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PROOF OF INSURANCE (2016) CLOSEDCERTIFICATE OF LIABILITY INSURANCE DATE(MM /DD /WW) 1 11/05/2015 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 Aon Risk Services Central, Inc. Pittsburgh PA Office CONTACT NAME: (A/C.NNo. Ext): (866) 283 -7122 aC No.): (800) 363 -0105 E -MAIL ADDRESS: Dominion Tower, 10th Floor 625 Liberty Avenue INSURER(S) AFFORDING COVERAGE NAIC # Pittsburgh PA 15222 -3110 USA INSURED INSURERA: Liberty Mutual Fire Ins Co 23035 Michael Baker International, Inc. PO Box 57057 Irvine CA 92619 -7057 USA INSURER B: Liberty Insurance Corporation 42404 INSURER c National union Fire Ins Co of Pittsburgh 19445 INSURER D: Lloyd's Syndicate No. 2623 AA1128623 INSURER E: DAMAGE TO RENTED INSURER F: COVERAGES CERTIFICATE NUMBER: 570060040333 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. Limits shown are as requested IN SR LTR TYPE OF INSURANCE ADD INSD UBR WVD POLICY NUMBER POLICY EFF MM /DD/YYYY P LI Y EXP MM /DD /YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY Attn: Masa Al ire TB2681004145715 08 30 2015 08 30 2016 EACH OCCURRENCE $2,000,000 CLAIMS -MADE X❑ OCCUR DAMAGE TO RENTED $100,000 PREMISES Ea occurrence X MED EXP (Any one person) $5,000 Contractual Liability PERSONAL &ADV INJURY $2,000,000 GENIAGGREGATE LIMITAPPLIES PER GENERAL AGGREGATE $4,000,000 POLICY PRO- JECT � LOC PRODUCTS - COMP /OP AGG $4,000,000 OTHER: A AUTOMOBILE LIABILITY As2- 681 - 004145 -725 08/30/2015 08/30/2016 COMBINED SINGLE LIMIT Ea accident $1,000,000 BODILY INJURY ( Per person) X ANYAUTO BODILY INJURY (Per accident) ALL OWNED SCHEDULED AUTOS AUTOS PROPERTY DAMAGE X HIREDAUTOS X NON -OWNED Per accident AUTOS C X UMBRELLALIAB X OCCUR BE033086983 08/30/2015 08/30/2016 EACH OCCURRENCE $10,000,000 EXCESS LIAB CLAIMS -MADE AGGREGATE $10,000,000 E DED I X RETENTION $10, 000 B WORKERS COMPENSATION AND wA768DO04145775 08/30/2015 08/30/2016 X PER STATUTE OTH- ER EMPLOYERS' LIABILITY Y/ N ADS E. L. LAC H ACC I DE NT $1,000,000 B ANY PROPRIETOR/ PARTNER/ EXECUTIVE N N/A wc7681004145785 08/30/2015 08/30/2016 OFFICER/MEMBEREXCLUDED' (Mandatory in NH) wi E.L. DISEASE -EA EMPLOYEE $1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below FE . DISEASE - POLICY LIMIT $1,000,000 D E &O -PL- Primary QC1502675 08/31/2015 08/31/2016 Per Claim $5,000,000 Professional & Pollution Aggregate $5,000,000 SIR applies per policy terns & condi ions DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: MSIS Proposal No. 143495, 500 S. Douglas Street IS /MND. City of El segund0 and its officials and employees are included as Additional insured in accordance with the policy provisions of the General Liability policy. General Liability evidenced herein is Primary and Non- contributory to other insurance available to an Additional insured, but only in accordance with the policy's provisions. A waiver of subrogation is granted in favor of City of El Segundo and its officials and employees in accordance with the policy provisions of the workers' Compensation policy. CERTIFICATE HOLDER CANCELLATION ©1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD Q d w c d 0) O 2 co co co 7 O O u7 O Z to V w 0) L) Z� s— Wi L� on SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of El Seggundo AUTHORIZED REPRESENTATIVE Attn: Masa Al ire 350 Main Street El Segundo CA 90245 USA ©1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD Q d w c d 0) O 2 co co co 7 O O u7 O Z to V w 0) L) Z� s— Wi L� on 2122014000107700091 Policy Nuinber 'FB2681004145,71-5 Issued by Liberty Mutual Fire Msurance Co. THIS ENDORSEW-WT CHANGES THE POLICY. PLEASE READ ITCAREFULLY. 