Loading...
PROOF OF INSURANCE (2017) CLOSEDC CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 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 have ADDITIONAL INSURED provisions or 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 CONTACT Bolton Connany NAMF r Pasadena, CA 91107 Suite 100 E-MAIL o Wk._ (626). 799 -7000 1 q�r�, I:UVtKA(ir_, I;l I It-IUA I t NLINIl itK: 31281055 KLVIJIUN NUMbhK: 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, I ,m .......... .... .._., .. ..�. ... ,_. A .I56L Obi MIFF POICYEXP LTR TYPE OF INSURANCE MLDFYYYY MONUMBER mfoDfyyyyl � ,ee. ........,... .,........ LIMITS - -. A ✓ COMMERCIAL GENERAL LIABILITY ,/ �/ ',72UEAHA5196 6/1/2016 6/1/2017 EACH OCCURRENCE $ 1,000,000 ..... ..iieYnG�Ew'14'h16'NiLb .,.,). ..,,,........ �� ........ � � ._ 00. CLAIMS -MADE OCCUR pR'EMCSL Eacgy.urronrs $ 300,0 _ INSURER(S) AFFORDING COVERAGE NAIC# www.boltonco.com 0008309 .w Com an INSURERA Hartford Fire. p �� 16161 INSURED Sialic Contractors Corporation �SrUtryanCe INSURER B Travelers Pro a Casualty Insurance Co 39682 dba: Shaman INSURER C: Hartford Accident and Indemnity Company 22357 11 1.111-1 12240 Woodruff Avenue INSURER q..... Hanover Insurance Company_. 22292 Downey CA 90241 GENIL AGGREGATE LIMIT APPLIES PER: INSURER E: I:UVtKA(ir_, I;l I It-IUA I t NLINIl itK: 31281055 KLVIJIUN NUMbhK: 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, I ,m .......... .... .._., .. ..�. ... ,_. A .I56L Obi MIFF POICYEXP LTR TYPE OF INSURANCE MLDFYYYY MONUMBER mfoDfyyyyl � ,ee. ........,... .,........ LIMITS - -. A ✓ COMMERCIAL GENERAL LIABILITY ,/ �/ ',72UEAHA5196 6/1/2016 6/1/2017 EACH OCCURRENCE $ 1,000,000 ..... ..iieYnG�Ew'14'h16'NiLb .,.,). ..,,,........ �� ........ � � ._ 00. CLAIMS -MADE OCCUR pR'EMCSL Eacgy.urronrs $ 300,0 C WORKERS COMPENSATION ! 72WEAZI8410 MED EXP,(Any, one person) $ 6/1/2017 ✓ PER OTH- cc AND EMPLOYERS' LIABILITY YIN `/ PERSONAL & ADV INJURY $ ........... _ - ---......... -... GENIL AGGREGATE LIMIT APPLIES PER: STATUTE _ FR I __ ANYPROPRIETOR /PARTNER /EXECUTIVE CERIMEMBEREXCLUDED? � N GENERAL AGGREGATE $ 2 SOOTLL(IC Y✓ -..... "� 4.....,,,,.d JECT U .� LOC E L EACH ACCIDENT $ 1 - - -- .. ......,., PRODUCTS COMP /OPAGG . ..2 $ A AUTOMOBILE LIABILITY 6/1/2016 6/1/2017 SINGLE LIMIT C c � — - ✓ ✓ $ 1 d 0 ANY AUTO E L DISEASE- POLICY LIMIT S 1 D Scheduled Equipment BODILY INJURY (Per person) $ .,.. OWNED ..................... SCHEDULED AUTOS ONLY AUTOS 6/1/2016 6/1/2017 Limit: $3,239,400 - Deductible: $1,OC D BODILY I,...., ....-----....... N J U R Y (Per accident) $ HIRED NON -OWNED RH39562599 6/1/2016 6/1/2017 mmRRLY6 LRT' DAMACiG:.... __....... AUTOS ONLY AUTOS ONLY (Far ac idp)retlh B UMBRELLA LAB �/ OCCUR �/... ZUP15S9047616NF 6/1/2016 6/1/2017 EACH OCCURRENCE $ 9 EXCESS LAB MADE AGGREGATE $ 9 _CLAIMS DED ✓ I'. RETENTION $O $ C WORKERS COMPENSATION ! 72WEAZI8410 6/1/2016 6/1/2017 ✓ PER OTH- cc AND EMPLOYERS' LIABILITY YIN `/ STATUTE _ FR I __ ANYPROPRIETOR /PARTNER /EXECUTIVE CERIMEMBEREXCLUDED? � N NIA E L EACH ACCIDENT $ 1 - - -- Ma (Mandatory ) 1 E L DISEASE -EA EMPLOYEE $ 1 If yes, describe under — - DESCRIPTION OF OPERATIONS below E L DISEASE- POLICY LIMIT S 1 D Scheduled Equipment RH39562599 6/1/2016 6/1/2017 Limit: $3,239,400 - Deductible: $1,OC D Re'nled /Leased Equipment RH39562599 6/1/2016 6/1/2017 Limit: $100,000- Deductible: $1,000 DESCRIPTION OF OPERATIONS I LOCATIONS/ VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) The Certificate of Insurance is subject to policy terms, conditions, limitations, and exclusions, GL Additional Insured and Primary Wording applies per HS24800713 attached, only� If required by Written contraWagreement. Auto Additional insured and Primary Wording piles per HA99160312 p 1 -2 Sitaolled, GL, Auto and WC Waivers of Subrogation apply Per HG00010605 pg 15 HA99160312 pg 4 -5 and t040306 attached. GL, / uto and WC Cancellation Clauses per HS24601214 pg 186, 1H03130611 and VVC990648 attached. Re: Shawnan Job #288, Project #PWW 16 -10, Imperial Highway Overlay Project. ,..Cone... City of El Segundo 350 Main Street El Segundo, CA 90245 IWIN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Cassandra Rosales ©1988 -2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 31281058 1 SIALCON -01 1 16 -17 Jobs- Public Agencies - All Linea I Tina Adams 1 8/9/2016 12:07:37 PM (PDT) I Page 1 of 16 AGENCY CUSTOMER ID: SIALCON -01 LOC #: ACX>R0 � ADDITIONAL REMARKS SCHEDULE AGENCY NAMED INSURED Sialic Contractors Corporation Bolton &wCompan wwww ______ _.................... dba: Shawnan POLICY NUMBER 12240 Woodruff Avenue Downey CA 90241 ........ .............wv w vvvvv _ vww.._vv vwwww v CARRIER NAIC CODE .... .......... EFFEE CTIVE DATE: Page of ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ADDENDUM 31261056 1 SIALCON -01 1 16 -17 Jobe - Public Agencies - All Lines I Tina Adams 1 8/9/2016 12:07:37 PM (PDT) I Page 2 of 16 POLICY NUMBER:72UEAHA5196 nk 14 Fd �W . THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - OPTION I This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Designated Project(s) Or Location(s) Or Or �.._ Of Covered Operations: When Required by Written Contract, Written Agreement or Permit Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. With respect to those person(s) or organization(s) (3) In connection with "your work" for shown in the Schedule above when you have the additional insured at the project(s) or agreed in a written contract or written agreement location(s) designated in the Schedule to provide insurance such as is afforded under and included within the "products - this policy to them, Subparagraph f., Any Other completed operations hazard ", but only if: Party, under the Additional Insureds When (a) The written contract or written Required By Written Contract, Written agreement requires you to provide Agreement Or Permit Paragraph of Section II - such coverage to such additional Who Is An Insured is replaced with the following: insured at the project(s) or location(s) f. Any Other Party designated in the Schedule; and Any other person or organization who is not an (b) This Coverage Part provides insured under Paragraphs a. through e. above, coverage for "bodily injury" or but only with respect to liability for "bodily "property damage" included within the injury", "property damage" or "personal and "products- completed operations advertising injury" caused, in whole or in part, hazard ". by your acts or omissions or the acts or The insurance afforded to the additional omissions of those acting on your behalf: insured shown in the Schedule applies: (1) In the performance of your ongoing (1) Only if the "bodily injury" or "property operations for such additional insured at damage" occurs, or the "personal and the project(s) or location(s) designated advertising injury" offense is committed: in the Schedule; (a) During the policy period; and (2) In connection with your premises owned (b) Subsequent to the execution of such by or rented to you and shown in the written contract or written agreement; Schedule; or and Form HS 24 80 07 13 Page 1 of 2 © 2013, The Hartford (Includes copyrighted material of Insurance Services Office, Inc., with its permission.) 31281056 1 SIALCON -01 1 16 -17 Jobe- Public Agencies - All Lines I Tina Adams 1 6/9/2016 12:07:37 PM (PDT) I Page 3 of 16 (c) Prior to the expiration of the period of time that the written contract or written agreement requires such insurance be provided to the additional insured. (2) Only to the extent permitted by law; and (3)Will not be broader than that which you are required by the written contract or written agreement to provide for such additional insured. With respect to the insurance afforded to the person(s) or organization(s) that are additional insureds under this endorsement, the following additional exclusion applies: This insurance does not apply to "bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of, or the failure to render, any professional architectural, engineering or surveying services, including: (1)The preparing, approving, or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders, designs or specifications; or (2)Supervisory, inspection, architectural or engineering activities. The limits of insurance that apply to the additional insured shown in the Schedule are described in the Limits Of Insurance section. How this insurance applies when other insurance is available to the additional insured is described in the Other Insurance Condition in Section IV - Commercial General Liability Conditions, except as otherwise amended below. B. With respect to insurance provided to the person(s) or organization(s) that are additional insureds under this endorsement, the When You Add Others As An Additional Insured To This Insurance subparagraph, under the Other Insurance Condition of Section IV — Commercial General Liability Conditions is replaced with the following: When You Add Others As An Additional Insured To This Insurance (a) Primary Insurance When Required By Contract This insurance is primary if you have agreed in a written contract or written agreement that this insurance be primary. If other insurance is also primary, we will share with all that other insurance by the method described in Paragraph (c) below. This insurance does not apply to other insurance to which the additional insured in the Schedule has been added as an additional insured. (b) Primary And Non - Contributory To Other Insurance When Required By Contract This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (I) The additional insured in the Schedule is a Named Insured under such other insurance; and (ii) You have agreed in a written contract or written agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured in the Schedule. (c) 'Method Of Sharing If all of the other insurance permits contribution by equal shares, we will follow this method also. Under this approach, each insurer contributes equal amounts until it has paid its applicable limit of insurance or none of the loss remains, whichever comes first. If any of the other insurance does not permit contribution by equal shares, we will contribute by limits. Under this method, each insurers share is based on the ratio of its applicable limit of insurance to the total applicable limits of insurance of all insurers. All other terms and conditions in the policy remain unchanged. Page 2 of 2 Form HS 24 80 07 13 31281058 1 SIALCON -01 1 16 -17 Jobe - Public Agencies - All Lines I Tina Adams 1 6/9/2016 12:07;37 PM (PDT) I Page 4 of 16 72UEAHA5198 COMMERCIAL AUTOMOBILE HA 99 16 03 12 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. COMMERCIAL AUTOMOBILE BROAD FORM EiMDOTSEWEVT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM To the extent that the provisions of this endorsement provide broader benefits to the "insured" than other provisions of the Coverage Form, the provisions of this endorsement apply. 1. BROAD FORM INSURED d. Any "employee" of yours while using a A. Subsidiaries and Newly Acquired or covered "auto" you don't own, hire or Formed Organizations borrow in your business or your The Named Insured shown in the personal affairs. Declarations is amended to include: C. Lessors as Insureds (1) Any legal business entity other than a Paragraph A.1. - WHO IS AN INSURED - of partnership or joint venture, formed as a Section II - Liability Coverage is amended to subsidiary in which you have an add: ownership interest of more than 50% on e. The lessor of a covered "auto" while the the effective date of the Coverage Form. "auto" is leased to you under a written However, the Named Insured does not agreement if: include any subsidiary that is an "insured" under any other automobile (1) The agreement requires you to policy or would be an "insured" under provide direct primary insurance for such a policy but for its termination or the lessor and the exhaustion of its Limit of Insurance. (2) The "auto" is leased without a driver. (2) Any organization that is acquired or Such a leased "auto" will be considered a formed by you and over which you covered "auto" you own and not a covered maintain majority ownership. However, "auto" you hire. the Named Insured does not include any D. Additional Insured if Required by Contract newly formed or acquired organization: (1) Paragraph A.1. - WHO IS AN INSURED (a) That is a partnership or joint - of Section II - Liability Coverage is venture, amended to add: (b) That is an "insured" under any other f. When you have agreed, in a written policy, contract or written agreement, that a (c) That has exhausted its Limit of person or organization be added as Insurance under any other policy, or an additional insured on your (d) 180 days or more after its business auto policy, such person or acquisition or formation by you, organization is an "insured ", but only unless you have given us notice of to the extent such person or the acquisition or formation. organization is liable for "bodily Coverage does not apply to "bodily injury" or "property damage" caused injury" or "property damage" that results by the conduct of an "insured" under from an "accident" that occurred before paragraphs a. or b. of Who Is An you formed or acquired the organization. Insured with regard to the B. Employees as Insureds ownership, maintenance or use of a covered "auto." Paragraph A.1. - WHO IS AN INSURED - of SECTION II - LIABILITY COVERAGE is amended to add: © 2011, The Hartford (Includes copyrighted material Form HA 99 16 03 12 of ISO Properties, Inc., with its permission.) Page 1 of 5 31281058 1 9IALCON -01 1 16 -17 Jobe - Public Agencies - All Linea I Tina Adams 1 8/9/2016 12;07;37 PM (PDT) I Page 5 of 16 The insurance afforded to any such additional insured applies only if the "bodily injury" or "property damage" occurs: (1) During the policy period, and (2) Subsequent to the execution of such written contract, and (3) Prior to the expiration of the period of time that the written contract requires such insurance be provided to the additional insured. (2) How Limits Apply If you have agreed in a written contract or written agreement that another person or organization be added as an additional insured on your policy, the most we will pay on behalf of such additional insured is the lesser of: (a) The limits of insurance specified in the written contract or written agreement; or (b) The Limits of Insurance shown in the Declarations. Such amount shall be a part of and not in addition to Limits of Insurance shown in the Declarations and described in this Section. (3) Additional Insureds Other Insurance If we cover a claim or "suit" under this Coverage Part that may also be covered by other insurance available to an additional insured, such additional insured must submit such claim or "suit" to the other insurer for defense and indemnity. However, this provision does not apply to the extent that you have agreed in a written contract or written agreement that this insurance is primary and non- contributory with the additional insured's own insurance. (4) Duties in The Event Of Accident, Claim, Suit or Loss If you have agreed in a written contract or written agreement that another person or organization be added as an additional insured on your policy, the additional insured shall be required to comply with the provisions in LOSS CONDITIONS 2. - DUTIES IN THE EVENT OF ACCIDENT, CLAIM , SUIT OR LOSS — OF SECTION IV — BUSINESS AUTO CONDITIONS, in the same manner as the Named Insured. E. Primary and Non - Contributory if Required by Contract Only with respect to insurance provided to an additional insured in 1.D. - Additional Insured If Required by Contract, the following provisions apply: (3) Primary Insurance When Required By Contract This insurance is primary if you have agreed in a written contract or written agreement that this insurance be primary. If other insurance is also primary, we will share with all that other insurance by the method described in Other Insurance 5.d. (4) Primary And Non - Contributory To Other Insurance When Required By Contract If you have agreed in a written contract or written agreement that this insurance is primary and non - contributory with the additional insured's own insurance, this insurance is primary and we will not seek contribution from that other insurance. Paragraphs (3) and (4) do not apply to other insurance to which the additional insured has been added as an additional insured. When this insurance is excess, we will have no duty to defend the insured against any "suit" if any other insurer has a duty to defend the insured against that "suit ". If no other insurer defends, we will undertake to do so, but we will be entitled to the insured's rights against all those other insurers. When this insurance is excess over other insurance, we will pay only our share of the amount of the loss, if any, that exceeds the sum of: (1) The total amount that all such other insurance would pay for the loss in the absence of this insurance; and (2) The total of all deductible and self- insured amounts under all that other insurance. We will share the remaining loss, if any, by the method described in Other Insurance 5.d. 2. AUTOS RENTED BY EMPLOYEES Any "auto" hired or rented by your "employee" on your behalf and at your direction will be considered an "auto" you hire. The OTHER INSURANCE Condition is amended by adding the following: © 2011, The Hartford (Includes copyrighted material Form HA 99 16 0312 of ISO Properties, Inc., with its permission.) Page 2 of 5 31981059 1 SIALCON -01 1 16 -17 Jobs- Public Agencies - All Lined 1 Tina Adams 1 6/9/7016 12:07:37 PM (PDT) I Page 6 of 16 72UEAHA5196 If any of the other insurance does not permit contribution by equal shares, we will contribute by limits. Under this method, each insurer's share is based on the ratio of its applicable limit of insurance to the total applicable limits of insurance of all insurers. 5. Premium Audit a. We will compute all premiums for this Coverage Part in accordance with our rules and rates. b. Premium shown in this Coverage Part as advance premium is a deposit premium only. At the close of each audit period we will compute the earned premium for that period and send notice to the first Named Insured. The due date for audit and retrospective premiums is the date shown as the due date on the bill. If the sum of the advance and audit premiums paid for the policy period is greater than the earned premium, we will return the excess to the first Named Insured. c. The first Named Insured must keep records of the information we need for premium computation, and send us copies at such times as we may request. 6. Representations a. When You Accept This Policy By accepting this policy, you agree: (1) The statements in the Declarations are accurate and complete; (2) Those statements are based upon representations you made to us; and (3) We have issued this policy in reliance upon your representations. b. Unintentional Failure To Disclose Hazards If unintentionally you should fail to disclose all hazards relating to the conduct of your business that exist at the inception date of this Coverage Part, we shall not deny coverage under this Coverage Part because of such failure. 7. Separation Of Insureds Except with respect to the Limits of Insurance, and any rights or duties specifically assigned in this Coverage Part to the first Named Insured, this insurance applies: a. As if each Named Insured were the only Named Insured; and b. Separately to each insured against whom claim is made or "suit" is brought. 8. Transfer Of Rights Of Recovery Against Others To Us a. Transfer of Rights Of Recovery If the insured has rights to recover all or part of any payment, including Supplementary Payments, we have made under this Coverage Part, those rights are transferred to us. The insured must do nothing after loss to impair them. At our request, the insured will bring "suit" or transfer those rights to us and help us enforce them. b. Waiver Of Rights Of Recovery (Waiver Of Subrogation) If the insured has waived any rights of recovery against any person or organization for all or part of any payment, including Supplementary Payments, we have made under this Coverage Part, we also waive that right, provided the insured waived their rights of recovery against such person or organization in a contract, agreement or permit that was executed prior to the injury or damage. 