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PROOF OF INSURANCE (2016) CLOSED (2)--, CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 11f20f2015 THIS CERTIFICATE 15 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. t7 IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must he endorsed, If SUBROGATION I S 'WAI'VED,, 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 m w certificate holder in lieu of such endorsertient(s), PRODUCER (866) —- 7122........_ �. µ._..... AOn Risk $erVlCeS central, Inc. - - -- Pittsburgh PA office (A/CNNCExtL- fAIC,NmwI (BOO) 363 -0105 NAME: ­ Dominion Tower, 10th Floor E -MAIL 625 Liberty Avenue ADDRESS: _ Pittsburgh PA 15222 -3110 USA INSURER(S) AFFORDING COVERAGE NAICN _ .. . ,. ......_.,.,.,. INSURED INSURER ... -m.w . -.- .,�,,,,,m„ -.. ...� ............. A: Liberty Mutual Fire Ins Co 23035 Michael Baker International, Inc„ INSURERB: Liberty Insurance Corporation .. 42404 POBox 57057 ....�..... a,.,.,..M.w,.,,,„„..„„�, ... ......._ .. ......_ - Irvine CA 92619 -7057 USA INSURER C; National Union Fire Ins Co of Pittsburgh 19445�� INSURERD. Lloyd's Syndicate NO. 2623 _ - AA1128623 INSURER E ... ....,._- .....- ..,.._.�. - .,w,.,. �.,,,,.�,_ ... ........... . ............ ... ._. - -.. INSURER F: COVERAGES CERTIFICATE NUMBER: 570060228188 REVISION NUMBER: 'THIS IS TO C; F.R f rY" THAT THE P01 IOES OF INSURANCE I..IFSI LD BELC)Wtr HAVE BEEN ISSUED TO THE INSWIED NAMED ABOVE FOIR THE K.)LICY" 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 INSR T TYPE OF INSURANCE INSO wvn POLICY NUMBER li rgMIDr1JY'M^A"t' MaMPG)r.Pr/YYY LIMITS X COMMERCIAL GENERAL LIABILITY TBZ681004145715 EACH OCCURRENCE $2,000.000 CLAIMS -MADE �X OCCUR LAIV7MI.9E iIJTiEWS "'rETi i $100,000 111 ,119999 PRF,�AISFS i. F^.: ..m..�..,,,,,m „m,.„�',,,,,,..., ww....,,�..- X ContracWal Liability MED EXP (Any one person) $5,000 .. � ........... ..... ... .... �.... PERSONAL & ACV INJURY S2,000,000 000, 000 eD _ 05 9& k AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $4 000 000 N POLICY X JEOT O LOC PRODUCTS COMPIOP AGG $4 _666",'665 0 -.._� ...,.,.,..-_.. .._ ., � OTHER . ,... ... 0 ti A AUTOMOBILE LIABILITY A52- 681 - 004145 -725 08110,101108/30 /1016 COMBINED SINGLE LIMIT $1,000,000 rEa ac Ide I1 X ANY AUTO BODILY INJURY ( Per person) - O . ................. . _....._ Z ' ALL OWNED ' ". SCHEDULED - .. BODILY INJURY (Per ecudent) « _ � AUTOS ........_m, -., ...� ,.,.,...._. .... ......... .,,.® ®.... � X HIRED AUTOS X NON OWNED PROPERTY DAMAGE v AUTOS ,,....,e .,.....AUTOS IPeracadm - _........ .. _.. _,w . _._.. ......... 1= C BE033086983 08/30/2015 08/30/2016 EACH OCCURRENCE 510,000,000 m X UMBRELLA LIAR X OCCUR V �... EXCESS LIAS CLAIMS-MADE AGGREGATE •��--------------- _ - -... .. $10,000,000,!. I DED X RETENTION$10.000 _.... ............. ...,_m, a.,, - ,..,,,, ........m.� -.. ....,_.. E INORAER�SCOMPENSA COMPENSATION ��'YD� yBG�p...'... AU768D0041457�.�75 ...08130 101 0 3...1U b X...PER OTH EMPLOYERS' LIABILITY 5 STATUTE as ANY PROPRIETOR I PARTNER J EXECUTIVE E L. EACH ACCIDENT � .. $1, 000, 000 B �aurrn�ld �E.nsl�lItLtyllr,r�� N NIA WC7681004145785 08/30/2015108/30/2016 E,L,DISEASE- EA�- - - - - -- - -- EMPLOYEE $1 000 000 ql y�oi�, describe ri una kPf,t„'.r8.9r ^'1lrafrl �l4h "' &pYkVBa,Ttl9,IN;lbravdeucw ED ISEASE- POLICYLIMIT �51, 000, 000 D E&0 -PL- Primary 401502675 U /31/2015 08/31/2016 Per Claim $5,000,UO1) SIR fappliesl per Ppolicy terns & condi ions Aggregate $5,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached it more space is required) , RE: Park Place Extension Project, ]N 145070. City Of El Segundo 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 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 Seg undo �"� AUTHORIZED REPRESENTATIVE I. Attn: Masa Al ire 3SO Main Street E1 Segundo CA 90245 USA C.Jri078 c ��/GSLCY.O IG�I?