PROOF OF INSURANCE (2018) CLOSED STEPH-1 OP ID: RH
�
CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDMYYY)
0310212017
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 pollcy(les)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 sndorsement(s)
PRODUCER CONTASCT Certificate Dept'
Wright,Finnegan Ass Carter s1 714 28 surance.co (FAIC NOM -283-1997
23001 Linda,Palma 288100 c 99:certlificat a""3.99wfcin .............."'................ 714 m______...__.____
John Carter CIC INSURER(S)AFFORDING COVERAGE NAIC S
INSURERA:Travelers Indemnity Co of CT _ 25682
INSURED Stephen DOreck Equipment INSURER a:Travelers Property Casualty Co � 25674
Rentals,Inc.; DDreck Construc INSURERc:Westchester Surplus Lines Ins 10172
9075 Telegraph Road
Pico Rivera,CA 90660 INSURER D:Ohio Security/Insurance Co 124082 I
INSURER E
OJeURER F
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER.
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLidY PERK)
D
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 MAYHAVE BEEN REDUCED BY PAID CLAIMS.
g TYPE OF INSURANCE _$LMw FOt((: e rl � .. w. LSArrS
L'T POLICY NUMBER (MMIDUYY"YYL(M'M(O Y)
A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,0w,000
CLAIMS-MADE 1�1 OCCUR X X DT22-00-720OP538-TCT-17 03/0112017 03!0112018 " pe 1()f'LI� � 300,00P g` rere
A "X Contractual Lia'b MED EXP(Any are person) S 5,
C X Pollution Liabil G27153136004 03/0112017 03/0112018 PERSONAL&ADV INJURY s 1r�r
GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2rowr
POLICY ®Pk O- ❑LOC PRODUCTS-COMPIOP AGG $ 2,000x000
tarl9(R P011ution s 2,000,000
AUTOMOBILE LIABILITY CUM NECy rIN'LE ILI 1r000r000
'MIJ S
(Ea accdent)
B ANY AUTO X X 'OT -810 -TIL-17 03!0112017 03!0112018 BODILY INJURY(Per person) $
ALL OWNED SCHEDULED V BODILY INJURY(Per accident) S
AUTOS AUTOS
X NON-OWNED PROPERTY DAMAGE I S
HIRED AUTOS UT S (Paracc,ident)
y��" g®
Comp/Coll $ $1,0000
UMBRELLA BRELLA LIAR ..X X OCCUR EACH OCCU'RR'ENiCE $ 5r�r
B X
EXCESS CLAIMS-MADE CUP-2J30069A-17-26 03101!2017 03101/2018 AGGREGATE I$ 5r000r
... �.
DED RETENTION S I S
W'ORIIERSCOMPENSATION X UTE ERH
A1+1"J EMPLOYERS'LIABILITf _L&._. _ ....................................
B ANY PROPRIETORPARTNERIEJECUTIVE YIN X DTJ-UB-720OP53847 03101/2017 03101/2018 E L EACH ACCIDENT I$ 1,00000
OPPICEtory InBER EXCLUDED? NIA
USL&H COVERAGE INCLUDE E L DISEASE-EA EMPLOYEE S 1,000,000
(Matwde(e h N(^1)
Ues,doscobe under
S u'RIPTION VP 4,WEPAT'I DNS bolc'w E L DISEASE-POLICY LIMIT $ 1,000,000
D Equipment SKS57272371 03/0112017 03/01/2018 DED 1000 855,1 8
D Equip Rented From OTHERS SKS57272371 08/1812016 08118 12017 ACV 130,0001
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Add VwW Remsrke SsheWe,may be stdehe V men spaee Is require)
VURARE NA OFFICERS SUAED D ROLNTEES M DASADDD ITI OVAL AN RIMAY WORDING APPLIES PER
THE BLANKET ADDITIONAL INSURED ENDORSEMENT ATTACHED TO THE POLICY-AS
REQUIRED BY WRITTEN CONTRACT. ADDITIONAL INSURED APPLIES TO AUTO LIABILITY.
WAIVER OF SUBROGATION APPLIES TO GENERAL LIABILITY,AUTO LIABILITY AND
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
CITY OF EL SEGUNDO ACCORDANCE WrtH THE POLICY PROVISIONS.
Attn: ARIANNE BOLA
350 MAIN STREET AUrHO (vE
R�zeoRErrtESENrAT
EL SEGUNDO,CA 90245 A
I
®1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD
VHOLDERCODE STEPH-1 PAGE 2
NOTEPAD:
{ INIUREWI NAME Stephen Doreck Equipment OP ID: RH Dote 03/02/2017
17-03 T�7' T'� CERTIFICATE HOLDER, IT EA'1 NON—PAYMENT TICEF — �IATIO AVE BW
WORKERS COMPENSATION. JOB. "WATER MAIN O
]C7—�� SI7 �"O M 201'�rC71« C� DAY 'WF�.'IT'T' T NOTICE O�" r.��I.TAT'I�711' WIL'�.
F PR04IUM.
insured. Dareck Constrruction,,Inc.;Stephen Doreck Equipment Rentals,Inc.
Polite: DT22-CO-7201OP538-TCT-17
ADDITIONAL IONAL r ED— OWNERS9 LESSEES R
CONTRACTORS —SCHEDULED PERSON OR
ORGANIZATION - COMPLMD OPERATIONS
OPERATIONS ASSCHEDULED
TMs endo momlies kwuranoo provMed undsrttrrs :
COMMERCIAL GENERALZ,IASUM COVERAGE PART
SCHEDULE '
Of AddftkWml Ineumd (e)
Or an ., !Sy. Location And DescrbAloni Of OPandkms
CITY OF EL SEGUNDO,ITS OFFICERS,OFFICIALS, JOB: WATER MAIN IMPROVEMENTS-MARIPOSA AVE.,
EMPLOYEES,AGENTS AND VOLUNTEERS PW 17-03,SDE JOB#2017-01.
