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PROOF OF INSURANCE (2016) CLOSEDOCCRAT -005 WEMI DATE (MM /DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 117/2016 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 (888) 825 -4322 CONTACT NAME: Michele Weaver Bowermaster & Associates PHONE FA'4X (Alp No; Ext):714- 733 -6200 215 tic' N' 714 252 ............ 8253 P.O. Box 6026 10805 Holder Street - Suite 350 _ .. mmm E-MAIL ADPRESs. mWeaVer oWermaSter.Com 0101.... �.._ ...� Cypress, CA 90630 INSURER(S) AFFORDING COVERAGE NAIC # CLAIMS -- INSURERA Ohio Securitv Insurance Companv 34630 INSURED Tierra West Advisors, Inc. -- ... INSURER B The Hartford Insurance Group 29459 2616 East 3rd Street INSURERC:Scotsdale Insurance Companv Los Angeles, CA 90033- - - - - - -- -. - ®,. INSURER D: 2,00..00 INSURER E r 0,000_.- 00,0,1 .. .,.,_ ..... ............... Y N BZS55709073 INSURER F: 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 INSR TYPE OF INSURANCE INSD ( WVD POLICY NUMBER 0000. IMMII1n WW1 rypryq� ICY XP ,vv........ .vv .v vv.... ...W ........................................ ., DDNY'YY LIMITS 0/1 A X COMMERCIAL GENERAL LIABILITY 4 2,00..00 ) CLAIMS OCCUR I X...,I OCCUR Y N BZS55709073 10/1/2015 DAMA 1011/2016 2,000,000 -MADE r�SO (.66RENTE!p�kn- CC@`sJ....$.... .................................... 0000 0000.. MED EXP (Any one person) $ 15,00 .,PERSONAL &ADVINJURY ,.sue .... ...............2,000,000 GEN °L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 X-.. POLICY u PR u LOG PRODUCTS COMP /OP AGG $ 4,000,000 OTHER; $ AUTOMOBILE LIABILITY 'Kr'LbMLtYNCCT ^aINC,�C.r IMtl $ 2,000,000 ,[La awcBdutl,p A ANY AUTO '.. N N BZS55709073 10/1/2015 10/1/2016 BODILY INJURY (Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS ..... . ............ ........... ............................... 0000.. ......., BODILY INJURY (Per accident) $ NON-OWNED X X ,. .(PLraccide'DAMAAaF $ HIREDAUTOS AUTOS f�Per accidenli $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE .,_ „...�._ . ......,.... ..,...... .,.,,..._... 0000.. AGGREGATE .,,, ..... $ DED RETENTION $ $ WORKERS COMPENSATION P YIN / IACCIDENT ` FRH B ANY PROPRIETOR/PARTNER/EXECUTIVE EDR EE'XECUTIVE E1' NIA Y 72WECLY5490 10/1/2015 10/112016 EEL EACH $ 1000,00. .(Mandatory in NH) E DISEASE - EA EMPLOYE $ 1,000,000 Ors, describe under DESCRIPTION 01” OPERATIONS beiaw .., .. E L DISEASE - POLICY LIMIT �I V $ 1,000,000 C ,Mist. Professional Liability N N EKI3164775 8115/2015 8/15/2016 Each Claim /Aggregate $2,000,00012,000,00 C Misc. Professional Liability N N �EKI3164775 8/15/2015 8/15/2016 Retention $15,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The City of El Segundo, its officials and employees are named additional insured per form BP79960713 including Primary and Non - Contributory Wording. Waiver of Subrogation applies to Workers Compensation per attached form #G- 2240 -3 B. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of El Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Planning & Building Safety Department ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Greg Carpenter 350 Main St AUTHORIZED REPRESENTATIVE El Segundo, CA 90245 -'" -- ©1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD BUSINESSOWNERS BP 79 96 07 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESSOWNERS LIABILITY EXTENSION ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SUBJECT PAGE AGGREGATE LIMITS OF INSURANCE 3 AMENDMENT OF INSURED CONTRACT DEFINITION 4 BLANKET ADDITIONAL INSURED (OWNERS, CONTRACTORS OR LESSORS) 2 BODILY INJURY 4 BROADENED COVERAGE FOR DAMAGE TO PREMISES RENTED TO YOU 2 DUTIES IN THE EVENT OF OCCURRENCE, OFFENSE, CLAIM OR SUIT 4 INCIDENTAL MEDICAL MALPRACTICE 2 MOBILE EQUIPMENT 2 NEWLY FORMED OR ACQUIRED ORGANIZATIONS 3 PERSONAL AND ADVERTISING INJURY 4 SUPPLEMENTARY PAYMENTS 2 Bail Bonds Loss Of Earnings ® 2013 Liberty Mutual Insurance. All rights reserved. BP 79 96 07 13 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 4 Section II - Liability is amended as follows: I. SUPPLEMENTARY PAYMENTS Paragraph f.(1)(b) of A Coverages is replaced by the following; (b) Up to $3000 for cost of bail bond required because of accidents or traffic law violations arising out of the use of any vehicle to which Business Liability Coverage for "bodily injury" applies. We do not have to furnish the bonds. Paragraph 11(1)(d) of A Coverages is replaced by the following; (d) All reasonable expenses incurred by the insured at our request to assist us in the Investigation or defense of the claim or "suit', including actual loss of earnings up to $500 a day because of time off from work. II. BROADENED COVERAGE FOR DAMAGE TO PREMISES RENTED TO YOU With respect to the coverage provided under this endorsement, Section II - Liability is amended as follows: 1. The final paragraph of B.I. Exclusions - Applicable To Business Liability Coverage is deleted and replaced by the following: With respect to the premises which are rented to you or temporarily occupied by you with the permis- sion of the owner, Exclusions c., d., e., g., h., k., I., m., n. and o. do not apply to "property damage ". 2. Paragraph D.2. Liability And Medical Expenses Limits Of Insurance is deleted and replaced by the following: The most we will pay under this endorsement for the sum of all damages because of all "property damage" to premises while rented to you or temporarily occupied by you with the permission of the owner is the Limit of Insurance shown in the Declaration. 