PROOF OF INSURANCE (2017) CLOSED (2)STEPH-1 OP ID: RH
A� o�ROrt
DATE 1 Y, CERTIFICATE CF LIABILITY INSURANCE 0910712016
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 endorsements .
PRODUCER NAME: Certificate Dept
Wright, Finnegan & Carter PIDIVE ..... .........
Insurance Associates Al No0 g',I 714-283-1999 ..tl �a o}. 714 - 283 -1997
23001 La Palma Ave 9100
Yorba Linda, CA 92887 roatss certificates vfclnsurance.c_ ..... _._
tie � om
INSURER(_ .__.........w...� _.,... ..- ... ...... - -. .......
John Carter CIC S) AFFORDING COVERAGE � NAIC 8
INSURED Doreck Construction Inc.
Stephen Doreck Equipment
Rentals, Inc.
9075 Telegraph Road
Pico Rivera, CA 90660
INSURER_ A: Travelers I n d e m n It m pa ny of
INSURER 13: Connecticut _.
INSURER c: Westchester Surplus Lines Insm
.... RM
INSURER D:ITITITa eco insurance om
..................._
INSURER E: First National Insurance Co
LUVC('Yi'.A,"Ceb 1:tiKIIrU'L:AWC NU1lyIL'SC.K:; Ktt,vI:"0IVWV NaM0a11:
X
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'r
�._
-- -
BODLY cadent)...
TYPE OF INSURANCE
POLICY NUMBER
MMIDD/YYYY
MM1�DIp�YY
LIMITS
GENERAL LIABILITY
_ ...... ....
HIRED AUTOS AUTOS
EACH OCCURRENCE
S
1,000,000
A
WX
COMMERCIAL GENERAL LIABILITY
X
X
DT22-CO- 7200P538- TCT -16
03/01/2016
03/01/2017
t �' R "1TL—
EsnccurrenceJ,.�„
300,00
�.._�.
UMBRELLA LU1B X OCCUR
5,000
EACH OCCURRENCE
S
CLAIMS -MADE X OCCUR
A
X
EXCESS LIAB CLAIMS -MADE
Anv one person)
MED EKP (,wwww
S
AGGREGATE
X
Contractual Liab
FD RIFTENTION $
_W......_ ..
PERSONAL &ADV INJURY
$
w
1,000,000
C
X
Pollution Liabi ._......
{ OTH-
WORHERS COMPENSATION X 7nRY1; I,
G27153136003
03/01/2016
03/01/2017
ElNlEuRtiAoL RE_ GAT.P E
OFFIC'RIMEMBER EXCLUDED? N 1 A mIT mS
L DISEASE TEA EMPLOYEE S m mm
i flCE
DSLBH OVERAGESNCLUDED
_....._22..,,000,,0- 0-_0
..
_
(yes, SCRIPTION OF OPERATIONS belcnu m............. DISEASEW- POLICY-LIMIT .- '.�m�..�m.
describe L POLICY LIMIT 5
LIMIT
GEN L ABC tE,ATE LIME ATP LI E PER
E EQUIP RENTED FROM OTHERS 25 -CC- 227754 -8 08/1812016 08/18/2017 ACV
130,000
D EQUIPMENT 25 -CC- 227754-8 03/01/2016 03/0112017 DED 1000
855,068
DESCRIPTION OF OPERATIONS I LOCATIONS l VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required)
PRODUCTS - COIPIO
E
2,00 0000
VOLUNTEERS ARE NAMED AS ADDITIONAL INSURED AND PRIMARY WORDING APPLIES PER
ra
TOLICI X .
THE BLANKET ADDITIONAL INSURED ENDORSEMENT ATTACHED TO THE POLICY - AS
REQUIRED BY WRITTEN CONTRACT. ADDITIONAL INSURED APPLIES TO AUTO LIABILITY„
WAIVER OF SUBROGATION APPLIES TO GENERAL LIABILITY, AUTO LIABILITY AND
nA_G.G_
.. _
PGo_
..$
�
00_
AUTOMOBILE LIABILITY
COMBINED SIPGLE LIMYT
F .1,
000,
A
X
AIJY AUTO
X
X
OT- 810.8D457897 -TI L -16
03/01/2016
03101/2017 BODILY INJURY (Pe, person}
S
ALL OWNED, SCHEDULED
BODLY cadent)...
X
AUTOS AUTOS
NON -OWNED
X
`.......
"'ftUi�''tiAr �ACia
_ ...... ....
HIRED AUTOS AUTOS
PER ACCIDENT
X
Hired Auto Phy Damage
UMBRELLA LU1B X OCCUR
EACH OCCURRENCE
S
5,000,000
A
X
EXCESS LIAB CLAIMS -MADE
OTSM- CUP- 7200P538- TIL -16
03101/2016
03/01/2017
AGGREGATE
S
5,000,000
FD RIFTENTION $
S
{ OTH-
WORHERS COMPENSATION X 7nRY1; I,
STS ,,, FH ...,_
AND EMPLOYERS' LIABILITY YIN ! J
A 0310112016 03!0112017 r ..
