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PROOF OF INSURANCE (2016 - 2017) CLOSEDLAYNE -2 OP ID: NCS '`BI RO CERTIFICATE OF LIABILITY INSURANCE DAT02/08/16 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). ......... ................ ._....,,,,,,,,,,,,,,,,,,,,_,_,w ..................... ....._,— ._..,...,,,,..�....��. CONTACT ... PRODUCER 925- 977 -9220 NAME Easterly Surety & Ins.Svcs.lnc PHONt FAX- 56 Mayhew Way 925- 977 -9224 ,Agcy No, EYt); �aC, No) -- - - - - -- Walnut Creek,, CA 94597 E-MAIL _.. ---- - - -- ", ................. Kevin P. Easterly ADDRESS,. INSURED C C Layne & Sons C. Craig Layne 213 Richmond Street El Segundo, CA 90204 INSURER(S) AFFORDING COVERAGE NAIC N INSURER A: James River Insurance Company 12203 INSURER B : State Comp.Ins.Fund of Ca 35076 COVERAGES CERTIFICATE NUMBER; 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, R .���.��� AD/h� min POLICY - ------ - -- „_. G�b@OiYIP��4'.P. FF IPii.,I�Y EXP ....... R TYPE OF INSURANCE rucw min POLICY NUMBER /YYy-Y fgpMyp,gq�},IyT^ LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,0 A X COMMERCIAL GENERAL LIABILITY X 00528483 04/14/15 04114116 PREMISES E S RENTED PREMISES,(Ea occurrence) $ BODILY INJURY (Per person) $ JCLAIMS -MADE [ X I OCCUR ALLOWNED� SCHEDULED MED EXP (Any one person) $ BODILY INJURY (Per LY INJU de $ AUTOS AUTOS PERSONAL & ADV INJURY $ NON -OWNED GENERAL AGGREGATE $ GEN L AGGREGATE LIMIT APPLIES PER PR PERTY OAMAa'L HIREDAUTOS .AUTOS PRODUCTS - COMP /OP AGG $ [Per 0-n $ POLICY X 'IECT LOG $ UMBRELLA LIAB OCCUR mm AUTOMOBILE LIABILITY I EACH OCCURRENCE $ M- Bi1,4pp S1N;aLE t. M I A X EXCESS LIAB I � CLAIMS MADE XL66037002 04/14/15 04/14/16 AGGREGATE $ DED X II RETENTION$ I $ WORKERS COMPENSATION X VVU b I A I U- I II U 111- AND EMPLOYERS' LIABILITY TQRV LIMITS a FR B ANY PROPRIETOR /PARTNER/EXECUTIVE Y X 9088031 02/01/16 02/01/17 E L EACH ACCIDENT $ OFFICER /MEMBER EXCLUDED? N/A (Mandatory in NH) E DISEASE - EA EMPLOYEE $ If yes, describe under ......- - -. -. - - -- DESCRIPTION OF OPERATIONS below L L OISE,ASB PCt ICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) ww w THE CITY OF EL SEGUNDO, ITS OFFICIALS AND EMPLOYEES ARE NAMED ADDITIONAL INSURED PER THE ATTACHED ENDORSEMENT FORMS CG2010 0704 AND CG2037 0704. THIS INSURANCE IS PRIMARY AND NON - CONTRIBUTORY. WORKER'S COMP WAIVER OF SUBROGATION APPLIES. *10 DAYS NOTICE OF CANCELLATION FOR NON - PAYMENT OF PREMIUM. CERTIFICATE HOLDER CANCELLATION CITY OF EL SEGUNDO 350 MAIN ST EL SEGUNDO, CA 90245 ACORD 25 (2010/05) ELSEGUN 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 J;7t,-, WWWWWWWWWWWWWWWWWWWWW ©1988- 2010WACORD CORPORATION. All rights reserved, The ACORD name and logo are registered marks of ACORD ANY AUTO BODILY INJURY (Per person) $ ALLOWNED� SCHEDULED BODILY INJURY (Per LY INJU de $ AUTOS AUTOS NON -OWNED PR PERTY OAMAa'L HIREDAUTOS .AUTOS [Per 0-n $ UMBRELLA LIAB OCCUR I EACH OCCURRENCE $ A X EXCESS LIAB I � CLAIMS MADE XL66037002 04/14/15 04/14/16 AGGREGATE $ DED X II RETENTION$ I $ WORKERS COMPENSATION X VVU b I A I U- I II U 111- AND EMPLOYERS' LIABILITY TQRV LIMITS a FR B ANY PROPRIETOR /PARTNER/EXECUTIVE Y X 9088031 02/01/16 02/01/17 E L EACH ACCIDENT $ OFFICER /MEMBER EXCLUDED? N/A (Mandatory in NH) E DISEASE - EA EMPLOYEE $ If yes, describe under ......- - -. -. - - -- DESCRIPTION OF OPERATIONS below L L OISE,ASB PCt ICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) ww w THE CITY OF EL SEGUNDO, ITS OFFICIALS AND EMPLOYEES ARE NAMED ADDITIONAL INSURED PER THE ATTACHED ENDORSEMENT FORMS CG2010 0704 AND CG2037 0704. THIS INSURANCE IS PRIMARY AND NON - CONTRIBUTORY. WORKER'S COMP WAIVER OF SUBROGATION APPLIES. *10 DAYS NOTICE OF CANCELLATION FOR NON - PAYMENT OF PREMIUM. CERTIFICATE HOLDER CANCELLATION CITY OF EL SEGUNDO 350 MAIN ST EL SEGUNDO, CA 90245 ACORD 25 (2010/05) ELSEGUN 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 J;7t,-, WWWWWWWWWWWWWWWWWWWWW ©1988- 2010WACORD CORPORATION. All rights reserved, The ACORD name and logo are registered marks of ACORD F'0 ICY NUMBER; 00052848-3 CG 20 10 07 04 ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR I ORGANIZATION This endorsement modifies insurance provided under the foilowing: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name 01 Additional Insured Person(s) Or 0 rgr FA �Uonj,�)_-. Location(s) Of Covered Operations where req ,,ui'ed by written contract or, wrillen agreerl'Ient ail operatioris of Rre narned insured . . ............. .. _­ .......... I mral lon re�j i-so to if iol sh,,)w,7 abovie, wifl ii)e s'nown in t1^8 j . . . ..... .. A. Section 11 Who Is An Insured �s arverided to B., WJ1 reSpe(, t,,e rwhide as an adcitJonal insuicKJ the 'on(s) or eicdional i,' swreds, the frAowlng addWonai ewk. orgwwat�on(s) shown� M the S��:J'wwl�Ae, bu� orfly stony ar)plly: wh respect to i iat)Aly tot "bcdily ir'uiryl'jj "'Prope'rty I h insuirance does, r o appIV to bodily rn;t,. r r..CY, daniage' or ",,)e,sona1 and adverfising Wljury' orcoefty darnage" cxm: irrnq a."e utused, in wh(cle or in pert, by' 1" AF work, pa1's Or c(IL.Jo 1. Your acts or oirnissioinsl, or merit ri,,", ished in cr)nno(.aion With suc.i"r work, 2. "],)a ae"S ()j'r rots' ors of 9'iose ac(ing 0i1 YOLA n", ho nrnq�R(' twhor Jlarl servik rd ' benaif; to �,)e perforried oy or a ,)o,44f of �n ffie rwilorrna we of your ongoing op(.,-.,rafionr, for he a,16fior ',,aI at !tie the hays tne ad&.Joirvl� ir&,jjred(.sl at the iocafier)(s) desilg- Govered riper been coiuplet,�,�d; car nated at)ove, Z Q'mt poiocirr of 'youir work" o' Wniich the ir,u,y or darnage anses has been jput lo its in-- ded u,se toy any pf.- sr,.w or orpa. irzatro aftv ,N trBan ainolwn' cowl'm(. engaged irr rgalxforvvng operations tcl' as Ir rino- pW as a par' of the say.ie project, CG 20 10 (Y7 04 (0 ISO Propei-Jes, inc—, 2004 Page 1 of 1 0 �10 -K.",Y NUMBEF"i: 00052848--3 IR CG 20 37 07 04 Well Mf • 'rtiiis modities insunaince, piov'ded dmder the fulawing, i.,� GF."NERAL [JABk. "t,y r,CVE.