8 LAN KET AD D I TIONAL INS,U RI ED This endorsement modifies insurance provided under the foIlowiing: COMMERCIAL, GENERAL. UABUTYCOVERAGE FORM SECTION 11 - W110 IS AN INSURED is aimended to include as an insured any person or organizafion for whom you have agreed in writinig to provide flabilfty insurance. BLW The unsurance provided by this arnendrneft 1 Applies only to "bodily injury* or "property damage' arising out of (a) 'your worlon or (b) prernises or other property owned by or rented to you; 2. Applies only to coverage and rninimurn finids of insurance required by they written agreement, but i n no event. exceeds either the scope of coverage or the finnifts of insurance provided by this policy; ainod 1 Does not apply to any person or organization for whium you have procured separate liabfty insurance while such insurance Is In effect, regardless of whether the scope of coverage or Ilimits of ins,uranice of this policy exceed those of such other insurance or whether such other insurance is valid and collectible. The following provisions also apply, 1. Where the applicable written agreernent iregWres the insured to provide Ilability insurance on a primary, excess, contingent, or ainy other basis, this policy will apply solely on the basis required by such written agreern ent and Item 4, Other Insurance of SECTION Uof this pollicy vAll not apply. Z Here the applicable written agreement does not specq on what basis the liability insurasice YAI apply, tine provisions of Item 4. Other Insurance of SECTION rV of this policy WII govern. 3 This endorsement sh:Ml not apply to any person or organization for any *boddy injury' or *property dam age* if any other additional insured endorsement on this policy appIIes to that person or organiz-ation with regard to the 'bodily injury' or "property damage'. 4. If any other addRional insured endorsement applies to any person ot arganizafion and you are obfigatied under a wriden agreement to provide liability insurance on a, primary, excess, contingent or any other basis for that additional insure di, this policy will apply solely on the lba sis, re quire d by mach writte n agre 0 me nt and Ite rn 4,, Other Insurance of SECTION U of this policy will not apply, regardless of whetherthe person or orgarflzation has available other valid and collectible insurance, if the appkable written agreement does not specify an w1hat Ibaasis the i3abIlity Insurance will apply, the provisions of Item 4. Other Insurance of SECTION IV of this policy will govern, 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 willi not enforce our right against the person or organization earned in the SchedUIe. (This agreernent applies only Io the extent that you perforr'n work under a written contract that reqUireS YOU to obtain this agreement frorn us.) This agreement shali not operate directiy or Indirectly to benefit anyone not naineld in the Schedule. Not appincable in AK, KY, NH and N,JI. The waiver does not apply to any right to recover payrnents which the Minnesota Workers Con pensa lion Reinsurance Associallion may have or pursue under K& 7936, SchedI.Ale, Where required by contract or written agreement prior to loss and allowed by Iaw. In the states of Alabama, Arizona, Arkansas, Colorado, Dist. Of Col, Georgia, Idaho, 11knois, Indiana, Michigan, Minnesota, Mississippi, IMissouri, Montana, Nevada, New Mexico, North Carolina, Oklahoma, Pennsylvania, Rhode Island, South Carohina, South Dakota, Vermont, West Virginia the premium charge is, 2'.001% of the total manual prerniurn, subject to a, rninirnurn PrellliLflll of $100 Iper policy. In the states of Connecticut Florida, Iowa, Maryland, Nebra:ska, Oregon the pre,rniuirn charqf, is I % of the total manual premium subject to a nilniirnuni prernium of $2 O per policy. In the state of Louisiana the premium charge is 2% of the total standard premiurn In a rr' Inlrnuai piremiunr� of $250 per policy, In the state o,f Massachusetts fire prerniurn charge is 1% of the total manual priernium. In the state of New York the premiJurn chairge Is 2.00% of the total manual premium, subject to a minfiTrurn premium of $250 per poHcy, In the state of"T"erinessee No Premium Charge In the state of Virginia the prerniurn charge Is 5.00% of the total rnanuall prerniurn, subject to a rnInilmurn preirnium of $250, per policy, Issued by Uberty hnsurance Corporation 21814 For aftachnieinl to Policy No, 'V1A768D0(_)4145775 Effer%ve Dat(,, Prarniwn $ ISSUed to Michael Balaer International, LI C WC 00 03 13 1983 Nafional Council on Componsation InSUrarice. Page 1 of 1 Ed, 04 /01 /19 84