IMIEMBE PARTNER E CCUTIVE X
1 , 000,000
Yµmmmmmm
OFFIC'RIMEMBER EXCLUDED? N 1 A mIT mS
L DISEASE TEA EMPLOYEE S m mm
i flCE
DSLBH OVERAGESNCLUDED
mm mm
1,000_,000
_
(yes, SCRIPTION OF OPERATIONS belcnu m............. DISEASEW- POLICY-LIMIT .- '.�m�..�m.
describe L POLICY LIMIT 5
1,000,00..
D
E EQUIP RENTED FROM OTHERS 25 -CC- 227754 -8 08/1812016 08/18/2017 ACV
130,000
D EQUIPMENT 25 -CC- 227754-8 03/01/2016 03/0112017 DED 1000
855,068
DESCRIPTION OF OPERATIONS I LOCATIONS l VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required)
CITY OF EL SEGUNDO, ITS OFFICERS, OFFICIALS, EMPLOYEES, AGENTS AND
VOLUNTEERS ARE NAMED AS ADDITIONAL INSURED AND PRIMARY WORDING APPLIES PER
THE BLANKET ADDITIONAL INSURED ENDORSEMENT ATTACHED TO THE POLICY - AS
REQUIRED BY WRITTEN CONTRACT. ADDITIONAL INSURED APPLIES TO AUTO LIABILITY„
WAIVER OF SUBROGATION APPLIES TO GENERAL LIABILITY, AUTO LIABILITY AND
HOLDER
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
CITY OF EL SEGUNDO ACCORDANCE WITH THE POLICY PROVISIONS.
CITY CLERK
350 MAIN STREET AUTHORIZED REPRESENTATIVE
EL SEGUNDO, CA 90245
O 1988 -2010 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD
InsureO. Doreck Constnictlon, Inc.; Stephen Doreck Equipment Rentals, Inc.
Polloy#: € DT22- CO.7200PS38- TCT -16�
This r'
COWMRCIAL Q9NEIMUMLffYCbWRAoE PART
CITY OF EL SEGUNDO, ITS OFFICERS, OFFICIALS, N
EMPLOYEES, AGENTS AND VOLUNTEERS I JOB: HILLCREST, CEDAR, HOLLY, WALNUT„
350 MAIN STREET, EL SEGUNDO, CA 90245 ' MARIPOSA - SDE JOB#2016 -11.
.Y � •'. ,w.; ry��x' k� b^�.. 4 w�° r k. yp r� xUw: " • '� y ^ �^ r�G��M"'' Y .! 1 � ,��
Insured. Doreck Construction, Inc.: Stephen Dorecic Equipment Rentals, Inc. COMMERCIAL GENERAL LIABILITY
P01100:' D "r'22•C: x)200 53 .kT•16
ally 1V11Vf►N17J.
COMMERCIAL GENERAL LIABILITY COVERAGE PART
I. WHO IS AN INSURED — (Section II) Is amended'
to include any person or organ on that you
agree in a "written contract requiring Insurweee'"
to Include as an additional Insured on this Cover-
age Part, but
a) Only with respect to debility+ for y injury ",
"property darrge" or "personal Injury"';, and
bj 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
orgaroni atlon does not qualify as an additional
Insured with respect to Itae independent arts
or omissions of such person or organization.
R. The insurance provided to the additional insured
by this endorsement is finvted as follows:
a) In the event that the Limits of Insurance of
this Coverage Part shown in they Declarations
exceed the limits of 1labllity required by the
"mitten 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
Sec lon III— Limits Of Insurance.
b) The insurance provided to the additional in-
sured does not apply to "bodily Injury", "pmp-
erty damage" or "personal InjuryO arising out
of the rendering of, or failure to render, any
professional architectural, engineering or sur-
veying services. Including-
1. The preparing, approving, or failing to
Prepare ar approve, maps, shop draw-
ings, opinions, reports, surveys, field or-
ders or grange orders. or the preparing,
approving, or failing to prepare or ap-
prove, drawings and specifications; and
II. Supervisory, inspection, architectural or
engineering. activities.
4. As a condition of ooverage provided to the
additional insured by this endomernent:
a) The additional Insured must give us written
notice as soon as practicable at an "oosr-
rence' or an offense Which may resu t in a
claiM To the extent possible, such node
should include:
CG D2 46 tab 05 0 2005 The St. Paul Travelers Companies, Inc- Page 1 of 2
COMMERCIAL GENERAL LIABILITY
i. Haw, when and where the 'occurrence`
or offense took place;
IL The names and addresses of any Injured
persons and vftesses; and
ill. The nature and location of any injury or
damage arising out of the "o=rrenee" or
offense.
bj If a claim is rnade or "suit" Is brought agalnst
the addttional insured, the additional insured
must:
1. Immediately record the specs of the
claim or'suit! and the date received; mid
ii. Notify us as soon as practicable.
The additional Insured must we 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 d aalm or 'suit'. cooperate
with us In the investigaBon or settlement of
the claim or defense against the "suit", and
otherwise comply with all policy caondMors.
d} The additional insured must tender the de-
fense and indemnity of any claim or *suit" to
any provider of "outer Insrjrane which would
cover tlhe additional insured for a lass 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 mmilahte to the additional Insured
which Hers that parson or organl atlon as a
nerred insured as described In paragraph t.
above.