3. Paragraph D.3. Liability And Medical Expenses Limits Of Insurance is deleted. III. INCIDENTAL MEDICAL MALPRACTICE Exclusion 1.j.(4) does not apply to Incidental Medical Malpractice Injury coverage. The following is added to F. LIABILITY AND MEDICAL EXPENSES DEFINITIONS: 23. 'Incidental Medical Malpractice Injury" means bodily injury arising out of the rendering of or failure to render, during the policy period, the following services: a. medical, surgical, dental, x -ray or nursing service or treatment or the furnishing of food or bev- erages in connection therewith; or b. the furnishing or dispensing of drugs or medical, dental or surgical supplies or appliances. This coverage does not apply to: 1. expenses incurred by the insured for first- aid to others at the time of an accident and the Duties in the Event of Occurrence, Claim or Suit Condition is amended accordingly; 2. any insured engaged in the business or occupation of providing any of the services described under a. and b. above; 3. injury caused by any indemnitee if such indemnitee is engaged in the business or occupation of providing any of the services described under a. and b. above. IV. MOBILE EQUIPMENT 1. Section C. Who is An Insured is amended to include any person driving "mobile equipment" with your permission. V. BLANKET ADDITIONAL INSURED (OWNERS, CONTRACTORS OR LESSORS) 1. Section C. Who Is An Insured is amended to include as an insured any person or organization whom you are required to name as an additional insured on this policy under a written contract or written agreement. The written contract or agreement must be: a. currently in effect or becoming effective during the term of this policy; and b. executed prior to the "bodily injury", "property damage ", "personal and advertising injury". ® 2013 Liberty Mutual Insurance. All rights reserved. BP 79 96 07 13 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 2 of 4 2. The insurance provided the additional insured is limited as follows: a. The person or organization is only an additional insured with respect to liability arising out of (1) Real property, as described in a written contract or written agreement, you own, rent, lease, maintain or occupy; (2) Caused in whole or in part by your ongoing operations performed for that insured. b. The limits of insurance applicable to the additional insured are those specified in the written contract or written agreement or the limits available under this policy, as stated in the Declara- tions, whichever are less. These limits are inclusive of and not in addition to the limits of insurance available under this policy. c. The insurance provided the additional insured does not apply to: (1) Liability arising out of the sole negligence of the additional insured; (2) "Bodily injury", "property damage ", "personal and advertising injury"; or defense coverage under the Supplementary Payments section of the policy arising out of an architect's, en- gineer's or surveyor's rendering of or failure to render any professional services including: (a) The preparing, approving maps, shop drawings, opinions, reports, surveys, field orders, change orders, or drawings and specifications; and (b) Supervisory, inspection, architectural or engineering activities. (3) Any "occurrence" that takes place after you cease to be a tenant in the premises described in the Declarations; or (4) Structural alterations, new construction or demolition operations performed by or for the person or organization designated in the Declarations. 3. Any coverage provided hereunder shall be excess over any other valid and collectible insurance avail- able to the additional insured whether primary, excess, contingent or on any other basis unless a contract specifically requires that this insurance be primary or you request that it apply on a primary basis. VI. NEWLY FORMED OR ACQUIRED ORGANIZATIONS The following is added to C. Who Is An Insured: 3. Any business entity acquired by you or incorporated or organized by you under the laws of any individual state of the United States of America over which you maintain majority ownership interest exceeding fifty percent. Such acquired or newly formed organization will qualify as a Named Insured if there is no similar insurance available to that entity. However, a. Coverage under this provision is afforded only until the 180th day after the entity was acquired or incorporated or organized by you or the and of the policy period, whichever is earlier; b. Coverages A. Paragraph 1. Business Liability, does not apply to: (1) "Bodily injury" or "property damage" that occurred before the entity was acquired or incor- porated or organized by you; and (2) "Personal and advertising injury" arising out of an offense committed before the entity was acquired or incorporated or organized by you; and c. Records and descriptions of operations must be maintained by the first Named Insured. No person or organization is an insured with respect to the conduct of any current or past partnership, joint venture or limited liability company that is not shown as a Named Insured in the Declarations. VII. AGGREGATE LIMITS The following is added to Aggregate Limits Paragraph 4. of D. Liability and Medical Expenses Limits of Insurance: The Aggregate Limits apply separately to each of "locations" owned by or rented