PROOF OF INSURANCE (2017) CLOSEDM
July 26, 2016
City of El Segundo — Public Works Dept.
Attn: Julie Hegvold
350 Main Street
El Segundo, CA 90245
Fang Z. NI
Risk Management &
Insurance
Franchise Agreement between City of El Segundo and Chevron U.S.A. Inc.
Ordinance No. 1396
Dear Sir /Madam:
Chevron U.S.A. Inc.
6001 Bollinger Canyon Rd,
San Ramon, CA 94583
Tel 925 842 9352
Fax 925 842 6007
Chevron U.S.A. Inc. ( "Chevron ") is covered for property and liability exposures through major
worldwide insurance programs with large deductibles. Losses that fall within these deductible levels,
including those for which Chevron is contractually liable, are self - administered and paid through the
financial resources of Chevron.
This is to confirm that the insurance requirements of the subject agreement fall within Chevron's
deductible levels. Therefore, losses for which Chevron is required to insure under the agreement will be
covered to the extent of the agreement's minimum insurance requirements and administered as described
above.
This further confirms that Workers' Compensation insurance requirements for Chevron companies are
satisfied through insured /self - insured programs depending upon the location of the employee's
workplace.
This letter is in lieu of a certificate of insurance and will remain valid until the expiration or earlier
termination of the subject agreement (or any renewal thereof).
Sincerely,
J ° 11.
Feng Z. Ni
cc: Ray Riddle
a�,
CONTINUATION
CERTIFICATE
TRAVELERS CASUALTY AND SURETY COMPANY OF AMERICA
a certain Bond No. 1 0331 281 9 -0384
dated effective July 18, 2006
(MONTH- DAY -YEAR)
on behalf of CHEVRON U.S.A. INC.
(PRINCIPAL)
and in favor of CITY OF EL SEGUNDO
(OBLIGEE)
does hereby continue said bond in force for the further period
beginning on
7/18/2016
(MONTH- DAY -YEAR)
and ending on
7/18/2017
(MONTH- DAY -YEAR)
Amount of bond
$ 100,000.00
Description of bond Pipeline Franchise - Franchise Ordinance #1396
Premium: $ 185.00
, Surety upon
PROVIDED: That this continuation certificate does not create a new obligation and is executed upon the express condition and provision
that the Surety's liability under said bond and this and all Continuation Certificates issued in connection therewith shall not be cumulative
and that the said Surety's aggregate liability under said bond and this and all such Continuation Certificates on account of all defaults
committed during the period (regardless of the number of years) said bond had been and shall be in force, shall not in any event exceed
the amount of said bond as hereinbefore set forth.
Signed and dated on January 11, 2017
(MONTH- DAY -YEAR)
By
ATTORNEY -IN -FACT Tracy Aston
CALIFORNIA ALL - PURPOSE ACKNOWLEDGMENT
A Notary Public or other officer completing this certificate verifies only the identity of the
individual who signed the document to which this certificate is attached, and not the truthfulness,
accuracy, or validity of that document.
State of California
County of Los Angeles
On `I A _N _ 1 r before me, Edward arcl C, Specter, No tar
Irk 'ublic, personally appeared
Tracy Aston ._ who proved to me on the basis of satisfactory evidence to be the person(s)
whose name(s) is /a-@ subscribed to the within instrument and acknowledged to me that
hg /she /th€y executed the same in his/her/ th� authorized capacity(i s), and that by his/her /th i
signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s)
acted, executed the instrument.
I certify under PENALTY OF PERJURY under the laws of
the State of California that the foregoing paragraph is true
and correct.
WITNESS my hand and official seal.
Signature CQ
Signature of Notary Public
EDWARD C. SPECTOR
Commission # 2081674
Notary Public California
Z Los Angeles County
M Comm. Ex Tres Se 24, 2018
WARNING: THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER
POWER OF ATTORNEY
TRAVELERSJFarmington Casualty Company St. Paul Mercury Insurance Company
Fidelity and Guaranty Insurance Company Travelers Casualty and Surety Company
Fidelity and Guaranty Insurance Underwriters, Inc. Travelers Casualty and Surety Company of America
St. Paul Fire and Marine Insurance Company United States Fidelity and Guaranty Company
St. Paul Guardian Insurance Company
Attorney -In Fact No.
230610
Certificate No. 006711633
KNOW ALL MEN BY THESE PRESENTS: That Farmington Casualty Company, St. Paul Fire and Marine Insurance Company, St. Paul Guardian Insurance
Company, St. Paul Mercury Insurance Company, Travelers Casualty and Surety Company, Travelers Casualty and Surety Company of America, and United States
Fidelity and Guaranty Company are corporations duly organized under the laws of the State of Connecticut, that Fidelity and Guaranty Insurance Company is a
corporation duly organized under the laws of the State of Iowa, and that Fidelity and Guaranty Insurance Underwriters, Inc., is a corporation duly organized under the
laws of the State of Wisconsin (herein collectively called the "Companies "), and that the Companies do hereby make, constitute and appoint
Tracy Aston, Kristine Mendez, KD Conrad, Simone Gerhard, Edward C. Spector, Lisa K. Crail, B. Aleman, Misty Wright, Renato F. Reyes, April
Martinez, and Marina Tapia
of the City of ,,,,,,,, "„ TS AB° ,State of California their true and lawful Attorneys) -in -Fact,
each in their separate capacity if more than one is named above, to sign, execute, seal and acknowledge any and all bonds, recognizances, conditional undertakings and
other writings obligatory in the nature thereof on behalf of the Companies in their business of guaranteeing the fidelity of persons, guaranteeing the performance of
contracts and executing or guaranteeing bonds and undertakings required or permitted in any actions or proceedings allowed by law.
IN WITNESS WHEREOF, the Companies have caused this instrument to be signed and their corporate seals to be hereto affixed, this 25th
day of March ......... ............................... 2016
Farmington Casualty Company
Fidelity and Guaranty Insurance Company
Fidelity and Guaranty Insurance Underwriters, Inca
St. Paul Fire and Marine Insurance Company
St. Paul Guardian Insurance Company
St. Paul Mercury Insurance Company
Travelers Casualty and Surety Company
Travelers Casualty and Surety Company of America
United States Fidelity and Guaranty Company
State of Connecticut
City of Hartford ss.
By; ......... ....
Robert L. Ran m ^okpi' Vice President
On this the 25th day of _,. - _March 2016 , before me personally appeared Robert L. Raney, who acknowledged himself to
be the Senior Vice President of Farmington Casualty Company, Fidelity and Guaranty Insurance Company, Fidelity and Guaranty Insurance Underwriters, Inc., St. Paul
Fire and Marine Insurance Company, St. Paul Guardian Insurance Company, St. Paul Mercury Insurance Company, Travelers Casualty and Surety Company, Travelers
Casualty and Surety Company of America, and United States Fidelity and Guaranty Company, and that he, as such, being authorized so to do, executed the foregoing
instrument for the purposes therein contained by signing on behalf of the corporations by himself as a duly authorized officer.
In Witness Whereof, I hereunto set my hand and official seal,
My Commission expires the 30th day of June, 2016. idIpib
58440 -8 -12 Printed in U.S.A.
-----------------
an MeC. Tetreault Notary Public
PER
11-Js Power of At,torney is granted undoir and by Ire aukhority of the i(Alow4lig, resofirtiones a optc(l by nhe Boank rW Directors oi'FaMirflhigton Casualty Couripany, F1delh,y
and Guiairauilo Insurance Conipany, MdOhy and CUsF,'1Tll1y lMeM.MCC, Uldcrvvfiteira,, hic., St. Paul Fn', OTIld McfDC hM1l1-eHCC 01,1111ofl)l, St. PIUl (Titoff(nDfl Jfi1wTU1JCL
' 'Colliparly, St� Paid Me'rcrltuy filsurance Company, Travelers Cronafty and Sniiely Company,'i'meleirs Casualty �unl Sltnrety Company ol'Ain""'rka' guild kjifik�d State's
Fld(day and (firmrabity Cojinpany, wt6cfii rem)hiitilom are nl aw nn ftflt and as f0low"'!
RES01111VU), flhar flit Chahlrilan, 0,1C President, any Mcc Chailimill, early Em"'cufive Mce 11"re'ek1wit, any scilliol V(%� Prv'odenit, my Vier, ilreskllein' ally secullad Vice
Pre,sldent, the Tnntstuer, airy Assi,,raifa '11"reasurer, the CoilIxe-ato Sea retary or any Assislaus Svcirctary jymy appornit Attonyeys-in Fact and Agents ua act f(m and on behalf
of [io; Company and rmay lVe, much app o�nitcc such authmity as hs or h o- cerdficme of mthorkly inay presc"Tibe to •igi[ll kviIh 0110 OUMU mid scal with tk
Cl'ompany's scat boinb, con lacN W fiM,lTrmlty, aTot oilm,,i "XI rilhigs obfi mtovy an In natuic ofu or coi[ohlronal undern ldn' and aoy
of said of m"r" oil dic Bowd tof Dkectors of any ThIlle 1111my n'mowu any sucill appocaec, rYPP4N 11,l',00(xl t[ji,' po V( o- jjjljrjn 01 it i�
FUIU1 Ill 1EIt REN'0I,VF,'1), illar 1he Challmnn' do", any Vice C.lriYnnrlui, any F, 'xceufivu %/ ce ilresidr,,ilr' any senr or V cc llle'srdenl or any Vice President may
(kde,galc aflt or any pair of the kme pifqx, aufillorCty to oille OT IC on officeirs oll employee."', ofilld"', C(Allpany'provided thw uach 'uch dcleg aion �5 in wrilllnlg and a copy
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