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PROOF OF INSURANCE (2016) CLOSEDyryt, DATE (MMIDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 6/29/2015 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 ondorsement(s ). _ PRODUCER Ed ewood Partners Insurance Center (EPIC) NAME: Denl Dryer g 94 IF rrac trole . 19000 MacArthur Blvd. PH Floor PHONE AX Irvine, CA 92612 tr tI1a °- -4s-1� EMAIL. . .... .... ........ e City of El Segundo 350 Main Street El Segundo CA 90220 ACORD 25 (2014/01) 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 Todd Holliday _ ©1988 -2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 25356445 1 15 -16 GL, AU, PL & WC w/ AI I Deni Dryer 1 6/29/2015 12:42:01 PM (PDT) I Page 1 of 4 INSURER(SI AFFORDING COVERAGE _ _ NAIC # www.edgewoodins.com ...__g .., INSURER A Travelers IDdemn)ty Comny Q? CT ......25682... INSURED ''.. INSURERS: Travelers ProDertv Casualtv Comoanv of America 25674 JM Diaz, Inc. _. y -_ - -- DBA: JMD INSURER c Travelers Casualtv and Suretv Co of America 31994 18645 E. Gale Ave., Ste #212 INSURER D City f Indust CA 91748 Y Industry mm......m_ ... - - INSURER E ; INSURER F: .......... COVERAGES CERTIFICATE NUMBER: 25356445 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 mm � � �Ui3' '. LIC PpLICY NUMBER _ – __ — POLICY EFF IMMIr1E11VVVY1 POLICY EXP !MM /DDIYYYYI LIMITS A COMMERCIAL GENERAL LIABILITY ✓ ✓ 6807E603393 6/27/2015 6/27/2016 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE ,/ OCCUR i GTOrt�NTL PRFMICFR (F. nrr irrPnrP1 $ 1,000,000 MED EXP_(Anv one person) $ '........, 10,000 .......... .................... ...__„- _...........___.,,..____ ..—. - PERSONAL & ADV INJURY $ 1,000,000 -� ...... _ G. _.. GENTAGGRE GATE ......................... .....................�_...._.._ GATE LIMIT APPLIES PER: ...._ m.. m,,,.... ......___....- _____...__...____ ''. GENERAL AGGREGATE $ 2,000,000 ............ . POLICY JECT ✓ p LOC .,.,...._,..I „ m„ m. ..m,._,..,..,mm,......�._...__. PRODUCTS - COMP/"OP' AGG $ ',......'. 2,000,000 OTHER: $ A AUTOMOBILE LIABILITY ✓ ✓ 6807E603393 6/27/2015 6/27/2016 COMBINED 1 SINGLE Lunar $ 1,000.000 ANY AUTO BODILY INJURY (Per person) $ ............. ALL OWNED _._._.... SCHEDULED ..... m,,,,,,,... ..........._.....,._.___- .._... BODILY INJURY (Per accident) $ ............... AUTOS NON -OWNED PR FPCP TY DAMAGE- $ - - -.... ✓ .... HIREDAUTOS ,...✓., AUTOS lPermcird¢dw�rrtl ......___....�. -- ... . B UMBRELLA �/ CUP7E606764 6/27/2015 6/27/2016 EACHOCCURRENCE $ 2000000 EXCESS LADE AGGREGATE $ 2,000,000 DED .... .........m.. 1 $ B WORKERS COMPENSATION ✓ U64288T923 H 6/27/2015 6/27/2016 ✓ STATUTE [0 r RT. AND EMPLOYERS' LIABILITY UTIyE Y 'I CEDAEEMPLOYEE NIA (MntdR E BER EXCLUDED? �J EL DISEASE $ 1,000,000 Iry s des0beunder L"hESCR PTION OF OPERA 'ri IONS briwaow E L DISEASE -POLICY LIMIT ' $ 1 ,000,000 C Professional Liability 105263164 6/27/2015 6/27/2016 $2,000,000 per Claim Claims Made Form $2,000,000 Aggregate Knowledge Date: 4/8/2005 $5,000 Per Claim Deductible '.. DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: El Segundo Bikeway Project Agreement Certificate holder is additional insured for general liability and hired and non -owned automobile liability coverage per form CG D3 81 0907 attached. General liability and hired and non -owed automobile liability coverages are primary and non - contributory and waiver of subrogation applies per CG D3 81 0907 but only if required by written contract with the named insured prior to an occurrence. Subject to all policy terms and conditions. CERTIFICATE HOLDER CANCELLATION City of El Segundo 350 Main Street El Segundo CA 90220 ACORD 25 (2014/01) 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 Todd Holliday _ ©1988 -2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 25356445 1 15 -16 GL, AU, PL & WC w/ AI I Deni Dryer 1 6/29/2015 12:42:01 PM (PDT) I Page 1 of 4 JM Diaz, Inc. DBA: JMD 6807E603393 6/29/2015 COMMERICAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED (ARCHITECTS, ENGINEERS AND SURVEYORS �1 This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. The following is added to WHO IS AN INSURED INSURANCE (Section III) for this Coverage (Section II): Part. 