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PROOF OF INSURANCE (2016 - 2017) CLOSEDClient#: 2042 MOOREIACO
/YYYY)
ACORD., CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD
031(MMIDD 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
-LOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
PRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
.,IPWORT NT. 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 endorsernent(s).
PRODUCER Mb Jo Lusk
Dealey, Renton & Associates PHONE . 510 465 - 3090_._ ................_.___......_.. ....._._.........._._.__...._.. PAAr� N� -510 452 - 2193..............
P. O. Box 12675 EWAI - - _ -._._ __.______ . _ L . ti __. ...... .. .............
AODRC;SS: jlusk�dealeyrenton..com
Oakland, CA 94604 -2675 ___ m ____ _ ............
... Travelers
NAIC #
510 465 -3090 INSURER A ; ln demmty Co.
of Conn 25682
INSURED INSURER B: Travelers Indemnity Company 25658
Moore lacofano Goltsman, Inc.
INSURER C: Travelers Property Casualty Co 25674_
800 Hearst Ave. - J
INSURER D Twin City Fire Insurance Co. 29459
Berkeley, CA 94710 ACE American Insurance Company 22667��.W�.......
INSURER E : P Y
COVERAGES CERTIFICATE
NUMBER:
REVISION NUMBER:
THIS IS TO CERTIFY THAT T!iE POLICIES
OF
INSURANCE
LISTEC BELOW HAVE BEEN
ISSUED TO
THE INSURED
NAMED ABOVE FOR THE
POLICY PER!OD
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,
XCL OF SUCH
EXCLUSIONS
POLICIES.
E
S SHOWN MAY HAVE BEEN
REDUCED
BY PAID CLAIMS
—
gNSR
LTR TAYFE OFONSDIRANCE
AOOLS�
INS
WI
Y!! ..
POLIO ,UMBER_.�,.,(MMIDD/YYYY,
Y" EFF
POLIO...
POLICY' EXP
�MM /DDIYYYY],
LIMITS
COMMERCIAL GENERAL LIABILITY
B CLAIMS -MADE � X� OCCUR
6802G257248
8/3112015
08/31/201
_PREMSES E Eoccu °ocel
$1 000 000
MED EXP (An,y on person „�
I „m
NAL V INJURY
PERSO, - & AD_...
$ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
GENERALAGGREGATE
$2,000,000
POLICY � JECT � LOC
PRODUCTS - COMP /OPA GG
$�2� ,000,0- 0
.S ...PRO-
AUTOMOBILE u ABILITY
... .,,,
.. ................ ..m...�
BA2 G258325
8/31/2015
....
08/31/201
CO MBINED SINGLE LIMIT
I 4. , Ao) _
-0 _
X1,000,000
X ANY AUTO
BODILY INJURY (Per person)
$
ALL OWNED SCHEDULED
_._.... AUTOS ,.... ,... AUTOS
,,.
...... .....-- u---- -w�..
. BODILY INJURY (Per accident
......_„
$
NON -OWNED
X.. HIRED AUTOS X AUTOS
PROPERTY DAMAGE
,Per arriclenl)
$
C X
CUPOH758762
3/22/2016
08/3 1/201
EACH OCCURRENCE
$1.0, 000000
EXCESS LIAB CLAIMS MADE
AGGREGATE
$1010001000
DED RETENTION $ ... ...
.... ..,.
„,,, ,. _
$ .,... .... .
D WORKERS COMT I
.,
57WEDD8525
4/01/2016
04101/201
X P ”
��T EPM
AND EMPLOYERS' LIABILITY Y
II
O
E? ECU TIVE�
E.L. EACH ACCIDENT
$110001QQM: 0
D N
IMandatory In NH)
NIA
E L DISEASE - EA EMPLOYEE
-- -'�-
, ....
$1,000t0U0
If yes, describe under
DESCRIPTION OF OPERATIONS below _......_.._..-
_
__.....
,.. ., ....� .. ............. w,...... .,_ w.. ...... ,..........
..., -.., .._._, ,..........
-..-. m.__....m...E,L
DISEASE - POLICY LIMIT
$1,000,000
E Professional
G21656434012
7/01/2015
07/011201
$'1,000,000' per Claim
Liability
$3,000,000 Annl Aggr.
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required)
General Liability Policy excludes claims arising out of the performance of professional services.
Note: 30 days notice of cancellation will be given except 10 days for non - payment.
Re: Project #13408.00, El Segundo Smoky Hollow Specific Plan Update
City of Duarte and its officers, officials, employees, agents, and designated volunteers are named as
additional insureds as respects general liability for claims arising from the operations of the named
insured.
CERTIFICATE. HOLDER CANCELLATION
City of El Segundo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
y g THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Planning & Bldg. Dept. ACCORDANCE WITH THE POLICY PROVISIONS.
Attn: Kimberly Christensen
350 Main Street AUTHORIZED REPRESENTATIVE
El Segundo, CA 90245 -3813
.........................
©1988 -2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014/01) 1 of 1 The ACORD name and logo are registered marks of ACORD
#S1651615/M1651503 AZM
POLICY NUMBER: 6802G239267
COMMERICAL GENERAL LIABILITY
ISSUE DATE: 08/31/2015
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
(ARCHITECTS, ENGINEERS !EE S AMID SURVEYORS)
This endorsement modifies insurance provided under the followings
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
NAME OF PERSON(S) OR ORGANIZATION(S�: City of El Segundo
Planning & Bldg. Dept.
Attn: Kimberly Christensen
350 Main Street
PROJECT /LOCATION OF COVERED OPERATIONS:
Name of additional insureds, cont'd: City of Duarte and its officers, officials, employees, agents, and designated volunteers
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 oper-
ations;
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 person
or organization has assumed liability in a contract
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
Declarations 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 Page t
© 2007 The Travelers Companies, Inc.
Includes the copyrighted material of Insurance Services Office Inc., with its permission
COMMERICAL GENERAL LIABILITY
Coverage 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 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
additional 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 insured when the
additional insured is also 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 CONDITIONS (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
project, or at the location, shown in the
Schedule above, performed by you, or on
your behalf, under 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 insurance"
with that additional insured entered into by
you before, and in effect when, the "bodily
injury" or "property damage" occurs, or the
"personal 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 under which you are required to
include the person or organization shown in
the Schedule as an additional insured on
this Coverage Part, provided that the "bodily
injury" and "property damage" occurs, and
the "personal injury" 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.
CG D3 82 09 07 Page 2
© 2007 The Travelers Companies, Inc.
Includes the copyrighted material of Insurance Services Office Inc., with its permission
Insured: Moore lacofano Goltsman, Inc.
Policy Number: 57WEDD8525
r .ve Date: 04/01/2016
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 % of the California workers' compensation premium
otherwise due on such remuneration.
SCHEDULE
Person or Organization Job Description
Name of person or organization cont'd: City of Duarte and its officers, officials, employees, agents,
City of El Segundo and designated volunteers
Planning & Bldg. Dept.
Attn: Kimberly Christensen
350 Main Street
Countersigned by
Authorized Representative
Form WC 04 03 06 (1) Printed in U.S.A.
Process Date: Policy Expiration Date: