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PROOF OF INSURANCE (2016) CLOSEDAC" CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD"YYY)
6/24/2015
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).
N MET
PRODUCER Adamson & McGoldrick Insurance Solutions A! Lvnn Beimer
1800 E. Lambert Rd., Ste 225 - i4dNt.....F.�� 714-257-964,e ................ ...,.,..........,- ...... FAX c..Nor.. ............71.4..257 9833
Brea, CA 92821 WP. ��� .m .....
COVERAGES CERTIFICATE NUMBER: 25241925 REVISION NUMBER:
THIS
IS TO CERTIFY THAT THE POLICIES
INSURERISI AFFORDING COVERAGE
......... ........ �.�.......... .......
...
NAIC #
..�.� -.. ......
www.snains.com
_ ----- - -- --- ------ ......... ......... ....... ....
...... .�.�.�.
INSURER A :
Travelers Cas.�.�..�..
Co of Amr
INDICATED.
25674
INSURED
INSURED
INSURER B
Traveler s Ind CO of Conn
OR OTHER
25682
Morrow - Meadows Corporation
CERTIFICATE
.......
...... ......... ................ ...... ......
... .........
.........
231 Benton Court
DESCRIBED
JNS9R.E.R..q ..
........................................................................................................................................................... ...............................
EXCLUSIONS
����
City of Industry CA 91789
INSURER D:
REDUCED BY
PAID CLAIMS,
INSR
L7R
''. INSURER E
A �UL'`
iMSn
13�
wvn
POLICY NUMBER
POLICY YEFF
EFF
rMM /DD
POLICY EXP
IMMIDD /VYVYI
INSURER F:
.... ....
A
Y+'
COVERAGES CERTIFICATE NUMBER: 25241925 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
L7R
..... ..,., ,..... .. ........... ... ..
TYPE OF INSURANCE
A �UL'`
iMSn
13�
wvn
POLICY NUMBER
POLICY YEFF
EFF
rMM /DD
POLICY EXP
IMMIDD /VYVYI
....... ...... LIMITS.
.... ....
A
Y+'
L
CO,MMLAIMS-MADEEI
✓
7/1/2015
7/1/2016
1,000,000
„LIOCC
OC &P & XOCU INCLUDE
PKMM SFSOF EN`rEb-
1717
✓ R
a)
$ 300 0001
- - -.
_d
Blanket Cont.L
MED EXP (Any one person)
$ 5,000
V
BFPD;Cross Lla
PERSONAL &ADVINJURY
$ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER
GENERAL AGGREGATE
$ 2,000,000
✓V JECli ❑
2 000 000
- POLICY LOG
PRODUCTS COMP /OP AGG
$
OTHER 50,000 Deductible
$
B
AUTOMOBILE LIABILITY
........- ..........
VTECAP9322612515
7/1/2015
..-...
/1/2016
COND E L IMn$
Mr£h� L
rFaa�r�idq,rcaq
. ...., ) . ..�
1.000.000
.... - ...,......
,�' AUTO
BODILY INJURY (Per person)
$
ALL OWNED SCHEDULED
BODILY INJURY (Per accident)
$
AUTOS AUTOS
_ _
NON
PANY
...............
............................... ...............................
$
v/ HIRED AUTOS ✓�
r�r}arEr ipn}DAMAGE
.... .... ..
UMBRELLA LIAB OCCUR
-- ------'
EACH OCCURRENCE
.- ............... ........................
$ ...............................
EXCESS LIAB CLAIMS - MADE
AGGREGATE
$.................................
DED RETENTION S
$
A
WORKERS COMPENSATION
VTC2JUB9494A622 -15
7/1/2015
7/1/2016
PER OTH-
CT,A,TI ITF FR,
AND EMPLOYERS' LIABILITY YIN
E.L EACH ACCIDENT
$ 1,000,000
ANY PROPRIETOR /PARTNER /EXECUTIVE
OFFICER /MEMBER EXCLUDED? J
N/A
-- --
E,L, DISEASE - EAEMPLOYEE_$
- "- - -----
1,000,000
(Mandatory inNH)
Ues �twsscrib' unftf
D .8CIRIPTION Or OPERATIONS bewow
E L, DISEASE - POLICY LIMIT
$ 1,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
Re: Job #215507, El Segundo Instrumentation & SCADA Services, 350 Main Street, El Segundo, CA 90245 -3813. City of El Segundo, its officials and
employees are additional insured to General Liability policy per the attached endorsement. Primary wording applies to General Liability policy per the
attached endorsement.
"10 days notice of cancellation for non - payment of premium.
GERTIFIGATE HOLDER
City of El Segundo / PUbIIC Works SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Y 9 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Attn: Lifan Xu ACCORDANCE WITH THE POLICY PROVISIONS.
