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PROOF OF INSURANCE (2017) CLOSED AC"W> DATE(MM/DDIYYYY) Jdre0. CERTIFICATE OF LIABILITY INSURANCE 11/23/2016 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 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 endorsement(s). PRODUCER NAME: Danny Lopez Dealey, Renton &Associates PHONE 714-427-3484 FAX P. O. Box 12675 (A/C,No,Ext): (A/C,No): Oakland CA 94604-2675 ADDRESS,d1opez aNnsdra,com INSURER(S)AFFORDING COVERAGE i NAIC# INSURERA:Travelers Indemnity Co.of Connect) 25682 INSURED INSURER B:Travelers Property Casualty Co of A ',25674 Risk Management Professionals INSURER C:U.S. Specialty Insurance Company 29599 Two Venture Plaza, Ste. 500 Irvine CA 92618 INSURER D: INSURER E: I INSURER F: COVERAGES CERTIFICATE NUMBER: 150746112 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP I LIMITS L'rR _ INSD WVD POLICY NUMBER �(MM1DD1YYYY'Y (MM1DDPYYYY,� B X COMMERCIAL GENERAL LIABILITY Y Y 68051-1241621 12/11/2016 12/11/2017 EACH OCCURRENCE $2,000,000 PAMAI",,E 10 REN fED $1,4700.gC10 CLAIMS-MADE X OCCUR PREMISES En wcciiuynmci�) MED EXP(Any one person) $1_0,000 4`''I':RSONAI.5 ADV INJURY $2,()00,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE' $4,000,000 POLICY X ]1 PRO- LOC IxrICIrSiU("'f'S,CC]MP if"fl''AG('a $4,000,000 JECT OTHER � A AUTOMOBILE LIABILITY _.._.._..._...�.__.—._Y_. _Y__m. .12/.._..._--_16 12/11/201�_.. Ea aw:cldeA� BAb707L92 • A 11/20 7 (.A.r' dpNl'C�,dP ANY AUTO BODILY INJURY(Per person) $ AUT OWNED SCHEDULED BODILY INJURY(Per accident) $ X HIRED AUTOS X NON-OWNED TerOa�id1"II�3AM7A(nL' $ UMBRELLA LAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAdMS-MADE AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION y UB7641Y390 11/12/2016 11/12/2017 X PER OD.I•' AND EMPLOYERS'LIABILITY YIN 1 A"I"1,11T U R ANY PROPRIETOR/PARTNER/EXECUTIVE NIA E,L,EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 II ea,describe under (.t S(.RIPI'tl(,pN(W OPERATW(WS below E.L DISEASE-POLICY LIMIT $1,000.006 C Professional Liability Y USS1526330 12/11/2015 12/11/2016 $2000„000 each claim $2,000,000 Aggregate Claims Made DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached it more space is required) CITY, its officials, and employees are additional insured as respects general liability for claims arising from the operations of the named insured as required per written contract or agreement. CERTIFICATE HOLDER CANCELLATION 30 Cacnellation/10 Non-Payment SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of El Segundo—Public Works THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ATTE: Lifan Xu,P.E, Principal CIVII Engineer ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main St El Segundo CA 90245-3813 AUTHORIZED REPRESENTATIVE 17 — Oc 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of',ACORD POLICY NUMBER: 6805H241621 COMMERICAL GENERAL LIABILITY ISSUE DATE:12/12/2016 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED. (ARCHITECTS, I S AND SURVEYORS) This endorsement modifies insurance provided under the following; COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE NAME OF PERSON(S) OR ORGANIZATION(S): City of E1 Segundo - Public works ATTE: Lifan Xu, P.E, Principal Civil Engineer 350 Main St El Segundo CA 90245-3813 PROJECT/LOCATION OF COVERED OPE CITY, its officials, and employees PROVISIONS A The following is added to WHO IS AN INSURED The insurance provided to such additional (Section II): insured is limited asfollows: The person or organization shown in the Sched- ule above is an additional insured on this Cover- d. This insurance does not apply to the render- age Part, but only with respect to liability for bod- ing of or failure to render any "professional ily injury", 'property damage" or 'personal injury services". caused, in whole or in part, by your acts or omis- sions or the acts or omissions of those acting on e. The limits of insurance afforded to the addi- your behalf: tional insured shall be the limits which you agreed in that'contract or agreement requir- a. In the performance of your ongoing oper- ing insurance" to provide for that additional ations; insured, or the limits shown in the Declarations for this Coverage Part, b. In connection with premises owned by or whichever are less. This endorsement does rented to you;or not increase the limits of insurance stated in the LIMITS OF INSURANCE (Section III)for C. In connection with your work and included this Coverage Part. within the "products-completed operations hazard." B. The following is added to Paragraph a. of 4. Other Insurance in COMMERCIAL GENERAL Such person or organization does not qualify as LIABILITY CONDITIONS(Section IV): an additional insured for"bodily injury", "property However, if you specifically agree in a contract or damage"or"personal injury'for which that person agreement requiring insurance that, for the addi- or organization has assumed liability in a contract tional insured shown in the Schedule, the insur- or agreement. ance provided to that additional insured under