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PROOF OF INSURANCE (2016) CLOSEDDA VIM 1?11)Wyyyyp CERTIFICATE OF LIABILITY INSURANCE 8/11:26/2015 . . . . ....... NAF 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 iWicertfficate holdor is an ADDITIONAL INSURED, the pollcy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsoment. A statement on this certificate does not confer rights to the certificate holder In lieu of such —PR 0 U C'ER CON fAC 1 NA V1 r WILLIS OF ILLINOIS, INC. PHOm (888) 780-5381 AX EAiC, (8 7) 737-8498 [ No. E*Q: A�(% N�) 233 S WACKER DR,SUITE 2000 'J No. ADIA E Certificate@hanover.com CHICAGO, IL 60606 11 INSQRFRJ$) AFFORONG, COVE.RAGE NAIC N INSLIFER A Cifizens, Ins Co of Amedca 31534 INSURED a4sum,'k 13 Hanover American Ins Co 36064 BUCKNAM INFRASTRUCTURE GROUP INC 3548 SEAGATE WAY SUITE 230 1 MJRF R D OCEANSIDE, CA 92056 1 INS L"I [�'k rr. R l: COVERAGES CERTIFICATE NUMBEW REVISION NUMBER: . ........... HIS 1,13 1[0 CERTIFY ]HAI THE PCXACIES OF VNSORANC[.: H"."IEQ BEL(WV HAVF� BEIIEN ISSAJEU -10 IHIE VNSURFD NAMFD ABOVE. FOR x01111 PCAJ1,-','e PLRIOD 0NCJIC6YTFD N0T 1111HS-TA1N['WqG ANY IvEQ UIREME114r, -ri::1IR1M OR GON01 10N OF ANY CONTRACT OR 01"IflEA DOCUMENT WITH RESPECI TO WHICH DAIS CEIRTIFICAN- MAY BF VSSUI' 11) OR MAY PERFA N, THE INSURANCE AFFORDED ['0' Nfl P0UC,11I:..S DESCIRIBIED HIEIIRI..'0 N I SUBJECt rom..i- ri-w. 1ERMS Ell XC -US �01'45 ANN) CON A N IONS 01'- SUCH P01 VQLS Llwrrs SHOVVN IMAY HAVE BE EN REDUCED BY PAID CN.AWS 94 �YIPK OF hNSLPRAW,'1E% LIMITS Ji" .0162mim VAARqffl)1'QL—, GENERA�. LIAMU1Y i I( , jRRENC'" r 1,000, X �01&01,: RC!;',� (J� PH 1�4,NL I kl'�fl I I R 'GSFS (Ea oowr�oncoj S 1,000,000 A I x 1 10,000 OBC A399956 01 �09/116/20115 09116t2016 �`�LD )'01 IAY�Y Qum POOR Il� lqC,11,4AJ 8A,F,V S 1,000,000 (A ll� RN S 2,000,000 GF NI iA l�� L111 1T P01 1 oES PRIH IW)UHCTS s 2,000,000 �x ".L' � [ Uq f AUTOMOMLIE UABILITY . ... . . . .......... . . . ......... . . . ........... 77W "'I'000,000 W, 1Ci61 y 11,14 R JV" r ilia .Allip oY A ALdk iWv'9d) SC I flEnUI LB OBC A399956 01 09/16/2015 09/16/2016 N,) I 0 x I 0MJ1 AQ rr"i (11 �er acudenR) ... ................... X UOASIRIEU. A �. OF I � IDCCI Q�Rl NG� X A 11:;XCIESSL�AB OBC A399956 01 09t`16/2015 09/16/2016 9,000,000 f.'A AIMS MAtK' - — - — ------ - -- - --------- ­' -------------- om �iR NIN :1I01I1LGYLR!5'LU4B1L1I1Y og' � y I N 1,000,000 Y ' WR:1: U�j,WIARTNI: N/A X WZC A399946 01 09/16/2015 09/16/2016 F1 E`10h"CICIDENIJ S iut. B WA,nddW�y lo, h 111 L D[Sl� A';I::: LA I: 411'� 0"1": 1, , 1,000,000 iv�" 01S� ASE 1'0u 11 1 IN11 T $ 1,000,000 . .... ...... -- ...... .. . ..... .. . . . . ...... » »» .......... . DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) City of El Segundo, its officers, officials, employees, agents, representatives, and certified volunteers are Additional Insured pursuant to the terms and conditions of form: 391- 1586 (General Liability Supplementary Endorsement) and 391-1602 (Additional Insured - Owners, Lessees or Contractors - Completed Operations). Waiver of subrogation as provided by: WC040306 (California Form), CERTIFICATE HOLDER ......... . . . . .... — CANCELLATIO-11-111-1--l-1111.1 . ............ . . . N ........... El Segundo City of 350 Main Street SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN El Segundo, CA 90245 ACCORDANCE WITH THE POLICY PROVISIONS, AU"i'ORIZED RfPRI:SEWAflVE C�1�1110*w . . . . . ................ . .... ©1988 -2010 ACORD CORPORATION, All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. GENERAL LIABILITY SUPPLEMENTARY ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM Additional Insured by Contract, Agreement or Permit Under SECTION II - LIABILITY, C. Who Is An Insured, Paragraph 4. is added as follows: a. Any person or organization for whom you are performing operations when you and such person or organization have agreed in writing in a contract, agreement or permit that such person or organization be added as an additional insured on your policy. Such person or organization is an additional insured only with respect to liability for "bodily injury ", "property damage" or "personal and advertising injury" caused, in whole or in part, by: (1) Your acts or omissions; or (2) The acts or omissions of those acting on your behalf, but only with respect to: (3) "Your work" for the additional insured(s) at the location designated in the contract, agreement or permit; or (4) Premises you own, rent, lease, control or occupy. This insurance applies on a primary basis if that is required by the written contract, agreement or permit. b. This provision does not apply: (1) Unless the written contract or written agreement has been executed or permit has been issued prior to the "bodily injury ", "property damage" or "personal and advertising injury "; (2) To any person or organization included as an insured by an endorsement issued by us and made part of this Policy; (3) To any lessor of equipment: (a) After the equipment lease expires; or (b) If the "bodily injury ", "property damage" or "personal and advertising injury" arises out of the sole negligence of the lessor; (4) To any: (a) Owners or other interests from whom land has been leased which takes place after the lease for that land expires; or (b) Managers or lessors of premises if: (i) The occurrence takes place after you cease to be a tenant in that premises; or (ii) The "bodily injury", "property damage" or "personal and advertising injury" arises out of structural alterations, new construction or demolition operations performed by or on behalf of the manager or lessor; or (5) To "bodily injury ", "property damage" or "personal and advertising injury" arising out of the rendering of or the failure to render any professional services. This includes but is not limited to any professional services as an architect or engineer arising out of any construction agreement or activities under which any insured or anyone acting on any insured's behalf provides or provided service, advice, expertise or work. Construction includes, but is not limited to, the plan, conception, design, build, construct, assembly, development, safety, erection, formation, reconstruct, rehabilitation, repair, or any improvement made to real property. Construction also includes the hihng, . supervision or management of any of these activities. However, this exclusion does not apply to liability arising out of an insured's presence at a jobsite that was not caused by professional activities listed in the above paragraph. c. Additional insured coverage provided by this provision will not be broader than coverage provided to any other insured. d. All other insuring agreements, exclusions, and conditions of the policy apply. Additional Insured by Contract, Agreement or Permit - Primary and Non - contributory The following is added to SECTION III - COMMON POLICY CONDITIONS: M. Other Insurance 1. Additional Insureds If you agree in a written contract, written agreement or permit that the insurance provided to any person or organization included as an Additional Insured under SECTION II - LIABILITY, Part C - Who is An Insured, is primary and non - contributory, the following applies: If other valid and collectible insurance is available to the Additional Insured for a loss we cover under SECTION II - LIABILITY, Part A. Coverages, Paragraph 1., Business Liability our obligations are limited as follows: a. Primary Insurance This insurance is primary to other insurance that is available to the Additional Insured which covers the Additional Insured as a Named Insured. 391 -1586 02 11 Includes copyrighted material of Insurance Services Offices, Inc., with its permission Page 1 of 2 4 1s rt 11 �- OBCA399956 1309570 We will not seek contribution from any (1) The total amount that all such other other insurance available to the insurance would pay for the loss in the Additional Insured except: absence of this insurance; and (1) For the sole negligence of the (2) The total of all deductible and self- insured Additional Insured; amounts under all that other insurance. (2) When the Additional Insured is an Additional Insured under another We will share the remaining loss, if any, with primary liability policy; or any other insurance that is not described in (3) When b.