9. When We Do Not Renew If we decide not to renew this Coverage Part, we will mail or deliver to the first Named Insured shown in the Declarations written notice of the nonrenewal not less than 30 days before the expiration date. If notice is mailed, proof of mailing will be sufficient proof of notice. SECTION V — DEFINITIONS 1. "Advertisement" means the widespread public dissemination of information or images that has the purpose of inducing the sale of goods, products or services through: a. (1) Radio; (2) Television; (3) Billboard; (4) Magazine; (5) Newspaper; or b. Any other publication that is given widespread public distribution. However, "advertisement" does not include: a. The design, printed material, information or images contained in, on or upon the packaging or labeling of any goods or products; or b. An interactive conversation between or among persons through a computer network. 2. "Advertising idea" means any idea for an "advertisement ". 3. "Asbestos hazard" means an exposure or threat of exposure to the actual or alleged properties of asbestos and includes the mere presence of asbestos in any form. 4. "Auto" means a land motor vehicle, trailer or semitrailer designed for travel on public roads, including any attached machinery or equipment. But "auto" does not include "mobile equipment ". 5. "Bodily injury" means physical: a. Injury; b. Sickness; or c. Disease sustained by a person and, if arising out of the above, mental anguish or death at any time. HG 00 01 06 05 Page 15 of 18 312 81050 1 SIALCON =01 1 16 -17 Jobs- Public Aganai@m = All hies@® I Tina Adams 1 9/9/2016 12107137 PM (PDT) I Fag@ 7 of 1€ 72UEAHA5198 (4) Necessary for the normal operation of the covered "auto" or the monitoring of the covered "auto's" operating system. b. Section III — Version CA 00 01 03 10 of the Business Auto Coverage Form, Physical Damage Coverage, Limit of Insurance, Paragraph C.2 and Version CA 00 01 10 01 of the Business Auto Coverage Form, Physical Damage Coverage, Limit of Insurance, Paragraph C are each amended to add the following: $1,500 is the most we will pay for "loss" in any one "accident" to all electronic equipment (other than equipment designed solely for the reproduction of sound, and accessories used with such equipment) that reproduces, receives or transmits audio, visual or data signals which, at the time of "loss ", is: (1) Permanently installed in or upon the covered "auto" in a housing, opening or other location that is not normally used by the "auto" manufacturer for the installation of such equipment; (2) Removable from a permanently installed housing unit as described in Paragraph 2.a. above or is an integral part of that equipment; or (3) An integral part of such equipment. c. For each covered "auto ", should loss be limited to electronic equipment only, our obligation to pay for, repair, return or replace damaged or stolen electronic equipment will be reduced by the applicable deductible shown in the Declarations, or $250, whichever deductible is less. 9. EXTRA EXPENSE - BROADENED COVERAGE Under Paragraph A. - COVERAGE - of SECTION III - PHYSICAL DAMAGE COVERAGE, we will pay for the expense of returning a stolen covered "auto" to you. 10. GLASS REPAIR -WAIVER OF DEDUCTIBLE Under Paragraph D. - DEDUCTIBLE - of SECTION III - PHYSICAL DAMAGE COVERAGE, the following is added: No deductible applies to glass damage if the glass is repaired rather than replaced. 11. TWO OR MORE DEDUCTIBLES Under Paragraph D. - DEDUCTIBLE - of SECTION III - PHYSICAL DAMAGE COVERAGE, the following is added: If another Hartford Financial Services Group, Inc. company policy or coverage form that is not an automobile policy or coverage form applies to the same "accident ", the following applies: (1) If the deductible under this Business Auto Coverage Form is the smaller (or smallest) deductible, it will be waived; (2) If the deductible under this Business Auto Coverage Form is not the smaller (or smallest) deductible, it will be reduced by the amount of the smaller (or smallest) deductible. 12. AMENDED DUTIES IN THE EVENT OF ACCIDENT, CLAIM, SUIT OR LOSS The requirement in LOSS CONDITIONS 2.a. - DUTIES IN THE EVENT OF ACCIDENT,CLAIM, SUIT OR LOSS - of SECTION IV - BUSINESS AUTO CONDITIONS that you must notify us of an "accident" applies only when the "accident" is known to: (1) You, if you are an individual; (2) A partner, if you are a partnership; (3) A member, if you are a limited liability company; or (4) An executive officer or insurance manager, if you are a corporation. 13. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS If you unintentionally fail to disclose any hazards existing at the inception date of your policy, we will not deny coverage under this Coverage Form because of such failure. 14. HIRED AUTO - COVERAGE TERRITORY Paragraph e. of GENERAL CONDITIONS 7. - POLICY PERIOD, COVERAGE TERRITORY - of SECTION IV - BUSINESS AUTO CONDITIONS is replaced by the following: e. For short-term hired "autos ", the coverage territory with respect to Liability Coverage is anywhere in the world provided that if the "insured's" responsibility to pay damages for "bodily injury" or "property damage" is determined in a "suit," the "suit" is brought in the United States of America, the territories and possessions of the United States of America, Puerto Rico or Canada or in a settlement we agree to. 15. WAIVER OF SUBROGATION TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US - of SECTION IV - BUSINESS AUTO CONDITIONS is amended by adding the following: C 2011, The Hartford (Includes copyrighted material Form HA 99 16 03 12 of ISO Properties, Inc., with its permission.) Page 4 of 5 31281050 1 SIALCON =01 1 16 =15 J ®b ®= Pub11a agniuiu® = all Lin @® I mind Adam 1 8/9/2016 MM 37 PM (PDT) I Pn9@ 0 of 16 We waive any right of recovery we may have against any person or organization with whom you have a written contract that requires such waiver because of payments we make for damages under this Coverage Form. 16. RESULTANT MENTAL ANGUISH COVERAGE The definition of "bodily injury" in SECTION V- DEFINITIONS is replaced by the following: "Bodily injury" means bodily injury, sickness or disease sustained by any person, including mental anguish or death resulting from any of these. 