6. The following definition is added to SECTION V.
— DEFINITIONS:
"Written contract requiring Insurance" means
that part of any written contract or agrearnent
under which you are required to include a
person or organization as an additional in-
sured on this Coverage Pail, provided that
the "beadily Injurer" and "property da a" oc-
curs and the *Personal Injury" ig caused by an
offense committed:
a. After the signing and execution of the
contract or agreement by you;
b. While that part of the cantraet or
agreement is In effect and
c. Before" end of the policy period
Page 2 of 2 0 2005 The St. Paul Travelers Companies, Inc. CG D246 08 05
insured: Doreck Construdton, Inc.; %Qphen Doreck Equipment Rentals, 1= COMMERCIAL GENERAL LIABiLiTY
Potlny#: DT22- CO.720OP538- TCT -16
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
A.
Broadened Named Insured
H.
Additional Insured — State or Political Subdivisions
B.
Extension of Coverage — Damage To Premises
I.
Other Insurance Condition
Rented To You
J.
Increased Supplementary Payments
Perils of fire, explosion, lightning, smoke. water
m Cost of bail bonds increased to $2,500
+ Limit increased to $300,000
. Loss of earnings increased to $60Q per day
C.
Blanket Waiver of Subrogation
K
Knowledge and Notice of Occurrence or Offense
D.
Blanket Additional Insured — Managers or Lessors
L
Unintentional Omission
of Premises
E.
incidental Ilfl+adi Malpractice
M.
Penal Injury— Assn by Contract
F.
Extension of Coverage .- Bodily Injury
N.
Blanket Additional Insured 4.essor of Leased
Equipment
G.
Contractual Liability -- Railroads
PROVISIONS
A. BROADENED NAMED INSURED
1. The Named Insured In Item 1. of the Declara-
tions is as follows:
The person or organization named in Rem 1.
of the Declarations and any organization,
other than a partnership, joint venture or Lim-
ited liability company, of which you maintain
ownership or In which you maintain the major-
ity Interest on the effective date of the policy.
However. coverage for any such additional
organization will use as of the date, if any,
during the policy period, that your no longer
maintain ownership of, or the majority interest
In, such organization.
2. WHO IS AN INSURED (Section II) Item 4.a.
is deleted and replaced by the following:
a. Coverage under this provision is afforded
only until the 180th day after you acquire
or form the organization or the end of the
policy period, whichever is earlier.
3. ThLS Provision A. does not apply to any pet.
son or organization for which coverage is ex-
cluded by endorsement.
Ek EXTENSION OF COVERAGE — DAMAGE TO
PREMISES RENTED TO YOU
1. The last paragraph of COVERAGE A. BOD-
ILY INJURY AND PROPERTY DAMAGE Ll-
ASILITY (Section 1 — Coverages) is deleted
and replaced by the following:
Exclusions r. through n. do not apply to dam.
age to premises while rented to you, or tem-
porarily occupied by you with permission of
the owner, caused by:
a. Fine;
b. Explosfon;
c. Lightning;
d. Smoke resulting from such fire, erosion,
or lightning; or
a Water.
A separate limit of insurance applies to this
coverage as described in Section III Limits Of
lihsur�cs.
CG D316 07 04 Copyright, The Travelers Indemnity Company, 2€04 Page 1 of 6
COMMERCIAL GENERAL LIABILITY
2- This Insurance does not apply to damage to
premises while rented to you, or temporarily
occupied by you with permission of the
owner, caused by:
a. Rupture, bursting, or opera"lion of pres-
sure relief devices;
b. Rupture or bursting due to expansion or
swelling of the contaft of any building or
structure, caused by or resulting from wa,
ter;
s~ Explosion of steam boilers. steam pipes,
steam engines, or steam turbines.
3. Paragraph 6. of UMfTS OF INSURANCE
(Section 111) to deleted and replaced by the
following:
Subjed to 'S. above, the Damage To Prem-
ises (tented To You Limit Is the most we will
pay under COVERAGE A. for the sum of all
damages because of `property damage to
any one premises wNla rented to you, or
temporarily occupied by you with permission
of the owner. caused by: fire; explosion; fight•
ning; smoke resulting from such fire, explo-
sion, or lightning; or water. The Damage To
Premises Rented To You Unit wi i apply to all
`property damage" proximately caused by the
same "occurrence, whether such damage
results from: fire; explosion; Hghtring; smoke
resulting" from such fins, explosion, or light -
Nng; or water, or any combination of any of
these causes.
The Damage To Premises Rented To You
Urnitwill be the higher of:
a. $304,000; or
b. The amount shown on the Declarations
for Damage To Premises Rented To You
Limit.
