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PROOF OF INSURANCE (2015 - 2016) CLOSEDe DATE (MM /DD/YYYY) C" CERTIFICATE OF LIABILITY INSURANCE 6/19/2015 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 pollcy(le) 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 Risk Strate )es Company NTACT 17ick Strategies r Dmoanv 2040 Fain Wtreet, Suite 450 PHONE .: FAX CA 92614 ..... WC, Not -- Irvine, F E,n, _ ,,, ,,,, 949 242 9240 INSURERS) AFFORDING COVERAGE _ _ NAIC # www.risk- strategies.com CA DOI License No. OF06675 INSURER A : Travelers Prooertv Casualtv Co. of America 25674 ......... ............................. ... _ . INSURED INSURER 13: Hanover Insurance Co. 22292 Lilley Planning Group, Inc. - 564 S. Brea Blvd. INSURER c Brea CA 92821 INSURER D: INSURER E: COVERAGES CERTIFICATE NUMBER: 79;17ARRl RFVLSION r11t1MRFR^ 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 POLICY EFF POLICY EXP� ,TR . TYPE OF INSURANCE ru, en un m POLICY ,N,.unaF.R innmDm IMMID ............. ...... ...... LIMITS .... ..NSR . A ✓ COMMERCIAL GENERAL LIABILITY 6808337X973 911912014 911912015 EACH OCCURRENCE $ $2,000,000 .. ..... CLAIMS -MADE ( ✓„ OCCUR "bAMAOE TO R`ENiFO PREMISES $ $1,000,000 ,(Eaoccurrence) MED EXP (Anv one person) 1­ $ $10,000 I PERSONAL BADVINJURY $ $2,000,000'.. GEN'L AGGREGATE LIMIT APPLIES PER : GENERAL AGGREGATE $ $4,000,000'. PRO- POLICY ✓ JECT LOC PRODUCTS - COMP /OP AGG $ $4,000,000 OTHER; $ A AUTOMOBILE LIABILITY 6808337X973 9/19/2014 9/19/2015 t COMBINED SINGLE u� rr Ea accadeti $ 2.000.00,,,,,,, ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY IN JURY URY (Per accident) ......... $ NON -OWNED HIREDAUTOS ✓,. AUTOS p mROPIERTY1OAMAGE ,Pair accident). $........ - .,...,. $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE $ DED RETENTION S $ A WORKERS COMPENSATION U134372T113 111/2015 111/2016 ®RH / PEAR AND EMPLOYERS' LIABILITY YIN TF ANY ECUr @Vdv O EXCLUDED? I. NIA ICE in in E L DISEASECEDA EMPLOYE $.m $1,000,000 1 "R��. da�cnbe �arGtlet ..... „$ DESCRIPTION OF OPERATIiON$ Wow E, L, DISEASE-- POLICY LIMIT $1,000,00 O B Professional Liability LH3A45833600 10/19/2014 10/19/2015 Per Claim: $2,000,000 Aggregate: $2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) This certificate issued to provide Evidence of Insurance only. The non -owned and hired auto liability limit is subject to the general liability per occurrence limit„ KT— CERTIFICATE HOLDER CANCELLATION „ I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Evidence of Insurance THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORQSO REPRESENTATIVE Michael Christian © 1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD 25176883 1 15 -16 WC, 14 -15 GL- HNOA -PL I Sherry Young 1 6/19/2015 12:38:35 PM (PDT) I Page 1 of 1 Insured: Lilley Planning Group, Inc. Policy No.: 6808337X973 Effective Date: 9/1912014 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED (ARCHITECTS, ENGINEERS AND SURVEYORS) ,. This endorsement modifies insurance provided under the following:,4 COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULEw, �k t 0 NAME OF PERSON(S) OR ORGANIZATION(S): City of El Segundo, its officials and employees PROJECT /LOCATION OF COVERED OPERATIONS Projects as on file with the insured, PROVISIONS A. The following is added to WHO IS AN INSURED (Section II): The person or organization shown in the Schedule above is an additional insured on this Coverage Part, but only with respect to liability for "bodily injury", "property damage" or "personal 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 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 person or organization has assumed liability in a contract or agreement. The insurance provided to such additional insured is limited as follows: d. This insurance does not apply to the rendering of or failure to render any "professional services ". limits shown in the Declarations for this Coverage Part, whichever are less. This endorsement does not increase the limits of insurance stated in the LIMITS OF INSURANCE (Section III) 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, for the additional insured shown in the Schedule, the insurance provided to that additional insured under this Coverage 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 additional 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 e. The limits of insurance afforded to the agreement requiring insurance" for such additional insured shall be the limits additional insured. But this insurance still is which you agreed in that "contract or excess over valid and collectible other agreement requiring insurance" to insurance, whether primary, excess, provide for that additional insured, or the contingent or on any other basis, that is CG D3 82 09 07 © 2007 The Travelers Companies, Inc. Page 1 of 2 Includes copyrighted material of Insurance Services Office, Inc., with its permission. CERT NO.; 22184014 Sherry Young 10/31/2014 10:02:49 AM (PDT) Page 2 of 5 available to the additional insured when the additional insured is also 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 CONDITIONS (Section IV): We waive any rights of recovery we may have against the additional insured shown in the Schedule above because of payments we make for "bodily injury", "property damage" or .,personal injury" arising out of "your work" on or for the project, or at the location, shown in the Schedule above, performed by you, or on your behalf, under a "contract or agreement requiring insurance" with that additional insured. We waive these rights only where you have agreed to do so as part of the .,contract or agreement requiring insurance" with that additional insured entered into by you before, and in effect when, the "bodily injury" or "property damage" occurs, or the "personal 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 under which you are required to include the person or organization shown in the Schedule as an additional insured on this Coverage Part, provided that the "bodily injury" and "property damage" occurs, and the "personal injury" 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. CG D3 82 09 07 © 2007 The Travelers Companies, Inc. Includes copyrighted material of Insurance Services Office, Inc., with its permission. MU NO.: 22:1.0401.4 .Sherry. Young 10/31(201.4 7.0:02:49 AM (PUF Page 3 of 5 Page 2 of 2 Insured: Lilley Planning Group, Inc. Policy No.: UB4000T274 Effective Date: 1/1/2014 WORKERS COMPENSATION AND EMPLOYERS LIABILITY ENDORSEMENT WC 99 03 76 (00) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT — CALIFORNIA (BLANKET WAIVER) 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. 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 5.000% of the California workers' compensation premium otherwise due on such remuneration. Schedule Person or Organization City of El Segundo, its officials and employees Job Description: Projects as on file with the insured Authorized Representative CERT NO.: 22184014 Sherry Young 10/31/2014 10:02:49 AM (PDT) Page 4 of 5 POLICY NUMBER: 6808337X973 UB4000T274 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. _ • I L1 I `o• Ir This endorsement modifies insurance provided under the following: ALL COVERAGE PARTS INCLUDED IN THIS POLICY SCHEDULE CANCELLATION: Number of Days Notice of Cancellation: 30 PERSON OR City of El Segundo, ORGANIZATION: its officials and employees Attn: City Clerk's office ADDRESS: 350 Main St. El Segundo CA 90245 PROVISIONS: If we cancel this policy for any statutorily permitted reason other than nonpayment of premium, and a number of days is shown for cancellation in the schedule above, we will mail notice of cancellation to the person or organization shown in the schedule above. We will mail such notice to the address shown in the schedule above at least the number of days shown for cancellation in the schedule above before the effective date of cancellation. L T4 05 03 11 © 2011 The Travelers Indemnity Company. All rights reserved. CERT MO.: 227.9407.4 ,Sherry. Young 10/31(2014 10:02:49 AM (PDT) Page 5 of 5 Page 1 of 1