PROOF OF INSURANCE (2017 - 2017) CLOSED Client#: 1266412 305FLEMIENV
ACORD,. CERTIFICATE OF LIABILITY IINSURANCE DATE(MMIDD/YYYY)
0812612016
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
"RESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IRTANT:If the certificate holder is an ADDITIONAL INSURED,the pol)cy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to
Germs 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 ";O N'��'O" Allie Mosier _
BB&T Insurance Services PN'CJNE' 714 941-290_0 _ N 877.297-1116
of Orange County
EAIYxlamosler bbandt,com L....mm. .....W....... . .. .. ...
2400 Katella Avenue Ste 1100 DDS$ I�NSURER(S)AFFORDING COVERAGE fin...^ NAIC M
....WW.__._w... . rrrrrw_
�I Anaheim,CA 92806 INSURER A:Homeland Insurance Company of N 34452
INSURED ... Travelers Pro a Casualty o 20855
1372 East Valencia. .v , ... .w. �. ........m. ............... Company�,.,._�___�- � .....I
lHSURER c: YP p rty p y CA 1,,,5674
INSURER D:West American Insurance Drive nce Com an 44393
Fullerton, CA 92831 .. Company
INSURER E
INSURER F: I
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 POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR 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 3Y PAID CLAIMS.
,q R_. . AN�OO,0L..S�UBpR w....�... w w. ..
POLICY EFF „(POLICY EXP TYPEOF INSURANCE IDIYYM�
LIMITS POLICY NUMBER I 1 „
qq ^FtImNTBD
...�....,.,.,.� L........... .�.. $ .000 000
COMMERCIAL GENERAL LIABILITY OCCURRENCE A X. $1
CLAIMS-MADE X�occuR 7930050560000 09/0112016 09/01/2017Hocc 300,Of
OO
X Pollution P Liability MED EXP(Any one person $10,000
Professional ..Liab PERSONAL&ADV INJURY $1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000
..
PRO- LOC . PRODUC..,TS-COMP/OPAu GG
„$.2..�. 0�00Y X JECT .�,0...
....0,,..0
OTHER .. BI/PD $$2 500
AUTOMOB ILE LIABILITY BAW57302315 COMBINED SI910112016 , . . NGO LIMI I S1,000,000,
X. ANY AUTO BODILY INJURY(Per person) $
.., ., BODILY INJURE............ .......wwww.........,.__IEEE
ALL OWNED SCHEDULED Y(Per accident) $
AUTOS AUTOS
X HIRED AUTOS X AUTOS NON-OWNED P PERIY DAMAGE $
( p'anp'1
A UMBRELLA LIAR _ OCCUR _ 7930050570000 9/0112016 09/01/2017 EACH OCCURRENCE� $51(�OO,OO(I
X EXCESS LIAB X CLAIMS-MADE AGGREGATE ,$S,OOO,OOO
B I°I
WORKERS E�ABILIT�SQ FLWC704305 5/0..... �PER IEEE Oriti' $
BILITY Y/N 112016 05/01/201)1
5!01/201 X..,I�sTATUT N
ANY PROPRIETOPJPARTNER/EXECUTIVE t EACH ACCIDENT $1,000,000
OFFI datoM MBE EXCLUDED? NIA' E.L.DISEASE .. .... ......
rY EA EMPLOYEE $1 000,000
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000
C Rented/Leased QT6606686M19ATIL16 9/01/2016 09/01/201 $1,000 Deductible
Equipment 1, $160,000 Max Per Item
DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Addhlonal Remarks Schedule,may be attached If more space Is required)
RE: Maintenance Agreement.
The City of El Segundo,its officers, officials,employees,agents and volunteers are named as additional
insured as respects general liability,this insurance is primary and noncontributory with any other
Insurance of the additional insured; and waiver of subrogation applies as respects workers compensation as
required by written contract,per endorsements attached. V V
(See Attached Descriptions)
CERTIFICATE DER', CANCELLATION
City of El Segundo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Department of Public Works ACCORDANCE WITH THE POLICY PROVISIONS.