350 MAIN STREET,EL SEGUNDO,CA 90245
A. Secdon 1I-Who Is An'llinuired b amwxW fo Enid*the e)a (s)SbOw In ft
SohWt"(called ft"i , but v*WM to
L IUIUtty for Obodk b*W or 00ropeft dental ,In whole or In pwk by el
the bostlon deskVu4W and desedbed In the schedWe of M endorserneft podwiTted fort*
")nd ee^Iruel kmawr end sd In Ism * " your
and such s)or orgee (s)have agfesd In wddm In a contned or e4 that
such s)yr (s)be norted as an additional on your
IL L.1ebillly for OboW kW.O ds "vir OpwowW and w1vedsft Infurir owned. In
whole or In peat,by;
a.Your or om ;or
b. The*cte or onibsimu aftme actfiv on ycur behalf,
In the porronyAnce of Vow wodho operafta for Ihe OaddlimW (s)et the (s)
IL Secdon IV — ConwnwvW Gawal Lill ift Condidone, 4. 00or Insltrrance Is emaided•and ft
*4owft ridded:
if you am roqubW by to wry hwurenoo,tlw I wumnas affarded by this Cow
emge Pid for the' In the Schedule is end we will not wwk
prom eny olwer' . c Wd ladditional I
ALL OTHER TERMS AND CONDMON8 OF THE POLICY REMAIN UNCHANGED.
u482-0Ios Ir► of ISO .Me,2DIX pop 1 of 1
with Its Iotldl.
Insured: Doreck Carstrudion,Inc.:Stephen 0oraok Equipment RwMs,Inc. COMMERCIAL GENERAL LIABILITY
PO4MA. DT22-CO-7200P538-TCT-17
THI$ ENDORSEMENT CHANGES THE POLICY. PLEASE:READ Cf CAREFULLY
BLANKET ADDITIONAL INSURED
(CONTRACTORS) CFTYOP CL S OUNDO,rTS OFFICERS,OFFICIALS,
EMP&.OYFES,AGCNIS AND VOLUNTEERS
350 MAIN STREET,EL SEGUNDO,CA 90245
This endoraerrwmt rnocifts insurance prolrldecd wader ttw RAOwbV.
COMMERCIAL OENF_RAL LMIUTY COVERAGE PART JOB: WATER MAIN IMPROVEMENTS-MARIPOSA AVE.,
PW 17-03,SDE JOB X 2017-01.
I. WHO IS AN IN UR,EC—(section 11)Is ame 'ed c) The insurance provided to the eddillonal In-
to Include any person or organimilon than you sured does not apply to fey I ury' or
w6e in a %wrrittaan contract requiring insurance *property damage caused by "fir WW
to include as an additional insured on this Cover- and Included In the .w nple op-
age Part,but: erattons herd"" unless the "written oontmct
a) Only with respect to liablIty ror*fly Injury', requirkV inst ra nW spodko4 'requires you
*propetky datngell or*personal Irv1ur)r4,and to provide such verage �for that additional
Insured, and then the insurance provided to
b) If. and only to ft extent ftt, the Injury or " acdoltlonal Insured applies only to aoth
dare Is caused by acts or o"ssivns of lbodily 'larw ny" or *property damage" that od,
you or your subewractor in the performance cum b+ak"the sand of the period of time for
of 'your wwoW to which the *written con4act which this "wrarttten contrad erg Insw—
iring * applies. The person or anoa" raqdres you to Ada►sca r mirage
organization does rwA quolify,as an additional or the end of the policy ',whichever
Insured with respect to the independent acts earlier.
orornbsiom of ash,paw or orgoriLmItIon. 2. The insure a provided to the anal Wured
2. The itt tram* provided to th6 taidditkmal insured by Ns endorsement to axes"over any valid and
by this endorsement Is limited as follows: collectible ble "'othat" Insurance.. Iltaer prlmaary,
a) to the event got the limits of lnwmce of excess, conftent or on any other bad, that Is
this Coverage Part shown In the Declarations available the additional Insured for a less we
eyed the limits of liability required by the cover wider this endorsement Howe, it the
""men contract rwaquInng Insurerve. the In- *written contract requiring Insure spacftsily
wimnoe pmvided to the additional insured raecluirea that this irmu arnce apply on as primary
shall be lirnike to the limits of liability re- bad or a primary and rxo-cordvibutory basis,
Wired by that "written contract maqu ing In- this Insurance Is primary to *oftw Insuren ""
surance. This endamecrtsBrl't soli not In*
available to the admiral Iced which covers
apse the limits of Insurance descwritoed In that person or orpnization as a named Insured
Section(i1—limits Of Insurance. for such Via, and we will not sham with that
b) The kmranos provided to the additional In- *Other insurance'. But Lilo ln�rrr� provided tls
the a d ditional Insured by this endoorsaa ment allll
surest�not apply to"bodily Injury""."props- excess over any valid &A collectible •otlrer Int.
+erty damage or -personal a lrq'ury""- arlSirta out sum % whether prtrary. tKoess, coatkVent or
of the randering of, or Wlure to render, any on any other basis. that is avallable to f
addi-
professional architectural,engineering or air- tional Insured when that perms or oMeniza1i
vo^ying servkra .Inctudirwg: an additional Insured uncleaear such *'other Insur.
I. Than preps ft. approving, or falling to once'.
prepare or prove. rnaps. shop, d 4. As a condition of provicie to the
opt �„ surveys, In additionst Insured by 0*endorsement
dem or change orders,„ or the Wiring. a) The ,additional Woured must tip us written
approving. or failing two � or W notice as soon as pra kable of an locour-
prove,drawings,and spectficalloml and
rence ' or an offense which may result In a
IL Supsrvlawsry. Inspection, architectural or ciaeirn. To the exient possible, such notice
wQboe tng activities, should include-
CG D2 48 08 05 *2005 The St.PoA Tire elei"s Compares,Inc. Page I of 2
COMMERCIAL GENERAL LIABILITY
I. How, when and where the "occurrence erg/provider of•other hmmnce'which wanld
or offense took place; cover th* additional instsed for a loss we
IL The names and addresses of any injured cover under this endorsement. However,this
persons and witnesses;and condition does not affect whether the Insur-
rovided to the additional Insured by
Iii. The nature and bcstfon of any IrJury or provided
endorsement Is primary to •utter Insur-
damage arfehag out of the'oawrrerme"or ance available to the additional insured
offense. which covers Out person or organization as a
b) If a claim is made or"suit Is brought against rsrrsed Insured as descibed In paragraphs S.
the additional insured, the additional inaatred above.
must: 6. The following definition Is added to SECTION V.