4. Paragraph a. of the definition of Insured con-
tract" (DEFINITIONS — Section V) Is deleted
and replaced by the following:
a. A contract for a lease of premises. How-
ever, that portion of the contract for a
lease of premises that indemnifies any
person or organization for damage to
premises while rented to you, or tempo-
rarily occupied by you with permission of
the owner, caused by: fire; explosion;
lightning; smoke resulting from such fire,
explosion, or lightning; or water, is not an
"insured contract;
5, This Provision B. does not apply ti coverage
for Damage To Premises vented To You of
COVERAGE A. BODILY INJURY AND
PROPERTY DAMAGE L ABILt7Y (Section I —
Cover es) Is excluded by endorsement.
C. BLANKET WAIVER OF SLIGROGATION
We waive any right of recovery we may have
against any person or organization because of
payments we snake for injury or damage arising
out of; premises owned on occupied by or rented
or loaned to you; ongoing operations pe€formed
by you or on your behalf, done under a Contract
with that person or oTanbm$orh: `your vvoW; or
"ymar Muds'. We waive tibia fight where you
have agreed to do so as part of a written contract,
exaouted by you before the "bodily Injury" or
'property damage" occurs or the "personal injury"
or "advertising injury" offense is committed.
D. BLANKET AODMONAL INSURED — MANAG-
ERS OIL LESSORS OF PREMISES
WHO IS AN INSURED (Section In is amended to
include as an insured any person or organ fixation
(referred to below as 'additional Insured") with
whom you have agreed in a written contract, exe-
cuted before the 'body irgrry k or "property dam-
s" occurs or the - personal Injury- or `" eMs-
Ing Injury" offense Is committed, to name as an
additional Insured, but only with respect to liability
arising out of the ownership, maintenance or use
of that part of any premises [eased to you, subject
to the following provisions:
1. L[mlts of Insurance. The limits of Insurance
afforded to the additional Insured shall be the
1lmitr* which you agreed to provide In the writ -
test contract„ or the limits shown on the Decla-
rations, wNchever are less.
2- The fturance afforded to the addillbonal In-
sured does not appty to:
a. Any "bodly injury" or "property damage"
that occurs, or "personal injury' or'adver-
tising inW caused by an offerer which
Is committed, after you cease to be a ten-
ant In that premises;
b. Any premises for which coverage is ex-
cluded by endorsement; or
c. Structural alterations, new construction or
demolition operations perfomhed by or on
behalf of such additional insured,
3. The irssura nce afforded to the additional In-
sured Is excess over any valid and cxaflectible
Page 2 of 6 Copyright, The Travelers Indemnity Company, 2004 CO D316 07 04
"other insurance' avelable to such additional
insured, unless you have agreed In the writ-
ten contract that this insurance must be pri-
mary to, or non- cont6butory with. such "other
Insurance*.
E, INCIDENTAL MEDICAL MALPRACTICE
1- The following is added to paragraph 1, incur-
Ing Agreement of COVERAGE A. - BODILY
INJURY AND PROPERTY DAMAGE LIABIL-
ITY (Section 1- Coverages):
"Bodily i*ry* arising out of the rendering of,
or failure to render, the following will be
deemed to be caused by an'occurrenW.,
a. Medical, surgical, dental, laboratory, x-ray
or nursing service, advice or instruction,
or the related furnishing of food or bever-
ages:
b. The furnishing or dispensing of drugs, or
medical, dental, or surgical supplies or
appliances,
c. First aid; or
COMMERCIAL GENERAL LiADILITY
together with all related ads or omissions in
the furnishing of the services described In
paragraph 1. above to any one person will be
deemed one'wturrence ",
S. This Provision E. does nDt apply if you are in
the busyness or occupation of pmvidng any of
the services describtd In paragraph 1, above.
6. The insurance provided by this Provision E.
shall be excess over any valid and ooliectible
"other Insurance' available to the insured,
whether primary, excess, contingent or on
any other basis, except for insurance that you
bought specifically to apply in excess of the
Limits of Insurance shown on the Declara-
tions of this Coverage Pat
F. EXTENSION OF COVERAGE - BODILY IN-
JURY
d. 'Good Samaritan services' As used In
this Provision E., 'Good Samaritan ser-
vices" are those medical services ren-
dered or provided In an emergency and
for which no remuneration is demanded G•
or received.
2 Paragraph 2.a.(1)(d) of WHO IS AN IN-
SURED (Section 2) does not apply to any
registered nurse, licensed practical nurse,
emergency medical technician or paramedic
employed by you, but only white performing
the services described in paragraph 1. above
and "Be acting within the scope of their em-
ployment by you. Any "employees" rendering
"Good Samaritan services" will be deemed to
be acting within the scope of their employ-
ment by you.
3. The following exclusion Is added to paragraph
2. Exdusions of COVERAGE A. - BODILY
INJURY AND PROPERTY DAMAGE LIABIL-
ITY (Section 1- Coverages):
(This insurance does not apply to:) "Bodily in-
jury" or "party damage" arising out of the
wilU viotation of a penal statute or ordinance
relating to the sale or pharmaceuticcais c o-
mitted by or with the knowledge or consent of
the insured.
