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PROOF OF INSURANCE (2016) CLOSED�-�k ✓ �a DATE (MMIDDIYYYY) A"- CERTIFICATE OF LIABILITY INSURANCE 7/30/2015 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 N AD W Jerry Hoyola, Greyling Insurance Brokerage PHONE N ;=o X case) sso -ao (770) 552 -4225 82 3780 Mansell Road E-MAIL . jarr .noyola grel*lin . com Suite 370 INSURERS AFFORDING COVERAGE NAICN Alpharetta GA 30022 INSURER ANational Union Fire Ins Co 19445 INSURED INSURERB:CO1Dlnerce & Industry Insurance ,19410 Kimley -Horn and Associates, Inc. INSURERCNew I"iclMhire Insurance 4„',"9TdljDr3.3Y 3841 P.O. Box 33068 INSURERD:Llovd's of London b85202 INSURER E: Raleigh NC 27636 [INSURER F: COVERAGES CERTIFICATE NUMBER:15 -16 (Kimley Janice) 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 , �... ADDL SUS .................... ......... ..........._ ........... _ POLICY EIFF (POLICY EXP I TR TYPE OF INSURANCE IN P wvn POLICY NUMBER MNNOW Y 0 LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY IREMISE,S, –(„Ea occopra'ync,;, .. $ ' 500,000„.— A CLAIMS -MADE X OCCUR 9645227 /1/2015 4/1/2016 MED EXP (Any one person) $ 25,000 X Contractual Liability PERSONAL &ADVINJURY $ 1,000,000 GENERAL AGGREGATE _... . $ _...._�.�,.................. 2,000,000 .......... GEN. L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 2,000,000 ..... POI..tlC`$ X IRO X '' IL00 $ _...�..._.._........... AUTOMOBILE LIABILITY COMNINED MNULF LI I Ea' q^J 0ntl R 1...0.000(1 A X ANY AUTO BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED 4982985 4/1/2015', /1/2016 AUTOS AUTOS X NON -OWNED X PROPERTY DAMAG3E $ HIRED AUTOS AUTOS X UMBRELLA LIAB X OCCUR .EACH OCCURRENCE ....._....... ....– .......................... '.. $ .................. 5,000,000 ..._­ B EXCESS LIAB CLAIMS -MADE. '.. AGGREGATE $ 51000,000 DED I X RETENTION$ 10,00C BE 020733086 '4/1/2015 /1/2016 $ WORKERS COMPENSATION 4 /1/2015 /1/2016 C. 399D145G (AOS) WC STATD OTH X Thc- I TIu EA AND EMPLOYERS' LIABILITY YIN .0 `. ' ANY PROPRIETOR /PARTNER /EXECUTIVE OFFICER /MEMBER EXCLUDED? N N/A E L EACH ACCIDENT $ ......... n.n. 1 . 000 000 "..A 9 4/1/2015 4/1/2016 A (Mandatory In NH 9901451 (CA) ( ry AS $ DISEASE EA EMPLOYE 1 .000 000 If es, describe under —I DESCRIPTION OF OPERATIONS below – ._ E L DISEASE POLICY LIMIT $ 1 000 000 D Professional Liability P070831500 4/1/2015 4/1/2016 Per Claim $2,000,000 Aggregate $2,000,000 DESCRIPTION OF OPERATIONS/ LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Re: 2015 -2016 On Call Services; Serine Ciandella. THe City of E1 Segundo, its officials 6 employees are named as Additional Insureds with respects to General Liability where required by written contract. The above referenced liability policies with the exception of professional liability are primary b non- contributory where required by written contract. CERTIFICATE HOLDER City of E1 Segundo Insurance Administrator 350 Main Street E1 Segundo, CA 90245 ACORD 25 (2010/05) wsn25 /gninnFi ni 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 avid Collings /JERRY ©1988 -2010 ACORD CORPORATION. All rights reserved. The Ar:r1Rr1 nomc nnrl Inn^ orc rnni.fn rll m rr; ^f Arr)Pr) POLICY NUMBER: 9645227 COMMERCIAL GENERAL LIABILITY CG 20 37 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following„ COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Orqanization(s): Location And Descriotion Of Completed Operations AS REQUIRED BY WRITTEN CONTRACT AS REQUIRED BY WRITTEN CONTRACT Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section II - Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location CG 20 37 07 04 designated and described in the schedule of this endorsement performed for that additional insured and included in the "products- completed operations hazard." 0 ISO Properties, Inc.,2004 Page 1 of 1 ❑ Policy Number: 9645227 COMMERCIAL GENERAL LIABILITY CG 20 33 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - AUTOMATIC STATUS 'TEN REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section II — Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured any person or or- additional insureds, the following additional exclu- ganization for whom you are performing operations sions apply: when you and such person or organization have This insurance does not apply to: agreed in writing in a contract or agreement that such person or organization be added as an addi- 1. "Bodily, injury", "property damage" or "personal tional insured on your policy. Such person or or- and advertising injury" arising out of the render - ganization is an additional insured only with re- ing of, or the failure to render, any professional spect to liability for "bodily injury", "property architectural, engineering or surveying ser- damage" or "personal and advertising injury' vices, including: caused, in whole or in part, by: a. The preparing, approving, or failing to pre - 1. Your acts or omissions; or pare or approve, maps, shop drawings, 2. The acts or omissions of those acting on your opinions, reports, surveys, field orders, change orders or drawings and specifica- behalf; tons; or in the performance of your ongoing operations for b. Supervisory, inspection, architectural or the additional insured. engineering activities. A person's or organization's status as an additional 2. "Bodily injury' or "property damage" occurring insured under this endorsement ends when your after. operations for that additional insured are com- pleted. a. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than ser- vice, maintenance or repairs) to be per- formed by or on behalf of the additional in- sureds) at the location of the covered operations has been completed; or b. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontrac- tor engaged in performing operations for a principal as a part of the same project. CG 20 33 07 04 0 ISO Properties, Inc., 2004 Page 1 of 1 O BLANKET 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. (The following "attaching clause" need be completed only when this endorsement is issued subsequent to preparation of the policy). This endorsement, effective 12:01 AM 0 4 / 01 / 15 forms a part of Policy No. 3 9 9 014 51 Issued to KIMLEY -HORN AND ASSOCIATES, INC. By NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA. We have a right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against any person or organization with whom you have a written contract that requires you to obtain this agreement from us, as regards any work you perform for such person or organization. The additional premium for this endorsement shall be 2.00 % of the total estimated workers compensation premium for this policy. WC 04 03 61 Countersigned by,_,__ (Ed. 11190) Authorized Representative