L Immediately record the specffics of the —DEFINITIONS:
claim or""suit`and the dtttc received; and VrIttsn contrad requiring insurance means
It. Notify us as loan as precticable. that part of any written contract or agreement
The additional Insured must see to It that we under which you are required to Include a
receive written notice of the claim or•suit"as Person or ordgar4wlon as an additional 1w
suned on this Co P ; provided that
goon as practicable. the 'bodily Injury'*and "property da ge"sag
c) The additional Insured must immediately curs and the"personal injury"is caused by an
send in copies of all legal papers received In offense committed:
connection with tugs cla3aim or m&W, cooperate a. After the signing and execution of the
with us in the Investigation or settiernent of by�;
claim or defense against the "sutif", sand contract or agreement
otherwise comply w1th all policy conditions. b. While that pert of the conhao or
d) The additional Insured must tender the de- agmement is In eff c%and
tense and indemnity of any claim or"suit/ to C. Before lute end of the poky period.
Page 2 of 2 0 2005 The St.Paul Travelers Companies,Inc. CO 02 46 08 05
Insaarsd: t comas k MWOM tr4;Stag n Condo Fq*ment RwWS,an4. COMMERCIAL GENERAL UABiLIT1f
Poll; DT2 - O.7' 0OPa 8-T T-17
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CONTRACTORS XTEND ENDORSEMENT
CRY OF EL SEGUNDO,ITS OFFICERS,OFFICIALS,
This AGENTS AND VOLUNTEERS
his end menu modMes Insurance provided under the M lhFfllg; 350 MAIN STREET,EI,SEGUNDO,CA=245
COMMt tCIAL GENT-RAL LIABILITY COVERAGE PART JOB: WATER MAIN IMPROVEMENTS-MARIPOSAAVE,
PW 17-03,SDE JOB#2017-01.
OENERAL DESWUPTION OF COVERAGE-Provisions A,-H'.and,M.-N'.of Hulas erx$orsam b n coverage,
and provision 1. of this er)dorsement may limit coverage. The fca#&MrV listing is a general coverage desaipticin
only, Umitations and exclusions nay°apply to these caveragea. Read all the PROVISIONS of this endorsatnent
carefully to determine rights,duties.and wheat is and is not aoverod.
A. Broadened Named Insurasd H. Additional Insured-State or Political Subdlvlrions
B. Extension of Coverage-Dwogo To Pramises 1. Other Irmurence Condition
Rented To You J. IncmeW Suptatementary Payments
* Peas of fire,eWoslom Ightrdng, =x*e,water + Cost of baf tx»tds increased to$2.5110
• Limit Increased to$340,000 a moss of eamkW Increased to$5110 per day
C. Blanket Waiver of Subrogation K. KnOvAedge and Notice,of QCCurrlence or Offense
D. Blanket Additional Insured-M anagem or Lessurs 1,,, UnIntaIrIItiorAd OmMkm
of Premises
E- Incift"MeadicM Mdr)reactica M. Persona!Iriury-Assumed by Contract
F. Extension of Cov"a-Bcdly Injury N. Blanket Additional Insured-Lessor of Leased
Equipment
0. Contradual Lability-Railroads
PROVISIONS 3. This Provision A. does not apply to any► per.
A. BROADENED NAMED INSURER son or orgeanlWion for which coverage is ex-
1. The Named Insured in Items 1. of the Declare- duded by endorsement:
bona Is as follows: B. EXTEIaISION OF COW ACE — DA.tM1IAOE TO
'The person or organization named in Item 1. PREMISES RENTED TO YOU
of the Declarations and any orgaint ation, 1. The last paragraph of COVERAGE A. BOD.
other then a partnership,joint venture or lira- ILY INJURY AND PROPERTY DAMAGE U-
Itad Uablity company, of which you maintain ;ABILrTY on I rages) Is deleted
ownership or in which you maintain the major- and replaced by the f
tty Interest on the effective date of the policy. Exduskans e;.through n.do not apply to dam-
However, coverap for any such additional age to promises while rented to you, or tear-
organization wig cease as of the date, If any. porarily oomoead by you with permission of
during the policy period, that you no longer the owner,caused by:
maintain ownership of,or the majority interest
in,such orgentzatlon. a. Firs:
2. WHO IS AN INSURED (Section S) Item 4.a. b. Expbslon;
Is deleted and replaced by the fotloWng: c. Ughtring.,
a. Coverage under"prWalon Is afforded d. Smoke resulting from such firs,etxpkx0an,
only until the 1130th day after you acquire or Ilghftng;or
or loran Vm organization or the end of the e. water.
policy period,whichever Is earlier. A separate Emit d insurance :applies to fhk
coverage as dandbed in Section M Limits of
Insures,
CO D3 16 07 04 Copyright,The TmMers,Indemnity Company,2004 Page 1 of 8
COMMERCIAL GENERAL LIABILITY
2. This Insurance does not aWy to damage to 5. Ibis Provision B. does not apVy 9 oove
prerrdses while rented to you, or temporarily for Damage To Premises Ranted To You of
oomoed by you with permission of the COVERAGE A. BODILY INJURY AND
owner.caused by: PROPERTY DAMAGE L ILITY(Section 1'—
a. Rupture, bursting, or operation of pres- Cover")is excluded by endorsement.