350 Main Street
El Segundo, CA 90245 -3813
AUTHORIZED REPRESENTATIVE
Ted Adamson
© 1988 -2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
25241925 I MORRO -1 1 15/16 GL AU WC UMB $5M I Lynn Beimer 1 6/24/2015 10:38:09 AM (PDT) I Page 1 of 3
VTC 2 J -C O -9 322 B 094 -15
7/1/2015 7/1/2016
COMMERCIAL GENERAL LIABILITY
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY
BLANKET ADDITIONAL INSURED
(CONTRACTORS)
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
1. WHO IS AN INSURED — (Section II) is amended
to include any person or organization that you
agree in a "written contract requiring insurance"
to include as an additional insured on this Cover-
age Part, but:
a) Only with respect to liability for "bodily injury ",
"property damage" or "personal injury "; and
b) If, and only to the extent that, the injury or
damage is caused by acts or omissions of
you or your subcontractor in the performance
of "your work" to which the "written contract
requiring insurance" applies. The person or
organization does not qualify as an additional
insured with respect to the independent acts
or omissions of such person or organization.
2. The insurance provided to the additional insured
by this endorsement is limited as follows:
a) In the event that the Limits of Insurance of
this Coverage Part shown in the Declarations
exceed the limits of liability required by the
"written contract requiring insurance ", the in-
surance provided to the additional insured
shall be limited to the limits of liability re-
quired by that "written contract requiring in-
surance". This endorsement shall not in-
crease the limits of insurance described in
Section III — Limits Of Insurance.
b) The insurance provided to the additional in-
sured does not apply to "bodily injury ", "prop-
erty damage" or "personal injury" arising out
of the rendering of, or failure to render, any
professional architectural, engineering or sur-
veying services, including:
The preparing, approving, or failing to
prepare or approve, maps, shop draw-
ings, opinions, reports, surveys, field or-
ders or change orders, or the preparing,
approving, or failing to prepare or ap-
prove, drawings and specifications; and
ii. Supervisory, inspection, architectural or
engineering activities.
,KHy�f:� +I:Iilf
c) The insurance provided to the additional in-
sured does not apply to "bodily injury" or
"property damage" caused by "your work"
and included in the "products- completed op-
erations hazard" unless the "written contract
requiring insurance" specifically requires you
to provide such coverage for that additional
insured, and then the insurance provided to
the additional insured applies only to such
"bodily injury" or "property damage" that oc-
curs before the end of the period of time for
which the "written contract requiring insur-
ance" requires you to provide such coverage
or the end of the policy period, whichever is
earlier.
3. The insurance provided to the additional insured
by this endorsement is excess over any valid and
collectible "other insurance ", whether primary,
excess, contingent or on any other basis, that is
available to the additional insured for a loss we
cover under this endorsement. However, if the
"written contract requiring insurance" specifically
requires that this insurance apply on a primary
basis or a primary and non - contributory basis,
this insurance is primary to "other insurance"
available to the additional insured which covers
that person or organization as a named insured
for such loss, and we will not share with that
"other insurance ". But the insurance provided to
the additional insured by this endorsement still is
excess over any valid and collectible "other in-
surance", whether primary, excess, contingent or
on any other basis, that is available to the addi-
tional insured when that person or organization is
an additional insured under such "other insur-
ance".
4. As a condition of coverage provided to the
additional insured by this endorsement:
a) The additional insured must give us written
notice as soon as practicable of an "occur-
rence" or an offense which may result in a
claim. To the extent possible, such notice
should include:
25241925 1 MORRO -1 1 15/16 GL AU WC UMB $5M I Lynn Beimer 1 6/24/2015 10:38:09 AM (PDT) I Page 2 of 3
Page 1 of 2
COMMERCIAL GENERAL LIABILITY
I. How, when and where the 'occurrence"
or offense took place;
ii. The names and addresses of any injured
persons and witnesses; and
Iii. The nature and location of any injury or
damage arising out of the 'occurrence" or
offense.
b) If a claim is made or "suit" is brought against
the additional insured, the additional insured
must:
I. Immediately record the specifics of the
claim or "suit' and the date received; and
!I. Notify us as soon as practicable.
The additional insured must see to it that we
receive written notice of the claim or "suit' as
soon as practicable.
c) The additional insured must immediately
send us copies of all legal papers received in
connection with the claim or "suit', cooperate
with us in the investigation or settlement of
the claim or defense against the "suit', and
otherwise comply with all policy conditions.
d) The additional insured must tender the de-
fense and indemnity of any claim or "suit' to
any provider of 'other insurance" which would
cover the additional insured for a loss we
cover under this endorsement. However, this
condition does not affect whether the insur-
ance provided to the additional insured by
this endorsement is primary to 'other insur-
ance" available to the additional insured
which covers that person or organization as a
named insured as described in paragraph 3.
above.
5. The following definition is added to SECTION V.
— DEFINITIONS:
"Written contract requiring insurance" means
that part of any written contract or agreement
under which you are required to include a
person or organization as an additional in-
sured on this Coverage Part, provided that
the "bodily injury" and "property damage" oc-
curs and the "personal injury" is caused by an
offense committed:
a. After the signing and execution of the
contract or agreement by you;
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 C 2005 Paul Travelers Companies, . I. 1
25241925 1 MORRO -1 I 15/16 GL AU WC UMB $5M I Lynn Beimer 1 6/24/2015 10:38:09 AM (PDT) I Page 3 of 3
T AVELEM
ONE TONER SQUARE
HARTFORD, CT 06163
WORKERS COMPENSATION
AND
EMPLOYERS LIABILITY POLICY
ENDORSEMENT WC 00 03 13 (00) -01
POLICY NUMBER: VTC2JUB9494A622 -15
WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT
We have the right to recover our payments from anyone liable for an Injury covered by this policy. We will not
enforce our right against the person or organization named In the Schedule. (This agreement applies only to the
extent that you perform work under a written contract that requires you to obtain this agreement from us.)
This agreement shall not operate directly or Incilrectly to benefit any one not named In the Schedule.
SCHEDULE
DESIGNATED PERSON. person or Organization:
City of El Segundo
Attn: PW Crept
50 Main St
El Segundo, CA 90245
Job Description:
City of Ell Segundo, its officials, officers, agents and employees
re: Eros sneering Plan Check Svcs, City of El Segundo
247D 941 C
DESIGNATED ORGANIZATION:
ANY PERSON OR ORGANIZATION FOR WHICH THE INSURED HAS
AGREED BY WRITTEN CONTRACT EXECUTED PRIOR TO LOSS TO
FURNISH THIS WAIVER.
2969521.1. MORko...L 1 7.5/16 GL AU WC UMB .$SM *Master 7empl.atell I Gloria Gabr iel 1 4/20/2016 3:39:38 P19 (PE7s') I Page 4 of 4
AC CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY)
1119/2016
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).
Adamson & McGoldrick insurance _
PRODUCER ce Solutions CONTACT GIDrVa Gabriel
E.MAwL 714.257 9644^ is 6, Nol: 714- 257 -9833
1800' E. Lambert Rd., Ste 225 1 "ONE
Brea, CA 9,2821(1
www.snains.com
...... ......................
INSURED
Morrow - Meadows Corporation
231 Benton Court
City of Industry CA 91789
INSURER(s) AFFORDING COVERAGE NAIC #
INSURER A: Greenwich Insurance ComDanv 22322
INSURER B:
INSURER C :
INSURER D:
INSURER E :
CnV'FRAnFS CERTIFICATE NUMBER- 9A10AOAR 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 ADt7L 5
.LTR .,.,., ., UBi h PM!DDY-EF"F PO 06y EXP
...-
TYPE OF INSURANCE IN SD WIVE) pnl ICY NIIMRFR Y �MMlnn/WWI M)yry,p[gp,T,r 1YY
LIMITS
CO
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$
_
d�MA� E TLS RFNir
--- ---
CLAIMS MADE OCCUR
9�REMISS QEedt rran¢yz
$
MED EXP (Any one person)
_ ...,.. ................ .........................
$ ... .................................. _.
PERSONAL & ADV INJURY
''... $
GEN'L
AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$
POLICY LOC
PRODUCTS COMP /OP AGG
... .......................
$ . ... --
OTHER:
_
$
AUTOMOBILE
LIABILITY
COMBINED S INC31-E LIMIT
$
ANY AUTO
BODILY INJURY (Per person)
$
..
ALL OWNED " SCHEDULED
......... .. ............ ..... . ...._..
BODILY INJURY (Per accident)
.................... .,.,. -.
$
AUTOS AUTOS
,. .__ ....... .....
........... ................. .....
...
, .....
NON -OWNED
... ..
,....f'
PROPERTY DAMAGE
.
$
HIRED AUTOS - AUTOS
,(Pernrndent
UMBRELLA LIAB OCCUR
EACH OCCURRENCE
$
EXCESS LIAB LAIMS,MADE
AGGREGATE
$
DED RETENTION$
$
WORKERS COMPENSATION
PER C 0-FH-
AND EMPLOYERS' LIABILITY YIN
CTATI ITE l
ANY Pr�OPRIEIOR ARTNERILXrCkJ'71VC
E L EACH ACCIDENT
OFFICER(MFMBFR FXCtl.47Dt.0
NIA
.
(Mandatory In NH)
Ct es, doscnbe order
'ALA °.SCRIPC'ION OF OPERATIONS Iholow
I E L. DISEASE POLICY LIMIT
$
A (Professional Liability CPL742045502 112112016 112112017
Limit: $5,000,000
Retention $150,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
Re: Job #215507, El Segundo Instrumentation & SCADA Services, 350 Main Street, El Segundo, CA 90245 -3813.
CERTIFICATE HOLDER CANCELLATION
City of El Segundo /Public Works SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Y g THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Attn: Lifan Xu ACCORDANCE WITH THE POLICY PROVISIONS.
350 Main Street
El Segundo, CA 90245 -3813
AUTHORIZED REPRESENTATIVE ..
Ted Adamson W-
©1988 -2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
28196986 1 MORRO -1 1 16/17 PROF $5M I Gloria Gabriel 1 1/19/2016 4:41:31 PM (PST) I Page 1 of 1