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PROOF OF INSURANCE (2017) CLOSED ELECBEL-01 OWEN' 'NA CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 1212212016 ............. ............................................................................................................. 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 o certificate holder in lieu of such endorsement this certificate does not confer ri hts tm„ the certi ' c (s)............................mmm a IT mm PRODUCER NRINTPcT Willis Towers Watson Certificate Center Willis of Texans,Inc. E -73 $ FAX" ' -2378 2ox 3Blvd Ex N°)(888)467 E-MAIL O60b19Cert ficates wiis.com Nashville,TN 37230-5191 INSURER(S)AFFORDING COVERAGE NAIC# INSURERA.OId Republic General Insurance Corporation 24139 INSURED INSURERB:Zurich American Insurance Company 16535 Elecnor Belco Electric,Inc. INSURER C: 4331 Schaefer Avenue INSURER D: Chino,CA 91710 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS....IS....TO....CERT�FY...THAT THE POLICIES OF.. F I R 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 POLIC ES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY 'AID CLAIMS, INSR YR TYPEOFINSURANCE INSD ADDL�SUBR POLICY IMMDD(YYYYI EXP.................................................................................................................. POLICY NUMBER LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE I X I OCCUR X X A6CGO8241602 11/01/2016 11/01/2017 L'A A 1 RElTIti w 100,000 � M ED,FXP,(Any,one,person), ,,$ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GIdN,AGGREGATE LIMIT APPLIES Ill P. G 23000,000 POLICY I X N PRO- ❑ LOC, PRODUCTS CDMP OP aGG s 2,000,000 $ AU—OMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (F.a,,,'IFeif?9M) ., X ANY AUTO X A6CA08241602 11/0112016 11/01/2017 BODILY INJURY„(Perpprson) $,,, X AUTOS ONLY AUTOSULED BODILY INJURY (per accident)„„$ „ HIRED NON-OWNED && AUTOS ONLY AUTOS ONLY yF DAMAGE �ircJcivaryI .$ .., $ AGGREGATE .. ,.,.,., $ 6 � UMBRELLA LIAB � X l OCCUR EACH aC RRENCE B X EXCESS LIAB CLAIMS-MADE SXS 1009316-02 11101/2016 11/01/2017 2,000,000 DED Y I RETENTION$ $ A WORKERS DcE°MOEET ft/PARTNER/E ECUTIVE Y� NIA X A6CW11561603 11/0112016 11101/2017 STATI,ITE ACCIDENT FIR $ 1,000,000 (Mandatory In NH) E L DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E L DISEASE•POLICY LIMIT $ DESCRIPTION OF THIS CERTIFICATE VOIDS LOCATIONS�VEHICLES TH Addltlonol IISSUED Remarks Schedule,may D attached If 1812 space is required) CERTIFICATE DATED:12N8/2016 Re:Fiber Optic Network Expansion-Project No,PW 16-33 The City of El Segundo,its officers,officials,employees and volunteers are included as Additional Insureds as respects to General Liability. General Liability policy shall be Primary to any other insurance in force for or which may be purchased by Additional Insureds. SEE ATTACHED ACORD 101 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of El Segundo-Dept.of Public Works A...... �,.�.,.�. .... UTHO RIZED REPRESENTATIVE VE John Gilmour 350 XXX 350 Main Street IElSer1.4t.DSjti2 CA 9024`>a �.....................................r. _......................... .............. ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID:ELECBEL-01 OWENSNA LOC#: 1..... AC<:? O ADDITIONAL REMARKS SCHEDULE Page 1 of 1 ............................. ........... ............... AGENCY NAMED INSURED ................................... Willis of Texas, Inc. 4331 Schaefer Avonue Elecnor Belco Electric,Inc. 's POLICY NUMBER Chino,CA 91710 SEE PAGE 1 CARRIER NAIC... ..,�.,�._____., _.. .._......... .... ..... E m SEE PAGE 1 SEE P 1 EFFEC TIVE DATE:SEE_PAGE 1 ADDITIONAL REMARKS ......................................................................................._.. ... ................................. .........,,,................ .................................................................... THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 2.5 FORM TITLE: certificate of Liability Insurance Description of Operations/Locations/Vehicles: Waiver of Subrogation applies in favor of Additional Insureds with respects to General Liability,Auto Liability,and Workers Compensation,as permitted by law. I I w........ ©2008 ACORD CORPORATION. All rights ACORD 101 (2008/01) 9 hts reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: A-6CG-082416-02 COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED 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) Location(s)Of Covered Operations CITY OF EL SEGUNDO, ITS OFFICERS, OFFICIALS, EMPLOYEES AND VOLUNTEERS. 