sere relief devices; C. BLANKET WAIVER OF SUBROGATION
b. Rupture or bursting due to expansion or We waive any right of recovery we may have
,swelling of the contents of any building or against any person or organization because of
structure,caused by or resulting from wa• payments we -make for injury or damage arising
W. out of: premises owned or ompied by or're
e Explosion of steam bolters. steam pipes, or loaned to yow. ongoing operations performed
steam engines,or 6tearn turbines. by you or on your behalf, done under is contract
3. Pankgraph f3. of LIMITS OF INSURANCE with IFeat tee or fie ' '�=r , or
(Section tit) Is deleted end replaced by the ucts". We waive this right where,
following: have agreed to do so as of a cwlntraot,
exewled by you before the 'bodily Injurer" or
Subject to L above, the Damage To Prom. "property damaW comrs or,the "personal Injury"
Ises Rented To You Ltmlt Is the most we will or"advertising offense is committed.
pay under COVERAGE A. for the sum of all O. BLANKET ADDITIONAL INSURED — MANAG•
damages because of "property damage" to ERS OR LESSORS OF PREMISES
any one premises while rented to you. or WHO IS AN INSURED
temporarily occupied by you with permission (Section In is amended to
of the owner,caused try:fire;explosion;fight- include as an Insured any pem3on or orgerhation
ring; smoke resulting from such fire, explo- (refemed to below in -additional Insured") with
ckx% or lightning: or water. The Damage To whom you have agreed In a written ormtract, exe-
Premises Rented To You Limit will apply to all cuted before the"bodily IrJW or*Property darm-
*p operty damage proximately caused by the a' " or the "personal Injury" or " erft-
same "occurrence!, whether such damage kV Injury" offense Is committed, to name as an
results from: fire; explosion; lightning; smoke additional Irmted, teat only with respect to Ilabllity
resulting from such tire, explosion. or light- arising out of the ownership. maintenance or use
Nng; or water, or any combination of any of of than part of any pr °nlses teased to you. subject
these Causes. to dw following provisions;
The Damage To Premises Rented To You 1• !knits of Insurance. The limits of insurance
Limit VAR be the higher of: afforded to the addWonat Insured shall be the
gmfs which you agreed to provide In the wrlt-
a. $300,000;or ten contract.or He limits shown on the Deda-
b. The amount shown on the Declarations rations, are less.
for Damage To Premises Rented To You 2 The k4mnos afforded to On additional In-
ILIMIL does not apply to:
4. Paragraph a.of the definition of Insured con- a. Any "godly Injury' or "property damage"
tract" (DEFINITIONS —Section V) Is deleted that occurs.or"persons!INS"or"adver-
and replaced by the fb0owkq yft Injury' cam by an offorse off which
a. A corsfiract for a lease of promises. How- Is committed,afar you cease to be a tart-
ever, that portion or the contract for a ant In that ;
lease of premises that Indernnifres any b. Any premises for which coverep Is ex-
person or organization for damage to eluded by endorsement or
premises white rented to you, or tempo-
rariy oocupled by you with permission of c. Structmal allerst1drm, now constnx:don or
the owner. caused by: fire; explosion; demolition operadons perforrned by or on
lightning; smoke resulting from such fire. Nebel-of such addldonal insured,
explosion or lightning; or water, Is not an 3. The Insurance afforded to the additional ltt-
"Insured cotracr; sured Is exam wror any veAd wW collectible
Page 2 of 6 Copyright,The Thwelem Indemnity Company,2004 CG D316 07 04
COMMERCiAL GENERAL LIABILITY
"other insuranoo'evadable to such addWonel together with all related ads or omissions In
insured, unless you have agreed In the writ the furnishing of the services described In
ten contract that this Insurance must be pri- paragraph 1.above to any are person will be
nary to,of tribu'tory with, such"other deemed one"occurrence".
Insurance'. fi- This Provision E.does note if
E. INCIDENTAL MEDICAL MALPRACTICE dw busy or occupation,of apply Y� are in
� providing pry of
1_ The following Is added to paragraph 1. Insur- the services described M paragraph 1.above.
Ing Agreement of COVERAGE A. — BODILY S. The Insurance provided by this Provision E.
INJURY AND PROPERTY DAMAGE= LIABIL- shall be excess over any valid and collectible
ITY(Section I—Coverages): "other insurance" "table to the Insured,
*Godly 1*ty" arising out of the rendering of, whether primary, exous, contingent or on
or fallure to render, the fallowing will be any other basis,except for Insurance that you
deemed to be caused by an" rterrW: bought spedfically to apply in excess of the
a. Medical,"Ical,dental,laboratory,x-ray Lhm to of Insurance shown on the Declare.
or nursing service. advice or Matruction, lions of this Coverage Part
or the related furnishing of food or bever- F. EXTENSION OF COVERAGE — BODILY IN-
ages: JURY
b. The furnishing or dispensing of drugs or The definition of "bodily Ir4urf (DEFINITIONS —
madicel, dental, or surgical supplies or Section V)is deleted and replaced by the follow,
appliances; Ing:
c. First aid;or ''Bodily Irluy means bodily Infury. mental an-
d. "Good Samaritan services." As used In gulsh. mental fury, shock fright, disability. hu-
nwlllation, sickness or disease sueWined by a per-
this Provision E., "Good Samaritan Mr- eon,including death resulting from any of those at
vices' are those medical services ran- any time.
dared or provided In an emergency and G CONTRACTUAL I- IL[IY—RAiL�tt]ACIS
for which no rernuneration is demanded G.
or received. 1. Paragraph a of the definition of'insured cork.
2. Paragraph 2.a.(1)(d) of WHO IS AN IN- tracer (DEFINITIONS — Section V) is deleted
SURED (Section 11) does not apply to any and replaced by the following:
registered nurse, tioensed practical nurse, c. Any easement or license agreement;
emergency medical technician or paramedic 2. Paragraph f.(1) of the definition of Insured
ernployed by you, InA only while performing contract" (DEFINITIONS — Section V) is do.
the services described In paragraph 1.above lated.
and while acting within the scope of their em- ADDITIONAL INSURED — STATE OR POLITI-
�oyrment by you. Any employees rendering CAL SU®DIVISIONS— R'S
Good Samaritan services will be deemed to
be acting within the scope of their employ- WHO IS AN INSURED(Section 11)Is amended to
ment by you. Include as an insured any sh to or political subdi-
3. The following exclusion Is added to paragraph vision.subject to"following provisions:
2. Exclusions of COVERAGE A. — BODILY 1. This insurance applies o*when re"md to
INJURY AND PROPERTY DAMAGE LIABIL- be provided by you by an ordinance, law or
ITY(Section I—Coverages). building code and only with reaped to opera.
