT EXECUTED PRIOR TO LOSS TO PROVIDE THIS WAIVER. DATE OF ISSUE: 11 -04 -13 ST ASSIGN: CERTIFICATE OF CORPORATE RESOLUTION The undersigned Secretary of KPFF, Inc. (the Corporation) hereby certifies that the following resolution was duly adopted by the Board of Directors of the Corporation on December 4, 2008: RESOLVED, that effective immediately, all KPFF Principals are authorized to sign, seal, deliver, negotiate, accept and enter into agreements, contracts and other instruments or documents by and on behalf of KPFF, Inc. (dba KPFF Consulting Engineers). k ff CERTIFICATE OF CORPORATE RESOLUTION The undersigned Secretary of KPFF, Inc. (the Corporation) hereby certifies that the following resolution was duly adopted by the Board of Directors of the Corporation on December 4, 2008: RESOLVED, that effective immediately, all KPFF Principals are authorized to sign, seal, deliver, negotiate, accept and enter into agreements, contracts and other instruments or documents by and on behalf of KPFF, Inc. (dba KPFF Consulting Engineers). Sandoval, Lili From: Nguyen, Trang Sent: Monday, June 15, 2015 2:50 PM To: Hegvold, Julie Cc: Sandoval, Lili; Shilling, Mona; Katsouleas, Stephanie Subject: RE: KPFF - Fire Station Retrofit Agmt Insurance accepted. Thanks, Trang From: Hegvold, Julie Sent: Monday, June 15, 2015 7:49 AM To: Nguyen, Trang Cc: Sandoval, Lili; Shilling, Mona; Katsouleas, Stephanie Subject: KPFF - Fire Station Retrofit Agmt Good Morning Trang, Attached for your insurance review and approval is a new consulting agreement with KPFF for the Fire Station Retrofit project and applicable insurance and endorsements. Please let me know if you need anything additionally. Thanks! C11' `° � =i ��.L1,13�;:r'I'.A a:�1P:'J J iP ,'i' 'ym