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PROOF OF INSURANCE (2016) CLOSED4C"� DATE (MM /DD/YYYY)
4 ,,,.,. CERTIFICATE OF LIABILITY INSURANCE 9/28/2015
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 CONTACT Jeri NO Ola
NAME: y y
Greyling Insurance Brokerage PHONE (770)552-4225 FAx
....: ,,.....,, ran /r, Nn) (866)550-4082
3780 Mansell Road E -MAIL ferry. noyola @greyli
ADDRESS. ng , com
Suite 370 INSURER(S) NAIC# 11 Alpharetta GA 30022 INSURERA:Travelers Indemnitv Company of 25658 11-11- _.
INSURED INSURER S Travelers Indemnity Company Of CT 25682
KPFF, Inc.
1601 5th Avenue
Suite 1600
Seattle WA 98101
............... m w _
INSURERC:Travelers Indemnity Company 25658
..
INSURER D Travelers Property Casualty Companv 25674
INSURER E :Llovd' s of London
COVERAGES CERTIFICATE NUMBER: 15 -16 (LA Structural) 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
I - ----
_ CLAIMS.
p SVn w POLICY EFF POLICY EXP
LTR TYPE OF INSURANCE SD W POLICY NUMBER mnnyyyi ruumnnwyi LIMIT
S
X COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE $ 1,000, 000
OAMA(E fC) 6%fi RVTV % 0 .
A i CLAIMS -MADE X OCCUR F'Fm&^Mn�"I � (�"3 orrrencrx) $ 300, 000
X WA Stop Gap 680- 1263L238 (AOS) 10/10/2015 10/10/2016 MEDEXP(Anyoneoerson) $ 10 000,1
Contractual Liability PERSONAL $ 1,000, 000'..
B X,... ._._._. e, ,... _ _
E LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
PRO- LOC 7 L5 0 CA 10 10 2015 10/10/2016 2 000
GEN'LAGGREGAT -
POLICYX JECT PRODUCTS- COMP /OPAGG $ 000
OTHER $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMfJ $ 1,000,000
( ,q ;ggdenq .......... .---- ._._, ......... ..,,,,.
C X ANY AUTO BODILY INJURY (Per person) $
-- ALL OWNED SCHEDULED ... ._._._. ...,.. � ...... ... ......
AUTOS ,„X....... AUTOS BA- 1283L587 10/10/2015 10/10/2016 BODILY INJURY (Per accident) $
NON -OWNED PRORTY DAMAGE
X HIRED AUTOS X AUTOS 1Par arr d-0 $
X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 10, 000, 000
D _EXCESS LIAB ............. CLAIMS -MADE AGGR... ..,,... ... _._..._..
EGATE $ 10.000.000
DED - X RETENTION$ 10.000 CUP- OF630530 10/10/2015 10/10/2016 $
WORKERS COMPENSATION X PER iTF ERH
AND EMPLOYERS' LIABILITY YIN
ANY PROIETOR/EXCLUDR/EXECUTIVE E.L. DISEASECIDA EMPLOYE $ 1.000.000
OFFICER/MEMBER OPRIET EXCLUDED N N/ A E L EACH _
D (Mandatory In NH UB- 5B36Y216 10/10/2015 10/10/2016 EI $ 11000,000
If yes, describe under °°
DESCRIPTION OF OPERATIONS below EL, DISEASE - POLICY LIMIT $ 11000.000
E Professional /Pollution B0146LDUSA1504384 10/10/2015 10/10/2016 Per Claim /Aggregate $10,000,000
Liability SIR $250,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required)
Re: KPFF Job #115277 - E1 Segundo Fire Station No. 1 Seismic Evaluation & Retrofit. The City of E1
Segundo is named as an Additional Insured with respects to General & Automobile Liability where required
by written contract. Waiver of Subrogation is applicable where required by written contract & allowed by
law. Umbrella Follows Form with respects to General, Automobile & Employers Liability Policies. Should
any of the above described policies be cancelled by the issuing insurer before the expiration date
thereof, 30 days' written notice (except 10 days for nonpayment of premium) will be provided to the
Certificate Holder.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City Of El Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Floriza Rivera, PW Dept . ACCORDANCE WITH THE POLICY PROVISIONS.
350 Main Street
El Segundo, CA 90245 AUTHORIZED REPRESENTATIVE
David Collings /JERRY
©1988 -2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
INS025 (201401)
COMMERCIAL GENERAL LIABILITY
Policy Number: 680- 127OL580
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
(Section 11):
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 acts or omis-
sions or the acts or omissions of those acting of
your behalf:
a. In the performance of your ongoing opera-
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.
INSURANCE (Section 111) for this Coverage
Part.
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;
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- C.
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
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.
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
CG D3 8109 07 © 2007 The Travelers Companies, Inc. Page 1 of 2
Includes the coovrichted material of Insurance Services Office. Inc., with its permission
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000878
COMMERCIAL AUTO
Policy Number: BA- 1283L587
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
AUTO COVERAGE PLUS ENDORSEMENT
This endorsement modifies insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
With respect to coverage provided by this endorsement, the provisions of the Coverage. Form apply unless modi-
fied by the endorsement.
GENERAL DESCRIPTION OF COVERAGE – This endorsement broadens coverage. However, coverage for any
injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or
limited by another endorsement to the Coverage Part, and these coverage broadening provisions do not apply to
the extent that coverage is excluded or limited by such an endorsement. The following listing is a general cover-
age description only. Limitations and exclusions may apply to these coverages. Read all the provisions of this en-
dorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered.
A. BLANKET ADDITIONAL INSURED
B. EMPLOYEE HIRED AUTO
C. EMPLOYEES AS INSURED
D. SUPPLEMENTARY PAYMENTS – INCREASED
LIMITS
E. TRAILERS – INCREASED LOAD CAPACITY
F. HIRED AUTO PHYSICAL DAMAGE
G. PHYSICAL DAMAGE – TRANSPORTATION
EXPENSES – INCREASED LIMIT
A. BLANKET ADDITIONAL INSURED
The following is added to Paragraph A.1., Who Is
An Insured, of SECTION II – LIABILITY COV-
ERAGE:
Any person or organization who is required under
a written contract or agreement between you and
that person or organization, that is signed and
executed by you before the "bodily injury" or
"property damage" occurs and that is in effect
during the policy period, to be named as an addi-
tional insured is an "insured" for Liability Cover-
age, but only for damages to which this insurance
applies and only to the extent that person or or-
ganization qualifies as an "insured" under the
Who Is An Insured provision contained in Section
II.
B. EMPLOYEE HIRED AUTO
1. The following is added to Paragraph A.1.,
Who Is An Insured, of SECTION II – LI-
ABILITY COVERAGE:
H. AUDIO, VISUAL AND DATA ELECTRONIC
EQUIPMENT – INCREASED LIMIT
I. WAIVER OF DEDUCTIBLE – GLASS
J. PERSONAL EFFECTS
K. AIRBAGS
L. AUTO LOAN LEASE GAP
M. BLANKET WAIVER OF SUBROGATION
performing duties related to the conduct of
your business.
2. The following replaces Paragraph b. in B.5.,
Other Insurance, of SECTION IV – BUSI-
NESS AUTO CONDITIONS:
b. For Hired Auto Physical Damage Cover-
age, the following are deemed to be cov-
ered "autos" you own:
(1) Any covered "auto" you lease, hire,
rent or borrow; and
(2) Any covered "auto" hired or rented by
your "employee" under a contract in
that individual "employee's" name,
with your permission, while perform-
ing duties related to the conduct of
your business.
However, any "auto" that is leased, hired,
rented or borrowed with a driver is not a
covered "auto ".
C. EMPLOYEES AS INSURED
An "employee" of yours is an "insured" while
operating a covered "auto" hired or rented The following is added to Paragraph A.1., Who Is
under a contract or agreement in that "em- An Insured, of SECTION II – LIABILITY COV-
ployee's" name, with your permission, while ERAGE:
CA T4 20 07 10 © 2010 The Travelers Indemnity Company. All rights reserved. Page 1 of 3
Includes copyrighted material of Insurance Services Office, Inc. with its permission.
K. AIRBAGS
The following is added to Paragraph B.3., Exclu-
sions, of SECTION III — PHYSICAL DAMAGE
COVERAGE:
Exclusion 3.a. does not apply to 'loss" to one or
more airbags in a covered "auto" you own that in-
flate due to a cause other than a cause of 'loss"
set forth in Paragraphs A.1.b. and A.1.c., but
only:
a. If that "auto" is a covered "auto" for Compre-
hensive Coverage under this policy;
b. The airbags are not covered under any war-
ranty; and
c. The airbags were not intentionally inflated.
We will pay up to a maximum of $1,000 for any
one 'loss ".
L. AUTO LOAN LEASE GAP
The following is added to Paragraph A.4., Cover-
age Extensions, of SECTION III — PHYSICAL
DAMAGE COVERAGE:
Auto Loan Lease Gap Coverage for Private
Passenger Type Vehicles
In the event of a total 'loss" to a covered "auto" of
the private passenger type shown in the Schedule
or Declarations for which Physical Damage Cov-
erage is provided, we will pay any unpaid amount
due on the lease or loan for such covered "auto"
less the following:
(1) The amount paid under the Physical Damage
Coverage Section of the policy for that "auto';
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COMMERCIAL AUTO
(2) Any:
(a) Overdue lease or loan payments at the
time of the 'loss ";
(b) Financial penalties imposed under a
lease for excessive use, abnormal wear
and tear or high mileage;
(c) Security deposits not returned by the les-
sor;
(d) Costs for extended warranties, Credit Life
Insurance, Health, Accident or Disability
Insurance purchased with the loan or
lease; and
(e) Carry-over balances from previous loans
or leases.
M. BLANKET WAIVER OF SUBROGATION
The following replaces Paragraph A.5., Transfer
Of Rights Of Recovery Against Others To Us,
of SECTION IV — BUSINESS AUTO CONDI-
TIONS:
5. Transfer Of Rights Of Recovery Against
Others To Us
We waive any right of recovery we may have
against any person or organization to the ex-
tent required of you by a written contract exe-
cuted prior to any "accident" or 'loss ", pro-
vided that the "accident" or "loss" arises out of
the operations contemplated by such con-
tract. The waiver applies only to the person or
organization designated in such contract.
- CA T4 20 07 10 © 2010 The Travelers Indemnity Company. All rights reserved.
Includes copyrighted material of Insurance Services Office, Inc. with its permission.
0008so
Page 3 of 3
TRAVELERS'I'
WORKERS COMPENSATION
ONE TOWER SQUARE AND
HARTFORD, CT 06183 EMPLOYERS LIABILITY POLICY
ENDORSEMENT WC 00 03 13 (00) -01
POLICYNUMBER: UB- 5836Y216
WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT
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. (ihis.agreement applies only to the
Went that you perform work under a written contract that requires you to obtain this agreement from us.)
This agreement shall not operate directly or Indirectly to benefit any one not named In the Schedule.
SCHEDULE
DESIGNATED PERSON:
DESIGNATED ORGANIZATION:
ANY PERSON OR ORGANIZATION FOR WHICH THE INSURED HAS AGREED
IN A WRITTEN CONTRACT EXECUTED PRIOR TO LOSS TO PROVIDE THIS
WAIVER.
DATE OF ISSUE: 11 -04 -13 ST ASSIGN:.