�Ra(� eJ f8Q ©1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD 1'122�M 1000077°MIIII;N Policy Number 1'132681004145715 Issued by Liberty Mutual Fire Insurance Co. THIS ENDORSEWNT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: „e COMMERCIAL GENERAL LIABILITY COVERAGE FORM SECTION II - WHO IS AN INSURED is amended to include as an insured any person or organization for whom you have agreed in writing to provide liability insurance. But, The insurance provided by this amendment: 1, Applies only to "bodily injury' or "property damage' arising out of (a) 'your work' or (b) premises or other property owned by or rented to you; 2. Applies only to coverage and minimum limits of insurance required by the written agreement, but in no event exceeds ether the scope of coverage or the limits of insurance provided by this policy; and 3. Does not apply to any person or organization for whom you have procured separate liability insurance while such insurance is in effect, regardless of whether the scope of coverage or limits of insurance of this policy exceed those of such other insurance or whether such other insurance is valid and collectible. The following provisions also apply: 1. 'Mier re the apphc aNe w6 en ayeerrnent requires tf °m insured to provide liability insurance on a primary, excess, r ontingent, or any other baMs, this policy WM q:sply solely on the basis required by such written agreement and ltem 4, Other, 413ur"ano ,e of 5 teC"11 N IV of the s poky will not apply. 2. Where the applicable written agreement does not specify on what basis the liability insurance will apply, the provisions of Item 4. Other Insurance of SECTION IV of this policy will govern. 3 This endorsement shall not apply to any person or organization for any 'bodily injury` or *property damage` K any other additional insured endorsement on this policy applies to that person or organization with regard to the 'bodily injury' or `property damage ". 4. If any other additional insured endorsement applies to any person or organization and you are obligated under a written agreement to provide liability insurance on a primary, excess, confingent, or any other basis for that additional insured, this policy will apply solely on the basis required by suOr wrlaten agreement and Item 4. 4 -'Mhei Insurance of Ii=C';I ION rV Hof thLk, poky will not apply, regardless of wkoAr ,upr t[r,e person or organs zabon hays, avWiable other oohing and collectible In%urancivv, "' the applicable written agrvemcnt does snot specufy on what beers the liability i isurance wall app y, the I °aroM,ions of Item 4, Other er lrmuramr of SECTION N IV of this policy will govern. LN 20 01 06 05 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA 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 2% of the Califomia workers' compensation premium otherwise due on such remuneration. Schedule Additional premium is a percent of the Califomia Manual Workers Compensation premium. Subject to a minimum premium charge of $ 250. Person or Qr anizatj n. Where required by contract or + written agreement prior to loss and �;�6' allowed by law` "�� Issued by Liberty Insurance Corporation 21814 For attachment to Policy No. WA7 -68D- 004145 -775 Issued to Michael Baker International, Inc. WC 04 03 06 Ed: 04/1984 Effective Date Premium $ Page 1 of 1