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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