to you or temporarily occupied by you with the permission of the owner. The Aggregate Limits also apply separately to each of your projects away from premises owned by or rented to you. For the purpose of this endorsement only, "location" means premises involving the same or connect- ing lots, or premises whose connection is interrupted only by a street, roadway, waterway or right - of -way of a railroad. ® 20131-1berty Mutual Insurance.All rights reserved. BP 79 96 07 13 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 3 of 4 VIII. DUTIES IN THE EVENT OF OCCURRENCE, OFFENSE, CLAIM OR SUIT 1. The requirement in E. Liability And Medical Expenses General Conditions paragraph 2.a. that you must see to it that we are notified of an "occurrence" or offense which may result in a claim applies only when the "occurrence" is known to any insured listed in Paragraph C.I. Who Is An Insured or any "employee" authorized by you to give or receive notice of an "occurrence" or claim. 2. The requirements in E. Liability And Medical Expenses General Conditions paragraph 2.b. that you must see to it that we receive notice of a claim or "suit" will not be considered breached unless the breach occurs after such claim or "suit" is known to any insured listed under Paragraph C.1. Who Is An Insured or any "employee" authorized by you to give or receive notice of an "occurrence" or claim. 1:1111111= Z•11]fWARIrl01ill Paragraph 3. of F. Liability And Medical Expenses Definitions is replaced by the following: IM 3. "Bodily Injury" means: lam a. Bodily injury, sickness, disease, or incidental medical malpractice injury sustained by a person, 09291M 6 and includes mental anguish resulting from any of these; and including death resulting from any of these at any time. X. AMENDMENT OF INSURED CONTRACT DEFINITION = Paragraph 9. of F. Liability And Medical Expenses Definitions is replaced by the following: 9. "Insured contract" means: a. A contract for a lease of premises. However, that portion of the contract for a lease of premises that indemnifies any person or organization for damage by fire to premises while rented to you or temporarily occupied by you with permission of the owner is not an "insured contract'; b. A sidetrack agreement; c. Any easement or license agreement, except in connection with construction or demolition oper- ations on or within 50 feet of a railroad; d. An obligation, as required by ordinance, to indemnify a municipality, except in connection with work for a municipality; e. An elevator maintenance agreement; f. That part of any other contract or agreement pertaining to your business (including an indem- nification of a municipality in connection with work performed for a municipality) under which you assume the tort liability of another party to pay for "bodily injury" or "property damage" to a third person or organization, provided the "bodily injury" or "property damage" is caused, in whole or in part, by you or by those acting on your behalf. However, such part of a contract or agreement shall only be considered an "insured contract" to the extent your assumption of the tort liability is permitted by law. Tort liability means a liability that would be imposed by law in the absence of any contract or agreement. Paragraph f. does not include that part of any contract or agreement: (1) That indemnifies a railroad for "bodily injury" or "property damage" arising out of construc- tion or demolition operations, within 50 feet of any railroad property and affecting any railroad bridge or trestle, tracks, road -beds, tunnel, underpass or crossing; (2) That indemnifies an architect, engineer or surveyor for injury or damage arising out of: (a) Preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or (b) Giving directions or instructions, or failing to give them, if that is the primary cause of the injury or damage; or (3) Under which the insured, if an architect, engineer or surveyor, assumes liability for an injury or damage arising out of the insured's rendering or failure to render professional services, including those listed in (2) above and supervisory, inspection, architectural or engineering activities. XI. PERSONAL AND ADVERTISING INJURY Paragraph 14. b. of F. Liability And Medical Expenses Definitions is replaced by the following: b. Malicious prosecution or abuse of process. ® 2013 Liberty Mutual Insurance. All rights reserved. BP 79 96 07 13 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 4 of 4 n- THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA Policy Number: 72 WEC LY5490 Endorsement Number: Effective Date: 10 / 01 / 15 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address: TIERRA WEST ADVISORS, INC. 2616 E 3RD ST LOS ANGELES, CA 90033 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 premium otherwise due on such remuneration. Person or Organization CITY OF NATIONAL CITY C/O CITY ATTORNEYS OFFICE ATTN: GREG CARPENTER CITY OF EL SEGUNDO, PLANNING & BUILDING SAFETY DEPARTMENT, 350 MAIN ST EL SEGUNDO, CA 90245 CITY OF GARDEN GROVE 11222 ACACIA PARKWAY GARDEN GROVE, CA 92840 SCHEDULE 5 % of the California workers' compensation Job Description 1243 NATIONAL CITY BLVD NATIONAL CITY CA 91950 CONTRACT PLANNINA SUOOORT SERVICES CONSULTING FOR CITY GENERAL PLAN UPDATES Countersigned by Authorized Representative Form WC 04 03 06 (1) Printed in U.S.A. Process Date: 08/17/15 Pol Icy Expiration Date: 10/01/16