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PROOF OF INSURANCE (2017 - 2018) CLOSED � � DATE(MMIDDIYYYY) 114'a— CERTIFICATE OF LIABILITY INSURANCE pl 5r12r2016 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 NI%Mga Sandy Peters FAX Dealey, Renton&Associates PHONE 626 844-3070 199 S Los Robles#540 I!-M Nay F"t)' INC" )` Pasadena, CA 91101 A'DD I SS,speters@dealeyrenton.com d'ealryrrro'rrlorro.col�� License#0020739 INSU,RER(S),AFFORDING COVERAGE NAIC# INSURER a:Westchest e r Surplus Lines Insurance 10172 V INSURED GALEJORDA INSURER B: „ Gale/Jordan Associates, Inc. INSUIZERC: 3858 Carson Street, Suite 200 Torrance, CA 90503-5613 INSURERD: 310-316-4377 INSURER E,:. INSURER F COVERAGES CERTIFICATE NUMBER: 1570925183 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. LTR COMMERCIAL GENERA AN5 4D POLICY NUMBER 4,128/2016 28/ 0"7Y7 EACH CCUR� fJ°IGE LIMITS N'SR TYPE OF INSURANCE(ABILITY C Y Y 024391656004 14128/2016FF POLICY'IY ...� X O $3.000.000 L CI_AINhS• OCCUR PR.EMISES(Ea,O renw) $50.000 � ItMAL7F �'.,,,, X Contractua"LUP0 ICED EXP(Any one aerson) $5.000 X XOU!nd ld-0 PFRSONAi.8.ADV INJURY T1,000 00C GL1NV_IVSGRrirA'oI LIMIT APPLIES PER: C't'M4"I°'rt,F^ry,4,(,� rt pI��TE $4000.0.00 PRO r4)tI(,,V JECT I..00 PRl3 UUTS OM�tOPAGC $4.000.000 X I�OTHER: Contractors Poll Contr.Poll,Liab $3,000,000 uC,bd�R&NVE'E,M„,iINC:tL LNp,{,Y A AUTOMOBILE LIABILITY Y 624391656004 4128(2016 4/28/2D17 Ica arot,aonf) $2,000,000 ANY AUTO EODII_Y INJURY(Per person) S ALL OYJE7 SCHEDULED r(WFt;:BODILY i INJURY V n(Per l:"acrlder t) $ A1JTOS AUTOS AUTOS HIREDAUTOS X n „ UMBRELLA LIAB :,.m::Y.:IJ R R1..=lIV-l° S EXCESS LIAB rt';I P.I Nut1i Itd::,Y.�f.. AGGREGATE W WORKERS .. � R1:'1F,,NI DED II;,;uV�l Yi(N NIA V u'ro-.I AND EMPLOYERS'LIABILITY S COMPENSATION F.::I< ER ANY['ROPRIETORlPAftTPDER(EHECU'rltfE EL EACH ACCIDENT 5 OFFICERIMEMBER ExCLUDED'r (Mandatory in NHp &Y,I, DISC ASV, FA r'IMP''l,011ILF S If yes,describe under DESGP,IPTION OF OPERA I IONS below .............. E V_ Di$it✓S�; 3"r:1k,VCY°I,IYJII"f E A Claims made I:...bil t� __.... .Ck-ii,., Form 4128(2010 4(28f2017 I;v3,000,000 I%erl�Ialm Protessionall..iaY.rlfl 624:791556004 I' $3,000,000 Annual Aggregate DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) RE:All Operations--City of El Segundo, its Officers, agents and employyees are named as additional insured as respects general and hired/non'-owned)auto liability for claims arising from the operations of ttl ee'roamed insured as required per written contract or agreement. CERTIFICATE HOLDER � CANCELLATION 30 Day NOC/10 Day for Nonilay of Prem SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of El Segundo, Public Works Dept. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 350 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. El Segundo CA 90245 Atr RI"F.D ras Prtr,:° OdTA°caVE ......_............ __. ....�...I ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD ADDITIONAL INSURED ENDORSEMENT—PRODUCTS-COMPLETED OPERATIONS HAZARD PRIMARY&NON-CONTRIBUTORY -�� �i -- ----' ------r�o'mr�moot"�b�------- Gale/Jordan Associates Inc - -------�-- -�---------�--s������m�����v���---- ECIP �1���0�4 018»m O4/28V2017 04/28/2016 »v> Westchester Surplus Lines Insurance Company __ _.......... ___ THUS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING: COMMERCIAL GENERAL LIABILITY COVERAGE PART CONTRACTOR'S POLLUTION LIABILITY COVERAGE PART SCHEDULE Any person mr organization that|man owner of real property personal property on which you are performing operations, ora contractor on whose behalf you are performing o enut|ono. mndon|yaCthmnpecifiovvhttennoqummtofounhpmnoonor � organization to you, wherein such request is made prior to commencement of operations. � (if nw entry appears mbove, information required ho complete this endorsement will he shown in the Declarations as applicable ho this mndnnwemem8.) Section 11—Who Is An Insured is amended to include as an additional insured the person(s)or organization(s)shown in the Schedule, but only with respect hm liability for bodily injury or property damage caused, |n whole or|n part, byyour work performed for that additional insured and included in the products-completed operations hazard, Furthermore, the coverage provided hereunder