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 on 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. 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 81 09 07 © 2007 The Travelers Companies, Inc. Page 1 of 2 Includes the copyrighted material of Insurance Services Office, Inc., with its permission, 25356445 115 -16 GL, AD, PL & WC w/ Al I Deni Dryer 1 6/29/2015 12:42:01 PM (PDT) I Page 2 of 4 TRAVELERSJ� ONS TOWER SQUARE HARTFORD, CT 06183 WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY JIM Diaz, Inc. ENDORSEMENT WC 00 03 13 (00) _ 01 POLICY NUMBER:UB4288T923 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. (This agreement applies only to the extent 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 BY WRITTEN CONTRACT EXECUTED PRIOR TO LOSS TO FURNISH THIS WAIVER. DATE OF ISSUE:6/29/2015 ST ASSIGN: 25356445 1 15 -7.6 GL, ATJ, PL & WC w/ AI I Deni. Dryer 1 6/29/207.5 7.2;42:01 PtK (PDT) I Page 4 of 4 COMMERICAL GENERAL LIABILITY injury" or "property damage" occurs, or the "per- sonal injury" offense is committed. D. The following definition is added to DEFINITIONS (Section V): "Contract or agreement requiring insurance" means that part of any contract or agreement un- der which you are required to include a person or organization as an additional insured on this Cov- erage Part, provided that the "bodily injury" and "property damage" occurs, and the "personal in- jury" is caused by an offense committed: a. After you have entered into that contract or agreement; b. While that part of the contract or agreement is in effect; and c. Before the end of the policy period. Page 2 of 2 © 2007 The Travelers Companies, Inc. Includes the copyrighted material of Insurance Services Office, Inc., with its permission. 25356445 1 15-16 er., AU, gf & WC W/ Az I Dent. Dryer 1 6/29/2015 12:42:0i PM (PDT) I Page 3 of 4 CG D3 81 09 07 ftk TRAVELERS / J WORKERS COMPENSATION AND ONE TOWER UR TFORD, CT 061 CT 061 83 EMPLOYERS LIABILITY POLICY HAR JM Diaz, Inc. ENDORSEMENT C 00 03 13 (00) _ 01 POLICY NUMBER:UB4288T923 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. (This agreement applies only to the extent 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 L�� L r] : I _r 1 t � •] 1 � :�3 • ] : F DESIGNATED ORGANIZATION: ANY PERSON OR ORGANIZATION FOR WHICH THE INSURED HAS AGREED BY WRITTEN CONTRACT EXECUTED PRIOR TO LOSS TO FURNISH THIS WAIVER. DATE OF ISSUE:6/29/2015 ST ASSIGN: 25356445 1 15 -7.6 GL, AU, PL [ GEC w/ Al I Deni Dryer 1 6/29/207.5 7.2:42:01 PM (PDT) I Page 4 of 4 COMMERICAL GENERAL LIABILITY injury" or "property damage" occurs, or the "per- sonal injury" offense is committed. D. The following definition is added to DEFINITIONS (Section V): "Contract or agreement requiring insurance" means that part of any contract or agreement un- der which you are required to include a person or organization as an additional insured on this Cov- erage Part, provided that the "bodily injury" and "property damage" occurs, and the "personal in- jury" is caused by an offense committed: a. After you have entered into that contract or agreement; b. While that part of the contract or agreement is in effect; and c. Before the end of the policy period. Page 2 of 2 © 2007 The Travelers Companies, Inc. Includes the copyrighted material of Insurance Services Office, Inc., with its permission„ 25356445 1 15 -16 GL, AU, PL 6, WC W/ Al I Deni Dryer 1 6/29/2015 12:42:01 PM (PDT) I Page 3 of 4 CG D3 81 09 07