(This Insurance does not apply to:)*BodBy in- lions performed by you or on your behalf for
jam" or "property dama9e" arising out of the which the state or political subdivision has is-
willful viotaftm or a penal statute or ordinance sued a permit.
relating to the sale of pharmaceuticals com- 2. This insurance does not apply to:
mitted by or with the knowledge or consent of a. "godly injury.' "property damage." "per-
the Insured. sonal injury"or"advertising injury arising
4. For the purposes of determining the applics- out of operations performed br the state
ble limits of Insurance. any act or omission or political sAxdivlsloM or
CC,D316 07 04 Copyright,The Travelers Indemnity Company,2004 Page3ofG
COMMERCIAL GENeRAL LIAMUTY
b. "Body injury" or "property damage" In- insured under any other policy,
eluded In the —products—completed o Inducing any umbrella or excess
tions hazard". policy.
1. OTHER INSURANCE CONDITION When this Insurance is excess, we
A. COMMERCIAL GENERAL UABILITY CON- will have no duty under Coverages A
DITIONS (Section K paragraph 4. (Other or B to defend the insured against
replaced by the Id- any"safe"If any provider of'other In-
Insurance)is deleted and suranwve has a duty to defend the ht-
�' and against 99d 'suit". K no pro-
4. Other Insurance vrider or "other Insurance' defands,
d valid and collectible'other I nsuranoe"is we will undertake to do so,but we will
avollable to the Insured for a loss we be entitled to the Irmn d's rights
cover under s A or 8 of this against all time prorvidem of 'other
Caverege Part.our obligations are limited Insurance'.
as follows: When this Insurance Is excess over
"athar insurance". vm wilt pay only
a. Primary insurance our share of the amount of the loss, If
This Insurance is primary except any,that exceeds the sum of.
when b. below applies. If this Insur- (1) The total arnount that all such
once is primary, our obligations are 'other Insurance" would pay for
not affected unless any of the "other the loss In the absence of this In.
Insurance" is also primary. Then. we surance;and
will share with all that "other I sur-
enve" by the method described In c. (2) The total of all deductible and
below. setf red amounts larder that
b. I %tcmrss Insurance
"Dow Insurance".
This Insurance Is ex ss over any of We wail share the remaining bass, If
the -other Inxwranob". Whether pri- any,with any other it u mce that is
mary, excess, contingent or on any not descrilmd In this Exosss Insur-
other basis: once provision.
(1) That Is Fire, Extended Coverage. thud Of Sharing
Butider's Rlstc, Installation Rislr. If all of the "other Insurance" permits
or sknlar coverage for 'your contribution by equal shares. we will
wow; fdtow this method ;also. Under this
(2) That is Fire Insurance for pm3m- a each provider of insurance
ises rented to you or temporarily contributes equal amounts until It has
oom4Aecl by you with permission paid its applicable limit of Insurance
or none of the loss remains, whkh-
of the arorner; ever oomes first.
(3) That is Insurance sad by �p�� .� Insurance does
you to cover you liability as a by equal
tenant for "property darnage' to shares villa wAl owdribute by limits.
premises wanted to you or tempo- Under this method.the share of each
rarly occupied by you with per- provider of insurance is based on the
mission of the owner,or redo of its applicable limit of Insur-
(4) If the loss arises out of the main- once to the total applicable limits of
Lena nos or use of aircraft, Insurance of all providers of Insw-
"autos'. or watercraft to the ex- atos,
tent not"ect to Exclusion g.of B. The following definition is added to DEFINITIONS
Section i gar A—Bodily (Section V):
[Nury And Property Damage U-
ablilty:or "Other rice":
(8) That Is available to the insured s+ Means insurance. or the funding d losses,
when the Insured is an additional that Is provided by.through or on bahelf a
Pogo 4 of 6 Copyright.The Travelers Indemnity Company,2004 CG D316 07 04
COMMERCIAL GENERAL.LIABILITY
(1) Another insurance company; 2. Nodca of an "oocenrenoe" or of an offense
(2) U's or any of our affillated Insurance com- which may result in a claim vdt be deemed to
panies, except when the Non cumulation be given as noon as practicable to us If It to
of Each Occurrence Llmh section of given In good faith as soon as predicable to
Paragraph 6 of LIMITS. OF INSURANCE your ' compensation insurer. This up-
(Section III)or the Non cumulation of Per plies only if you subtatluently give notice of
sonal and Advertising Iroury Wnit sections the " " or offense to us as soon as
of Paragraph 4 of LIMITS OF INSUR practicable r you, one of your "exemitive
ANCE(Sedlon M)apples: officers!(If you are a ),one d your
(3) Any risk retention group; partnem who is an Individual (II you are a
pip),one of your managers(id you are
(4) Any self-insurance method or program a limited liability company), or an""employee'
other then any funded by you end over (rich as an Insurance, loss control or risk
which this Coverage Part applies:or manager or ristrator)designated by you
(3) to a such no5ce discovers that the -occur.
Fm me transfer or risk n�n�o- rence"or offeme may involve this policy.
b. Was not Include umbrella insurance, or ex. 3. This Provision K does not apply as respects
cess insurance,that you bought specifically to the specific number of days within which you
apply In excess of the Limits of Insurance are required to notify us In writing of the
shown on the Dedarations of this Coverage abrupt oarnmencernent of a discharge, w
Part, tease or escape of "polutants" that causes
J. INCREASED SUPPLEMENTARY PAYMENTS "bodily ln(ury" or "property damage which
may otherwise be covered under this policy.