(2) below applies. this Excess Insurance provision and was not If this insurance is primary, our bought specifically to apply in excess of the obligations are not affected unless Limits of Insurance shown in the Declarations any of the other insurance is also of this Coverage Part. primary. Then, we will share with all c. Method Of Sharing that other insurance by the method described in b.(3) below. If all of the other insurance permits contribution by equal shares, we will follow this method also. b. Excess Insurance Under this approach each insurer contributes This insurance is excess over: equal amounts until it has paid its applicable limit (1) Any of the other insurance, whether of insurance or none of the loss remains, primary, excess, contingent or on any whichever comes first. other basis: If any of the other insurance does not permit (a) That is Fire, Extended Coverage, contribution by equal shares, we will contribute by Builder's Risk, Installation Risk limits. Under this method, each insurer's share is or similar coverage for "your based on the ratio of its applicable limit of work "; insurance to the total applicable limits of (b) That is Fire insurance for insurance of all insurers. premises rented to the Additional III. Aggregate Limit of Insurance (Per Project) Insured or temporarily occupied by the Additional Insured with a. For purposes of the coverage provided by this permission of the owner; endorsement, D. Liability and Medical Expenses Limits of Insurance under Section II - Liability is (c) That is insurance purchased by amended by adding the following: the Additional Insured to cover The General Aggregate Limit under D. Liability the Additional Insureds liability and Medical Expenses Limits of Insurance applies as a tenant for "property separately to each of "your projects" or each damage" to premises rented to location listed in the Declarations. the Additional Insured or temporarily occupied by the b. For purposes of the coverage provided by this endorsement F. Liability And Medical Expenses Additional Insured with Definitions under Section II - Liability is amended permission of the owner; or by adding the following: (d) If the loss arises out of the a. "Your project" means: maintenance or use of aircraft, "autos" or watercraft to the I. Any premises, site or location at, on, or in extent not subject to Exclusion g. which "your work" is not yet completed; of SECTION II - LIABILITY, Part and A. Coverages, 1. Business Liability. ii. Does not include any location listed in the Declarations. When this insurance is excess, we will have no duty under SECTION II - LIABILITY, Part A. IV. Blanket Waiver of Subrogation Coverages, 1. Business Liability to defend the Paragraph K. Transfer Of Rights Of Recovery Against insured against any "suit" if any other insurer Others To Us in Section III - Common Policy Conditions is has a duty to defend the insured against that amended by the addition of the following: "suit ". If no other insurer defends, we will We will waive any right of recovery we may have against undertake to do so, but we will be entitled to any person or organization when you have agreed in a the insured's rights against all those other written contract, permit or agreement to waive any rights insurers. of recovery against such person or organization because When this insurance is excess over other of payments we make for injury or damage arising out of insurance, we will pay only our share of the your ongoing operations or "your work" done under a amount of the loss, if any, that exceeds the contract with that person or organization and included in sum of: the "products- completed operations hazard ". 