this CG D3 82 09 07 Page 1 ©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 injury" arising out of"your work" on or for the basis, or a primary and non-contributory project, or at the location, shown in the basis, this insurance is primary to other Schedule above, performed by you, or on insurance that is available to such additional your behalf, under a "contract or agreement insured which covers such additional insured requiring insurance" with that additional as a named insured, and we will not share insured. We waive these rights only where with the other insurance, provided that: you have agreed to do so as part of the "contract or agreement requiring insurance" (1) The "bodily injury" or "property damage" with that additional insured entered into by for which coverage is sought occurs; you before, and in effect when, the "bodily and injury" or "property damage" occurs, or the "personal injury" offense is committed. (2) The "personal injury" for which coverage is sought arises out of an offense D. The following definition is added to committed; DEFINITIONS (Section V): after you have entered into that "contract or "Contract or agreement requiring insurance" agreement requiring insurance" for such means that part of any contract or additional insured. But this insurance still is agreement under which you are required to excess over valid and collectible other include the person or organization shown in insurance, whether primary, excess, the Schedule as an additional insured on contingent or on any other basis, that is this Coverage Part, provided that the "bodily available to the additional insured when the injury" and "property damage" occurs, and additional insured is also an additional the "personal injury" is caused by an offense insured under any other insurance. committed: C. The following is added to Paragraph 8. a, After you have entered into that contract Transfer Of Rights Of Recovery Against or agreement; Others To Us in COMMERCIAL GENERAL LIABILITY CONDITIONS (Section IV): b. While that part of the contract or agreement is in effect; and We waive any rights of recovery we may have against the additional insured shown in c. Before the end of the policy period. the Schedule above because of payments we make for "bodily injury", "property damage" or "personal CG D3 82 09 07 Page 2 ©2007 The Travelers Companies, Inc. Includes the copyrighted material of Insurance Services Office Inc.,with its permission POLICY#:BA6707L92A COMMERCIAL AUTO CA 20 48 02 99 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY„ DESIGNATED INSURED This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions ofthe Coverage Form apply unless modi- fied by this endorsement. This endorsement identifies person(s)or organization(s)who are "insureds" under the Who Is An Insured Provi- sion 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. Endorsement Effective: 12/11/2016 Countersigned By: Named Insured: �� Risk Management Professionals " _..............._......__........_........_.._..._..._.._._..._.._...__......._..._.........M...p...e. _. (Authorized Representative) SCHEDULE ....�..................................................�................. Name of Person(s)or Organization(s): CITY, its officials, and employees (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to the endorsement.) Each person or organization shown in the Schedule is an "insured" for Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured Provision contained in Section II of the Coverage Form. CA 20 48 02 99 Copyright, Insurance Services Office, Inc., 1998 COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY BLANKET WAIVER OF SUBROGATION This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this required of you by a written contract executed endorsement, the provisions of the Coverage Form prior to any"accident"or"loss", provided that apply unless modified by the endorsement. the "accident" or"loss" arises out of the Paragraph S. Transfer of Right Of Recovery Against operations contemplated by such contract. Others To Us of the CONDITIONS section is replaced The waiver applies only to the person or by the following: organization designated in such contract. 5. Transfer Of Rights Of Recovery Against Others To Us We waive any right of recovery we may have against any person or organization to the extent CA T3 40 08 08 ©2008 The Travelers Companies, Inc. 1 TRAVELERS.J WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 99 03 76(00)—001 POLICY NUMBER: UB7641Y390 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT CALIFORNIA (BLANKET WAIVER) 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. 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 3.00 % of the California workers' compensation premium otherwise due on such remuneration. Schedule Person or Organization Job Description ALL PERSONS OR ORGANIZATIONS THAT ARE PARTIE TO A CONTRACT THAT REQUIRES YOU TO OBTAIN THIS AGREEMENT, PROVIDED YOU EXECUTED THE CONTRACT BEFORE THE LOSS. DATE OF ISSUE:12-/12/2016 ST ASSIGN: cA 017106