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PROOF OF INSURANCE (2016) CLOSEDDATE(MM /DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 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. O IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to %NVD the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the Ma+n/'D IY certificate holder in lieu of such endorsement(s). LIMITS PRODUCER CONTACT NAME: Q Aon Risk Services Central, Inc, -(866) 283 -7122 F Pittsburgh PA Office IA/C. No. Ext): iAlC. No ); C800) 363 -0105 9 Dominion Tower, 10th Floor E -MAIL 625 Liberty Avenue ADDRESS: 2 Pittsburgh PA 15222 -3110 USA EACH OCCURRENCE INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURERA: Liberty Mutual Fire Ins Co _ -23035 Michael Baker International, Inc, INSURER B: Liberty Insurance Corporation 42404 PO Box 57057 Irvine CA 92619 -7057 USA INSURER C: National Union Fire Ins Co of Pittsburgh 19445 INSURER D: Lloyd's syndicate No. 2623 AA1128623 ...... _.. ''. INSURER E: $100,000 INSURER F: '.. X 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', LTR TYPE OF INSURANCE INSO %NVD POLICY NUMBER Ma+n/'D IY M4PlNdDDI"e"'Y"VY LIMITS City of El Segundo x j X COMMERCIAL GENERAL LIABILITY Attn: Masa Alkire 7B 350 Main Street E1 Segundo CA 90245 USA EACH OCCURRENCE S2,000,000 CLAIMS -MADE OCCUR ©1988 -2014 ACORD CORPORATION. All rights reserved,. O PREMISES (Ea occurre,nne) $100,000 The ACORD name and logo are registered marks of ACORD '.. X MED EXP (Any one person) S5,000 Contractual Liability PERSONAL & ADV INJURY $2,000,000 GEMLAGGREGATELIMITAPPLIESPER: rh 0 GENERAL AGGREGATE $4,000,000 POLICY PECOT- �X LOC PRODUCTS - COMP /OPAGG $4,000,000 OTHER: 0 0 r A AUTOMOBILE LIABILITY A52- 681 - 004145 -725 08/30/2015 08/30/2016 COMBINED SINGLE LIMIT !Fa arni rlanFl S1,000,000 ANYAUTO BODILY INJURY ( Per person) Z X ALL OWNED SCHEDULED BODILY INJURY (Per accident) N X AUTOS AUTOS HIRED AUTOS X NON -OWNED V PROPERTY DAMAGE AUTOS (Per accident) w Q C X UMBRELLALIAB X OCCUR BE 33086983 0 / 302015 08/30/2016 EACH OCCURRENCE $10,000,000 C) EXCESS LIAB CLAIMS -MADE AGGREGATE .. $10,000,000 ................ DIED I X RETENTION $10,000 B WORKERS COMPENSATION AND WA7 DO 4145775 68736 2015 08/30/2016 X PER STATUTE OTH- FR EMPLOYERS' LIABILITY Y1'IN A E L EACH ACCIDENT $1,000,00o B ANY PROPRIETOR/ PARTNER/ EXECUTIVE N NIA WC7681004145785 08/30/2015 08/30/2016,,, OFFICEOPRIETEREXCLUDE '.. (Mandatory WI E L DISEASE -EA EMPLOYEE $1,000,000 IF yes, describe under ''. DESCRIPTION OF OPERATIONS below - E,L, DISEASE-POLICY LIMIT $1, 000, 000 - D E&O -PL- Primary QC1502675 08/31/2015 08/31/2016 Per C aim $5,000,000 I Professional & Pollution Aggregate $5,000,000 SIR applies per policy ter s & condi'ions sand +sure reet IS /MND. City Of `I 5etuncI ' n�cI its official emslJo ee clude�dlaasaAdditional Insured i 9��acc.�ordance with the o p p Icy provisions the Genera Liability General Lial ity herein is Primary Non insurance of Policy. evidenced and - Contributory to other available to an Additional insured) bu °L onlyy in accordance With the policy's �nrovisions. A Waiver of subrogation is granted in favor of City of El Segundo and 'its off'iciaals a,nd employees in accor °dance wwith the policy provisions of the workers" Compensation policy. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE d EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of El Segundo x j AUTHORIZED REPRESENTATIVE Attn: Masa Alkire 350 Main Street E1 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 212201400007700091 Policy Number TB2681004145715 Issued by Liberty Mutual Fire Insurance Co. THIS ENDORSEWNT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED This endorsement modifies insurance provided under the following: 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 either 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. Where the applicable written agreement requires the insured to provide liability insurance on a primary, excess, contingent, or any other basis, this policy will apply solely on the basis required by such written agreement and Item 4. Other Insurance of SECTION N of this policy 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" if 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, contingent, or any other basis for that additional insured, this policy will apply solely on the basis required by such written agreement and Item 4. Other Insurance of SECTION IV of this policy will not apply, regardless of whether the person or organization has available other valid and collectible insurance. If 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. LN 20 01 06 05 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 anyone not named in the Schedule, Not applicable in AK, KY, NH and NJ. The waiver does not apply to any right to recover payments which the Minnesota Workers Compensation Reinsurance Association may have or pursue under M.S. 79.36. Schedule Where required by contract or written agreement prior to loss and allowed by law. In the states of Alabama, Arizona, Arkansas, Colorado, Dist. Of Col, Georgia, Idaho, Illinois, Indiana, Michigan, Minnesota, Mississippi, Missouri, Montana, Nevada, New Mexico, North Carolina, Oklahoma, Pennsylvania, Rhode Island, South Carolina, South Dakota, Vermont, West Virginia the premium charge is 2.00% of the total manual premium, subject to a minimum premium of $100 per policy. In the states of Connecticut, Florida, Iowa, Maryland, Nebraska, Oregon the premium charge is 1% of the total manual premium subject to a minimum premium of $250 per policy. In the state of Louisiana the premium charge is 2% of the total standard premium subject to a minimum premium of $250 per policy. In the state of Massachusetts the premium charge is 1 % of the total manual premium. In the state of New York the premium charge is 2.00% of the total manual premium, subject to a minimum premium of $250 per policy. In the state of Tennessee No Premium Charge In the state of Virginia the premium charge is 5.00% of the total manual premium, subject to a minimum premium of $250 per policy. Issued by Liberty Insurance Corporation 21814 For attachment to Policy No. WA768DO04145775 Effective Date Issued to Michael Baker International, LLC Premium $ WC 00 0313 ©1983 National Council on Compensation Insurance, Page 1 of 1 Ed. 04/01/1984