391 -1586 02 11 Includes copyrighted material of Insurance Services Offices, Inc., with its permission Page 2 of 2 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:. BUSINESSOWNERS COVERAGE FORM SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations BLANKET PER WRITTEN CONTRACT THE UNITED STATES OF AMERICA(INCLUDING ITS TERRITORIES AND POSSESSIONS); PUERTO RICO;& CANADA Information required to complete this Schedule, if not shown above, will be shown in the Declarations, w The following is added to Paragraph C. Who Is An Insured in Section II - Liability: Any person(s) or organization(s) shown in the Schedule is is also an additional insured, 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 de- scribed in the Scheduleof this endorsement per- formed for that additional insured and included in the "products- completed operations hazard ". 391 - 1602 12 11 Includes copyrighted material of Insurance Services Offices, Inc., with its permission Page 1 of 1 ,. e, WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA 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. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) 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 2% % of the California workers' compensation premium otherwise due on such remuneration. Person or Organization ONLY WHERE REQUIRED BY Schedule Job Description CONTRACT This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective Insured Policy No. WZC- A399946 -01 Endorsement No. Premium $ Insurance Company THE HANOVER AMERICAN INSURANCE COMPANY Countersigned By WC 04 03 06 (Ed. 04-84) .��. DATE (MM /DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 0911512014 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). CONTACT PRODUCER Willis of Illinois, Inc. mePH E Frf1 1 97 .. ...... .... ., ..... c/o 26 Century lvd FAX ry /a/r Nn 7 945 7375 (A/C- Noll B55 467 2378 PHONE P.O. Box 305191 E m` certificates®willie c m COVERAGE Nashville, TN 372305191 USA °' INSURER(S) AFFORDIN 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. ...o....,... . g..................._.............._......_....._ _.............................. _ W._._..„.._........._...._.._ �............................. ..... ....._.. ............ ___............... ........ ............ �................_............. INSR +'4.661. POLICY EFF POLICY EXP L7R TYPE OF INSURANCE itisn wvn POLICY NUMBER IMMIDDIYYYYI IMMIDDIVYYYI LIMITS THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN COMMERCIAL GENERAL City of El Segundo . AUTHORIZED REPRESENTATIVE Attention: Stephanie Katsouleas, P.E, 350 Main Street (;1 Segundo, CA 90245 -0000 EACH OCCURRENCE $ �LIABILITY CLAIMS -MADE OCCUR I,I PRFMIRFSIFanrriirranral_ $ MED EXP (Any one person) _. $ PERSONAL & ADV INJURY $ _ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY [::] J PRO. InCT LOC PRODUCTS - COMP/OP AGG $ $ OTHER: PAUTOMOBILE LIABILITY CO IN' "O 0GLE UMIT '..� Ea awida t $ , BODILY INJURY (Per person) $ ANY AUTO 'ALLOWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ NON -OWNED HIREDAUTOS AUTOS PROPERTY DAMAGE /aef_Acc on $ UMBRELLA LIAB Id OCCUR EACH OCCURRENCE ..... ............................... $ EXCESS LIAB CLAIMS -MADE AGGREGATE $ OE9 RET €N1 $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y./ N PER OT`H- ., , , crnn IrF, ,,,,,,,,,,,,,, FR ANY PROPRIETOR /PARTNER /EXECUTIVE E L EACH ACCIDENT $ OFFICER/MEM BER EXCLUDED? N NIA E L, DISEASE - EA EMPLOYE -` $ (Mandatory In NH) y describe under f],EFC'R,IPTICI.N.OF nPFRATI(1NR hglnw E L DISEASE - POLICY LIMIT $ A Liability MCH288359767 09/16/2014 09/16/2015 $1,000,000 Per Claim [rofessional $1,000,000 Aggregate DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached it more space is required) CERTIFICATE HOLDER CANCELLATION ©1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 26 (2014/01) The ACORD name and logo are registered marks of ACORD SR ID:7084953 BATCH:Batch #: 84789 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of El Segundo . AUTHORIZED REPRESENTATIVE Attention: Stephanie Katsouleas, P.E, 350 Main Street (;1 Segundo, CA 90245 -0000 44 4� ©1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 26 (2014/01) The ACORD name and logo are registered marks of ACORD SR ID:7084953 BATCH:Batch #: 84789