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PROOF OF INSURANCE (2017) CLOSEDi CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DDNYYY) 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 Edgewood Partners Insurance Center (EPIC) NAME: 19000 MacArthur Blvd. PH Floor PHONE FAX Irvine, CA 92612 (1 .No_Ex*, (949) 263 -0606 (A/c, No): (949) 263 -0906 www,edgewoodins.com INSURED JIM Diaz, Inc. DBA: JM «' 18645`E:`Gale Ave., Ste #212 City of Industry CA 91748 Cf 1VFRAnF.S CERTIFICATE NUMBER: inqqnnAr, INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Travelers Property Casualty Company of America 25674 INSURER B: Travelers Casualty and Surety Co America 31194 INSURER C : INSURER D 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. INSR POLICYEFF POLICY EXP... .., ... ... .., LTR TYPE OF INSURANCE INSn WVn POLICY NUMBER. MM /DD/YYYY MM /DD/YYYY LIMITS. A r' COMMERCIAL GENERAL LIABILITY ✓ `/ 6807E603393 6/27/2016 6/27/2017 EACH OCCURRENCE $ 1,000,000 .1 CLAIMS -MADE OCCUR 'PREMISES, a occurrence)_ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ 1 ,000,000 .... GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGA^ TE $ 2,000,000 _ POLICY JECT ✓,,,, LOC PRODUCTS- COMP /OPAGG,$ 2,000,000 OTHER; $ A AUTOMOBILE LIABILITY ✓ ✓ 6807E603393 6/27/2016 6/27/2017 COMBINCO SiIIGLL LIMI t $ (Ea al ;dcl i) 1 000 000 11 1 1- ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED '' BODILY INJURY Per accident) $ AUTOS ONLY AUTOS HIRED . NON OWNED ., PROPERTY DAMAGE $ ✓ AUTOS ONLY ✓ AUTOS ONLY (Pex„d oddeyui) ,,, $ A UMBRELLALIA6 ✓ OCCUR �/ CUP7E606764 6/27/2016 6/27/2017 EACH OCCURRENCE $ 2000,000 I. EXCESS LIAB '.. CLAIMS -MADE -,,.. AGGREGATE $ 2,000,000 .. ......,,,.,. ,,,,,, ..... DED RETENTION$0 ..,,, .. .,.$ ..., A WORKERS COMPENSATION ✓ UB4288T923 6/27/2016 6/27/2017 AND Y I❑N STAT4TE FRH ECUTIVE PRIET R/ A E L EACH ACCIDENT 1,000,000 CB DEEP OFFICE N / A ,$ — ,x 0 ''. fM DESCRIPTION OF OPERATIONS below E.L.. DISEASE -POLICY LIMI1'E...$ 1,000,000 000 B Professional Liability 105263164 6/27/2016 6/27/2017 $2,000,000 per Claim Claims Made Form $2,000,000 Aggregate Knowledge Date: 4/8/2005 $10,000 Per Claim Deductible DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: El Segundo Bikeway Project Agreement Certificate holder is additional insured for general liability and hired and non -owned automobile liability coverage per form CG D3 81 0907 attached.. General liability and hired and non -owed automobile liability coverages are primary and non - contributory and waiver of subrogation applies per CG D3 81 0907 but only if required by written contract with the named insured prior to an occurrence. Subject to all policy terms and conditions. CERTIFICATE HOLDER CANCELLATION City of El Segundo 350 Main Street El Segundo CA 90220 ACORD 25 (2016103) 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 Todd Holliday © 1988 -2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 30320086 116 -17 GL, AU, PL & WC W/ AI I Denise Yamada 1 6/8/2016 4:56:02 PM (PDT) I Page 1 of 3 JM Diaz, Inc. DBA: JMD 6807E603393 6/8/2016 COMMERICAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURE (ARCHITECTS, ENGINEERS AND SURVEYORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. The following is added to WHO IS AN INSURED (Section II): Any person or organization that you agree in a "contract or agreement requiring insurance" to in- clude as an additional insured on this Coverage Part, but only with respect to liability for "bodily in- jury", "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 on any basis to any person or organization for which cover- age as an additional insured specifically is added by another endorsement to this Cover- age Part. e. This insurance does not apply to the render- ing of or failure to render any "professional services ". f. 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 the insurance provided to an additional insured under this Cov- erage Part must apply on a primary basis, or a primary and non - contributory basis, this insurance is primary to other insurance that is available to such additional insured which covers such addi- tional 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 ". But this insur- ance still is excess over valid and collectible other insurance, whether primary, excess, contingent or on any other basis, that is available to the insured when the insured is an additional 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 any person or organization because of payments we make for "bodily injury", "property damage" or "personal injury" arising out of "your work" performed by you, or on your behalf, under a "contract or agreement requiring insurance" with that person or organization. We waive these rights only where you have agreed to do so as part of the "contract or agreement requiring insur- ance" with such person or organization entered into by you before, and in effect when, the "bodily CG D3 81 09 07 © 2007 The Travelers Companies, Inc. Includes the copyrighted material of Insurance Services Office, Inc., with its permission. 303200P,F 0 C -1 GF,, AU, PL & we W/ AT ( Denise va.u­da ( 6/B/2016 4�56,02 PM Wl') 9 Page 2 of Page 1 of 2 COMMERICAL GENERAL LIABILITY injury" or "property damage" occurs, or the "per- sonal injury" 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 a person or organization as an additional insured on this Cov- erage Part, provided that the "bodily injury" and "property damage" occurs, and the "personal in- jury" is caused by an offense 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. Includes the copyrighted material of Insurance Services Office, Inc., with its permission, 30320088 11 IC 17 GC„ AU, PL & WC 2"/ Al v Denise Yarauda a C/8/2010 4r5602 PM (PUT.`) 0 Page 7, vf.` 3 CG D3 81 09 07