shall be primary and not contributing with any other insurance available to those designated above under any other third party liability policy. All other terms and conditions remain the same, ENV'3226(10'08) copyright muooays, psQe 1 of Named Insured Endorsement Number ' Gale/Jordan Associates Inc � -- - -'-- Effective Date mEndorsement Policy SYM1301 Policy Number Policy Period 04/28/2016 to 04/28/2017 04C28t2016 Company)lsskmd By(Name of In r n -- --- ---- ----- � � Westchester Surplus Linea Insurance Company Insert the policy number. The remainder m/m^mmrmmm**w»o"°"pleted""w°mmmis=*°semomis issued subsequent w the preparation m the policy. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED ENDORSEMENT-OWNERS, LESSEES OR CONTRACTORS (PRIMARY AND NON-CONTRIBUTORY) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE CONTRACTOR'S POLLUTION LIABILITY COVERAGE SCHEDULE: ' Name of Person mrOrriom}zaUlap/ Any person or organization that is an owner of real property or personal property on which you are performing operations,or a contractor on whose behalf you are performing operations, and only at the specific written request of such person or organization to you,wherein such request is made prior to commencement of operations. (If no entry appears above, |mNummatimm required to complete this endorsement will be shown in the 6i6iiiatimms as applicable bo this andonwmment.) SECTION UY ^WHO IS AN INSURED is amended to include: A. SECTION 11 ~ WHO IS AN INSURED is amended to include as on insured the person or organization shown in the Schedule, but only with respect to liability arising out of your ongoing operations performed for that insured. B. With respect to the insurance afforded to these additional inouredo,the following exclusion is added: 2. Exclusions This insurance does not apply bubodily Injury n,property damage occurring after: (1) All work, including mateda|a, parts or equipment furnished in connection with such work, on the project(other than aem|ue, maintenance or repairs)to be performed by or on behalf of the additional insured(s)at the site of the covered operations has been completed; or (2)That portion of your vwmrk out of which the injury or damage arises has been put to Its intended use by any person ororgmn o organization other than another contractor or subcontractor engaged in performing operations for a principal aoo part of the same project. C. The coverage provided hereunder shall be primary and not contributing with any other insurance available to those designated above under any other third party liability policy. ENV'3101 (08'04) Includes copyrighted material of Insurance Services Office, Inc.with Its ponn|woion Page 1of1 ..........w.__.._........_.........._.....__M..................._..__.. ........�_..........._�........_.. ...._..... ..... ........... .�.. Named Insured Endorsement Number Gale/Jordan Associates Inc Policy Symbol Num �w_.�. .m ._......�..........._..., bar Poli Period Effective Date of Endorsement w W ECP G24391656 004 04/28/2016 t .. m28/2017 0412812016 ._........................._..._.of w�Insu�w...�_tan nyp .......m o 041 i.........................,,,,,......�....... lssrwad tay(Naano co Comlae Westchester Surplus Lines Insurance Company Insert the policy number. The rem"er of the Inform®lion is to be completed only when this endorsement is issued subsequent to the preparation of the policy. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART CONTRACTORS POLLUTION LIABILITY COVERAGE PART SCHEDULE Nsn�q_qf eprson or Orf>zr. .....tlW..�._...._...__. m...... rww�w_...............ww..._w..............._..... .............. Any person or organization that is an owner of real property or personal property on which you are performing operations, or a contractor on whose behalf you are performing operations, and only at the specific written request of such person or organization to you,wherein such request is made prior to commencement of operations. (if no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) The TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Condition is amended by the addition of the following: 'We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or your work done under a contract with that person or organization and included in the products-completed operations hazard, This waiver applies only to the person or organization shown in the Schedule above. All other terms and conditions remain the same. ENV-3143(03-05) Includes copyrighted material of Insurance Services Office,Inc.with Its permission Page 1 of 1 CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YXYY) 1 02/02/1017 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION EJMS Services ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE P0,Sox 33269 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. o (CA 1994) Los Gatos CA 95031 FORDING COVERAGE NAIC# ....... INSURERS AFFORDING S URER'A: Compensation .insurance 1 5076 gals/ordan associates,inc. INSIFtq=R B State lnsuronce Fund ... 3858 Carson St. INSURER C: Suite 200 INSURER D: Torrance I CA 90503 INSURER E: COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. _. ..........m.. .._I PC7UCY EFFECT Pi7°i.a'C CXP'11 ATI .....,., ..._.�......_...,......�..�,.., ._.,—...,_. .._.....----........._..,,,,,, TYP�U E, POLICY NUMBER � LIMITS GENERAL LIABILITY EACH OCCURRENCE $ ?MB,_& —COMMERCIAL GENERAL LIABILITY O S CLAIMS MADE OCCUR M'ED EXP RENTED (A+^ ores PERSONAL 8 ADV INJURY S. �.................... I GENERAL AGGREGATE .$... GEN'LAGGREGATELIMITAP PLIES PER: I PRODUCTS-COT MPa ` POLICY F PRC.1 �7�LOC .......................,.,... AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANYAUTO (Ea accident) S - V ALL OWNED AUTOS BODILY INJURY S SCHEDULED AUTOS (Per person) V HIRED AUTOS BODILY INJURY NON-OWNED AUTOS y (Per accident) S PROPERTY DAMAGE (Per accident) GARAGE LIABILITY OTHER THAN LEA ACCIDENT S _�ANY AUTO OTHER EA ACC $ ®, AGG '$ EXCESS I UMBRELLA.LIABILITY EACH OCCURRENCE S OCCUR CLAIMS MADE AGGREGATE S .. DEDUCTIBLE ^.. .. $ ....... RETENTION S $ A WORKERS COMPENSATION v ANYXP'R0P`RIE'rER .XECU'1'oVE YIN E"✓R.�EACk9S IDE T......�OkT __..3 1,000.000 Y 1110442-17 2/1/1017 2/1/1018 1. AND EMPLOYERSUABILJTY IMandatory In NHI E.L DISEASE,-EA EMPLOYEE $ 1-000,000 Vt an„describe sander E L DISEASE•POLICY LIMIT ..................__. S ECEAL PROVISIONS below m .. pyggT $, 1,000,t700 OTHER DESCRIPTION OF OPERATIONS 1 LOCATIONS!VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT SPECIAL PROVISIONS Christopher K.Gale,President-Excluded Thomas A.Jordan,Secretary Treasurer-Excluded p II w CERTIFICATE HOLDER CANCELLATION City of El Segundo,Public Works Dept SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION 350 Main St. DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN EI Segundo,CA 90245-3813 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,CTS AGENTS OR REPRESENTATIVES'. 1 AUTHORIZED REPRESEHTA ,„,,, „✓"'� Daniel.).Cloud ACORD 25(2009101) ©1988-2009 AC IdD CORPORITION', All rights reserved. The ACORD name and logo are registered marks of ACOK i IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25(2001108) ENDORSEMENT AGREEMENT WAIVER OF SUBROGATION 1118442-17 STATE RENEWAL INSURANCE NA FUND 2-70-70-25 PAGE 1 HOME OFFICE SAN FRANCISCO EFFECTIVE FEBRUARY 3, 2017 AT 12 . 01 A.M. ALL EFFECTIVE DATES ARE AND EXPIRING FEBRUARY 1, 2018 AT 12 . 01 A.M. AT 12:01 AM PACIFIC STANDARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME GALE/JORDAN ASSOCIATES, INC. 3858 W CARSON ST STE 200 TORRANCE, CA 90503 ANYTHING IN THIS POLICY TO THE CONTRARY NOTWITHSTANDING, IT IS AGREED THAT THE STATE COMPENSATION INSURANCE FUND WAIVES ANY RIGHT OF SUBROGATION AGAINST, CITY OF EL SEGUNDO, PUBLIC WORKS DEPT WHICH MIGHT ARISE BY REASON OF ANY PAYMENT UNDER THIS POLICY IN CONNECTION WITH WORK PERFORMED BY, GALE/JORDAN ASSOCIATES, INC. IT IS FURTHER AGREED THAT THE INSURED SHALL MAINTAIN PAYROLL RECORDS ACCURATELY SEGREGATING THE REMUNERATION OF EMPLOYEES WHILE ENGAGED IN WORK FOR THE ABOVE EMPLOYER. IT IS FURTHER AGREED THAT PREMIUM ON THE EARNINGS OF SUCH EMPLOYEES SHALL BE INCREASED BY 03%. NOTHING IN THIS ENDORSEMENT CONTAINED SHALL BE HELD TO VARY, ALTER, WAIVE OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS POLICY OTHER THAN AS STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR LIMITATIONS OF THIS ENDORSEMENT. COUNTERSIGNED AND ISSUED AT SAN FRANCISCO: FEBRUARY 6, 2017 2570 AUTHORIZED REPRESENT BVE PRESNDE,NT AND CEO SCIF FORM 10217 (REV.7-2014) OLD DP 217