4. For the purposes of determining the apatica-
bte limits of insurance, any act or omission
The definition of "bodily Injury' (DEFINITIONS -
Sedton V) is deleted and replaced by the follow-
ing:
`Sodlly Irdury' means bodily Injury, mental an-
guish, mental injury, shock, fright, disabitity, hu-
rniiiation, sk:kness or disease sustained by a per-
son, including death resulting from any of these at
any time.
CONTRACTUAL LIABILITY- PAILROADS
1. Paragraph c~ of the definition of insured con -
tract" ( DEFINITIONS - Section V) is deleted
and replaced by the following:
c. Any easement or license agreement:
2 Paragraph f.(1) of the deffnitton of "insured
contracC (DEFINITIONS - Section 'V) is de-
leted.
H. ADDITIONAL INSURED - STATE OR POL.iTI-
CAL SUBDIVISIONS - PERMITS
WHO IS AN INSURED (Section 11) is amended to
indude as an insured any state or political subdi-
vision, subject to the following provisions:
I. This Insurance applies only when required to
be provided by you by an ordnance, law or
building code and only with respect to opera-
tions performed by you or on your behan for
which the state or political subdivision has is-
sued a permit.
2. This Irmuranoe does not apply to:
a. " Bodiy Injury." " perty damage," 'per.
sonal lnjury" or "advertising injury' arising
out of operations performed for the state
or political subdivision; or
CO 0:3 116 07 04 Copyright, The Trmmlem Indemnity Company, 2004 Page 3 of 6
COMMERCIAL GENERAL UABIUTY
b. 'Bodly injury" or "property damage" in-
cluded in the "products- completed ora-
tions hazard`.
1. OTHER INSURANCE CONDrWN
A. COMMERCIAL GENERAL UABiLITY CON-
DITIONS (Section Iv), paragraph: 4. (Other
Insurance) is deleted and replaced by the fol-
lowing:
4. Other insurance
If valid and collectible 'other insurance- is
available to the Insured for a ions we
cover under Coverages A or B of tt>ls
Coverage Part. our obligations are limited
as fotlaws:
a. primary insurance
This insurance is primary except
when b. below applies. If this Insur-
ance is primary, our obl[iigations are
not affected unless any of time "other
Insurance" Is also primary. Then, we
will share with all that "other Imur-
ance" by the method described In c.
below.
b. Excess insurance
This Insurance is excess over any of
the "other Insurance ", whether pri-
mary, excess, contingent or on any
other basis:
(1) That is Fire, Extended Coverage,
Builder's Risk, Installation Risk,
or similar coverage for 'your
work";
(2) That Is Fire insurance for prem-
ises rented to you or temporerfiy
occupied by you with permission
of the owner,
(3) That is insurance purchased by
you to cover your liability as a
tenant for *'property damage" to
premises rented to you or tempo -
rarly occupied by you with per-
mission of the owner, or
(4) If the loss arises out of the main-
tenance or use of aircraft,
"autos% or watercraft to the ex-
tent not subject to Exclusion g. of
Section I — Coverage A — Bodily
Injury And Property Damage Li-
ability, or
insured under any other policy,
including any umbrella or excess
policy.
When this insutance is excess, we
will have no duty under Coverages A
or B to defend the Insured against
any "suit" If any provider or'aftr in-
surance" has a duty to defend the In-
sured against that 'suit". If no pro-
vider of "outer irmurance" defends,
we will undertake to do so, but we will
be entitled to the Insuned's rights
against all those providers of "other
kmranoe%
When this insuranoe Is excess over
"other Insurance ", we will pay only
our share of the amount of the loss, if
any, that exceeds the sum it
(1) The total amount that all such
-other Insurance" would pay for
the lass In the absence of this in-
surance; and
(2) The toted of aEl deductible and
sett-htsured amounts under that
"other Insurance ".
We will share the remaining loss, If
any, with any "other insurance" that is
not described in this Excess lnsur-
$rice provision.
c. Method Of Sharing
If all of the "other insurance" permits
contribution by equal shares, vve will
follow this method also. Under this
approach each provider d insurance
contributes equal amounts until it has
paid its applicable limit of insurance
or mane of the loss remains, which-
ever comes first.
If any of the "other insurance- does
not permit contribution by equal
shares, we will contribute by iirnits.
Under this method, the share of each
provider of insurance is based on the
ratio of its applicable Grit of insur-
ance to the tonal applicable limits of
insurance of all providers of Insur-
ance.
B. The following definition is added to DEFIiVITiONS
(Section V):
"Other insurance":
(5) That is available to the insured $. Means insurance, or the funding of losses,
when the insured Is an additional that is provided by, through or on behalf of:
Page 4 of 6 Copyright, The.Travelers Indemnity Company, 2004 CG 031a d? C4
(1) Another Insurance company;
(2) Us or any of our affitlated Insurance corn -
panles, except when the Non cumulatwn
of Each Occurrence Limit section of
Paragraph 5 of LIMITS OF INSURANCE
(Section III) or the Non cumulation of Per-
sonal and Advertising Injury limit sections
of Paragraph 4 of LIMITS OF INSUR-
ANCE (Section 111) apples,
(3) Any risk retention group;
(4) Any self- insurance method or prograrn,
other than any funded by you and over
which this Coverage Part applies: or
(5) Any similar risk transfer or risk manage-
ment method.
b. Does not includa tm bralla insurance, or ex-
cess insurance, that you bought specificalty to
apply in exoess of the Limits of insurance
shown on the Declarations of this Coverage
Part.