Paragraphs 1,b. and 1.d. of SUPPLEMENTARY L UNINTENTIONAL OMISSION
PAYMENTS—COVERAGES A AND B(Section I
The fdaldnwrl >g added to COMMERCIAL GEN-
-Cove m
Coverages)are amended as follows:
1. In paragraph 'I.b,the amount we will pay for EIM LIABILITY CONDITIONS (Section IV).
the cost of bail bonds Is Irtaeased to$25W.
paragraph 6. isms):
In paragraph 1.d„the amount ring will pay for The unintentional omission of, or unintentional
2. foss of earnings Is Increased to�5fl0�day. error in, any intimation provided by you which
we raged upon In Issuing this policy shall not
K KNOWLEDGE AND NOTICE OF OCCUR. prejudice your rights under this Insiurance. Now-
RENCE OR OFFENSE ever, this Provision L.does not affect our right to
1. The following is added to COMMERCIAL collect additional prorNum or to aawdse our right
GENERAL LIABILITY CONDITIONS (Seddon of cancellation or non renewal in accordance with
M paragraph 2. (Duties In The Event of Oc. eta bte state Insurence laws, codes or regula-
currence.Offense.Claim or Suit):
Notice of an "occurrence" or d an offense M. PERSONAL MURY — ASSUMED BY CON•
which may result in a claim must be given as TRACT
anon as practicable after knowledge of the 1. The following Is added to Exclusion e. (1) of
"occurrence!or offense has been reported to PoWraph 2., Entushms of Coverage B.
you, one of your "executive officers• (ff you Personal Injury, Advertising hyury, and
are a corporation), one of your partners who Web Bite Injury LlabIMy of the Web XTEND
Is an Individual(If you are a partnership), one Liability endorsement
of your managers (if you are a bested lability Solely for the purposes of gablilty assumed in
company), or an "employea" (such as an In- an »lhaured contmcV. reasonable attorney
surance, loss control or risk manager or ad- fees and necessary Iltlggadon expenses In-
miMstrator) designated by you to give such curred by or for a party other than an Insured
nedG& are deemed to be damages because of"per-
Knowledge by any other "employee" of an sonal Injury"provided:
"occurrence" or oftnse does not knply that (a) Liability to such party for. or for the cost
you also have such knowledge. of,that perWs defense has also been as-
CO D3 1B 07 04 Copyright,The Travelers indemnity Cornpany,2DD4 Page 5 d 6
COMMERCIAL GENERAL LIABILITY
sumed In the same 'insured coriftea ; N. BLANKLY ADDITIONAL INSURED — LESSOR
and OF LEASED EQUIPMENT
(b) Such attorney fees and litigation ex- WHO IS AN INSURED(Section It)Is amended to
penses are for deferne of that party Include as are Insured any person or organization
against a civll or alternative dispute reso- (Warrod to below as "additional Ineu with
lutlon proceeding in which damages to whom you have agreed In a wd ten corrtraes, axe-
which this Insurance applies are alleged. cuted before this bodly Llurf or"property dam.
2. Paragraph 2.d. of SUPPLEMENTARY PAY- age occurs or the "personal injury" or Oadverds-
MENTS r-COVERAGES A AND 6 (Section I kg In)ury' d fanse Is committed, to name as an
Coverages) Is deleted and replaced by the additional Insured.but only with respect to their I-
following: abillty for'bodily Inf ury", "properly damage',"""par
d. The ailbgatibns in the "wait" and the in- 1 Ira)ury" or *advertising injury" caused, In
formation was krwow about the •occur- whole or In part, by your acts or ornissions in the
rate"or offense are such oast no conflict maintenance. Operation or use of equipment
appears to exist between the Interests of based to you by such additional Insured, mgoct
to the following provisions:
de Insured and the interests at the in- 1. Umits of Irwunance. The limits of Irmnrnce
�i�' afforded to flaw additional insured shad be the
3. The third sentence of Paragraph 2 of SUP- limits which you agreed m provide in the writ-
PLEMENTARY PAYMENTS— COVERAGES
ten contract.or the limits shown an the Decla-
A AND S (Section I -• Coverages) Is deleted ��,whichever curs less.
and replaced by the fdi�ovrlrrog: Z, The Insurance albnded to the addHlonal ha•
Notwlthstanrling the Provisions of Paragraph cared done ntst apply to any"��Y �1�or
2..b.(Z)i�Section 1-- Coverage A«�Bodily In- •ply damage• first occurs. or "personed
jury And Property Damage Liability, or the Icy+Or"advertising Irt(ury" by an of.prnaislorLS of Paragraph 2.e.(1) of Section 1� fenstr which�oorrrtnifted.after the equipment
Coverage B—Personal Injury.Advertising In- fame irwss.
Jury And Web Site IraJury Liability, such pay'- 3. The Insurance afforded to the additional In-
ments will not be deemed to be damages for �d �excess over valid and collectible
�dY hlluaY +mod "Prot�dY �9®"• or mother insurence' available to sudr a�Idl'd
damages for*personal injury"", and will not re• Insured, unless cup
duoe the limits of Insurance. you he" reed in the writ-
ten contract that this insurance must be pri-
4. This provision M. does not apply tr coverage rrrary�,or noncontributory with, such "other
for "personal Injury" liability le excluded by mart't oe".
endorsement.
Page 6 of 6 Copyright.The Travelers Indemnity Company.2004 CG DS 16 07 04
COMMERCIAL GENERAL UABIL 1Y
POLICY NUMBER: DT22-CO-7200PS36-TCT-17 ISSUE DATE: 03101/2017
THIS ENDORSEMMT CHANGES THE POUCY. PLI^AISE READ R WWFULLY,
DESIGNATED PROJECT(S)
GENERAL AGGREGATE LIMIT
This ertdonlement modltieS Insurance provided Under the fdIdwing:
COMMERCIAL.GENERAL LIABIUTY COVERAGE PART
Designated PrvJad
Designated ProJect(s): general Agg (s):
CITY OF EL SEGUNDO,ITS OFFICERS,OFFICIALS, JOB: WATER MAIN IMPROVEMENTS-MARIPOSA AVE.,
EMPLOYEES,AGENTS AND VOLUNTEERS PW 17-03,SDE JOB#2017-01.
