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