J. INCREA$Ep $UPPLEMENTARY PAYMENTS
Paragraphs 1,b, and 1.d. of SUPPLEMENTARY
PAYMENTS — COVERAGES A AND B (Section
-- Coverages) are amended as follows:
1. In paragraph 'bib.. the amount we will pay for
the cost of bail bonds Is Increased to $2500.
2. In paragraph i.d., the amount we will pay fbr
toss of earnings is Increased to $500 a day.
K. KNOWLEDGE AND NOTICE OF OCCUR-
RENCE OR OFFENSE
1. The following is added to COMMERCIAL
GENERAL LIABILITY CONDITIONS (Section
IV), paragraph 2. (Duties In The Event of Do-
currence. Offense, Claim or Suit):
Notice of an "occurrence" or of an offense
whim may result in a claim must be given as
soon as practicable after knowledge of the
*occurrence! or offense has been reported to
you, one of your "executive officers' (if you
are a corporation), one of your partners Who
is an individual (if you are a partnership), one
of your managers (if you are a limited liability
company), or an "employee" (such as an in-
surance, loss control or risk manager or ad-
ministrator) designated by you to give such
notice.
Knowledge by any other "employee" of an
"occurrence" or offense does not Imply that
you also have such knowledge.
COMMERCIAL GENERAL LIABILITY
2. Notice of an ' occurrence' or of an offense
which may result in a clah will be deemed to
be glean as soon as practicable to cis If It Is
given in good faith as soon as practicable to
your workers' compensation insurer. This ap-
plles only if you Subsequenifyr give notice of
the "orcurrencW or offense to us as soon as
practicable after you, one of your `executive
oRcere (if you are a vorporation), one of your
partners who is an Individual (I you are a
partnership), one of your managers (if you are
a Hunited liability company), or an "employee"
(such as an Insurance, Pons control or risk
manager or a nistrator) designated by you
to give such notice discovers that the - occxrr-
rence" or offense may involve this policy.
3. This Provision K. does not apply as respects
the specific number of days within whteh you
are required to notify us in writing of the
abrupt owrimencement of a discharge, re-
lease or escape of "poiiutante that causes
"bodily Injury" or "property damage' which
may otherwise be oovered under tics policy.
L UNINTENTIONAL OMISSM
The Wowing is added to COMMERCIAL GEN-
ERAL LIABILITY CONDITIONS (Section IV),
paragraph 6. (Representation#
The unintentional on scion of, or unintentional
ens In, any Information provided by your which
we celled upon in issufng this policy shall not
prejudice your rights under this Insurance. How-
ever, this Proviscon L, does not affect our right to
collect additional premium or to exerdse our right
of cancellation or nonrenewal in accordance with
applicable state insurance laws, cosies or regula-
tions,
hL PERSONAL tWURY -- ASSUMED BY CON-
TRACT
1. The following is added to Exclusion e. (1) of
Paragraph 2., Exclusions of Coverage 13.
Personal Injury, Advertising injury, and
Web Site Injury LIabIW of the Web XTiEND
Liability endorsement:
Solely for the purposes of liability assumed in
an "insured contract", reasonable attorney
fees and necessary litigation expenses In-
curred by or for a party other than an insured
are deemed to be damages because of "per-
sonal injury" provided:
(a) l- lability to such party for, or for the cost
of, that party's defense has also been as-
CG D316 07 04 Copyright, The Travelers Indemnity Company, 20D4 Page 5 of 6
COMMERCIAL GENERAL LIABILITY
sumed in the same `insured contaaci:
and
(b) Such attorney fees and litigation ex-
penses are for defense of that party
against a civil or alternative dispute reso-
lution proceeding in which damages to
which this insurance applies are alleged.
2. Paragraph 2.d. of SUPPLEMENTARY PAY -
MENTS — COVERAGES A AND B (Section I
-- Coverages) is deleted and replaced by the
following;
d. The enegatlons In the "suit" and the in-
formation we know about the 'occur-
rence" or offense are such that no conflict
appears to exist between the kterests of
the Insured and the interests of the in-
demnitee;
3. The third sentence of Paragraph 2 of SUP-
PLEMENTARY PAYMENTS — COVERAGES
A AND B (Section I -- Coverages) Is deleted
and replaced by the following:
Notwithstanding the provisions of Paragraph
2.b.(2) of Secl3on I ,- Coverage A •- Bodily In-
jury And Property Dauge Liability, or the
provisions of Paragraph 2.e.(1) of Section I
Coverage B — Personal IrJury. Advertising In-
jury And web Site Injury Liability, such pay-
ments wilt not be deemed to be damages for
* bodly iryury" and "property darnage ", or
damages for "personal injury% and will not re-
duce the limits of Insurance.
