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PROOF OF INSURANCE (2016) CLOSEDIll r C CERTIFICATE OF LIABILITY INSURANCE °A9i4i2o1/'S"' 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 - _._A' Ti na 1,7^_i o 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 .... 7ADiY SU'Bi'� POLICY EFF POLICY EXP .� ...... LTR TM... ....... _ ...__... . ,... ... ......... -' --- - - --.. PE OF INSURANCE 8 iwzn wvn POLICY NUMBER !,MMIDDfYWYI IMWQWYYYI LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS -MADE LX..I OCCUR PRFM CFS (Fn n- i�r�anrvil $� 300 000 X ADDTL INSURED /PRIMARY 680- 2273L506 6/13/2015 6/13/2016 MED EXP (Anyone person) $ 5 , 0 00 X BLNKT WvR OF SUBRO - AS REQUIRED BY WRITTEN PERSONAL8ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: CONTRACT GENERALAGGREGATE � $ 2,000 00 0 .X PRO- POLICY JEC6 LOC CONTRACTUAL LIAB INCLD ...... ............ ...--- PRODUCTS COMP /OP AGG ... ,......... ,.. $ 2 , 000 , 000 OTHER: $ AUTOMOBILE LIABILITY COMBINCOSINGIE LIMIT $ INCLUDED A _ person) $ ALILOWNED SCHEDULED AUTOS AUTOS 680- 22731,506 6/13/2015 6/13/2016 'BODILY -INJURY (Per e ccident) $ X.. R PROPERTY DAMAGE . -- $ . HIRED AUTOS AUTOS a., tl aa�ld�galtl) X UMBRELLA LIAB 1 X OCCUR EACH OCCURRENCE $ 2,000.000 A EXCESS LIAB CLAIMS -MADE AGGREGATE _ $ 2,,000,000 nFn ! X RETENTION$ 0 CUP- 6536Y635 6/13/2015 6/13/2016 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITY YIN STATUTE FR ANY PROPRIETOR /PARTNER /EXECUTIVE E,L EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? NIA .. - (Mandatory in NH) E DISEASE - EA EMPLOYEE $ If yes, descrlke under _..... --....--- ...... ............ ,... ... DESCRiP'TtlO�N OF OPERATIONS below IE ,L, DISEASE - POLICY LIMIT $ B Professional Liability IAE11427 -05 12/1/2014 12/1/2015 Each Claim $2,000,000 Claims Made Annual Aggregate $2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Certificate Holder is Additional Insured for General Liability but only if required by written contract with the Named Insured prior to an occurrence and as per attached endorsement. Coverage is subject to all policy terms and conditions. *30 days notice of cancellation, except for 10 days notice for non - payment of premium. For Professional Liability coverage, the aggregate limit is the total insurance available for all covered claims reported within the policy period. I Irllr/i I r- rIVL.LfIrK UANUL:LILA 1 IVN City of E1 Segundo Building and Safety Division „u Attn: Mr. Paige Vaughan44I 350 Main Street ” E1 Segundo, CA 90245 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 Tina Cowie /SGL»C ©1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS025 /9mann /1 r r / m� POLICY NUMBER: 680- 2273L506 NAMED INSURED: Hayer Consultants, Inc. COMMERCIAL GENERAL LIABILITY POLICY PERIOD: 6/13/2015 to 6/13/16 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 INSURANCE (Section III) for this Coverage (Section II): Part. 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 ads or omis- sions or the acts or omissions of those acting on your behalf: a. In the performance of your ongoing opera -" A 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 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 Page 1 of 2 C The Travelers Companies, Inc. CG D3 891 09 07 Includes the copyrighted material of Insurance Services Office, Inc, with its permission. COMMERCIAL GENERAL LIABILITY injury" or "property damage" occurs, or the "per- erage Part, provided that the "bodily injury'" and sonal injury" offense is committed. " "property damage " occurs, and the "personal in- D. The following definition is added to DEFINITIONS fury " Is carried by an offense committed: (Section V): a. After you have entered into that contract or "Contract or agreement requiring insurance" agreement; means that part of any contract or agreement un- b. While that part of the contract or agreement is der which you are required to include a person or in effect; and organization as an additional insured on this Cov- c. Before the end of the policy period. Page 2 of 2 © The Travelers Companies, Inc. CG D3 891 09 07 Includes the copyrighted material of Insurance Services Office, Inc. with its permission. POLICYHOLDER COPY Sc P.O. BOX 8192, PLEASANTON, CA 94588 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 09 -15 -2015 THE CITY OF EL SEGUNDO SC 350 MAIN ST EL SEGUNDO CA 90245 -3813 GROUP: POLICY NUMBER: 9100543 -2015 CERTIFICATE ID: 4 CERTIFICATE EXPIRES: 05 -24 -2016 05 -24- 2015/05 -24 -2016 This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 10 days advance written notice to the employer, We will also give you 10 days advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policy listed herein. Notwdthstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy. Authorized Representative President and CEO EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT #1600 - KAUR, JASVINDER PRESIDENT - EXCLUDED„ ENDORSEMENT #1600 - KAUR, NAVDEEP SECRETARY TREASURER - EXCLUDED, ENDORSEMENT #2570 ENTITLED WAIVER OF SUBROGATION EFFECTIVE 2015 -09 -15 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. THIRD PARTY NAME: THE CITY OF EL SEGUNDO EMPLOYER HAYER CONSULTANTS, INC. SC 4067 HARDWICK ST PMB 250 LAKEWOOD CA 90712 [VP2,CS] (REV.7 -2014) PRINTED : 09 -15 -2015 ENDORSEMENT AGREEMENT WAIVER OF SUBROGATION 9100543 -15 RENEWAL SC PAGE 1 HOME OFFICE SAN FRANCISCO EFFECTIVE SEPTEMBER 15, 2015 AT 12.01 A.M. ALL EFFECTIVE DATES ARE AND EXPIRING MAY 24, 2016 AT 12.01 A.M. AT 12:01 AM PACIFIC STANDARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME HAYER CONSULTANTS, INC. q�h 4067 HARDWICK ST PMB 250 LAKEWOOD, CA 90712 ANYTHING IN THIS POLICY TO THE CONTRARY NOTWITHSTANDING, IT IS AGREED THAT THE STATE COMPENSATION INSURANCE FUND WAIVES ANY RIGHT OF SUBROGATION AGAINST, THE CITY OF EL SEGUNDO WHICH MIGHT ARISE BY REASON OF ANY PAYMENT UNDER THIS POLICY IN CONNECTION WITH WORK PERFORMED BY, HAYER CONSULTANTS, INC. IT IS FURTHER AGREED THAT THE INSURED SHALL MAINTAIN PAYROLL RECORDS ACCURATELY SEGREGATING THE REMUNERATION OF EMPLOYEES WHILE ENGAGED IN WORK FOR THE ABOVE EMPLOYER. IT IS FURTHER AGREED THAT PREMIUM ON THE EARNINGS OF SUCH EMPLOYEES SHALL BE INCREASED BY 03 %. NOTHING IN THIS ENDORSEMENT CONTAINED SHALL BE HELD TO VARY, ALTER, WAIVE OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS POLICY OTHER THAN AS STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR LIMITATIONS OF THIS ENDORSEMENT. COUNTERSIGNED AND ISSUED AT SAN FRANCISCO: AUTHORIZED REPRESENT IVE SCIF FORM 10217 (REV.7 -2014) SEPTEMBER 17, 2015 PRESIDENT AND CEO 2570 OLD DP 217