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 B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following additional organization(s) shown in the Schedule, but only exclusions apply: with respect to liability for"bodily injury", "property This insurance does not apply to "bodily injury" or " damage" or "personal and advertising injury" pp y y ry caused, in whole or in part, by: property damage occurring after: 1. Your acts or omissions;or 1. All work, including materials, parts or equipment furnished in connection with such 2. The acts or omissions of those acting on your work, on the project (other than service, behalf; maintenance or repairs) to be performed by or in the performance of your ongoing operations for on behalf of the additional insured(s) at the the additional insured(s) at the location(s) location of the covered operations has been designated above. completed; or However: 2. That portion of "your work" out of which the 1. The insurance afforded to such additional injury or damage arises has been put to its intended use by any person or organization insured only applies to the extent permitted by other than another contractor or subcontractor law; and engaged in performing operations for a 2. If coverage provided to the additional insured is principal as a part of the same project. 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. CG 20 10 04 13 ©Insurance Services Office, Inc., 2012 Page 1 of 2 C. With respect to the insurance afforded to these 2. Available under the applicable Limits of additional insureds, the following is added to Insurance shown in the Declarations; Section III—Limits Of Insurance: whichever is less. If coverage provided to the additional insured is This endorsement shall not increase the required by a contract or agreement, the most we applicable Limits of Insurance shown in the will pay on behalf of the additional insured is the Declarations. amount of insurance: 1. Required by the contract or agreement;or Page 2 of 2 0 Insurance Services Office, Inc., 2012 CO 20 1 0 04 13 POLICY NUMBER: -6CG-082416-02 COMMERCIAL GENERAL LIABILITY CG 20 37 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES O 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 CITY OF EL SEGUNDO, ITS OFFICERS, OFFICIALS, EMPLOYEES AND VOLUNTEERS. 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 B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following is added to organization(s) shown in the Schedule, but only Section III-Limits Of Insurance: with respect to liability for "bodily injury" or If coverage provided to the additional insured is "property damage"caused, in whole or in part, by required by a contract or agreement, the most we 1.your work" at the location designated and will pay on behalf of the additional insured is the described in the Schedule of this endorsement amount of insurance: performed for that additional insured and included in the "products-completed operations 1. Required by the contract or agreement;or hazard". 2. Available under the applicable Limits of However: Insurance shown in the Declarations; 1. The insurance afforded to such additional whichever is less. insured only applies to the extent permitted This endorsement shall not increase the applicable by law; and Limits of Insurance shown in the Declarations. 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. CG 20 37 04 13 0 Insurance Services Office, Inc., 2012 Page 1 of 1 COMMERCIAL GENERAL LIABILITY CG 20 0104 13 THIS ENDORSEMENT CHANGES THE POLICY. IT CAREFULLY, OTHER PRIMARY AND NONCONTRIBUTORY - INSURANCE N CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance (2) You have agreed in writing in a contract or Condition and supersedes any provision to the agreement that this insurance would be contrary: primary and would not seek contribution Primary And Noncontributory Insurance from any other insurance available to the additional insured. This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and CG 20 0104 13 0 Insurance Services Office, Inc., 2012 Page 1 of 1 POLICY NUMBER:A-6CG-082416-02 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 Of Person Or Organization: CITY OF EL SEGUNDO, ITS OFFICERS, OFFICIALS, EMPLOYEES AND VOLUNTEERS. 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 0 Insurance Services Office, Inc., 2008 Page 1 of 1 0 OLD REPUBLIC GENERAL INSURANCE CORPORATION WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT I 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. I This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule CITY OF EL SEGUNDO, ITS OFFICERS, OFFICIALS, EMPLOYEES AND VOLUNTEERS 'I The premium charge for this endorsement is $0.00 i I I I d ELECNOR BELCO ELECTRIC, INC.Named Insure .. Policy Number A-& ....._. ....... _... 15616-03 Endorsement No. 000 Policy Period 11/09/2016 to Endorsement Effective Date: w 11/oi/zoi6 11/01/2017 _ Producer's Name: OLD REPUBLIC CONSTRUCTION INSURANCE AGENCY, INC. ... ..Producer Number. 0000007006 I AUTHORIZED REPRESENTATNE DATE WC 99 03 16(09106)