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PROOF OF INSURANCE (2017 - 2018) CLOSED �o^o 0 I DATE(MM/DDNYYY) CERTIFICATE OF LIABILITY INSURANCE 5116/2017 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 have ADDITIONAL INSURED provisions or 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). CONT PRODUCER Garrett/Mosier/Griffith/Sistrunk I NAMEAOT Ashley Brewster Risk Management& Insurance Services PHONE Fax 12 Truman (tAtC<No.Exe: 949-559-3377 (A/C.No): 949-559-6703 Irvine, CA 92620 I ADDRESS: ashlevb(o-)gmgs.com INSURER(S)AFFORDING COVERAGE NAIC# www.gmgs.com OB84519 I INSURER A: Great Divide Insurance Company 25224 INSURED INSURER B: Peerless Insurance Company 24198 EEC Environmental dba Enviromental Engineering Contracting Inc., I INSURER C: One City Boulevard West, Suite 1800 (INSURER D: Nautilus Insurance Company 17370 Orange CA 92868 I INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: 35667931 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. INSR TYPE OF INSURANCE ADDL SUER POLICY EFF POLICY EXP w LIMITS LTR INSD VD POLICY NUMBER (MM/DDiYYYY) (MM/DD/YYYY) A ,/ COMMERCIAL GENERAL LIABILITY GLP2006942-14 10/31/2016 10/31/2017 EACH OCCURRENCE $ 5,000,000 DAMAGE TO CLAIMS-MADE ❑f OCCUR PREMISES(Ea RENTE ence) $ 109,090 _ MED EXP(Any one person) S 5,000 _ I PERSONAL&ADV INJURY S 5,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: (GENERAL AGGREGATE $ 5,000,000 POLICY ✓❑JECOT- [--]LOC I PRODUCTS-COMP/OP AGG S 5,000,000 OTHER: $ B AUTOMOBILE LIABILITY CBP8977390 10/31/2016 10/31/2017 COMBINED SINGLE LIMIT S _ (Ea accident) 1,000,000 ✓ ANY AUTO I BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS (BODILY INJURY(Per accident) $ _ HIRED NON-OWNED (PROPERTY DAMAGE S ✓ AUTOS ONLY ✓ AUTOS ONLY (Per accident) I S UMBRELLA LIAB HCLAIMS-MADE OCCUR EACH OCCURRENCE S EXCESS LIAB I AGGREGATE $ DED I I RETENTIONS S A WORKERS COMPENSATION WCA2008815-14 5/24/2017 5/24/2018 ,/ I STATUTE I I OERH AND EMPLOYERS'LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE r----1/N I E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? NIA (Mandatory in NH) I E.L.DISEASE-EA EMPLOYEE $ 1,000,000 it yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 1,000,000 D Pollution Liability CCP2006941-14 10/31/2016 10/31/2017 Each Poll Occurrence$5,000,000 Professional Liability Each Prof Liab Claim$5,000,000 General Aggregate:$5,000,000 DESCRIPTION OF OPERATIONS]LOCATIONS/VEHICLES (ACORD 161,Additional Remarks Schedule,maybe attached if more space is required) RE:Sewer System Management Plan As respects General Liability coverage, City of El Segundo,its officials and employees are added as Additional Insureds and this insurance is primary per ENV2154AO906 attached.As respects Automobile Coverage,Business Auto Coverage Form CA 00 01 10 01 applies. As respects Workers'Compensation coverage,a Waiver of Subrogation is hereby included per WC040306 attached. As respects General Liability coverage,30-day written notice of cancellation(10 days for non-payment of premium)applies per IL00171198 attached. CERTIFICATE HOLDER CANCELLATION Sewer System Management Plan City of El Segundo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE g THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Public Works ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street El Segundo CA 90245 AUTHORIZED REPRESENTATIVE _ I Grill Griffith ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 35667931 1 16-17 G/A/UMB/POLL/E&O 17-18 WC I Ashley Brewster i 5/16/2017 9:18:21 AM (PDT) I Page 1 of 4 GLP2008942-14 EEC Environmental ENDORSEMENT This endorsement forms a part of the policy to which it is attached. Please read it carefully. | ADDITIONAL INSURED— BLANKET—OWNERS, LESSEES OR CONTRACTORS | This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Who is An Insured (Section 11) is amended to include as an insured any person(s) or organizations,for whom you are performing operations under a written contract or agreement,which is in effect prior to the performance of your work which is the subject of such written contract or agreement,that such person(s) or organization(s) be added as an additional insured on your policy, but Only with respect to liability for bodily injury, property damage or personal and advertising injury caused, in whole or in part, by: 1' Your acts or omissions, or the acts or omissions of those acting on your behalf, in the performance of your ongoing operations for the additional insured;or 2' Your work performed for such person(s) or organizations(s) and included in the products-completed operations hazard, only when required by the written contract or written agreement. With respect to damages caused by your work, as described above,the coverage provided hereunder shall be primary and not contributing with any other insurance available to those designated above, but only when required by written contract oragreement. wu00nuv Berkley Specialty Underwriting affiliate of Nautilus Insurance Company and Great Divide Insurance Company.All rights reserved. 