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PROOF OF INSURANCE (2016) CLOSED'"R '"Ro CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 10/25/2015 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 NAME OUTFRONT Media Certificate Processing ........ Arthur J. Gallagher & Co. al - r-,,,. 818-539-2300 � Fo c N. 818-539-1801 _ Insurance Brokers of CA, Inc. LIC #0726293 505 N. Brand Boulevard, Suite 600 o M RIFCC Certrequets�a /g com Glendale CA 91203 -3944 �.. INSURER(S) AFFORDING COVERAGE NAIC # ........ INSURERA New Hampshire Insurance Companv 23841 INSURED CBSOUTD -02 INSURER B .AIG Insurance Company Of Cane........... a ......... ......... Canada OUTFRONT Media Inc. INSURERC:ACE Propertv & Casualty Insurance C 20699 Outfront Decaux Street Furniture, LLC INSURER Specialty In 405 Lexington Avenue _ _ e Attach m v 26883 New York NY 10174 INSURER E Se Attached Insurance C RER D AI Ompan ed INSURER F : COVERAGES CERTIFICATE NUMBER: 1025299328 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, - ............................................................................................................................................... ............................... -----------.. ............................... 14s_ R TYPE OF INSURANCE A S POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER (MMIDD/YYYYI (MM /DD/YYYYI A X COMMERCIAL GENERAL LIABILITY GL9575176 (USA) 5/1/2015 '11/2016 EACH OCCURRENCE $2.000.000 B RMGL9897565 (Canada) /1/2015 /1/2016 CLAIMS -MADE X OCCUR PREN114ES (F oArr(amc $2 000,000 MED EXP (Any one Derson) $10.000 ___.._. ...._..... ..,.,,., .... ..............................m ..........,......------- - - - -.. ........ .....,,,,... ................ . ... PERSONAL & ADV INJURY $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $4.000.000 _.X....- POLICY ❑ JEo L.._] LOC PRODUCTS- COMPIOPAGG $4. 000,000 OTHER: $ A AUTOMOBILE LIABILITY '/1/2015 /1/2016 $ CA5339581 USA 2,000,000 B ( ) (s� a�c_r.Iw�n?ttD X ANY AUTO RMBA12670802 (Canada) /1/2015 /1/2016 BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS HIRED AUTOS NON -OWNED gy�py7µ( $ AUTOS (Per bccidamM C X UMBRELLA LIAB X OCCUR XOOG27638557 /1/2015 6/1/2016 EACH OCCURRENCE $10,000,000 EXCESS LIAB CLAIMS -MADE AGGREGATE $10,000,000 DED X RETENTIONS 10,000 $ E WORKERS. COMPENSATION See Attached /1/2015 /1/2016 rEL ER OTH- AND EMPLOYERS' LIABILITY Y / N TATUTE ER ,ANY PROf'RIE rOIldI'ARTtOq .riIFXECU'GIVE � NIA ACH ACCIDENT $2,000,000 U' Mr�FJCERIM15MBER EXCLUDED? (Mandator y in NH) ISEASE - EA EMPLOYEE $2,000,000 „ describe under ...... ' °' ° ° ° " "---- - - - - -- 0 RIPTION OF OPERATION x belo . ISEASE - POLICY LIMIT $2,000,000 D Auto Physical Damage CA 6758489 /1/2015 /1/2016 Comp /Coll Ded $500,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of El Segundo, its officials, and employees are additional insured for General Liability, on a primary and non - contributory basis, as respects the Named Insureds operations, if the Named Insured has agreed, prior to loss, to provide such coverage. Please refer to attached General Liability endorsement for scope of Additional Insured status. Rights of Subrogation have been waived with respects to General Liability and Workers Compensation as required by written contract, executed prior to a loss and only with respects to operations of the Named Insured. Should any of the above - described policies be cancelled before the expiration date thereof, the issuing company will mail thirty (30) days written notice to the Certificate Holder. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of El Segundo, Its Officials, and employees )` °�.,, ACCORDANCE WITH THE POLICY PROVISIONS. City Clerk p 350 Main Street, Room 5 AUTHORIZED REPRESENTATIVE El Segundo CA 90245 -3813 USA ©1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ENDORSEMENT This endorsement, effective 12:01 A.M. 06/01/2015 forms a part of Policy No. GL 957 -51 -76 issued to OUTFRONT MEDIA INC. ° by NEW HAMPSHIRE INSURANCE COMPANY ADDITIONAL INSURED - WHERE REQUIRED UNDER CONTRACT OR AGREEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM Section II - Who is an Insured, 1., is amended to add: f) Any person or organization to whom you become obligated to include as an additional insured under this policy, as a result of any contract or agreement you enter into which requires you to furnish insurance to that person or organization of the type provided by this policy, but only with respect to liability arising out of your operations or premises owned by or rented to you. However, the insurance provided will not exceed the lesser of: 1. The coverage and /or limits of this policy, or 2. The coverage and /or limits required by said contract or agreement. AUTHORIZE AUTHORIZE5 REPRESENTATIVE 61712 (9/01) OUTFRONT Media Inc. Effective: 06/01/2015 to 06/01/2016 Worker's Compensation Policy Numbers States Insurance Company Policy Number Policy Term NAIC No. AOS New Hampshire Ins. Cc, _ WC 021 -94 -2756 06/01/2015 to 06/01/2016 23841 FL New Hampshire Ins. Co. WC 021 -94 -2757 06/01/2015 to 06/01/2016 23841 CA National Union Fire Ins. Cc, WC 021 -94 -2758 06/01/2015 to 06/01/2016 19445 MA, ND, OH, Illinois National Ins. Co„ WC 021 -94 -2759 06/01/2015 to 06/01/2016 23817 WA, WI, WY I L- THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Endorsement No. 002 This endorsement, effective 12 :01 AM 06/01/2015 Forms a part of Policy No. WC 021 -94 -2758 055- 01- 061M5tl-00MM Issued to OUTFRONT MED I A INC. , By NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA. , NOTICE TO POLICYHOLDER This endorsement modifies insurance provided under this Workers Compensation and Employers Liability Insurance Policy Premium for this endorsement: SUBJECT TO AUDIT IT IS HEREBY AGREED THAT FORM WC040306 WAIVER OF RIGHTS TO RECOVER IS ADDED TO THE POLICY. _ ALL OTHr:" RKS- CON/ M-ONS -AND 'EXCLUSIONS- *REMAIN- UNCHAUGED: Issue Date: 10/22/15 WC 99 06 11 Q (Ed. 01/97) Authorized Representative WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT -- CALIFORNIA 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 pollcy). This endorsement, effective 12:01 AM 06/01/2015 forms a part of Policy No. WC 021 -94 -2758 Issued to OUTFRONT MED I A INC. By NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA. X Premium I NCLUDED 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 2.00 % of the California workers' compensation premium otherwise due on such remuneration. Schedule Person or Organization CITY OF EL SEGUNDO 350 MAIN ST, EL SEGUNDO CA 90245 Job Description CITY OF EL SEGUNDO ITS OFFICIALS, OFFICERS, AGENTS AND EMPLOYEES. RE: ENGINEERING PLAN CHECK SVCS, CITY OF EL SEGUNDO. WC 04 03 06 Countersigned by_ (Ed. 04/84) Authorized Representative