350 MAIN STREET,EL SEGUNDO,CA 80245
X For aH sums which the insured becomes legally 2_ Any peymm is made under COVERAGE A.
obligated to pay as damages caused by "occur- for darnages or under COVERAGE M for
rer cee urder COVERAGE A. (SECTION 4, and medical expenses shall reduce the Desig-
fdr at medical expenses causod by accideft un- dated Prgect General Aggregate Lknit for
der COVERAGE C (SECTION Q. which am be that designated "projec '", Such payments
attributed only to "rations at a single desig- Shall not reduce the General Aggregate,Limit
natm°projecr Shawn In#*Schedule above: shown In the Declarations nor shalt they re•
1. A separate Designated Project General Ag- duo* any other Designated Project General
aragate Limit applies to each designated`pro- Azmate Umk for arty other designated
Jeer, and that limit is equal to the amount of `I ►)e'cr shown In tip Schedule above.
the General Aggregate Limit shown In the rf The finrits shown In Ow Dectarallons for Each
DeclaretiorM unless .separate Designated Oaaurnmoe, Damao*To Prernlses Rented
Project General Aggra to(s) are ached- To You and Medical Expense eentinue to
uled above, apply. However, instead of being subject fo
2: 'the designated Project General Aggregate the General Aggregate LIn* shown in the
Limit Is the most we will pay for ttts sum of all Declarations,such limits will be subject to ftre
damages under COVERAGE A, except Unit. ei sd Project General Ag-
da s of'bodily[Nunn"or*map-
" damage included In the 'products- B. For all sums which the Insured becomes legally
comploted opeeetions hezwd', and for math- obligated to pay as demagm caused by O5pcoo-
cal expenses under COVERAGE C. regard- renaes•under COVERAGE A (SECTION Q, end
less of the number of: for all medical eqm caused by socidents,un-
a. Insuirms; der COVERAGE C. (SECTION n, whlah cannot
f uteel only to operations at a s' ^e desig-
b. Claims made or"suits"brougFle;or n "
ProjeW shown ins the,Schedule above:
c- Persons or oManizations maMng claims
or bringkV Osults".
00 D21 It 0104 Copyright The Travelem Indemnity Company.2004 Page 1 of 2
COMMERCIAL GENERAL LIABILITY
1. Any payments made under COVERAGE A. vided, any payments for damages because of
for damages or under COVERAGE C. for "bodily Injury" or "property damage" included in
medical expenses shell reduce the amount the "products-completed operations hazard" will
available under the General Aggregate Limit reduce the Products-Competed Operations Ag-
or the Products-Completed Opera Ag- gregate Limit, and not reduce the General Aggre-
gregate Limit.whichever Is applicable;and gate Limit nor the Designated Project General
2. Such payments shall not reduce any Desig- Aggregate Limit
nated Project General Aggregate Limit E. For the purposes of this endorsement the Cefinl-
C. part 2.of SECTION 10--LIMITS OF INSURANCE tions Section Is amended by the addition of the
Is deleted and replaced by the following: following definition:
2. The General Aggregate Limit is the most we "'Project" means an area away from presses
will pay for the sum of: owned by or rented to you at which you are per.
a. Damages under Coverage B;and forming t For the meant to a contract or
g purposes of determining the
b. Damages from *occurrences" under applicable aggregate limit of Insurance, each
COVERAGE A (SECTION 1) and for all "project° that includes premises involving the
medical expenses caused by accidents some or connecting lots,or premises whose con-
under COVERAGE C (SECTION 1)which nection is interrupted only by a street, roadway,
cannot be attributed only to operations at waterway or right-of-way of a railroad shall be
a single designated"project"shown in the considered a single"project".
SCHEDULE above. F. The provisions of SECTION III — LIMITS OF
D. When coverage for liability arising out of the INSURANCE rat otherwise modified by this en-
"products-completed operations hazard" is pro- dorsement shell continue to apply as stipulated.
Page 2 of 2 Copyright,The Travelers Indemnity Company,2004 CO 02 11 0104
tenured. Pann R Inc.:Stephen OWN*Equonent Rentals.Inc. GOMIWIE MVFC
Fak-A DT-810-813457897-TIL-17
THIS 1KNOORS)EMENT CHANOES THE POLICY. PLEASS READ IT CAREFULLY.
AUTO COVERAGE PLUS ENDOR ESL SIS FFICERS,OFFICALS,
EMPLOYEES,AGENTS AND VOLUNTEERS
TANS endorsement 350 MAIN STREET,EL SEGUNDO,CA 90245
pi�OiVbK♦I Urldertll�'ft?'
WSINESS AUTO COWRAAE FWM JOB: WATER MAIN IMPROVEMENTS-MARIPOSAAVE.,
1 2? S�7E S 17-0`W,
V� e,d by this and (t) dr a� »Cm*Ltta
MOnt the kM d V10 COVW406 FotM any Insurance. I t or Woes rnodlifled try " envent. lnrsuo I or
A PEES lI"ZM COVRt"19 lease:end
SECTI4M II► - PW SICAL DAMAGE COVER— (0} beWi0ft front prev"bans,
AGE,A Cord e.4, jor�e is or kmmft
a by Om f4I Q COV 6 ECIT — % VWAL
POMOMI Effects C AND DATA ELECTRONIC EQtNP llM NaT
We wtl pay up to X400 for " W b [ T I II THU pnoova oN
Patel eI� l� oI:SoutoC
SECTION III — ICAL DAMAGE COMER
(1) awned by sn"insured';and AGE, 'S. Vx4iuslofts. oweption pa ph e» jo
M In cMrony=covered eutor; bxftAbft 4.0&4A Is"OW W4 rotmd wrth
In the event of al fatal ihert%se of your cmand ! f�catlra�trKr
.e "» a. Equ MWA end Ueed With such
No deductiMes spplll to Personal !?Nau Ccver6 i , rates or
tape, lorovkled'such equipment Is W W
IL AUTO LOAN Is EASE GAP COVERAGE sWbd 0*IpraMnersd"rrrW at 0°UnW Of the
loss! or Is rommble frc m a housino unit
SECTION M – PWSICAL DAMAGE COVE-* whkh Is parnmwitly I tiled in the covered
Ate,A. Coverage.4. 0mraratle Extensions Is `autW at Of the 10W, and amh
amended by sddkv W,following: t IS to tare solely operated
Auto Loan Chap Coverage, for PrNM by of the power ter m the" V*e
PassongarTypo Vohicles cal systaM In cc upon r " .or
In the event cf a toW "to a mend"auW of Q. WAWER OF O C' I –GLASS
'Me Privab passenger type shown In the Schedule SECTION S' — ICAL E
or III Wr ch Ph AKE, b,, u . Is arneWo by wwkv the
IS POVIC104.we+Wr l d amount Poll
duo on t1we low or loan for woh,oavewd"auta" e �o d " u�ka" �r to
Iess folyowwlr� s dwrave It to alaza IS repaired rather than
(7th The arnount pold under l Darnave nVaced.