�'-iAGE'u'. FIXMIT SVII EDULE Name Of Additional Insured Person(s) Location And Description Of bons ompleted Opera- Or Oraenization(s): ................ . ....... . . . . . .............................. T where requked by w iren c(,,nt.i act or w 1�en agreenleni 0 qpetatiun,,,.� ut the� narned insured Mforrnaliorc reqOedl ',o cairnn1eilp aia do Scniidde� H nor shown ahove, wM b(.,i si�,cvvn 31 a p De,.ia aliors Semfloin I1 -- Who Is An Insured is am�,-,v,dwl to iridudF,..) as an additiona Insu,f,,- Me person(s) ci, rgai za-, Haan(() shown in 1'ne Sciedulr.), tl,ut of 1y w1h respoc, to p ope , jr* IiabTty fair todfly ln�jry o� Ly darrage' ca,,dsed, in wh0c, or in part, by yow work" al t-c Ileaca ficirm dcs g nWed and descinbirg', i,,, the sdhectj6e at V,1s eirdorse- rnerit performed folir Unat addkiona.l -nsuec, and 'inc uded urn �,azar,,Y. CG 20 37 07 04 @5 S(-) Properiies, ru,', 20'04 Page 1 of 1 a V PRIMA ONTRIBUTORY ENDORSEMENT -1 antis endorsement mo6fies Gnsurance provided under to foflowMg: ALL COVEFiAGE FIARTS P� a e 6f maIlion -al lns'u,-re,-d Person(s) Or Qrgnizafian(-;) ,j' no entry appears at,"oWn, this endoirsaMBM aW)k8S to w AacliDortz misureas covenea N8 o,'I tcv, 11 Any coverage provk1ed to an Addit oral under fts poky shaH be excess over any other vaild vuid Cofi eOUe insurance Avajlai:�'e w� such Addificinat lr'�Sured whetheir primary, exicess, contingent or on any other basis unless a wrilten contract or written agreement specfflca4y requires that this insurance apply on a primary and noncontributory basps . ALI OTI--IER TERMS AND C014DIT1014S OF THE POLICY REMAIN UNCI-MNGED. AP5031 US 0 4-10 Page I of I POUCY Nf..Dfl' ERf 00052848-3 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This ens dorsernent rnodfies insurance provided Under the tokw�ng: I C(AAMI-KIAi, JA3H FY COVERAG'F PAR' ,,")PFRAI IONS L AFfl ,,I TY (,(-')VEF--W3E PAF-IT Mime Of FlIerson Or Orgardzallow, Where reqi,i4'ed by wltlen contract or written agreement li,jfom,�at[on f,eq�,Ired to ,,ompWe �lnrs Schf-.,idu- I he following is added to Paragraph B. Transfer Of Rights Of Recovery Against Others To Us oi Section IV — Conditions: ww t si,*wn inme [)ec araiOns. We any I i(I'lG 04 1 P--.nve-v we h nwr a, "I f)sl he P H f S a I 0, r'14" I " 1, 0 , v"lzKon Shown it lit"I ab,we Ppyrner,is m4 "or ijwy damage PVSIIn'l " "ut " ,I fun, �;l I .yt)4n wo�k' Llo-e i,n0e� a w4h !�,!t Po(SM G i ,, I ail -CJ i I 'I t " � , welly "he pom'son 0, CG 24 04 05 09 (D ftiurancx.) SaMcas Office, inc, 200 8 Page 1 of 1 13 DATE (MMIDD/YYYY) C)RE CERTIFICATE OF LIABILITY INSURANCE 03/01/2016 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 the 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, Remon Wasfi REMON WASFI PHONE 310 - 322 -1132 FAX -310- 640 -1057 Math SjajOFW�m EL SEGUNDO, CA 90245 �a remon.wasfi,k0w3@statefaim corn Ns ES) AFFORDING COVERAGE NAlcn INSURERA;State Farm General Insurance Company 25151 -_�... ........... _.......... ................................................ ........... INSURED CC LAYNE & SONS INSURER B; 213 RICHMOND ST. INSURER C; EL SEGUNDO, CA90245 - 3719 INSURER D; INSURER E: INSURER F COVERAGEIS CERTIFICATE NUMBER: 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. IL6 .......... TYPE OF INSURANCE .... ....... ' ' -. POLICY NUMBER PO 'Y� E'er 06k'U Y k�S4P,-, _ , .�.�.�. .... LIMITS.... .... ........ A COMMERCIAL GENERAL LIABILITY Y EACH OCCURRENCE $ CLAIMS -MADE Z OCCUR PREMISES Fe _CUapU MED EXP (Any one person b PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ PRO- PRODUCT POLICY JECT LOC S COMP 0P AGG S OTHER! $ AUTOMOBILE LIABILITY 4461681- C26 -75C 03/26/2016 03/26/2017 MMNE SINGLE UM11T y 1,000,000 ffmi S t) 211 9368 - C26 -75Y 03/26/2016 03/26/2017 ANY AUTO BODILY INJURY (Per person) $ 1,000,000 X ALL O AUTOS OWNED ULED BODILY INJURY (Per accident) $ 1,000,000 470 7387 - C26 -75B 03126/2016 03126/2017 ..• NON -OWNED PROPERTY OAMIACaE __.._ _ HIREDAUTOS AUTOS 3226846- C26 -75F 03/26/2016 03/26/2017 PePa I "M1— $ 1,000,000 $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE $ DED RETENTIONS $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITY YIN STATUTE_ _. ER ANY PROPMETO"ARTN'ERIEXECUTIVE NIA E L EACH ACCIDENT _ $ _ OF'EICERWEM R EXCL'UDE-00? ...... .. (Mandatory in NH) E L DISEASE - EA EMPLOYEE 3 Ifyes dlas0bo under DESGMP"I ION OF OiPE RAT IONS botdwe E L DISEASE - POLICY LIMIT E DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) ADDITIONAL INSURED: THE CITY OF EL SEGUNDO, ITS OFFICERS, OFFICIALS, EMPLOYEES, AGENTS AND VOLUNTEERS AS ADDITIONAL INSURED. CERTIFICATE HOLDEN. CANCELLATI'O'N' CITY OF EL SEGUNDO SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 350 MAIN STREET n N THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN EL SEGUNDO, CA 90245 � t� ) ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ®1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD 1001486 132849.9 02 -04 -2014 'V DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE I 03/01/2016 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 Remon Wasfl ®1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 26 (2014101) The ACORD name and logo are registered marks of ACORD 1001486 132849.9 02 -04 -2014 NAME: o o� N.1.310-640-1057 1 F.r; 310- 322 -1132 T " �jf���, 432 MAIN ST n.wasfi.kOw3 sta��- ������������ ADDRE remo efarm co m EL SEGUNDO CA 90245 ,..,. INSURER(Sl A��FFORDING COVERAGE N AIG p �_... INSURER Farm General Insurance Company 25151 INSUREO_m ......C.C�LAYNE &SONS ......... ______ _.mm, ,,,, , INSURER B: 213 RICHMOND ST. wsuRERC: EL SEGUNDO, CA90245 - 3719 .. .......................................................... ............................. .. ��.. INSURERD . n.. n. .. ............................. INSURER E .................................. . .. ........ ,_ nmm._......... ................. ............... INSURERF : COVERAGES CERTIFICATE NUMBER: 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. - ISIS R TYPE OF INSURANCE 101.0r, wr POLICY N11 , en 1L�lYµ P U Y EX O I MLL I LIMITS IMMIDD/YYYY Ml DIYW V .... A COMMERCIAL GENERAL LIABILITY Y EACH OCCURRENCE $ — ......... 'DAMAGE TO RENTED_ . - .. .... CLAIMS -MADE x OCCUR PRFMISFS IFa nrru ranrPY S - - -_ ------..__ ..................... ............................... ( n. v one oersoN $ _..........__.._.._.. ..... ............................... PERSONAL S ADV INJURY E ............................ - ---- ........... - ............... ._.............. ............................... GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE E POLICY 1 JECT LOC PRODUCTS - COMP /OP AGG $ AUTOMOBILE LIABILITY 284 5408- C26 -75H 03/26/2016 03/26/2017 } IN LE Ll MIT $ 1,000,000 ANY AUTO BODILY INJURY (Per person) E ALL OWNED SCHEDULED AUTOS UT X... BODILY INJURY Per ..............� ( accident) S mm..... NON -OWNED Po 6aCE'R':TYrt0AMAGE.. ... ,..�� S HIRED AUTOS AUTOS /r' a UMBRELLA LIAR OCCUR EACI OC- CLNRRENCE S EXCESSLIAB CLAIMS -MADE -- AfiaGRE�`rAi7E y _. .......... - .............. DED RETENTION $ y WORKERS COMPENSATION I PER OTH- ANDEMPLOYERS'LUIBILITY YIN STATUTE_ .,.,.,.ER y". ^ ANY PROPRIETOR/PARTNERIEXECUTIVE OF''FICERIMEMBER EXCLUDED N / A E L EACH ACCIDENT E ., ,,,,,, , __`__ ". (. ` Myyv�andak In NH) E L DISEASE SE • EA EMPLOYEE $ If es descrIbe under RIPITION OPERATIONS .... ° --._ -- _.. ______._ E L D OF below OISEAa SE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached it more space Is required) ADDITIONAL INSURED: CHEVRON USE INC., AND ITS SUBSIDIARIES AND AFFILIATES NAMED AS ADDITIONAL INSURED, CERTIFICATE HOLDER CANCELLATION, CITY OF EL SEGUNDO FA LD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 350 MAIN STREET EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN EL SEGUNDO, CA 90245 W RDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ®1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 26 (2014101) The ACORD name and logo are registered marks of ACORD 1001486 132849.9 02 -04 -2014 ffivak% I . • 213 RICHMOND ST EL SEGUNDO, CA 90245 AN7,7MING IN THIS POLICY TO 'IHE CONTRARY NOTWITHSTANDING, IT IS AGREED 'I7HAT T'HE STATE COMPENSATION INSUPANCE FUND WAIVES AklY RIflHT DF SUBROGATION A03AINST, CITY OF EL SEGUNDO WHICH MIGHT ARISE BY REASON OF Ally PAYMENT' UNDER THIS POLICY IN CONNECTION WITH WORK PERFORMED BY, C C LAY NE & SONS INC IT IS FURTHER AGREED TTIAT '111E INSURED SHALL MAIN'TAIN PAYROLL RECORDS ACCURATELY SE03REGATING THE REMUNERATION OF EMPLOYEES 'WHILE ENGAGED IN WORK FOR THE ABOVE E�VPLOYER. 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 #R EXTEND ANY OF THE TERMS, CONDITIONS. AGREEMENTS, OR LIMITATIONS OF THIS 7OLICY OTHER THAN AS STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE AELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR -IMITATIONS OF THIS ENDORSEMENT. COUNTERSIGNED AND ISSUED AT SAN FRANCISCO: SCIF FORM 10217 (REV.7.2D141 V� � PRESIDENT AND CEO