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PROOF OF INSURANCE (2016) CLOSEDClient#: 1266412 305FLEMIENV ACORDTM CERTIFICATE 4129/2FICATE OF LIABILITY INSURANCE UAT /29 /2D/Y016 6 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. .. "_[MP'6FjTAN „_ff 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 endors ment(s), PRODUCER NAME CONTACT Allie Mosier BB &T Insurance Services ac° No Ext 714-941-2900 � " " " " " ".. of Orange Count =dial' �(acNo), 877-297 -1116 g Y ADDRESS: amosler@.bban'.dt.COm 2400 Katella Avenue Ste 1100 ���....._......." .......... ................... " "INSURER(S) ........................ AFFORDING COVERAGE NAICq Anaheim, CA 92806 " "" _____u AFFORDING ........_ OVERA v11E......_�............�_ _� _ INSURERA: Starr Indemnity & Liability Co 38318 INSURED ............. ............_ _............._.. ___ "..........�........... ,,,, ,,,,,,,,,,,,,,- _........ INSURER B: American States Insurance Co 19704 Fleming Environmental Inc. -.. _-...........-__ _ 1372 East Valencia Drive INSURER c : Cypress man Co A) 10855 Travelers Property Casualty mM„ P Y ( __. Fullerton, CA 92831 INSURER D P Y Y -- 25674 INSURER E 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 CONTRACTOR 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. LTR AOOL SUf TYPE OF INSURANCE ,.,.,. .,.._._. _ -... _ ----._._„ _ ..__ R . t«TR . -.. _. - IN R WVD POLICY NUMBE... $ POLICY" _ ............. ..... (` ) (- POLICY EXP... ............. Y EFF P LIMITS MMIDD /YYYY MM /DD/YYYY). - - .... ..................... - .,., A X COMMERCIAL GENERAL LIABILITY 1000065882151 9/0112015 09/01/2016 R 0,000 ^,. X X ecC.I.. DAMAGE TQ RENTED `PREMISESUE 000 CLAIMS -MADE OCCUR . � $300 X Pollution Liability MED EXP `Any one person) s25000 ww y X Professional Llab PERSONAL & ADV INJURY ....................... $1,000 000. .... .... GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE s2,000,000 PRO - POLICY JECT LOG PRODUCTS - COMPIOP AGG ......................... $ 0,,000 OTHER: BI /PD Ded $$5,000 Ded AUTOMOBILE LIABILITY B __._.. 01 C 17208723 09/01/2015 09/01/201 COMBINED j IN�'�L� LIMI U $1,000,000 X ANY AUTO BODILY INJURY (Per person) $ ALL OWNED" SCHEDULED .X BODILY INJURY (Per accident) $ NON -OWNED X HIRED AUTOS AUTOS PROPEiif DAIMAG-E " fper acci enI $ A UMBRELLA LIAR X OCCUR 1000336696151 9/0112015 09/01/2016 EACH OCCURRENCE X EXCESS LIAB CLAIMS -MADE AGGREGATE .. "" m$ Sr O, O, O,,, O0, Om,_,,, ,,,,,,,,,,,,, ". ",,,,,,,,,,,,,,, DEC) X RETENTION $0 $� COMPENSATION WORKERS COMA. C FLWC704305 PER OTH 5/0112016 05/01/2017 X EB•• .... AND EMPLOYE LIABILITYT.ATLlT�_ Y / N ANY PROPRIETOFVPARTNER/EXECUTIVE E L EACH ACCIDENT $1,000x000 OFFICLRJMd,EMaER EXCLUDED? NJ N/A (Mandatory In NH) E.L,. DISEASE - EA EMPLOYEE. $1 000.000 If yes describe under DESCRIPTION OF OPERATIONS ... below mmmmITITITITmmmITITITIT . _.......... E.L DISEASE POLICY LIMIT $1,0007000 D Rented /Leased QT6606686M19ATIL15 9/01/2015 09101/201 $1,000 Deductible Equipment $160,000 Max Per Item DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) RE: Maintenance Agreement. The City of El Segundo, its officers, officials, employees, agents and volunteers are named as additional insured as respects general liability, this insurance is primary and noncontributory with any other insurance of the additional insured; and waiver of subrogation applies as respects workers compensation as required by written contract, per endorsements attached. (See Attached Descriptions) CI of El Segundo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE g THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Department of Public Works ACCORDANCE WITH THE POLICY PROVISIONS. 150 Illinois Street El Segundo, CA 90245 AUTHORIZED REPRESENTATIVE ©1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) 1 of 2 The ACORD name and logo are registered marks of ACORD #S16082097/M16082077 ACMOS SAGITTA 25.3 (2014/01) 2 of 2 #S16082097/M16082077 Policy No. 1000065882151 *"Starr Indemnity & Liability Company Dallas, TX 1- 866 - 519 -2522 Primary and Non - contributory, Additional insured and Waiver of Subrogation This endorsement modifies the insurance coverage form(s) listed below that have been purchased by you and evidenced as such on the Declarations page. Please read the endorsement and respective policy(ies) carefully. Commercial General Liability Coverage Form Owners and Contractors Protective Liability Coverage form Products /Completed Operations Liability Coverage Form Contractors Pollution Liability Coverage Form Professional Liability Coverage Form Site Pollution Liability Coverage Form SCHEDULE All as required by written, signed or executed contract. A. SECTION II - WHO IS AN INSURED is amended to include as an insured the person or organization shown in the schedule of this endorsement, but only with respect to liability arising out of "your work" for that insured by or for you. B. As respects additional insureds as defined above, this insurance also applies to "bodily injury" or "property damage" arising out of your negligence when the following written contract requirements are applicable: 1. Coverage available under this coverage part shall apply as primary insurance. Any other insurance available to these additional insured's shall apply as excess and not contribute as primary to the insurance afforded by this endorsement. 2. We waive any right of recovery we may have against these additional insured's because of payments we make for injury or damage arising out of "your work" done under a written contract with the additional insured. 3. The term insured is used separately and not collectively, but the inclusion of more than one insured shall not increase the limits or coverage provided by this insurance. Insureds and Agents are advised that certificates of insurance should be used only to provide evidence of insurance in lieu of an actual copy of the applicable insurance policy. Certificates should not be used to amend, expand or otherwise alter the terms of the actual policy. ALL OTHER TERMS AND CONDITIONS REMAIN UNCHANGED. Signed for STARR INDEMNITY & LIABILITY COMPANY Charles H. Dangelo, resldent d ad ».klm �G I"�p," Nehemiah E. Ginsburg, General, ounseI OG - 023 (06111) Page 1 of 1 Copyright © C. V. Starr & Company and Starr Indemnity & Liability Company. All rights reserved. Includes copyrighted material of ISO Properties, Inc., used with its permission. WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 04108 (Ed. 9 -14) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA BLANKET BASIS 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.) The additional premium for this endorsement shall be 2% of the total manual premium otherwise due on such remuneration. The minimum premium for this endorsement is $350. This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. F'Til:i� +111 -1 BLANKET WAIVER Person /Organization Blanket Waiver — Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. Job Description Waiver Premium All CA Operations 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 05/01/2016 Insured Insurance Company Cypress Insurance Company WC 99 0410B (Ed. 9 -14) Policy No, FLWC704305 Countersigned by Endorsement No. Premium $