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PROOF OF INSURANCE (2016) CLOSEDA R 8/13/ CERTIFICATE OF LIABILITY INSURANCE D /13/ 201IDDIY5 5 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(les) 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 T Carly Underwood Greyling Insurance Brokerage PHONE (770) 552 -4225 F'AX (866)550 -4082 3780 Mansell Road E-MAIL carly,-underwood@greyling.com ADDRESS� Suite 370 INSURERASI AFFORDING COVERAGE NAIC# Alpharetta GA 30022 iucnRGRA •Nati nnaI TTninn Fi ra Tnc Cn 11 QddR INSURED INSNRFR R -Liberty Insurance Corporation Geosyntec Consultants, Inc. INgllRERCNew Hampshire Insurance Comna 900 Broken Sound Parkway NW INSLIRERDAIG Specialty Insurance Comna Suite 200 INSURER E Boca Raton FL 33487 INSURER COVERAGES CERTIFICATE NUMBER-15 -16 (Geosvntec Main) 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. INSIR POLI Y EFF POLICY EXP I TR TYPE OF INSURANCE lNqR I WVD POLICY NUMBER AMMrnnryYyy% AMMrnnrvyyy%'... LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A COMMERCIAL CLA MS MADEERA LIABILITY OCCUR 5302659 /1/2015 /1/2016 PREMISCS Ea o au $ 500,000 roe MED XP ( (Any one person) $ 25,000 PERSONAL & ADV INJURY $ 1,000,000 X Contractual Liability GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 2,000,000 POLICY LE PRO„ X. LOC $ AUTOMOBILE LIABILITY (Fa,a jda , SIN ME Lq f 51.000,000 X BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE -- (PPrarridPnt) $ $ $ A '.. A ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS 6403892 (AOS) 6403893 (MA) /1/2015 /1/2015 /1/2016 4/1/2016 Is X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 10,000,000 AGGREGATE $ 10,000,000 B EXCESS LIAB CLAIMS -MADE WRETENTION$ $ DED LX] 10,00 H7- 651- 291560 -015 /1/2015 /1/2016 O A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR /PARTNER /EXECUTIVE YIN OFFICER/MEMBER EXCLUDED? N1 (Mandatory in NH) N/A 039901411 (AOS) 39901412 (CA) /1/2015 4/1/2015 .4/1/2016 /1/2016 X rnCSTATU- 07 11V , E, L,. EACH ACCIDENT $ 1 . 000.000 E.L. DISEASE - EA EMPLOYEE! $ 1.000.000 If yes, describe under DESCRIPTION OF OPERATIONS below E L DISEASE POLIOY LIMIT $ 1 . 000. 000 D Professional Liability COPS 1951904 /1/2015 /1/2016 Per Claim -_ -- $8,000,000 Contractors Poll. Liab. Aggregate $10,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) Re: Stormwater Permit Implementation Assistance; August 13/2016, THe City of E1 Segundo, its officers & employees are named as Additional Insureds with respects to General & Automobile Liability where required by written contract. The above referenced liability policies with the exception of professional liability are primary & non - contributory where required by written contract. Waiver of Subrogation is applicable where required by written contract & allowed by law. FICATE HOLDER City of E1 Segundo Public Works 350 Main Street 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 E1 Segundo, CA 90245 -3813 David Collings /CARLY ACORD 25 (2010/05) ©1988 -2010 ACORD CORPORATION. All rights reserved. INS025 (gmnn.m m The ArOlPr) name and Innn arc rcnicfororl mar4c of AR(1Rn Policy Number: GL 5302659 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 WHEN 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- tions; or in the performance of your ongoing operations( , 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- a. All /including pleted. work, 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 © ISO Properties, Inc., 2004 Page 1 of 1 C] POLICY NUMBER: GL 5302659 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 Organization(s): Location And Description 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 designated and described in the schedule of this endorsement performed for that additional insured and included in the "products- completed operations hazard." CG 20 37 07 04 0 ISO Properties, Inc.,2004 Page 1 of 1 11 ENDORSEMENT This endorsement, effective 12:01 A.M. 04/01/15 forms a part of policy No. GL 5302659 issued toGeosyntec Consultants, Inc. by NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY COVERAGE FOR SPECIFIED PERSONS OR ORGANIZATIONS NAMED AS ADDITIONAL INSUREDS - ONGOING AND COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM The following paragraph is added to SECTION II - WHO IS AN INSURED and applies only to persons or organizations we have added to your policy as additional insureds by endorsement to comply with insurance requirements of written contracts relative to: a) the performance of your ongoing operations for the additional insureds; or b) "your work" performed for the additional insureds and included in the "products - completed operations hazard ": This insurance is primary over any similar insurance available to any person or organization we have added to this policy as an additional insured. However, this insurance is primary over any other similar insurance only if the additional insured is designated as a named insured in the Declarations of the other similar insurance. We will not require contribution of limits from the other similar insurance if the insurance afforded by this endorsement is primary. This insurance is excess over any other valid and collectible insurance, whether primary, excess, contingent or on any other basis, if it is not primary as defined in the paragraph above. All other terms and conditions of the policy are the same. 90533 (3/06) A t1horized Repp sentative or Counters, ggnatura iln States Where Applloablap Page 1 of 1 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 folbwing 'aftacting clause' need be completed only when this endorsement Is issued subsequent to preparation of the policy). d This endorsement, effective 12:01 AM 0 4 / 01 / 15 forms a part of Policy No. 0 3 9 9 01412 k Issued to GEOSYNTEC CONSULTANTS, 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 tight 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. 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'u enfities vu n ple aiaa: a heiamt; lhai a iu "l i l he arrrrai. nt s tri:IlowTMv a file un US dollars :�:oi vaMa iln other ci.ruOence„, the iau4:,Mrul eapiauval uat ,apapli8s t;tt: 'Iflr'Iltu4`ms, Go.uWii�i;� fair t't.uls &fii�,' Contract means an agreement with a Client Subcontract means an agreement with a Subcontractor, Independent Contractor or Vendor, Standard means the most current form published on the Contracts Management site Non - Standard means a form drafted by other than Geosyntec/MMI or a modified Standard form Approved means any Non - Standard or Standard form approved by Legal. Billable means actual or potential billable costs associated with contract document Non-Billable means actual or potential costs associated with the contract documents which are not billable to a client Variance means written grant of authority by a higher signature level to a lower one. Order means a separate document that authorizes scope, rates /budget and schedule under an MSA or PSA Standard Access, Teaming and Confidentiality Agreements may be signed at all levels below Company Officers - Standard or Approved Non - standard Client , Contracts /Orders No Limit No Limit - Standard or Approved Non - standard Subcontracts /IC Agreements /Orders Principals - Standard or Approved Non - standard Client To $100,000 N/A Contracts /Orders - Standard or Approved Non - standard Subcontracts /IC To $50,000 To $5,000 Agreements /Orders Associates - Standard or Approved Non - standard Subcontracts/IC To $50,000 To $2,000 Agreements/Orders Pre - approved Signature Authority Variances: Hope Selgison - Principal Level Karen Kosiarek - Principal Level All other Signature Authority Permitted Variances: Company Officer to Principal Principal to Associate Delegation: -All permitted Variances must be confirmed in writing by the granting employee (internal email acceptable form) - Signing Authority Variances must be documented in project files. -The Original Level employee remains responsible for the signed document — delegate carefully, Contact the Contract Specialist who supports your office for questions on, or assistance with, signing authority. http: // home.geosyntec.com /pm /cm/ signing %20authorityl /home.aspx 9/9/2015