4. This provision M. does not apply If coverage
for "personal Injury' liability Is excluded by
endorsement
N. BLANKET ADVITIONAL INSURED — LESSOR
OF LEASED EQUIPMENT
WHO IS AN INSURED (Section ih Is amended to
Include as an Iresur+ed any person or organization
(referred to below as "additional fnsured") with
whom you have agreed In a writlari eantraet, exe-
cuted before the "bodily injury' or "property dam•
age" ours or the 'personal lnjury° or 'advertis-
ing Injury" offense Is committed, to name as an
additlonal 'insured, but only with respect to their II-
ability for "bodily injury", "property damage ", "per-
sona! Injury" or "advertising Wgury" caused, in
whole or In part, by your acts or anisdons In the
maintenance, operation or use of equipment
leased to you by such addltl al Insured, atbject
to the follvWkig provisions:
1. Umits of Insurance. The limits of insurance
afforded to the addillaml Insured shall be the
limits which you agreed to p Tide in the writ-
ten contract or the limits shown on the Dects-
rations, whichever am less.
2. The insurance afforded to the addhonal fn-
sured does net apply to any "bodily injury° or
"property damage" that occurs, or "personal
injury' or "advertising Injury" caused by an of-
fanse which is committed. Biter the equipment
lease expires.
3. The Insurance afforded to the adtiftional In-
sured Is excess over any valid and collectible
"other insurance' available to such additionat
Insured, unless you have agreed In the writ-
ten contract that this Insurance must be pri-
mary to, or non- cxmtn'butory with, such "other
Insurance".
Page 6 of 6 Copyright, The Travelers Indemnity Company, 2004 CO D316 07 04
POLICY NUMBER: ll'M- CG- 72WJF538-TQ'r -16
COMMERCIAL GENE AL LIABILITY
ISSUE :DATE 03101/2016
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ R CAREFULLY.
This ertriorsement modifies Insurance provided under the fallowing:
COMMERCIAL GENERAL LIABILITY GOVrz SAGE PART
SCHEDULE
Designated Project(s):
De2igna+6erd Project
Gailoral Agg a4
JOB: HILLCREST, CEDAR, HOLLY, WALNUT,
MARIPOSA - SDE JOB #2016 -11.
A. For all sums which the insured becomes legally
obligated to pay as damages caused by wo=ir-
rences' under COVERAGE A. (SECTION Q, and
for all medical expenses caused by accidents un-
der COVERAGE C (SECTION 1), which can be
attributed only to operations at a single desig-
nated " projecx" shown In the Schedule above:
1. A separate Designated Project General Ag-
gregate Limit applies to each designated *pro-
ject`, and that Umit is equal to the amount of
the General Aggregate Limit shown in the
Declarations, unless . separate. Designated
Project General Aggregato(s) are sched-
uled shove.
2. The Designated Project General Aggregate
Limit is the most we will pay for the sum of all
damages under COVERAGE A. except
damages because of 'bodily [Nury" or "prop-
erty damage"' Included in the "products -
completed operations hazard'", and for medi-
cal expenses under COVERAGE C, regard-
less of the number oaf:
a. Insureds:
b. Claims made or "suits' brought; or
a Persons or organizations rnaldng clams
or bringing *suits'.
Z. Any payments made tender COVERAGE A.
for damages or under COVERAGE C. for
medical expenses shall reduce the Desig-
nated Project General Aggregate Limit for
that designated "Project". Such payments
shall not reduce the Generat Aggregate Limit
shown In the Declarations nor shall they re-
duce any other Designated ect General
Aggregate Limit for any other designated
"project" shown In the Schedule above.
4. The limits shown in the Declarations for Each
Occurrence, Damage To Premises !Ranted
To You and Medical Expense continue to
apply. I-towever, instead of being subject to
the General Aggregate Limit shown in the
Declarations, such limits will be subject to the
applicable Designated Project General Ag-
gregate Limit.
S. For all sums which the insured becomes legally
obligated to pay as damages caused by '"occur-
rences" under COVERAGE A. (SECTION_ t), and
for aft medics expenses caused by accidents un-
der COVERAGE C. (SECTION I ), which cannot
be attributed only to operations at a sinfale desig-
nated "projw "" shown In the Schedule above:
CG D2 111101 04 Copyright. The Travelers Indemnity Company, 2004 Page 1 of 2
COMMERCIAL GENERAL LIABILITY
I. Any payments made under COVERAGE A.
for damages or under COVERAGE C. for
medical expenses shall reduce the amount
available under the General Aggregate Limit
or the Produds- Completed Opera Ag-
gregate Limit, whichever is applicable: and
2. Such payments shall not reduce any Desig-
rated Project General Aggregate Umlt.
C. part 2. of SECTION III — LIMITS OF INSURANCE
Is deleted and replaced by the following:
2. The General Aggregate Limit is the most v+e
will pay far the sum of
a. Damages underCoverag• 8; and
b. Damages from "accum moee under
COVERAGE A (SECTION Q mid for all
medical expenses caused by taoe,nts
under COVERAGE C (SECTION Q which
cannot be attributed only to operations at
a single designated `project" shaven in the
SCHEDULE above.
D. When coverage for liability arising out of the
"producte- completed operatierm hazard' is pro-
vided, any payments for damages because of
"bodgy Injury" or "property damage" Included in
the "products-completed operations hazard" will
reduce the Products - Completed Operations Ag.
gregate Limit, and not reduce the General Aggre-
gale Limit nor the Designated Project General
Aggregate LlmIL
E. For the purposes of this endorsement the DOnl-
t1we Section is amended by the addition of the
rollovwing defirdtlon:
`Project" means an area may from premises
owned by or rented to you at which you are per -
forming operations pursuant to a contract or
agreement. For ttte purposes of detemiining the
applicable aggregate limit of Insurance, each
"project" that Includes promises involving the
seme or connecting lots, or premises why cen-
neetion is interrupted only by a straA roadway,
waterway or right-of-Way of a railroad shall be
considered a single 'pnn ecr.
F. The provisions of SEC' ON III — LIMITS OF
INSURANCE not otherwise modified by this en-
dorsement shall c oreinue to apply as stipulated.
Page 2 of 2 Copyright, The Travelers Indemnity Company, 2004 CG D2 11 01 04
JOB: HILLCREST, CEDAR, HOLLY, WALNUT,
MARIPOSA - SDE JOB#2016 -11.
Insured; Dareck Construotion, Mo.; Stephen Doreck Equipment Rentals, Ina COMMERCIAL AUTO
Pollcyk: DT- 810- 8D457897 -Tff-16
TWS ENDORSEMENT CIS ES THE POLICY. PLFASE READ IT CARPFULLY
AUTO COVERAGE S ENDORSEMENT
CITY OF EL SEGUNDO, ITS OFFICERS, OFFICIALS,
EMPLOYEES, AGENTS AND VOLUNTEERS
TNq erWW313rtl " Pfd Wj(W #* folloWft: 350 MAIN STREET, EL SEGUNDO, CA 90245
• BUSINESS AUTO COVERAGE FORM
We 1Al pay up to for "low to wearing W
parel and other peftwal offum which aw
(1) owned by an "insured'; and
(2) lr� or on your covered 'auto".
in the event of a total *w ft I*W of your covered
'auto'.
(2)
(a) Overdue leaseften paymerft at to time
(b) Ftnancial pwWdos Wowed under a
lease for excessWe use, abna mvg wear
and tear or tigh mileage;
(e) Secc>rily deposits not rekffyned by the.
sor,
I '. Health. Aoddwa o DisaWty
i wxsnce purchme4 wVh 9* loon or
;arid
(a) Csrry -abler warleft from previous
or le
C, COIVERAOE EMMMON — AUDn VISUAL
AND DATA IC, E ONIC 111QUOMW NOT
MONO SOLELY FOR THE P'ROWCTION
OF SOUND
k
E, D, Derducxlble in amended by aWJN the
f0II
No deductH34a far a oovorad °auto' vA apply to
glass: dam-asp If the glass Is repolred rear therm
E. HIRED AtFM 'F ft ZilUWAGE C0VFA
AGE
CA T4 20 07 OB rka,aos et,o eopyelpHeod nw�brisf d lnwranoi 8arrdo�a oM600, �e+c wte+ ite pe Pop ! of 2
lndudK p* momW of The St Paul Travelers .1=
COMMERCIAL AUTO
Physical Damage, Coverage is edernded to
'auras' that you hire, Trent or lbomw subject to the
VAOWI
(1) The most we W1 pay for" JoW in any one
"acoldenf to a hired, rer ed or bomjmd
'seta" Is that kmer ot
It
(a) Any `auto' that Is hired, rented or bor-
rowed with a driver; or
(b) Any `I that Is hired. rented or bor-
rowed from ycw "employee'.
F. BLANKET WALVM OF SUBROGATION
Page 2 of 2 14OA400 NMI c0PYdQhW nUWW cmt IMUMMICS SOMicso list WRh ft wm9,Wu% CA T4 20 07 46
thm pd re WW of The t. Paul Tmftkm OwnpargIn. lam.
,Z *4,
WORKERS COMPERSATUM
AND
EMPLOYERS L ABIL Y POLICY
ENDORSEMENT WC N 03 76 (00) —
POLICY NUMBER: 1)'r1- UB-7200P538 -i6
WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS
ENDORSEMENT - CALIFORNIA
(BLANKET WAIVER)
Wh have the right to recover our payments from ;anyone noble for an Injury covered by this policy. We will not
enforce our right against the person or organization named In the Schedule.
You must maintain payroll records accurately segregating the remuneration of your employees while engaged in
the work daacxibed in the Schedule.
The additional premium for this endorsement shall be
miurn otherwise due on such remuneration.
Schedule
Person or Organization
CITY OF EL SEGUNDO, ITS OFFICERS, OFFICIALS,
EMPLOYEES, AGENTS AND VOLUNTEERS
350 MAIN STREET, EL SEGUNDO, CA 90245
DATE OF ISSUE: 03/01/2016 ST ASSIGN:
% of the Calilomia workers' compensation pre-
Job Oeseription
JOB: HILLCREST, CEDAR, HOLLY, WALNUT,
MARIPOSA - SDE JOB42016 -11.
11---)