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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