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PROOF OF INSURANCE (2017) CLOSED ��"-"`� DATE(MMIDD/YYYY) •'" CERTIFICATE OF LIABILITY INSURANCE 12/8/2016 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 CONTACT NAME Dealey, Renton&Associates PHONE 714-427-6810 FAX 714-427-6818 DRA License 0020739 (AIC,N°"'Ext): (Arc,No), P.O. Box 10550 UD 'SS: Santa Ana CA 92711-0550 MSURERIS)ArFORDING COVERAGE NAIL 0 INSURER A:Travelers Indemnity Co. of Connecti 25682 INSURED NCMENGINEE INSURERS,Travelers Property Casualty Co of A 25674 —_ NCM Engineering Corp. INSURER c:Travelers Casualty&Surety Co.Ame 31194 22362 Gilberto, Suite 125 Rancho Santa Margarita CA 92688 INSURER D INSURER E: INSURER F COVERAGES CER'TIFICA'TE NUMBER:645954432 RE'V'ISION 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 6F INSURANCE iADDL SUBR j POLICY EFF POLICY EXP i LIMITS LTR INSD WVD I POLICY NUMBER (MM/DDIYYYY) (MM/DDIYYYY) B X COMMERCIAL GENERAL LIABILITY Y Y 6805HO6721A 12/5/2016 12/5/2017 EACH OCCURRENCE $1,000,000 0AMAGIH TO HFN'PED CLAIMS-MADE X ' OCCUR PRENUSES,(Eau.ccu;�rrosreg $1 0100.000 X Contractual MED EXP(An),one persorwl $10„000 Liability PERSONAL&ADV INJURY $1,;000 000 GE'WL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 PRO- POLICY X JECT LOC PRODUCTS-COMP/OP AGG ',$2,000,000 OTHER: $ A AUTOMOBILE LIABILITY Y Y BA1D072177 12/5/2016 12/5/2017 CUMBINED SINGLE 1-4011 $ _ (k.a sccpdenl,) 1,000.000 X ANY AUTO BODILY INJURY(Per person) $ AUTOS NED SCHEDULED BODILY INJURY(Per accident) $ UTOS NON-OWNED PROPER FY DAMAGE X HIRED AUTOS X AUTOS (Por ars:rc�Nerrl,) $ B X UMBRELLA LIAB X OCCUR CUPOD565564 12/5/2016 12/5/2017 EACH OCCURRENCE $2,000,000 EXCESS LIAB I CLAIMS-MADE AGGREGATE $2,000,000 DED RETENTION$ $ B WORKERS COMPENSATION y UB4022T740 12/512016 12/5/2017 x PER 01H_ AND EMPLOYERS'LIABILITY Y/N STATUTE ER ,ANYPROPRIETOR/PARTNER/EXECUTIVE E.L EACH ACCIDENT $1,000,000 OFFICER/MEMEER EXCLUDED? N/A (Mandatory in NH) - E L DISEASE-EA EMPLOYCE $1,000,000 If yes,describe under, DESCRIPTION OF OtNzRAXIONS below E L DISEASE-POLICY LIMIT $1,000,000 C Professional Liab. 106419895 12/5/2016 12/5/2017 Per Claim $2,000,000 Claims Made Annual Aggr. $2,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) General Liability policy excludes claims arising out of the performance of professional services. Umbrella policy is a follow-form to underlying General Liability/Auto Liability/Employers Liability. Re: Park Place Extension Project. City of E1 Segundo, its officers, employees or agents are additional insured on general & hired and non owned auto liability as per written contract. Coverage afforded the additional insured is primary and non-contributory as respects to general liability coverage. Waiver of subrogation included in work comp, general, hired and non-owned auto liability as per written contract. CERTIFICATE HOLDER CANCELLATION 30 Day NOC/10 Day for NonPay of Prem SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of El Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 350 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. El Segundo CA 90245 AUTHORIZED REPRESENTATIVE ,., wsxuM Mwar ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: 6805HO6721A COMMERICAL GENERAL LIABILITY ISSUE DATE:12/8/2016 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL I S (ARCHITECTS, INGI 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 350 Main Street E1 Segundo CA 90245 PROJECT/LOCATION OF COVERED OPERATIONS: General Liability policy excludes claims arising out of the performance of professional services. Umbrella policy is a follow-form to underlying General Liability/Auto Liability/Employers Liability. 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 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 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. OTHER INSURANCE CE - ADDITIONAL INSUREDS EDS This endorsement modifies insurance provided under the following COMMERCIAL GENERAL LIABILITY COVERAGE PART PROVISIONS b. The "personal injury" or"advertising injury"for COMMERCIAL GENERAL LIABILITY CONDITIONS which coverage is sought arises out of an of- (Section IV), Paragraph 4. (Other Insurance), is fense committed amended as follows: subsequent to the signing and execution of that 1. The following is added to Paragraph a. Primary contract or agreement by you. Insurance: 2. The first Subparagraph (2) of Paragraph b. Ex- However, if you specifically agree in a written con- cess Insurance regarding any other primary in- tract or written agreement that the insurance pro- surance available to you is deleted. vided to an additional insured under this 3. The following is added to Paragraph b. Excess Coverage Part must apply on a primary basis, or Insurance, as an additional subparagraph under a primary and non-contributory basis, this insur- Subparagraph (1): ance is primary to other insurance that is avail- That is available to the insured when the insured able to such additional insured which covers such is added as an additional insured under any other additional insured as a named insured, and we policy, including any umbrella or excess policy. will not share with that other insurance, provided that: a. The "bodily injury" or "property damage" for which coverage is sought occurs; and CG DO 37 04 05 Copyright 2005 The St. Paul Travelers Companies, Inc. All rights reserved. Page 1 of 1 POLICY#:BAlD072177 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: 12/5/2016 Countersigned By: Named Insured: NCM Engineering Corp. (Authorized Representative) SCHEDULE Name of Person(s) or Organization(s): City of El Segundo 350 Main Street El Segundo CA 90245 (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 TRAVELERV WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 99 03 76(00)— 001 POLICY NUMBER:UB4022T740 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 City of El Segundo General Liability policy excludes claims 350 Main Street arising out of the performance of El Segundo CA 90245 professional services. Umbrella policy is a follow-form to underlying General Liability/Auto Liability/Employers Liability. Re: Park Place Extension Project. City of El Segundo, its officers, employees or agents are additional insured on general & hired and non owned auto liability as per written contract. Coverage afforded the additional insured is primary and non-contributory as respects to general liability coverage. Waiver of subrogation included in work comp, general, hired and non-owned auto DATE OF ISSUE:12/8/2016 ST ASSIGN: CA 017106