Coverage Section of " ; 10. HIRED AUTO PRyur.AL DAMAGE COVER.
and AGE
(2) ArV. SECTION III -W PMICAL DAMAGE C
((a) Overdue leaaftm reerss alt the am ASE, �A...� Imo,A. rs l el rm is the fokowkv:
(b) a IMlrra d Aldo Physical D ak oo,
low* 1br excewAw use, abnomval wgar shorn
w d tea or N$n i If hI "413108* arcs 00mried woutoe `lbr WbIfty
(c) Secu tY depwft not rebxnad by em-kn. Coverep cod, this
nor, Omega Covetoga for 4A n tha
CA T4 20 0T OS km*A or#W 66prVA44 WAWW of framoM b-fM Vd1h NO P001101ft. POM i cf 2
the dTkw+r�baL 1" rw�,
COMMERCIAL AUTO
Physical Damage Coverage Is extended b tent requk+ed of you by a written con red me.
*autWftt you hire,want or borrm subject to the outwt+d prior to any Wooddoor or lose, pro-
fcf g: vided that the"eocident!or"Iowa" out of
(1) The most we will pay for"bas"in any one the operalibm contemplated by such con-
"accMont"to a hired, rented or borrowed tract.The wolvor soles only to the person,or
'auto"Is the Wsor of: organization designated in such contract
(a) 560,000; G. BLANKET ADDRIONAL INSURED
(b) The actual cash value of the dam. SECTION S—IIABII JiY COVERAGE,part A.1.
aped or stolen property as of the time Who Is An Insured,pa c.Is emended by
of the"lose;at adding the
(c) The cost of repalft or replacing the Any person,or oqpnWolon that you an roqt*W
damaged or stolen property with to Inreude as an additional insured on No Cover-
COW property of Ike ItInd and quality. age Form In a wrMan contract or agreement duet
(2) An s4ustment for depreciation mid Is signed and executed by you b the"bodlly,
physk ,ul con�tion will be me>ie In deter InJury"°r occurs and that is In
n**Io actual cash value In the event of a etfed during the policy perlod Is an Innured"for
total low. Liaabfiiy Coverage,h only fcaw°demages to which
this In" es aril'only to Odom that
(8) If a repair or replacernent results In beater person or onwftaflon, quafflies as an "InsurmW
thou Kite kind or quality, we w0l not pay under the Who Is An Insured provision awftined
for the amount or bottaftnent. In Section IL
(4) A deduable equal to the highest Physical K EMPLOYEE INRED AUTOS
Damage deductible applicable to any SECTION A —LIABLUTY COVERAGE,A.Cav"
owned covered"autos *rage,1.Who Is An insured is amended by add.
(S) This Coverage Bdonalon does not apply Ing the fatoruwirr:
to. mpl
_ An "employee"of yours Is an"irwrred`while W
(a) Any"auto that Is hired,rented or bor- ersting an"auto"hired or ranted under a contract
rowed wit a driver;or cr agreement In that "empi0yeee name, with
(b) Arty•auto"that Is hired.rented or bor- your permission, WW9 performing duties related
rowed from your OemployW, to the conduct of your buses.
F. BLANKET WAIVER OF SUBROGATION L COVERAGE EX ENItltdlwl—TRAILERS
SECTION IV—BUSINES6 AUTO CONDITIONS, SECTION I — COVERED AUTOS, C. Corbin
A. Loss Conditions. & Trans%r Of Rights Of Tmllers, Molbile Equlpmsnt and Temporary
Recovery Against Others To Us Is deWed and Subadh to Autos, paragraph 1. Is deleted and
replaced by the'followwring: replaced by the following:
S. Transfer Of Rights Of Recovery Against 1. "Trallers' with a load rapacity of 5.000
Others To Us pounds or Jess designsel prinway for tavel
We welve any right of recovery we may have can public roads.
against any person or organisation to the ox-
Pop 2 of 2 Inchifts fats amW of Awemnm Swim Ma.Aye.WW ft pwmiasko, CA T4 2007"
kwkwn awe a*yf~nnwWwA 917m at Paul i oom rwm.
T1mvqAemProMW WORKERS COMPENSATION
AND
EMPLOYERS UASIUTY POLICY
ENDORSEMENT WC 99 03 76(00) —
POLICY NUMBER: DTJ-UB-7200P538-17
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. Wo w9t not
enforc*our right against the person or origantzadtlon named In the Schedule.
You must maintain payroll records accurately sagregIating the remuneration of your+ampl'oyees while engaged In
the work described in the Schedule.
The adudiflortal Premium far trdfi endcr &MAt shall be %of the Calilomta workwo'compensation pre-
miurn otherwise due on such remit eration.
echedule
Pennon or Organization Jab Dos rh ti0h
CITY OF EL SEGUNDO,ITS OFFICERS,OFFICIALS, JOB: WATER MAIN IMPROVEMENTS-MARIPOSA AVE.,
EMPLOYEES,AGENTS AND VOLUNTEERS PW 17-03,SDE JOB#2017-01.
350 MAIN STREET,EL SEGUNDO,CA 90245
DATE OF ISSUE: 03/01/2017 ST ASSIGN;