+ 150 Illinois Street
IEEE ..... ... .
El Segundo,CA 90245 AUTHORIZED REPRESENTATIVE
C 1988-2014 ACORD CORPORATION.All rights reserved.
ACORD 25(2014101) 1 of 2 The ACORD name and logo are registered marks of ACORD
#S16725233/M16725210 ACMOS
DESCRIPTIONS (Continued from Page 1)
Should any policy be cancelled before the expiration date, BBBT Insurance Services will mail 30(thirty)
days written notice to the certificate holders which require such action per written contract or agreement,
110 days notice of cancellation for non-payment of premium.
i
SAGITTA 25.3(2014101) 2 of 2
#S16725233/M16725210
Fleming Environmental Inc.
Policy Number: 793005056 0000
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS - SCHEDULED PERSON OR
ORGANIZATION - FORM I
This endorsement only modifies coverage provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
CONTRACTORS ENVIRONMENTAL LIABILITY COVERAGE PART
SCHEDULE
Name of Person or Organization:
Any person or organization for which the Named Insured has agreed to provide insurance prior to loss as
provided by this policy but only to the scope of insurance agreed to by the Named Insured.
(If no entry appears above, information required to complete this endorsement will be shown in the Declarations
as applicable to this endorsement.)
A. SECTION II — WHO IS AN INSURED is amended to include as an insured the person or organization
shown in the SCHEDULE above, 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 insureds, the following exclusion is added:
2. Exclusions
This insurance does not apply to bodily injury, property damage or environmental damage
occurring after:
(a) All work, including materials, parts or equipment furnished in connection with such work,
on the project (other than service, 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
(b) That portion of your work out of which the injury or damage arises has been put to its
intended use by any person or organization other than another contractor or
subcontractor engaged in performing operations for a principal as a part of the same
project.
All other terms and conditions remain the same.
OBENV GE 301 (02 11) Includes copyrighted material of Insurance Services Office, Inc. 1 of 1
Copyright,OneBeacon Insurance Group,2011
Fleming Environmental Inc.
Policy Number: 793005056 0000
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
PRIMARY AND NOS-CONTRIBUTORY ENDORSEMENT
This endorsement modifies coverage provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
CONTRACTORS ENVIRONMENTAL LIABILITY COVERAGE PART
SECTION IV-CONDITIONS, 8. Other Insurance, is amended by adding the following paragraph:
This insurance will be considered primary to, and non-contributory with any other insurance issued directly to a
person or organization added as an additional insured under this policy, only if you specifically agree, in a written
contract or agreement, that this insurance must be primary to, and non-contributory with, such other insurance.
All other terms and conditions remain the same.
OBENV GE 319(02 11) Includes copyrighted material of Insurance Services Office, Inc. 1 of 1
Copyright,OneBeacon Insurance Group,2011
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC gg 0410B
(Ed.9-14)
WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT-CALIFORNIA
BLANKET BASIS
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. (This agreement applies only to the extent that you
perform work under a written contract that requires you to obtain this agreement from us.)
The additional premium for this endorsement shall be 2%of the total manual premium otherwise due on such
remuneration. The minimum premium for this endorsement is $350.
This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule
SCHEDULE
BLANKET WAIVER
Person/Organization Blanket Waiver—Any person or organization for whom the Named Insured has
agreed by written contract to furnish this waiver.
Job Description Waiver Premium
All CA Operations
This endorsement changes the policy to which It Is attached and is effective on the date Issued unless otherwise stated_
(The Information boom Is required only when this endorsement Is Issued subsequent to preparation of the policy.)
Endorsement Effective 05/0112016 Pollcy No. FLM704305 Endorsement No.
Insured Premium$
Insurance Company Cypress Insurance Company
Countersigned by
WC 99 04108
(Ed.9.14)