0 1emn'eooe,n Insurance Services Office,mo,material used urpermission. ENV c1s4A000a Page of 1 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WCU403W6D484 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT � CALIFORNIA 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 ororganization named in the Schedule. (This agreement applies only 1m the extent that you perform work under awritten contract that requires you to obtain this agreement from us.) 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 ahm|| be 0.0096 of the California workers'compensation premium otherwise due on such remuneration. Schedule Person mrOrganization An required by written contract This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below|s required only when this endorsement isissued subsequent tm preparation uY the policy) Endorsement Effective Policy No. VVCA2008815-14 Endorsement No. 5/24/2U17 Insured Premium EEC Environmental Insurance Company: Countersigned by Great Divide Insurance Company WCQ483@6U484 1998 by the Workers'Compensation Insurance Rating Bureau of California. Page of All rights reserved. From the VVC|RB'a California Workers'Compensation Insurance Forms Manual 2001. 35667931 1 16-17 G/A/UMB/POLL/E&O 17-18 WC I Ashley Brewster 1 5/16/2017 9:18:21 AM (PDT) I Page 3 of 4 EEC Environmental dba Enviromental Engineering Contracting Inc., IL 00 1711 98 COMMON POLICY CONDITIONS All Coverage Parts Included in this policy are subject to the following conditions. A. Cancellation b. Give you reports on the conditions we find', 1. The first Named Insured shown in the Declara- and tions may cancel this policy by mailing or deliv- c. Recommend changes. ering to us advance written notice of cancella- 2. We are not obligated to make any Inspections, tion. surveys, reports or recommendations and any 2. We may cancel this policy by mailing or deliver- such actions we do undertake relate only to fin- ing to the first Named Insured written notice of surability and the premiums to be charged.We cancellation at least: do not make safety inspections. We do not un- a. 10 days before the effective date of cancel- dertake to perform the duty of any person or lation if we cancel for nonpayment of pre- orgailization to provide for the health or safety mium;or of workers or the public. And we do not warrant b. 30 days before the effective date of cancel- that conditions: lation if we cancel for any other reason. a. Are safe or healthful;or 3. We will mail or deliver our notice to the first b. Comply with laws, regulations, codes or Named Insured's last.mailing address known to standards. US. 3. Paragraphs 1.and 2.of this condition apply not 4. Notice of cancellation will state the effective only to us, but also to any rating, advisory, rate date of cancellation- The policy period will end service or similar organization which makes in- on that date. surance Inspections, surveys, reports or rec- ommendations. 5. If this policy Is cancelled, we will send the first 4. Paragraph 2.of this condition does not apply to Named Insured any premium refund due. If we any Inspections, surveys, reports or recom- cancel, the refund will be pro rata. If the first mendations we may make relative to certifica- Named Insured cancels, the refund may be tion, under state or municipal statutes, ordi� less than pro rata. The cancellation will be ef- nances or regulations,of boilers,pressure ves- fective even if we have not made or offered a sets or elevators. refund. B. It notice Is mailed, proof of mailing will be suffi- E. Premiums cient proof of notice. The first Named Insured shown in the Declara- B. Changes tions: This policy contains all the agreements between 1. Is responsible for the payment of all premiums; You and us concerning the Insurance afforded. and The first Named Insured shown in the Declarations 2. Will be the payee for any return premiums we Is authorized to make changes in the terms of this pay. policy with our consent. This policy's terms can be F. Transfer Of Your Rights And Duties Under This amended or waived only by endorsement Issued Policy by us and made a part of this policy. Your rights and duties under this policy may not be C. Examination Of Your Books And Records transferred without our written consent except In We may examine and audit your books and re- the case of death of an Individual named insured. cords as they relate to this policy at any time dur- if you die,your rights and duties will be transferred Ing the policy period and up to three years after- to your legal representative but only while acting ward. within the scope of duties as your legal representa- D. Inspections And Surveys tive. Until your legal representative Is appointed, 1. We have the right to: anyone having proper temporary custody of your property will have your rights and duties but only a. Make inspections and surveys at any time; with respect to that property. IL 001711 98 Copyright,Insurance Services Office,Inc., 1998 Pagel of 113 35667931 16-17 G/A/UMB/POLL/E&O 17-18 WC I Ashley Brewster 1 5/16/2017 9:18:21 AM (PDT) I Page 4 of 9 CERTIFICATE OF LIABILITY INSURANCE ( DAT5/16 /2017(MMIDDNYYY) 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 have ADDITIONAL INSURED provisions or 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 Garrett/Mosier/Griffith/Sistrunk I CONTACT NAME: Ashley Brewster Risk Management& Insurance Services PHONE FAX 12 Truman I(AfC.No.Ext1: 949-559-3377 (A/C No): 949-559-6703 E Irvine, CA 92620 I ooRRESS: ashleyb(agmgs.com INSURER(S)AFFORDING COVERAGE NAIC# www.gmgs.com OB84519 INSURERA: Great Divide Insurance Company 25224 INSURED INSURER 8: EEC Environmental dba Enviromental Engineering Contracting Inc., INSURERC: One City Boulevard West, SUlte 1800 INSURER D: Orange CA 92868 INSURER E: INSURER F: I COVERAGES CERTIFICATE NUMBER: 35667701 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER (MM/DD/YYYYI (MM/DD/YYYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S RNTE CLAIMS-MADE F OCCUR I PREM SESO(EaEoccur ence) S MED EXP(Any one person) S _ I PERSONAL&ADV INJURY S GEN'L AGGREGATE LIMIT APPLIES PER: I GENERAL AGGREGATE S POLICY❑ PRO- POLICY ❑LOC PRODUCTS-COMP/OP AGG S OTHER: S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S _ (Ea accident) ANY AUTO BODILY INJURY(Per person) S OWNED SCHEDULED I BODILY INJURY(Per accident) S _ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE S AUTOS ONLY AUTOS ONLY I(Per accident) — S UMBRELLALIAB OCCUR EACH OCCURRENCE S EXCESS LIAB HCLAIMS-MADE I AGGREGATE S DED I I RETENTION S $ A WORKERS COMPENSATION WCA2008815-14 5/2412017 5/24/2018 f (STATUTE (EORH AND EMPLOYERS'LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE Y/❑N N/A I E.L.EACH ACCIDENT $ 1,000,000 OFFICERIMEMBER EXCLUDED? (Mandatory in NH) I E.L.DISEASE-EA EMPLOYEE $ 1,000,000 if yes,describe under DESCRIPTION OF OPERATIONS below I E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS f VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) RE:Sewer System Management Plan As respects Workers'Compensation coverage,a Waiver of Subrogation is hereby included per WC040306 attached. CERTIFICATE HOLDER CANCELLATION Sewer System Management Plan City Of El Segundo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE g THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Public Works ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street El Segundo CA 90245 AUTHORIZED REPRESENTATIVE i Griff Griffith ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 35667701 1 17-18 WC I Ashley Brewster 5/16/2017 9:16:35 AM (PDT) Page i of 2 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY @C 040306 0484 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT � CALIFORNIA 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 hzthe extent that you perform work under a written contract that requires you to obtain this agreement from us.) 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 0.00%of the California workers'compensation premium otherwise due un such remuneration. Schedule Person orOrganization As required by written contract This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated, (The information below Is required only when this endorsement is issued subsequent to preparation of the policy) Endorsement Effective Policy No. VVCA2008815-14 Endorsement No. 5/24/2017 Insured Premium EEC Environmental Insurance Company: Countersigned by Great Divide Insurance Company WC 0483060484 1QQ8by the Workers'Compensation Insurance Rating Bureau ofCalifornia. Page imf I All rights reserved. From the WC|RB's California Workers'Compensation Insurance Forms Manual 2W01. 35667701 1 17-18 WC I Ashley Brewster 1 5/16/2017 9:16:35 AM (PDT) I Page 2 of 2