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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: