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PROOF OF INSURANCE (2017) CLOSEDJLEEENG -01 YUENG CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) `� 1 8116/2016 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 pollcy(les) 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). PRODUCER `"""t°"9"`"" 8T5 Ho reardeftoad tea PHONE h 25J416 -7862 FAX ...... License NAME uen PP �N (925 416 -7869 Suite' 240y _........ Pleasanton, CA 94588DmwwGienl�loausa Com INSURER(S) AFFORDING COVERAGE _ N_AIC INSURERA :Travelers Property Casualty Company of America 25674 INSURED INSURER B: Argonaut Insurance Compen)► 19601 JLee Engineering, Inc. INSURER C: 430 S. Garfield Avenue, #301 INSURER D: Alhambra, CA 91801 _._._ _._.._.__...._..........._ ....... ........................._____. INRIIRFR F COVERAGES CERTIFICATE NUMBER: 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. oSC P 'FF P l " ...... _.-- .....__- ......... ..........._...... TYPE OF INSURANCE POLICY NUMBER MMID I M LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,00 CLAIMS -MADE ❑ X OCCUR 6808855N594 0910112016 08/0112017 CSRENTEIS P)2EMIS5JEakaccurre 1,000,00 MED EXP 4Any oneeraon S 10,00 PERSONAL & ADV INJURY S 2,000,00 _ _ _ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE s 4,000,00 POLICY [K] JERCCT' ❑ LOC PRODUCTS - COMPIOP AGG $ 4,000,00 ._....._. _. . _. ... OTHER: S AUTOMOBILE LIABILITY a attldanl S 2,000,00 A ANY AUTO 6808855N594 0910112016 08101/2017 BODILY INJURY (Per person) $ ALL OWNED _ SCHEDULED AUTOS BODILY INJURY (Per accident) $ W X AONO-0WNED a HIRED AUTOS UTS {dYlk9iA¢��wi S UMBRELLA LIAB OCCUR EACH OCCURRENCE S EXCESS LIAB CLAIMS- MADE AGGREGATE _. ....._._ ................... $ ............................... DEDRETENTIONS ER YIN ITEAC A ANY RIETORIPA TNER X CUTIVE UB329OT632 1 09/0112016 09/01/2017 E.L. EACH $ 1,000,00 ER ('M'andslory In NN) NIA E.L. DISEASE - EA EMPLOYE S 1,000,00 as D1 dR TIO OPERATIONS El. DISEASE - POLICY LIMIT -$ $ 1,000,00 B Professional Liab. IAE1252604 0910112016 0810112017 Per Claim 1,000,00 B Professional Liab. IAE1252604 0910112016 0910112017 Aggregate 1,000,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached K mom spew 1's required) All Operations of the Named Insured. General Liability only: City of El Segundo, its officers, officials, employees, and authorized volunteers Is named as Additional Insured but only as respects liability arising out of the Named Insured's operations in Professional Services Agreement; such coverage Is Primary and Non - Contributory as respects any insurance carried by the Additional Insured with respect to work performed by the Named Insured. Also, note that the aforementioned General Liability /includes coverage for Hired 3 Non -Owned Auto Liability. Above policies include Waiver of Subrogation In favor of the aformentioned Additional Insured. 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 City of El Segundo 350 Main Street " IN 22giank, 98 IRM ®1986 -2014 ACORD CORPORATION, All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABILITY POLICY NUMBER: 680- 8855N594. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED (ARCHITECTS, ENGINEERS AND SURVEYORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE NAME OF PERSON(S) OR ORGANIZATION(S): ANY PERSON OR ORGANIZATION FOR WHICH THE INSURED HAS AGREED BY WRITTEN CONTRACT PROJECT /LOCATION OF COVERED OPERATIONS: PROVISIONS A. The following is added to WHO IS AN INSURED (Section II): The person or organization shown in the Sched- ule above is an additional insured on this Cover- age Part, but only with respect to liability for "bod- ily injury", "property damage" or "personal injury " caused, in whole or in part, by your acts or omis- sions or the acts or omissions of those acting on your behalf: a. In the performance of your ongoing opera- tions; b. In connection with premises owned by or rented to you; or c. In connection with "your work" and included within the "products -completed operations hazard ". Such person or organization does not qualify as an additional insured for "bodily injury", "property damage" or "personal injury" for which that per- son or organization has assumed liability in a con- tract or agreement. The insurance provided to such additional insured is limited as follows: d. This insurance does not apply to the render- ing of or failure to render any "professional services ". e. The limits of insurance afforded to the addi- tional insured shall be the limits which you agreed in that "contract or agreement requir- ing insurance" to provide for that additional insured, or the limits shown in the Declara- tions for this Coverage Part, whichever are less_ This endorsement does not increase the limits of insurance stated in the LIMITS OF INSURANCE (Section III) for this Coverage Part. B. The following is added to Paragraph a. of 4. Other Insurance in COMMERCIAL GENERAL LIABILITY CONDITIONS (Section IV): However, if you specifically agree in a "contract or agreement requiring insurance" that, for the addi- tional insured shown in the Schedule, the insur- ance provided to that additional insured under this CG D3 82 09 07 © 2007 The Travelers Companies, Inc. Page 1 of 2 Includes the copyrighted material of Insurance Services ofbce, Inc., with its permission COMMERCIAL GENERAL LIABILITY Coverage Part must apply on a primary basis, or a primary and non-contributory basis, this insur- ance is primary to other insurance that is avail- able to such additional insured which covers such additional insured as a named insured, and we will not share with the other insurance, provided that: (1) The "bodily injury" or "property damage" for which coverage is sought occurs; and (2) The "personal injury" for which coverage is sought arises out of an offense committed; after you have entered into that "contract or agreement requiring insurance" for such addi- tional Insured. But this Insurance still is excess over valid and collectible other insurance, whether primary, excess, contingent or on any other basis, that is available to the additional in- sured when the additional insured is also an addi- tional insured under any other insurance. C. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us in COMMERCIAL GENERAL LIABILITY CON- DITIONS (Section IV): We waive any rights of recovery we may have against the additional insured shown in the Schedule above because of payments we make for "bodily injury", "property damage" or "personal injury" arising out of "your work" on or for the pro- ject, or at the location, shown in the Schedule above, performed by you, or on your behalf, un- der a "contract or agreement requiring insurance" with that additional insured. We waive these rights only where you have agreed to do so as part of the "contract or agreement requiring insur- ance" with that additional insured entered into by you before, and in effect when, the "bodily injury" or "property damage" occurs, or the "personal in- jury" offense is committed. D. The following definition is added to DEFINITIONS (Section V): "Contract or agreement requiring insurance" means that part of any contract or agreement un- der which you are required to include the person or organization shown in the Schedule as an ad- ditional insured on this Coverage Part, provided that the "bodily injury" and "property damage" oc- curs, and the "personal injury" is caused by an of- fense committed: a. After you have entered into that contract or agreement; 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 © 2007 The Travelers Companies, Inc. CG D3 82 09 07 Includes the copyrighted material of Insurance Services Office, Inc., with its permission TRAVELERS WORKERS COMPENSATION AND ONE TOWER SQUARE EMPLOYERS LIABILITY POLICY HARTFORD, CT 06183 ENDORSEMENT WC 99 03 76 ( A) - 001 POLICY NUMBER: UB- 3290T63 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA (BLANKET WAIVER) 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. The additional premium for this endorsement shall be 03. 00 % of the California workers' compensation pre- mium. Schedule Person or Organization Job Description ANY PERSON OR ORGANIZATION FOR WHICH THE INSURED HAS AGREED BY WRITTEN CONTRACT EXECUTED PRIOR TO LOSS TO FURNISH THIS WAIVER. o— d� m= n� O� O� rem nip m= wrwery �nnw raw n� o� This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of . the policy.) Endorsement Effective Policy No. Endorsement No. Insured Premium Insurance Company Countersigned by DATE OF ISSUE: 07 -08 -15 ST ASSIGN: Page 1 of 1 026407