17. EXTENDED CANCELLATION CONDITION Paragraph 2. of the COMMON POLICY CONDITIONS - CANCELLATION - applies except as follows: If we cancel for any reason other than nonpayment of premium, we will mail or deliver to the first Named Insured written notice of cancellation at least 60 days before the effective date of cancellation. 18. HYBRID, ELECTRIC, OR NATURAL GAS VEHICLE PAYMENT COVERAGE In the event of a total loss to a "non- hybrid" auto for which Comprehensive, Specified Causes of Loss, or Collision coverages are provided under this Coverage Form, then such Physical Damage Coverages are amended as follows: a.lf the auto is replaced with a "hybrid" auto or an auto powered solely by electricity or natural gas, we will pay an additional 10 %, to a maximum of $2,500, of the "non- hybrid" auto's actual cash value or replacement cost, whichever is less, b.The auto must be replaced and a copy of a bill of sale or new lease agreement received by us within 60 calendar days of the date of "loss," c. Regardless of the number of autos deemed a total loss, the most we will pay under this Hybrid, Electric, or Natural Gas Vehicle Payment Coverage provision for any one "loss" is $10,000. For the purposes of the coverage provision, a.A "non- hybrid" auto is defined as an auto that uses only an internal combustion engine to move the auto but does not include autos powered solely by electricity or natural gas. b.A "hybrid" auto is defined as an auto with an internal combustion engine and one or more electric motors; and that uses the internal combustion engine and one or more electric motors to move the auto, or the internal combustion engine to charge one or more electric motors, which move the auto. 19. VEHICLE WRAP COVERAGE In the event of a total loss to an "auto" for which Comprehensive, Specified Causes of Loss, or Collision coverages are provided under this Coverage Form, then such Physical Damage Coverages are amended to add the following: In addition to the actual cash value of the "auto ", we will pay up to $1,000 for vinyl vehicle wraps which are displayed on the covered "auto" at the time of total loss. Regardless of the number of autos deemed a total loss, the most we will pay under this Vehicle Wrap Coverage provision for any one "loss" is $5,000. For purposes of this coverage provision, signs or other graphics painted or magnetically affixed to the vehicle are not considered vehicle wraps. 02011, The Hartford (Includes copyrighted material Form HA 99 16 0312 of ISO Properties, Inc., with its permission.) Page 5 of 5 312 81058 1 ®IALCCN = 01 1 16 =19 dob®= PuAllo Agonole@ = All Lln@® I Ting Adam® 1 019/2616 l2i0707 PM (PDT) I Page 9 of 16 F1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. 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 California workers' compensation premium otherwise due on such remuneration, SCHEDULE Person or Organization Any Person or Organization For Whom The Named Insured Has Agreed By Written Contract to Furnish this Waiver ,�i/ / Job Description Countersigned by Authorized Representative Form WC 04 03 06 (1) Printed in U,S,A. Process Date: Policy Expiration Date: B /1/2017 .1162M I .bIAU..7014 1 I 16 =17 Tobma Publiv. Apaaoio@ = All Linoaa I Tina Adam I 849/2016 1207137 PM fPrf"f9 I Paaga 10 0 16 72UEAHA5196 !;I, THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTRACTORS BROAD FORM ENDORSEMENT T This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART INDEX 1. Alienated Premises Coverage .................................................................................... ............,..,.,............. 1 2. Damage To Your Work .................................................................................. ............................... 3 Contractors Limited Professional Liability ...................................................... ............................... 4. Per Project and Per Location General Aggregate Limits Of Insurance .......... ............................... 5. Motor Vehicle Laws ........................................................................................ ............................... 6. Medical Payments Coverage — Including Products - Completed Operations ............................... 7. Insured Contract — Construction Operations And Municipal Work ................. ............................... 8. Injury To Employee's Reputation With Respect To Incidental Medical Malpractice ..................... 9. Bodily Injury Employee Suits .......................................................................... ............................... 10. Consolidated Insurance (Wrap -Up) Programs ............................................... ............................... 11. Access Or Disclosure Of Confidential Or Personal Information And Data - Related Liability .......,. 12. Contractual Liability Coverage For Personal And Advertising Injury ............... ............................... 13. Supplementary Payments ............................................................................... ............................... 14. Two Or More Coverage Parts Or Policies Issued By Us ................................. ............................... 15. Notice of Cancellation to Certificate Holders ................................................... ............................... 1. ALIENATED PREMISES COVERAGE Exclusion j. Damage To Property of Section I — Coverage A is amended as follows: a. The following exception to the exclusion is deleted: Paragraph (2) of this exclusion does not apply if the premises are "your work" and were never occupied, rented or held for rental by you. b. This exception is replaced by the following: Paragraph (2) of this exclusion does not apply if the premises are "your work ". 2. DAMAGE TO YOUR WORK Exclusion I. Damage To Your Work of Section I - Coverage A is replaced by the following: I. Damage to Your Work "Property damage" to that particular part of "your work" out of which damage arises and included in the "products- completed operations hazard ". 1 2 3 3 3 3 4 4 4 5 6 6 6 This exclusion does not apply if the damaged work or the work out of which the damage arises was performed on your behalf by a subcontractor. This provision does not apply if exclusion I. Damage To Your Work has been otherwise modified by endorsement. 3. CONTRACTORS LIMITED PROFESSIONAL LIABILITY The following exclusion is added to Paragraph 2., Exclusions of Section I - Coverage A - Bodily Injury And Property Damage Liability, and to Paragraph 2., Exclusions of Section I - Coverage B - Personal And Advertising Injury Liability: This insurance does not apply to "bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of or failure to render any professional services by you with respect to your providing engineering, architectural or surveying services in your capacity as an engineer, architect or surveyor. O 2014, The Hartford 31281058 1 SIAL€ON41 1 16 =19 dubrg= Publlu Apnulaa = All Lin @a I Tina Adam® 1 6/g/2016 120707 PM (PDT) I Paga 11 of 16 Page 1 of 6 B. Subparagraph f. of the definition of "insured contract" (Section V — Definitions) is replaced by the following: That part of any other contract or agreement pertaining to your business (including an indemnification of a municipality in connection with work performed for a municipality) under which you assume the tort liability of another party to pay for "bodily injury", "property damage ", or "personal and advertising injury" to a third person or organization. Tort liability means a liability that would be imposed by law in the absence of any contract or agreement. Paragraph f. includes that part of any contract or agreement that indemnifies a railroad for "bodily injury", "property damage ", or "personal and advertising injury" arising out of construction or demolition operations, within 50 feet of any railroad property and affecting any railroad bridge or trestle, tracks, road -beds, tunnel, underpass or crossing. However, Paragraph f. does not include that part of any contract or agreement: (1) That indemnifies an architect, engineer or surveyor for injury or damage arising out of: (a) Preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or (b) Giving directions or instructions, or failing to give them, if that is the primary cause of the injury or damage; or (2) Under which the insured, if an architect, engineer or surveyor, assumes liability for an injury or damage arising out of the insured's rendering or failure to render professional services, including those listed in (1) above and supervisory, inspection, architectural or engineering activities. 13. SUPPLEMENTARY PAYMENTS In the Supplementary Payments — Coverages A and B provision: The limit for the cost of bail bonds in increased to $2,500. 14. TWO OR MORE COVERAGE PARTS OR POLICIES ISSUED BY US If this policy and any other policy issued to an insured by us or any affiliated company provides coverage that applies to the same claim or damages, the maximum applicable limit(s) of liability or limit of insurance under all the policies will not exceed the highest applicable limit of liability or limit of insurance under any one policy. This condition does not apply to any policy issued by us or an affiliated company specifically written to apply as excess insurance over this policy. 15. NOTICE OF CANCELLATION TO CERTIFICATE HOLDER(S) This policy is subject to the following additional Conditions: A. If this policy is cancelled by the Company, other than for nonpayment of premium, notice of such cancellation will be provided at least thirty (30) days in advance of the cancellation effective date to the certificate holder(s) with mailing addresses on file with the agent of record or the Company. B. If this policy is cancelled by the Company for nonpayment of premium, or by the insured, notice of such cancellation will be provided within (10) days of the cancellation effective date to the certificate holder(s) with mailing addresses on file with the agent of record or the Company. If notice is mailed, proof of mailing to the last known mailing address of the certificate holder(s) on file with the agent of record or the Company will be sufficient proof of notice. Any notification rights provided by this endorsement apply only to active certificate holder(s) who were issued a certificate of insurance applicable to this policy's term. Failure to provide such notice to the certificate holder(s) will not amend or extend the date the cancellation becomes effective, nor will it negate cancellation of the policy. Failure to send notice shall impose no liability of any kind upon the Company or its agents or representatives. Page 6 of 6 Form HS 24 50 12 14 1.281058 1 81MCOIW41 1 1617 Jeabr3::.PuBl", A€ flflA.wa :: All L.in@a I Tina Adam@ 1 0/ %/2016 1.20701 PM (PDT) I Paga 12 of 16 w 72UEAHA5198 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTICE OF CANCELLATION TO CERTIFICATE HOLDER(S) This policy is subject to the following additional Conditions: A. If this policy is cancelled by the Company, other than for nonpayment of premium, notice of such cancellation will be provided at least thirty (30) days in advance of the cancellation effective date to the certificate holder(s) with mailing addresses on file with the agent of record or the Company. B. If this policy is cancelled by the Company for nonpayment of premium, or by the insured, notice of such cancellation will be provided within (10) days of the cancellation effective date to the certificate holder(s) with mailing addresses on file with the agent of record or the Company. • If notice is mailed, proof of mailing to the last known mailing address of the certificate holder(s) on file with the agent of record or the Company will be sufficient proof of notice. Any notification rights provided by this endorsement apply only to active certificate holder(s) who were issued a certificate of insurance applicable to this policy's term. Failure to provide such notice to the certificate holder(s) will not amend or extend the date the cancellation becomes effective, nor will it negate cancellation of the policy. Failure to send notice shall impose no liability of any kind upon the Company or its agents or representatives. © 2011, The Hartford 31281938 1 SIALCON41 1 16 =19 Job §= Publia Agoncin = All Lino@ I Ting Adams I 0/P/2016 12107137 PM (PDT) I Pogo 13 of 16 Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CANCELLATION BY US Policy Number: 72WEAZI841 0 Endorsement Number: Effective Date: 6/1/2016 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address: Sialic Contractors Corporation dba: Shawnan 12240 Woodruff Avenue Downey CA 90241 Paragraph 2. Of Part Six - Conditions, D. Cancellation in the Workers' Compensation and Employers' Liability Insurance Policy Provisions is replaced by the following: 2. We may cancel this policy by mailing or delivering to the Named Insured written notice of cancellation at least: a. 30 days before the effective date of cancellation or as required by statute whichever is longer if we cancel for nonpayment of premium; or b. 10 days before the effective date of cancellation or as required by statute, whichever is longer, if we cancel for any other reason. Nothing herein contained shall be held to vary, waive, alter, or extend any of the terms, conditions, agreements or declarations of the policy, other than as herein stated. Form WC 99 05 48 Printed in USA Process : Policy Expiration e: 6/1/201 112810 §8 1 ®IAiCON =01 116 =17 70W=Publia Agenai ®N = All Pined I 'Ping Adam@ 1 8/9/2016 120707 PM (PDT) I Peg@ 14 of 16 n!, THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. 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 California workers' compensation premium otherwise due on such remuneration. SCHEDULE Person or Organization Job Description Countersigned by Authorized Representative Form WC 04 03 06 (1) Printed in U.S.A. Process Date: Policy Expiration Date: 6/1/2017 11201.058 1 � TALCON =01 1 16 17 wJobm- Public Agonai@a ::: Att.. f.,,nam I Tina faalam 1 8/912016 120707 PM PDT) I Page 1:9 of 1:6 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA Policy Number: 72 WEA ZI8410 Endorsement Number: 002 Effective Date: 06/01/16 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address: SIALIC CONTRACTORS CORPORATION 12240 WOODRUFF AVENUE DOWNEY CA 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 otherwise due on such remuneration. Person or Organization CITY OF EL SEGUNDO, ITS OFFICIALS, EMPLOYEES, AGENTS AND VOLUNTEERS. CITY OF EL SEGUNDO 350 MAIN STREET EL SEGUNDO, CA 90245 SCHEDULE Countersigned by Form WC 04 03 06 (1) Printed in U.S.A. Process Date: 08/08/16 % of the California workers' compensation premium Job Description SHAWNAN JOB #288, PROJECT #PW 16 -10, IMPERIAL HIGHWAY OVERLAY PROJECT lk� Authorized Representative Policy Expiration Date: 06/01/17 71281058 1 BIALCOW -01 1 16 =17 Jab ®= aublia Aganai ®a - All LiMs I Tina Adam® 1 8/9/2016 12107177 9M (9 ®T) I Pag® 16 of 16