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PROOF OF INSURANCE (2015) CLOSEDOP ID: RG DATE (MM /DD /YYYY) ,,. CERTIFICATE OF LIABILITY INSURANCE 05/30/14 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 PRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. PORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to ,ne 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 Phone: 949 - 553 -9800 Nl ME CONTACT The Wooditch Company Insurance PHONE FAX Services, Inc. Fax: 949 - 553 -0670 ft No II 1 Park Plaza, Suite 400 ADDRESS: FESS: __ ..... Irvine, CA 92614 PRaoor� COLIC -1 Jamie Younger CUSTOMER ID #: _.. . .... Pipe.. . . .. .... ....... ...... . . .. .. INSURERIS) AFFORDING COVERAGE NAIC # INSURED Southwest line INSURER A:Old Republic General Ins. Corp 24139 and Trenchless Corp. INSURERB:St. Paul Fire & Marine Ins. Co 24767 22118 S. Vermont Ave. _ d.....� Torrance, CA 90502 LNsusu!E! GS......________........_.......___..._____ _.......___ ..................._ ._.....__ ..._....._............. .............__..._.._..�..._. INSURER D: 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 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. INTSRR .... .............FfJl1CY NAJIYI^BER m .. ........ ..Ap7Ndocy.IYYY e,� .MMI�Q _- .... ....._........_- .. �- TYPE OF INSURANCE LIMITS GENERAL LIABILITY EACH OCCURRENCE_ $ 1,000,00 A X OMMERCIAL GENERAL LIABILITY X X Al CGO0581406 06/01/14 06/01/15 � III D PREMISES (Ea 4cc��Yr��'pfir�'.. 100,00C $ , .0 ... . CLAIMS -MADE I X OCCUR MED EXP (Any one person) _$ 5,00 PERSONAL 8 ADV_INJURY $ 1,000,00 �� GENERAL AGGREGATE $ 2,000,00 �� oEN'L AGGREGATE LIMIT APPLIES PER: PROD UCTS - COMP /OP AGG $ 2,000,00 ..,,.. -.,. �.., PRO - POLICY X LOC _ ............... �...�_._...___._�_...�_,,,....� m- ......- - .....- ._.,. $ AUTOMOBILE LIABILITY X X COMBINED SINGLE LIMIT $ 1,000,000 A X ANY AUTO AlCA00581406 06/01/14 06/01/15 (Ea accident) BODILY INJURY (Per person) $ ALL OWNED AUTOS .... .....�m.,,,,,, -. BODILY INJURY (Per accident) ,- .,-..- �...... $ SCHEDULED AUTOS mm PROPERTY DAMAGEmwm..� HIRED AUTOS (Per accident) $ $ NON -OWNED AUTOS $ X UMBRELLA LIAB J X OCCUR EACH OCCURRENCE $ 1,000,00 B EXCESS LIAB CLAIMS -MADE we. �. ZUP- 81M06329 -14 -NF 06/01/14 06/01/15 AGGREGATE �_ ._ _._.._... $ 1,000,00 ........w�.. DEDUCTIBLE $ X RETENTION $ 10 000 $ WORKERS COMPENSATION X �RX t 1 ITS H- AND EMPLOYERS' LIABILITY YIN EL EACH ACCIDENT $ 1,000,00 A ANY PROPRIETORIPARTNER /EXECUTIVE " OFFICERIMEMBER EXCLUDED? N/A X AlCW93331405 06/01/14 06/01/15 1,000,00 - (Mandatory in NH) E.L.. DISEASE - EA EMPLOYEE $ If DESCRIPTION OF OPERATIONS below EL ...w_......... ..._. . _ -MIT DISEASE - POLICY LIMIT 1 $ 1,000,00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) *Except 10 Days Notice of Cancellation for Non- Payment of Premium. RE: All by the Named Insured during the operations performed current policy ity E1 Segundo, its loXees included period. of officials, and em are as Additional Insureds as respects General and Auto Lability per attached endorsements. * SEE NOTES ** glaipwv /auaiwv /wowv City of El Segundo 350 Main Street El Segundo, CA 90245 ACORD 25 (2009109) CITYEL1 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 ©1988 -2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are .egistet marks of ACORD COLIC -1 PAGE 2 NOTEPAD INSURED'S NAME Southwest Pipeline OP ID: RG DATE 05/30/14 *Should this policy be cancelled before the expiration date, The Wooditch Company will mail 30 (thirty) days written notice to those Certificate Solders which require such action per contract or agreement.* NOTEPAD. HOLDER CODE CITYEL1 COLICA PAGE 3 INSURED'S NAME Southwest Pipeline OP ID: RG DATE 05/30/14 is Insurance shall apply as Primary and Non - Contributory per attached dorsement, liver of Subrogation for Workers Compensation, General Liability, and ito Liability: See Attached Endorsements. POLICY NUMBER: AlCGO0581406 COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED ULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organizations) I Location(s) Of Covered Operations Where Required By Written Contract. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. CG 20 10 04 13 C Insurance Services Office, Inc., 2012 Page 1 of 2 C. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. Page 2 of 2 © Insurance Services Office, Inc., 2012 CG 20 10 0413 POLICY NUMBER: AlCGO0581406 COMMERCIAL GENERAL LIABILITY CG 20 37 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL AL INS RED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following:. COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS /COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations Where required by written contract, but only when Where required by written contract, but only when coverage for Completed Operations is specifically coverage for Completed Operations is specifically required by that contract. required by that contract. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the Schedule of this endorsement performed for that additional insured and included in the "products- completed operations hazard ". However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 37 0413 0 Insurance Services Office, Inc., 2012 Page 1 of 1 Policy Number: Al CGO0581406 OLD REPUBLIC GENERAL INSURANCE CORPORATION CHANGES ADDITIONAL INSURED PRIMARY WORDING SCHEDULE THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING: COMMERCIAL GENERAL LIABILITY COVERAGE FORM Name of Additional Insured Person(s) Or Organization (s): As required by written contract. Location(s) of Covered Operations Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The insurance provided by this endorsement is primary insurance and we will not seek contribution from any Other insurance of a like kind available to the person or organization shown in the schedule above unless the other insurance is provided by a contractor other than the person or organization shown in the schedule above for the same operation and job location. If so, we will share with that other insurance by the method described in paragraph 4.c, of Section IV —Commercial General Liability Conditions. All other terms and conditions remain unchanged. io lrle� AUTHORIZED REPRESENTATIVE CG EN GN 0029 09 06 06 -01 -2014 DATE POLICY NUMBER: AlCGO0581406 COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER, OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS /COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name c)t Person ter c)rgamzation; Where required by written contract. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV — Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products - completed operations hazard ". This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 1 POLICY NUMBER: AlCA00581406 COMMERCIAL AUTO CA 20 48 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED FOR COVERED AUTOS LIABILITY COVERAGE This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. SCHEDULE Name Of Person(s) Or Organization(s): WHERE REQUIRED BY WRITTEN CONTRACT. Infoimation required to cornDlete this Schedule, if not shown above, will be shown in the Declarations, Each person or organization shown in the Schedule is an "insured" for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Paragraph A.1. of Section II — Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms and Paragraph D.2. of Section I — Covered Autos Coverages of the Auto Dealers Coverage Form. CA 20 48 1013 a Insurance Services Office, Inc., 2011 Page 1 of 1 POLICY NUMBER: AlCA00581406 COMMERCIALAUTO CA 04 44 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. SCHEDULE Name(s) Of Person(s) Or Organization(s): WHERE REQUIRED BY WRITTEN CONTRACT, Information required to complete this Schedule, if not shown above. will be shown in the Declarations. The Transfer Of Rights Of Recovery Against Others To Us condition does not apply to the person(s) or organization(s) shown in the Schedule, but only to the extent that subrogation is waived prior to the "accident" or the "loss" under a contract with that person or organization. CA 04 4410 13 a Insurance Services Office, Inc., 2011 Page 1 of 1 Policy No. Al CW93331405 OLD REPUBLIC GENERAL INSURANCE CORPORATION WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING: WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY INSURANCE 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. This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule WHEN REQUIRED BY WRITTEN CONTRACT. The premium charge for this endorsement is $0.00 AUTHORIZED REPRESENTATIVE WC 99 03 15 (09106) 06/01/2014 DATE